Target Organ Damage In Patients Research Articles

The Effect of Obstructive Sleep Apnea on Subclinical Target Organ Damage in Patients With Resistant Hypertension

IntroductionAmong all patients with hypertension, those with resistant hypertension (RH) have the highest rates of subclinical organ damage (SOD). The prevalence of obstructive sleep apnea (OSA) is high in RH patients, and it could contribute to SOD. We aimed to investigate how OSA and its treatment are related to SOD in a large cohort of RH patients. MethodsThis is an ancillary analysis to the SARAH study, a multicentre observational cohort aiming to evaluate the impact of OSA on RH. Individuals with RH who were undergoing a sleep study and have information on at least one of the SOD variables (vascular, cardiac or renal damage) were selected. Patients were followed-up for three years. ResultsIn total, 503 subjects were included. The participants were predominantly male, obese, and the median (IQR) apnea–hypopnea index (AHI) was 15.5 (7.90–31.5)events/h. No differences in the presence of vascular or cardiac damage were observed between OSA and non-OSA patients. A lower estimated glomerular filtration rate (eGFR) was observed in participants with OSA than in those without OSA, with an adjusted effect of −8.69mL/min/1.73m2 (−13.59, −3.79; p value<0.001). Kidney damage was also greater in subjects with OSA, with an adjusted OR (95% CI) of 1.77 (1.09, 2.87; p value=0.02). The eGFR showed a linear dose–response relationship with OSA severity. Among patients treated with CPAP, lower eGFR values were observed in noncompliant subjects. ConclusionsOSA could contribute to worsening renal function in patients with RH. No compliance with CPAP was associated with lower values of eGFR.

Efficacy of antihypertensive treatment for target organ protection in patients with masked hypertension (ANTI-MASK): a multicentre, double-blind, placebo-controlled trial

Masked hypertension is associated with target organ damage (TOD) and adverse health outcomes, but whether antihypertensive treatment improves TOD in patients with masked hypertension is unproven. In this multicentre, randomised, double-blind, placebo-controlled trial at 15 Chinese hospitals, untreated outpatients aged 30-70 years with an office blood pressure (BP) of <140/<90mm Hg and 24-h, daytime or nighttime ambulatory BP of ≥130/≥80, ≥135/≥85, or ≥120/≥70mm Hg were enrolled. Patients had ≥1 sign of TOD: electrocardiographic left ventricular hypertrophy (LVH), brachial-ankle pulse wave velocity (baPWV) ≥1400cm/s, or urinary albumin-to-creatinine ratio (ACR) ≥3.5mg/mmol in women and ≥2.5mg/mmol in men. Exclusion criteria included secondary hypertension, diabetic nephropathy, serum creatinine ≥176.8μmol/L, and cardiovascular disease within 6 months of screening. After stratification for centre, sex and the presence of nighttime hypertension, eligible patients were randomly assigned (1:1) to receive antihypertensive treatment or placebo. Patients and investigators were masked to group assignment. Active treatment consisted of allisartan starting at 80mg/day, to be increased to 160mg/day at month 2, and to be combined with amlodipine 2.5mg/day at month 4, if the ambulatory BP remained uncontrolled. Matching placebos were used likewise in the control group. The primary endpoint was the improvement of TOD, defined as normalisation of baPWV, ACR or LVH or a ≥20% reduction in baPWV or ACR over the 48-week follow-up. The intention-to-treat analysis included all randomised patients, the per-protocol analysis patients who fully adhered to the protocol, and the safety analysis all patients who received at least one dose of the study medication. This study is registered with ClinicalTrials.gov, NCT02893358. Between February 14, 2017, and October 31, 2020, 320 patients (43.1% women; mean age±SD 53.7±9.7 years) were enrolled. Baseline office and 24-h BP averaged 130±6.0/81±5.9mm Hg and 136±8.6/84±6.1mm Hg, and the prevalence of elevated baPWV, ACR and LVH were 97.5%, 12.5%, and 7.8%, respectively. The 24-h BP decreased on average (±SE) by 10.1±0.9/6.4±0.5mm Hg in 153 patients on active treatment and by 1.3±0.9/1.0±0.5mm Hg in 167 patients on placebo. Improvement of TOD occurred in 79 patients randomised to active treatment and in 49 patients on placebo: 51.6% (95% CI 43.7%, 59.5%) versus 29.3% (22.1, 36.5%; p<0.0001). Per-protocol and subgroup analyses were confirmatory. Adverse events were generally mild and occurred in 38 (25.3%) and 43 (26.4%) patients randomised to active treatment and placebo, respectively (p=0.83). Our results suggest that antihypertensive treatment improves TOD in patients with masked hypertension, highlighting the need of treatment. However, the long-term benefit in preventing cardiovascular complications still needs to be established. Salubris China.

Impact of Obesity on Target Organ Damage in Patients with Metabolic Syndrome.

Metabolic syndrome (MetSy) is characterized by the presence of obesity, hypertension, altered glucose metabolism, and/or increased non-HDL cholesterol. This study aimed at elucidating the association between obesity with subclinical target organ damage and biochemical parameters included in MetSy pathogenesis. This study included 130 apparently healthy subjects. Plasma levels of oxidized-LDL-cholesterol (ox-LDL-Chol), nitric oxide (NO) metabolites, inducible NO synthase (iNOS), and plasminogen activator inhibitor-1 (PAI-1) were measured. Non-invasive assessment of liver disease included fatty liver index (FLI) and nonalcoholic fatty liver disease (NAFLD) fibrosis score. Carotid artery plaques were assessed by color Doppler imaging. A total of 65 patients with MetSy were included in the MetSy group, while 65 without MetSy entered the control group. Ox-LDL-Chol levels were higher in the MetSy group compared to the control group, regardless of obesity. Levels of NO metabolites were similar in obese and non-obese patients with MetSy, but lower than in the control group. Obese patients with MetSy had higher iNOS values compared to non-obese ones, with similar PAI-1 levels. NAFLD was present in all obese patients with MetSy compared to 70% of non-obese subjects. Hypertension, higher values of waist-to-hip ratio, PAI-1, and remnant cholesterol were associated with NAFLD. Finding of asymptomatic carotid plaques was associated with patients' age, hypertension, and higher waist-to-hip ratio. MetSy and obesity significantly alter the levels of NO metabolites, iNOS, ox-LDL-Chol, and PAI-1. High prevalence of NAFLD in obese patients with MetSy requires active screening and treatment of potential risk factors.

The heart rate non-dipping pattern was associated with target organ damage in patients with chronic kidney disease.

We performed the study to investigate the association between heart rate (HR) non-dipping pattern and target organ damage in patients with chronic kidney disease (CKD) and hypertension. In this cross-sectional study, 447 patients with CKD and hypertension were enrolled. 24h ambulatory blood pressure monitoring was conducted. Linear regression and logistic regression analysis were conducted to investigate the association between HR non-dipping pattern and target organ damage, including estimated glomerular filtration rate (eGFR), left ventricular mass index (LVMI), and left ventricular hypertrophy (LVH). Overall, 261 patients (58.4%) followed non-dipping patterns of HR. HR non-dipping pattern remained to be significantly associated with reduced eGFR (β: -0.384; 95% CI: -0.719 to -0.050; p = 0.025) and the higher prevalence of CKD stages 4-5 (OR: 2.141; 95% CI: 1.153 to 3.977; p = 0.016). Meanwhile, HR non-dipping pattern was independently associated with LVMI (β: 0.021; 95% CI: 0.000 to 0.041; p = 0.049) and LVH (OR: 1.78; 95% CI: 1.07 to 2.96; p = 0.027) after adjusting for confounding factors. HR non-dipping pattern was independently associated with impaired renal function and cardiac damage. Non-dipping HR deserves further attention and needs to be detected and treated during the management of CKD patients.

Hypertension and arterial wall stiffness in clinical practice: literature review

Arterial stiffness, as a marker of subclinical target organ damage in patients with hypertension (HTN), is an important and independent predictor of mortality and cardiovascular morbidity. The review examines factors contributing to increased vascular wall stiffness with a focus on smoking, pathogenesis of increased arterial stiffness with aging, and the effect of arterial stiffness on increased systolic and pulse pressure. Particular attention is paid to the effect of pulse pressure on the risk of cardiovascular events, primarily on the incidence of stroke and cognitive impairment. Thiazide-like diuretics and calcium antagonists have the greatest evidence base in HTN treatment in the elderly due to their ability to reduce systolic and pulse pressure, reduce arterial stiffness and have a positive effect on prognosis. The use of amlodipine/indapamide retard combination promotes more effective treatment of elderly patients with HTN.

Association between short-term blood pressure variability and target organ damage in non-dialysis patients with chronic kidney disease

BackgroundIt is unclear whether short-term blood pressure variability (BPV) is associated with target organ damage in patients with non-dialysis chronic kidney disease (CKD).MethodsA cross-sectional, single-center study was conducted among 3442 non-dialysis CKD patients hospitalized in the department of Nephrology of the Fifth Affiliated Hospital of Sun Yat-sen University from November 2017 to July 2022 and collected the demographic, laboratory, clinic blood pressure, ambulatory blood pressure data, and short-term BPV assessed by the weighted standard deviation (wSD) derived from ambulatory blood pressure monitoring (ABPM). Multivariate logistic analyses were used to evaluate the independent effects between short-term BPV and subclinical target organ damage, including left ventricular hypertrophy (LVH), abnormal carotid intima-media thickness (CIMT), low estimated glomerular filtration rate (eGFR), and albuminuria.ResultsThe average age of the participants was 47.53 ± 14.06 years and 56% of participants were male. The baseline eGFR was 69 mL/min/1.73 m2. Based on the tertile distribution of wSD according to equal numbers, patients were divided into three categories with T1(< 9.66 mmHg), T2(9.66–12.23 mmHg), and T3(> 12.23 mmHg) of SBPV; T1(< 8.17 mmHg), T2(8.17–9.93 mmHg), and T3(> 9.93 mmHg) of DBPV. The participants with the higher wSD group had a higher prevalence of target organ damage than their counterparts (P-trend < 0.05). An increasing trend in short-term variability was present with advancing CKD stages (P-trend < 0.001). Multivariate logistic analyses results showed that the odds ratio (OR) of SBP wSD was (1.07 [1.03,1.11], P < 0.001) for LVH, (1.04 [1.01,1.07, P = 0.029) for abnormal CIMT, (1.05 [1.02,1.08], P = 0.002) for low eGFR, and (1.06 [1.02,1.09], P = 0.002) for albuminuria; The OR of DBP wSD was (1.07 [1.02,1.12], P = 0.005) for LVH, (1.05 [1.01,1.09], P = 0.028) for abnormal CIMT, (1.05 [1.01,1.09], P = 0.022) for low eGFR, and (1.05 [1.01,1.10], P = 0.025) for albuminuria when adjusted for confounding factors and mean BP.ConclusionsIn conclusion, short-term BPV is associated with target organ damage, and irresponsible of average blood pressure levels, in Chinese non-dialysis CKD participants.

Resveratrol acts as an antioxidant in leukocytes of patients with diabetes mellitus 2 through the AMPK signaling pathway

Diabetes is characterized by disturbances in serum glucose levels caused by insulin resistance, with consequent high blood glucose levels. Permanently increased blood glucose tends to lead to an increase in reactive oxygen species (ROS). Therefore, one of the mechanisms to contain this process is to consider antioxidant treatment. Within this context, resveratrol (RSV) stands out. Among the pathways of action of this compound, AMPK plays a fundamental role in regulating its antioxidant activity. The objective of the work aims to verify the antioxidant profile of RSV, through the AMPK pathway, in leukocytes of patients with type 2 diabetes mellitus (DM2) between 60 and 80 years old. 12 individuals were selected, divided into two groups: control group (n=6) and experimental group (n=6). After blood collection and leukocyte separation, the luminol-dependent chemiluminescence assay was performed. To analyze the involvement of the AMPK pathway, the inhibitor compound C was used. The result obtained showed that there was an antioxidant behavior of AMPK in cells stimulated with peroxide and treated with RSV, this in turn decreased the production of ROS in leukocytes of all samples, but this effect was less significant in DM2 patients. This oxidation, which is more pronounced in diabetics, can lead to target organ damage. As RSV played an important role in reducing ROS, we concluded that it is an important compound in preventing target organ damage in patients with this comorbidity, acting through the AMPK pathway.

Research Progress on the Relationship between the Changes of Retinal Microcirculation and Systemic Target Organ Damage in Patients with Hypertension

Research Progress on the Relationship between the Changes of Retinal Microcirculation and Systemic Target Organ Damage in Patients with Hypertension

Comparison of Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors in the Management of Arterial Stiffness and Target Organ Damage in Patients with Hypertension

Comparison of Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors in the Management of Arterial Stiffness and Target Organ Damage in Patients with Hypertension

Hypertriglyceridemic waist phenotype is associated with left ventricular hypertrophy in Chinese hypertension patients

Left ventricular hypertrophy (LVH), the most common target organ damage in patients with hypertension, is closely related to excessive visceral adipose tissue (VAT) accumulation in the body. The hypertriglyceridemic waist (HTHW) phenotype can act as a surrogate marker of excessive VAT. However, the relationship between the HTHW phenotype and LVH in patients with hypertension remains unknown. The present study aimed to investigate whether the HTHW phenotype is associated with LVH, using echocardiography in a cross-sectional study involving 4470 middle-aged and older Chinese patients with hypertension. Logistic regression analysis revealed that patients with the HTHW phenotype were 1.52-fold more likely to experience LVH than those with normal triglyceride levels and normal waist circumference. This association was independent of age, sex, and other potentially confounding factors. In the stratified analysis, a stronger correlation was found among women, people of at least 70years of age, and people with hyperuricemia. These results suggest that distinguishing the HTHW phenotype in patients with hypertension could serve as a simple and effective screening strategy for identifying people with a higher risk of developing LVH.

S-46-4: NONDIPPER PULSE RATE PATTERN WAS ASSOCIATED WITH BLOOD PRESSURE VARIABILITY AND INCREASE OF BNP: J-HOP STUDY

Background: The association between nondipper pulse rate (PR) pattern was reported. However, the association between nondipper PR pattern, blood pressure variability and hypertensive target organ damage remains unclear. Methods: Ambulatory BP monitoring (ABPM) was conducted in 1,003 hypertensive patients enrolled in the Japan Morning Surge Home Blood Pressure (J HOP) Study. Ambulatory BP monitoring was performed on a weekday with an automatic system that recorded the wearers BP and PR every 30 minutes for 24 hours. Nondipper PR status was defined as (awake PR minus sleep PR)/awake PR &lt; 0.1, and we evaluated standard deviation (SD) of systolic BP in daytime and nighttime as BP variability. We also measured the brain natriuretic peptide level (BNP), and conducted echocardiography to estimate the left ventricular mass index (LVMI). Results: The SD of systolic BP in nighttime, BNP and LVMI in patients with nondipper PR (N = 247) were higher than that in patients with dipper PR (N = 756, SD of systolic BP: 13.3 ± 4.6 vs. 12.7 ± 4.1 mmHg, p = 0.041; median BNP: 25.2 vs. 17.6 pg/dL, p &lt; 0.001, LVMI: 101.4 ± 29.1 vs. 97.3 ± 42.2 g/m2, p = 0.021). Systolic BP in nighttime in patient with nondipper PR was similar to that in patient with dipper PR (119.5 ± 15.2 vs. 119.9 ± 15.1 mmHg, p = 0.63). The SD of systolic BP in nighttime was associated with BNP and LVMI (BNP: r = 0.08, p = 0.006; LVMI r = 0.10, p = 0.001). Nondipper PR was independently associated with BNP (β = 0.10, p &lt; 0.001), but not with LVMI (β = 0.03, p = 0.37) after adjustment for systolic BP and SD of systolic BP in nighttime. Conclusions: Nondipper PR pattern was associated with blood pressure variability and hypertensive target organ damage in patients with cardiovascular risk factor.

Primary Aldosteronism and the Role of Mineralocorticoid Receptor Antagonists for the Heart and Kidneys.

Primary aldosteronism (PA) is the most common cause of secondary hypertension but is frequently underrecognized and undertreated. Patients with PA are at a markedly increased risk for target organ damage to the heart and kidneys. While patients with unilateral PA can be treated surgically, many patients with PA are not eligible or willing to undergo surgery. Steroidal mineralocorticoid receptor antagonists (MRAs) are highly effective for treating PA and reducing the risk of target organ damage. However, steroidal MRAs are often underprescribed and can be poorly tolerated by some patients due to side effects. Nonsteroidal MRAs reduce adverse renal and cardiovascular outcomes among patients with diabetic kidney disease and are bettertolerated than steroidal MRAs. While their blood pressure-lowering effects remain unclear, these agents may have a potential role in reducing target organ damage in patients with PA.

Features of the manifestation of arterial hypertension in patients with a new coronavirus infection

The purpose. Assessment of the presence of the cardiovascular risk factors, associated clinical conditions, the degree of target organ damage in patients with arterial hypertension depending on the new coronavirus infection. Material and methods. In a retrospective cohort study 284 patients with arterial hypertension were identified, 162 of them had a novel coronavirus infection and 122 patients didn’t have a history of a new coronavirus infection. Patients who had a new coronavirus infection were divided into groups depending on the disease. Inclusion criteria were the presence of arterial hypertension in history and taking antihypertensive therapy. Results. Patients with hypertension who’ve had a new coronavirus infection are more likely to have risk factors such as smoking, overweight, early menopause as opposed to patients with hypertension without indication of past COVID-19. Comparing patients with increased severity of the novel coronavirus infection elevated uric acid levels and hypercholesterolemia were associated with more severe COVID-19 (p &lt; 0.05). Patients with chronic kidney disease, cerebrovascular disease, detection of atherosclerotic lesions of the brachiocephalic arteries and diabetes mellitus have an increased probability of deaths occur from the novel coronavirus infection (p &lt; 0.05). There was no significant difference between the compared groups of coronary heart disease, atrial fibrillation, chronic heart failure and also the daily blood pressure profile and a severe course of COVID-19. Сonclusion. The presence of diabetes mellitus, cerebrovascular disease, chronic kidney disease, detection of atherosclerotic lesions of the brachiocephalic arteries, and also hyperuricemia or hypercholesterolemia in patients with hypertension revealed a risk of severe coronavirus infection.

Intima-Media Thickness in Women with the History of Hypertensive Disorders of Pregnancy as a Risk Marker of the Occurrence of Cardiovascular Pathology in Advanced Reproductive and Perimenopausal Age

Over the past twenty years, it has been proven that a history of preeclampsia entails a 4-fold risk of hypertension, coronary heart disease, stroke, type 2 diabetes, metabolic syndrome in the affected women at the age of 50-55 years. Evaluation of intima-media thickness (IMT) has diagnostic value for the assessment of remodeling and atherosclerotic vascular lesions and practical importance as a predictor of vascular accidents in patients with hypertension and atherosclerosis.&#x0D; The aim. To evaluate the IMT as an integrative biomarker of the occurrence of cardiovascular pathology in women with hypertensive disorders of pregnancy in their advanced reproductive age and in perimenopausal age.&#x0D; Materials and methods. We studied 51 women at the age of 48-55 years with the history of severe preeclampsia. The women were asked to fill out a questionnaire in which they indicated the presence of a diagnosis of hypertension, angina pectoris at the time of filling the questionnaire. The diagnosis of hypertension and angina attacks as well as other descriptions of the disease were taken away from the results of the women’s questionnaire. The investigators were not given copies of medical records. The control group consisted of 20 women aged 48-55 who had no history of preeclampsia or any other hypertensive disorders of pregnancy. Ultrasound imaging of the carotid arteries was performed according to the recommendations of the American Society of Echocardiography 2020 in women of both groups using SonoAce-8000 Ex scanner (Medison, South Korea) with a linear sensor UST5524 with a frequency of 7 MHz. IMT less than 0.7 mm was taken as a normal value for women.&#x0D; Results. It was revealed that almost every fourth woman at the age of 48-55 with the history of preeclampsia had signs of early angina attacks, and 30% suffered from hypertension. A threatening fact is that almost 6% of women at the age of 48-55 had the history of vascular thrombosis which is a manifestation of early atherosclerotic vascular lesions in the group of women with gestational hypertensive disorders. It is noteworthy that 21 (41.2%) women with the history of severe preeclampsia felt healthy and did not have any complaints. Importantly, among the women surveyed who had no health complaints, 66.6% (14 of 21) had IMT 0.85±0.01 mm. This accounts for about one third (27.4%) among 51 patients. This category of women is at high risk of developing cardiovascular complications in the future and require further monitoring and detailed examination. Thrombotic complications (dynamic bowel obstruction, mesenteric vascular thrombosis) were observed in 3 (5.9 %) women at the age of 48-55 with the history of severe preeclampsia.&#x0D; Conclusions. Examinations of women with the history of preeclampsia revealed that women at the age of 48-55 had increased IMT. It should be noted that increased IMT was found both in women with cardiovascular pathology (hypertension, thrombosis, angina attacks) and in asymptomatic patients. Taking into account that increased IMT is one of the characteristics of target organ damage in patients with hypertension and the marker of cardiovascular events in asymptomatic patients, it is important to include this examination in follow-up for women with the history of severe preeclampsia in order to avoid the development of early severe cardiovascular pathologies.

Role of plasma 8-OXO-2’-deoxyguanosine in target organ damage in patients with hypertension and type 2 diabetes

Background: The aim of the study was to determine the prognostic value of 8-oxo-2’-deoxyguanosine (8-OHdG) plasma levels for cardiovascular complications (CVC) development in hypertension (HTN) and type 2 diabetes mellitus (T2DM) comorbidity. Material and methods: One hundred fifty-six patients (mean age 61.71 ± 0.87 years) with the combined course of HTN stage II and T2DM (group 1) and 100 non-diabetic patients with HTN stage II (mean age 60.59 ± 0.87 years, group 2) were examined. Lipid, carbohydrate metabolism, plasma insulin, plasma 8-OHdG (by ELISA), blood pressure levels were measured. Observation period was 12 months. Results: Plasma levels of 8-OHdG in the patients’ groups were significantly higher than in the controls (p &lt; 0.001), in the group 1 higher than in group 2 (15.37 ± 0.27 ng/L vs . 14.00 ± 0.29 ng/L, respectively, p = 0.002). Plasma levels of 8-OHdG in group-2 patients who developed cardiovascular complications during observation period were significantly higher than in those without cardiovascular complications (16.47 ± 0.62 ng/L vs. 15.11 ± 0.29 ng/L, respectively, p = 0.046). The ROC analysis made it possible to propose the 8-OHdG plasma level ≥ 15.68 ng/L as an identifier for the cardiovascular complications in patients with studied comorbidity. In group 1, in patients with 8-OHdG plasma level ≥ 15.68 ng/L such cardiovascular risk factors as total cholesterol (TC) (p = 0.034), low density lipoprotein cholesterol (LDL-C) (p = 0.035), systolic blood pressure (p = 0.022), HOMA-IR (p = 0.046) were significantly higher compared with those whose level of this indicator was &lt; 15.68 ng/L. Conclusion: Determination of the plasma 8-OHdG allows not only for assessment of the severity of oxidative stress, but also for determination of the course and prognosis in comorbidity of HTN and T2DM.

PREVALENCE OF TARGET ORGAN DAMAGE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS IN IBERICAN STUDY

Objective: The general aim of IBERICAN study is to know the prevalence and incidence of cardiovascular risk factors and cardiovascular and renal disease in Spain. The aim of this abstract is to know the prevalence of subclinical target organ damage (TOD) and type 2 of Diabetes mellitus (T2DM) in population of the IBERICAN Study. Design and method: The IBERICAN Study is a longitudinal, observational, and multicentric study with subjects between 18 to 85 years of age, recruited in Primary Care (PC) and who will be follow up at least 10 years. The final sample size is estimated in 8,066 patients. We show the baseline characteristics of the patients in the first visit (n = 8,066). To define the TOD, we consider the ESH 2013 Guide criteria: pressure pulse in aged &gt; 60 mmHg, ankle/brachial index &lt; 0.9, microalbuminuria: albumin/creatinine ratio (between 30 - 299 mg/g), glomerular filtration (CDK-EPI &lt; 60 ml/min), left ventricular hypertrophy (electrocardiogram or ECHO). Results: 1,434 patients had T2DM (20.1%), 56.4% men. 44.8% of patients with T2DM had TOD. Of the patients with TOD, the mean BMI was 31.7 ± 9.6 Kg/m2. By type of TOD: pulse pressure at &gt; 60 mmHg: 29.2%; ankle/brachial index &lt; 0.9: 3.0%; microalbuminuria: 17.0%; left ventricular hypertrophy: 7.0%. The prevalence of cardiovascular risk factors in patients with T2DM and TOD compared to non-TOD was: Hypertension 84.8% vs 68.4%, p&lt; 0.001; dyslipidemia 78.2% vs 71.6%, p &lt; 0.01; obesity 52.0% vs 49.7% p = 0.376; alcohol consumption 17.0% vs 15.2% p = 0.369; smoking 12.4% vs 14.7%, p = 0.202; sedentary lifestyle 38.5% vs 33.7%, p = 0.061. Conclusions: The prevalence of TOD in patients with T2DM in primary care is high, half of the patients. By type of TOD, elevated pulse pressure in the elderly and microalbuminuria were the most prevalent. Arterial hypertension and dyslipidemia were more prevalent in patients with TOD.

Vascular target organ damage in patients with Philadelphia negative myeloproliferative syndrome: A propensity score analysis

PurposeTo assess whether subjects with Philadelphia negative myeloproliferative neoplasms (Ph-MPNs) show differences in the presence of vascular, cardiac or renal target organ damage (TOD) and other vascular function parameters as compared to individuals without this condition. MethodsAn observational study was conducted. Fifty-seven subjects diagnosed with Ph-MPNs used as cases and 114 subjects without Ph-MPNs as controls. We matched the subjects with and without Ph-MPNs using the propensity scores in a 1:2 ratio using the variables gender, type 2 diabetes mellitus, high blood pressure, hyperlipidaemia and smoking. Vascular, cardiac and renal TOD were established according to the criteria of the European Society of Hypertension and Cardiology guidelines. Arterial stiffness was also assessed using the cardio-ankle vascular index (CAVI). ResultsMean age was 63.50±11.70 and 62.90±8.32 years in subjects with and without Ph-MPNs, 32 females (56%) in the first group and 62 (54%) in the second. Subjects with Ph-MPNs have a higher percentage of carotid injury than subjects without Ph-MPNs (35.1% vs. 21.1%) and higher albumin/creatinine ratio. In the logistic regression analysis, subjects with Ph-MPNs had an OR=2.382 (IC95% 1.066–5.323) for carotid injury versus those without haematological disease. ConclusionsSubjects with Ph-MPNs have twice the risk of by carotid injury than those without haematological disease.

Arterial stiffness and central aortic blood pressure in patients with hypertension and abdominal aortic aneurysm

Objective. To assess the arterial stiffness, peripheral and central aortic blood pressure (PBP and CBP), and to determinate their relationships with indicators of structural changes of the affected aorta in patients with hypertension (HTN) and abdominal aortic aneurysms (AAA).Design and methods. We examined 75 patients with HTN and AAA and 75 controls with HTN without AAA. Groups matched by age and gender. A PBP was measured by OMRON (Japan). Noninvasive measurements of CBP, augmentation index (AIx), augmentation pressure (AP), carotid-femoral pulse wave velocity (cfPWV) were assessed by SphygmoCor (AtCorMedical, Australia).Results. There was no difference in cfPWV between patients with AAA and control group (10,3 (2,2) vs 9,7 (2,1) m/s; р = 0,102). Age, systolic PBP, and aortic diameter were independent predictors of cfPVV in patients with AAA (β = 0,271, р = 0,029; β = 0,272, р = 0,030 и β = –0,361, р = 0,004, respectively). Patients with large aortic diameter of AAA (&gt; 60 mm) had decreased cfPWV compared with control group (8,8 (1,5) vs 9,7 (2,1) m/s; р &lt; 0,05), patients with AAA diameter less than 60 mm, on the contrary, had increased cfPVV compared with the controls (11,8 (1,7) vs 9,7 (2,1) m/s; р &lt; 0,001). Patients with AAA and patients of control group did not differ in systolic and pulse PBP (138,6 (16,4) vs 138,1 (13,6) mm Hg; р = 0,831 and 58,6 (11,8) vs 59,6 (10,2) mm Hg; р = 0,569, respectively). AIx and AP were higher in patients with AAA versus patients without AAA (27,6 (8,2) vs 21,3 (7,9)%; р &lt; 0,001 and 17,3 (6,8) vs 13,9 (5,4) mm Hg; р = 0,001, respectively). Systolic and pulse CBP were higher in patients with AAA than in patients of control group (130,0 (16,4) vs 124,9 (13,9) mm Hg; р = 0,046 and 49,5 (11,7) vs 45,7 (9,9) mm Hg; р = 0,031, respectively).Conclusions. In patients with AAA cfPWV decreased with the expansion of the maximum aortic diameter. CfPWV is not suitable for accurate arterial stiffness assessment in patients with HTN and AAA due to the apparent confounding effect of aneurysm on the biomechanical properties of the aorta. Local assessment of the elastic properties of the aorta such as computed tomography angiography and magnetic resonance imaging is required for arterial stiffness evaluation in patients with AAA. Parameters of the reflected pulse wave such as AP and AIx are increased in patients with AAA. This might contribute to the increase in central aortic BP and target organ damage in patients with HTN combined with AAA.

High prevalence of hypertension and target organ damage in patients with 11β-hydroxylase deficiency.

Prevalence of hypertension and hypertension-mediated organ damage (HMOD) had not been well studied in patients with 11β-hydroxylase deficiency (11β-OHD). The study was to assess the prevalence and risk factors of hypertension and HMOD in patients with 11β-OHD. Retrospective cohort analysis in a single medical centre. Twenty-eight patients with 11β-OHD were recruited between January 2003 and June 2021, and their diagnosis had been confirmed by Sanger sequencing. Blood pressure and clinical indicators for the assessment of HMOD occurrence were collected from the medical records. Medication adherence of antihypertensive drugs and glucocorticoids were determined by the patients' biochemistry. Logistic regression was used to identify factors associated with HMOD. Prevalence of hypertension and HMOD in the cohort was 100% and 50%, respectively. The kidneys (71.43%) are the organ most commonly damaged by high blood pressure, followed by the heart (64.29%), eyes (57.14%) and brain (21.43%). Risk factors of HMOD were hypokalemia (odds ratio [OR]: 9.16; 95% confidence interval [CI]: 1.634-51.43; p = .012), blood pressure ≥ 180/110 mmHg (OR: 22.0, 95% CI: 3.08-157.34; p = .002) and irregular glucocorticoid use (OR: 3.18, 95% CI: 1.13-8.98; p = .021). Blood pressure ≥ 180/110 mmHg was an independent predictor for HMOD. Hypertension and HMOD are prevalent in patients with 11β-OHD in our study. These findings illustrate the importance of early HMOD evaluation and optimal glucocorticoid medication in 11β-OHD patients.

A CLINICAL STUDY ON PRESENTATION OF HYPERTENSIVE EMERGENCIES IN TERTIARY CARE HOSPITAL

BACKGROUND:The clinical prole of hypertensive emergency patients presenting to hospitals in a developing country like ours is unknown. The current study sought to assess the modes of presentation, clinical prole, and spectrum of target organ damage in hypertensive emergency patients. AIM: Ÿ To evaluate the modes of presentations in patients with hypertensive emergencies. Ÿ To evaluate the modes of clinical prole. Ÿ To evaluate the modes of the spectrum of target organ damage in patients with hypertensive emergencies. MATERIALS AND METHODS: A six-month hospital-based prospective study was conducted in the Department of General Medicine, Santhiram Medical College, and General Hospital after approval from the Hospital Ethics and Research Committee. The study population included patients admitted to the hospital with severely elevated blood pressure and clinical evidence or laboratory evidence of acute target organ damage. The clinical prole and laboratory proles of fty of these patients were examined. RESULTS: Males were more likely than females to develop a hypertensive emergency. The most common symptoms were neurological decit, dyspnea, chest pain, convulsions, and vision loss. The vast majority of the patients had a history of hypertension. Higher blood pressure levels at presentation were linked to a poor outcome. Hyponatremia and hyperkalemia are two laboratory abnormalities observed in these patients. The most common type of target organ damage observed was intracerebral haemorrhage. In the current study, there was a 22% in-hospital mortality rate. CONCLUSION: Known hypertensives are more likely to present with acute target organ damage due to a hypertensive emergency. The most common mode of presentation is a neurological decit. The most common type of target organ damage in the current study was acute intracerebral haemorrhage