ESTIMATION OF POTASSIUM CONTENT OF DIFFERENT VARIETIES OF BANANA FRUIT IN AN INDIAN DELTA IS THERE A CLINICAL RELEVANCE

Banana fruit is one of the commonly taken foods in many parts of the world. The fruit is known for its high potassium content. We wished to study the potassium content of eleven types of ripe banana fruit available in the cauvery delta region of South India. We measured two values in each of the eleven types of banana fruit. We found the mean varied from 460.75mg/100gm in the Rasthali variety to 921.75 in the karpura valli variety. The potassium binding capacity of the soil and the fertilizers pumped may influence the values. The literature which presently describes the values between 200 to 400mg/100g cautions the use of bananas in patients taking antihypertensive medications like enalapril and in patients with renal dysfunction. Our study which shows the values to be double the described ones, will throw light on additional caution in such cases. We admit that there was no soil study in this work which can influence the potassium content. Before any dietetic advice on the intake of potassium, the bananas of the concerned geographical area and such high potassium values should be taken into account. When the needs to cater the patients of potassium arise in uncomplicated hypertension, the varieties karpuravalli and peyampalam can be considered.

Characteristics and comorbidities of veterans treated with enzalutamide or abiraterone.

e17022 Background: Prostate cancer (PCa) is the most common male malignancy and is the fourth leading cause of cancer-related death in males worldwide. Enzalutamide (ENZ) and Abiraterone (AA) are used in the treatment of castrate resistant PCa after androgen deprivation therapy (ADT), however these agents have not been directly compared. These drugs have various adverse effects with different mechanisms of action and may be selected based on comorbid conditions. In this study, we aim to identify patient characteristics and comorbidities of patients treated with ENZ versus AA. Methods: Patients treated with AA or ENZ between September 10, 2014 and June 3, 2017 were identified in the Veterans Health Administration and followed until April 2020. Only patients with a pathologic diagnosis of PCa and treatment with ADT prior to AA or ENZ were included. Age at initiation of treatment, Elixhauser comorbidity score, PSA at initiation of AA or ENZ, Gleason score at diagnosis, treatment with ADT, docetaxel, and cabazitaxel was collected. Months of filled prescriptions were used to determine length of treatment. Results: Of 2575 patients, 1095 (42.5%) were initially treated with ENZ, 1480 (57.5%) with AA, and 1330 (51.7%) received both agents. Overall, 756 (29.4%) of patients were of black race. Docetaxel was used in 32.3% of patients and cabazitaxel in 11.7% of patients, with no differences between ENZ or AA cohorts. There were no significant differences in time from pathologic diagnosis to initial ADT therapy, or subsequently to treatment with ENZ or AA in either group. Furthermore, there were no differences in PSA (n = 1243, median AA 33.7 vs ENZ 30.7, p = 0.538) or Gleason scores (n = 1816, mean AA 7.85 vs ENZ 7.94, p = 0.142). Patients initially treated with ENZ compared to AA were older (mean 74.2 vs. 73.7 years, p = 0.032), had higher mean comorbidity score (7.1 vs. 6.7, p = 0.002), and had a longer duration of first treatment (median 10.5 months vs. 9.0 months, p < 0.001). As a second agent, ENZ also had a longer duration of treatment (median 5.0 vs. 4.2 months, p < 0.001). Patients treated initially with ENZ were more likely to have heart failure (18.2% vs. 13.7%, p = 0.002), cardiac arrhythmia (42.1% vs 36.6%, p = 0.004), valvular disease (13.7% vs 10.3%, p = 0.009), peripheral vascular disorders (26.8% vs 22.7%, p = 0.016), uncomplicated hypertension (86.8% vs 83.6%, p = 0.024), complicated hypertension (20.2% vs 16.9%, p = 0.033), uncomplicated diabetes (43.9% vs 37.4%, p = 0.001), complicated diabetes (26.0% vs 19.9%, p = 0.000), renal failure (28.3% vs 22.6%, p = 0.001). Conclusions: Overall, we found that patients initially treated with ENZ were older and had higher rates of cardiovascular disease and diabetes compared to those initially treated with AA. Assessment of comorbidities may be helpful in treatment selection to facilitate personalized medicine in prostate cancer, prevent adverse events, and improve outcomes.

Treatment of hypertension during the COVID-19 pandemic: questions about the blockade of the renin-angiotensin-aldosterone system

Arterial hypertension was one of the most common comorbidities associated with a high risk of death in hospitalized patients with COVID-19. Patients with hypertension are routinely and according to standards treated with angiotensinconverting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARB) II. ACE inhibitors or ARB II are included in fixed combinations of antihypertensive drugs recommended for patients with uncomplicated hypertension, as well as when combined with various comorbidities. During the COVID-19 pandemic, there were suggestions about the potential for a negative effect of drugs of these classes on the course and outcomes of a new coronavirus infection. There was a need for a quick response from the most reputable medical organizations to the question of the use of ACE inhibitors and ARB II during the COVID-19 pandemic. The expert position was soon published despite the lack of evidence from randomized clinical trials. Was there any reason for concern about the treatment of ACE inhibitors and ARB II for COVID-19? What are the relationships between the renin-angiotensin-aldosterone system (RAAS) and COVID-19? Is there any new data from clinical trials that can confirm or deny the previously presented position of professional societies regarding the use of RAAS blockers in COVID-19? What is the role of the difference in the mechanism of action of an ACE inhibitor and ARB II in COVID-19? Is it possible that RAAS blockers will be helpful in treating COVID-19? Will the tactics of hypertension pharmacotherapy change in the near future? In this review article, modern concepts on this problem are discussed and answers to the listed questions reflecting the achieved level of knowledge are formulated.

Physical Comorbidity According to Diagnoses and Sex among Psychiatric Inpatients in South Korea

People with mental disorders are susceptible to physical comorbidities. Mind–body interventions are important for improving health outcomes. We examined the prevalence of physical comorbidities and their differences by diagnoses and sex among psychiatric inpatients. The dataset, from National Health Insurance claims data, included 48,902 adult inpatients admitted to psychiatric wards for at least 2 days in 2016 treated for schizophrenia, schizotypal and delusional disorders, or mood disorders. We identified 26 physical comorbidities using the Elixhauser comorbidity measure. Among schizophrenia-related disorders, other neurological disorders were most common, then liver disease and chronic pulmonary disease. Among mood disorders, liver disease was most common, then uncomplicated hypertension and chronic pulmonary disease. Most comorbid physical diseases (except other neurological disorders) were more prevalent in mood disorders than schizophrenia-related disorders. Male and female patients with schizophrenia-related disorders showed similar comorbidity prevalence patterns by sex. Among patients with mood disorders, liver disease was most prevalent in males and third-most in females. In both diagnostic groups, liver disease and uncomplicated diabetes mellitus were more prevalent in males, and hypothyroidism in females. Mental health professionals should refer to a specialist to manage physical diseases via early assessments and optimal interventions for physical comorbidities in psychiatric patients.

Resting heart rate and the use of β-blockers in the treatment of patients with arterial hypertension

Higher resting heart rate was shown to correlate with worse prognosis both in general population and in various disease groups. Scientific societies dealing with patients with hypertension propose assessment of resting heart rate as a standard risk factor. In patients with uncomplicated hypertension and elevated resting heart rate they propose use of cardioselective β1-adrenolytics. This decision should be preceded by careful examination of potential modified reasons. In the paper we express several concerns regarding standard provision of heart rate lowering drugs in particular clinical situations. The algorithm showing proposed steps in assessment of elevated heart rate is provided.

Efficacy of Telemedicine in Hypertension Care Through Home Blood Pressure Monitoring and Videoconferencing: Randomized Controlled Trial (Preprint)

BACKGROUND The burden of time is often the primary reason why patients discontinue their treatment. Telemedicine may help patients adhere to treatment by offering convenience. OBJECTIVE This study examined the efficacy and safety of telemedicine for the management of hypertension in Japan. METHODS Patients with uncomplicated hypertension were recruited through web advertising between November 2015 and February 2017. They were then screened, stratified by office systolic blood pressure (SBP), and randomized into two groups: usual care (UC) and telemedicine. The telemedicine group used a 3G network–attached home blood pressure (BP) monitoring device, consulted hypertension specialists from an academic hospital through web-based video visits, and received prescription medication by mail for 1 year. The UC group used the same BP monitoring device but was managed using self-recorded BP readings, which included their diary entries and office BP taken in a community practice setting. RESULTS Initial screening was completed by 99 patients, 54% of whom had untreated hypertension. Baseline BP was similar between the groups, but the weekly average SBP at the end of the 1-year study period was significantly lower in the telemedicine group (125, SD 9 mmHg vs 131, SD 12 mmHg, respectively; <i>P</i>=.02). SBP in the telemedicine group was 3.4 mmHg lower in the morning and 5.8 mmHg lower in the evening. The rate of SBP control (135 mmHg) was better in the telemedicine group (85.3% vs 70.0%; <i>P</i>=.01), and significant adverse events were not observed. CONCLUSIONS We present evidence suggesting that antihypertensive therapy via home BP telemonitoring and web-based video visits achieve better BP control than conventional care and is a safe treatment alternative that warrants further investigation. CLINICALTRIAL UMIN-CTR UMIN000025372; https://tinyurl.com/47ejkn4b

VEGETATIVE AND CEREBRAL EFFECTS OF CARVELIS ® COMPONENTS IN PATIENTS WITH ARTERIAL HYPERTENSION

Key words: arterial hypertension, autonomic imbalance, dysfunction of cerebral and subcortical structures of blood pressure regulation, Carvelis treatment. In almost 36% of patients, the syndrome of arterial hypertension (AH) is determined by a combination of psychoemotional disorders with autonomic dysfunction. The aim of the study was to study the features of psychoemotional disorders and autonomic homeostasis in 78 middle-aged patients with uncomplicated hypertension and their correction using Carvelis in complex antihypertensive therapy.

Age- and Phenotype-Dependent Changes in Circulating MMP-2 and MMP-9 Activities in Normotensive and Hypertensive Rats

Matrix metalloproteinases (MMPs) are important in the pathogenesis of numerous diseases. The present study aimed to monitor the activation of MMP-2 and MMP-9 in spontaneously hypertensive rats (SHR) and their normotensive counterparts—Wistar-Kyoto rats (WKY). The animals were divided according to age (7, 20, and 52 weeks) and phenotype into: WKY-7, WKY-20, WKY-52, SHR-7, SHR-20 and SHR-52 groups. MMP plasma activities were determined by gelatine zymography. We monitored selected parameters of oxidative stress and antioxidant status. N-terminal pro-brain natriuretic peptide (NT-proBNP) was determined as a marker of heart function and neurohumoral activation. SHR-7 showed higher MMP-2 activity compared with WKY-7, while SHR-52 showed lower MMP-2 and MMP-9 activities compared with WKY-52. Examining age-dependent changes in MMP activities, we found a decrease in MMP-2 activity and increase in MMP-9 activity with increasing age in both phenotypes. Parameters of oxidative stress and antioxidant status as well as NT-proBNP levels were not significantly worsened due to aging in SHR. Our results suggest that hypertension is accompanied by varying MMP activation during aging. The results of our study may indicate that MMP-2 inhibition is therapeutically applicable during the development of hypertension, while in developed, stabilized and uncomplicated hypertension, systemic MMP-2 and MMP-9 inhibition may not be desirable.

Gender characteristics of retinal parameters in patients with uncomplicated hypertension

Aim. To establish gender specificities of retinal arteriolar and venular diameters, foveal avascular zone (FAZ) area, subfoveal choroid thickness (SCT), and to determine their association with cardiovascular risk and prognosis in patients with uncomplicated hypertension (HTN).Material and methods. The study included 70 patients (56 males and 14 females) aged 45-59 years with stage I or II HTN. There were following exclusion criteria: diabetes, liver failure, clinically relevant ophthalmic pathology. We assessed routine hemodynamic parameters, biochemical profile, serum N-terminal procollagen-III peptide, urinary albumin-creatinine ratio, 24-hour urinary albumin excretion, retinal parameters. All patients underwent electrocardiography and echocardiography. Ten-year risk of fatal cardiovascular disease (SCORE) was estimated. Based on scanning laser ophthalmoscopy, central retinal arterial (CRAE) and venous (CRVE) equivalents, arteriovenous ratio (AVR) were calculated. Using optical coherence tomography angiography, we determined FAZ area and SCT. Data processing was performed using StatSoft Statistica 10.Results. Hypertensive women were characterized by significantly larger FAZ area (p<0,001), CRVE (p=0,005), CRAE (p=0,012) compared with men. SCT values (p>0,05) were comparable. CRVE was associated with Cornell voltage product (r=0,3) in the male group. In women, age was negatively correlated with SCT (r=-0,54); SCORE value was inversely associated with SCT (r=-0,56), AVR (r=-0,53), CRAE (r=-0,3).Conclusion. In patients with uncomplicated HTN, the gender specificities of retina are manifested by a relative decrease of arteriolar diameters in males and a relative increase of venular diameters and FAZ in females. SCT decreases most clearly with age among hypertensive women. Men are characterized by a direct association of retinal venular diameters with a quantitative electrocardiographic marker of left ventricular hypertrophy. In women, there are an inverse association of SCT and arteriolar diameters with a ten-year risk of fatal cardiovascular disease.

Early structural and functional left ventricular disorders in young patients with hypertension: a role of insulin resistance

Cardiac remodeling refers to factors that increase the risk of cardiovascular events in patients with hypertension (HTN). Changes in myocardial structure and function can be caused not only by hemodynamic causes, but also a number of metabolic disorders.Aim. To analyze the associations of insulin resistance and left ventricular (LV) remodeling in a cohort of young patients with untreated uncomplicated hypertension and high normal blood pressure (BP).Material and methods. The presented cohort cross-sectional study included 105 subjects. We analyzed clinical, demographic and anthropometric characteristics, performed a biochemical panel (creatinine, potassium, lipid profile, glucose, insulin, uric acid) with the estimation of insulin resistance scores (HOMA-IR, METs-IR, TyG), a glycosylated hemoglobin test. Urine albumin-to-creatinine ratio was determined. Office and 24-hour ambulatory BP measurement and two-dimensional speckletracking echocardiography were performed in all patients.Results. The median age was 23 years (men — 85%); 51% of participants were overweight or obese, 39% had dyslipidemia, 21% — insulin resistance. Signs of LV remodeling were observed in 38 (40%) subjects: 32 (34%) — concentric remodeling, 5 (5%) — concentric LV hypertrophy (LVH), 1 (1%) — eccentric LVH. Defects of LV systolic global longitudinal strain (GLS) were observed in 44 (47%) young patients with HTN and preHTN. Stepwise multivariate regression analysis revealed that the TyG index was an independent predictor of LV GLS defects (b=0,38, p=0,001).Conclusion. In a cohort of young patients with HTN and high normal blood pressure, there is a high prevalence of insulin resistance, metabolic disorders, and early signs of LV remodeling and subclinical systolic dysfunction. The TyG index, available for estimation by routine biochemical tests, is an independent factor affecting the LV GLS.