bims-adreca Biomed News
on Adrenal calcium
Issue of 2024–04–14
nineteen papers selected by
Bakhta Fedlaoui, INSERM
  1. Low Cortisone as a Novel Predictor of the Low-Renin Phenotype.
  2. Utility of Repeat Sampling in Bilateral Aldosterone Suppression During Adrenal Vein Sampling for Primary Aldosteronism.
  3. Pitfalls in the preoperative and postoperative workup of patients with primary aldosteronism.
  4. Re: The impact of superselective adrenal artery embolization on renal function in patients with primary aldosteronism: a prospective cohort study.
  5. Surgical versus medical management of patients with primary hyperaldosteronism and indeterminate adrenal vein sampling: A 10-year experience of the Cleveland Clinic.
  6. Where and how are we going? Simplifying the definitive diagnosis of primary aldosteronism.
  7. The application of superselective adrenal artery embolization in primary aldosteronism: evaluation, challenges, and response to Mr. Cabrelle and his team.
  8. Association of adrenal steroids with metabolomic profiles in patients with primary and endocrine hypertension.
  9. Mitochondrial fission: a new mechanism of hypertension and cardiovascular remodeling induced by Angiotensin II.
  10. Medication fill duration in pediatric hypertension: adherence, blood pressure control, and disparities.
  11. Eight weeks of treatment with mineralocorticoid receptor blockade does not alter vascular function in individuals with and without type 2 diabetes.
  12. Novel biomarkers in patients with uncontrolled hypertension with and without kidney damage.
  13. Comparison of incident hypertension between SGLT2 inhibitors vs. DPP4 inhibitors.
  14. Correlation of Homocysteine and Blood Pressure Variability with Left Ventricular Hypertrophy in Patients with Hypertension and Carotid Atherosclerosis.
  15. Adrenal tumors in patients with neuroendocrine neoplasms.
  16. Arterial hypertension in infants with congenital diaphragmatic hernia following surgical repair.
  17. Frequency of office blood pressure measurements and the seasonal variability of blood pressure: results of the Hungarian Hypertension Registry.
  18. Reactive oxygen species impair Na+ transport and renal components of the renin-angiotensin-aldosterone system after paraquat poisoning.
  19. Evaluating prescription of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in patients with diabetes and albuminuria.
  1. J Endocr Soc. 2024 Apr 06. 8(6): bvae051
    Low Cortisone as a Novel Predictor of the Low-Renin Phenotype.
    Alejandra Tapia-Castillo, Cristian A Carvajal, Jorge A Pérez, Alejandra Sandoval, Fidel Allende, Sandra Solari, Carlos E Fardella.
      A large proportion of patients with low-renin hypertension (LRH) correspond to primary aldosteronism (PA). However, some of these subjects have low to normal aldosterone. Since low renin is driven by excessive mineralocorticoids or glucocorticoids acting on mineralocorticoid receptors (MRs), we hypothesize that a low-cortisone condition, associated classically with 11βHSD2 deficiency, is a proxy of chronic MR activation by cortisol, which can also lead to low renin, elevated blood pressure, and renal and vascular alterations.
    Objective: To evaluate low cortisone as a predictor of low renin activity and its association with parameters of kidney and vascular damage.
    Methods: A cross-sectional study was carried out in 206 adult subjects. The subjects were classified according to low plasma renin activity (<1 ng/mL × hours) and low cortisone (<25th percentile).
    Results: Plasma renin activity was associated with aldosterone (r = 0.36; P < .001) and cortisone (r = 0.22; P = .001). A binary logistic regression analysis showed that serum cortisone per ug/dL increase predicted the low-renin phenotype (OR 0.4, 95% CI 0.21-0.78). The receiver operating characteristic curves for cortisone showed an area under the curve of 0.6 to discriminate subjects with low renin activity from controls. The low-cortisone subjects showed higher albuminuria and PAI-1 and lower sodium excretion. The association study also showed that urinary cortisone was correlated with blood pressure and serum potassium (P < .05).
    Conclusion: This is the first study showing that low cortisone is a predictor of a low-renin condition. Low cortisone also predicted surrogate markers of vascular and renal damage. Since the aldosterone to renin ratio is used in the screening of PA, low cortisone values should be considered additionally to avoid false positives in the aldosterone-renin ratio calculation.
    Keywords:  aldosterone; cortisol; cortisone; low-renin hypertension
    DOI:  https://doi.org/10.1210/jendso/bvae051
  2. JCEM Case Rep. 2024 Apr;2(4): luae051
    Utility of Repeat Sampling in Bilateral Aldosterone Suppression During Adrenal Vein Sampling for Primary Aldosteronism.
    Bella Halim, Eric X Z Yong, Matthew Egan, Richard J MacIsaac, David O'Neal, Nirupa Sachithanandan.
      Primary aldosteronism (PA) is the most common form of secondary hypertension. Accurate subtyping of PA is essential to identify unilateral disease, as adrenalectomy improves outcomes. Subtyping PA requires adrenal vein sampling (AVS), which is technically challenging and results from AVS may not always be conclusive. We present a case of a 37-year-old man with PA whose AVS studies were inconclusive due to apparent bilateral aldosterone suppression (ABAS). As a result, our patient was misdiagnosed as having bilateral PA and medically managed until a repeat AVS showed lateralization to the right adrenal gland. ABAS is an underrecognized phenomenon that may confound the subtyping of PA. We recommend repeating AVS in such cases and discuss strategies to minimize ABAS.
    Keywords:  adrenal vein sampling; apparent bilateral aldosterone suppression; double-down AVS; primary aldosteronism
    DOI:  https://doi.org/10.1210/jcemcr/luae051
  3. Gland Surg. 2024 Mar 27. 13(3): 461-464
    Pitfalls in the preoperative and postoperative workup of patients with primary aldosteronism.
    Marta Araujo-Castro, Iñigo García Sanz.
      
    Keywords:  Primary aldosteronism (PA); adrenal venous sampling (AVS); adrenalectomy
    DOI:  https://doi.org/10.21037/gs-23-482
  4. Hypertens Res. 2024 Apr 09.
    Re: The impact of superselective adrenal artery embolization on renal function in patients with primary aldosteronism: a prospective cohort study.
    Giulio Cabrelle, Chiara Zanon, Gian Paolo Rossi.
      
    Keywords:  Hypertension; Primary aldosteronism; Superselective adrenal artery embolization
    DOI:  https://doi.org/10.1038/s41440-024-01664-0
  5. J Clin Hypertens (Greenwich). 2024 Apr 11.
    Surgical versus medical management of patients with primary hyperaldosteronism and indeterminate adrenal vein sampling: A 10-year experience of the Cleveland Clinic.
    Chineme Onwubueke, Saif M Borgan, Huijun Xiao, Keren Zhou.
      In patients with primary hyperaldosteronism (PA), adrenal vein sampling (AVS) can identify patients suitable for unilateral adrenalectomy. However, in AVS with an indeterminate aldosterone-to-cortisol lateralization (ACL) ratio of 3.0-4.0, clinical guidance is unclear. The authors screened all patients undergoing AVS at the Cleveland Clinic from October 2010 to January 2021 and identified 18 patients with indeterminate ACL results. Ten underwent adrenalectomy and eight continued medical management. The surgical group was younger (58.5 vs. 68 years, p = .17), and more likely to have a unilateral imaging adrenal abnormality (90% vs. 38%, p = .043) and a lower contralateral suppression index (0.63 vs. 1.1, p = .14). Post-treatment, the surgical group had a significant reduction in diastolic blood pressure (-5.5 mmHg, p = .043) and aldosterone (4.40 vs. 35.80 ng/mL, p = .035) and required fewer anti-hypertensive medications (2 vs. 3, p = .015). These findings may support the benefit of adrenalectomy in a select group of patients with indeterminate ACL.
    Keywords:  aldosterone excess; outcomes of care; secondary high blood pressure (HBP); treatment and diagnosis/guidelines
    DOI:  https://doi.org/10.1111/jch.14810
  6. Hypertens Res. 2024 Apr 08.
    Where and how are we going? Simplifying the definitive diagnosis of primary aldosteronism.
    Tetsuo Nishikawa, Kazuki Nakai, Yuya Tsurutani, Yoko Matsuzawa, Jun Saito, Masao Omura.
      
    Keywords:  Chemiluminescent enzyme immunoassay; Liquid chromatography-mass spectrometry/mass spectrometry; Plasma aldosterone concentration; Primary aldosteronism; Radioimmunoassay
    DOI:  https://doi.org/10.1038/s41440-024-01666-y
  7. Hypertens Res. 2024 Apr 09.
    The application of superselective adrenal artery embolization in primary aldosteronism: evaluation, challenges, and response to Mr. Cabrelle and his team.
    Ze-Qun Lai, Yi-Fei Dong.
      
    Keywords:  Glomerular ultrafiltration; Primary aldosteronism; Superselective adrenal arterial embolization
    DOI:  https://doi.org/10.1038/s41440-024-01668-w
  8. Front Endocrinol (Lausanne). 2024 ;15 1370525
    Association of adrenal steroids with metabolomic profiles in patients with primary and endocrine hypertension.
    Robin Knuchel, Zoran Erlic, Sven Gruber, Laurence Amar, Casper K Larsen, Anne-Paule Gimenez-Roqueplo, Paolo Mulatero, Martina Tetti, Alessio Pecori, Christina Pamporaki, Katharina Langton, Mirko Peitzsch, Filippo Ceccato, Aleksander Prejbisz, Andrzej Januszewicz, Christian Adolf, Hanna Remde, Livia Lenzini, Michael Dennedy, Jaap Deinum, Emily Jefferson, Anne Blanchard, Maria-Christina Zennaro, Graeme Eisenhofer, Felix Beuschlein.
       Introduction: Endocrine hypertension (EHT) due to pheochromocytoma/paraganglioma (PPGL), Cushing's syndrome (CS), or primary aldosteronism (PA) is linked to a variety of metabolic alterations and comorbidities. Accordingly, patients with EHT and primary hypertension (PHT) are characterized by distinct metabolic profiles. However, it remains unclear whether the metabolomic differences relate solely to the disease-defining hormonal parameters. Therefore, our objective was to study the association of disease defining hormonal excess and concomitant adrenal steroids with metabolomic alterations in patients with EHT.
    Methods: Retrospective European multicenter study of 263 patients (mean age 49 years, 50% females; 58 PHT, 69 PPGL, 37 CS, 99 PA) in whom targeted metabolomic and adrenal steroid profiling was available. The association of 13 adrenal steroids with differences in 79 metabolites between PPGL, CS, PA and PHT was examined after correction for age, sex, BMI, and presence of diabetes mellitus.
    Results: After adjustment for BMI and diabetes mellitus significant association between adrenal steroids and metabolites - 18 in PPGL, 15 in CS, and 23 in PA - were revealed. In PPGL, the majority of metabolite associations were linked to catecholamine excess, whereas in PA, only one metabolite was associated with aldosterone. In contrast, cortisone (16 metabolites), cortisol (6 metabolites), and DHEA (8 metabolites) had the highest number of associated metabolites in PA. In CS, 18-hydroxycortisol significantly influenced 5 metabolites, cortisol affected 4, and cortisone, 11-deoxycortisol, and DHEA each were linked to 3 metabolites.
    Discussions: Our study indicates cortisol, cortisone, and catecholamine excess are significantly associated with metabolomic variances in EHT versus PHT patients. Notably, catecholamine excess is key to PPGL's metabolomic changes, whereas in PA, other non-defining adrenal steroids mainly account for metabolomic differences. In CS, cortisol, alongside other non-defining adrenal hormones, contributes to these differences, suggesting that metabolic disorders and cardiovascular morbidity in these conditions could also be affected by various adrenal steroids.
    Keywords:  Cushing’s syndrome; adrenal steroids; endocrine hypertension; metabolomics; pheochromocytoma; primary aldosteronism; primary hypertension
    DOI:  https://doi.org/10.3389/fendo.2024.1370525
  9. Hypertens Res. 2024 Apr 10.
    Mitochondrial fission: a new mechanism of hypertension and cardiovascular remodeling induced by Angiotensin II.
    Kohei Ueda, Shigeru Shibata.
      
    Keywords:  Fission; Mitochondria; Vascular dysfunction
    DOI:  https://doi.org/10.1038/s41440-024-01670-2
  10. Pediatr Nephrol. 2024 Apr 10.
    Medication fill duration in pediatric hypertension: adherence, blood pressure control, and disparities.
    Meghan M McLaughlin, Conrad D Gleber, Hongyue Wang, Jill S Halterman, Marc B Lande.
       BACKGROUND: Medication nonadherence is a barrier to hypertension control. The Centers for Disease Control and Prevention recommends prescribing 90-day fills for maintenance medications yet antihypertensives are often dispensed as 30-day fills. Our objectives were to examine how often patients receive 30-day supplies of medication despite prescriptions for longer duration and to examine the effect of medication fill duration on adherence and hypertension control.
    METHODS: We conducted a retrospective cohort study of pediatric patients with hypertension over a 3-year period. For each patient, days prescribed per fill were compared to days dispensed per fill using pharmacy reports and insurance claim data. Proportion of Days Covered (PDC) was calculated to estimate adherence. Hypertension control was determined by provider assessment of control and blood pressure measurement at the final visit.
    RESULTS: Final cohort included 449 patients. A total of 70% had at least one prescription for ≥ 90 days but only 37% had at least one dispense for ≥ 90 days. There was no difference in the likelihood of being prescribed a 90-day fill by insurance type (public vs. private); however, patients with public insurance were less likely to be dispensed a 90-day fill (OR = 0.068, p < 0.001). Patients who received 90-day fills had better adherence (median PDC 77.5% vs. 58.1%, p < 0.001) and were more likely to have hypertension control based on provider assessment.
    CONCLUSIONS: Longer fill duration is associated with improved adherence and hypertension control. Patients with public insurance are markedly less likely to be dispensed 90-day fills, a modifiable barrier to improving adherence.
    Keywords:  Adherence; Health disparities; Hypertension; Refill data
    DOI:  https://doi.org/10.1007/s00467-024-06363-z
  11. Physiol Rep. 2024 Apr;12(7): e16010
    Eight weeks of treatment with mineralocorticoid receptor blockade does not alter vascular function in individuals with and without type 2 diabetes.
    Stine H Finsen, Mie R Hansen, Pernille B L Hansen, Stefan P Mortensen.
      Aldosterone has been suggested to be involved in the microvascular complications observed in type 2 diabetes. We aimed to investigate the effect of mineralocorticoid receptor (MR) blockade on endothelial function in individuals with type 2 diabetes compared to healthy controls. We included 12 participants with type 2 diabetes and 14 controls. We measured leg hemodynamics at baseline and during femoral arterial infusion of acetylcholine and sodium nitroprusside before and 8 weeks into treatment with MR blockade (eplerenone). Acetylcholine infusion was repeated with concomitant n-acetylcysteine (antioxidant) infusion. No difference in leg blood flow or vascular conductance was detected before or after the treatment with MR blockade in both groups and there was no difference between groups. Infusion of n-acetylcysteine increased baseline blood flow and vascular conductance, but did not change the vascular response to acetylcholine before or after treatment with MR blockade. Skeletal muscle eNOS content was unaltered by MR blockade and no difference between groups was detected. In conclusion, we found no effect of MR blockade endothelial function in individuals with and without type 2 diabetes. As the individuals with type 2 diabetes did not have vascular dysfunction, these results might not apply to individuals with vascular dysfunction.
    Keywords:  aldosterone; endothelial function; mineralocorticoid receptor; type 2 diabetes
    DOI:  https://doi.org/10.14814/phy2.16010
  12. Blood Press. 2024 Dec;33(1): 2323980
    Novel biomarkers in patients with uncontrolled hypertension with and without kidney damage.
    Karl Marius Brobak, Lene V Halvorsen, Hans Christian D Aass, Camilla L Søraas, Arleen Aune, Eirik Olsen, Ola Undrum Bergland, Stine Rognstad, Kjersti B Blom, Jon Arne K Birkeland, Aud Høieggen, Anne Cecilie K Larstorp, Marit D Solbu.
       INTRODUCTION: Estimated glomerular filtration rate (eGFR) and urine albumin/creatinine ratio (ACR) are insensitive biomarkers for early detection of hypertension-mediated organ damage (HMOD). In this nationwide cross-sectional study, we assessed potential biomarkers for early HMOD in healthy persons and patients with hypertension. We hypothesised that plasma levels of biomarkers: (1) are different between healthy controls and patients with hypertension, (2): can classify patients with hypertension according to the degree of hypertension severity.
    DESIGN AND METHODS: Patients with hypertension prescribed ≥2 antihypertensive agents were selected from a multicentre study. Healthy controls were selected from an ongoing study of living kidney donor candidates. Uncontrolled hypertension was defined as systolic daytime ambulatory blood pressure ≥135 mmHg. Kidney HMOD was defined by ACR > 3.0 mg/mmol or eGFR < 60 mL/min/1.73 m2. Patients with hypertension were categorised into three groups: (1) controlled hypertension; (2) uncontrolled hypertension without kidney HMOD; (3) uncontrolled hypertension with kidney HMOD. Fifteen biomarkers were analysed using a Luminex bead-based immunoassay, and nine fell within the specified analytical range.
    RESULTS: Plasma levels of Interleukin 1 receptor antagonist (IL-1RA), neutrophil gelatinase-associated lipocalin (NGAL) and uromodulin were significantly different between healthy controls (n = 39) and patients with hypertension (n = 176). In regression models, with controlled hypertension (n = 55) as the reference category, none of the biomarkers were associated with uncontrolled hypertension without (n = 59) and with (n = 62) kidney HMOD. In models adjusted for cardiovascular risk factors and eGFR, osteopontin (OPN) was associated with uncontrolled hypertension without kidney HMOD (odds ratio (OR) 1.77 (1.05-2.98), p = 0.03), and regulated upon activation normal T-cell expressed and secreted (RANTES) with uncontrolled hypertension with kidney HMOD (OR 0.57 (0.34-0.95), p = 0.03).
    CONCLUSIONS: None of the biomarkers could differentiate our hypertension groups when established risk factors were considered. Plasma OPN may identify patients with uncontrolled hypertension at risk for kidney HMOD.
    Keywords:  Hypertension; fibrosis; hypertension-mediated organ damage (HMOD); inflammation; kidney damage
    DOI:  https://doi.org/10.1080/08037051.2024.2323980
  13. Hypertens Res. 2024 Apr 10.
    Comparison of incident hypertension between SGLT2 inhibitors vs. DPP4 inhibitors.
    Yuta Suzuki, Hidehiro Kaneko, Akira Okada, Jin Komuro, Katsuhito Fujiu, Norifumi Takeda, Hiroyuki Morita, Junya Ako, Akira Nishiyama, Yuichiro Yano, Masaki Ieda, Koichi Node, Hideo Yasunaga, Issei Komuro.
      Although several randomized clinical trials have reported the potential benefit of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in reducing blood pressure (BP), whether SGLT2i can reduce incident hypertension is unknown. We analyzed individuals with diabetes who were newly prescribed SGLT2i or dipeptidyl peptidase 4 inhibitors (DPP4i) in a large-scale epidemiological database. The primary outcome was the incidence of hypertension. A propensity score matching algorithm was employed to compare the subsequent development of hypertension between the SGLT2i and DPP4i groups. After propensity score matching, 5708 well-balanced pairs of SGLT2i and DPP4i users were identified. SGLT2i administration was associated with a reduced risk of hypertension (HR 0.91, 95% CI: 0.84-0.97). The advantage of SGLT2i use over DPP4i use for incident hypertension was generally consistent in several sensitivity analyses, and subgroup analyses showed that SGLT2i use was significantly associated with a lower risk of hypertension in men, patients with baseline HbA1c of <7.5%, and baseline systolic blood pressure ≥127 mmHg. Our investigation using nationwide real-world data demonstrated the potential advantage of SGLT2i over DPP4i in reducing the development of hypertension in individuals with diabetes.
    Keywords:  Diabetes; Epidemiology; Hypertension; SGLT2 inhibitors
    DOI:  https://doi.org/10.1038/s41440-024-01649-z
  14. Altern Ther Health Med. 2024 Apr 12. pii: AT9029. [Epub ahead of print]
    Correlation of Homocysteine and Blood Pressure Variability with Left Ventricular Hypertrophy in Patients with Hypertension and Carotid Atherosclerosis.
    Rui Liu, Yiwen Weng, Chunlian Zeng, Fei Dai, Jing Chen, Mengjiao Gou, Yalu Qin.
       Objective: It is of positive significance for clinical management to infer the changes of BPV and blood Hcy in the risk of cardiovascular disease progression in patients with hypertension by ambulatory blood pressure test. We aimed to explore the correlation of homocysteine and blood pressure variability with left ventricular hypertrophy in patients with hypertension and carotid atherosclerosis.
    Methods: A total of 333 elderly hypertensive patients admitted to Jinniu District People's Hospital in Chengdu from February 2020 to December 2021 were selected as the study subjects. They were divided into the pure hypertension group and hypertension combined with the carotid atherosclerosis group. In addition, the two groups were divided into the hypertension combined with left ventricular remodeling subgroup and the hypertension without left ventricular remodeling subgroup. Plasma Hcy levels were measured on a BECKMAN AU 680 automated biochemistry analyzer. Ambulatory blood pressure was measured by HINGMED ABP-03 monitoring system. IMT measurement was performed using a GE LOGIQ E9 ultrasound. Left ventricular diastolic function measurement was performed using a GE LOGIQ E9 ultrasound.
    Results: Blood Hcy, 24-h mean SBP, 24-h mean DBP, 24-h SBP coefficient of variation, and 24-h DBP coefficient of variation were significantly higher in hypertension combined with the carotid atherosclerosis group than the pure hypertension group (P < .05). Moreover, LVMI, E/A, and E/e were greater in the carotid atherosclerosis group than in the normal carotid group (P < .05). IMT, blood Hcy, 24-h mean SBP, 24-h mean DBP, 24-h SBP coefficient of variation, 24-h DBP coefficient of variation, E/A, and E/e were significantly higher in the hypertensive combined with left ventricular remodeling subgroup than in the non-left ventricular remodeling subgroup (P < .05). IMT was positively correlated with blood Hcy, 24-h SBP, 24-h DBP, 24-h SCV, 24-h DCV, LVMI, E/A, and E/e (P < .05).
    Conclusion: There was a position correlation of Hcy and BPV with left ventricular hypertrophy in patients with hypertension combined with carotid atherosclerosis.
  15. Endocrine. 2024 Apr 06.
    Adrenal tumors in patients with neuroendocrine neoplasms.
    Henrik Falhammar, Adam Stenman, C Christofer Juhlin, Anna Kistner.
       PURPOSE: To study the prevalence of primary adrenal tumors and adrenal metastases in patients with neuroendocrine neoplasms (NENs) and describe these in detail. NENs can be further divided into neuroendocrine tumor (NET) and neuroendocrine carcinoma (NEC).
    METHODS: A review of medical files was conducted for all patients who underwent a 68Gallium-DOTATOC-PET/CT during 2010-2023 or adrenalectomy during 1999-2023 at the Karolinska University Hospital.
    RESULTS: In total, 68Gallium-DOTATOC-PET/CT was performed on 1750 individuals with NEN, among whom 12 (0.69%) had adrenal tumors. Of these, 9 (0.51%) were NEN metastases. Out of 1072 adrenalectomies, 4 (0.37%) showed evidence of NEN metastases. Thus, 16 patients with NEN exhibited adrenal tumors. The adrenal tumors were found on average 5 years after the NEN diagnosis and 19% of the adrenal tumors with simultaneous NEN were benign. Few had all adrenal hormones measured. None had an adrenal insufficiency nor an adrenal biopsy. Another synchronous metastasis was found in 69% at the time of the adrenal tumor discovery. During the median 2-year follow-up, 38% of the subjects had deceased (with the exclusion of individuals presenting supposedly benign adrenal tumors 31%) all due to tumor complications. A comparison between individuals identified through 68Gallium-DOTATOC-PET/CT and those who underwent adrenalectomy revealed a higher prevalence of NETs in the former group and NECs in the latter group.
    CONCLUSION: Adrenal primary tumors and adrenal metastases are infrequent occurrences in patients with NEN. Most cases involved the presence of NEN metastasis upon the initial discovery of adrenal tumors. The overall prognosis was found to be favorable.
    Keywords:  68Gallium-DOTATOC-PET/CT; Adrenal metastasis; Adrenal tumor; Adrenalectomy; Neuroendocrine cancer; Neuroendocrine tumor
    DOI:  https://doi.org/10.1007/s12020-024-03810-7
  16. Eur J Pediatr. 2024 Apr 06.
    Arterial hypertension in infants with congenital diaphragmatic hernia following surgical repair.
    Clara Engel, Judith Leyens, Bartolomeo Bo, Lennart Hale, Hannah Lagos Kalhoff, Lotte Lemloh, Andreas Mueller, Florian Kipfmueller.
      Pulmonary hypertension (PH) and cardiac dysfunction are established comorbidities of congenital diaphragmatic hernia (CDH). However, there is very little data focusing on arterial hypertension in CDH. This study aims to investigate the incidence of arterial hypertension in neonates with CDH at hospital discharge. Archived clinical data of 167 CDH infants who received surgical repair of the diaphragmatic defect and survived for > 60 days were retrospectively analyzed. Blood pressure (BP) values were averaged for the last 7 days before discharge and compared to standard BP values for sex, age, and height provided by the AHA in 2004. BP values reaching or extending the 95th percentile were defined as arterial hypertension. The use of antihypertensive medication was analyzed at discharge and during hospitalization. Arterial hypertension at discharge was observed in 19 of 167 infants (11.3%) of which 12 (63%) were not receiving antihypertensive medication. Eighty patients (47.9%) received antihypertensive medication at any point during hospitalization and 28.9% of 152 survivors (n = 44) received antihypertensive medication at discharge, although in 45.5% (n = 20) of patients receiving antihypertensive medication, the indication for antihypertensive medication was myocardial hypertrophy or frequency control. BP was significantly higher in ECMO compared to non-ECMO patients, despite a similar incidence of arterial hypertension in both groups (13.8% vs. 10.1%, p = 0.473). Non-isolated CDH, formula feeding, and minimal creatinine in the first week of life were significantly associated with arterial hypertension on univariate analysis. Following multivariate analysis, only minimal creatinine remained independently associated with arterial hypertension.   Conclusion: This study demonstrates a moderately high incidence of arterial hypertension in CDH infants at discharge and an independent association of creatinine values with arterial hypertension. Physicians should be aware of this risk and include regular BP measurements and test of renal function in CDH care and follow-up. What is Known: • Due to decreasing mortality, morbidity is increasing in surviving CDH patients. • Pulmonary hypertension and cardiac dysfunction are well-known cardiovascular comorbidities of CDH. What is New: • There is a moderately high incidence of arterial hypertension in CDH infants at discharge even in a population with frequent treatment with antihypertensive medication. • A more complicated hospital course (ECMO, higher degree of PH, larger defect size) was associated with a higher risk for arterial hypertension.
    Keywords:  Arterial hypertension; Blood pressure; Congenital diaphragmatic hernia; Extracorporeal membrane oxygenation; Follow-up
    DOI:  https://doi.org/10.1007/s00431-024-05509-3
  17. Blood Press. 2024 Dec;33(1): 2337170
    Frequency of office blood pressure measurements and the seasonal variability of blood pressure: results of the Hungarian Hypertension Registry.
    János Nemcsik, Johanna Takács, Dorottya Pásztor, Csaba Farsang, Attila Simon, Dénes Páll, Péter Torzsa, Szilveszter Dolgos, Akos Koller, Norbert Habony, Zoltán Járai.
       PURPOSE: Hypertension is a major public health problem, thus, its timely and appropriate diagnosis and management are crucial for reducing cardiovascular morbidity and mortality. The aim of the new Hungarian Hypertension Registry is to evaluate the blood pressure measurement practices of general practitioners (GPs), internists and cardiologists in outpatient clinics, as well as to assess the seasonal variability of blood pressure.
    MATERIALS AND METHODS: Omron M3 IT devices were used during four-month periods between October 2018 and April 2023 in GP practices and in hypertension clinics. The blood pressure data were then transmitted online from the monitors' cuffs to a central database using the Medistance system of Omron.
    RESULTS: Family physicians (n = 2491), and internists/cardiologists (n = 477) participated in the study. A total of 4804 821 blood pressure measurements were taken during 10 four-month evaluation periods. In the ten periods, the daily average number of measurements was between 3.0 and 5.6. Following ESH diagnostic criteria, the proportion of subjects in optimal, normal and high-normal blood pressure categories were 14, 13.4 and 16.7%, respectively. Altogether 56% of the measurements belonged to stage 1, stage 2 or stage 3 hypertension categories (31.6, 17.1 and 7.4%, respectively). On average, a difference of 5/2 mmHg was observed between winter and summer data in systolic and diastolic blood pressures, respectively. The average systolic blood pressure values were higher in GP practices with more than 2000 patients than in the ones with less than 1500 patients (141.86 mmHg versus 140.02 mmHg, p < 0.05).
    CONCLUSION: In conclusion, the low daily average number of blood pressure measurements indicates a limited blood pressure screening awareness/capacity in the case of Hungarian family physicians. In GP practices with more patients, blood pressure is usually less well-controlled. These results suggest that the further promotion of home blood pressure monitoring is necessary.
    Keywords:  Hypertension; blood pressure measurement; office blood pressure; seasonal variability
    DOI:  https://doi.org/10.1080/08037051.2024.2337170
  18. An Acad Bras Cienc. 2024 ;pii: S0001-37652024000100601. [Epub ahead of print]96(1): e20230971
    Reactive oxygen species impair Na+ transport and renal components of the renin-angiotensin-aldosterone system after paraquat poisoning.
    Marry A S Cirilo, Valéria B S Santos, Natália K S Lima, Humberto Muzi-Filho, Ana D O Paixão, Adalberto Vieyra, Leucio D Vieira.
      Paraquat (1,1'-dimethyl-4,4'-bipyridyl dichloride) is an herbicide widely used worldwide and officially banned in Brazil in 2020. Kidney lesions frequently occur, leading to acute kidney injury (AKI) due to exacerbated reactive O2 species (ROS) production. However, the consequences of ROS exposure on ionic transport and the regulator local renin-angiotensin-aldosterone system (RAAS) still need to be elucidated at a molecular level. This study evaluated how ROS acutely influences Na+-transporting ATPases and the renal RAAS. Adult male Wistar rats received paraquat (20 mg/kg; ip). After 24 h, we observed body weight loss and elevation of urinary flow and serum creatinine. In the renal cortex, paraquat increased ROS levels, NADPH oxidase and (Na++K+)ATPase activities, angiotensin II-type 1 receptors, tumor necrosis factor-α (TNF-α), and interleukin-6. In the medulla, paraquat increased ROS levels and NADPH oxidase activity but inhibited (Na++K+)ATPase. Paraquat induced opposite effects on the ouabain-resistant Na+-ATPase in the cortex (decrease) and medulla (increase). These alterations, except for increased serum creatinine and renal levels of TNF-α and interleukin-6, were prevented by 4-hydroxy-2,2,6,6-tetramethylpiperidin-1-oxyl (tempol; 1 mmol/L in drinking water), a stable antioxidant. In summary, after paraquat poisoning, ROS production culminated with impaired medullary function, urinary fluid loss, and disruption of Na+-transporting ATPases and angiotensin II signaling.
    DOI:  https://doi.org/10.1590/0001-3765202420230971
  19. Clin Nephrol. 2024 Apr 12.
    Evaluating prescription of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in patients with diabetes and albuminuria.
    Kittiphan Chienwichai, Phirada Chaloemwa, Sorawat Sangkaew, Arunchai Chang.
       AIM: Although guidelines recommend the use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB) in patients with diabetes, hypertension, and albuminuria, their use remains suboptimal in several developed countries. Limited data are available on ACEi/ARB use in developing countries. Here, we assessed the use of ACEi/ARB and identified factors contributing to their underutilization at Hatyai Hospital, Thailand.
    MATERIALS AND METHODS: This retrospective cross-sectional study was conducted using data from the Hatyai Hospital database. Adult patients with diabetes, hypertension, and albuminuria were included. Clinical data and laboratory results were extracted. Furthermore, this study recorded pre-specified conditions that influenced physicians' decisions regarding the prescription of ACEi/ARBs in patients who did not adhere to guidelines.
    RESULTS: Of 4,655 eligible patients, 500 patients were selected. The average age of the patients was 66.3 years, and 59.6% were female. The adherence rate was 72.4%. Multivariate logistic regression analysis found a significant association between non-adherence and chronic kidney disease (CKD) stage (OR = 1.29, 95% CI: 1.04 - 1.60, p = 0.019). The most common pre-specified condition contributing to non-adherence was "no condition identified" (69.8%). Among the cases of non-adherence, 21.7% were due to ACEi/ARB discontinuation after acute kidney injury, followed by hyperkalemia (5.1%) and a moderate increase in serum creatinine (4.3%).
    CONCLUSION: ACEi/ARB therapy was suboptimal in patients with diabetes, hypertension, and albuminuria. Non-adherence was associated with CKD stage, possibly because of concerns about adverse events and healthcare-related factors.
    DOI:  https://doi.org/10.5414/CN111247
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