Subjects -> MEDICAL SCIENCES (Total: 8803 journals)
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INTERNAL MEDICINE (178 journals)                     

Showing 1 - 180 of 180 Journals sorted alphabetically
Abdomen     Open Access  
ACP Hospitalist     Full-text available via subscription   (Followers: 9)
ACP Internist     Full-text available via subscription   (Followers: 10)
ACP Journal Club     Full-text available via subscription   (Followers: 11)
Acta Clinica Belgica     Hybrid Journal   (Followers: 1)
Acute and Critical Care     Open Access   (Followers: 11)
Acute Medicine     Full-text available via subscription   (Followers: 9)
Advances in Hepatology     Open Access   (Followers: 4)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
African Journal of Primary Health Care & Family Medicine     Open Access   (Followers: 6)
African Journal of Thoracic and Critical Care Medicine     Open Access  
American Family Physician     Full-text available via subscription   (Followers: 38)
American Journal of Hypertension     Hybrid Journal   (Followers: 31)
Anales de Medicina Interna     Open Access   (Followers: 1)
Anatomy & Physiology : Current Research     Open Access   (Followers: 9)
Angiology     Hybrid Journal   (Followers: 5)
Annals of Colorectal Research     Open Access   (Followers: 1)
Annals of Internal Medicine     Full-text available via subscription   (Followers: 392)
AORN Journal     Hybrid Journal   (Followers: 27)
Apollo Medicine     Open Access  
Archives of Drug Information     Hybrid Journal   (Followers: 5)
Archivos de Medicina Interna     Open Access   (Followers: 1)
Asia Oceania Journal of Nuclear Medicine & Biology     Open Access   (Followers: 4)
Asian Pacific Journal of Tropical Disease     Full-text available via subscription   (Followers: 3)
Australasian Physical & Engineering Sciences in Medicine     Hybrid Journal   (Followers: 1)
BMI Journal : Bariátrica & Metabólica Iberoamericana     Open Access   (Followers: 1)
BMJ Open Diabetes Research & Care     Open Access   (Followers: 35)
BMJ Quality & Safety     Hybrid Journal   (Followers: 69)
Bone & Joint Journal     Hybrid Journal   (Followers: 139)
Brain Communications     Open Access   (Followers: 4)
Brain Science Advances     Open Access  
Canadian Journal of General Internal Medicine     Open Access   (Followers: 2)
Cardiovascular Medicine in General Practice     Full-text available via subscription   (Followers: 7)
Case Reports in Internal Medicine     Open Access   (Followers: 1)
Cell Death & Disease     Open Access   (Followers: 3)
Cellular and Molecular Gastroenterology and Hepatology     Open Access   (Followers: 3)
Cephalalgia     Hybrid Journal   (Followers: 8)
Cephalalgia Reports     Open Access   (Followers: 4)
Chronic Diseases and Injuries in Canada     Free   (Followers: 1)
Clinical Ethics     Hybrid Journal   (Followers: 13)
Clinical Liver Disease     Open Access   (Followers: 5)
Clinical Nutrition     Hybrid Journal   (Followers: 98)
Clinical Thyroidology     Full-text available via subscription   (Followers: 1)
CNE Pflegemanagement     Hybrid Journal  
Communication Law and Policy     Hybrid Journal   (Followers: 5)
Current Diabetes Reports     Hybrid Journal   (Followers: 30)
Current Hepatology Reports     Hybrid Journal  
Current Research: Integrative Medicine     Open Access  
CVIR Endovascular     Open Access   (Followers: 1)
Der Internist     Hybrid Journal   (Followers: 12)
Diabetes     Full-text available via subscription   (Followers: 603)
Diabetes Care     Full-text available via subscription   (Followers: 577)
Diabetes Internacional     Open Access  
Diabetes Spectrum     Full-text available via subscription   (Followers: 17)
Diagnosis     Hybrid Journal   (Followers: 1)
Egyptian Journal of Bronchology     Open Access  
Egyptian Journal of Internal Medicine     Open Access   (Followers: 1)
Egyptian Journal of Neurosurgery     Open Access  
Egyptian Liver Journal     Open Access   (Followers: 2)
Egyptian Spine Journal     Open Access  
EMC - Aparato Locomotor     Hybrid Journal  
Endovascular Neuroradiology / Ендоваскулярна нейрорентгенохірургія     Open Access   (Followers: 1)
eNeuro     Open Access   (Followers: 3)
Ergonomics     Hybrid Journal   (Followers: 24)
European Journal of Inflammation     Open Access   (Followers: 2)
European Journal of Internal Medicine     Full-text available via subscription   (Followers: 10)
European Journal of Translational Myology     Open Access  
European Radiology Experimental     Open Access   (Followers: 2)
Head and Neck Tumors     Open Access   (Followers: 1)
Health Sociology Review     Hybrid Journal   (Followers: 14)
HemaSphere     Open Access   (Followers: 2)
Hepatology Communications     Open Access  
Hepatoma Research     Open Access   (Followers: 3)
Human Physiology     Hybrid Journal   (Followers: 5)
ImmunoHorizons     Open Access  
Immunological Medicine     Open Access  
Infectious Diseases: Research and Treatment     Open Access   (Followers: 5)
Inflammation and Regeneration     Open Access   (Followers: 2)
Inflammatory Intestinal Diseases     Open Access  
Innere Medizin up2date     Hybrid Journal   (Followers: 1)
Internal and Emergency Medicine     Hybrid Journal   (Followers: 5)
Internal Medicine Journal     Hybrid Journal   (Followers: 9)
International Journal of Abdominal Wall and Hernia Surgery     Open Access   (Followers: 1)
International Journal of Anatomy and Research     Open Access   (Followers: 2)
International Journal of Angiology     Hybrid Journal  
International Journal of Artificial Organs     Hybrid Journal   (Followers: 3)
International Journal of Hyperthermia     Open Access  
International Journal of Internal Medicine     Open Access   (Followers: 3)
International Journal of Noncommunicable Diseases     Open Access  
International Journal of Psychiatry in Clinical Practice     Hybrid Journal   (Followers: 6)
Iranian Journal of Neurosurgery     Open Access   (Followers: 1)
Italian Journal of Anatomy and Embryology     Open Access   (Followers: 1)
JAC-Antimicrobial Resistance     Open Access   (Followers: 4)
JAMA Internal Medicine     Full-text available via subscription   (Followers: 363)
JCSM Clinical Reports     Open Access   (Followers: 3)
JHEP Reports     Open Access  
JIMD Reports     Open Access  
JMV - Journal de Médecine Vasculaire     Hybrid Journal   (Followers: 1)
Joint Commission Journal on Quality and Patient Safety     Hybrid Journal   (Followers: 41)
JOP. Journal of the Pancreas     Open Access   (Followers: 2)
Journal of Basic & Clinical Physiology & Pharmacology     Hybrid Journal   (Followers: 1)
Journal of Bone Oncology     Open Access   (Followers: 1)
Journal of Cancer & Allied Specialties     Open Access  
Journal of Clinical and Experimental Hepatology     Full-text available via subscription   (Followers: 3)
Journal of Clinical Movement Disorders     Open Access   (Followers: 3)
Journal of Community Hospital Internal Medicine Perspectives     Open Access  
Journal of Cutaneous Immunology and Allergy     Open Access  
Journal of Developmental Origins of Health and Disease     Hybrid Journal   (Followers: 2)
Journal of Endoluminal Endourology     Open Access  
Journal of Gastroenterology and Hepatology Research     Open Access   (Followers: 4)
Journal of General Internal Medicine     Hybrid Journal   (Followers: 23)
Journal of Hypertension     Hybrid Journal   (Followers: 14)
Journal of Infectious Diseases     Hybrid Journal   (Followers: 48)
Journal of Interdisciplinary Medicine     Open Access  
Journal of Internal Medicine     Hybrid Journal   (Followers: 11)
Journal of Liver : Disease & Transplantation     Hybrid Journal   (Followers: 7)
Journal of Medical Internet Research     Open Access   (Followers: 24)
Journal of Movement Disorders     Open Access   (Followers: 2)
Journal of Pain and Symptom Management     Hybrid Journal   (Followers: 46)
Journal of Pancreatic Cancer     Open Access  
Journal of Renal and Hepatic Disorders     Open Access  
Journal of Solid Tumors     Open Access   (Followers: 1)
Journal of Sports Medicine and Allied Health Sciences : Official Journal of the Ohio Athletic Trainers Association     Open Access   (Followers: 1)
Journal of the American Board of Family Medicine     Open Access   (Followers: 11)
Journal of the European Mosquito Control Association     Open Access  
Journal of Translational Internal Medicine     Open Access  
Jurnal Vektor Penyakit     Open Access  
La Revue de Medecine Interne     Full-text available via subscription   (Followers: 3)
Lege artis - Das Magazin zur ärztlichen Weiterbildung     Hybrid Journal   (Followers: 1)
Liver Cancer International     Open Access  
Liver Research     Open Access  
Molecular Diagnosis & Therapy     Hybrid Journal   (Followers: 3)
Molecular Therapy - Oncolytics     Open Access  
Multiple Sclerosis and Demyelinating Disorders     Open Access   (Followers: 7)
MYOPAIN. A journal of myofascial pain and fibromyalgia     Hybrid Journal   (Followers: 18)
Neuro-Oncology Advances     Open Access   (Followers: 1)
Neurobiology of Pain     Open Access   (Followers: 2)
Neurointervention     Open Access   (Followers: 6)
Neuromuscular Diseases     Open Access  
Nigerian Journal of Gastroenterology and Hepatology     Full-text available via subscription  
OA Alcohol     Open Access   (Followers: 5)
Oncological Coloproctology     Open Access  
Open Journal of Internal Medicine     Open Access  
Pleura and Peritoneum     Open Access  
Pneumo News     Full-text available via subscription  
Polish Archives of Internal Medicine     Full-text available via subscription   (Followers: 2)
Preventing Chronic Disease     Free   (Followers: 2)
Progress in Transplantation     Hybrid Journal   (Followers: 1)
Prostate International     Open Access   (Followers: 2)
Psychiatry and Clinical Psychopharmacology     Open Access   (Followers: 1)
Pulmonary Therapy     Open Access   (Followers: 2)
Quality of Life Research     Hybrid Journal   (Followers: 20)
Research and Practice in Thrombosis and Haemostasis     Open Access  
Revista Chilena de Fonoaudiología     Open Access   (Followers: 1)
Revista de la Sociedad Peruana de Medicina Interna     Open Access   (Followers: 4)
Revista del Instituto de Medicina Tropical     Open Access  
Revista Hispanoamericana de Hernia     Open Access   (Followers: 1)
Revista Médica Internacional sobre el Síndrome de Down     Full-text available via subscription   (Followers: 1)
Revista Virtual de la Sociedad Paraguaya de Medicina Interna     Open Access   (Followers: 1)
Romanian Journal of Diabetes Nutrition and Metabolic Diseases     Open Access   (Followers: 1)
Romanian Journal of Internal Medicine     Open Access  
Russian Journal of Child Neurology     Open Access   (Followers: 1)
Scandinavian Journal of Primary Health Care     Open Access   (Followers: 8)
Schlaf     Hybrid Journal  
Schmerzmedizin     Hybrid Journal  
Scientific Journal of the Foot & Ankle     Open Access   (Followers: 1)
SciMedicine Journal     Open Access   (Followers: 3)
SEMERGEN - Medicina de Familia     Full-text available via subscription   (Followers: 1)
The Journal of Critical Care Medicine     Open Access   (Followers: 9)
Therapeutic Advances in Chronic Disease     Open Access   (Followers: 8)
Therapeutic Advances in Musculoskeletal Disease     Hybrid Journal   (Followers: 6)
Thieme Case Report     Hybrid Journal   (Followers: 1)
Tijdschrift voor Urologie     Hybrid Journal  
Tissue Barriers     Hybrid Journal   (Followers: 1)
Transactions of the Royal Society of Tropical Medicine and Hygiene     Hybrid Journal   (Followers: 3)
Transgender Health     Open Access   (Followers: 3)
Trends in Anaesthesia and Critical Care     Full-text available via subscription   (Followers: 23)
US Cardiology Review     Open Access  
Vascular and Endovascular Review     Open Access   (Followers: 1)
Ожирение и метаболизм     Open Access  


Similar Journals
Journal Cover
American Journal of Hypertension
Journal Prestige (SJR): 1.322
Citation Impact (citeScore): 3
Number of Followers: 31  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0895-7061 - ISSN (Online) 1941-7225
Published by Oxford University Press Homepage  [416 journals]
  • From the Editor-in-Chief: Issue at a Glance
    • Authors: Schiffrin E.
      Pages: 301 - 303
      Abstract: The current issue of the American Journal of Hypertension for April 2021 begins with an Editorial by Wilczynski et al.1 proposing that a cytokine/bradykinin storm is responsible for the apparent cytokine storms reported to lead to worse outcomes in coronavirus disease (COVID)-19. This is a novel concept that has some evidence supporting it as reported in this viewpoint, and which offers opportunities for therapeutic intervention in this tantalizing disease.
      PubDate: Wed, 14 Apr 2021 00:00:00 GMT
      DOI: 10.1093/ajh/hpab044
      Issue No: Vol. 34, No. 4 (2021)
  • A Cytokine/Bradykinin Storm Comparison: What Is the Relationship Between
           Hypertension and COVID-19'
    • Authors: Wilczynski S; Wenceslau C, McCarthy C, et al.
      Pages: 304 - 306
      Abstract: hpaa217_graphical_abstract
      PubDate: Tue, 20 Apr 2021 00:00:00 GMT
      DOI: 10.1093/ajh/hpaa217
      Issue No: Vol. 34, No. 4 (2021)
  • Wearable Technology to Detect Stress-Induced Blood Pressure Changes: The
           Next Chapter in Ambulatory Blood Pressure Monitoring'
    • Authors: Ringrose J; Padwal R.
      Pages: 330 - 331
      Abstract: Without tradition, art is a flock of sheep without a shepherd. Without innovation, it is a corpse.Sir Winston Churchill
      PubDate: Fri, 19 Mar 2021 00:00:00 GMT
      DOI: 10.1093/ajh/hpaa158
      Issue No: Vol. 34, No. 4 (2021)
  • Renal Sodium Handling: Perspective on Adaptation to Clinical Practice
    • Authors: Suzuki D; Hoshide S, Kario K.
      Pages: 332 - 334
      Abstract: Population-based studies showed excessive salt intake was the one of the risks for high blood pressure and cardiovascular disease.1,2 Sodium reduction leads to blood pressure reductions and the magnitude of blood pressure lowering was greater for older adults and nonwhite populations, while the magnitude of reduction of blood pressure was lower in younger people, especially under 35 years of age.3 Thus, the level of elevated blood pressure can vary from individual to individual even in the similar salt intake.4
      PubDate: Wed, 13 Jan 2021 00:00:00 GMT
      DOI: 10.1093/ajh/hpab001
      Issue No: Vol. 34, No. 4 (2021)
  • SARS–CoV-2 Receptor ACE2 Gene Is Associated with Hypertension and
           Severity of COVID 19: Interaction with Sex, Obesity, and Smoking
    • Authors: Hamet P; Pausova Z, Attaoua R, et al.
      Pages: 367 - 376
      Abstract: BACKGROUNDAngiotensin-converting enzyme 2 (ACE2) has been identified as the entry receptor for coronaviruses into human cells, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19). Since hypertension (HT) is a leading comorbidity in non-survivors of COVID-19, we tested for association between ACE2 gene and HT in interaction with specific pre-existing conditions known to be associated with COVID-19 severity.METHODSGenetic analysis of ACE2 gene was conducted in French-Canadian (FC) and British populations.RESULTSIn FC individuals, the T allele of the single nucleotide polymorphism rs2074192 of ACE2 gene was a risk factor for HT in adult obese males [odds ratio (OR) = 1.39, 95% confidence interval (CI) 1.06–1.83)] and even more so in obese males who smoked (OR = 1.67, CI: 1.24–2.55), but not in lean males, non-smoker males or females. The T allele was significantly associated with severity of HT and with earlier penetrance of HT in obese smoking males. Significant interaction between the T allele and obesity was present in both sexes. The association of ACE2 (rs233575) genotype with blood pressure was also seen in adolescents but the interaction with obesity was present only in females. Several variants in ACE2 gene were found to be associated with HT in obese, smoking males in British individuals of the UK Biobank. In addition, we observed more severe outcomes to COVID-19 in association with ACE2 risk alleles in obese, smoking males.CONCLUSIONSThis is the first report that ACE2 variants are associated with earlier penetrance and more severe HT and with more severe outcomes of COVID-19 in obese smoking males.
      PubDate: Sat, 02 Jan 2021 00:00:00 GMT
      DOI: 10.1093/ajh/hpaa223
      Issue No: Vol. 34, No. 4 (2021)
  • Dapagliflozin Does Not Affect Short-Term Blood Pressure Variability in
           Patients With Type 2 Diabetes Mellitus
    • Authors: Papadopoulou E; Theodorakopoulou M, Loutradis C, et al.
      Pages: 404 - 413
      Abstract: BackgroundIncreased blood pressure variability (BPV) is associated with increased cardiovascular and all-cause mortality in patients with type-2 diabetes mellitus (T2DM). Sodium-glucose co-transporter 2 (SGLT-2) inhibitors decrease the incidence of cardiovascular events, renal events, and death in this population. This study aimed to evaluate the effect of dapagliflozin on short-term BPV in patients with T2DM.MethodsThis is a secondary analysis of a double-blind, randomized, placebo-controlled trial in 85 patients with T2DM. Subjects were randomized to dapagliflozin 10 mg/day or placebo for 12 weeks. All participants underwent 24-hour ambulatory blood pressure (BP) monitoring with Mobil-O-Graph-NG device at baseline and study-end. SD, weighted SD (wSD), coefficient of variation, average real variability (ARV), and variation independent of mean were calculated for the 24-hour, daytime and nighttime periods.ResultsDapagliflozin reduced 24-hour brachial BP compared with placebo. From baseline to study-end 24-hour brachial BPV indexes did not change with dapagliflozin (SBP-ARV: 11.51 ± 3.45 vs. 11.05 ± 3.35; P = 0.326, SBP-wSD: 13.59 ± 3.60 vs. 13.48 ± 3.33; P = 0.811) or placebo (SBP-ARV: 11.47 ± 3.63 vs. 11.05 ± 3.00; P = 0.388, SBP-wSD: 13.85 ± 4.38 vs. 13.97 ± 3.87; P = 0.308). Similarly, no significant changes in BPV indexes for daytime and nighttime were observed in any group. At study-end, no between-group differences were observed for any BPV index. Deltas (Δ) of all indexes during follow-up were minimal and not different between groups (SBP-wSD: dapagliflozin: −0.11 ± 3.05 vs. placebo: 0.12 ± 4.20; P = 0.227).ConclusionsThis study is the first to evaluate the effects of an SGLT-2 inhibitor on short-term BPV in T2DM, showing no effect of dapagliflozin on all BPV indexes studied.Clinical trials registrationTrial Number NCT02887677.
      PubDate: Mon, 22 Mar 2021 00:00:00 GMT
      DOI: 10.1093/ajh/hpaa207
      Issue No: Vol. 34, No. 4 (2021)
  • The Influence of Abdominal Obesity on Endothelial Function of the Tibial
           Artery in the Elderly Essential Hypertensives of Different Sex
    • Authors: Cai X; Huang H, Shen Y, et al.
      Pages: 428 - 428
      Abstract: BackgroundTo investigate the relationship between abdominal obesity and endothelial function of the tibial artery in the elderly essential hypertensives of different sex.MethodsA total of 658 elderly patients (≥60 years old) with essential hypertension and 64 elderly subjects without clinical evidence of hypertension were recruited from the department of geriatrics from August 2000 to May 2016. The dilatation of anterior tibial artery induced by reactive hyperemia was examined by high-resolution vascular ultrasound and was defined as endothelium-dependent dilatation (EDD). All the participants were divided into 4 groups based on blood pressure (≥140/90 mm Hg) and waist circumference (male ≥90 cm, female ≥85 cm): normotensive without abdominal obesity (n = 34), normotensive with abdominal obesity (n = 30), hypertensive without abdominal obesity (n = 287), and hypertensive with abdominal obesity (n = 371).ResultsA gradual decline in EDD was observed from normotensive without abdominal obesity (9.37 ± 1.11%), normotensive with abdominal obesity (8.59 ± 0.99%), hypertensive without abdominal obesity (7.70 ± 0.30%) to hypertensive with abdominal obesity (6.75 ± 0.26%) (P < 0.05). There was no significant difference in EDD between the male and female elderly hypertensives with or without abdominal obesity. In male elderly hypertensives, EDD in those with central obesity was more blunted compared with those without central obesity (6.31 ± 0.38% vs. 7.46 ± 0.38%, P < 0.05). Whereas, in female elderly hypertensives, EDD in those with abdominal obesity was similar to those without abdominal obesity. In male elderly hypertensives, EDD was correlated with waist circumference (r = −0.194, P < 0.05) while such association was not shown in females. Multivariate linear regression analysis revealed that waist circumference was associated with EDD (β = −0.161, P < 0.05) in the male elderly hypertensives, but not in females.ConclusionsWaist circumference is an influencing factor of EDD in male elderly essential hypertension patients. However, abdominal obesity has little effect on EDD of the tibial artery in female elderly hypertensives.
      PubDate: Tue, 20 Apr 2021 00:00:00 GMT
      DOI: 10.1093/ajh/hpaa219
      Issue No: Vol. 34, No. 4 (2021)
  • Effects of Telmisartan on Myocardial Protein Profiles in Hypertensive Rats
    • Authors: Feng Y; Zhou M, Wang J, et al.
      Pages: 428 - 428
      Abstract: BackgroundTo investigate the effects of telmisartan on the protein profiles of the left ventricular myocardium in spontaneously hypertensive rats (SHR).MethodsSixteen SHR were randomly divided into control and telmisartan treatment groups. Rats were treated with sterile water (10 ml/kg) or telmisartan (4.33 mg/kg) by gavage for 12 weeks. Wistar-Kyoto (WKY) rats treated with sterile water (10 ml/kg) as controls. At the end of 12 weeks of control or telmisartan treatment, rats were sacrificed, and hearts were collected for protein preparations, isotope labeling, and mass spectrometric analysis.ResultsIn total, there were 23 differentially expressed proteins in the left ventricular myocardium between control and telmisartan treatment groups in SHR. Compared with the telmisartan group, the upregulated proteins in the SHR were dual-specificity mitogen-activated protein kinase kinase 3-like, transgelin, and haptoglobin subtype 2. The downregulated proteins in the SHR were as follows: von Willebrand factor (fragment), kininogen 1, small ribonucleoprotein-related protein, fibrinogen beta chain, protein mass 3 (fragment), proteasome 26s, heat shock protein 27-related protein 1, tenascin X, fibronectin subtype 2, transferrin receptor protein, platelets 1, cathepsin L1, complement factor B, isoform CRA_b, fibrinogen isomer, immunoglobulin heavy chain (γ polypeptide), and α 1 antiprotease.ConclusionsTelmisartan differentially regulates myocardial protein expression in hypertensive rats including heat shock protein 27, fibrinogen, fibronectin, proteasome 26s, and transgelin, as well as proteins in biochemical, metabolic, and signal transduction pathways. These changes in protein expression may contribute to the antihypertrophic effects of telmisartan in hypertension.
      PubDate: Tue, 20 Apr 2021 00:00:00 GMT
      DOI: 10.1093/ajh/hpaa204
      Issue No: Vol. 34, No. 4 (2021)
  • Resting Heart Rate as a Cardiovascular Risk Factor in Hypertensive
           Patients: An Update
    • Authors: Palatini P.
      Pages: 307 - 317
      Abstract: A large body of evidence has shown that resting heart rate (RHR) holds important prognostic information in several clinical conditions. In the majority of the general population studies, a graded association between RHR and mortality from all causes, cardiovascular (CV) disease, ischemic heart disease, and stroke has been observed. These associations appeared even stronger and more consistent in hypertensive patients. Studies performed with 24-hour ambulatory recording have shown that an elevated nighttime heart rate may confer an additional risk on top of office RHR. The mechanisms by which tachycardia alone or in association with sympathetic overactivity induces CV damage are well understood. Fast RHR is a strong predictor of future hypertension, metabolic disturbances, obesity, and diabetes. Several experimental lines of research point to high RHR as a main risk factor for the development of atherosclerosis, large artery stiffness, and CV disease. Elevated RHR is a common feature in patients with hypertension. Thus, there is a large segment of the hypertensive population that would benefit from a treatment able to decrease RHR. Improvement of unhealthy lifestyle should be the first goal in the management of the hypertensive patient with elevated RHR. Most clinical guidelines now recommend the use of combination therapies even in the initial treatment of hypertension. Although no results of clinical trials specifically designed to investigate the effect of RHR lowering in human beings without CV diseases are available, in hypertensive patients with high RHR a combination therapy including a cardiac slowing drug at optimized dose seems a sensible strategy.Tachycardia can be considered both as a marker of sympathetic overactivity and as a risk factor for cardiovascular events. In this sketch, the main cardiovascular and metabolic effects of increased sympathetic tone underlying high heart rate are shown. The link between tachycardia and cardiovascular events can be explained also by the direct hemodynamic action of heart rate on the arteries and the left ventricular (LV) wall.
      PubDate: Mon, 16 Nov 2020 00:00:00 GMT
      DOI: 10.1093/ajh/hpaa187
      Issue No: Vol. 34, No. 4 (2020)
  • Hypertension in Chronic Kidney Disease (CKD): Diagnosis, Classification,
           and Therapeutic Targets
    • Authors: Georgianos P; Agarwal R.
      Pages: 318 - 326
      Abstract: Blood pressure (BP) in the office is often recorded without standardization of the technique of measurement. When office BP measurement is performed with a research-grade methodology, it can inform better therapeutic decisions. The reference-standard method of ambulatory BP monitoring (ABPM) together with the assessment of BP in the office enables the identification of white-coat and masked hypertension, facilitating the stratification of cardiorenal risk. Compared with general population, the prevalence of resistant hypertension is 2- to 3-fold higher among patients with chronic kidney disease (CKD). The use of ABPM is mandatory in order to exclude the white-coat effect, a common cause of pseudoresistance, and confirm the diagnosis of true-resistant hypertension. After the premature termination of Systolic Blood Pressure Intervention Trial due to an impressive cardioprotective benefit of intensive BP-lowering, the 2017 American Heart Association/American College of Cardiology guideline reappraised the definition of hypertension and recommended a tighter BP target of <130/80 mm Hg for the majority of adults with a high cardiovascular risk profile, inclusive of patients with CKD. However, the benefit/risk ratio of intensive BP-lowering in particular subsets of patients with CKD (i.e., those with diabetes or more advanced CKD) continues to be debated. We explore the controversial issue of BP targets in CKD, providing a critical evaluation of the available clinical-trial evidence and guideline recommendations. We argue that the systolic BP target in CKD, if BP is measured correctly, should be <120 mm Hg.
      PubDate: Thu, 17 Dec 2020 00:00:00 GMT
      DOI: 10.1093/ajh/hpaa209
      Issue No: Vol. 34, No. 4 (2020)
  • Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Blockers,
           and COVID-19: Demonstrating the Actionability of Real-World Evidence
    • Authors: Hennessy S; Cohen J.
      Pages: 327 - 329
      Abstract: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are used by many millions of people1 for highly prevalent conditions including hypertension, heart failure, and diabetes. It was therefore quite concerning when mechanistic considerations regarding the role of angiotensin-converting enzyme 2 (ACE2) in the pathogenesis of SARS-CoV-22 led to the hypotheses that these widely used, lifesaving drugs might both increase the risk of developing COVID-19 and worsen outcomes in people who developed COVID-19. These hypotheses were especially concerning because the aforementioned therapeutic indications for using ACEIs and ARBs themselves are among the most prevalent comorbidities in patients who develop COVID-19, and are associated with worse outcomes of COVID-19.3,4 Based on these mechanistic considerations, some authors went so far as to recommend that ACEIs and ARBs be discontinued in patients with active COVID-19 infection, and that their discontinuation be considered in some people who are at high risk for developing COVID-19.5,6 It is therefore reassuring that the recent population-based cohort study conducted by Dublin et al.7 found that ACEIs and ARBs do not appear to increase the risk of developing COVID-19 or to increase the risk of hospitalization in those who develop COVID-19, and that there is no dose–response relationship between ACEI/ARB use and risk of developing COVID-19 or of being hospitalized once a person has developed COVID-19.
      PubDate: Fri, 06 Nov 2020 00:00:00 GMT
      DOI: 10.1093/ajh/hpaa177
      Issue No: Vol. 34, No. 4 (2020)
  • Sex and Age Differences in Ambulatory Blood Pressure Monitoring
    • Authors: Khaddage S; Patterson J, Sargent L, et al.
      Pages: 335 - 338
      Abstract: BACKGROUNDClinical practice guidelines endorse using ambulatory blood pressure monitoring (ABPM) for the diagnosis and management of hypertension. However, ABPM is not always tolerated by patients, and differences between individuals according to age and sex remain unexplored.METHODSThis is a post hoc analysis of a prospective, single-arm clinical trial (NCT03920956) that evaluated the feasibility of an ABPM service provided at 2 community pharmacies. Tolerability was assessed using a previously published survey, which included 7 yes/no questions and 8 answered on a scale of 0–10. Descriptive statistics and Chi-square analyses were used to summarize the data for the patient surveys and to describe sex and age differences in device tolerability.RESULTSOf the 52 subjects enrolled, 50 (96%) completed the survey; half were female with a mean (SD) age of 57.5 years (15.8). Chi-square analyses showed that compared with their male counterparts, females were more likely to find the monitor cumbersome to wear (76.2% vs. 40%, P = 0.014). Subjects under 55 years of age were more likely to be disturbed by the noise of the monitor during driving (38.1% vs. 4.2%, P = 0.005) and at other times (35.0% vs. 8.3%, P = 0.029), and to find the monitor embarrassing to wear (33.3% vs. 7.1%, P = 0.019).CONCLUSIONSAlthough ABPM was generally well-tolerated overall, we did identify age and sex differences in tolerability. These factors should be considered to ensure patient acceptance and tolerability of ABPM.
      PubDate: Thu, 12 Nov 2020 00:00:00 GMT
      DOI: 10.1093/ajh/hpaa182
      Issue No: Vol. 34, No. 4 (2020)
  • Renin–Angiotensin–Aldosterone System Inhibitors and COVID-19 Infection
           or Hospitalization: A Cohort Study
    • Authors: Dublin S; Walker R, Floyd J, et al.
      Pages: 339 - 347
      Abstract: BackgroundAngiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may increase the risk of coronavirus disease 2019 (COVID-19) infection or affect disease severity. Prior studies have not examined risks by medication dose.MethodsThis retrospective cohort study included people aged ≥18 years enrolled in a US integrated healthcare system for at least 4 months as of 2/29/2020. Current ACEI and ARB use was identified from pharmacy data, and the estimated daily dose was calculated and standardized across medications. COVID-19 infections and hospitalizations were identified through 6/14/2020 from laboratory and hospitalization data. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for race/ethnicity, obesity, and other covariates.ResultsAmong 322,044 individuals, 826 developed COVID-19 infection. Among people using ACEI/ARBs, 204/56,105 developed COVID-19 (3.6 per 1,000 individuals) compared with 622/265,939 without ACEI/ARB use (2.3 per 1,000), yielding an adjusted OR of 0.91 (95% CI 0.74–1.12). For use of <1 defined daily dose (DDD) vs. nonuse, the adjusted OR for infection was 0.92 (95% CI 0.66–1.28); for 1 to <2 DDDs, 0.89 (95% CI 0.66–1.19); and for ≥2 DDDs, 0.92 (95% CI 0.72–1.18). The OR was similar for ACEIs and ARBs and in subgroups by age and sex. 26% of people with COVID-19 infection were hospitalized; the adjusted OR for hospitalization in relation to ACEI/ARB use was 0.98 (95% CI 0.63–1.54), and there was no association with dose.ConclusionsThese findings support current recommendations that individuals on these medications continue their use.
      PubDate: Tue, 13 Oct 2020 00:00:00 GMT
      DOI: 10.1093/ajh/hpaa168
      Issue No: Vol. 34, No. 4 (2020)
  • Characteristics of US Adults Who Would Be Recommended for Lifestyle
    • Authors: Jackson S; Park S, Loustalot F, et al.
      Pages: 348 - 358
      Abstract: BackgroundThe 2017 American College of Cardiology / American Heart Association Guideline for blood pressure (BP) management newly classifies millions of Americans with elevated BP or stage 1 hypertension for recommended lifestyle modification alone (without pharmacotherapy). This study characterized these adults, including their cardiovascular disease risk factors, barriers to lifestyle modification, and healthcare access.METHODSThis cross-sectional study examined nationally representative National Health and Nutrition Examination Survey data, 2013–2016, on 10,205 US adults aged ≥18, among whom 2,081 had elevated BP or stage 1 hypertension and met 2017 ACC/AHA BP Guideline criteria for lifestyle modification alone.RESULTSAn estimated 22% of US adults (52 million) would be recommended for lifestyle modification alone. Among these, 58% were men, 43% had obesity, 52% had low-quality diet, 95% consumed excess sodium, 43% were physically inactive, and 8% consumed excess alcohol. Many reported attempting lifestyle changes (range: 39%–60%). Those who reported receiving health professional advice to lose weight (adjusted prevalence ratio 1.21, 95% confidence interval 1.06–1.38), reduce sodium intake (2.33, 2.00–2.72), or exercise more (1.60, 1.32–1.95) were significantly more likely to report attempting changes. However, potential barriers to lifestyle modification included 28% of adults reporting disability, asthma, or arthritis. Additionally, 20% had no health insurance and 22% had no healthcare visits in the last year.ConclusionsOne-fifth of US adults met 2017 ACC/AHA BP Guideline criteria for lifestyle modification alone, and many reported attempting behavior change. However, barriers exist such as insurance gaps, limited access to care, and physical impairment.
      PubDate: Thu, 29 Oct 2020 00:00:00 GMT
      DOI: 10.1093/ajh/hpaa173
      Issue No: Vol. 34, No. 4 (2020)
  • Prevalence and Determinants of Masked Hypertension in Nigeria: The REMAH
    • Authors: Odili A; Danladi B, Chori B, et al.
      Pages: 359 - 366
      Abstract: BackgroundEstimating the burden of hypertension in Nigeria hitherto relied on clinic blood pressure (BP) measurement alone. This excludes individuals with masked hypertension (MH), i.e., normotensive clinic but hypertensive out-of-clinic BP.MethodsIn a nationally representative sample of adult Nigerians, we obtained clinic BP using auscultatory method and out-of-clinic BP by self-measured home BP with semi-automated oscillometric device. Clinic BP was average of 5 consecutive measurements and home BP was average of 3 days duplicate morning and evening readings. MH was clinic BP <140 mm Hg systolic and 90 mm Hg diastolic and home BP ≥135 mm Hg systolic and/or 85 mm Hg diastolic.ResultsAmong 933 participants, the prevalence of sustained hypertension, MH, and white-coat hypertension was 28.3%, 7.9%, and 11.9%, respectively. Among subjects whose clinic BP were in the normotensive range (n = 558), the prevalence of MH was 13%; 12% among untreated and 27% among treated individuals. The mutually adjusted odds ratios of having MH among all participants with normotensive clinic BP were 1.33 (95% confidence interval, 1.10–1.60) for a 10-year higher age, 1.59 (1.09–2.40) for a 10 mm Hg increment in systolic clinic BP, and 1.16 (1.08–1.28) for a 10 mg/dl higher random blood glucose. The corresponding estimates in the untreated population were 1.24 (1.03–1.51), 1.56 (1.04–2.44), and 1.16 (1.08–1.29), respectively.ConclusionsMH is common in Nigeria and increasing age, clinic systolic BP, and random blood glucose are the risk factors.
      PubDate: Mon, 14 Dec 2020 00:00:00 GMT
      DOI: 10.1093/ajh/hpaa211
      Issue No: Vol. 34, No. 4 (2020)
  • Stress-Induced Blood Pressure Elevation Self-Measured by a Wearable
           Watch-Type Device
    • Authors: Tomitani N; Kanegae H, Suzuki Y, et al.
      Pages: 377 - 382
      Abstract: BACKGROUNDPsychological stress contributes to blood pressure (BP) variability, which is a significant and independent risk factor for cardiovascular events. We compared the effectiveness of a recently developed wearable watch-type BP monitoring (WBPM) device and an ambulatory BP monitoring (ABPM) device for detecting ambulatory stress-induced BP elevation in 50 outpatients with 1 or more cardiovascular risk factors.METHODSThe WBPM and ABPM were both worn on the subject’s nondominant arm. ABPM was measured automatically at 30-minute intervals, and each ABPM measurement was followed by a self-measured WBPM measurement. We also collected self-reported information about situational conditions, including the emotional state of subjects at the time of each BP measurement. We analyzed 642 paired BP readings for which the self-reported emotional state in the corresponding diary entry was happy, calm, anxious, or tense.RESULTSIn a mixed-effect analysis, there were significant differences between the BP values measured during negative (anxious, tense) and positive (happy, calm) emotions in both the WBPM (systolic BP [SBP]: 9.3 ± 2.1 mm Hg, P < 0.001; diastolic BP [DBP]: 8.4 ± 1.4 mm Hg, P < 0.001) and ABPM (SBP: 10.7 ± 2.1 mm Hg, P < 0.001; DBP: 5.6 ± 1.4 mm Hg, P < 0.001). The absolute BP levels induced by emotional stress self-measured by the WBPM were similar to those automeasured by the ABPM (SBP, WBPM: 141.1 ± 2.7 mm Hg; ABPM: 140.3 ± 2.7 mm Hg; P = 0.724). The subject’s location at the BP measurement was also significantly associated with BP elevation.CONCLUSIONSThe self-measurement by the WBPM could detect BP variability induced by multiple factors, including emotional stress, under ambulatory conditions as accurately as ABPM.
      PubDate: Thu, 27 Aug 2020 00:00:00 GMT
      DOI: 10.1093/ajh/hpaa139
      Issue No: Vol. 34, No. 4 (2020)
  • Automated Noninvasive Central Blood Pressure Measurements by Oscillometric
    • Authors: Trinkmann F; Benck U, Halder J, et al.
      Pages: 383 - 393
      Abstract: BackgroundCentral blood pressure becomes increasingly accepted as an important diagnostic and therapeutic parameter. Accuracy of widespread applanation tonometry can be affected by calibration and operator training. To overcome this, we aimed to evaluate novel VascAssist 2 using automated oscillometric radial pulse wave analysis and a refined multi-compartment model of the arterial tree.MethodsTwo hundred and twenty-five patients were prospectively enrolled. Invasive aortic root measurements served as reference in MEASURE-cBP 1 (n = 106) whereas applanation tonometry (SphygmoCor) was used in MEASURE-cBP 2 (n = 119).ResultsIn MEASURE-cBP 1, we found a mean overestimation for systolic values of 4 ± 12 mmHg (3 ± 10%) and 6 ± 10 mmHg (9 ± 14%) for diastolic values. Diabetes mellitus and low blood pressure were associated with larger variation. In MEASURE-cBP 2, mean overestimation of systolic values was 4 ± 4 mmHg (4 ± 4%) and 1 ± 4 mmHg (1 ± 7%) of diastolic values. Arrhythmia was significantly more frequent in invalid measurements (61 vs. 18%, P < 0.0001) which were most often due to a low quality index of SphygmoCor.ConclusionsCentral blood pressure estimates using VascAssist 2 can be considered at least as accurate as available techniques, even including diabetic patients. In direct comparison, automated measurement considerably facilitates application not requiring operator training and can be reliably applied even in patients with arrhythmias.
      PubDate: Tue, 03 Nov 2020 00:00:00 GMT
      DOI: 10.1093/ajh/hpaa174
      Issue No: Vol. 34, No. 4 (2020)
  • Renal Sodium Handling in Relation to Environmental and Genetic Factors in
           Untreated Chinese
    • Authors: Kang Y; Cheng Y, Guo Q, et al.
      Pages: 394 - 403
      Abstract: BACKGROUNDWe investigated proximal and distal renal tubular sodium handling, as assessed by fractional excretion of lithium (FELi) and fractional distal reabsorption rate of sodium (FDRNa), in relation to environmental and genetic factors in untreated patients.METHODSOur study participants were suspected hypertensive patients being off antihypertensive medication for ≥2 weeks and referred for 24-hour ambulatory blood pressure monitoring. We collected serum and 24-hour urine for measurement of sodium, creatinine, and lithium concentration, and calculated FELi and FDRNa. We genotyped 19 single-nucleotide polymorphisms associated with renal sodium handling or blood pressure using the ABI SNapShot method.RESULTSThe 1,409 participants (664 men, 47.1%) had a mean (±SD) age of 51.0 ± 10.5 years. After adjustment for host factors, both FELi and FDRNa were significantly (P ≤ 0.01) associated with season and humidity, explaining ~1.3% and ~3.5% of the variance, respectively. FELi was highest in autumn and lowest in summer and intermediate in spring and winter (P = 0.007). FDRNa was also highest in autumn but lowest in winter and intermediate in spring and summer (P < 0.001). Neither FELi nor FDRNa was associated with outdoor temperature or atmospheric pressure (P ≥ 0.13). After adjustment for host and environmental factors and Bonferroni multiple testing, among the 19 studied genetic variants, only rs12513375 was significantly associated with FELi and FDRNa (P ≤ 0.004) and explained about 1.7% of the variance.CONCLUSIONSRenal sodium handling as measured by endogenous lithium clearance was sensitive to major environmental and genetic factors. Our finding is toward the use of these indexes for the definition of renal tubular dysfunction.
      PubDate: Thu, 01 Oct 2020 00:00:00 GMT
      DOI: 10.1093/ajh/hpaa160
      Issue No: Vol. 34, No. 4 (2020)
  • Urinary Sodium and Potassium, and Risk of Ischemic and Hemorrhagic Stroke
           (INTERSTROKE): A Case–Control Study
    • Authors: Judge C; , O’Donnell M, et al.
      Pages: 414 - 425
      Abstract: BACKGROUNDAlthough low sodium intake (<2 g/day) and high potassium intake (>3.5 g/day) are proposed as public health interventions to reduce stroke risk, there is uncertainty about the benefit and feasibility of this combined recommendation on prevention of stroke.METHODSWe obtained random urine samples from 9,275 cases of acute first stroke and 9,726 matched controls from 27 countries and estimated the 24-hour sodium and potassium excretion, a surrogate for intake, using the Tanaka formula. Using multivariable conditional logistic regression, we determined the associations of estimated 24-hour urinary sodium and potassium excretion with stroke and its subtypes.RESULTSCompared with an estimated urinary sodium excretion of 2.8–3.5 g/day (reference), higher (>4.26 g/day) (odds ratio [OR] 1.81; 95% confidence interval [CI], 1.65–2.00) and lower (<2.8 g/day) sodium excretion (OR 1.39; 95% CI, 1.26–1.53) were significantly associated with increased risk of stroke. The stroke risk associated with the highest quartile of sodium intake (sodium excretion >4.26 g/day) was significantly greater (P < 0.001) for intracerebral hemorrhage (ICH) (OR 2.38; 95% CI, 1.93–2.92) than for ischemic stroke (OR 1.67; 95% CI, 1.50–1.87). Urinary potassium was inversely and linearly associated with risk of stroke, and stronger for ischemic stroke than ICH (P = 0.026). In an analysis of combined sodium and potassium excretion, the combination of high potassium intake (>1.58 g/day) and moderate sodium intake (2.8–3.5 g/day) was associated with the lowest risk of stroke.CONCLUSIONSThe association of sodium intake and stroke is J-shaped, with high sodium intake a stronger risk factor for ICH than ischemic stroke. Our data suggest that moderate sodium intake—rather than low sodium intake—combined with high potassium intake may be associated with the lowest risk of stroke and expected to be a more feasible combined dietary target.
      PubDate: Mon, 16 Nov 2020 00:00:00 GMT
      DOI: 10.1093/ajh/hpaa176
      Issue No: Vol. 34, No. 4 (2020)
  • ACE-2 Downregulation and Incidence of Severe Acute Respiratory
           Syndrome-Coronavirus-2 (SARS-CoV-2) Infection
    • Authors: Weir R; Glen C, McDowell K.
      Pages: 426 - 426
      Abstract: To the Editor: Dublin et al. present an excellent manuscript which not only adds to the growing evidence base that prescription of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin-receptor blockers (ARBs) is not associated with increased incidence or severity of severe acute respiratory syndrome-coronavirus-2 (SARS- CoV-2) infection but also shows no adverse effect on clinical outcomes, irrespective of the dosage prescribed.1 SARS-CoV-2 utilizes cellular ACE-2 for viral entry.2 Multiple recent publications suggest that ARBs upregulate ACE-2 (albeit with intraclass variations) while ACEi have at most minimal effects.2 Dublin et al.’s study therefore infers, indirectly, that chronically increased ACE-2 does not predispose to SARS-CoV-2 infection or severity despite its high affinity for ACE-2.1,2
      PubDate: Wed, 18 Nov 2020 00:00:00 GMT
      DOI: 10.1093/ajh/hpaa191
      Issue No: Vol. 34, No. 4 (2020)
  • Response to “ACE-2 Downregulation and Incidence of Severe Acute
           Respiratory Syndrome–Coronavirus-2 (SARS–CoV-2) Infection”
    • Authors: Dublin S; Walker R, Floyd J, et al.
      Pages: 427 - 427
      PubDate: Tue, 15 Dec 2020 00:00:00 GMT
      DOI: 10.1093/ajh/hpaa212
      Issue No: Vol. 34, No. 4 (2020)
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Heriot-Watt University
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