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Background: Coronavirus Disease-2019 (COVID-19) is an infectious disease caused by SARS-CoV-2 virus. Severity of this disease influenced by old age, sex, comorbidities, and other factors. Hypertension and type 2 diabetes mellitus are the most common comorbidities in COVID-19 patients that cause high morbidity and mortality. Objective(s): To analyze the survival of COVID-19 patients with hypertension comorbidity and compare it between diabetes mellitus and non-diabetes mellitus group. Method(s): This retrospective, descriptive study included COVID-19 patients with hypertension comorbidity at Internal Medicine ward Dr. Soetomo Hospital Surabaya from May 2020 to December 2021. Data on age, sex, hypertension, diabetes mellitus type 2, symptoms, vital signs, laboratory finding, length of stay, and outcome were taken from medical records and we carried out kaplan-meier method and log rank test by using SPSS. Result(s): This study obtained 698 sample of confirmed COVID-19 patients and after applying exclusion criteria there were 174 patients with hypertension comorbidity. Most patient were female (60.3%) and age 51-60 years (38.5%). The most common symptoms were shortness of breath (62.1%) and cough (50.6%). There were 50 hypertension and 79 non-hypertension patients died and Survival analysis showed a significant statistical difference between both groups (p=0.042). From 50 deceased hypertensive patients, there are 36 and 14 hypertensive patients with and without diabetes mellitus respectively but survival analysis showed a non-significant statistical difference between both groups (p=0.081) Conclusion(s): There is significant statistical difference in survival analysis in patients with hypertension. We should be aware about COVID-19 patients with hypertension.
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BACKGROUND: According to the results of the ESSE-RF study, the frequency of obesity in the population reached 29.7%. Obesity is one of the main risk factors for the development of cardiovascular diseases. Features of the course of COVID-19 in patients with obesity is a very urgent problem. AIM: The aim of the study was a comparative investigation of clinical and laboratory-instrumental parameters in AH patients with or without obesity who had COVID-19 associated pneumonia, to identify the role of obesity as a potential predictor of post-COVID cardiovascular complications 3 months after discharge from the hospital. MATERIALS AND METHODS: Materials and methods. The study included 174 patients with COVID-19-associated pneumonia. Group 1 included 78 patients with AH without obesity, group 2 - 96 patients with AH and obesity. All patients were tested with a blood sample at the time of admission and 3 months after discharge from the hospital. We assessed parameters of general blood test, biochemistry, hemostasis, inflammation biomarkers - concentration of C-reactive protein (CRP), highly sensitive CRP (hs-CRP), homocysteine, IL-6, etc. All patients initially underwent computed tomography of the chest. In both groups, 24-hour blood pressure monitoring was performed using BPLaB device, according to the standard protocol;echocardiography using an expert class ultrasound diagnostic system Vivid S70. The study is registered with the Clinical Trials.gov database Identifier: NCT04501822. RESULT(S): Results. The biomarker that significantly distinguished the both groups of patients, as well as subgroups according to the degree of obesity was the concentration of maxCRP and hs-CRP, which was significantly higher in group 2. In addition, the registered maximum values of MPO, NT-proBNP, IL-1,6, TNA-alpha and NRL parameters in group 2 of patients with 2-3 degrees of obesity, may indicate the highest probability of developing delayed adverse cardiovascular complications in this group of patients. Mean systolic blood pressure, variability of systolic and diastolic blood pressure, and heart rate at night were significantly higher in AH patients with obesity. Numerous correlations of obesity with laboratory and instrumental parameters have been registered, which may indicate an increased likelihood of delayed unwanted cardiovascular complications in this particular group of patients. Multiple regression showed that obesity is an independent predictor of an increase in LDH, hs-CRP and right atrium. CONCLUSION(S): Dynamic control of the studied parameters in patients with AH and OB registered an increased concentration of CRP at the initial stage and 3 months after treatment, with a general trend towards a decrease in the increased initial structural parameters of ECHO CG. The logistic regression method showed that the presence of OB in patients with AH is an independent factor causing increased levels of immune inflammation (CRP), a marker of tissue destruction (LDH), and load on the right atrium.Copyright © Endocrinology Research Centre, 2022.
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Although the effect of face masks on preventing airborne transmission of SARS-CoV-2 is well studied, no study has evaluated their effect on blood pressure (BP). Therefore, we investigated the effect of surgical masks on BP in 265 treated hypertensive patients. Following the routine mask-on office BP measurement, patients were left alone and randomized to automated office BP measurement, with measurements taken after first wearing a mask for 10 min, then without wearing the mask for 10 min, and vice versa. Among the participants, 115 were women (43.4%), the mean age was 62 +/- 12 years, and the mean office BP was 134 +/- 15/81 +/- 12 mmHg. There was no significant difference between mask-on unattended systolic BP (133 +/- 15 mmHg) and mask-off unattended systolic BP (132 +/- 15 mmHg) (P = 0.13) or between mask-on unattended diastolic BP (77 +/- 13 mmHg) and mask-off unattended diastolic BP (76 +/- 13 mmHg) (P = 0.32). Surgical masks had no effect on BP in treated hypertensive patients.Copyright © 2022 Krause und Pachernegg GmbH. All rights reserved.
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Introduction: Reduced accessibility to routine follow-up visits in GP surgeries during the COVID-19 pandemic as well as the failure to report to health care facilities for fear of infection may have disrupted doctor-patient cooperation and worsened adherence to therapeutic recommendations. Aim of the research: To examine the quality of life of patients with arterial hypertension and their assessment adherence to therapeutic recommendations during the COVID-19 pandemic. Material(s) and Method(s): A total of 103 hypertensive patients of the Independent Public Healthcare Centre of the Ministry of Interior and Administration in Wroclaw were examined. The World Health Organization Quality of Life Instrument Short Form (WHOQOL-BREF) and the Adherence in Chronic Diseases Scale (ACDS) were used. Result(s): The mean score for perception of quality of life was 3.64 +/-0.73. Quality of life was rated best in the psychological domain (M = 15.05, SD = 2.42) and worst in the physical domain (M = 13.25, SD = 2.67). 57.28% (59/103) of the respondents had medium adherence, 23.30% (24/103) had low adherence, and 19.42% (20/103) had high adherence. The level of adherence was significantly better among patients keeping a self-monitoring diary compared to those who did not keep such a diary (24.19 +/-2.86 vs. 21.86 +/-4.56, p = 0.007). Patient age (r = 0.323, p = 0.001) and systolic blood pressure value (r = -0.193, p = 0.05) significantly correlated with adherence level. The higher the level of adherence, the better the quality of life in the psychological (r = 0.197, p = 0.046) and social (r = 0.198, p = 0.045) domains. Conclusion(s): Adherence to the therapeutic plan and good patient-doctor cooperation are extremely important for the level of quality of life of hypertensive patients.Copyright © 2023 Termedia Publishing House Ltd.. All rights reserved.
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Objective To explore the effect of WeChat group management on blood pressure control rate and drug compliance of hypertension patients during the epidemic of coronavirus disease 2019 (COVID-19) . Methods A total of 428 consecutive patients with essential hypertension in our outpatient department from Jan. 2020 to Dec. 2020 were enrolled and randomly divided into experimental group and control group with a ratio of 1 : 1. There were 214 patients in the experimental group, 110 males and 104 females, with an average age of (55.48+/-6.11) years. There were 214 cases in the control group, 108 males and 106 females, with an average age of (56.52+/-5.19) years. WeChat groups were established for the 2 groups separately. Information on education, supervised medication and lifestyle of hypertension was provided to the patients in the experimental group through WeChat, while no active intervention was given to the control group. The blood pressure control rate and medication possession ratio (MPR) were calculated at 1, 3, 6 and 12 months of intervention, and the differences between the 2 groups were compared. Results There were no significant differences in the blood pressure control rate (91.12%[195/214] vs 90.65% [194/214], 86.67%[182/210]vs 89.62%[190/212])or MPR (0.90+/-0.03 vs 0.90+/-0.05, 0.85+/-0.04 vs 0.88+/-0.03) between the 2 groups at 1 or 3 months of intervention (all P>0.05). At 6 and 12 months, the blood pressure control rate (81.73%[170/208]vs 88.57%[186/210],75.12%[154/205]vs 85.99%[178/207]) and MPR (0.74+/-0.04 vs 0.87+/-0.05, 0.58+/-0.05 vs 0.85+/-0.03) of patients in the experimental group were significantly higher than those in the control group (all P<0.05). Conclusion During the COVID-19 epidemic, WeChat group management of hypertension patients by doctors could improve patients' blood pressure control rate and drug compliance and strengthen patients' self-management ability.Copyright © 2022, Second Military Medical University Press. All rights reserved.
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BACKGROUND: According to the results of the ESSE-RF study, the frequency of obesity in the population reached 29.7%. Obesity is one of the main risk factors for the development of cardiovascular diseases. Features of the course of COVID-19 in patients with obesity is a very urgent problem. AIM: The aim of the study was a comparative investigation of clinical and laboratory-instrumental parameters in AH patients with or without obesity who had COVID-19 associated pneumonia, to identify the role of obesity as a potential predictor of post-COVID cardiovascular complications 3 months after discharge from the hospital. MATERIALS AND METHODS: Materials and methods. The study included 174 patients with COVID-19-associated pneumonia. Group 1 included 78 patients with AH without obesity, group 2 - 96 patients with AH and obesity. All patients were tested with a blood sample at the time of admission and 3 months after discharge from the hospital. We assessed parameters of general blood test, biochemistry, hemostasis, inflammation biomarkers - concentration of C-reactive protein (CRP), highly sensitive CRP (hs-CRP), homocysteine, IL-6, etc. All patients initially underwent computed tomography of the chest. In both groups, 24-hour blood pressure monitoring was performed using BPLaB device, according to the standard protocol;echocardiography using an expert class ultrasound diagnostic system Vivid S70. The study is registered with the Clinical Trials.gov database Identifier: NCT04501822. RESULT(S): Results. The biomarker that significantly distinguished the both groups of patients, as well as subgroups according to the degree of obesity was the concentration of maxCRP and hs-CRP, which was significantly higher in group 2. In addition, the registered maximum values of MPO, NT-proBNP, IL-1,6, TNA-alpha and NRL parameters in group 2 of patients with 2-3 degrees of obesity, may indicate the highest probability of developing delayed adverse cardiovascular complications in this group of patients. Mean systolic blood pressure, variability of systolic and diastolic blood pressure, and heart rate at night were significantly higher in AH patients with obesity. Numerous correlations of obesity with laboratory and instrumental parameters have been registered, which may indicate an increased likelihood of delayed unwanted cardiovascular complications in this particular group of patients. Multiple regression showed that obesity is an independent predictor of an increase in LDH, hs-CRP and right atrium. CONCLUSION(S): Dynamic control of the studied parameters in patients with AH and OB registered an increased concentration of CRP at the initial stage and 3 months after treatment, with a general trend towards a decrease in the increased initial structural parameters of ECHO CG. The logistic regression method showed that the presence of OB in patients with AH is an independent factor causing increased levels of immune inflammation (CRP), a marker of tissue destruction (LDH), and load on the right atrium.Copyright © Endocrinology Research Centre, 2022.
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BACKGROUND: According to the results of the ESSE-RF study, the frequency of obesity in the population reached 29.7%. Obesity is one of the main risk factors for the development of cardiovascular diseases. Features of the course of COVID-19 in patients with obesity is a very urgent problem. AIM: The aim of the study was a comparative investigation of clinical and laboratory-instrumental parameters in AH patients with or without obesity who had COVID-19 associated pneumonia, to identify the role of obesity as a potential predictor of post-COVID cardiovascular complications 3 months after discharge from the hospital. MATERIALS AND METHODS: Materials and methods. The study included 174 patients with COVID-19-associated pneumonia. Group 1 included 78 patients with AH without obesity, group 2 - 96 patients with AH and obesity. All patients were tested with a blood sample at the time of admission and 3 months after discharge from the hospital. We assessed parameters of general blood test, biochemistry, hemostasis, inflammation biomarkers - concentration of C-reactive protein (CRP), highly sensitive CRP (hs-CRP), homocysteine, IL-6, etc. All patients initially underwent computed tomography of the chest. In both groups, 24-hour blood pressure monitoring was performed using BPLaB device, according to the standard protocol;echocardiography using an expert class ultrasound diagnostic system Vivid S70. The study is registered with the Clinical Trials.gov database Identifier: NCT04501822. RESULT(S): Results. The biomarker that significantly distinguished the both groups of patients, as well as subgroups according to the degree of obesity was the concentration of maxCRP and hs-CRP, which was significantly higher in group 2. In addition, the registered maximum values of MPO, NT-proBNP, IL-1,6, TNA-alpha and NRL parameters in group 2 of patients with 2-3 degrees of obesity, may indicate the highest probability of developing delayed adverse cardiovascular complications in this group of patients. Mean systolic blood pressure, variability of systolic and diastolic blood pressure, and heart rate at night were significantly higher in AH patients with obesity. Numerous correlations of obesity with laboratory and instrumental parameters have been registered, which may indicate an increased likelihood of delayed unwanted cardiovascular complications in this particular group of patients. Multiple regression showed that obesity is an independent predictor of an increase in LDH, hs-CRP and right atrium. CONCLUSION(S): Dynamic control of the studied parameters in patients with AH and OB registered an increased concentration of CRP at the initial stage and 3 months after treatment, with a general trend towards a decrease in the increased initial structural parameters of ECHO CG. The logistic regression method showed that the presence of OB in patients with AH is an independent factor causing increased levels of immune inflammation (CRP), a marker of tissue destruction (LDH), and load on the right atrium.Copyright © Endocrinology Research Centre, 2022.
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Background: Pulmonary Arterial Hypertension (PAH) is a form of pulmonary hypertension, where the narrowing of arteries in the lungs restricts blood flow and so increases pressure in the vessels. Studies have demonstrated that initial combination therapies are optimal for PAH management. However, prescription of monotherapy treatment is still prevalent as a first line therapy. Purpose(s): The purpose of this research was to investigate prescribing trends of physicians for first line patients with PAH in the UK, Germany, Italy and Spain. We investigated the proportions of newly diagnosed patients and the prescription trends for monotherapy and combination therapy prior to and during the COVID-19 pandemic. Method(s): A multi-country, multi-centre online medical chart review study of patients with PAH was conducted between April - June of 2019, 2020 and 2021 respectively. Recruited from a large access panel, 178 treating cardiologists, pulmonologists & rheumatologists in the UK (n=16), Germany (n=55), Italy (n=55) and Spain (n=52) were screened for duration of practice in their speciality and caseload (>=5 PAH patients in the last 3 months), and provided data on 694 PAH patients (UK = 71, Germany = 206, Italy = 208, Spain = 209). Reported patient data pertained to medical chart information reflecting the prior year, i.e., Q2 2021 data reflected the 2020 period (advent of the COVID-19 pandemic). Result(s): In this dataset, there has been a consistent decrease in the proportion of newly diagnosed (i.e. diagnosed within 12 months of being reported) patients reported from 2019 to 2020 and 2021. In 2019, 49% of the reported patients were diagnosed within the last 12 months. However, the newly diagnosed patient population dropped to 37% in 2020 and continued to drop to 27% in 2021. Despite this, there has been an increase in reported first line patients within the newly diagnosed segment from 74% in 2019, to 75% in 2020, then at 87% in 2021. This increase can be seen to coincide with the ongoing COVID-19 pandemic. In 2019, 58% of reported newly diagnosed patients were recorded as receiving monotherapy. This did drop to 33% in 2020;however, in 2021 monotherapy uptake increased to 47%. Of note, the usage of the endothelin receptor antagonist (ERA) drug class increased from 67% in 2019 to 83% in 2020 but dropped to 69% in 2021. Conclusion(s): This data set suggests a decreasing trend in newly diagnosed patients and a gradual shift in treatment type to first line monotherapy prescription, which coincided with the height of the COVID-19 pandemic. More newly diagnosed patients (those diagnosed within 12 months of being reported) are receiving monotherapy treatment at the expense of combination therapy, and this has also coincided with the pandemic. Further investigation using comparator cohort is warranted to assess whether the challenges physicians faced during the pandemic has had a causal effect on the prescribing habits for PAH therapies.
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Background: A non-immediate hypertensive response short after COVID- 19 vaccination has been reported. Mild to moderate elevated arterial blood pressure (BP) levels have been documented few days after a single or two-doses vaccine. This study sought to investigate this observation as a potential side effect in patients with known hypertension and healthy controls. Method(s): A total of 100 vaccinated patients between the age of 50 to 70 years old were studied. They were randomly assigned to one of the approved and available vaccines (Pfizer, Astra Zeneca, Moderna, Johnson & Johnson). Half of them were hypertensives under medical treatment and half of them were not. All participants had systolic BP <140mmHg and diastolic BP <90mmHg before vaccination and volunteered for standard daily home BP measurements (HBPM) and ambulatory BP measurements (ABPM) between the 1st and the 21st day after considered fully COVID-19 vaccinated. Result(s): All patients, hypertensives or not, had at some point a recorded hypertensive response for both systolic (SBP) and diastolic (DBP) BP after considered fully vaccinated. Hypertensives were older and with higher body mass index (BMI). Some of the hypertensive patients received additional medication whereas some of the non-hypertensive patients started life modification changes and systematic BP measurements for a possible diagnosis of hypertension. Conclusion(s): Vaccination for COVID-19 seems to be related with a short period of hypertensive response. This phenomenon was partial and mostly observed in older overweight hypertensives. (Table Presented).
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Objective. To study the changes in the vascular wall, vascular age and metabolic parameters in polymorbid COVID-19 conva-lescents. Material and methods. The study included 62 patients with hypertension who reached the target blood pressure (BP) with dual an-tihypertensive therapy after severe and extremely severe COVID-19. The following examinations were performed: laboratory tests of metabolic parameters, assessment of changes in the vessel elasticity indices (pulse-wave velocity (PWV), augmentation index (AI), central systolic BP (cSBP), 24-hour BP monitoring, and non-invasive markers of liver fibrosis. Results. According to office BP measurements, after the coronavirus infection, an increase in systolic BP (SBP) by 29.6% and di-astolic BP (DBP) by 23.6%, as well as heart rate (HR) by 11.8% (p<0.05) was reported during regular antihypertensive therapy. In addition, 24-hour BP monitoring data indicated an increase in the average daily SBP, DBP, and heart rate. After the coronavirus infection, an increase in PWV by 35.4% (p<0.05), AI by 24.4% (p<0.05), cSBP by 22.1% were reported. Carbohydrate and lipid metabolism parameters deteriorated. A pronounced adverse effect of coronavirus infection on liver function was observed. The vascular age (according to the modified SCORE scale) increased by 6 years (p<0.05). Conclusion. Our study showed that patients after severe and extremely severe COVID-19 have a high risk of liver fibrosis, hypertension and lipid metabolism control worsening and accelerating vascular aging.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.
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Cold agglutinin disease(CAD) is an autoimmune disease that occurs against erythrocyte antigens. It is usually idiopathic, but some infections can also be a trigger. CAD becomes active in the peripheral circulation at lower temperatures more easily when exposed to cold, causing hemolysis or agglutination. In this article, the management of a coronary bypass case with CA formation in intraoperative period is presented. A 46-year-old diabetic and hypertensive male patient had COVID-19 2 months ago. Cardiopulmonary bypass(CPB) was initiated with adequate heparinization, and the patient was cooled to 32degreeC. It was noticed that there were clots in the cardioplegia delivery line(+1degreeC). Agglutinations were observed in the autologous blood of the patient whose ACT values were normal. After CPB, the operation was completed without any problems and the patient was discharged on the 5th day with recovery. A diagnosis of CAD was made with the results of peripheral smear and immunologic tests. Determination of antibody concentration and thermal amplitude in the preoperative period in patients with CAD is very important. While preparing such patients for surgery, heating of room, patient, fluids, planning of normothermic CPB, and using warm cardioplegia are required. The relationship between CAD and COVID has started to take place in the literature. The patient we presented had a COVID 2 months ago, cold agglutinin may have been induced by COVID or may have arisen idiopathic. Considering that many people may have had a COVID nowadays, care should be taken especially in the perioperative period of cardiac surgery.Copyright © Telif hakki 2022 Gogus-Kalp-Damar Anestezi ve Yogun Bakim Dernegi Dergisi - Available online at www.gkdaybd.org.
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Background Management of pediatric pulmonary hypertension (PH) may require manipulation of multiple receptor sites to maximize response to medical therapy. Assessment of response typically occurs through imaging, labs, physical exam and recurrent cardiac catheterization, with anesthetic exposure to assess pulmonary artery pressures (PAP) and vascular resistance (PVR). We aimed to assess feasibility, safety and utility of remote PAP monitoring in pediatric PH patients. Methods We reviewed 4 pediatric patients with significant PH, each of whom underwent cardiac catheterization with pulmonary vasoreactivity testing and placement of a CardioMEMS remote PAP monitoring device. Results Four patients (P1-4: ages 5, 6, 8 and 10 years old) underwent CardioMEMS insertion without procedural complication. P1, P2 and P3 presented with unrepaired VSD;ASD with partial anomalous pulmonary venous return;and ASD and PDA, respectively, while P4 had prior repair of atrioventricular canal. Three patients had Down syndrome. All had elevated PAP and PVR. Mean left lower PA branch size was 7 mm. Mean PAP prior to therapy was 70 mm Hg for P1, 82 for P2, 93 for P3 and 30 for P4. All 4 patients required initiation of triple therapy for treatment of PH, with improvement or normalization of PAP by CardioMEMS, which also included surgical or catheter based intervention for 3 patients. Post-repair of P2, he was unable to be separated from cardiopulmonary bypass and was placed on ECMO. Right ventricular cardiac output improved over 2 weeks, with improvement of PAP determined through serial CardioMEMS. He was successfully decannulated, utilizing CardioMEMS in the OR. Two patients also developed COVID respiratory infections at home with CardioMEMS assessments allowing for oxygen and medication titration. Conclusion Remote PAP monitoring is feasible and appears safe in pediatric patients with adequate PA size. It allows for manipulation of medical therapy with real time knowledge of impact on PAP and can augment management during weaning of mechanical cardiac support. It may also augment decision-making in management of PH patients with developmental disabilities in whom traditional assessments may be more challenging.Copyright © 2023 American College of Cardiology Foundation
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Background: One of the most common co-morbidities identified among COVID-19 patients was hypertension. Debates on use of Angiotensin-Converting Enzyme Inhibitors (ACEI) and Angiotensin-Receptor blockers (ARB) emerged due to an interaction of the said drugs with Angiotensin-converting enzyme 2 (ACE2), an enzyme which is a point of entry of coronavirus. This study aims to give an update on the work of Zhang et al13 in exploring the association of ACEI/ARB use on mortality and disease severity. Method(s): This meta-analysis involves review of observational studies among hypertensive COVID-19 patients with composite data on ACEI and ARB use. The literature search included studies published from December 2019 until June 30, 2020. Analyses were performed determining the odds ratio of each event using the raw data obtained from each study. Random effects model and Cochran-Mantel-Haenszel Method were utilized at 95% confidence interval. To check for heterogeneity, X2 test and I2 statistic were calculated. Subgroup analyses on ACEI users and ARB users were also done. Cochrane Review Manager (REVMAN 5.3) was used and Forest plots were generated. In this update, the total population of patients with confirmed COVID-19 infection was more than 50,000 with hypertensive patients comprising more than half of the sample population. The analyses done manifested decreased frequency of both outcomes with ACEI/ARB use. Result(s): The calculated odds ratio for mortality and disease severity were 0.63 and 0.56, respectively. However, a statistically significant heterogeneity existed for both outcomes. Subgroup analyses among ACEI users versus ACEI/ARB non-users (odds ratio for mortality = 0.95, I2 = 0%;and odds ratio for disease severity = 0.30, I2 = 0%), and ARB users versus ACEI/ARB non-users (odds ratio for mortality = 0.70, I2 =f 68%;and odds ratio for disease severity = 0.48, I2 = 77%) also manifested decreased frequency of both outcomes. However, significant heterogeneity exists among the ARB users, which is in contrary among the ACEI users. Conclusion(s): The use of ACEI contributes to a statistically significant reduction of mortality and disease severity among hypertensive patients with confirmed COVID-19 infection. We recommend continuing analysis of association of ACEI and ARB use and clinical outcomes since recent analysis suggests a beneficial effect especially in the ACEI group. At present, our findings are still in line with the current recommendation to not discontinue the use of ACEI and ARB among our hypertensive patients.
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Background: Treprostinil is a prostacyclin analogue which has been approved in the EU for intravenous (i.v.) and subcutaneous (SC) administration in patients with PAH. LIQ861 is a dry powder formulation of treprostinil which can be used for inhalation via a handheld device. Objectives and methods: LTI-201 was a multicentre, Phase 2, open-label, dose-escalation study to evaluate the HD dose-response and safety of LIQ861, followed by an open-label extension period. In "Part A" HD response was measured by right heart catheterization for 120 minutes after a single 26.5 or 53 mug dose of LIQ861. In "Part B" patients were titrated to symptomatic relief (<=159 mug QID) and were reassessed after 16 weeks using right heart catheterization and clinical assessments. Result(s): Fifteen PAH Patients (60 % female, mean age 56 +/- 14.3 years, mean pulmonary vascular resistance (PVR) 605+/-246 dynes/sec/cm-5) were included. In Part A HD measures (PVR and mean pulmonary arterial pressure) improved with a peak response after 15 minutes for both doses. The study was stopped early due to the COVID19 pandemic with only 6 patients completing Part B. At Week 16, these HD responses also improved and clinical assessments improved or remained stable for these patients. All doses of LIQ861 were generally well-tolerated with only one serious adverse event (short episode of hypoxia after inhalation). The most frequently reported adverse events were cough and throat irritation and most were assessed as mild in severity. Conclusion(s): LIQ861 was overall safe and well tolerated. An expected improvement in HD measures was seen with acute and chronic dosing.
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Background: Hypertension is the most important modifiable cause of cardiovascular (CV) disease and all-cause mortality worldwide. Numerous epidemiological studies and pharmacological intervention trials have demonstrated that lower and lowering blood pressures (BP) are associated with fewer CV events and lower mortality. Despite the positive correlations between BP levels and later CV events are continuous since BP levels as low as 90/60 mmHg in almost all large-scale epidemiological studies, the diagnostic criteria of hypertension and BP thresholds and targets of antihypertensive therapy have largely remained at the level of 140/90 mmHg in the past 30 years (since the release of the Fifth Report of the Joint National Committee [JNC 5] on high BP in 1993). The publication of both the SPRINT and the STEP trials (comprising >8,500 Caucasian/African and Chinese participants, respectively) provides enough evidence to shake this 140/90 mmHg dogma. In both trials, lowering systolic BP (SBP) to <130 mmHg, compared to the traditional SBP target of <140 (130-139) mmHg, was consistently associated with a 25-30% relative risk reduction in CV events. Another dogma regarding hypertension management is "office (or clinic) BP measurements" Although standardized office BP measurement has been widely recommended, the practice of office BP measurements is hard to be or has never been ideal in real-world practice. Further, the debate regarding the numerical equivalence between automated office BP (AOBP) measurements adopted in the SPRINT trial and office BP measurements has never been settled. The variations of office BP readings and the differences between office BP and home BP readings bewilder not only patients, but also healthcare professionals. On the other hand, out-of-office BP monitoring receives growing attention in contemporary hypertension guidelines. Home BP monitoring (HBPM) and ambulatory BP monitoring (ABPM) are two recognized approaches to obtaining out-of-office BP. HBPM is easy-to-use, more likely to be free of environmental and/or emotional stress (such as white-coat effect), feasible to document long-term BP variations, of good reproducibility and reliability, and more correlated with hypertension-mediated organ damage (HMOD) and CV events. Methods/Results: The Taiwan Hypertension Society (THS) and the Taiwan Society of Cardiology (TSOC) jointly issued the Consensus Statement on HBPM in 2020. The "722" protocol to standardize HBPM has been advocated by both Societies and widely accepted by healthcare professionals. In the 2022 Taiwan Hypertension Guidelines, we break the dogma of "office BP-based management strategy" and further expand the role of HBPM to the whole hypertension management process, from diagnosis to long-term follow-up. The Task Force considers that, to improve the quality of long-term management of all chronic diseases including hypertension, patients themselves should take an active role and HBPM is the right tool to achieve this goal, regardless of many other advantages of HBPM. This approach is of particularly importance in the post-COVID era and can bridge the management with artificial intelligence technologies. Conclusion(s): To facilitate implementation of the guidelines, a series of flowcharts to encompass assessment, adjustment, and HBPM-guided hypertension management are provided.
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The pandemic on SARS-CoV-2 infection has adversely impacted mankind all over the globe and more importantly, amidst individuals having Type-2 diabetic mellitus (T2DM) as well as among those who produce SARS-CoV-2 intricacies. Humoral and T cell-mediated immunity are adaptive immunity has a pivotal role to play in removing pathogens, comprising SARS-CoV-2. The infected cells are being eliminated by the primarily cytotoxic CD8+ T cells as well as certain antibodies in opposition to SARS-CoV-2 among humoral immunological responses possess the capacity for neutralizing this virus or by eliminating the infected cells with the support of cytotoxic in order to manage the progression of the disease. This cross-sectional study was carried out between January 2022 to December 2022. The serum samples were used to analyze SARS-CoV-2 total Ab among individuals having and not having T2DM and several metabolic risk factors like hypertension using WANTAI SARS-CoV-2 Total Ab ELISA Kit. There were 354 individuals, of which 141 (39.8%) had T2DM and 213 (60.2%) were nondiabetic patients. T2DM showed reduced antibody levels (average 5 AU/ml) than those without diabetes (average 12 AU/ ml). SARS-CoV2 total antibody levels are considerably lower in hypertension patients (8 AU/ml) over those who are normotensive (14 AU/ml). The present study implies that the continuous monitoring of the total antibody profile of SARS-CoV-2 that may be a practical strategy to help individuals with T2DM and hypertension to determine their need of precautionary doses for sustaining SARS-CoV-2 vaccines by producing immunity for protection against infections.Copyright © The Author(s) 2023.
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This study aims to describe COVID-19 vaccination coverage and its influential factors in hypertensive patients who were administered by community general practitioners in China. A cross-sectional survey was carried out using data from electronic health record systems. The subjects were hypertensive patients who had been involved in the health management of the Essential Public Health Service (EPHS) program in Hangzhou City, China. As of Aug 3, 2022, the full and booster vaccination rates were 77.53% and 60.97% in randomly selected 96,498 subjects. There were disparities across regions, age, and gender in the distribution of COVID-19 vaccination coverage. Obesity and daily alcohol consumption were factors in the promotion of COVID-19 vaccination. Current smoking, non-daily physical exercise, irregular medication adherence, and comorbidities were risk factors for COVID-19 vaccination. Coverage rates have decreased depending on the number of risk factors. The ORs (95% CI) were 1.78 (1.61 ~ 1.96) of full vaccination and 1.74 (1.59 ~ 1.89) of booster vaccination in subjects with ≥4 risk factors, compared to those without risk factors. In summary, the progress of COVID-19 vaccination among community hypertensive patients lagged behind that of the general population during the same period. Individuals who lived in urban areas, were elderly, and had an irregular medication adherence, comorbidities, and multiple risk factors should be highlighted in the COVID-19 vaccination campaign.
Subject(s)
COVID-19 , Hypertension , Vaccination Coverage , Humans , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , Cross-Sectional Studies , East Asian People , General Practitioners , Hypertension/epidemiologyABSTRACT
The COVID-19 (COronaVIrus Disease 2019) caused more than 3.5 million deaths all over the world. Patients who have underlying comorbidity, such as cardiovascular and pulmonary diseases have shown worse prognosis. In view of this, undivided attention was focused on patients with such rare conditions as pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). There is currently limited data available regarding COVID-19 infection in CTEPH patients. The available data are mostly case studies or small case series. The aim of this publication was to describe the course of COVID-19 in patients with previously diagnosed CTEPH. Methods. The study included 92 patients with an established diagnosis of CTEPH, who were managed in the Federal State Budgetary Institution National medical research center of cardiology named after academician E.I.Chazov, Ministry of Health of the Russian Federation. 62 patients with CTEPH and confirmed COVID-19 were enrolled, including 62% women. The mean age was 55.8 ± 14.8 years. Results. The duration of COVID-19 was 14 [10;30] days. The fever, general weakness, anosmia, and dyspnea were the most frequent presentations at diagnosis of COVID-19 in CTEPH patients. According to the multispiral computed tomography (CT) chest scans, more than half of the patients (54.2%) had mild disease (category CT-1). Most of the patients were under specific therapy (92%), mainly riociguat at an average daily dose of 5.75 ± 2.2 mg/day. All patients received anticoagulants. No need for long-term respiratory support and no lethal outcomes were registered in the study group. Conclusion. Small pilot studies demonstrated favorable clinical course of COVID-19 in CTEPH patients. This finding could be explained by the protective effect of anticoagulation and specific treatment.
ABSTRACT
Objective: Main issues in the treatment of hypertension are the low level of blood pressure (BP) control and the economic burden for health care systems. Mobile application with telemonitoring of BP could contribute to better control and lower costs by reducing office visits. This could be useful nowadays with difficult access to health system due to covid-19. The purpose of this study was to investigate if an innovative management strategy of hypertension, such as the use of ESH care application for smartphones combined with a dedicated platform, could improve hypertension control and replace frequent office visits. Design and method: 30 uncontrolled hypertensive patients, treated or untreated [mean age 53 ± 9 years, mean office BP (OBP) 146.3 ± 6.2 / 92.5 ± 9 mmHg, 53% men, 33% smokers, 23% with hypercholesterolemia] were randomized to the application assisted strategy (AAS) (17 patients), where a mobile phone application was offered to communicate home BP measurements (HBPm), or to regular office visits (13 patients). Patients BP measurements (HBPm for AAS and OBP for standard care group) were evaluated in 1 and 3 months with treatment titration if uncontrolled. In all patients OBP and ambulatory BP measurement (ABPM) were evaluated in 6 months. Results: In both groups the reduction in OBP and ABPM was significant in 6 months. In the AAS group the reduction in systolic/diastolic OBP and 24 h systolic/ diastolic BP in 6 months was -26.5 ± 5.6 / -19.4 ± 8.2 mmHg (p < 0,001) and -19.6 ± 7.7 / -13.8 ± 4.8 mmHg (p < 0.001), respectively. In the standard care group, the reduction in systolic/diastolic OBP and 24 h systolic/diastolic BP in 6 months was -22.6 ± 9.7 / -9.6 ± 11 mmHg (p < 0.005) and -18.4 ± 6.0 / - 8.8 ± 4.4 mmHg (p < 0.001). In AAS group compared to standard care group there was a greater reduction in 24 h diastolic BP (-13.8 ± 4.8 mmHg vs -8.8 ± 4.4 mmHg, p = 0.016) and in diastolic OBP (-19.4 ± 8.2 mmHg vs -9.6 ± 11.0 mmHg, p = 0.04). Conclusions: The present results indicate that the monitoring of patients through a mobile health tool could be useful in hypertension management as it is correlated with better BP control compared to office visits. The trial is still enrolling patients.
ABSTRACT
Objective: While there are several studies that have focused on the role of face masks in preventing airborne transmission of SARS-CoV-2, few data are available on their effects on physiological measures, and no study has examined their effects on blood pressure (BP). The purpose of our study was to investigate the effect of surgical masks on BP in drug-treated hypertensive patients who had a routine follow-up visit to a university hospital outpatient hypertension clinic. Design and method: The study included already treated hypertensive patients aged > 18 years, while the exclusion criteria were atrial fibrillation or any other arrhythmia affecting the BP measurement, an arm circumference > 42 cm, mental disorders, Parkinson disease, pregnancy, intolerance to the BP measurement method, or unwillingness to participate. A new surgical mask was provided to all participants to replace the face mask that was already in use. After the routine mask-on office BP measurement, patients were left alone and randomized to automated office BP measurement, with measurements taken after first wearing a mask for 10 min, then without wearing the mask for 10 min, and vice versa. Results: A total number of 265 patients were included in the study. Among the participants, 115 were women (43.4%), the mean age was 62 ± 12 years, and the mean office BP was 134 ± 15 / 81 ± 12 mmHg. There was no significant difference between mask-on unattended systolic BP (133 ± 15 mmHg) and mask-off unattended systolic BP (132 ± 15 mmHg) (P = 0.13) or between mask-on unattended diastolic BP (77 ± 13 mmHg) and mask-off unattended diastolic BP (76 ± 13 mmHg) (P = 0.32). Moreover, there was no difference in the heart rate (mask-on first, 69 ± 11 bpm;mask-off first, 69 ± 11 bpm, P = 0.7). Conclusions: Common surgical masks do not affect systolic/diastolic BP levels during unattended BP measurements in treated hypertensive patients.