TY - JOUR A1 - Traub, Jan A1 - Frey, Anna A1 - Störk, Stefan T1 - Chronic neuroinflammation and cognitive decline in patients with cardiac disease: evidence, relevance, and therapeutic implications JF - Life N2 - Acute and chronic cardiac disorders predispose to alterations in cognitive performance, ranging from mild cognitive impairment to overt dementia. Although this association is well-established, the factors inducing and accelerating cognitive decline beyond ageing and the intricate causal pathways and multilateral interdependencies involved remain poorly understood. Dysregulated and persistent inflammatory processes have been implicated as potentially causal mediators of the adverse consequences on brain function in patients with cardiac disease. Recent advances in positron emission tomography disclosed an enhanced level of neuroinflammation of cortical and subcortical brain regions as an important correlate of altered cognition in these patients. In preclinical and clinical investigations, the thereby involved domains and cell types of the brain are gradually better characterized. Microglia, resident myeloid cells of the central nervous system, appear to be of particular importance, as they are extremely sensitive to even subtle pathological alterations affecting their complex interplay with neighboring astrocytes, oligodendrocytes, infiltrating myeloid cells, and lymphocytes. Here, we review the current evidence linking cognitive impairment and chronic neuroinflammation in patients with various selected cardiac disorders including the aspect of chronic neuroinflammation as a potentially druggable target. KW - neuroinflammation KW - cognitive impairment KW - dementia KW - myocardial infarction KW - heart failure KW - hypertension KW - coronary artery disease KW - atrial fibrillation KW - cardiac arrest KW - aortic valve stenosis Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-304869 SN - 2075-1729 VL - 13 IS - 2 ER - TY - JOUR A1 - Reel, Smarti A1 - Reel, Parminder S. A1 - Erlic, Zoran A1 - Amar, Laurence A1 - Pecori, Alessio A1 - Larsen, Casper K. A1 - Tetti, Martina A1 - Pamporaki, Christina A1 - Prehn, Cornelia A1 - Adamski, Jerzy A1 - Prejbisz, Aleksander A1 - Ceccato, Filippo A1 - Scaroni, Carla A1 - Kroiss, Matthias A1 - Dennedy, Michael C. A1 - Deinum, Jaap A1 - Eisenhofer, Graeme A1 - Langton, Katharina A1 - Mulatero, Paolo A1 - Reincke, Martin A1 - Rossi, Gian Paolo A1 - Lenzini, Livia A1 - Davies, Eleanor A1 - Gimenez-Roqueplo, Anne-Paule A1 - Assié, Guillaume A1 - Blanchard, Anne A1 - Zennaro, Maria-Christina A1 - Beuschlein, Felix A1 - Jefferson, Emily R. T1 - Predicting hypertension subtypes with machine learning using targeted metabolites and their ratios JF - Metabolites N2 - Hypertension is a major global health problem with high prevalence and complex associated health risks. Primary hypertension (PHT) is most common and the reasons behind primary hypertension are largely unknown. Endocrine hypertension (EHT) is another complex form of hypertension with an estimated prevalence varying from 3 to 20% depending on the population studied. It occurs due to underlying conditions associated with hormonal excess mainly related to adrenal tumours and sub-categorised: primary aldosteronism (PA), Cushing’s syndrome (CS), pheochromocytoma or functional paraganglioma (PPGL). Endocrine hypertension is often misdiagnosed as primary hypertension, causing delays in treatment for the underlying condition, reduced quality of life, and costly antihypertensive treatment that is often ineffective. This study systematically used targeted metabolomics and high-throughput machine learning methods to predict the key biomarkers in classifying and distinguishing the various subtypes of endocrine and primary hypertension. The trained models successfully classified CS from PHT and EHT from PHT with 92% specificity on the test set. The most prominent targeted metabolites and metabolite ratios for hypertension identification for different disease comparisons were C18:1, C18:2, and Orn/Arg. Sex was identified as an important feature in CS vs. PHT classification. KW - metabolomics KW - machine learning KW - hypertension KW - primary aldosteronism KW - pheochromocytoma/paraganglioma KW - Cushing syndrome KW - biomarkers Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-286161 SN - 2218-1989 VL - 12 IS - 8 ER - TY - JOUR A1 - Gaudron, Philipp Daniel A1 - Liu, Dan A1 - Scholz, Friederike A1 - Hu, Kai A1 - Florescu, Christiane A1 - Herrmann, Sebastian A1 - Bijnens, Bart A1 - Ertl, Georg A1 - Störk, Stefan A1 - Weidemann, Frank T1 - The septal bulge - an early echocardiographic sign in hypertensive heart disease JF - Journal of the American Society of Hypertension N2 - Patients in the early stage of hypertensive heart disease tend to have normal echocardiographic findings. The aim of this study was to investigate whether pathology-specific echocardiographic morphologic and functional parameters can help to detect subclinical hypertensive heart disease. One hundred ten consecutive patients without a history and medication for arterial hypertension (AH) or other cardiac diseases were enrolled. Standard echocardiography and two-dimensional speckle tracking -imaging analysis were performed. Resting blood pressure (BP) measurement, cycle ergometer test (CET), and 24-hour ambulatory BP monitoring (ABPM) were conducted. Patients were referred to "septal bulge (SB)" group (basal-septal wall thickness >= 2 mm thicker than mid-septal wall thickness) or "no-SB" group. Echocardiographic SB was found in 48 (43.6%) of 110 patients. In this SB group, 38 (79.2%) patients showed AH either by CET or ABPM. In contrast, in the no-SB group (n = 62), 59 (95.2%) patients had no positive test for AH by CET or ABPM. When AH was solely defined by resting BP, SB was a reasonable predictive sign for AH (sensitivity 73%, specificity 76%). However, when AH was confirmed by CET or ABPM the echocardiographic SB strongly predicted clinical AH (sensitivity 93%, specificity 86%). In addition, regional myocardial deformation of the basal-septum in SB group was significantly lower than in no-SB group (14 +/- 4% vs. 17 +/- 4%; P < .001). In conclusion, SB is a morphologic echocardiographic sign for early hypertensive heart disease. Sophisticated BP evaluation including resting BP, ABPM, and CET should be performed in all patients with an accidental finding of a SB in echocardiography. KW - Septal bulge KW - hypertension KW - blood pressure monitoring KW - echocardiography KW - heart disease Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-191433 VL - 10 IS - 1 ER - TY - THES A1 - Köchel, Katrin T1 - Sekundärneoplasien bei Patienten mit primärem Hyperaldosteronismus T1 - Secondary neoplasms in patients with primary aldosteronism N2 - Der primäre Hyperaldosteronismus ist die häufigste Ursache einer sekundären Hypertonie. Ein Aldosteronüberschuss kann in vitro und in vivo DNA-Schäden verursachen. In einzelnen Fallberichten wurde über eine Koinzidenz des primären Hyperaldosteronismus mit Nierenzellkarzinomen wie auch anderen Tumoren berichtet. Die Prävalenz benigner und maligner Neoplasien bei Patienten mit primärem Hyperaldosteronismus wurde bislang jedoch noch nicht untersucht. In der multizentrischen MEPHISTO-Studie wurde die Prävalenz von benignen und malignen Tumorerkrankungen bei 338 Patienten mit bestätigtem primärem Hyperaldosteronismus untersucht. Hypertensive Probanden der populationsbasierten SHIP-Studie dienten als gematchte Kontrollgruppe. Bei 120 (35,5%) der 338 Patienten mit primärem Hyperaldosteronismus war eine Tumorerkrankung diagnostiziert worden, 30 der Patienten hatten zwei oder mehr Neoplasien. Das Auftreten eines Malignoms wurde bei 9,5% der Patienten mit primärem Hyperaldosteronismus und bei 6,0% der hypertensiven Kontrollgruppe dokumentiert (p=0,08). Patienten mit primärem Hyperaldosteronismus und einem Malignom in der Vorgeschichte wiesen bei der Diagnose des primären Hyperaldosteronismus höhere Aldosteronspiegel auf (p=0,009). Es konnte zudem ein signifikanter Zusammenhang zwischen der Höhe des Aldosteronspiegels und der Malignomprävalenz beobachtet werden (p=0,03). Insgesamt wurden unter den Patienten mit primären Hyperaldosteronismus 158 Neoplasien nachgewiesen, die in 62% der Fälle benigne und in 25% der Fälle maligne waren (14% Neoplasien unbekannter Dignität). Ein Nierenzellkarzinom wurde bei 5 Patienten (13% aller malignen Tumore) diagnostiziert, in der hypertensiven Kontrollgruppe trat kein Nierenzellkarzinom auf. Im Vergleich zur hypertensiven Kontrollgruppe wurde bei Patienten mit primärem Hyperaldosteronismus ein Trend hin zu einer erhöhten Prävalenz von Malignomen beobachtet, der beim Nierenzellkarzinom besonders deutlich ausgeprägt und signifikant mit der Höhe des Aldosteronspiegels assoziiert war. N2 - Primary aldosteronism is the most common cause of secondary hypertension. Aldosterone excess can cause DNA damage in vitro and in vivo. Single case reports have reported a coincidence of primary aldosteronism with renal cell carcinoma and other tumors. However, the prevalence of benign and malignant neoplasms in patients with primary aldosteronism has not yet been studied. In the multicenter MEPHISTO study the prevalence of benign and malignant tumors was investigated in 338 patients with confirmed primary aldosteronism. Matched hypertensive subjects from the population based SHIP cohort served as controls. Of the 338 patients with primary aldosteronism, 120 (35.5%) had been diagnosed with a tumor at any time, 30 had two or more neoplasms. Lifetime malignancy occurence was reported in 9.5% of patients with primary aldosteronism and in 6.0% of hypertensive controls (p=0.08). Patients with primary aldosteronism and a history of malignancy had higher baseline aldosterone levels at diagnosis of primary aldosteronism (p=0.009) and a strong association between aldosterone levels and the prevalence of malignancies was observed (p=0.03). In total, 158 neoplasms were identified in the patients with primary aldosteronism, which were benign in 62% and malignant in 25% of cases (14% of unknown dignity). Renal cell carcinoma (RCC) was diagnosed in 5 patients (13% of all malignancies) and was not reported in controls. Compared to hypertensive controls, in patients with primary aldosteronism a trend towards an increased prevalence for malignancies was observed which was particularly obvious for renal cell carcinoma and significantly associated with baseline aldosterone levels. KW - Sekundärtumor KW - Aldosteron KW - Hyperaldosteronismus KW - Endokrinopathie KW - Neoplasma KW - Sekundärneoplasie KW - primärer Hyperaldosteronismus KW - neoplasm KW - aldosterone KW - primary aldosteronism KW - hypertension KW - arterielle Hypertonie Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-207156 ER - TY - JOUR A1 - Tiffe, Theresa A1 - Morbach, Caroline A1 - Rücker, Viktoria A1 - Gelbrich, Götz A1 - Wagner, Martin A1 - Faller, Hermann A1 - Störk, Stefan A1 - Heuschmann, Peter U. T1 - Impact of patient beliefs on blood pressure control in the general population: findings from the population-based STAAB cohort study JF - International Journal of Hypertension N2 - Background. Effective antihypertensive treatment depends on patient compliance regarding prescribed medications. We assessed the impact of beliefs related towards antihypertensive medication on blood pressure control in a population-based sample treated for hypertension. Methods. We used data from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) study investigating 5000 inhabitants aged 30 to 79 years from the general population of Würzburg, Germany. The Beliefs about Medicines Questionnaire German Version (BMQ-D) was provided in a subsample without established cardiovascular diseases (CVD) treated for hypertension. We evaluated the association between inadequately controlled hypertension (systolic RR >140/90 mmHg; >140/85 mmHg in diabetics) and reported concerns about and necessity of antihypertensive medication. Results. Data from 293 participants (49.5% women, median age 64 years [quartiles 56.0; 69.0]) entered the analysis. Despite medication, half of the participants (49.8%) were above the recommended blood pressure target. Stratified for sex, inadequately controlled hypertension was less frequent in women reporting higher levels of concerns (OR 0.36; 95%CI 0.17-0.74), whereas no such association was apparent in men. We found no association for specific-necessity in any model. Conclusion. Beliefs regarding the necessity of prescribed medication did not affect hypertension control. An inverse association between concerns about medication and inappropriately controlled hypertension was found for women only. Our findings highlight that medication-related beliefs constitute a serious barrier of successful implementation of treatment guidelines and underline the role of educational interventions taking into account sex-related differences. KW - hypertension Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-200992 VL - 2019 ER - TY - THES A1 - Haring, Bernhard T1 - Natriumkonsum, Bluthochdruck und Kognitive Beeinträchtigung T1 - Dietary Sodium, Hypertension and Cognitive Impairment N2 - Natrium ist mit verschiedenen physiologischen Prozessen verbunden und spielt insbesondere in der Blutdruckregulation sowie in der Entstehung eines essentiellen Hypertonus eine bedeutende Rolle. Die täglich konsumierte Natriummenge der Gegenwart übersteigt den physiologisch notwendigen Natriumbedarf sowie den von den Fachgesellschaften empfohlenen Referenzwerten bedeutend. Exzessiver Natriumkonsum bei gleichzeitigem Vorliegen eines Bluthochdrucks erhöht das kardiovaskuläre Risiko beträchtlich. Eine Konsumbeschränkung in Verbindung mit adäquatem Blutdruckmanagment wird von zahlreichen Fachgesellschaften empfohlen. Zum Zeitpunkt der Untersuchung ist weitestgehend ungeklärt, ob Bluthochdruck im Alter sowie ein exzessiver Natriumkonsum mit oder ohne begleitendem Hypertonus die kognitive Funktionsfähigkeit beeinträchtigt. Anhand der Daten der Women’s Health Initiative Memory Study, konnte vorliegende Arbeit einen eindeutigen Zusammenhang zwischen dem Vorliegen eines Bluthochdrucks und dem Auftreten milder kognitiver Beeinträchtigung bei postmenopausalen Frauen ≥ 60 Jahre zeigen. Gleichzeitig weist vorliegende Untersuchung auf einen möglichen Zusammenhang zwischen erhöhtem Natriumkonsum und spätere kognitive Funktionsfähigkeit bei hypertensiven Frauen hin. Während eine natriumarme Ernährung das Risiko für kognitiven Abbau bei hypertensiven Individuen nicht erhöhte, wurde eine Assoziation zwischen natriumreicher Ernährung und einem gesteigerten Risiko für kognitive Verschlechterung beobachtet. Allerdings waren diese Ergebnisse nicht signifikant und bedürfen weiterer Überprüfung. Auswirkungen einer natriumreichen Ernährung auf die kognitive Funktionsfähigkeit bei normotensiven Frauen wurden nicht gefunden. Die Resultate dieser Untersuchung unterstreichen den über die kardiovaskuläre Prävention hinaus reichenden Stellenwert einer adäquaten Blutdruckregulation im Allgemeinen sowie einer Natriumrestriktion bei hypertensiven Individuen im Besonderen zum Erhalt kognitiver Funktionsfähigkeit. N2 - Dietary sodium is involved in many physiological processes and has been shown to play a major part in the development of hypertension. Daily sodium consumption currently exceeds the necessary amount and is far above recommended limits. Excessive dietary sodium intake has been associated with cardiovascular disease. To this point, it remains to be shown if hypertension and excessive dietary sodium intake are associated with cognitive decline in older individuals. Results of this investigation provide significant evidence for a robust association between hypertension and mild cognitive impairment in postmenopausal women aged 60 years and older. Moreover, findings indicate a possible relationship between dietary sodium intake and cognitive decline in hypertensive women. Whereas high sodium consumption was found to be associated with cognitive decline, low sodium intake was not associated with an increased risk for cognitive decline in hypertensive women. However, these results were statistically non-significant and further research is warranted. A relationship between high sodium intake and cognitive functioning in normotensive women was not observed. In conclusion, this investigation emphasizes the importance of blood pressure control for cognitive functioning and highlights the role of sodium consumption for hypertensive individuals. KW - Hypertonie KW - Alter KW - Demenz KW - Natriumkonsum KW - Bluthochdruck KW - Hypertension KW - kognitive Beeinträchtigung KW - dietary sodium KW - hypertension KW - cognitive decline Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-123223 ER -