Category: Statistics

J Hypertens. 2022 Jun 1;40(Suppl 1):e29. doi: 10.1097/01.hjh.0000835528.11250.2d.

ABSTRACT

OBJECTIVE: Hypertension is one of the most important factors for cardiovascular disease. It has been repeatedly proposed as a prognostic factor of severe COVID-19 and has been included in clinical risk scores to predict the occurrence of critical illness in ospitalised with COVID-19. Also, it has been postulated the relation between antihypertensive drugs and the severity of COVID-19. The aims of our study were to analyze whether hypertension and antihypertensive treatment represent an independent risk factor for death or intensive care unit admission in patients with SARS-COV2.

DESIGN AND METHOD: Observational, retrospective, single-center cohort study of all patients admitted to Hospital Virgen Macarena diagnosed with COVID-19 between the months of March and December 2020. A bivariate analysis was performed using Pearson’s chi-square.

RESULTS: 608 patients required admission for COVID-19. A total of 83.7% were hypertensive, specifically 75.9% were under antihypertensive treatment (35.7% with only 1 drug, 29.9% were taking two drugs, 9% with three drugs, and 1.3% with 4 drugs). 26.2% were treated with an ACEI, 24.8% with ARA-II, 16.8% with calcium-antagonists, 30.9% with diuretics, 21.2% with beta-blockers, 0, 5% with alpha-blockers). Hypertension did not show a statistically significant relationship with mortality (p = 0.34), increase in mortality and ICU admissions. Neither treatment with ACEI (p = 0.4), ARB-II (p = 0.45), calcium antagonists (p = 0.53), diuretics (p = 0.68), alpha blockers (p = 0.07) demonstrated relation with those items. Surprisingly, beta-blockers increased the mortality in patients with SARS-COV2 (p = 0.048). Probably this results can be explained as these drugs were indicated for rate control in patients with atrial fibrillation (p = 0.006). The number of antihypertensive drugs used also did not show a statistically significant relationship with an increase in mortality (p = 0.978).

CONCLUSIONS: Hypertension is a highly prevalent pathology in patients ospitalised with COVID-19 infection. However, high blood pressure was not associated with a higher risk for mortality in patients with SARS-COV-2, neither the type or the number of antihypertensive drug used. Only beta-blockers alter outcomes in hypertensive patients with COVID-19, as they were associated with more deaths.

PMID:36027544 | DOI:10.1097/01.hjh.0000835528.11250.2d

J Hypertens. 2022 Jun 1;40(Suppl 1):e28. doi: 10.1097/01.hjh.0000835516.74875.81.

ABSTRACT

OBJECTIVE: The Covid-19 pandemic necessitated a decrease in non-Covid-19 related diagnostic and therapeutic procedures in many countries. We explored the impact on hypertension care in the Excellence Center (EC) network of the European Society of Hypertension.

DESIGN AND METHOD: We conducted an electronic survey regarding 6 key procedures in hypertension care among our ECs.

RESULTS: Overall, 54 ECs from 18 European and 3 non-European countries participated. From 2019 to 2020, there was a significant decrease in the median number per center of ambulatory blood pressure monitorings (ABPMs; 544 vs 289), duplex ultrasound investigations of renal arteries (DUS RA; 88.5 vs 55), computed tomographic investigations of renal arteries (CT RA; 66 vs 19.5), percutaneous renal artery angioplasties (PTA RA; 5 vs 1), laboratory tests for catecholamines (2019: 116 vs 67.5) and for ennin/aldosterone (146 vs 83.5). All comparisons were statistically significant with p < 0.001, respectively (Figure). While the reduction in all diagnostic and therapeutic procedures was observed in all 3-months period comparisons between 2019 and 2020, the most profound decrease occurred from April to June 2020, which was the period of the first wave and the first lockdown in most countries. In this period, as compared to 2019, the median reduction in 2020 was 50.7% (ABPM), 47.1% (DUS RA), 50% (CT RA), 57.1% (PTA RA), 46.9% (catecholamines) and 41% (ennin/aldosterone), respectively. Based on Friedman test, overall differences in reduction between 3 months time intervals were statistically highly significant.

CONCLUSIONS: Diagnostic and therapeutic procedures related to hypertension were dramatically reduced during the first year of the Covid-19 pandemic, with the largest reduction during the first lockdown. The long-term consequences regarding blood pressure control and, ultimately, cardiovascular events remain to be investigated.

PMID:36027541 | DOI:10.1097/01.hjh.0000835516.74875.81

J Hypertens. 2022 Jun 1;40(Suppl 1):e26. doi: 10.1097/01.hjh.0000835508.38962.a6.

ABSTRACT

OBJECTIVE: ACE2, part of the counterregulatory arm of the ennin-angiotensin system, serves both as protective toward oxidative stress and cardiovascular enninling and as key entry for SARS-CoV-2. ACE2 has two isoforms, non-glycosylated and glycosylated, being this latter accountable for the binding with SARS-CoV-2. After the binding, viruses use proteases as cathepsin-L (Cat-L) to entry the cells. Both ACE2 glycosylation and Cat-L activity are pH-dependent. Gitelman and Bartter syndromes (GS/BS), rare genetic tubulopathies, are characterized by electrolytic alterations, activation of the ennin-angiotensin system, yet normo-hypotension, increased levels of ACE2 and metabolic alkalosis with likely increased intracellular pH. We reported that during the first wave of COVID-19 in early 2020 none of our cohort of 128 GS/BS patients from the major hotspots in Northern Italy had been infected or suffered any major COVID-19 symptoms and in a second survey on the same cohort in 2021 we reported only 8 positives, 4 asymptomatic and 4 with very light symptoms This study aims to investigate potential mechanisms as ACE2 glycosylation and Cat-L activity related to patients’ metabolic alkalosis and viral entry/infection.

DESIGN AND METHOD: Mononuclear cells ACE2 glycosylation (Western blot) and blood Cat-L activity (ELISA) from 20 GS/BS patients have been compared to those from 15 heathy subjects.

RESULTS: Non-glycosylated ACE2 was higher in GS/BS (0.82 ± 0.19 d.u. vs 0.67 ± 0.13 p = 0.01); glycosylated ACE2 was not different (0.85 ± 0.28 in GS/BS vs 0.73 ± 0.23 p = 0.19). Cat-L activity was lower in GS/BS (3.90 ± 1.13 r.f.u. vs 5.31 ± 0.8 p < 0.001) and inversely correlated with blood bicarbonate (HCO3-), while a negative correlation between glycosylated ACE2 and HCO3- approaches statistical significance (p = 0.08).

CONCLUSIONS: GS/BS’s metabolic alkalosis, likely by increasing intracellular pH, influences the glycosylation of ACE2 and the activity of Cat-L, providing a mechanistic explanation for the near complete absence of COVID-19 or its symptoms reported in our cohort. These findings provide a rationale for pursuing the identification and/or synthesis of new drugs that specifically target ACE2 glycosylation and/or proteases involved in SARS-CoV-2 infection.

PMID:36027539 | DOI:10.1097/01.hjh.0000835508.38962.a6

J Hypertens. 2022 Jun 1;40(Suppl 1):e22. doi: 10.1097/01.hjh.0000835480.16494.e1.

ABSTRACT

OBJECTIVE: To assess the persistence of BP phenotypes according to office and 24-h ABPM in youth over time.

DESIGN AND METHOD: Retrospective study including 582 children who underwent measurement of both office BP (OBP) and ABPM on the same day. The second office BP and ABPM was performed within 1 year apart. OBP was measured using an oscillometric device validated in children. ABPM was performed using oscillometric SpaceLabs 90207 monitors. OBP and ABPM were classified according to the criteria of the ESH (Lurbe et al J Hypertens 2016). Four phenotypes based on OBP and ABPM were defined: true normotensives, sustained hypertensives, white-coat hypertensives, and masked hypertensives. Persistence and Kappa statistic were used to evaluate the concordance of BP phenotypes. Factors related with persistence on BP phenotypes were evaluated using logistic regression models.

RESULTS: At the initial assessment, the majority of children fell within the category of true normotension (77%), followed by masked hypertension (13%), sustained hypertension (5%) and white coat hypertension (5%). The prevalence of true normotensive increased significantly in the follow-up. The flow through phenotypes is shown in the Figure.Only 38 initial true normotensive patients changed to other categories, mainly masked (12); 63 of initial masked hypertension changed, mainly to normotensive (58); 24 of white coat changed predominantly to normotension (16); finally, 25 of sustained changed, largely to normotension (14), but 9 children migrated to masked. The overall agreement was 74.2% (kappa 0.20). The grade of agreement was slightly higher for boys than for girls. In the multivariable model, higher age showed to be a protective factor, whereas increased office SBP and waist circumference were significant risk factors. The masked hypertensive phenotype carried the highest risk for lack of persistence.

CONCLUSIONS: Children with hypertensive BP phenotypes should be re-evaluated because a large percentage of them will become normotensive. High BP levels and high BMI z-score or waist circumference were significant risk predictors for the lack of persistence on BP phenotypes.

PMID:36027532 | DOI:10.1097/01.hjh.0000835480.16494.e1

J Hypertens. 2022 Jun 1;40(Suppl 1):e23. doi: 10.1097/01.hjh.0000835488.45395.d3.

ABSTRACT

OBJECTIVE: Functional characteristics of the vascular system underly changes associated with aging, such as increasing arterial stiffness. Research suggests that these age-associated changes may be accelerated in the presence of cardiovascular risk factors. So far, normative data on arterial stiffness in unselected adolescents and young adults have been scarce. Recently, measurements of carotid stiffness (cS) parameters have been included in a national health examination survey.

DESIGN AND METHOD: The population-based KiGGS cohort 11-year-follow-up included high-resolution B-mode sonography with semi-automated edge-detection and automatic electrocardiogram-gated real-time quality control. In 4,305 participants aged 14-28 years, distensibility coefficient (DC), stiffness index ß, Young’s (YEM) and Peterson’s elastic modulus (Ep) were assessed. Centiles were modelled by sex, age and height simultaneously, using generalized additive models for location, scale and shape. Log- binomial regression models were used to investigate associations of blood pressure with cS > = 90th centile (P90) as outcomes. Hypertensive blood pressure was defined according to German guidelines (> = P95 systolic or diastolic for age, height and sex according to KiGGS centiles until age 17 and > = 140/90 mmHg from age 18).

RESULTS: Multivariable models show that hypertensive blood pressure in childhood is associated with an increased risk of elevated cS (> = P90 for age, height and sex) eleven years later for all parameters of cS, with the exception of stiffness indexß (no association). Effect estimates for DC, YEM and Ep range from 1.77 [CI 1.28-2.44] for DC to 1.41 [CI 0.99-2.01] for YEM. Cross-sectional associations of blood pressure with cS parameters show even stronger associations (relative risks between 1.3 and 3.3).

CONCLUSIONS: Using state-of-the-art sonography and centiles computed with novel statistical methods, this study confirms that, at the population level, hypertensive blood pressure in childhood is linked to increased carotid stiffness in young adulthood. The results emphasize that healthy lifestyles and healthy living environments in childhood and adolescence represent an early investment in cardiovascular health.

PMID:36027534 | DOI:10.1097/01.hjh.0000835488.45395.d3

J Hypertens. 2022 Jun 1;40(Suppl 1):e14-e15. doi: 10.1097/01.hjh.0000835416.29059.27.

ABSTRACT

OBJECTIVE: Atrial fibrillation (AF) is the most common sustained arrhythmia which often is asymptomatic and undiagnosed. An automated blood pressure (BP) monitor with an algorithm which detects atrial fibrillation with high diagnostic accuracy during routine measurement was used for AF screening in the elderly general population Greece.

DESIGN AND METHOD: EMENO health survey (2013 to 2016) applied a multi-stage stratified random sampling method to select a random sample of the general adult (> = 18 years) population of Greece. For participants aged > = 65 years screening for AF was performed with triplicate automated BP measurements using a validated automated upper-arm cuff oscillometric device with embedded algorithm for detecting AF (Microlife BPA100 Plus AFIB).

RESULTS: A total of 1,838 individuals aged > = 65 years were recruited and 975 with AF data on at least 1 BP measurement were analysed (mean [SD] age 75.3 (6.6)) years, men 45.1%, BMI 30.3 (5.2) kg/m2, hypertensives 80.7%). Of them, 65 (7.1%) had AF detected in all their 3 BP readings (AF group), 661 (69.5%) have no AF in all 3 readings (no AF group), and 249 (23.4%) had AF in 1 or 2 readings (uncertain AF group). Participants with AF were older than non-AF (by 3.4 years on average, p < 0.001), had lower systolic BP (by 4.6 mmHg, p < 0.05), and more frequent cardiovascular disease (29% vs 14%, p < 0.01). Among AF patients, 43% reported a previous AF diagnosis compared to 8.8% and 11.9% in no AF and uncertain AF group respectively (p < 0.001). Hypertension tended to be more common in the AF than the non-AF group (88% vs. 80%, p = NS). Of the 65 AF group, 57% were undiagnosed and all required anticoagulant therapy (men with CHA2DS2-VASc > = 1 or women > = 2).

CONCLUSIONS: Almost 7% of people aged > = 65 years in Greece had AF detected during routine automated BP measurement. 57% of them were undiagnosed and all required anticoagulant treatment for stroke prevention. Screening for AF using routing automated BP measurement in the elderly appears to be a useful method for early detection and management of asymptomatic AF.

PMID:36027516 | DOI:10.1097/01.hjh.0000835416.29059.27

J Hypertens. 2022 Jun 1;40(Suppl 1):e7. doi: 10.1097/01.hjh.0000835352.04456.88.

ABSTRACT

OBJECTIVE: According to some guidelines white-coat hypertension (WCH) carries little or no increase of cardiovascular (CV) risk in absence of organ damage (OD) but no data are available on this issue.

DESIGN AND METHOD: Using the population data from Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA), we evaluated CV and total mortality over a median follow-up of 29 years in WCH (elevated office and normal 24-hour or home blood pressure, BP) and normotensive controls (N, normal in- and out-of-office BP) with no echocardiographic left ventricular hypertrophy and no reduction of estimated glomerular filtration rate. Analysis was extended to sustained hypertension (SH, in- and out-of-office BP elevation) and to N, WCH and SH with cardiac and renal OD.

RESULTS: During the 29 years follow-up there were in the 1423 subjects nalysed 165 CV and 526 all cause deaths. OD was detected in 10.6%, 30.5% and 43.8% of N, WCH and SH, respectively. After adjustment for confounders no-ODWCH exhibited a risk of fatal CV events lower than that of no-ODSH but greater than that of no-ODN (HR 2.0, 95% CI: 1.1-3.6, P = 0.02), this being the case also for all cause mortality. Compared with no-ODN, no-ODWCH also exhibited a greater 10 year adjusted risk to develop new SH or OD. Similar findings were obtained in N, WCH and SH with OD. The present study provides the first evidence that WCH with no cardiac and renal OD is accompanied by an increased long-term risk of mortality, new hypertension and new OD, thereby not representing a clinically innocent condition.

CONCLUSIONS: The present study provides the first evidence that WCH with no cardiac and renal OD is accompanied by an increased long-term risk of mortality, new hypertension and new OD, thereby not representing a clinically innocent condition.

PMID:36027500 | DOI:10.1097/01.hjh.0000835352.04456.88

J Hypertens. 2022 Jun 1;40(Suppl 1):e7. doi: 10.1097/01.hjh.0000835344.28675.93.

ABSTRACT

OBJECTIVE: It has been hypothesized that unattended blood pressure (BP) measurement may provide complementary clinical information to conventionally attended BP measurement. The role of sympathetic nervous system activation during attended and unattended BP measurements is largely undetermined.

DESIGN AND METHOD: We studied 161 untreated hypertensive patients undergoing attended and unattended office BP measurements. Patients were divided into two groups – group A, unattended systolic BP greater than the attended systolic BP (n = 79), and group B, unattended systolic BP equal or lower than the attended (n = 82). All participants underwent muscle sympathetic nerve activity (MSNA) estimation by microneurography. Unattended and attended BP measurements were performed with the same device in a random order for each patient on the day of MSNA recording. MSNA levels were compared between the two groups.

RESULTS: We examined 161 hypertensive patients [54% men, mean age 56 ± 12 years, BMI 29 ± 5 kg/m2, mean attended BP 140 ± 17 / 87 ± 13 mmHg, mean unattended BP 141 ± 20 / 85 ± 12 mmHg]. Group A and group B had statistically significant differences between attended systolic BP (136.7 ± 17.8 vs 143.7 ± 15.7 mmHg respectively, p = 0.009), attended diastolic BP (85.5 ± 14.7 vs 89.7 ± 11.4 mmHg respectively, p = 0.04), unattended systolic BP (145.5 ± 19 vs 135.7 ± 19.9 mmHg respectively, p = 0.002) and unattended diastolic BP (86.9 ± 13 vs 83.2 ± 11.2 mmHg respectively, p = 0.05). However, the two groups did not differ as regards MSNA levels (41.6 ± 8.9 vs. 42.1 ± 8.1 bursts per minute respectively, p = 0.7). MSNA levels did not correlate to attended and unattended systolic/diastolic BP in both groups.

CONCLUSIONS: sympathetic nervous system activity may not contribute significantly to the differential BP levels during attended or unattended BP measurements.

PMID:36027498 | DOI:10.1097/01.hjh.0000835344.28675.93

J Hypertens. 2022 Jun 1;40(Suppl 1):e4. doi: 10.1097/01.hjh.0000835316.96189.00.

ABSTRACT

OBJECTIVE: The nycterohemeral rhythm of blood pressure (BP) and heart rate has been associated with cardiovascular outcomes. However, long-term prognostic significance of BP at different levels of heart rates has rarely been studied. We therefore conducted the present analysis to investigate the prognostic values for cardiovascular outcome by the ambulatory BP parameters during different time windows.

DESIGN AND METHOD: We enrolled 5 large cohorts from whole world, including CARDIA, IDACO, JHS, SPRINT to find out independent prognostic factors for cardiovascular disease mortality, feature engineering and feature transformation were used. Several statistical and machine learning methods including the stepwise procedure, lasso penalty, and random survival forest with bootstrap technique were used to screen important candidates of risk factors. Models building are based on systolic BP replacement into the established Framingham risk score. Directly one to one replacement and indirectly two stage replacement methods are considered with variable diversity. C-statistics, NRI are used for model performance evaluation.

RESULTS: In model building procedure, nighttime BP combined with pulse pressure, morning-evening difference of SBP and weighted SBP consistently had a higher C-statistics than had office systolic BP. In validation datasets, equations incorporating mean BP and pulse pressure had best performance in C-index (0.754). In contrast, the C-index (higher is better), of the usual Framingham risk score with office systolic BP are 0.744. Furthermore, the best model had acceptable predicted accuracy based on model calibration statistics (p > 0.05).

CONCLUSIONS: Our study demonstrated that mean BP at night combined with pulse pressure, morning-evening difference of SBP and weighted SBP, throughout 24 hours had the largest predictive power of 20-year cardiovascular death in population with ABPM recordings. The transportability of the proposed cardiovascular risk function should be evaluated in future studies.

PMID:36027491 | DOI:10.1097/01.hjh.0000835316.96189.00

J Hypertens. 2022 Jun 1;40(Suppl 1):e317. doi: 10.1097/01.hjh.0000838844.45851.de.

ABSTRACT

OBJECTIVE: To compare the effects of intensive vs standard blood pressure (BP) targets on the mortality of hypertensive patients with chronic renal disease.

DESIGN AND METHOD: A bibliographic search of all relevant databases was carried out without restriction by language, year of publication or publication status.We considered randomized controlled clinical trials on patients older than 18 years, diagnosed with hypertension and chronic renal disease who were allocated to either “intensive” BP target (less than or equal to 130/80 mmHg) or “standard” BP target (less than or equal to 140-160/90-100 mmHg). Additionally, trials should include more than 50 participants per group followed during at least one year. Trials were not limited by any concomitant disease or baseline cardiovascular risk.We contacted trials’ authors to obtain Individual Patient Data and, if necessary, extracted information from chronic renal patients.COVIDENCE software was used for screening, the Cochrane Review Manager (RevMan web) for data synthesis and analysis, and the Cochrane Risk of Bias Tool (ROB2) to assess the risk of bias for each trial.

RESULTS: A total of 2298 records were identified by the bibliographic search. We obtained the full text of 29 publications from the pre-selected studies. Of these, six studies met the inclusion criteria and we obtained Individual Patient Data for all of them (AASK, SPRINT, HOT, ACCORD BP, MDRD, SPS3).There was no statistically significant difference in total mortality between the intensive and standard blood pressure target groups (RR 0.92, 95%CI 0.75-1.13, p = 0.42, 6 studies, 7,348 participants). In absolute terms, there were 5 additional deaths per 1000 participants in the standard target group (95% CI: 6 fewer to 16 more deaths per 1000 participants). Overall deaths were 227/3352 (6.8%) in the intensive target group vs 285/3996 (7.9%) in the standard target group (Figure).The quality of evidence was moderate according to the GRADE assessment.

CONCLUSIONS: Intensive blood pressure lowering targets in patients with arterial hypertension and chronic renal disease do not result in lower mortality compared to standard blood pressure lowering.

PMID:36027480 | DOI:10.1097/01.hjh.0000838844.45851.de