2022 October-December Volume 8 Issue 4
EDITORIAL
Arterial hypertension in the elderly and treatment targets
Leonida Gherasim 1, 2 *
1 Department of Cardiology, University Emergency Hospital, Bucharest, Romania
2 Department 4 - Cardio Thoracic Pathology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Abstract
No abstract available.
J Hypertens Res (2022) 8(4):99–105 [download PDF]
REVIEWS
The role of the cardiopulmonary exercise test in the hypertensive population
Monica Stoian 1, 2, Maria Dorobanțu 1, 2
1 Department of Cardiology, Emergency Clinical Hospital, Bucharest, Romania
2 Department of Cardiology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Abstract
The cardiopulmonary exercise test is a noninvasive method that provides an integrative assessment of exercise response and allows the evaluation of functional capacity and exercise limitation. It can be used in a wide spectrum of clinical applications, such as the evaluation of patients with unexplained exertional dyspnea or heart failure, for identifying myocardial ischemia and assessing valvular heart disease. In the hypertensive population, the cardiopulmonary exercise test allows the identification of patients with masked hypertension or with masked heart failure with preserved ejection fraction. Also, it can provide information about the efficiency of antihypertensive treatment.
J Hypertens Res (2022) 8(4):106–110 [download PDF]
Low renin hypertension – an endocrine perspective
Mariana Costache Outas 1 *
1 Department of Endocrinology, Outpatient Clinic, Coltea Clinical Hospital, Bucharest, Romania
Abstract
Approximately 30% of hypertensive patients have low renin concentrations. Measurement of renin and aldosterone is the key to diagnosing low-renin hypertension and confirming the phenotype. It occurs because of inherited genetic syndromes, acquired somatic mutations and endogenous and exogenous factors. Therapy depends on the subtype of low-renin hypertension. Primary aldosteronism is the leading cause of secondary hypertension worldwide and is the main form of low-renin hypertension. Its harmful effects outstrip those due to blood pressure elevation alone. Surgical intervention may sometimes result in a complete cure, obviating the need for lifelong antihypertensive treatment. This review will discuss the main factors responsible for an accurate differential diagnosis of low-renin hypertension.
J Hypertens Res (2022) 8(4):111–118[download PDF]
ORIGINAL ARTICLES
New predictors of self-reported adherence measured with Morisky Medication Scale and blood pressure control in Romanian hypertensive patients – SEPHAR IV
Radu Sebastian Gavril 1 #, Ovidiu Mitu 1, 2 # *, Andrei Drugescu 1, Radu Stefan Miftode 1, Cristian Haba 1, Alexandru Costache 1, Florin Mitu 1, 3, 4, Oana Gheorghe-Fronea 5, 6, Alexandra Dumitrache 6, Maria Dorobanțu 4, 5, 6
1 First Medical Department, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
2 Cardiology Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, Romania
3 Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, Iasi, Romania
4 Academy of Medical Sciences, Bucharest, Romania
5 Department of Cardiothoracic Pathology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
6 Department of Cardiology, Emergency Clinical Hospital, Bucharest, Romania
Abstract
This paper aims to find new predictors of poor antihypertensive treatment adherence in the Romanian adult hypertensive population. Six hundred eighty hypertensive subjects identified in the SEPHAR IV survey were evaluated by a study questionnaire, including a 4-item Morisky Medical Adherence Score (MMAS-4), BP and anthropometric measurements, and laboratory workup. BP control was defined as <140/90 mmHg at both study visits (4 days apart). According to the MMAS-4 score, adherence was considered low (3-4p), moderate (1-2p) and high (0p). Statistical analysis was performed with SPSS Statistics 18.0 software at a significance level of p≤0.05. Of the total 680 hypertensive subjects, 461 were receiving antihypertensive treatment. According to BP control, treated hypertensives were further divided into two groups – controlled (181 subjects, 39.2%) and uncontrolled HTN (280 subjects, 60.8%). The mean age was 63.25±11.65 years and the female gender was more prevalent (61.1%). Distribution regarding residence was balanced (urban area – 51.5%). Low antihypertensive treatment adherence was recorded in 46 subjects representing 9.9% of the total group, with a significantly higher rate among uncontrolled hypertensive subjects [35 subjects (12.5%) vs. 11 subjects (6.1%); p=0.024]. Total cholesterol (AUC=0.659; CI=95%: 0.557–0.761; p=0.005) and LDL cholesterol (AUC=0.645; CI=95%: 0.537–0754; p=0.011) were statistically significant predictors of low treatment adherence. The MMAS-4 is a readily available tool that can be used in daily clinical practice. The lipid profile can be used to identify less adherent HT patients. Future research should establish a metabolic profile of the nonadherent patient and focus on developing strategies to increase adherence.
J Hypertens Res (2022) 8(4):119–128 [download PDF]
Diabetes-induced lipid panel particularities in hypertensive patients: A pilot NMR spectroscopy study
Laura-Adina Stanciulescu 1, 2, Alina Nicolescu 3, 4, Catalin Duduianu 3, 5, Calin Deleanu 3, 4 *, Maria Dorobanțu 2 *
1 Department of Cardiology, Emergency Clinical Hospital, Bucharest, Romania
2 Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
3 Costin D. Nenitescu Institute of Organic and Supramolecular Chemistry, Romanian Academy, Bucharest, Romania
4 Petru Poni Institute of Macromolecular Chemistry, Romanian Academy, Iasi, Romania
5 Faculty of Applied Chemistry and Material Science, Politehnica University of Bucharest, Bucharest, Romania
Abstract
Cardiovascular diseases are the leading cause of death globally, constantly increasing morbidity and mortality each year, despite significant advances in diagnosis and treatment. Among the multiple cardiovascular risk factors, hypertension, diabetes mellitus type II and dyslipidemia are the most frequent and show the best correlations with the risk of further developing a major cardiovascular event. We set out to assess the influence of diabetes on the lipid panel in hypertensive patients as a sub-analysis of a larger study that we have previously developed regarding the need for fasting prior to blood sampling in a cohort of subjects admitted in a tertiary cardiovascular emergency unit with acute coronary syndromes. It was observed that the fasten triglycerides levels, the VLDL and IDL particle number, apolipoprotein A1, A2, B100 levels, as well as the ratio of apo B100/apo A1 are all potentially useful markers that could be successfully used to differentiate between the strictly hypertensive patients and the ones that associate type II diabetes mellitus. The study also confirmed once more our previous reports that the fasting status upon sampling has little influence on the lipid panel final value.
J Hypertens Res (2022) 8(4):129–136 [download PDF]