updated 7:24 PM UTC, Jan 27, 2023

2022 April-June Volume 8 Issue 2

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EDITORIAL

The new therapeutics for patients with hypertension and diabetes – what can we expect?

Peter M. Nilsson 1
1 Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden

Abstract

No abstract available.

J Hypertens Res (2022) 8(2):51–52 [download PDF]

REVIEW

The electrophysiologist’s conundrum: catheter ablation of atrial fibrillation in hypertensive patients

Adelina Pupaza 1 #, Steliana Paja 1 #, Alexandra Acostachioae 1 #, Radu Vatasescu 1, 2 *
1 Cardiology Department, Clinic Emergency Hospital of Bucharest, Bucharest, Romania
2 Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

Abstract

Hypertension (HTN) is a well-established major cardiovascular risk factor, with a growing prevalence in the population and underlies several other entities. It has been recognized as an independent predictor of atrial fibrillation (AF). HTN and AF, in conjunction, contribute to increased stroke risk. The emergence of catheter ablation in AF revolutionized the management of AF; however, recurrence rates have shadowed its merits. It was initially hypothesized that recurrence rates relate strictly to an electrophysiological substrate. However, further research revealed that several factors, including HTN, perpetuate an atrial substrate, especially when uncontrolled. In turn, this prompted the scientific community to advocate for rigorous evaluation before and after transcatheter ablation and aggressive control of blood pressure to ensure a higher rate of success and better long-term management.

J Hypertens Res (2022) 8(2):53–63 [download PDF]

ORIGINAL ARTICLES

The importance of beta-blocker treatment in diabetic hypertensive patients with different dipper patterns, in particular on the nocturnal non-dipper profile

Viorel Manea 1, 2, Calin Pop 1, 3, Lavinia Pop 1, Mircea Ioachim Popescu 4, 5
1 Emergency Clinical County Hospital of Baia Mare, Baia Mare, Romania
2 Cardiology Office, Manxmed SRL, Baia Mare, Romania
3 Faculty of Medicine, Vasile Goldis University, Arad, Romania
4 Emergency Clinical County Hospital of Oradea, Oradea, Romania
5 Faculty of Medicine, Oradea University, Oradea, Romania

Abstract

Ambulatory blood pressure monitoring (ABPM) is the access way to the dippers’ status in diabetic hypertensive patients, and it reveals the effects of antihypertensive medication in different dipper patterns. Of patients with consecutive type 2 diabetes mellitus (DM) patients with high blood pressure (HBP), 166 were treated with angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), beta-blockers (βB), calcium channel blockers (CCB), diuretics and different combinations of them, and were subjected to 24 hours’ ABPM. We assessed the BP (blood pressure) circadian variation, variability of resting mean heart rate (MHR), and the correlations with the variety of drug combinations. There were 80 non-dippers (48.20%), 22 reverse dippers (13.26%), 57 dippers (34.34%) and 7 extreme-dippers (4.20%). Non-dippers treated with βB (67.50%) had lower 24 h/MHR – 72.46 bpm vs. 78.00 bpm (p=0.015) of those without βB, night MHR – 68.77 bpm vs. 73.26 bpm (p=0.038) and day MHR – 74.61 bpm vs. 81.50 bpm (p=0.005). Dippers had lowered MAP – 89.77 mmHg and MHR – 71.61 beats per minute (bpm) compared with 91.80 mmHg and 74.26 bpm found in non-dippers (p=0.29; p=0.13). Dippers were treated with ACEI (63.16%), ARB (19.30%), CCB (40.35%), combinations of these (12.28%), βB (59.65%), diuretics (75.44%). The non-dippers diabetics have increased MHR and MAP as compared to dippers, but non-dippers treated with beta-blockers have significantly lower MHR and MAP than those without BB. Treatment of BP with beta-blockers does not significantly influence lowering MHR and MAP in dippers profile. The effect of reduction of MHR on the non-dipper profile is beneficial for the prognosis of these patients, lowering cardiovascular risk.

J Hypertens Res (2022) 8(2):64–73 [download PDF]

Influence of SARS-COV-2 infection on circadian behavior of blood pressure

Carina Bogdan 1, 2, Oana Elena Ciolpan 1, 2, Adrian Apostol 1, 2, Nicolae Albulescu 1, 2, Larisa Iscruleasa 2, Mihaela Viviana Ivan 1, 2 *
1 Cardiology Discipline, Department VII – Internal Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
2 Pius Brinzeu Emergency County Hospital, Timisoara, Romania

Abstract

This study aimed to investigate the relationship between blood pressure variability using ambulatory blood pressure monitoring (ABPM) and biological outcomes in non-previously hypertensive patients with mild-moderate COVID-19. A total of 20 patients hospitalized with COVID-19 were enrolled in this study. Patients were grouped according to the severity of COVID-19 into mild and moderate. Variables such as mean arterial pressure (MAP), systolic/diastolic (max/mean values), pulse weighted average, and day/night index were analyzed using ABPM. Patients with a drop of more than 10% in nocturnal blood pressure during the circadian rhythm are referred to as dippers, while patients with a smaller decrease are referred to as non-dippers. We compared the level of C-reactive protein (CRP), vitamin D, fasting blood glucose, ferritin, fibrinogen and investigated the relationship among the groups. Moreover, this study aimed to determine the impact of COVID-19 severity on blood pressure (BP) values and variability in 24-hour ABPM. Moderate COVID-19 patients with hypertension were older (61±12 vs. 43±10 years; P<0.001), had higher levels of CRP (29.4±9.2 vs. 10.3±3.2 mg/dL; P=0.009), ferritin (445±35 vs. 300±24 µg/l; P=0.032), fibrinogen (578±48 vs. 475±34 mg/dl; p=0.042) and higher non-dipper status (70% vs. 30%; P=0.013), than those with mild symptoms. There was a proportional relationship between COVID-19 severity and age, CRP levels, fibrinogen, ferritin and arterial blood pressure variability (day-night index-non dipper status) (all, P<0.05). Moderate COVID-19 patients without previous hypertension developed this disease and were significantly associated with greater non-dipper status and worsened biological outcomes. Advanced age and systemic inflammation are proportional to higher blood pressure and lower night/day index status. Additional attention is needed for COVID-19 patients with new-onset hypertension and high BP values with non-dipper status.

J Hypertens Res (2022) 8(2):74–77 [download PDF]