UNASSIGNED: Normalization of blood pressure in hypertensive patients is a major challenge for practitioners. Knowledge of the factors associated with normalization of blood pressure could help optimize management of these hypertensive patients. In this study, we analysed the factors predictive of this in a population of hypertensive patients followed as outpatients in a specialised department.
UNASSIGNED: Retrospective and analytic study (January 2021-May 2022) of adult hypertensive patients over 40 years old who had been receiving antihypertensive treatment as outpatients in the Cardiology Department of the Bouake Teaching Hospital for at least 6 months. We studied the epidemiological and clinical parameters as well as the factors involved in the normalization of blood pressure in this population. Statistical analysis was performed using SPPS version 26 software (SPSS Inc., Chicago, IL, USA).
UNASSIGNED: We collected 194 patients records (57.7% women). The mean age was 59.13 years [extremes: 40-89 years]. One hundred and nine (56.2%) patients had a low socioeconomic status and 151 (77.83%) had at least 2 cardiovascular risk factors. The mean systolic blood pressure on admission was 171.12 ± 22.38 mmHg [extremes: 140-259 mmHg] and the mean diastolic blood pressure was 97.98 ± 17.83 mmHg [extremes: 60-168 mmHg]. First-line treatment consisted of dual anti-hypertensive therapy (n = 133; 68.55%) and fixed combination (n = 152; 78.35%). Only 25.25% (n = 49) of patients achieved normalization of blood pressure with therapeutic adherence estimated at 37.62% (n = 73). In multivariate analysis adjusted for anti-hypertensive treatment adherence, age (OR = 1.03; 95% CI = 1.002-1.059; p = 0.039), absence of alcoholism (OR = 9.48; 95% CI = 2.13-42.11; p = 0.003), number of cardiovascular risk factors <2 (OR = 1.52; 95% CI = 1.06-2.16; p = 0.021), normalization of uricemia (OR = 1.05; 95% CI = 1.00-1.11; p = 0.039) and natraemia (OR = 1.01; 95% CI = 1.00-1.03; p = 0.021), dual therapy (OR = 0.40; 95% CI = 0.18-0.90; p = 0.027), change in treatment for optimization (OR = 4.22; 95% CI = 1.71-10.37; p = 0.002), intellectual education (OR = 10.40; 95% CI = 4.31-25.10; p < 0.001) and health insurance (OR = 0.09; 95% CI = 0.04-0.21; p < 0.001) were the main factors predicting normalization of blood pressure.
UNASSIGNED: Control of cardiovascular risk factors and compliance with treatment are the main factors in normalizing blood pressure.

Arterial hypertension is a highly prevalent chronic disease worldwide, with several etiologies and treatments that may eventually have side effects or result in patients developing tolerance. There is growing interest in traditional medicine and functional foods to isolate biomolecules that could be useful as coadjuvants for treating several aliments. Pitaya, a desert fruit endemic in Mexico, is a rich source of bioactive molecules (betalains and phenolic compounds). In this work, the vasorelaxation properties of pitaya juice concentrate and fraction one were investigated using aortic and mesenteric rings from rats. The incubation of rings with pitaya juice concentrate or fraction one induced significant vasorelaxation, independent of the endothelium, and showed resistance to potassium channel blockers. This vasorelaxation was associated with the transmembrane influx of extracellular calcium through the vascular smooth muscle cells, with an inhibitory effect on the voltage-dependent calcium channel currents. Also, 400 mg/mL of pitaya juice concentrate in spontaneous hypertensive rats reduced their blood pressure for 48 h. Phytochemical analyses showed that the primary compounds in F1 were glycosidic in nature, and could be a complex mixture of disaccharides, dimeric disaccharides, or even tetrasaccharides. The glycosidic compounds found in F1 primarily contributed to vasodilatation, establishing a voltage-dependent calcium channel inhibition as a possible molecular target.

Angiogenesis, the natural mechanism by which fresh blood vessels develop from preexisting ones, is altered in arterial hypertension (AH), impacting renal function. Studies have shown that hypertension-induced renal damage involves changes in capillary density (CD), indicating alterations in vascularization. We aimed to elucidate the role of the apelin receptor (APLNR), neuronal nitric oxide synthase (nNOS), and vascular endothelial growth factor (VEGF) in hypertension-induced renal damage. We used two groups of spontaneously hypertensive rats aged 6 and 12 months, representing different stages of AH, and compared them to age-matched normotensive controls. The kidney tissue samples were prepared through a well-established protocol. All data analysis was conducted with a dedicated software program. APLNR was localized in tubular epithelial cells and the endothelial cells of the glomeruli, with higher expression in older SHRs. The localization of nNOS and VEGF was similar. The expression of APLNR and nNOS increased with AH progression, while VEGF levels decreased. CD was lower in young SHRs compared to controls and decreased significantly in older SHRs in comparison to age-matched controls. Our statistical analysis revealed significant differences in molecule expression between age groups and varying correlations between the expression of the three molecules and CD.

BACKGROUND: This study evaluated the effects of concurrent isolated training (T) or training combined with the antioxidant N-acetylcysteine (NAC) on cardiac remodeling and oxidative stress in spontaneously hypertensive rats (SHR).
METHODS: Six-month-old male SHR were divided into sedentary (S, n = 12), concurrent training (T, n = 13), sedentary supplemented with NAC (SNAC, n = 13), and concurrent training with NAC supplementation (TNAC, n = 14) groups. T and TNAC rats were trained three times a week on a treadmill and ladder; NAC supplemented groups received 120 mg/kg/day NAC in rat chow for eight weeks. Myocardial antioxidant enzyme activity and lipid hydroperoxide concentration were assessed by spectrophotometry. Gene expression of NADPH oxidase subunits Nox2, Nox4, p22 phox, and p47 phox was evaluated by real time RT-PCR. Statistical analysis was performed using ANOVA and Bonferroni or Kruskal-Wallis and Dunn.
RESULTS: Echocardiogram showed concentric remodeling in TNAC, characterized by increased relative wall thickness (S 0.40 ± 0.04; T 0.39 ± 0.03; SNAC 0.40 ± 0.04; TNAC 0.43 ± 0.04 *; * p < 0.05 vs T and SNAC) and diastolic posterior wall thickness (S 1.50 ± 0.12; T 1.52 ± 0.10; SNAC 1.56 ± 0.12; TNAC 1.62 ± 0.14 * mm; * p < 0.05 vs T), with improved contractile function (posterior wall shortening velocity: S 39.4 ± 5.01; T 36.4 ± 2.96; SNAC 39.7 ± 3.44; TNAC 41.6 ± 3.57 * mm/s; * p < 0.05 vs T). Myocardial lipid hydroperoxide concentration was lower in NAC treated groups (S 210 ± 48; T 182 ± 43; SNAC 159 ± 33 *; TNAC 110 ± 23 *# nmol/g tissue; * p < 0.05 vs S, # p < 0.05 vs T and SNAC). Nox 2 and p22 phox expression was higher and p47 phox lower in T than S [S 1.37 (0.66-1.66); T 0.78 (0.61-1.04) *; SNAC 1.07 (1.01-1.38); TNAC 1.06 (1.01-1.15) arbitrary units; * p < 0.05 vs S]. NADPH oxidase subunits did not differ between TNAC, SNAC, and S groups.
CONCLUSIONS: N-acetylcysteine supplementation alone reduces oxidative stress in untreated spontaneously hypertensive rats. The combination of N-acetylcysteine and concurrent exercise further decreases oxidative stress. However, the lower oxidative stress does not translate into improved cardiac remodeling and function in untreated spontaneously hypertensive rats.

Heart failure with preserved ejection fraction (HFpEF) is frequently observed in elderly physically deconditioned subjects, mainly women with hypertension, obesity, glucose intolerance/diabetes, atrial fibrillation, anaemia, coronary artery disease, chronic pulmonary disease, and chronic renal insufficiency. In practice, these conditions represent the majority of cardiac diseases we deal with in our daily clinical practice. For this reason, the HFpEF disease does not exist as a single entity and, as such, no specific unifying therapy could be found. New classification attempts still do not consider the multifaceted aspect of the HF syndrome and appear rather as an artefactual attempt to categorize a condition which is indeed not categorizable. The aim of the present article is to critically review the construction of the concept of the HFpEF syndrome and propose the return of a pathophysiological approach in the evaluation and treatment of patients. Considering the huge economic efforts employed up to date to run awfully expensive trials and research in this field, it is time to call action and redirect such resources towards more specific pathophysiological classifications and potential specific therapeutic targets.

Cardiovascular disease (CVD), a broad-spectrum term comprising coronary artery disease, stroke, hypertension, and heart failure, presents as one of the most significant strains on global healthcare systems. Coronary artery disease, caused by atherosclerosis, has various modifiable risk factors such as dietary changes and exercise. Since these risk factors are found to be linked to oxidative stress and inflammations, the dietary supplementation with vitamins\' role in treating and preventing the diseases has been of much debate. With various vitamins having anti-inflammatory and antioxidative properties, studies have explored their correlation with cardiovascular health. Therefore, this narrative review explores and evaluates the benefits and risks of all vitamin supplementations in patients with CVD and provides future recommendations.

BACKGROUND: Hypertension and atherosclerotic cardiovascular diseases (ASCVD) increase cardiovascular risk and worsen patients\' prognoses. One early predictor of increased risk is a change in arterial stiffness. This study aimed to evaluate arterial stiffness parameters using the non-invasive photoplethysmography (PPG) method in Polish patients with arterial hypertension (AH) and/or atherosclerosis (AS).
METHODS: The study group consisted of 333 patients (Caucasians, both sexes, aged 30-85 years old). Patients were analyzed in four groups depending on AH and AS (Group I: patients without AH or AS, Group II: AH patients, Group III: AS patients, and Group IV: AH/AS patients) and, in addition, according to sex and history of SARS-CoV-2 infection. Arterial stiffness parameters, i.e., reflection index (RI), peak-to-peak time (PPT), and stiffness index (SI) were automatically calculated with PPG based on the analysis of the pulse wave contour.
RESULTS: Mean values of RI and SI were higher in men than women (p < 0.001 each). Diastolic blood pressure (DBP) also differed between sexes (p = 0.010). Mean SI values differed between the study groups (p = 0.038) with the highest SI found in AS/AH patients and the lowest-in patients without AH or AS. The mean SI values were significantly lower in women compared to men in both Group I and Group II (p = 0.006 and p < 0.001, respectively). The mean values of RI were also greater in men than in women in Group I and Group II (p < 0.001 for each group). Regarding COVID-19 history, only HR values differed between patients with and without COVID-19 in AH patients (p = 0.012). In AH patients, men had higher values of RI and SI compared to women (p < 0.001 and p < 0.001). On the other hand, AS women with COVID-19 had significantly greater mean values of SI (9.66 m/s ± 1.61) than men with COVID-19 (7.98 m/s ± 1.09) (p = 0.045).
CONCLUSIONS: The present study confirmed that sex had a significant impact on arterial stiffness parameters. Both AH and AS affected arterial stiffness. Heart rate was greater in hypertensive patients after COVID-19 compared to hypertensive patients without COVID-19.

The May Measurement Month (MMM) screening campaign initiated by the International Society of Hypertension aimed to assess the prevalence of hypertension and associated risk factors to increase and improve population awareness of raised blood pressure (BP) and methods of prevention. The MMM is a cross-sectional survey of adults aged 18 years and over of both sexes who gave informed consent to participate in the survey and to have their BP measured. Kazakhstan participated in the campaign for the first time in 2021. Blood pressure was measured three times on a single occasion, and data on cardiovascular risk factors were collected. A total of 1763 respondents from 4 regions participated in the screening. The mean age was 41 ± 14.4 years; 31.5% of all participants were found to have hypertension, of whom 41.8% were aware, 34.0% on treatment, and only 15.8% controlled (<140/90 mmHg). Significant differences in these rates were found between age and sex groups. The screening campaign confirms low levels of awareness of hypertension and associated risk factors in the population in Kazakhstan and the need for annual screening and implementation of national hypertension control programmes.

Postpartum hypertension (PPHT) is hypertension that persists or develops after delivery and is a frequent cause of readmission, affecting 10% of pregnancies. This interim analysis aims to describe the cohort and to determine the feasibility and acceptance of a home-based telemonitoring management strategy (HBTMS) in PPHT patients. Enrollment at the University Hospital Basel began during the 2020 SARS-CoV-2 pandemic. Maternity-ward patients were screened for preexisting hypertension, hypertensive disorders of pregnancy, and de novo PPHT. In this pragmatic non-randomized prospective trial, the participants chose the HBTMS or standard of care (SOC), which consisted of outpatient hypertension clinic appointments. The HBTMS was a smartphone application or a programmed spreadsheet to report blood pressure (BP), followed by telephone consultations. Three months postpartum, the participants underwent a 24 h BP measurement and a blood, biomarker, and urine analysis. A total of 311 participants were enrolled between 06/20 and 08/23. The mean age was 34 (±5.3) years. The current pregnancy history demonstrated the following (≥1 diagnosis possible): 10% had preexisting hypertension, 27.3% gestational hypertension, 53% preeclampsia (PE), 0.3% eclampsia, 6% HELLP (hemolysis, elevated liver enzymes, and low platelets), and 18.3% de novo PPHT. A family history of cardiovascular disease and PE was reported in 49.5% and 7.5%, respectively. In total, 23.3% were high-risk for PE. A total of 68.5% delivered via c-section, the mean hospitalization was 6.3 days (±3.9), and newborn intrauterine growth restriction occurred in 21%. A total of 99% of the participants chose the HBTMS. This analysis demonstrated that the HBTMS was accepted. This is vital in the immediate postpartum period and pertinent when the exposure of hospital visits should be avoided.

UNASSIGNED: HELLP syndrome is a serious disorder that can occur in pregnancy; it has many possible complications and is associated with adverse maternal outcome. Due to the lack of predictive parameters for HELLP syndrome, finding the right time for delivery is challenging. In contrast to preeclampsia, hypertension is not an essential part of the diagnosis; nevertheless, many women with HELLP syndrome are hypertensive. The role and possible implications of hypertension in HELLP syndrome are not fully understood.
UNASSIGNED: In this retrospective cohort study, we analyzed the maternal outcomes of 59 patients diagnosed with HELLP syndrome. The patients were divided into three groups according to their blood pressure levels during their stay in hospital. These three groups were compared in terms of patient characteristics and maternal outcomes. A combined endpoint for adverse maternal outcome was defined which included blood pressure and antihypertensive medication at discharge from hospital, severe postpartum anemia, and eclampsia.
UNASSIGNED: Women with hypertensive crises had an unfavorable outcome compared to women with lower blood pressure levels. Patients with higher blood pressure during pregnancy were more likely to be hypertensive at discharge and needed a combination of antihypertensive agents significantly more often. The risk of an adverse maternal outcome increased with the severity of hypertension. An increase in systolic blood pressure by 10 mmHg raised the risk of an adverse outcome by 74% (95% CI: 1.22-2.66).
UNASSIGNED: Hypertension not only plays an important role in preeclampsia but also affects the outcomes of patients with HELLP syndrome. These patients need to be identified quickly and treated accordingly as they are at risk of cardiovascular impairment. Patients should be followed up closely after delivery to reduce cardiovascular morbidity.
UNASSIGNED: Das HELLP-Syndrom stellt eine ernsthafte Schwangerschaftserkrankung dar; es ist mit vielen potenziellen Komplikationen behaftet und geht mit ungünstigen mütterlichen Outcomes einher. Da es an prädiktiven Parametern für das HELLP-Syndrom fehlt, ist es schwierig, den richtigen Zeitpunkt für die Entbindung zu ermitteln. Im Gegensatz zur Präeklampsie stellt das Auftreten einer Hypertonie keinen Bestandteil der Diagnose HELLP-Syndrom dar, dennoch haben viele Frauen mit HELLP-Syndrom Bluthochdruck. Die Rolle und die möglichen Implikationen einer Hypertonie beim HELLP-Syndrom sind noch nicht vollständig erforscht.
UNASSIGNED: In dieser retrospektiven Kohortenstudie haben wir die mütterlichen Outcomes von 59 Patientinnen mit HELLP-Syndrom analysiert. Die Patientinnen wurden in 3 Gruppen unterteilt entsprechend ihrem jeweiligen Blutdruckniveau während ihres Aufenthalts im Krankenhaus. Die 3 Gruppen wurden bezüglich ihrer Patientencharakteristika und mütterlichen Outcomes verglichen. Es wurde ein kombinierter Endpunkt für ungünstiges mütterliches Outcome definiert, welcher den Blutdruck der Patientin und die Einnahme blutdrucksenkender Medikamente bei der Entlassung aus dem Krankenhaus, starke Anämie postpartal sowie das Auftreten einer Eklampsie einschloss.
UNASSIGNED: Frauen mit hypertensiven Krisen hatten ein ungünstigeres mütterliches Outcome verglichen mit Frauen mit niedrigerem Blutdruck. Patientinnen mit Bluthochdruck während der Schwangerschaft hatten eher Bluthochdruck und benötigten signifikant häufiger eine Kombination blutdrucksenkender Mittel bei der Entlassung aus dem Krankenhaus. Das Risiko eines ungünstigen mütterlichen Outcomes nahm mit dem Schweregrad der Hypertonie zu. Eine Erhöhung des systolischen Blutdrucks um 10mmHg erhöhte das Risiko eines ungünstigen Ergebnisses um 74% (95%-KI [1.22–2.66]).
UNASSIGNED: Die Hypertonie spielt nicht nur bei der Präeklampsie eine wichtige Rolle, sie beeinflusst auch das Outcome von Patientinnen mit HELLP-Syndrom. Diese Patientinnen müssen schnell identifiziert und entsprechend behandelt werden, da sie ein höheres Risiko für kardiovaskuläre Schäden haben. Ein engmaschiges Programm zur Überwachung dieser Patientinnen nach der Entbindung sollte eingeführt werden, um die kardiovaskuläre Morbidität zu senken.