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Merks P, Chełstowska B, Religioni U, Neumann-Podczaska A, Krasiński Z, Kobayashi A, Plagens-Rotman K, Drelich E, Fehir-Sola K, Fijałkowski Ł, Baj I, Vaillancourt R, Wieczorowska-Tobis K, Mastalerz-Migas A, Koziol M, Pinkas J, Szymański FM, Hering D. Enhancing Patient Adherence to Newly-Prescribed Medicine for Chronic Diseases: A Comprehensive Review and Cost-Effective Approach to Implementing the New Medicine Service in Community Pharmacies in Poland. Med Sci Monit 2024; 30:e942923. [PMID: 38431771 PMCID: PMC10919058 DOI: 10.12659/msm.942923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/27/2023] [Indexed: 03/05/2024] Open
Abstract
New Medicine Service (NMS) components are an important element to improve patient compliance with medical recommendations. NMS provides support to patients prescribed new medicines, helping them to manage long-term conditions. The purpose of this service is to provide patients with advice, guidelines, and educational materials regarding the use of new medicines to increase patient compliance and therapy safety. The NMS has already been introduced in many European countries. This review aims to identify the benefits and potential barriers to implementing the NMS in community pharmacies and to suggest solutions that would increase its effectiveness. Previous studies have primarily shown that the NMS improves patient compliance with therapy, accelerating the expected effects of the therapy. Pharmacist support during implementation of a new drug therapy substantially increases patient safety. As the experience of numerous countries shows, both pharmacists and patients express positive opinions on this service. Therefore, it seems that NMS should be an indispensable part of pharmaceutical patient care in any healthcare system. This article aims to review the implementation of the New Medicine Service (NMS) for community pharmacists in Poland and the provision of a cost-effective approach to improve patient adherence to newly-prescribed medicine for chronic diseases.
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Affiliation(s)
- Piotr Merks
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
| | - Beata Chełstowska
- Department of Biochemistry and Laboratory Diagnostics, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
| | - Urszula Religioni
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, Warsaw, Poland
| | | | - Zbigniew Krasiński
- Department of Vascular and Endovascular Surgery, Angiology and Phlebology, Poznań University of Medical Sciences, Poznań, Poland
| | - Adam Kobayashi
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
| | - Katarzyna Plagens-Rotman
- Center for Sexology and Pediatric, Adolescent Gynecology, Division of Gynecology, Department of Perinatology and Gynecology, Poznań University of Medical Sciences, Poznań, Poland
| | - Ewelina Drelich
- The Polish Pharmacy Practice Research Network (PPPRN), Warsaw, Poland
| | - Katarina Fehir-Sola
- European Association of Employed Community Pharmacists (EPhEU), Vienna, Austria
| | - Łukasz Fijałkowski
- Department of Organic Chemistry, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Bydgoszcz, Poland
| | | | - Regis Vaillancourt
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
- The Polish Pharmacy Practice Research Network (PPPRN), Warsaw, Poland
| | | | | | - Mark Koziol
- Pharmacy Defence Association, Birmingham, United Kingdom
| | - Jarosław Pinkas
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, Warsaw, Poland
| | - Filip M. Szymański
- Department of Civilization Diseases, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
| | - Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
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Hering D, Narkiewicz K. Novel approaches: targeting sympathetic outflow in the carotid sinus. Blood Press 2023; 32:2232873. [PMID: 37470450 DOI: 10.1080/08037051.2023.2232873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/31/2023] [Accepted: 06/29/2023] [Indexed: 07/21/2023]
Abstract
Uncontrolled hypertension drives the global burden of increased cardiovascular disease (CVD) morbidity and mortality. Although high blood pressure (BP) is treatable and preventable, only half of the patients with hypertension undergoing treatment have their BP controlled. The failure of polypharmacy to attain adequate BP control may be due to a lack of physiological response, however, medication non-adherence and clinician inertia to increase treatment intensity are critical factors associated with poor hypertension management. The long-time medication titration, lifelong drug therapy, and often multi-drug treatment strategy are frustrating when the BP goal is not achieved, leading to increased CVD risk and a substantial burden on the healthcare system. Growing evidence indicates that neurohumoral activation is critical in initiating and maintaining elevated BP and its adverse consequences. Over the past decades, device-based therapies targeting the mechanisms underlying hypertension pathophysiology have been extensively studied. Among these, robust clinical experience for hypertension management exists for renal denervation (RDN) and baroreflex activation therapy (BAT), carotid body denervation (CBD), central arteriovenous anastomosis, and to a lesser extent, deep brain stimulation. Future studies are warranted to define the role of device-based approaches as an alternative or adjunctive treatment option to treat hypertension.
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Affiliation(s)
- Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
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Yaneva-Sirakova T, Coca A, Sierra C, Cunha P, Hering D. Predictive value of new cardiovascular tools for stroke risk reclassification. Blood Press 2023; 32:2237129. [PMID: 37477278 DOI: 10.1080/08037051.2023.2237129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Affiliation(s)
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Cristina Sierra
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - Pedro Cunha
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Hospital Senhora da Oilveira, Life and Health Research Institute, Minho University, Guimarães, Portugal
| | - Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
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Yaneva-Sirakova T, Petrov I, Traykov L, Coca A, Cunha PG, Gasecki D, Farukh B, Kotsis V, Vicario A, Manios E, Sierra C, Hering D. Twenty-four-hour ambulatory blood pressure monitoring-from silent to whispering brain damage. Blood Press 2023; 32:2208228. [PMID: 37209040 DOI: 10.1080/08037051.2023.2208228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/22/2023]
Affiliation(s)
| | - Ivo Petrov
- Acibadem City Clinic UMHAT Cardiovascular Center, Sofia, Bulgaria
| | - Latchezar Traykov
- Department of Neurology, UMHAT "Alexandrovska", Neurology clinic, Medical University Sofia, Bulgaria
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Pedro G Cunha
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk; Hospital Senhora da Oilveira, Life and Health Research Institute, Minho University, Guimarães, Portugal
| | - Dariusz Gasecki
- Department of Adult Neurology, Medical University of Gdansk, Gdansk, Poland
| | - Bushra Farukh
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, United Kingdom
| | - Vasilios Kotsis
- Third Dept. of Int. Medicine, Papageorgiou Hospital, Aristotle University, Thessaloniki, Greece
| | - Augusto Vicario
- Heart-Brain Unit, Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - Efstathis Manios
- Dept. of Clinical Therapeutics National, and Kapodistrian University of Athens, Alexandra Hospital, Greece
| | - Cristina Sierra
- Department of Internal Medicine, University of Barcelona, Hospital Clinic, Barcelona, Spain
| | - Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
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Wileczek A, Stodolkiewicz-Nowarska E, Reichert A, Kustron A, Sledz J, Biernikiewicz W, Orlik B, Lipka M, Kutarski A, Hering D, Zając M, Stec S. Reevaluation of indications for permanent pacemaker implantation after cardioneuroablation. Kardiol Pol 2023; 81:1272-1275. [PMID: 37997826 DOI: 10.33963/v.kp.97828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Antoni Wileczek
- Division of Electrophysiology, Cardioneuroablation, Catheter Ablation and Cardiac Stimulation, Subcarpathian Center for Cardiovascular Intervention, Sanok, Poland.
- ELMEDICA, EP-Network, Skarżysko-Kamienna, Poland.
| | | | | | - Anna Kustron
- ELMEDICA, EP-Network, Skarżysko-Kamienna, Poland
| | - Janusz Sledz
- ELMEDICA, EP-Network, Skarżysko-Kamienna, Poland
| | | | - Bartłomiej Orlik
- 5th Department of Invasive Cardiology and Angiology, American Heart of Poland, Mielec, Poland
| | - Michał Lipka
- 5th Department of Invasive Cardiology and Angiology, American Heart of Poland, Mielec, Poland
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdańsk, Poland
| | - Magdalena Zając
- Department of Special Pedagogy and Speech Therapy, Faculty of Pedagogy, Kazimierz Wielki University, Bydgoszcz, Poland
| | - Sebastian Stec
- Division of Electrophysiology, Cardioneuroablation, Catheter Ablation and Cardiac Stimulation, Subcarpathian Center for Cardiovascular Intervention, Sanok, Poland
- CardioMedicum Medical Center, Institute of Cardiovascular Science, Kraków, Poland
- ELMEDICA, EP-Network, Skarżysko-Kamienna, Poland
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Oertel M, Hering D, Kittel C, Nacke N, Kröger K, Kriz J, Fuchs M, Baues C, Vordermark D, Engenhart-Cabillic R, Herfarth KK, Lukas P, Schmidberger H, Marnitz-Schulze S, Borchmann P, Engert A, Haverkamp U, Eich HTT. Quality Analysis of Radiation Therapy for Hodgkin Lymphoma in the HD 16/17 Trials: A Final Report By the Reference Radiation Oncology Panel of the German Hodgkin Study Group. Int J Radiat Oncol Biol Phys 2023; 117:S62. [PMID: 37784540 DOI: 10.1016/j.ijrobp.2023.06.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The HD 16 and 17 trials by the German Hodgkin Study Group (GHSG) have evaluated the use of consolidative radiotherapy (RT) in early-favorable and -unfavorable stage Hodgkin lymphoma (HL), respectively (1, 2). Quality of RT planning and execution is pivotal for treatment outcome in HL with protocol violations jeopardizing prognosis (3). Consequently, the present work aims at a decisive analysis of quality and dosimetry in the modern era. MATERIALS/METHODS Random samples of 100 involved-field RT (IFRT) plans in HD16 and 176 plans in HD17 (134 involved-node RT (INRT) and 42 IFRT) were selected for analysis. Evaluation was performed systematically by the reference radiation oncology panel using pre-chemotherapy imaging, recommendation by the reference radiation oncology and RT planning imaging and graded as "correct", "minor" or "major deviation", respectively. RT doses to the target volume and organs at risks (OAR) were analyzed using dose-volume histograms. RESULTS Median RT doses were 20 Gy (19.8 Gy-21.6 Gy) in HD16 and 30 Gy in HD17 (IFRT: 18-30.6 Gy, INRT: 14 Gy-40 Gy). Overall, 84.0%, 69.0%, and 76.1% of RT series in HD16, the IFRT-group of HD17 and the INRT-group of HD17, respectively, were planned correctly. The main reason for major deviation was an insufficient coverage of an involved region (11 %-14.3 %). There was no significant difference in quality between IFRT and INRT in HD17 (p = 0.418 for any deviations; p = 0.466 for major deviations). In comparison to previous GHSG studies in the respective stages, a significant increase in correct RT-series (p<0.001) and decrease in major deviations (p<0.001) occurred. However, doses to OAR varied individually with median values of 4.3 Gy (0.2 Gy-9.2 Gy), 4.7 Gy (0.2 Gy-15.2 Gy) and 3.8 Gy (0.0 Gy-16.0 Gy) for mean doses to the right lung, left lung and heart in HD16, respectively. Correspondingly, values were 9.8 Gy (0.3 Gy-20.0 Gy), 10.5 Gy (0.2 Gy-26.5 Gy) and 13.1 Gy (0.5 Gy-30.4 Gy) for mean doses to the right lung, left lung and heart in HD17, respectively. The size of the planning target volume decreased significantly with INRT compared to IFRT (median values: 1163.1 ml vs. 1464.3 ml; p = 0.043). However, only some OAR-parameters (V25 of the right and left lung, respectively, thyroid and spinal cord) showed significant differences between INRT and IFRT in HD17. The use of intensity-modulated techniques in HD 17 resulted in an increase in V5 and V10 of the lungs with a concomitant decrease in V20-V30. CONCLUSION Quality of RT in the planning and treatment of HL has improved significantly with the latest GHSG study generation. Future analyses will focus on a further individualization of treatment fields. LITERATURE
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Affiliation(s)
- M Oertel
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - D Hering
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - C Kittel
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - N Nacke
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - K Kröger
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - J Kriz
- Department of Radiation Oncology, Alexianer Clemenshospital Muenster, Muenster, Germany
| | - M Fuchs
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - C Baues
- Department of Radiation Oncology and CyberKnife Center, University Hospital of Cologne, Cologne, Germany
| | - D Vordermark
- Department of Radiation Oncology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - R Engenhart-Cabillic
- Department of Radiotherapy and Radiation Oncology, University Hospital Giessen-Marburg, Marburg, Germany
| | - K K Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - P Lukas
- Department of Radiooncology, Medical University Innsbruck, Innsbruck, Austria
| | - H Schmidberger
- Department of Radiotherapy and Radiation Oncology, University Hospital Mainz, Mainz, Germany
| | - S Marnitz-Schulze
- Department of Radiation Oncology and CyberKnife Center, University Hospital of Cologne, Cologne, Germany
| | - P Borchmann
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - A Engert
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - U Haverkamp
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - H T T Eich
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
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Ruhle A, Roesch J, Oertel M, Fabian A, Wegen S, Trommer M, Hering D, Maeurer M, Dobiasch S, von der Grün J, Medenwald D, Süß C, Hoeck M, Fleischmann DF, Löser A, Heß S, Tamaskovic B, Vinsensia M, Hecht M, Nicolay NH. MRI, FDG-PET/CT and Image-Guidance for Re-Irradiation of Locoregionally Recurrent or Second Primary Head-and-Neck Squamous Cell Carcinoma Patients - Results of a Multicenter Cohort Study. Int J Radiat Oncol Biol Phys 2023; 117:e619-e620. [PMID: 37785856 DOI: 10.1016/j.ijrobp.2023.06.2002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To investigate patterns of care and prognostic benefits of MRI, FDG-PET/CT and image-guidance in re-irradiation of locoregionally recurrent or second primary head-and-neck squamous cell carcinomas (r/s HNSCCs) within a multicenter cohort study. MATERIALS/METHODS Patients receiving re-irradiation for r/s HNSCC between 2009 and 2020 at 16 tertiary cancer centers in Germany were retrospectively analyzed in terms of MRI and FDG-PET/CT usage for treatment planning and regarding image-guidance frequency during re-irradiation. Patterns of use of these modalities over time were analyzed by binary logistic regression analysis, and the association between the usage of these modalities and best locoregional treatment response was analyzed with chi-square tests. Cumulative incidence analyses of locoregional failures with death as competing event were performed. RESULTS In the total cohort of 297 patients, 226 (76%) were male, median age was 62 years (IQR, 56-70), and median ECOG was 1 (IQR, 1-2). There were 260 locoregionally recurrent HNSCCs, and 37 second primary HNSCCs; 44 patients (15%) had distant metastases at the time of re-irradiation. MRI and FDG-PET/CT was used for re-irradiation planning in 117 (39%) and 71 patients (24%), respectively. In median, image guidance (IGRT) was performed twice weekly (IQR, 1-5), usually with cone beam CTs or megavolt-CTs, and 85 patients (29%) received daily IGRT during re-irradiation. Usage of MRI (OR = 0.967; 95% CI, 0.892-1.048; p = .416), FDG-PET/CT (OR = 1.053; 95% CI, 0.960-1.156; p = .274), or daily IGRT (OR = 1.057; 95% CI, 0.968-1.115; p = .218) did not increase in frequency over time within the analyzed time span but was significantly dependent on the treatment center (χ2(15), P<.001 for all modalities). Daily IGRT was associated with a higher rate of at least stable disease after re-irradiation as assessed by RECIST criteria (χ2(1) = 4.011, p<.05). There was a trend towards better RECIST-assessed treatment response for MRI (χ2(1) = 3.223, p = .073) and FDG-PET/CT (χ2(1) = 2.792, p = .095) as part of the re-irradiation planning process. Incidence of locoregional failures was not dependent on MRI (SHR = 0.94; 95% CI, 0.67-1.33; p = 0.741, Fine-Gray), FDG-PET/CT (SHR = 0.88; 95% CI, 0.59-1.33; p = 0.552) or daily IGRT (SHR = 0.76; 95% CI, 0.51-1.14, p = 0.182), There was a trend towards lower acute grade 3/4-toxicities in patients receiving daily IGRT (χ2(1) = 3.354, p = 0.067). CONCLUSION Our data suggest that daily IGRT may increase disease control and should be regularly applied for re-irradiation of r/s HNSCCs. MRI and FDG-PET/CT usage were not associated with the incidence of locoregional failures after re-irradiation. However, prospective trials with multiparametric MRI and/or FDG-PET/CT for optimal re-irradiation planning are warranted.
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Affiliation(s)
- A Ruhle
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany; Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - J Roesch
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - M Oertel
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - A Fabian
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - S Wegen
- Department of Radiation Oncology, CyberKnife and Radiotherapy, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - M Trommer
- Department of Radiation Oncology, CyberKnife and Radiotherapy, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - D Hering
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - M Maeurer
- Department of Radiation Oncology, University Hospital Jena, Jena, Germany
| | - S Dobiasch
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - J von der Grün
- Department of Radiotherapy and Oncology, Goethe-University Frankfurt am Main, Frankfurt, Germany
| | - D Medenwald
- Department of Radiation Oncology, University Hospital Halle, Halle, Germany
| | - C Süß
- Department of Radiation Oncology, University Hospital Regensburg, Regensburg, Germany
| | - M Hoeck
- Department of Radiation Oncology, University Hospital Augsburg, Augsburg, Germany
| | - D F Fleischmann
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - A Löser
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Outpatient Center of the UKE GmbH, Hamburg, Germany; Department of Radiation Oncology, University Medical Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - S Heß
- Department of Radiation Oncology, University Hospital Würzburg, Julius-Maximilians-University, Würzburg, Germany
| | - B Tamaskovic
- Department of Radiation Oncology, Düsseldorf University Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - M Vinsensia
- Department of Radiation Oncology, University Hospital Mannheim, Mannheim, Germany
| | - M Hecht
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg, Germany
| | - N H Nicolay
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany; Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
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Sahoo SK, Pathni AK, Krishna A, Sharma B, Cazabon D, Moran AE, Hering D. Financial implications of protocol-based hypertension treatment: an insight into medication costs in public and private health sectors in India. J Hum Hypertens 2023; 37:828-834. [PMID: 36271130 PMCID: PMC10471490 DOI: 10.1038/s41371-022-00766-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/20/2022] [Accepted: 09/30/2022] [Indexed: 11/10/2022]
Abstract
Hypertension is a major public health challenge in low- and middle-income countries (LMICs) and calls for large-scale effective hypertension control programs. Adoption of drug and dose-specific treatment protocols recommended by the World Health Organization-HEARTS Initiative is key for hypertension control programs in LMICs. We estimated the annual medication cost per patient using three such protocols (protocol-1 and protocol-2 with Amlodipine, Telmisartan, using add-on doses and different drug orders, adding Chlorthalidone; protocol-3 with a single-pill combination (SPC) of Amlodipine/Telmisartan with dose up-titration, and addition of Chlorthalidone, if required) in India. The medication cost was simulated with different hypertension control assumptions for each protocol and calculated based on prices in the public and private sectors in India. The estimated annual medication cost per patient for protocol-1 and protocol-2 was $33.88-58.44 and $51.57-68.83 for protocol-3 in the private sector. The medication cost was lower in the generic stores ($5.78-9.57 for protocol-1 and protocol-2, and $7.35-9.89 for protocol-3). The medication cost for patients was the lowest ($2.05-3.89 for protocol-1 and protocol-2, and $2.94-3.98 for protocol-3) in the public sector. At less than $4 per patient per annum, scaling up a hypertension control program with specific treatment protocols is a potentially cost-effective public health intervention. Expanding low-cost generic retail networks would extend affordability in the private sector. The cost of treatment with SPC is comparable with non-SPC protocols and can be adopted in a public health program considering the advantage of simplified logistics, reduced pill burden, improved treatment adherence, and blood pressure control.
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Affiliation(s)
| | | | | | | | | | - Andrew E Moran
- Resolve to Save Lives, New York, NY, USA
- Columbia University Irving Medical Center, New York, NY, USA
| | - Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland.
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Weber MA, Hering D, Nikoleishvili D, Imedadze A, Dughashvili G, Klimiashvili Z, Bekaia E, Shengelia T, Kabalava M, Goguadze O, Emukhvari T, Druker V, Buelna T, Heuser R, Hashemian S, Provanzano R. Durability of the Blood Pressure Effects of Renal Pelvis Denervation in Patients with Hypertension During a 12-Month Observation. Am J Nephrol 2023:000533569. [PMID: 37651994 DOI: 10.1159/000533569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/08/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION We previously completed a trial of renal pelvic denervation for treating hypertension that reduced blood pressure by the 2-month primary endpoint. However, information on the durability of effectiveness is a critical requirement for device therapy and we now report data up to 12 months. METHODS This was an open label single-arm feasibility study in patients with increased blood pressure despite taking an average of 2.7 medications. The key endpoint reported here was ambulatory blood pressure at 12 months following renal pelvic denervation. RESULTS In the 17 patients (mean age 56) studied, there was a reduction from the baseline of 148 + 8.7 mmHg in the primary endpoint of mean daytime systolic blood pressure at 12 months of 19.1 (26.7, 11.6) mmHg, P<0.001, as compared with the 2-month result of 19.4 (24.9, 14.0) mmHg. The 24-hour systolic blood pressure fell by 19.3 (26.7, 11.9), P<0.001, and nighttime systolic fell by 18.7 (27.5, 9.8), P<0.001, mmHg at 12 months. Diastolic pressures also fell significantly from baseline at 12 months. As well, automated office systolic blood pressure was reduced from the baseline of 156.5 + 12.3 by 24.8 (33.2. 16.8) mmHg, P<0.001, at 12 months as compared with 22.4 (31.5, 13.3) at 2-months. . All blood pressure changes at 12 months were not different from those at 2 months, thus confirming the durability of the procedure. There were no serious procedural, clinical or laboratory adverse events related to the intervention. Serum creatinine fell from 1.03 + 0.22 to 0.82 + 0.16 mg/dl and estimated glomerular filtration rate rose from 79.6 + 17.8 to 96.3 + 16.4 ml/min/1.73m2 by 12 months, again sustaining effects seen at 2 months. DISCUSSION/CONCLUSION These findings provide evidence that the significant blood pressure-lowering effects of renal pelvis denervation are durable and safe for at least one year and provide the basis for a pivotal randomized blinded trial to further define the safety and effectiveness of this procedure.
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Noreen N, Bashir F, Khan AW, Safi MM, Lashari WA, Hering D. Determinants of Adherence to Antihypertension Medications Among Patients at a Tertiary Care Hospital in Islamabad, Pakistan, 2019. Prev Chronic Dis 2023; 20:E42. [PMID: 37229649 DOI: 10.5888/pcd20.220231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Medication nonadherence leads to poor health outcomes, frequent complications, and high economic impact. Our objective was to assess the determinants of adherence to medication regimens among patients with hypertension. METHODS We conducted a cross-sectional study of patients with hypertension attending the cardiology clinic of a tertiary care hospital in Islamabad, Pakistan. Data were collected by using semistructured questionnaires. A score of 7 or 8 on the 8-item Morisky Medication Adherence Scale was classified as good adherence, 6 as moderate, and less than 6 as nonadherence. Logistic regression was performed to determine covariates associated with medication adherence. RESULTS We enrolled 450 patients with hypertension (mean age, 54.5 y; SD, 10.6). Medication adherence was good among 115 (25.6%) patients and moderate among 165 (36.7%); 170 (37.8%) patients were nonadherent. Most patients (72.7%) had uncontrolled hypertension. Nearly half (49.6%) were unable to afford monthly medication. In bivariate analysis, nonadherence was associated with female sex (odds ratio [OR], 1.44; P = .003) and long waiting times in the health care facility (OR, 2.93; P = .005); the presence of comorbidities (OR, 0.62; P = .01) was associated with good adherence. In multivariate analysis, nonadherence was associated with unaffordability of treatment (OR, 2.25; P = .002) and uncontrolled hypertension (OR, 3.16; P < .001). Good adherence determinants included adequate counseling (OR, 0.29; P < .001) and education (OR, 0.61; P = .02). CONCLUSION Addressing identified barriers, including medication affordability and patient counseling, should be included in Pakistan's national policy on noncommunicable disease.
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Affiliation(s)
- Nadia Noreen
- Directorate of Central Health Establishments, Prime Minister's Health Complex, National Institutes of Health Premises, Islamabad, Pakistan
| | - Faiza Bashir
- Pakistan Health Research Council, National Institute of Health, Islamabad, Pakistan
| | - Abdul Wali Khan
- Ministry of National Health Services, Khosar Block, Islamabad, Pakistan
| | | | | | - Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
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Krishna A, Murali S, Moran AE, Saxena A, Gill SS, Hering D, Kaur P. Understanding the Role of Staff Nurses in Hypertension Management in Primary Care Facilities in India: A Time-Motion Study. Prev Chronic Dis 2023; 20:E39. [PMID: 37200503 DOI: 10.5888/pcd20.220232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION India is facing a shortage of staff nurses; thus, a better understanding of nurses' workloads is essential for improving and implementing noncommunicable disease (NCD) control strategies. We estimated the proportion of time spent by staff nurses on hypertension and other NCD activities in primary care facilities in 2 states in India. METHODS We conducted a cross-sectional study in 6 purposively selected primary care facilities in Punjab and Madhya Pradesh during July through September 2021. We used a standardized stopwatch to collect data for time spent on direct hypertension activities (measuring blood pressure, counseling, recording blood pressure measurement, and other NCD-related activities), indirect hypertension activities (data management, patient follow-up calls), and non-NCD activities. We used the Mann-Whitney U test to compare the median time spent on activities between facilities using paper-based records and the Simple mobile device-based app (open-source software). RESULTS Six staff nurses were observed for 213 person-hours. Nurses spent 111 person-hours (52%; 95% CI, 45%-59%) on direct hypertension activities and 30 person-hours (14%; 95% CI, 10%-19%) on indirect hypertension activities. The time spent on blood pressure measurement (34 minutes) and documentation (35 minutes) was the maximum time on any given day. Facilities that used paper records spent more median time (39 [IQR, 26-62] minutes) for indirect hypertension activities than those using the Simple app (15 [IQR, 11-19] minutes; P < .001). CONCLUSION Our study found that hypertension activities required more than half of nurses' time in India's primary care facilities. Digital systems can help to reduce the time spent on indirect hypertension activities.
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Affiliation(s)
- Ashish Krishna
- Indian Council of Medical Research - National Institute of Epidemiology, Chennai, Tamil Nadu Housing Board, Ayapakkam, Chennai - 600077
- Resolve to Save Lives, New Delhi, India
| | - Sharan Murali
- Indian Council of Medical Research - National Institute of Epidemiology, Chennai, India
| | - Andrew E Moran
- Resolve to Save Lives, New York, New York
- Columbia University Irving Medical Center, New York, New York
| | - Ashish Saxena
- Directorate of Health Services, Government of Madhya Pradesh, Bhopal, India
| | - Sandeep Singh Gill
- Department of Health and Family Welfare Punjab, Chandigarh, Punjab, India
| | - Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Prabhdeep Kaur
- Indian Council of Medical Research - National Institute of Epidemiology, Chennai, India
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Stec S, Jankowska-Polańska B, Jagielski D, Wileczek A, Josiak K, Śledź J, Reichert A, Kustroń A, Zyśko D, Skonieczny B, Fedorowski A, Ratajska A, Zając M, Hering D, Wąsek W, Stodółkiewicz-Nowarska E. Rationale and design of SAN.OK randomized clinical trial and registry: Comparison of the effects of evidence-based pacemaker therapy and cardioneuroablation in sinus node dysfunction. Cardiol J 2022; 29:1031-1036. [PMID: 36385604 PMCID: PMC9788751 DOI: 10.5603/cj.a2022.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Sebastian Stec
- Division of Electrophysiology, Cardioneuroablation, Catheter Ablation and Cardiac Stimulation, Subcarpathian Center for Cardiovascular Intervention, Sanok, Poland,Elmedica, EP-Network, SKA, Poland
| | | | - Dariusz Jagielski
- Department of Cardiology, Center for Heart Diseases, 4th Military Hospital, Wroclaw, Poland
| | - Antoni Wileczek
- Division of Electrophysiology, Cardioneuroablation, Catheter Ablation and Cardiac Stimulation, Subcarpathian Center for Cardiovascular Intervention, Sanok, Poland,Elmedica, EP-Network, SKA, Poland
| | - Krystian Josiak
- Department of Cardiology, Center for Heart Diseases, 4th Military Hospital, Wroclaw, Poland,Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | | | | | | | - Dorota Zyśko
- Department of Cardiology, Center for Heart Diseases, 4th Military Hospital, Wroclaw, Poland,Department of Emergency Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Bartosz Skonieczny
- Department of Cardiology, Center for Heart Diseases, 4th Military Hospital, Wroclaw, Poland
| | - Artur Fedorowski
- Department of Cardiology, Karolinska University Hospital, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Anna Ratajska
- Psychological Therapeutic and Research Center, University Hospital No. 2, Bydgoszcz, Poland,Department of Humanization, Medicine and Sexology, Institute of Health Sciences, University of Zielona Gora, Poland
| | - Magdalena Zając
- Department of Pedagogy, University of Kazimierz Wielki, Bydgoszcz, Poland
| | - Dagmara Hering
- Department of Hyper tension and Diabetology, Medical University of Gdansk, Poland
| | - Wojciech Wąsek
- Department of Internal Medicine, Institute of Health Sciences, College of Medical Sciences, Rzeszow University, Poland
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Azizi M, Mahfoud F, Weber MA, Sharp ASP, Schmieder RE, Lurz P, Lobo MD, Fisher NDL, Daemen J, Bloch MJ, Basile J, Sanghvi K, Saxena M, Gosse P, Jenkins JS, Levy T, Persu A, Kably B, Claude L, Reeve-Stoffer H, McClure C, Kirtane AJ, Mullin C, Thackeray L, Chertow G, Kahan T, Dauerman H, Ullery S, Abbott JD, Loening A, Zagoria R, Costello J, Krathan C, Lewis L, McElvarr A, Reilly J, Cash M, Williams S, Jarvis M, Fong P, Laffer C, Gainer J, Robbins M, Crook S, Maddel S, Hsi D, Martin S, Portnay E, Ducey M, Rose S, DelMastro E, Bangalore S, Williams S, Cabos S, Rodriguez Alvarez C, Todoran T, Powers E, Hodskins E, Paladugu V, Tecklenburg A, Devireddy C, Lea J, Wells B, Fiebach A, Merlin C, Rader F, Dohad S, Kim HM, Rashid M, Abraham J, Owan T, Abraham A, Lavasani I, Neilson H, Calhoun D, McElderry T, Maddox W, Oparil S, Kinder S, Radhakrishnan J, Batres C, Edwards S, Garasic J, Drachman D, Zusman R, Rosenfield K, Do D, Khuddus M, Zentko S, O'Meara J, Barb I, Foster A, Boyette A, Wang Y, Jay D, Skeik N, Schwartz R, Peterson R, Goldman JA, Goldman J, Ledley G, Katof N, Potluri S, Biedermann S, Ward J, White M, Mauri L, Sobieszczky P, Smith A, Aseltine L, Stouffer R, Hinderliter A, Pauley E, Wade T, Zidar D, Shishehbor M, Effron B, Costa M, Semenec T, Roongsritong C, Nelson P, Neumann B, Cohen D, Giri J, Neubauer R, Vo T, Chugh AR, Huang PH, Jose P, Flack J, Fishman R, Jones M, Adams T, Bajzer C, Mathur A, Jain A, Balawon A, Zongo O, Bent C, Beckett D, Lakeman N, Kennard S, D’Souza RJ, Statton S, Wilkes L, Anning C, Sayer J, Iyer SG, Robinson N, Sevillano A, Ocampo M, Gerber R, Faris M, Marshall AJ, Sinclair J, Pepper H, Davies J, Chapman N, Burak P, Carvelli P, Jadhav S, Quinn J, Rump LC, Stegbauer J, Schimmöller L, Potthoff S, Schmid C, Roeder S, Weil J, Hafer L, Agdirlioglu T, Köllner T, Böhm M, Ewen S, Kulenthiran S, Wachter A, Koch C, Fengler K, Rommel KP, Trautmann K, Petzold M, Ott C, Schmid A, Uder M, Heinritz U, Fröhlich-Endres K, Genth-Zotz S, Kämpfner D, Grawe A, Höhne J, Kaesberger B, von zur Mühlen C, Wolf D, Welzel M, Heinrichs G, Trabitzsch B, Cremer A, Trillaud H, Papadopoulos P, Maire F, Gaudissard J, Sapoval M, Livrozet M, Lorthioir A, Amar L, Paquet V, Pathak A, Honton B, Cottin M, Petit F, Lantelme P, Berge C, Courand PY, Langevin F, Delsart P, Longere B, Ledieu G, Pontana F, Sommeville C, Bertrand F, Feyz L, Zeijen V, Ruiter A, Huysken E, Blankestijn P, Voskuil M, Rittersma Z, Dolmans H, Kroon A, van Zwam W, Vranken J, de Haan. C, Renkin J, Maes F, Beauloye C, Lengelé JP, Huyberechts D, Bouvie A, Witkowski A, Januszewicz A, Kądziela J, Prejbisj A, Hering D, Ciecwierz D, Jaguszewski MJ, Owczuk R. Effects of Renal Denervation vs Sham in Resistant Hypertension After Medication Escalation: Prespecified Analysis at 6 Months of the RADIANCE-HTN TRIO Randomized Clinical Trial. JAMA Cardiol 2022; 7:1244-1252. [PMID: 36350593 PMCID: PMC9647563 DOI: 10.1001/jamacardio.2022.3904] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Importance Although early trials of endovascular renal denervation (RDN) for patients with resistant hypertension (RHTN) reported inconsistent results, ultrasound RDN (uRDN) was found to decrease blood pressure (BP) vs sham at 2 months in patients with RHTN taking stable background medications in the Study of the ReCor Medical Paradise System in Clinical Hypertension (RADIANCE-HTN TRIO) trial. Objectives To report the prespecified analysis of the persistence of the BP effects and safety of uRDN vs sham at 6 months in conjunction with escalating antihypertensive medications. Design, Setting, and Participants This randomized, sham-controlled, clinical trial with outcome assessors and patients blinded to treatment assignment, enrolled patients from March 11, 2016, to March 13, 2020. This was an international, multicenter study conducted in the US and Europe. Participants with daytime ambulatory BP of 135/85 mm Hg or higher after 4 weeks of single-pill triple-combination treatment (angiotensin-receptor blocker, calcium channel blocker, and thiazide diuretic) with estimated glomerular filtration rate (eGFR) of 40 mL/min/1.73 m2 or greater were randomly assigned to uRDN or sham with medications unchanged through 2 months. From 2 to 5 months, if monthly home BP was 135/85 mm Hg or higher, standardized stepped-care antihypertensive treatment starting with aldosterone antagonists was initiated under blinding to treatment assignment. Interventions uRDN vs sham procedure in conjunction with added medications to target BP control. Main Outcomes and Measures Six-month change in medications, change in daytime ambulatory systolic BP, change in home systolic BP adjusted for baseline BP and medications, and safety. Results A total of 65 of 69 participants in the uRDN group and 64 of 67 participants in the sham group (mean [SD] age, 52.4 [8.3] years; 104 male [80.6%]) with a mean (SD) eGFR of 81.5 (22.8) mL/min/1.73 m2 had 6-month daytime ambulatory BP measurements. Fewer medications were added in the uRDN group (mean [SD], 0.7 [1.0] medications) vs sham (mean [SD], 1.1 [1.1] medications; P = .045) and fewer patients in the uRDN group received aldosterone antagonists at 6 months (26 of 65 [40.0%] vs 39 of 64 [60.9%]; P = .02). Despite less intensive standardized stepped-care antihypertensive treatment, mean (SD) daytime ambulatory BP at 6 months was 138.3 (15.1) mm Hg with uRDN vs 139.0 (14.3) mm Hg with sham (additional decreases of -2.4 [16.6] vs -7.0 [16.7] mm Hg from month 2, respectively), whereas home SBP was lowered to a greater extent with uRDN by 4.3 mm Hg (95% CI, 0.5-8.1 mm Hg; P = .03) in a mixed model adjusting for baseline and number of medications. Adverse events were infrequent and similar between groups. Conclusions and Relevance In this study, in patients with RHTN initially randomly assigned to uRDN or a sham procedure and who had persistent elevation of BP at 2 months after the procedure, standardized stepped-care antihypertensive treatment escalation resulted in similar BP reduction in both groups at 6 months, with fewer additional medications required in the uRDN group. Trial Registration ClinicalTrials.gov Identifier: NCT02649426.
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Affiliation(s)
- Michel Azizi
- Université Paris Cité, F-75006 Paris, France,Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, F-75015 Paris, France,INSERM, CIC1418, F-75015 Paris, France
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge
| | - Michael A. Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York
| | - Andrew S. P. Sharp
- University Hospital of Wales, Cardiff and University of Exeter, Exeter, United Kingdom
| | - Roland E. Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Melvin D. Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | | | - Joost Daemen
- Erasmus MC, University Medical Center Rotterdam, Department of Cardiology, Rotterdam, the Netherlands
| | - Michael J. Bloch
- Department of Medicine, University of Nevada School of Medicine, Vascular Care, Renown Institute of Heart and Vascular Health, Reno
| | - Jan Basile
- Division of Cardiovascular Medicine, Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston
| | | | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | | | | | - Terry Levy
- Royal Bournemouth Hospital, Dorset, United Kingdom
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Benjamin Kably
- Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Department of Pharmacology, Paris, France
| | | | | | | | - Ajay J. Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Danny Do
- for the RADIANCE-HTN Investigators
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- for the RADIANCE-HTN Investigators
| | | | - Thu Vo
- for the RADIANCE-HTN Investigators
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Hering D, Nikoleishvili D, Imedadze A, Dughashvili G, Klimiashvili Z, Bekaia E, Shengelia T, Kobalava M, Goguadze O, Emukhvari T, Druker V, Sackner-Bernstein J, Weber MA. Transurethral Renal Pelvic Denervation: A Feasibility Trial in Patients with Uncontrolled Hypertension. Hypertension 2022; 79:2787-2795. [PMID: 36254733 DOI: 10.1161/hypertensionaha.122.20048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Endovascular renal denervation reduces blood pressure (BP). We explored an alternative approach to renal denervation using radiofrequency energy delivered across the renal pelvis utilizing the natural orifice of the urethra and the ureters. METHODS This open-label, single-arm feasibility study enrolled patients with uncontrolled hypertension despite antihypertensive drug therapy. The primary effectiveness endpoint was the change in ambulatory daytime systolic BP (SBP) 2 months following renal pelvic denervation. RESULTS The 18 patients (mean age 56±12 years) enrolled were taking an average of 2.7 antihypertensive drugs daily. Renal pelvic denervation reduced mean daytime SBP by 19.4 mm Hg (95% CI, -24.9 to -14.0, P<0.001) from its baseline of 148.4±8.7 mm Hg. Mean nighttime (-21.4 mm Hg [95% CI, -29.5 to -13.3]) and 24-hour (-20.3 mm Hg [95% CI, -26.2 to -14.5]) SBP each fell significantly (P<0.001) as did the corresponding diastolic BPs (P<0.001). Office SBP decreased from 156.5±12.3 mm Hg to 22.4 mm Hg (95% CI, -31.5 to -13.3, P<0.001) by 2 months. Office SBP decreased over time (P=0.001 by linear trend test) starting by day 1 with a decrease of 8.3 mm Hg (95% CI, -16.9 to 0.3, P=0.057). There were no serious adverse events. Mild transitory back pain followed the procedure. Serum creatinine decreased by 0.08 mg/dL (P=0.02) and estimated glomerular filtration rate increased by 7.2 mL/min/1.73m2 (P=0.03) 2 months following ablation procedure. CONCLUSIONS Based on these initial findings, a well-powered, sham-controlled trial of renal pelvic denervation to more fully establish its safety and effectiveness is now justified in patients with uncontrolled hypertension despite drug therapy. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT05440513.
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Affiliation(s)
- Dagmara Hering
- College of Health Solutions, Arizona State University, Phoenix, AZ (D.H.).,Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (D.H.)
| | - David Nikoleishvili
- Israeli-Georgian Medical Research Clinic Helsicore, Tbilisi, Georgia (D.N., G.D., E.B., M.K., T.E.)
| | | | - Gvantsa Dughashvili
- Israeli-Georgian Medical Research Clinic Helsicore, Tbilisi, Georgia (D.N., G.D., E.B., M.K., T.E.)
| | | | - Eter Bekaia
- Israeli-Georgian Medical Research Clinic Helsicore, Tbilisi, Georgia (D.N., G.D., E.B., M.K., T.E.)
| | - Tamar Shengelia
- Pineo Medical Ecosystem, Tbilisi, Georgia (A.I., Z.K., T.S., O.G.)
| | - Mamuka Kobalava
- Israeli-Georgian Medical Research Clinic Helsicore, Tbilisi, Georgia (D.N., G.D., E.B., M.K., T.E.)
| | - Otar Goguadze
- Pineo Medical Ecosystem, Tbilisi, Georgia (A.I., Z.K., T.S., O.G.)
| | - Tamar Emukhvari
- Israeli-Georgian Medical Research Clinic Helsicore, Tbilisi, Georgia (D.N., G.D., E.B., M.K., T.E.)
| | | | | | - Michael A Weber
- State University of New York, Downstate Medical School, Brooklyn, NY (M.A.W.)
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Guillamat-Prats R, Hering D, Rami M, Haerdtner C, Santovito D, Rinne P, Pagano S, Nicolas Vuilleumier N, Schmid S, Janjic A, Enard W, Weber C, Maegdefessel L, Hilgendorf I, Steffens S. GPR55 deficiency in B-cells promotes atherosclerosis and regulates plasma cell maturation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.3052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Atherosclerosis is a chronic and multifactorial disease accompanied by an imbalance between resolving and pro-inflammatory lipid mediators. Targeting lipid signaling might offer new therapeutical targets for improving the clinical outcome in cardiovascular disease patients. We considered lysophosphatidylinositol (LPI) and its receptor G protein-coupled receptor (GPR)55 as a potential modulator of atherosclerosis. Its role in regulating atherosclerosis and B cell function is unknown.
We hypothesize that GPR55 signaling affects atherosclerosis by regulating B cell function.
Atherosclerotic plaques were compared between apolipoprotein-E-deficient (ApoE−/−) and ApoE−/−Gpr55−/− mice after 4 to 16 weeks Western Diet (WD; 0.15% cholesterol; n=12–15 per group). To test the role of B cell GPR55, we generated mixed chimeras by irradiating low density lipoprotein receptor deficient (Ldlr−/−) mice and reconstituting with a mixture of μMT and wildtype or μMT and Gpr55−/− bone marrow cells. Circulating B cells were sorted and bulk RNA sequencing analysis was performed. We performed atheroma plaque characterization, qPCR and ELISA of tissue lysates and measure plasma immunoglobulins. Circulating and tissue leukocyte counts were determined.
We confirmed Gpr55 expression on circulating B cells, which was higher compared to T and myeloid cells. ApoE−/−Gpr55−/− mice had significantly larger plaques after 4 & 16 weeks WD compared to ApoE−/−, with increased body weight & cholesterol levels. In addition, global Gpr55 deficiency resulted in enhanced aortic pro-inflammatory cytokine mRNA expression, a massively upregulated IgG levels and increased counts of splenic germinal center and plasma cells. ApoE−/−Gpr55−/− B-cell RNA-seq analysis showed 460 differential expressed genes compared to ApoE−/−. The main pathways affected were calcium ion transport, immunoglobulin production, T & B cell activation, and cellular response to stress. B cell specific Gpr55 deficiency blunted the metabolic effects but still translated in larger atherosclerotic plaques and elevated plasma IgG levels.
Both global and B cell-restricted Gpr55 deficiency promotes atherosclerosis and is associated with a pro-inflammatory phenotype.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The authors received funds from the Deutsche Forschungsgemeinschaft (STE1053/6-1, STE1053/8-1 to S.S. and SFB1123 to S.S., C.W. and L.M.), the German Ministry of Research and Education (DZHK FKZ 81Z0600205 to S.S.) and the LMU Medical Faculty FöFoLe program (1061 to R.G.P.). I.H. is supported by the DFG (HI1573/2 and CRC1425 #422681845).
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Affiliation(s)
- R Guillamat-Prats
- Institute for Cardiovascular Prevention (IPEK-LMU) , Munich , Germany
| | - D Hering
- Institute for Cardiovascular Prevention (IPEK-LMU) , Munich , Germany
| | - M Rami
- Institute for Cardiovascular Prevention (IPEK-LMU) , Munich , Germany
| | - C Haerdtner
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology I , Freiburg , Germany
| | - D Santovito
- Institute for Cardiovascular Prevention (IPEK-LMU) , Munich , Germany
| | - P Rinne
- University of Turku , Turku , Finland
| | - S Pagano
- Geneva University Hospitals , Geneva , Switzerland
| | | | - S Schmid
- Institute for Cardiovascular Prevention (IPEK-LMU) , Munich , Germany
| | - A Janjic
- Ludwig-Maximilians University, Anthropology and Human Genomics, Faculty of Biology, , Munich , Germany
| | - W Enard
- Ludwig-Maximilians University, Anthropology and Human Genomics, Faculty of Biology, , Munich , Germany
| | - C Weber
- Institute for Cardiovascular Prevention (IPEK-LMU) , Munich , Germany
| | | | - I Hilgendorf
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology I , Freiburg , Germany
| | - S Steffens
- Institute for Cardiovascular Prevention (IPEK-LMU) , Munich , Germany
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16
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Merks P, Cameron JD, Balcerzak M, Religioni U, Świeczkowski D, Konstanty M, Hering D, Szymański FM, Jaguszewski M, Vaillancourt R. Evaluation of a pharmacist-led intervention to improve medication adherence in patients initiating dabigatran treatment: a comparison with standard pharmacy practice in Poland. BMC Prim Care 2022; 23:210. [PMID: 35986241 PMCID: PMC9389729 DOI: 10.1186/s12875-022-01821-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 08/05/2022] [Indexed: 11/10/2022]
Abstract
Backround Dabigatran is a direct thrombin inhibitor used to treat cardiac arrhythmias, and rates of non-adherence to dabigatran in Polish populations are high. The current study examined how a pharmacist-led intervention of counselling with pictogram-enhanced medication instructions, and smartphone medication reminders, can improve adherence to dabigatran. Methods A 3-month pharmacist-led intervention was conducted in community pharmacies in Poland on 325 men and women filling a dabigatran prescription for the first time. Participating pharmacies were assigned into the Control Group (n = 172 patients) or the Intervention Group (n = 153 patients). The primary outcome of this prospective study was self-reported medication adherence assessed at 3 time points (day 7, day 21, and day 90) after initiation of dabigatran. Results Patients in the Intervention Group were significantly more adherent (mean days on Dabigatan/week) than the Control Group at 7 days (6.0 ± 0.9 vs 5.4 ± 1.1, p < 0.0001), 21 days (5.6 ± 1.0 vs 4.9 ± 1.3, p < 0.0001), and 90 days (5.5 ± 1.3 vs 4.4 ± 2.0, p < 0.0001), respectively. The percentage of patients in the Intervention Group who reported taking dabigatran twice/day as prescribed was significantly higher than the Control Group at 7 days (82.7% vs 71.4%, p = 0.0311), at 21 days (84.4% vs 58%, p < 0.0001), and at 90 days (78.4% vs 39.7%, p < 0.0001), respectively. The proportion of patients fully adherent (every day, twice/day) at 90 days was significantly higher in the Intervention Group than in the Control Group (26.1% vs 13.2%, p = 0.0145). Conclusions Our findings support the role for interventions in community pharmacies in Poland to improve medication adherence, thus providing evidence for the efficacy of a pharmacist-led pictogram and smartphone-based program to support optimal dabigatran treatment.
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17
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Guillamat-Prats R, Hering D, Rami M, Hädtner C, Santovito D, Rinne P, Bindila L, Hristov M, Pagano S, Vuilleumier N, Schmid S, Janjic A, Enard W, Weber C, Maegdefessel L, Faussner A, Hilgendorf I, Steffens S. B cell-specific GPR55 deficiency promotes atherosclerosis. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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18
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Gruszka K, Drożdż T, Wojciechowska W, Jankowski P, Terlecki M, Bijak M, Hering D, Bilo G, Drożdż D, Rajzer M. Effects of uric acid-lowering therapy in patients with essential arterial hypertension. Blood Press Monit 2022; 27:152-160. [PMID: 35120026 DOI: 10.1097/mbp.0000000000000578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Asymptomatic hyperuricemia (AHU) is elevated serum uric acid (UA) without symptoms. This study aimed to determine the effects of AHU treatment with allopurinol on selected hypertension-mediated organ damage (HMOD) indices in patients with uncomplicated essential arterial hypertension (AH). METHODS Patients aged 30-70 years with AHU and AH grade 1-2 with adequate blood pressure (BP) control, without previous urate-lowering therapy (ULT), were divided into two groups: (a) ULT (receiving allopurinol) and (b) control (age- and sex-matched patients without ULT). Both received a UA-lowering diet. BP (office, 24 h and central), echocardiographic parameters, carotid intima-media thickness (IMT) and lab tests [high-sensitivity C-reactive protein (hs-CRP)] were measured at baseline and at 6 months follow-up. RESULTS Of 100 participants, 87 (44 ULT, 43 controls) completed the study. At 6 months follow-up, there was a greater reduction in serum UA concentration in the ULT group than in the control group. Patients receiving allopurinol had significant reductions in office systolic and diastolic BP, central systolic BP, pulse pressure, IMT (0.773 ± 0.121 vs. 0.752 ± 0.13 mm, P = 0.044) and hs-CRP (3.36 ± 2.73 vs. 2.74 ± 1.91 mg/L, P = 0.028) compared to controls. Multivariate regression analysis revealed the independent relationship between reduction in IMT and UA lowering (P < 0.026). CONCLUSION In patients with AH and AHU, treatment with allopurinol leads to improvement in BP control and reduction in HMOD intensity, in particular IMT. The decrease in hs-CRP concentration associated with ULT may have a beneficial effect on a patient's long-term prognosis.
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Affiliation(s)
- Krystian Gruszka
- Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Krakow
| | - Tomasz Drożdż
- Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Krakow
| | - Wiktoria Wojciechowska
- Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Krakow
| | - Piotr Jankowski
- Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Krakow
| | - Michał Terlecki
- Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Krakow
| | - Magdalena Bijak
- Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Krakow
| | - Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Bilo
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Dorota Drożdż
- Jagiellonian University Medical College, Department of Pediatric Nephrology and Hypertension, Krakow, Poland
| | - Marek Rajzer
- Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Krakow
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19
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Harężlak T, Religioni U, Szymański FM, Hering D, Barańska A, Neumann-Podczaska A, Allan M, Merks P. Drug Interactions Affecting Kidney Function: Beware of Health Threats from Triple Whammy. Adv Ther 2022; 39:140-147. [PMID: 34845649 PMCID: PMC8799554 DOI: 10.1007/s12325-021-01939-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022]
Abstract
Triple whammy (TW) is a potentially dangerous drug combination that can lead to acute kidney injury (AKI). This drug interaction (DI) occurs when angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) are used together with diuretics and non-steroidal anti-inflammatory drugs (NSAIDs). One of the most serious consequences of TW DI is an increased risk of developing pre-renal acute kidney injury (pr-AKI). The term TW, in the context of a DI affecting kidney function, is not very widespread. The aim of this article was to gather information on this interaction. Previous knowledge on the mechanism of TW and how to increase patient awareness of this interaction is described. In addition, the specific nature of the acute kidney injury (AKI) caused by triple whammy (AKITW) is presented. On the basis of the current state of knowledge, recommendations on how to manage the TW DI are also demonstrated.
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Affiliation(s)
- Tomasz Harężlak
- Collegium Medicum in Bydgoszcz, Nicolaus University, Torun, Poland
- 10 Military Research Hospital in Bydgoszcz, Bydgoszcz, Poland
| | - Urszula Religioni
- Collegium of Business Administration, Warsaw School of Economics, Madalinskiego 6/8, 02-513, Warsaw, Poland.
| | - Filip M Szymański
- Department of Civilization Diseases, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, Kazimierza Woycickiego 1 Street, 01-938, Warsaw, Poland
| | - Dagmara Hering
- First Department of Cardiology, Medical University of Gdansk, Gdańsk, Poland
| | - Agnieszka Barańska
- Department of Computer Science and Medical Statistics With the Studio of Remote Learning, Medical University of Lublin, 20-954, Lublin, Poland
| | | | - Matthew Allan
- Ulladulla Medical Clinic, Philip Centre Shop 6/Princes Highway, Ulladulla, NSW, 2539, Australia
| | - Piotr Merks
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, Kazimierza Woycickiego 1 Street, 01-938, Warsaw, Poland
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20
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Czerw A, Religioni U, Szymański F, Nieradko-Heluszko A, Mękal D, Hering D, Kowalczuk A, Merks P, Borowska M, Bogdan M, Pajewska M. Normalization of the Mini-MAC (Mental Adjustment to Cancer) Questionnaire among Cancer Patients. Int J Environ Res Public Health 2021; 18:ijerph182312603. [PMID: 34886329 PMCID: PMC8656664 DOI: 10.3390/ijerph182312603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 11/16/2022]
Abstract
Cancer is associated with discomfort and many changes in patients’ lives to which they must adapt. The main objective of the study was to assess the use of the mini-MAC questionnaire scale among persons diagnosed with malignant cancer and to develop standards allowing differentiation of patients with diagnosed cancer in terms of their style of adjustment to the disease. The mini-MAC questionnaire is a widely used tool in assessing coping strategies among cancer patients. Sten standards have been developed to determine the level of results on the questionnaire scales in the low–average–high categories. The study included 1187 patients diagnosed with malignant cancer who are covered by outpatient care at the Maria Sklodowska-Curie Institute—Oncology Center in Warsaw. The questionnaire concerning mental adjustment to cancer was used (mini-MAC). Patients with cancer most often adopt strategies of fighting spirit and positive reevaluation. The variables that differentiate the results most significantly include gender, presence of metastasis, and the state of undergoing chemotherapy. The mini-MAC questionnaire should be a tool for psycho-oncological diagnosis of patients’ attitudes towards cancer. The obtained results indicate that cancer patients are characterized by their constructive style of adjustment to the disease.
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Affiliation(s)
- Aleksandra Czerw
- Department of Health Economics and Medical Law, Medical University of Warsaw, 02-091 Warsaw, Poland;
- Department of Economic and System Analyses, National Institute of Public Health—NIH—National Research Institute, 00-791 Warsaw, Poland;
- Correspondence:
| | - Urszula Religioni
- Collegium of Business Administration, Warsaw School of Economics, 02-513 Warsaw, Poland;
| | - Filip Szymański
- Departament of Civilization Diseases, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, Kazimierza Woycickiego 1 Street, 01-938 Warsaw, Poland;
| | - Agnieszka Nieradko-Heluszko
- Subdepartment of Social Medicine and Public Health, Department of Social Medicine, Pomeranian Medical University in Szczecin, 70-103 Szczecin, Poland;
| | - Dominika Mękal
- Department of Oncological Prevention, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Dagmara Hering
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, 80-211 Gdansk, Poland;
| | | | - Piotr Merks
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, 01-938 Warszawa, Poland;
| | - Mariola Borowska
- Department of Health Economics and Medical Law, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Magdalena Bogdan
- Department of Social Medicine and Public Health, Medical University of Warsaw, 02-007 Warsaw, Poland;
| | - Monika Pajewska
- Department of Economic and System Analyses, National Institute of Public Health—NIH—National Research Institute, 00-791 Warsaw, Poland;
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21
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Jaguszewski MJ, Gasecka A, Hering D, Filipiak KJ, Szarpak L, Fijałkowski M, Gruchała M. Levosimendan improves the acute course of takotsubo syndrome: a pooled analysis. ESC Heart Fail 2021; 8:4360-4363. [PMID: 34342162 PMCID: PMC8497347 DOI: 10.1002/ehf2.13486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/11/2021] [Accepted: 06/07/2021] [Indexed: 01/31/2023] Open
Affiliation(s)
| | - Aleksandra Gasecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Dagmara Hering
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Krzysztof J Filipiak
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Lukasz Szarpak
- Maria Sklodowska-Curie Medical Academy in Warsaw, Warsaw, Poland.,Maria Sklodowska-Curie Białystok Oncology Center, Białystok, Poland
| | - Marcin Fijałkowski
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Marcin Gruchała
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
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22
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Genc A, Gilis-Malinowska N, Kasprzyk P, Gasecka A, Perdyan A, Kacperczyk J, Fijalkowski M, Gruchala M, Szarpak L, Safiejko K, Filipiak KJ, Hering D, Jaguszewski M. Malignancy predicts short-term mortality in Takotsubo: insights from a meta-analysis of 125 359 patients. ESC Heart Fail 2021; 8:4357-4359. [PMID: 34227750 PMCID: PMC8497220 DOI: 10.1002/ehf2.13428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/12/2021] [Accepted: 05/02/2021] [Indexed: 12/13/2022] Open
Affiliation(s)
- Alicja Genc
- 1st Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | | | - Piotr Kasprzyk
- 1st Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Aleksandra Gasecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.,Laboratory of Experimental Clinical Chemistry and Vesicle Observation Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Adrian Perdyan
- 1st Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Justyna Kacperczyk
- Department of Internal Medicine and Cardiology, Collegium Medicum of University of Warmia and Mazury, Olsztyn, Poland
| | - Marcin Fijalkowski
- 1st Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Marcin Gruchala
- 1st Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Lukasz Szarpak
- Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland.,Maria Sklodowska-Curie Medical Academy in Warsaw, Warsaw, Poland
| | - Kamil Safiejko
- Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
| | - Krzysztof J Filipiak
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Dagmara Hering
- 1st Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Milosz Jaguszewski
- 1st Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
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23
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Hering D, Hubbard BS, Weber MA, Heuser RR. Impact of Renal Pelvic Denervation on Systemic Hemodynamics and Neurohumoral Changes in a Porcine Model. Am J Nephrol 2021; 52:429-434. [PMID: 34038910 DOI: 10.1159/000516186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/25/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The blood pressure (BP) response to arterial renal denervation (RDN) is variable. METHODS This study examined the effectiveness of renal pelvic denervation (RPD) on BP, heart rate (HR), norepinephrine (NE), and histopathology in 42 swine. NE levels were measured immediately, 7, 14, 30, and 90 days after RPD. Intra-arterial BP and HR were measured throughout RPD and after 14 days in 5 swine. RESULTS During the procedure, RPD immediately reduced systolic BP (-20.6 ± 18.3 mm Hg), diastolic BP (-6.0 ± 8.3 mm Hg), and HR (-5.4 ± 5.6 bpm), which remained decreased at follow-up. The porcine kidneys had a mean NE reduction of 76% directly post procedure and 60% after 7 days, 64% after 14 days, 57% after 30 days, and 65% after 90 days. Histopathological examination confirmed nerve ablation. CONCLUSIONS These preliminary findings suggest that the renal pelvis nerve ablation is an encouraging target for RDN. Clinical trials are required to test the feasibility of RPD in human hypertension.
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Affiliation(s)
- Dagmara Hering
- Arizona State University, Tempe, Arizona, USA
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | | | - Michael A Weber
- State University of New York, Downstate Medical Center, New York, New York, USA
| | - Richard R Heuser
- University of Arizona College of Medicine, Phoenix, Arizona, USA
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24
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Merks P, Świeczkowski D, Balcerzak M, Religioni U, Drelich E, Krysiński J, Hering D, Jaguszewski M. Patient counselling service with the use of pictograms as the example of pharmacist intervention to improving compliance and medicine safety. Cardiol J 2021; 28:879-886. [PMID: 33634843 PMCID: PMC8747827 DOI: 10.5603/cj.a2021.0022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background Pharmaceutical pictograms have been designed to help communicate medication instructions to patients. Pictograms used within a patient counseling service can significantly improve medication compliance and adherence. The study aimed to assess the improvement of adherence to therapy with the use of pictogram intervention in comparison to standard pharmacy practice in community pharmacies. Methods Pictograms informing about the proper way of using metoprolol prolonged release tablets were designed to be used on the packages of the drug in community pharmacies. Pharmacies belonging to a pharmacy practice-based research network were randomly assigned to a group using pictograms when dispensing the drug or one following their normal practice. At the first visit, all patients answered a structured questionnaire about their medication behavior in the preceding 7 days. The same questions were asked 4 weeks later to follow-up treatment adherence change and compare patients from pictogram group and standard practice group. Descriptive statistics was used to analyze the data, and the McNemar test was used to compare categorical data at baseline and follow-up. Results Of a total of 253 patients screened, 117 and 104 patients completed the study in the standard practice and pictogram groups, respectively. The use of pictograms significantly improved medication adherence in the following areas: not omitting doses (p < 0.0001), not crushing tablets (p = 0.004), number of tablets/day (p = 0.49), and time of use (p = 0.001), compared to the standard practice group. Conclusions Our results suggest that pictograms are effective in conveying messages about the proper way of using medications, and they increase treatment adherence, in comparison to standard dispensing practice.
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Affiliation(s)
- Piotr Merks
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, Poland., Auditorium Maximum, bud. 21 pok. 201 (II piętro) ul. Kazimierza Wóycickiego 1/3, 01-938 Warszawa, 01-938 Warszawa, Poland.
| | | | | | - Urszula Religioni
- Collegium of Business Administration, Warsaw School of Economics, Warsaw, Poland
| | - Ewelina Drelich
- Department of Pharmaceutical Technology, Collegium Medicum, Bydgoszcz, Poland, Nicolaus University, Torun, Poland
| | - Jerzy Krysiński
- Department of Pharmaceutical Technology, Collegium Medicum, Bydgoszcz, Poland, Nicolaus University, Torun, Poland
| | - Dagmara Hering
- First Department of Cardiology, Medical University of Gdansk, Poland
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25
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Scuteri A, Benetos A, Sierra C, Coca A, Chicherio C, Frisoni GB, Gasecki D, Hering D, Lovic D, Manios E, Petrovic M, Qiu C, Shenkin S, Tzourio C, Ungar A, Vicario A, Zaninelli A, Cunha PG. Routine assessment of cognitive function in older patients with hypertension seen by primary care physicians: why and how-a decision-making support from the working group on 'hypertension and the brain' of the European Society of Hypertension and from the European Geriatric Medicine Society. J Hypertens 2021; 39:90-100. [PMID: 33273363 DOI: 10.1097/hjh.0000000000002621] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
: The guidelines on hypertension recently published by the European Societies of Hypertension and Cardiology, have acknowledged cognitive function (and its decline) as a hypertension-mediated organ damage. In fact, brain damage can be the only hypertension-mediated organ damage in more than 30% of hypertensive patients, evolving undetected for several years if not appropriately screened; as long as undetected it cannot provide either corrective measures, nor adequate risk stratification of the hypertensive patient.The medical community dealing with older hypertensive patients should have a simple and pragmatic approach to early identify and precisely treat these patients. Both hypertension and cognitive decline are undeniably growing pandemics in developed or epidemiologically transitioning societies. Furthermore, there is a clear-cut connection between exposure to the increased blood pressure and development of cognitive decline.Therefore, a group of experts in the field from the European Society of Hypertension and from the European Geriatric Medicine Society gathered together to answer practical clinical questions that often face the physician when dealing with their hypertensive patients in a routine clinical practice. They elaborated a decision-making approach to help standardize such clinical evaluation.
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Affiliation(s)
- Angelo Scuteri
- Department of Medical, Surgical, and Experimental Sciences, University of Sassari, Sassari
- Sardinia Aging Well Network, Reference Site of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA), Bologna, Italy
| | - Athanasios Benetos
- Department of Geriatrics, CHRU Nancy and INSERM DCAC, Université de Lorraine, Nancy, France
| | - Cristina Sierra
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - António Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Christian Chicherio
- Department of Geriatrics and Rehabilitation, Memory Center, Geneva University Hospitals
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
| | - Giovanni B Frisoni
- Department of Geriatrics and Rehabilitation, Memory Center, Geneva University Hospitals
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
| | | | - Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
| | - Dragan Lovic
- Cardiology Department, Clinic for Internal Disease, Hypertensive Centre Singidunum University, School of Medicine Nis, Nis, Serbia
| | - Efstathios Manios
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School of Athens, Alexandra Hospital, Athens, Greece
| | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Chengxuan Qiu
- Department of Neurobiology, Care Sciences and Society, Aging Research Center and Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Susan Shenkin
- Division of Geriatric Medicine, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Cristophe Tzourio
- University Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, CHU Bordeaux, Bordeaux, France
| | - Andrea Ungar
- Division Geriatrica UTIG, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Augusto Vicario
- Heart and Brain Unit, Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - Augusto Zaninelli
- Department of General Practice, School of Medicine, University of Florence, Florence, Italy
| | - Pedro G Cunha
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Serviço de Medicina Interna do Hospital da Senhora da Oliveira, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
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Guillamat-Prats R, Hering D, Rami M, Haerdtner C, Bindila L, Faussner A, Hilgendorf I, Steffens S. B cell-specific GPR55 deficiency promotes atherosclerosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atherosclerosis is accompanied by an imbalance between resolving and pro-inflammatory lipid mediators. Targeting lipid signaling pathways might offer a new anti-inflammatory therapy for improving the clinical outcome in cardiovascular disease patients. We considered lysophosphatidylinositol (LPI) and its receptor G protein-coupled receptor (GPR)55 as a potential modulator of atherosclerosis. Its role in regulating atherosclerosis and B cell function is unknown.
Hypothesis
We assessed the hypothesis that GPR55 signaling causally affects atherosclerosis and whether it has a specific role in regulating B cell function in this disease.
Methods
Atherosclerotic plaques were compared between apolipoprotein E deficient (ApoE−/−) and ApoE−/−Gpr55−/− mice after 4 to 16 weeks Western Diet (WD; 0.15% cholesterol; n=12–15 per group). To specifically test the role of B cell GPR55 in atherosclerosis, we generated mixed chimeras by lethally irradiating low density lipoprotein receptor deficient (Ldlr−/−) mice and reconstituting with a mixture of μMT and wildtype (control) or μMT and Gpr55−/− bone marrow cells. Circulating B cells were sorted and bulk RNA sequencing analysis was performed. We performed lipid and immunostainings of murine aortic root plaques, qPCR and ELISA of tissue lysates, as well as multiplex analysis of plasma immunoglobulins. Leukocyte plasma and tissue counts were determined by flow cytometry.
Results
GPR55 expression in mouse and human atherosclerotic plaques was detected by immunostaining. Furthermore, we confirmed murine Gpr55 mRNA expression on sorted circulating B220+B cells via qPCR, which was higher compared to CD3+ T cells, while CD11+ myeloid cells as well as NK cells had only low Gpr55 mRNA levels. ApoE−/−Gpr55−/− mice had significantly larger plaques after 4&16 weeks WD compared to ApoE−/− controls, with more pronounced body weight increases and higher cholesterol levels at the 16 weeks WD time point. In addition, global Gpr55 deficiency resulted in enhanced aortic pro-inflammatory cytokine mRNA expression (IL-1β, IL-6, TNFα) and a massively upregulated IgG1 plasma levels and increased percentages of splenic germinal center and plasma cells. B-cell RNA-seq analysis showed 460 differential expressed regulated genes in the ApoE−/−Gpr55−/− compared to ApoE−/−. The main pathways affected were calcium ion transport, immunoglobulin production, negative regulation of phosphorylation, and cellular component morphogenesis, suggesting a dsysregulation of B cell function. B cell specific Gpr55 deficiency blunted the metabolic effects on body weight and cholesterol, but still translated in larger atherosclerotic plaques and elevated plasma IgG levels compared to the respective controls.
Conclusion
Both global and B cell-restricted Gpr55 deficiency promotes atherosclerosis and is associated with a more pro-inflammatory phenotype. Our findings suggest a novel role for GPR55 in regulating B cell development and function.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Deutsche Forschungsgemeinschaft (DFG)
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Affiliation(s)
| | - D Hering
- Institute for Cardiovascular Prevention (IPEK), Munich, Germany
| | - M Rami
- Institute for Cardiovascular Prevention (IPEK), Munich, Germany
| | - C Haerdtner
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology I, Freiburg, Germany
| | - L Bindila
- Johannes Gutenberg University Mainz (JGU), Institute of Physiological Chemistry, Mainz, Germany
| | - A Faussner
- Institute for Cardiovascular Prevention (IPEK), Munich, Germany
| | - I Hilgendorf
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology I, Freiburg, Germany
| | - S Steffens
- Institute for Cardiovascular Prevention (IPEK), Munich, Germany
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27
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Zaldivia MTK, Hering D, Marusic P, Sata Y, Lee R, Esler MD, Htun NM, Duval J, Hammond L, Flierl U, Wang X, Drummond GR, Walton A, Gardiner EE, Andrews RK, Schlaich MP, Peter K. Successful renal denervation decreases the platelet activation status in hypertensive patients. Cardiovasc Res 2020; 116:202-210. [PMID: 30715163 DOI: 10.1093/cvr/cvz033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 12/18/2018] [Accepted: 01/31/2019] [Indexed: 12/23/2022] Open
Abstract
AIMS To determine whether renal denervation (RDN) in hypertensive patients affects the platelet activation status. METHODS AND RESULTS We investigated the effect of RDN on the platelet activation status in 41 hypertensive patients undergoing RDN. Ambulatory blood pressure (BP), plasma sympathetic neurotransmitter Neuropeptide Y, and platelet activation markers were measured at baseline, at 3 months, and 6 months after RDN. RDN significantly decreased BP at 3 months (150.6 ± 11.3/80.9 ± 11.4 mmHg to 144.7 ± 12.0/77.1 ± 11.1 mmHg; P < 0.01) and at 6 months (144.3 ± 13.8/78.3 ± 11.1 mmHg; P < 0.01). Plasma levels of the sympathetic neurotransmitter Neuropeptide Y, an indicator of sympathetic nerve activity, were significantly decreased at 3 months (0.29 ± 0.11 ng/mL to 0.23 ± 0.11 ng/mL; P < 0.0001) and at 6 months (0.22 ± 0.12 ng/mL; P < 0.001) after RDN. This was associated with a reduction in platelet membrane P-selectin expression (3 months, P < 0.05; 6 months, P < 0.05), soluble P-selectin (6 months, P < 0.05), circulating numbers of platelet-derived extracellular vesicles (EVs) (3 months, P < 0.001; 6 months, P < 0.01), and phosphatidylserine expressing EVs (3 months, P < 0.001; 6 months, P < 0.0001), indicative of a reduction in platelet activation status and procoagulant activity. Only patients who responded to RDN with a BP reduction showed inhibition of P-selectin expression at 3 months (P < 0.05) and 6 months (P < 0.05) as well as reduction of glycoprotein IIb/IIIa activation at 3 months (P < 0.05). Notably, 13 patients who took aspirin did not show significant reduction in platelet P-selectin expression following RDN. CONCLUSION Our results imply a connection between the sympathetic nervous system and the platelet activation status and provide a potential mechanistic explanation by which RDN can have favourable effects towards reducing cardiovascular complications.
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Affiliation(s)
- Maria T K Zaldivia
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Dagmara Hering
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia.,Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Petra Marusic
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia.,Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Yusuke Sata
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Rebecca Lee
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Murray D Esler
- Department of Medicine, Monash University, Melbourne, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Nay M Htun
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Jacqueline Duval
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Louise Hammond
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Ulrike Flierl
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - Xiaowei Wang
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Grant R Drummond
- Department of Physiology, Anatomy and Microbiology, School of Life Sciences, La Trobe University, Bundoora, Australia
| | - Antony Walton
- Department of Medicine, Monash University, Melbourne, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Elizabeth E Gardiner
- ACRF Department of Cancer Biology and Therapeutics, John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Robert K Andrews
- Department of Medicine, Monash University, Melbourne, Australia.,Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | - Markus P Schlaich
- Department of Medicine, Monash University, Melbourne, Australia.,Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia.,Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Karlheinz Peter
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.,Department of Medicine, Monash University, Melbourne, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
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28
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Heuser RR, Hering D. Locally applied chemotherapy is where it's at: New hope in treating infrapopliteal disease. Catheter Cardiovasc Interv 2020; 96:402-403. [DOI: 10.1002/ccd.29142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Richard R. Heuser
- University of Arizona College of Medicine Phoenix Arizona USA
- Vascular Heart and Lung Associates Mesa Arizona USA
| | - Dagmara Hering
- Department of Cardiology Arizona State University Phoenix Arizona USA
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29
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Krishna A, Pathni AK, Sharma B, Shivashankar R, Shrivastava S, Hering D. A perspective of private health care providers in the state of Madhya Pradesh on adopting key strategies of the India hypertension control initiative. J Clin Hypertens (Greenwich) 2020; 22:1321-1327. [PMID: 33289944 DOI: 10.1111/jch.13944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/11/2020] [Accepted: 06/24/2020] [Indexed: 12/01/2022]
Abstract
The India Hypertension Control Initiative (IHCI) has been implemented in public health facilities. This study assessed the perspective of private physicians (PPs) on adopting the core strategies of the IHCI in Bhopal district of Madhya Pradesh. A semi-structured interview was purposely applied to 30 PPs to obtain their opinions on standardized hypertension treatment protocols, patient-centered services, and easy-to-use information system in their private practices. Verbatim data were recorded and analyzed thematically. Only 11 PPs followed the state hypertension treatment protocol. Among the remaining 19 PPs, the major reasons for not adopting protocol were (1) limited availability of single component hypertension drugs, (2) preferences for fixed dose combinations (FDCs), and (3) fear of either losing patients due to a lack of immediate blood pressure control or causing drug-related adverse effects. None of the interviewed doctors had resources to provide patient-centered care and use a digital health information system. Overall, the interviewed doctors identified that free supply of hypertension treatment protocol drugs, inclusion of FDCs in treatment protocol, increasing number of staff for follow-up visits, and patient education, IT-based solutions for patient records, employee incentives, and need for national data sharing policies are the key actions to accelerate the adoption of IHCI strategies in the private sector. This exploratory qualitative study suggests that engagement of private sector in the IHCI is feasible. Plans to expand the IHCI to the private sector should consider ensuring the wider availability of hypertension treatment protocol drugs and developing a simple user-friendly digital platform for patient monitoring.
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Affiliation(s)
| | | | | | | | | | - Dagmara Hering
- Lancet Commission on Hypertension Group.,Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
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30
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Hering D, Heuser RR. Belt and suspenders: Why it pays to protect and cover during carotid stenting. Catheter Cardiovasc Interv 2020; 96:128. [PMID: 32652846 DOI: 10.1002/ccd.29083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 11/11/2022]
Abstract
Carotid stenting results show equivalence to carotid endarterectomy. Most patients undergoing carotid intervention are asymptomatic. Using embolic protection with a covered mesh stent shows promise in this first large multicenter study.
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Affiliation(s)
- Dagmara Hering
- Department of Cardiology, Arizona State University, Phoenix, Arizona, USA
| | - Richard R Heuser
- University of Arizona College of Medicine, Phoenix, Arizona, USA.,Vascular Heart and Lung Associates, Mesa, Arizona, USA
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31
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Hering D, Heuser RR. Lithotripsy for peripheral artery disease: Encouraging immediate results…But show us the money! Catheter Cardiovasc Interv 2020; 95:969-970. [PMID: 32294327 DOI: 10.1002/ccd.28874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 11/06/2022]
Abstract
Of adults, 12% have PAD, with nearly 30% older than 70 years with the disorder. With obesity, diabetes mellitus, tobacco abuse, hypercholesterolemia, and poorly controlled hypertension, the incidence of PAD continues to increase. Endovascular treatment of femoropopliteal disease has an alarmingly high rate of restenosis, even with new technology with target lesion revascularization rates at 40-60% at 1 year. Intravascular lithotripsy appears to be safe and acutely effective, but there is no long-term data on whether it has a role in effective treatment of PAD.
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Affiliation(s)
- Dagmara Hering
- Department of Cardiology, Arizona State University, Tempe, Arizona, USA
| | - Richard R Heuser
- Department of Cardiology, Vascular Heart and Lung Associates, Mesa, Arizona, USA.,Professor of Medicine, University of Arizona College of Medicine, Phoenix, Arizona
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32
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Jaworska K, Hering D, Mosieniak G, Bielak-Zmijewska A, Pilz M, Konwerski M, Gasecka A, Kapłon-Cieślicka A, Filipiak K, Sikora E, Hołyst R, Ufnal M. TMA, A Forgotten Uremic Toxin, but Not TMAO, Is Involved in Cardiovascular Pathology. Toxins (Basel) 2019; 11:toxins11090490. [PMID: 31454905 PMCID: PMC6784008 DOI: 10.3390/toxins11090490] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/16/2019] [Accepted: 08/23/2019] [Indexed: 12/13/2022] Open
Abstract
Trimethylamine-N-oxide (TMAO) has been suggested as a marker and mediator of cardiovascular diseases. However, data are contradictory, and the mechanisms are obscure. Strikingly, the role of the TMAO precursor trimethylamine (TMA) has not drawn attention in cardiovascular studies even though toxic effects of TMA were proposed several decades ago. We assessed plasma TMA and TMAO levels in healthy humans (HH) and cardiovascular patients qualified for aortic valve replacement (CP). The cytotoxicity of TMA and TMAO in rat cardiomyocytes was evaluated using an MTT test. The effects of TMA and TMAO on albumin and lactate dehydrogenase (LDH) were assessed using fluorescence correlation spectroscopy. In comparison to HH, CP had a two-fold higher plasma TMA (p < 0.001) and a trend towards higher plasma TMAO (p = 0.07). In CP plasma, TMA was inversely correlated with an estimated glomerular filtration rate (eGFR, p = 0.002). TMA but not TMAO reduced cardiomyocytes viability. Incubation with TMA but not TMAO resulted in the degradation of the protein structure of LDH and albumin. In conclusion, CP show increased plasma TMA, which is inversely correlated with eGFR. TMA but not TMAO exerts negative effects on cardiomyocytes, likely due to its disturbing effect on proteins. Therefore, TMA but not TMAO may be a toxin and a marker of cardiovascular risk.
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Affiliation(s)
- Kinga Jaworska
- Department of Experimental Physiology and Pathophysiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, 02-106 Warsaw, Poland
| | - Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdansk, 80-211 Gdansk, Poland
| | - Grażyna Mosieniak
- Laboratory of Molecular Bases of Aging, Nencki Institute of Experimental Biology, Polish Academy of Sciences, 02-093 Warsaw, Poland
| | - Anna Bielak-Zmijewska
- Laboratory of Molecular Bases of Aging, Nencki Institute of Experimental Biology, Polish Academy of Sciences, 02-093 Warsaw, Poland
| | - Marta Pilz
- Department of Soft Condensed Matter, Institute of Physical Chemistry, Polish Academy of Sciences, 01-224 Warsaw, Poland
| | - Michał Konwerski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-106 Warsaw, Poland
| | - Aleksandra Gasecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-106 Warsaw, Poland
| | | | - Krzysztof Filipiak
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-106 Warsaw, Poland
| | - Ewa Sikora
- Laboratory of Molecular Bases of Aging, Nencki Institute of Experimental Biology, Polish Academy of Sciences, 02-093 Warsaw, Poland
| | - Robert Hołyst
- Department of Soft Condensed Matter, Institute of Physical Chemistry, Polish Academy of Sciences, 01-224 Warsaw, Poland
| | - Marcin Ufnal
- Department of Experimental Physiology and Pathophysiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, 02-106 Warsaw, Poland.
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33
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Carnagarin R, Fonseca R, Brockman D, Hering D, Matthews VB, Mihailidou A, Reid C, Lee R, Lambert GW, Burrell LM, Sharman JE, Xia X, Poulter NR, Beaney T, Islam SM, Carrington M, Schlaich MP. May Measurement Month 2017: an analysis of blood pressure screening results from Australia-South-East Asia and Australasia. Eur Heart J Suppl 2019; 21:D14-D16. [PMID: 31043866 PMCID: PMC6479418 DOI: 10.1093/eurheartj/suz052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Increased blood pressure (BP) is the single biggest contributing risk factor to the global disease burden. May Measurement Month (MMM) is a global initiative of the International Society of Hypertension aimed at raising awareness of high BP. In Australia, hypertension affects around six million adults and continues to remain the greatest attributable cause of cardiovascular mortality and morbidity (48.3%), stroke deaths (28%), and kidney disease (14%). An opportunistic cross-sectional survey was carried out during May 2017 predominantly in capital cities across Australia which included adult volunteers. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. Additional information obtained included anthropometric data and responses to questionnaires on demographic, lifestyle, and environmental factors. Data were collected from 3817 individuals. After multiple imputation, of the 3758 individuals for whom a mean of the second and third BP reading was available, 1188 (31.2%) had hypertension. Of 3213 individuals not receiving antihypertensive treatment, 591 (18.4%) were hypertensive, and 239 (40.1%) of the 596 individuals receiving treatment had uncontrolled BP. Adjusted BP was higher in association with antihypertensive medication, cerebrovascular disease, smoking, and alcohol consumption. Blood pressure was higher when measured on the right arm and on Tuesdays. MMM17 was one of the largest BP screening campaigns undertaken in Australia using standardized BP measurements. In line with previous surveys, around one-third of screened adults had hypertension and approximately 40% of treated individuals remained uncontrolled. These results suggest that opportunistic screening can identify significant numbers with raised BP.
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Affiliation(s)
- Revathy Carnagarin
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, Australia
| | - Ricardo Fonseca
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Derrin Brockman
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, Australia
| | - Dagmara Hering
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, Australia
| | - Vance B Matthews
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, Australia
| | | | | | - Rebecca Lee
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | | | - Louise M Burrell
- Department of Medicine, University of Melbourne, Austin Health, Melbourne, Australia
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Xin Xia
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | | | | | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, Australia.,Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Cardiology, Royal Perth Hospital, Perth, Australia.,Department of Nephrology, Royal Perth Hospital, Perth, Australia
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34
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Cierpka-Kmieć K, Hering D. Tachycardia: The hidden cardiovascular risk factor in uncomplicated arterial hypertension. Cardiol J 2019; 27:857-867. [PMID: 30799548 DOI: 10.5603/cj.a2019.0021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/04/2019] [Indexed: 12/30/2022] Open
Abstract
Early detection and management of elevated blood pressure is crucial in reducing the burden of cardiovascular disease (CVD). The importance of an absolute risk assessment and patient risk stratification has been highlighted in the European hypertension guidelines since 2003. Amongst numerous risk factors influencing patient prognosis, elevated heart rate (HR) has been indicated as important predictor of future risk of hypertension, coronary heart disease, sudden cardiac death, heart failure, CVD, stroke, total cancer and mortality. Given that resting HR can be easily determined in clinical practice and modified by lifestyle changes as well as beta-blocker therapy, it seems reasonable that lowering resting HR should be a potential target to reduce disease burden and premature mortality. However, there is a lack of outcome studies of HR lowering in tachycardia-related hypertension. This review outlines the underlying mechanisms of early course hypertension pathophysiology with the critical role of the sympathetic nervous system activation, the prognostic significance of fast HR and the mechanistic rationale for the use of non-pharmacological approaches and/or highly long-acting cardioselective beta-blockers with some consideration given to betaxolol properties.
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Affiliation(s)
| | - Dagmara Hering
- Medical University of Gdansk, Poland, Debinki 7, 80-952 Gdansk, Poland.
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35
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Lachowska K, Bellwon J, Moryś J, Gruchała M, Hering D. Slow breathing improves cardiovascular reactivity to mental stress and health-related quality of life in heart failure patients with reduced ejection fraction. Cardiol J 2019; 27:772-779. [PMID: 30697682 DOI: 10.5603/cj.a2019.0002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 12/31/2018] [Accepted: 01/03/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Previous studies have demonstrated therapeutic benefits of slow breathing (SLOWB) in chronic heart failure (HF) but its impact on cardiovascular reactivity in response to laboratory stressors remains unknown. METHODS Using device-guided breathing this study explored the acute and long-term effects of SLOWB on hemodynamic responses to handgrip, mental and cold pressor tests, and health-related quality of life (QoL) in stable HF patients with reduced ejection fraction (HFrEF) who had received all available optimal drug and device therapies. Blood pressure (BP) and heart rate (HR) were measured in 21 patients with HFrEF (23.9 ± 5.9%) at rest, during laboratory stressors, before and after acute SLOWB, and 12 weeks after SLOWB home training (30 min daily). Health-related QoL (MacNew questionaries) was assessed before and 12 weeks after SLOWB home training. RESULTS Resting BP significantly increased in response to three laboratory stressors. Pressor and cardiac changes during mental stress were greater than responses to the handgrip test (p < 0.05). Mental stress also produced a greater HR change than cold pressor test (p < 0.05). Both acute and long-term SLOWB significantly reduced BP and HR responses to mental stress (p < 0.05), but not to isometric and cold pressor tests. SLOWB improved scores of all domains of QoL (p < 0.05) at 12 weeks follow-up. CONCLUSIONS These findings demonstrate that SLOWB reduces acute and chronic effects of cardiovascular reactivity to mental stress and improves various aspects of health-related QoL in patients with severe HFrEF. Whether stress reduction and psychological changes achieved with SLOWB may translate to improved outcomes in HFrEF warrants further exploration.
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Affiliation(s)
- Kamila Lachowska
- Medical University of Gdansk, Poland, Debinki 7, 80-952 Gdansk, Poland
| | - Jerzy Bellwon
- Medical University of Gdansk, Poland, Debinki 7, 80-952 Gdansk, Poland
| | - Joanna Moryś
- Medical University of Gdansk, Poland, Debinki 7, 80-952 Gdansk, Poland
| | - Marcin Gruchała
- Medical University of Gdansk, Poland, Debinki 7, 80-952 Gdansk, Poland
| | - Dagmara Hering
- Medical University of Gdansk, Poland, Debinki 7, 80-952 Gdansk, Poland.
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36
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Szymański FM, Barylski M, Cybulska B, Wożakowska-Kapłon B, Krasiński Z, Mamcarz A, Widecka K, Płatek AE, Dudek D, Mickiewicz A, Kobayashi A, Dzida G, Grajek S, Wełnicki M, Zubilewicz T, Ufnal M, Hering D, Mizia-Stec K, Kasprzak J, Koziński M, Imiela J, Narkiewicz K, Gorczyca I, Postuła M, Jaguszewski MJ, Filipiak KJ. Recommendation for the management of dyslipidemia in Poland — Third Declaration of Sopot. Interdisciplinary Expert Position Statement endorsed by the Polish Cardiac Society Working Group on Cardiovascular Pharmacotherapy. Cardiol J 2018; 25:655-665. [DOI: 10.5603/cj.2018.0141] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 11/25/2022] Open
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37
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Schlaich M, Schultz C, Shetty S, Hering D, Worthley S, Delacroix S, Reddy V, Sievert H, Zeller T, Noory E, Boehm M, Mahfoud F, Malek F, Kmonicek P, Neuzil P. 1416Transvenous carotid body ablation for resistant hypertension: main results of a multicentre safety and proof-of-principle cohort study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- M Schlaich
- The University of Western Australia, Dobney Hypertension Centre, Perth, Australia
| | - C Schultz
- Royal Perth Hospital, Cardiology, Perth, Australia
| | - S Shetty
- Fiona Stanley Hospital, Cardiology, Perth, Australia
| | - D Hering
- The University of Western Australia, Dobney Hypertension Centre, Perth, Australia
| | - S Worthley
- Royal Adelaide Hospital, Cardiology, Adelaide, Australia
| | - S Delacroix
- Royal Adelaide Hospital, Cardiology, Adelaide, Australia
| | - V Reddy
- Mount Sinai Medical Center, Cardiology, New York, United States of America
| | - H Sievert
- CardioVascular Center Frankfurt, Cardiology, Frankfurt am Main, Germany
| | - T Zeller
- University of Freiburg, Heart Centre Freiburg-Bad Krozingen, Freiburg, Germany
| | - E Noory
- University of Freiburg, Heart Centre Freiburg-Bad Krozingen, Freiburg, Germany
| | - M Boehm
- Saarland University Hospital, Cardiology, Homburg, Germany
| | - F Mahfoud
- Saarland University Hospital, Cardiology, Homburg, Germany
| | - F Malek
- Na Homolce Hospital, Cardiology, Prague, Czech Republic
| | - P Kmonicek
- Na Homolce Hospital, Cardiology, Prague, Czech Republic
| | - P Neuzil
- Na Homolce Hospital, Cardiology, Prague, Czech Republic
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Hering D, Guillamat-Prats R, Rami M, Kobold S, Döring Y, Steffens S. G-Protein coupled receptor 55 deficiency promotes atherosclerosis and inflammation in mice. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hering D, Szymański FM. Comparison of hypertension epidemiology and treatment in Poland and Australia. Kardiol Pol 2018; 76:520-528. [DOI: 10.5603/kp.a2018.0002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 12/12/2017] [Indexed: 11/25/2022]
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Hering D, Kucharska W, Chrostowska M, Narkiewicz K. Age-dependent sympathetic neural responses to ß 1 selective beta-blockade in untreated hypertension-related tachycardia. Blood Press 2018; 27:158-165. [PMID: 29308931 DOI: 10.1080/08037051.2018.1423543] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Elevated heart rate (HR) increases cardiovascular morbidity and mortality in hypertension. The impact of beta-blockers on patient prognosis in hypertension is controversial. This study examined the age-related effects of betaxolol on HR, muscle sympathetic nerve activity (MSNA), blood pressure (BP) and sympathovagal balance in untreated males with hypertension and tachycardia. METHODS Ten young (age 26 ± 1 years) and seven older (age 50 ± 4 years) males underwent measurement of BP, HR, HR variability (Poincare plot) and MSNA before and after 8 weeks treatment with betaxolol at the initial starting dose of 10 mg/day, which was increased to 20 mg/day once daily after 4 weeks in all subjects. RESULTS In younger subjects, betaxolol decreased systolic BP (-13 ± 4 mm Hg, p = .01) and HR (-29 ± 4 bpm, p < .001) but not MSNA (3 ± 3 burst/min., p = 0.47) after 8 weeks. In older subjects a pronounced reduction in BP (-27 ± 7, p = .007) was accompanied by a significant decrease in MSNA (-13 ± 5 burst/min., p < .05) and HR (-17 ± 4 bpm, p = .002). SD1/SD2 ratio of Poincare plot increased in younger (0.36 ± 0.03 vs 0.51 ± 0.05, p = .004), but not in older (0.43 ± 0.08 vs 0.54 ± 0.12, p = .50) subjects. CONCLUSION Autonomic neural responses to betaxolol are age-dependent in hypertension-related tachycardia. Betaxolol reduces sympathetic drive to the heart, but not to the peripheral vessels confirming the contribution of augmented cardiac sympathetic activity to disease pathophysiology in younger adults. In older hypertensives, the sympathovagal balance is not influenced by betaxolol. The paradoxical reduction in MSNA despite lowering of BP and HR in older patients may suggest age-related functional decrements in autonomic control and/or inhibitory effects of betaxolol on the central nervous system.
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Affiliation(s)
- Dagmara Hering
- a Department of Hypertension and Diabetology , Medical University of Gdansk , Gdansk , Poland
| | - Wiesława Kucharska
- a Department of Hypertension and Diabetology , Medical University of Gdansk , Gdansk , Poland
| | - Marzena Chrostowska
- a Department of Hypertension and Diabetology , Medical University of Gdansk , Gdansk , Poland
| | - Krzysztof Narkiewicz
- a Department of Hypertension and Diabetology , Medical University of Gdansk , Gdansk , Poland
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Hopper I, Gronda E, Hoppe UC, Rundqvist B, Marwick TH, Shetty S, Hayward C, Lambert T, Hering D, Esler M, Schlaich M, Walton A, Airoldi F, Brandt MC, Cohen SA, Reiters P, Krum H. Sympathetic Response and Outcomes Following Renal Denervation in Patients With Chronic Heart Failure: 12-Month Outcomes From the Symplicity HF Feasibility Study. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.06.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Hering D, Nowak R, Czechowicz K, Kucharska W, Boutouyrie P, Laurent S, Narkiewicz K. [LB.03.03] SYMPATHETIC NERVE ACTIVITY IS INDEPENDENTLY LINKED TO GEOMETRIC AND ELASTIC PROPERTIES OF COMMON CAROTID ARTERY IN RESISTANT HYPERTENSION. J Hypertens 2017. [DOI: 10.1097/01.hjh.0000523174.13986.e4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Neuzil P, Reddy V, Malek F, Kmonicek P, Sievert H, Zeller T, Noory E, Bohm M, Mahfoud F, Worthley S, Montarello J, Schultz C, Shetty S, Hering D, Schlaich M. 4123Long term effect of transvenous carotid body ablation in the treatment of patients with resistant hypertension. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.4123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lachowska K, Gruchała M, Narkiewicz K, Hering D. Sympathetic Activation in Chronic Heart Failure: Potential Benefits of Interventional Therapies. Curr Hypertens Rep 2017; 18:51. [PMID: 27193773 DOI: 10.1007/s11906-016-0660-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Heart failure (HF) is a major and growing public health problem. This condition is associated with poor prognosis, a high rate of mortality, frequent hospitalization and increasing costs to health care systems. Pharmacological approaches aimed at reducing morbidity and mortality in HF have primarily focused on inhibition of the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system (SNS), both of which have been associated with disease development, progression and adverse cardiovascular (CV) outcomes. The increasing number of hospitalizations for HF decompensation suggests the failure of available treatment options, indicating the necessity for alternative therapeutic approaches. Alongside pharmacological and cardiac resynchronization therapies in selected patients with arrhythmia, recent advancements in the management of HF have been directed at inhibiting relevant neurogenic pathways underlying disease development and progression. Initial evidence regarding the safety and effectiveness of interventional procedures suggests that HF patients may benefit from novel adjunctive therapies. Here we review the critical role of sympathetic activation in HF and the rationale for therapeutic interventions including device-based and interventional approaches aimed at restoring autonomic neural balance in this condition.
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Affiliation(s)
- Kamila Lachowska
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Marcin Gruchała
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Dagmara Hering
- Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Level 3 MRF Building, Rear 50 Murray Street, Perth, WA, 6000, MDBP: M570, Australia.
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45
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Eikelis N, Hering D, Marusic P, Duval J, Hammond LJ, Walton AS, Lambert EA, Esler MD, Lambert GW, Schlaich MP. The Effect of Renal Denervation on Plasma Adipokine Profile in Patients with Treatment Resistant Hypertension. Front Physiol 2017; 8:369. [PMID: 28611687 PMCID: PMC5447749 DOI: 10.3389/fphys.2017.00369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/18/2017] [Indexed: 12/16/2022] Open
Abstract
Background: We previously demonstrated the effectiveness of renal denervation (RDN) to lower blood pressure (BP) at least partially via the reduction of sympathetic stimulation to the kidney. A number of adipocyte-derived factors are implicated in BP control in obesity. Aim: The aim of this study was to examine whether RDN may have salutary effects on the adipokine profile in patients with resistant hypertension (RH). Methods: Fifty seven patients with RH undergoing RDN program have been included in this study (65% males, age 60.8 ± 1.5 years, BMI 32.6 ± 0.7 kg/m2, mean ± SEM). Throughout the study, the patients were on an average of 4.5 ± 2.7 antihypertensive drugs. Automated seated office BP measurements and plasma concentrations of leptin, insulin, non-esterified fatty acids (NEFA), adiponectin and resistin were assessed at baseline and the 3 months after RDN. Results: There was a significant reduction in mean office systolic (168.75 ± 2.57 vs. 155.23 ± 3.17 mmHg, p < 0.001) and diastolic (90.68 ± 2.31 vs. 83.74 ± 2.36 mmHg, p < 0.001) BP 3 months after RDN. Body weight, plasma leptin and resistin levels and heart rate remained unchanged. Fasting insulin concentration significantly increased 3 months after the procedure (20.05 ± 1.46 vs. 29.70 ± 2.51 uU/ml, p = 0.002). There was a significant drop in circulating NEFA at follow up (1.01 ± 0.07 vs. 0.47 ± 0.04 mEq/l, p < 0.001). Adiponectin concentration was significantly higher after RDN (5,654 ± 800 vs. 6,644 ± 967 ng/ml, p = 0.024). Conclusions: This is the first study to demonstrate that RDN is associated with potentially beneficial effects on aspects of the adipokine profile. Increased adiponectin and reduced NEFA production may contribute to BP reduction via an effect on metabolic pathways. Clinical Trial Registration Number: NCT00483808, NCT00888433.
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Affiliation(s)
- Nina Eikelis
- Human Neurotransmitters and Neurovascular Hypertension and Kidney Disease Laboratories, Baker Heart and Diabetes InstituteMelbourne, VIC, Australia.,Iverson Health Innovation Research Institute, Swinburne University of TechnologyMelbourne, VIC, Australia
| | - Dagmara Hering
- Human Neurotransmitters and Neurovascular Hypertension and Kidney Disease Laboratories, Baker Heart and Diabetes InstituteMelbourne, VIC, Australia.,School of Medicine and Pharmacology - Royal Perth Hospital Unit, University of Western AustraliaPerth, WA, Australia
| | - Petra Marusic
- Human Neurotransmitters and Neurovascular Hypertension and Kidney Disease Laboratories, Baker Heart and Diabetes InstituteMelbourne, VIC, Australia.,School of Medicine and Pharmacology - Royal Perth Hospital Unit, University of Western AustraliaPerth, WA, Australia
| | - Jacqueline Duval
- Human Neurotransmitters and Neurovascular Hypertension and Kidney Disease Laboratories, Baker Heart and Diabetes InstituteMelbourne, VIC, Australia
| | - Louise J Hammond
- Human Neurotransmitters and Neurovascular Hypertension and Kidney Disease Laboratories, Baker Heart and Diabetes InstituteMelbourne, VIC, Australia
| | | | - Elisabeth A Lambert
- Human Neurotransmitters and Neurovascular Hypertension and Kidney Disease Laboratories, Baker Heart and Diabetes InstituteMelbourne, VIC, Australia.,Iverson Health Innovation Research Institute, Swinburne University of TechnologyMelbourne, VIC, Australia
| | - Murray D Esler
- Human Neurotransmitters and Neurovascular Hypertension and Kidney Disease Laboratories, Baker Heart and Diabetes InstituteMelbourne, VIC, Australia.,Heart Centre Alfred HospitalMelbourne, VIC, Australia
| | - Gavin W Lambert
- Human Neurotransmitters and Neurovascular Hypertension and Kidney Disease Laboratories, Baker Heart and Diabetes InstituteMelbourne, VIC, Australia.,Iverson Health Innovation Research Institute, Swinburne University of TechnologyMelbourne, VIC, Australia
| | - Markus P Schlaich
- Human Neurotransmitters and Neurovascular Hypertension and Kidney Disease Laboratories, Baker Heart and Diabetes InstituteMelbourne, VIC, Australia.,School of Medicine and Pharmacology - Royal Perth Hospital Unit, University of Western AustraliaPerth, WA, Australia.,Heart Centre Alfred HospitalMelbourne, VIC, Australia
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46
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Hering D, Schlaich MP. Response to Letter to the Editor by Drs. Yang and Yu entitled: Renal denervation in patients with chronic kidney disease. Int J Cardiol 2017; 235:190. [PMID: 28342491 DOI: 10.1016/j.ijcard.2017.02.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 02/24/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Dagmara Hering
- School of Medicine - Royal Perth Hospital Unit, University of Western Australia, Australia
| | - Markus P Schlaich
- School of Medicine - Royal Perth Hospital Unit, University of Western Australia, Australia; Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart & Diabetes Institute, Melbourne, Australia; Heart Centre Alfred Hospital, Melbourne, Australia.
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47
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Lee CJ, Kim BK, Yoon KB, Lee HY, Dominiczak AF, Touyz RM, Jennings GLR, Cho EJ, Hering D, Park S. Case of Refractory Hypertension Controlled by Repeated Renal Denervation and Celiac Plexus Block: A Case of Refractory Sympathetic Overload. Hypertension 2017; 69:978-984. [PMID: 28416585 DOI: 10.1161/hypertensionaha.117.09260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Chan Joo Lee
- From the Cardiology Division, Severance Cardiovascular Hospital (C.J.L., B.-K.K., S.P.) and Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute (K.B.Y.), Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Republic of Korea (H.-Y.L.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (A.F.D., R.M.T.); Baker IDI Heart and Diabetes Institute, Melbourne, Australia (G.L.R.J.); Division of Cardiology, St. Paul's Hospital, College of Medicine, The Catholic University, Seoul, Republic of Korea (E.J.C.); and School of Medicine and Pharmacology - Royal Perth Hospital Unit, The University of Western Australia (D.H.)
| | - Byeong-Keuk Kim
- From the Cardiology Division, Severance Cardiovascular Hospital (C.J.L., B.-K.K., S.P.) and Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute (K.B.Y.), Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Republic of Korea (H.-Y.L.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (A.F.D., R.M.T.); Baker IDI Heart and Diabetes Institute, Melbourne, Australia (G.L.R.J.); Division of Cardiology, St. Paul's Hospital, College of Medicine, The Catholic University, Seoul, Republic of Korea (E.J.C.); and School of Medicine and Pharmacology - Royal Perth Hospital Unit, The University of Western Australia (D.H.)
| | - Kyung Bong Yoon
- From the Cardiology Division, Severance Cardiovascular Hospital (C.J.L., B.-K.K., S.P.) and Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute (K.B.Y.), Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Republic of Korea (H.-Y.L.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (A.F.D., R.M.T.); Baker IDI Heart and Diabetes Institute, Melbourne, Australia (G.L.R.J.); Division of Cardiology, St. Paul's Hospital, College of Medicine, The Catholic University, Seoul, Republic of Korea (E.J.C.); and School of Medicine and Pharmacology - Royal Perth Hospital Unit, The University of Western Australia (D.H.)
| | - Hae-Young Lee
- From the Cardiology Division, Severance Cardiovascular Hospital (C.J.L., B.-K.K., S.P.) and Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute (K.B.Y.), Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Republic of Korea (H.-Y.L.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (A.F.D., R.M.T.); Baker IDI Heart and Diabetes Institute, Melbourne, Australia (G.L.R.J.); Division of Cardiology, St. Paul's Hospital, College of Medicine, The Catholic University, Seoul, Republic of Korea (E.J.C.); and School of Medicine and Pharmacology - Royal Perth Hospital Unit, The University of Western Australia (D.H.)
| | - Anna F Dominiczak
- From the Cardiology Division, Severance Cardiovascular Hospital (C.J.L., B.-K.K., S.P.) and Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute (K.B.Y.), Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Republic of Korea (H.-Y.L.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (A.F.D., R.M.T.); Baker IDI Heart and Diabetes Institute, Melbourne, Australia (G.L.R.J.); Division of Cardiology, St. Paul's Hospital, College of Medicine, The Catholic University, Seoul, Republic of Korea (E.J.C.); and School of Medicine and Pharmacology - Royal Perth Hospital Unit, The University of Western Australia (D.H.)
| | - Rhian M Touyz
- From the Cardiology Division, Severance Cardiovascular Hospital (C.J.L., B.-K.K., S.P.) and Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute (K.B.Y.), Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Republic of Korea (H.-Y.L.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (A.F.D., R.M.T.); Baker IDI Heart and Diabetes Institute, Melbourne, Australia (G.L.R.J.); Division of Cardiology, St. Paul's Hospital, College of Medicine, The Catholic University, Seoul, Republic of Korea (E.J.C.); and School of Medicine and Pharmacology - Royal Perth Hospital Unit, The University of Western Australia (D.H.)
| | - Garry L R Jennings
- From the Cardiology Division, Severance Cardiovascular Hospital (C.J.L., B.-K.K., S.P.) and Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute (K.B.Y.), Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Republic of Korea (H.-Y.L.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (A.F.D., R.M.T.); Baker IDI Heart and Diabetes Institute, Melbourne, Australia (G.L.R.J.); Division of Cardiology, St. Paul's Hospital, College of Medicine, The Catholic University, Seoul, Republic of Korea (E.J.C.); and School of Medicine and Pharmacology - Royal Perth Hospital Unit, The University of Western Australia (D.H.)
| | - Eun Joo Cho
- From the Cardiology Division, Severance Cardiovascular Hospital (C.J.L., B.-K.K., S.P.) and Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute (K.B.Y.), Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Republic of Korea (H.-Y.L.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (A.F.D., R.M.T.); Baker IDI Heart and Diabetes Institute, Melbourne, Australia (G.L.R.J.); Division of Cardiology, St. Paul's Hospital, College of Medicine, The Catholic University, Seoul, Republic of Korea (E.J.C.); and School of Medicine and Pharmacology - Royal Perth Hospital Unit, The University of Western Australia (D.H.)
| | - Dagmara Hering
- From the Cardiology Division, Severance Cardiovascular Hospital (C.J.L., B.-K.K., S.P.) and Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute (K.B.Y.), Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Republic of Korea (H.-Y.L.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (A.F.D., R.M.T.); Baker IDI Heart and Diabetes Institute, Melbourne, Australia (G.L.R.J.); Division of Cardiology, St. Paul's Hospital, College of Medicine, The Catholic University, Seoul, Republic of Korea (E.J.C.); and School of Medicine and Pharmacology - Royal Perth Hospital Unit, The University of Western Australia (D.H.)
| | - Sungha Park
- From the Cardiology Division, Severance Cardiovascular Hospital (C.J.L., B.-K.K., S.P.) and Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute (K.B.Y.), Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Republic of Korea (H.-Y.L.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (A.F.D., R.M.T.); Baker IDI Heart and Diabetes Institute, Melbourne, Australia (G.L.R.J.); Division of Cardiology, St. Paul's Hospital, College of Medicine, The Catholic University, Seoul, Republic of Korea (E.J.C.); and School of Medicine and Pharmacology - Royal Perth Hospital Unit, The University of Western Australia (D.H.).
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Schlaich MP, Hering D, Sata Y. Renal denervation in less severe forms of (resistant) hypertension-Quo vadis? J Clin Hypertens (Greenwich) 2017; 19:369-370. [PMID: 28383187 DOI: 10.1111/jch.12979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, WA, Australia.,Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia.,Neurovascular Hypertension and Kidney Disease Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Dagmara Hering
- Dobney Hypertension Centre, School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, WA, Australia
| | - Yusuke Sata
- Neurovascular Hypertension and Kidney Disease Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
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49
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Hering D, Jaguszewski M. Levosimendan: New hope therapy for takotsubo syndrome. Cardiol J 2017; 23:616-617. [PMID: 27976790 DOI: 10.5603/cj.2016.0101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 12/14/2016] [Indexed: 11/25/2022] Open
Affiliation(s)
- Dagmara Hering
- Dobney Hypertension Centre, School of Medicine and Pharmacology, Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia Editorial Office, Cardiology Journal.
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50
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Hering D, Trzebski A, Narkiewicz K. Recent advances in the pathophysiology of arterial hypertension: potential implications for clinical practice. Pol Arch Intern Med 2017; 127:195-204. [PMID: 28377560 DOI: 10.20452/pamw.3971] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Hypertension remains a major and growing public health problem associated with the greatest global rate of cardiovascular morbidity and mortality. Although numerous factors contribute to poor control of blood pressure (BP) and to pseudoresistance (eg, unawareness, lifestyle habits, nonadherence to medication, insufficient treatment, drug‑induced hypertension, undiagnosed secondary causes), true resistant hypertension (RH) is reported in 10.1% of patients treated for elevated BP. While the mechanisms underlying RH remain complex and not entirely understood, sympathetic activation involved in the pathophysiology of hypertension, disease progression, and adverse complications is further augmented in patients with drug‑resistant hypertension. The well‑established contribution of neurogenic component of hypertension has led to the introduction of new alternative therapies aimed specifically at modulating central and neural reflexes mechanisms involved in BP control. Although clinical benefits of lowering BP with renal denervation, baroreflex activation therapy, carotid body denervation, central arteriovenous anastomosis, and deep brain stimulation have advanced our knowledge on uncontrolled hypertension, the variable BP response has prompted extensive ongoing research to define predictors of treatment effectiveness and further investigation of pathophysiology of RH. Very recently, research on the role of vasopressinergic neurons, masked tachycardia, and impaired brain neural activity has provided novel insights into hypertension. This review briefly summarizes the role of the centrally mediated sympathetic nervous system in hypertension, the therapeutic strategies that distinctively target impaired neural reflex mechanisms, and potential implications for future clinical research and therapies.
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