Effectiveness of treatment of arterial hypertension in Central Europe from 1972 to 2022

BACKGROUND

Hypertension is a leading cause of cardiovascular disease. This review examines the literature on hypertension control in the Czech Republic from 1972 to 2022 addressing limited data on its effectiveness.

METHODS

A literature review was conducted covering the period from 1972 to 2022, utilizing MEDLINE (PubMed), Web of Science, and Scopus databases. Articles were selected based on title and abstract evaluations, with full-text reviews performed as needed. Thirteen studies involving 44,990 participants were included in this review.

RESULTS

Control rates increased from 2.8% (men) and 5.2% (women) in 1985 to 32.3% (men) and 37.4% (women) from 2015 to 2018. Women showed better blood pressure control. Specialised centres achieved higher success (48%) than general practitioners (18.4%). Diabetic patients had a lower percentage (29.1%) of patients meeting their target values (<130/80 mmHg) compared to non-diabetic patients, who had a higher percentage (60.6%) meeting their target values (<140/90 mmHg).

CONCLUSION

Hypertension treatment success rate in the Czech Republic improved significantly over the last 50 years and is currently comparable to that of other European countries with similar healthcare resources. However, it still remains suboptimal and lags behind the countries with the most successful treatment outcomes (Tab. 3, Fig. 1, Ref. 37). Text in PDF www.elis.sk Keywords: hypertension, treatment, effectiveness, Czech Republic, blood pressure.

Hypoglycemia and antihyperglycemic treatment in adult MODY patients - A systematic review of literature

Maturity onset diabetes of the young (MODY) is a heterogeneous group of diseases caused by a single mutation in one of the 14 genes involved in the regulation of glucose homeostasis. GCK, HNF1A, and HNF4A genes are among the most common genes affected. Expression of these genes in the key organs for defense against hypoglycemia and their participation in counter-regulation to hypoglycemia may potentially put individuals with a heterozygous mutation in these genes at increased risk for hypoglycemia. In HNF4A-MODY and HNF1A-MODY patients, normal or even increased insulin sensitivity together with glucose-independent mechanism of action of the first-line therapy - sulphonylurea derivatives - often leads to hypoglycemia, even at the much lower dose used in type 2 diabetes. This review aims to analyze clinical studies and case reports concerning hypoglycemia associated with antihyperglycemic treatment in adult MODY patients.

How can maturity-onset diabetes of the young be identified among more common diabetes subtypes?

Maturity onset diabetes of the young (MODY) represents a diabetes type which has an enormous clinical impact. It significantly alters treatment, refines a patient's prognosis and enables early detection of diabetes in relatives. Nevertheless, when diabetes is manifested the vast majority of MODY patients are not correctly diagnosed, but mostly falsely included among patients with type 1 or type 2 diabetes, in many cases permanently. The aim of this article is to offer a simple and comprehensible guide for recognizing individuals with MODY hidden among adult patients with another type of long-term diabetes and in women with gestational diabetes.

Long non-coding RNA exchange during the oocyte-to-embryo transition in mice

The oocyte-to-embryo transition (OET) transforms a differentiated gamete into pluripotent blastomeres. The accompanying maternal-zygotic RNA exchange involves remodeling of the long non-coding RNA (lncRNA) pool. Here, we used next generation sequencing and de novo transcript assembly to define the core population of 1,600 lncRNAs expressed during the OET (lncRNAs). Relative to mRNAs, OET lncRNAs were less expressed and had shorter transcripts, mainly due to fewer exons and shorter 5′ terminal exons. Approximately half of OET lncRNA promoters originated in retrotransposons suggesting their recent emergence. Except for a small group of ubiquitous lncRNAs, maternal and zygotic lncRNAs formed two distinct populations. The bulk of maternal lncRNAs was degraded before the zygotic genome activation. Interestingly, maternal lncRNAs seemed to undergo cytoplasmic polyadenylation observed for dormant mRNAs. We also identified lncRNAs giving rise to trans-acting short interfering RNAs, which represent a novel lncRNA category. Altogether, we defined the core OET lncRNA transcriptome and characterized its remodeling during early development. Our results are consistent with the notion that rapidly evolving lncRNAs constitute signatures of cells-of-origin while a minority plays an active role in control of gene expression across OET. Our data presented here provide an excellent source for further OET lncRNA studies.

Long terminal repeats power evolution of genes and gene expression programs in mammalian oocytes and zygotes

Retrotransposons are “copy-and-paste” insertional mutagens that substantially contribute to mammalian genome content. Retrotransposons often carry long terminal repeats (LTRs) for retrovirus-like reverse transcription and integration into the genome. We report an extraordinary impact of a group of LTRs from the mammalian endogenous retrovirus-related ERVL retrotransposon class on gene expression in the germline and beyond. In mouse, we identified more than 800 LTRs from ORR1, MT, MT2, and MLT families, which resemble mobile gene-remodeling platforms that supply promoters and first exons. The LTR-mediated gene remodeling also extends to hamster, human, and bovine oocytes. The LTRs function in a stage-specific manner during the oocyte-to-embryo transition by activating transcription, altering protein-coding sequences, producing noncoding RNAs, and even supporting evolution of new protein-coding genes. These functions result, for example, in recycling processed pseudogenes into mRNAs or lncRNAs with regulatory roles. The functional potential of the studied LTRs is even higher, because we show that dormant LTR promoter activity can rescue loss of an essential upstream promoter. We also report a novel protein-coding gene evolution—D6Ertd527e—in which an MT LTR provided a promoter and the 5′ exon with a functional start codon while the bulk of the protein-coding sequence evolved through a CAG repeat expansion. Altogether, ERVL LTRs provide molecular mechanisms for stochastically scanning, rewiring, and recycling genetic information on an extraordinary scale. ERVL LTRs thus offer means for a comprehensive survey of the genome's expression potential, tightly intertwining with gene expression and evolution in the germline.

Half-Life of Sulfonylureas in HNF1A and HNF4A Human MODY Patients is not Prolonged as Suggested by the Mouse Hnf1a(-/-) Model

OBJECTIVES

Sulfonylurea derivatives are widely used for clinical treatment of human subjects with Maturity Onset Diabetes of the Young (MODY) caused by mutations in HNF-1α or HNF-4α despite the mechanism leading to their hypersensitivity is incompletely understood. In Hnf1a(-/-) mice, serum concentrations and half-life of sulfonylurea derivatives are strongly increased. We thus hypothesized that reduced sulfonylurea derivatives clearance stands behind their therapeutic potential in human HNF1A/HNF4A MODY subjects.

DESIGN AND METHODS

Single doses of 3 mg glipizide and 5 mg glibenclamide/glyburide were administered sequentially to seven HNF1A/HNF4A MODY subjects and six control individuals matched for their age, BMI and CYP2C9 genotype. Pharmacokinetic (plasma concentration levels, Cmax, tmax, t1/2, AUC) and pharmacodynamic parameters (glycemia, C-peptide and insulin plasma levels) were followed for 24 hours after drug administration.

RESULTS

We provide the first evidence on the pharmacokinetics and pharmacodynamics of sulfonylurea derivatives in human MODY subjects. The half-life of glipizide did not change, and reached 3.8±0.7 and 3.7±1.8 h in the MODY and control subjects, respectively. The half-life of glibenclamide was increased only in some MODY subjects (t1/2 9.5±6.7 and 5.0±1.4 h, respectively). Importantly, the intra- individual responses of MODY (but control) subjects to glipizide and glibenclamide treatment were highly correlated. With regards to pharmacodynamics, we observed a differential response of control but not MODY subjects to the doses of glipizide and glibenclamide applied.

CONCLUSIONS

We rejected the hypothesis that all human MODY-associated mutations in HNF1A / HNF4A induce changes in the pharmacokinetics of sulfonylureas in humans analogically to the Hnf1a(-/-) mouse model.

The relationship between estimated GFR based on the CKD-EPI formula and renal inulin clearance in potential kidney donors

It is not yet clear whether or not renal function in the living donor can be sufficiently assessed by estimated glomerular filtration rate (GFR) using creatinine-based equations. The present paper investigates the relationship between GFR values determined using renal inulin clearance (Cin) and those estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Our study was performed in 287 potential kidney donors with a mean age of 48 ± 10 years. Mean Cin was 1.47 ± 0.28 (1.10 - 2.50) mL/s/1.73 m2. Total bias when using the CKDEPI formula was -0.0183 mL/s/1.73 m2, precision 0.263 mL/s/1.73 m2, and accuracy 90.6% within ± 30% of Cin. The sensitivity of CKD-EPI to estimate a decrease in Cin below 1.33 mL/s/1.73 m2 was 50.5%, with an 85% specificity of detecting a value above the cutoff. Receiver-operating curve analysis for the above produced an area under the curve of 0.766 ± 0.0285 (CI 0.712 - 0.813). For donor screening purposes, CKD-EPI should be interpreted with great caution.

Pulmonary function alterations after correction of mitral stenosis

The aims of the study is to demonstrate the degree of pulmonary function reversibility after successful correction of mitral stenosis, transvenous as well as surgical. Before and in the short- and long-term follow-up after mitral stenosis correction (mitral valve replacement and percutaneous balloon mitral valvuloplasty) echocardiographic and pulmonary function studies were performed in 125 patients with pure or dominant mitral stenosis in order to investigate the influence of hemodynamic changes on pulmonary function. Immediately after procedure moderation of bronchial obstruction could be detected although only in balloon valvuloplasty group. In pts after surgery dramatic decline of pulmonary function due to thoracotomy was found. In the long-term follow-up substantial improvement of all ventilatory parameters in both groups was revealed, diffusing capacity remained unchanged. The favourable evolution was comparable in both groups. The explanation are time consuming beneficial peripheral metabolic, circulatory and organic pulmonary changes, what implies also irrelevant changes of PF in the early phase and unalterable diffusing capacity. (Tab. 1, Fig. 4, Ref. 15.)