Novel biomarkers in patients with uncontrolled hypertension with and without kidney damage

INTRODUCTION

Estimated glomerular filtration rate (eGFR) and urine albumin/creatinine ratio (ACR) are insensitive biomarkers for early detection of hypertension-mediated organ damage (HMOD). In this nationwide cross-sectional study, we assessed potential biomarkers for early HMOD in healthy persons and patients with hypertension. We hypothesised that plasma levels of biomarkers: (1) are different between healthy controls and patients with hypertension, (2): can classify patients with hypertension according to the degree of hypertension severity.

DESIGN AND METHODS

Patients with hypertension prescribed ≥2 antihypertensive agents were selected from a multicentre study. Healthy controls were selected from an ongoing study of living kidney donor candidates. Uncontrolled hypertension was defined as systolic daytime ambulatory blood pressure ≥135 mmHg. Kidney HMOD was defined by ACR > 3.0 mg/mmol or eGFR < 60 mL/min/1.73 m2. Patients with hypertension were categorised into three groups: (1) controlled hypertension; (2) uncontrolled hypertension without kidney HMOD; (3) uncontrolled hypertension with kidney HMOD. Fifteen biomarkers were analysed using a Luminex bead-based immunoassay, and nine fell within the specified analytical range.

RESULTS

Plasma levels of Interleukin 1 receptor antagonist (IL-1RA), neutrophil gelatinase-associated lipocalin (NGAL) and uromodulin were significantly different between healthy controls (n = 39) and patients with hypertension (n = 176). In regression models, with controlled hypertension (n = 55) as the reference category, none of the biomarkers were associated with uncontrolled hypertension without (n = 59) and with (n = 62) kidney HMOD. In models adjusted for cardiovascular risk factors and eGFR, osteopontin (OPN) was associated with uncontrolled hypertension without kidney HMOD (odds ratio (OR) 1.77 (1.05-2.98), p = 0.03), and regulated upon activation normal T-cell expressed and secreted (RANTES) with uncontrolled hypertension with kidney HMOD (OR 0.57 (0.34-0.95), p = 0.03).

CONCLUSIONS

None of the biomarkers could differentiate our hypertension groups when established risk factors were considered. Plasma OPN may identify patients with uncontrolled hypertension at risk for kidney HMOD.

Effect of Drug Monitoring on Adherence and Blood Pressure: A Multicenter Randomized Clinical Trial

BACKGROUND

Drug concentration in blood or urine is an acknowledged method to detect non-adherence. Observational studies suggest that informing patients about low or absent serum drug levels improves blood pressure (BP). We performed a multicenter randomized clinical trial to test the hypothesis that therapeutic drug monitoring (TDM) could improve drug adherence and BP in patients with uncontrolled hypertension and reduced adherence to antihypertensive drugs.

METHODS

Patients were ≥18 years on stable treatment with at least two antihypertensive agents. We planned to randomize 80 non-adherent patients with a systolic daytime ambulatory BP (ABPM) ≥135 mmHg to TDM-intervention or not. The control group and the study-personnel who measured BP remained uninformed about serum drug measurements throughout. All patients and physicians were blinded for BPs. Lifestyle advice and detailed information on disease process and importance of BP treatment were given to both groups.

RESULTS

From 2017 to 2022, we randomized 46 diagnosed non-adherent from a total of 606 patients with uncontrolled hypertension. The TDM-group had a 6.7 (±14.5) mmHg reduction from 147.9 (±10.3) to 141.1 (±14.1) mmHg, and the control group experienced a 7.3 (±13.2) mmHg reduction from 147.1 (±9.2) to 139.1 (±17.4) mmHg, p=0.9 between groups. Adherence improved in both groups, 73% in the TDM group and 59% in the control group became adherent at three months, p=0.51.

CONCLUSIONS

In our prospective multicenter clinical trial of uncontrolled and non-adherent hypertensive patients, we found no additional effect of therapeutic drug monitoring (TDM) on blood pressure and drug adherence compared with standard care.

Gender Differences in Cardiac Organ Damage in Arterial Hypertension: Assessing the Role of Drug Nonadherence

INTRODUCTION

Cardiac organ damage like left ventricular (LV) hypertrophy and left atrial (LA) enlargement is more prevalent in women than men with hypertension, but the mechanisms underlying this gender difference remain unclear.

METHODS

We tested the association of drug nonadherence with the presence of LV hypertrophy and LA enlargement by echocardiography in 186 women and 337 men with uncontrolled hypertension defined as daytime systolic blood pressure (BP) ≥ 135mmHg despite the prescription of at least two antihypertensive drugs. Drug adherence was assessed by measurements of serum drug concentrations interpreted by an experienced pharmacologist. Aldosterone-renin-ratio (ARR) was measured on actual medication.

RESULTS

Women had a higher prevalence of LV hypertrophy (46% vs. 33%) and LA enlargement (79% vs 65%, both p < 0.05) than men, while drug nonadherence (8% vs. 9%, p > 0.514) did not differ. Women were older and had lower serum renin concentration and higher ARR than men, while 24-h systolic BP (141 ± 9 mmHg vs. 142 ± 9 mmHg), and the prevalences of obesity (43% vs. 50%) did not differ (all p > 0.10). In multivariable analyses, female gender was independently associated with a two-fold increased risk of LV hypertrophy (OR 2.01[95% CI 1.30-3.10], p = 0.002) and LA enlargement (OR 1.90 [95% CI 1.17-3.10], p = 0.010), while no association with drug nonadherence was found. Higher ARR was independently associated with LV hypertrophy in men only (OR 2.12 [95% CI 1.12-4.00] p = 0.02).

CONCLUSIONS

Among patients with uncontrolled hypertension, the higher prevalence of LV hypertrophy and LA enlargement in women was not explained by differences in drug nonadherence.

REGISTRATION

URL:  https://www.

CLINICALTRIALS

gov ; Unique identifier: NCT03209154.

Abstract P142: Factors Associated With Persistent Cardiac Organ Damage In Primary Aldosteronism After One Year Of Treatment

Introduction: Adrenalectomy and medical treatment of primary aldosteronism (PA) both induce regression of left ventricle (LV) hypertrophy, while the effects on LV myocardial function are less investigated.

Hypothesis: We hypothesized that persistent cardiac organ damage was more prevalent in medically treated PA patients.

Methods: Eighty-four patients (57±11 years, 27% female) with PA underwent echocardiography at time of diagnosis and after 1 year of treatment (49% adrenalectomized, 51% medically treated). Persistent cardiac organ damage was identified as LV hypertrophy or low LV systolic function by midwall shortening or global longitudinal strain (GLS), both at baseline and at follow-up. LV diastolic function was assessed by left atrial enlargement and estimated LV filling pressure (E/e’). Results from logistic regression analyses are reported as odds ratio (OR) with 95% confidence intervals (CI).

Results: After 1 year, a significant regression of LV hypertrophy was observed in adrenalectomized patients (44% vs. 22%, p=0.038), but not in medically treated patients (59% vs. 50%, p=0.206). Midwall shortening, E/e’ and prevalence of enlarged left atrium improved significantly in both treatment groups (all p<0.001), while GLS remained unchanged. In multivariable logistic regression analysis, receiving medical treatment for PA (OR 4.98 [95% CI 1.26-18.88] was a strong predictor of persistent LV hypertrophy independent of higher body mass index (OR 1.20 [95% CI 1.04-1.38]) and presence of diabetes (OR 6.48 [95% CI 1.20-34.83], all p<0.05). Important covariables of persistently low midwall shortening were persistent LV hypertrophy (OR 3.50 [95% CI 1.12-10.96]) and suppression of plasma renin activity after 1 year of treatment (OR 4.31 [1.15-16.12], both p<0.05). The strongest predictor of persistently low GLS was higher HbA 1c (OR 2.37[95% CI 1.12-5.02], p=0.024).

Conclusions: In PA, LV hypertrophy regression was more common in adrenalectomized patients. Persistent LV hypertrophy and impaired glucose metabolism were the major factors associated with persistent LV myocardial dysfunction independent of treatment.

Detection of Nonadherence to Antihypertensive Treatment by Measurements of Serum Drug Concentrations

[Figure: see text].

Preclinical cardiac disease in women and men with primary aldosteronism

PURPOSE

We tested the sex-specific associations between primary aldosteronism (PA), left ventricular (LV) hypertrophy and LV systolic myocardial function.

MATERIAL AND METHODS

Conventional and speckle tracking echocardiography was performed in 109 patients with PA and 89 controls with essential hypertension (EH). LV hypertrophy was identified if LV mass index exceeded 47.0 g/m^2.7 in women and 50.0 g/m^2.7 in men. LV systolic myocardial function was assessed by global longitudinal strain (GLS) and midwall shortening.

RESULTS

PA patients had higher prevalence of LV hypertrophy (52 vs. 21%, p < 0.001) than EH patients in both sexes, while GLS did not differ by sex or hypertension aetiology. In multivariable analyses, presence of LV hypertrophy was associated with PA and obesity in both sexes, while lower systolic myocardial function, whether measured by GLS or midwall shortening, was not associated with PA, but primarily with higher body mass index and LV mass index, respectively, in both sexes (all p < 0.05).

CONCLUSION

Having PA was associated with higher prevalence of LV hypertrophy both in women and men, compared to EH. PA was not associated with LV systolic myocardial function in either sex.

Traditional Chinese medicine syndromes in women with frequently recurring cystitis: frequencies of syndromes and symptoms

BACKGROUND

Frequently recurrent acute cystitis in adult women is common in Western medicine. In prophylactic treatment, women are treated between attacks of acute cystitis to prevent recurrences. A recent study has shown that acupuncture seems effective for prophylaxis.

OBJECTIVES

To describe the frequency of traditional Chinese medicine (TCM) syndromes found in females vulnerable to recurrent cystitis, and which symptoms most often form the basis for TCM diagnoses made in this condition.

METHODS

A descriptive study based on TCM diagnostic methods as used by experienced acupuncturists, and a questionnaire of symptoms used in TCM diagnostics.

RESULTS

Of 61 women with frequently recurring cystitis, 90% were diagnosed as having either a Spleen/Kidney yang xu/qi xu (54%), or a Liver qi stagnation (36%). Only 10% fell in other diagnostic groups. Of all symptoms noted, only three differed in frequency between the two main diagnostic groups: feeling cold (29/33 vs. 13/22, P<0.05), feeling tired (25/33 vs. 4/22, P<0.001), and having a preference for sweets (10/33 vs. 2/22, P<0.05).

CONCLUSION

Our findings have implications for TCM-based diagnostic work in females with recurrent cystitis, and also indicate that recurrent cystitis may be used as a case for further TCM research.

[Can acupuncture prevent cystitis in women?]

67 adult women with a history of recurrent lower urinary tract infection (UTI) were randomized for acupuncture treatment, sham acupuncture, or no treatment. The incidence rate of UTI over the following six months was noted. In the acupuncture group a total of 85% was free of cystitis during the six-month observational period, as compared to 58% in the sham group (p < 0.05), and 36% in the control group (p < 0.01). Compared to the acupuncture group, twice as many incidents of cytitis occurred in the sham group, and three times as many in the control group (p < 0.05). Acupuncture seems a worthwhile alternative in the prevention of frequently recurring cystitis in women.

Acupuncture in the prophylaxis of recurrent lower urinary tract infection in adult women

OBJECTIVE

To evaluate the effect of acupuncture in the prevention of recurrent lower urinary tract infection (UTI) in adult women.

DESIGN

A controlled clinical trial with three arms: an acupuncture group, a sham-acupuncture group, and an untreated control group. Patients were followed for 6 months.

SETTING

An acupuncture clinic in Bergen, Norway.

SUBJECTS

Sixty-seven adult women with a history of recurrent lower UTI.

MAIN OUTCOME MEASURES

Acute lower UTIs during the 6-month observation period.

RESULTS

Eighty-five percent were free of lower UTI during the 6-month observation period in the acupuncture group, compared with 58% in the sham group (p < 0.05), and 36% in the control group (p < 0.01). There were half as many episodes of lower UTI per person-half-year in the acupuncture group as in the sham group, and a third as many as in the control group (p < 0.05).

CONCLUSION

Acupuncture seems a worthwhile alternative in the prevention of recurring lower UTI in women.