bluuebunny/crossref_metadata_2025 huggingface dataset:
THE EFFECT OF DARK AND WHITE CHOCOLATE ON BLOOD PRESSURE AND RENAL PERFUSION AS ASSESSED WITH DOPPLER ULTRASOUND IN HEALTHY VOLUNTEERS
Authors: Pruijm Menno , Gargiulo Louise , Brito Wendy , Hendriks-balk Marielle , Theiler Kenji , Wuerzner Gregoire
Published: May 2024

Objective:

Dark chocolate (DC) is rich in calories but also in cocoa, a substance with anti-oxidative and antihypertensive properties. Acute intake of DC vasodilates coronary arteries, but the effect on blood pressure and renal hemodynamics is poorly understood. The aim of this randomized, placebo controlled study was to investigate whether DC induces changes in blood pressure and renal perfusion as assessed with Doppler ultrasound, both at rest and during sympathetic stimulation, as compared to cocoa-free white chocolate (WC).

Design and method:

Seventeen healthy volunteers aged 42±14 years (47% women) were randomized to eat 1g/kg of DC (70% cocoa) or 1g/kg of WC. The renal resistive index (RRI), a proxy of intra-renal vascular resistance, was measured just before and two hours after chocolate consumption. Blood pressure (BP) and heart rate were measured with a Finapress device. At each time point, a 3-minute handgrip test was performed as sympathetic stimulus; during the handgrip, supplementary RRI values were measured. Two weeks later, the same exams were repeated with the other type of chocolate.

Results:

DC intake decreased RRI from 0.62±0.04 to 0.60±0.04 (p=0.039), whereas RRI did not change after the intake of WC (before: 0.62±0.05, after: 0.62±0.04, p=0.47), see Figure. DC had no effect on BP in persons consuming >50g/chocolate/week, whereas SBP increased from 115±17 to 122±15 mmHg (p=0.02) in non regular chocolate eaters. Handgrip exercise also lowered the RRI from 0.62 to 0.57 (p=0.001) and flattened the Doppler curves, while increasing SBP (from 115±15 to 139±16mmHg, p=0.001). In women, the effect on RRI was attenuated by the ingestion of DC.

Conclusions:

The ingestion of DC lead to an acute reduction in RRI, suggesting intra-renal vasodilatation, whereas WC had no effect. BP only increased in non-regular DC eaters, suggesting that regular DC eaters got accustomed to the BP-modifying effects of DC. Handgrip exercise led, surprisingly, also to reductions in RRI, especially in young participants. Whether this is a sign of or sympathetically induced intra-renal vasodilatation or vascular reactivity needs further study.
PRACTICE-BASED BLOOD PRESSURE MANAGEMENT IN 1000 PATIENTS USING THE CUREAPP HT DIGITAL THERAPEUTICS FOR HYPERTENSION
Authors: Nomura Akihiro , Takagi Yusuke , Tanigawa Tomoyuki , Kario Kazuomi
Published: May 2024

Objective:

The HERB-DH1 randomized controlled trial recently demonstrated significant reductions in ambulatory, home, and office blood pressures in essential hypertension patients using a novel digital therapeutics (DTx) app for hypertension (CureApp HT, CureApp, Inc.) for up to six months. However, its effectiveness in clinical practice, particularly regarding the influence of patient age and concurrent antihypertensive medication use, remains underexplored. This study aims to assess blood pressure changes in the first 1000 hypertensive patients prescribed the DTx app in a practice-based real-world data (RWD) cohort.

Design and method:

Deidentified data from the CureApp HT clinical information database were analysed. The primary endpoint was the change in morning home SBP from baseline to week 12. Key secondary endpoints included changes in morning home SBP from baseline to week 24, and app engagement rates from baseline to week 12 and 24. We also compared home morning SBPs between the practice-based RWD cohort and the historical HERB-DH1 control group using analysis of covariance.

Results:

The practice-based RWD cohort (mean age, 54.8 ± 11.6 years; 48.9% female; baseline morning home SBP, 132.8 ± 12.9 mmHg; and median app engagement rate, 91.7%) showed reductions in morning home SBP of -4.9 mmHg (CI, -5.6 to -4.2) at week 12 and -6.1 mmHg (CI, -7.3 to -5.0) at week 24, both significantly larger than those in the HERB-DH1 control group. Subgroup analysis revealed pragmatic SBP reductions with DTx in patients aged equal or more than 65 years or on antihypertensive medication at baseline, populations previously excluded in the HERB-DH1 trial.

Conclusions:

Conclusions: Significant reductions in morning home SBP were observed in the first 1000 hypertensive patients prescribed the DTx app compared to the HERB-DH1 control group. These findings might suggest importance of the DTx app’s engagement and effectiveness that could extends to elderly patients and those on antihypertensive medication.
EFFECT OF DASH VS. MEDITERRANEAN DIET ON METABOLIC SYNDROME PREVALENCE IN ADULTS WITH HIGH NORMAL BLOOD PRESSURE OR GRADE 1 HYPERTENSION: A RANDOMIZED CONTROLLED TRIAL
Authors: Filippou Christina , Thomopoulos Costas , Konstantinidis Dimitrios , Dimitriadis Kyriakos , Tatakis Fotis , Siafi Eirini , Manta Eleni , Drogkaris Sotirios , Stathoulopoulou Maria , Polyzos Dimitrios , Grigoriou Kalliopi , Kakouri Niki , Tsoumpou Ioanna , Andrikou Ioannis , Kasiakogias Alexandros , Tsioufis Konstantinos
Published: May 2024

Objective:

Lifestyle interventions are recommended as the first-line treatment to control metabolic syndrome components. However, studies directly comparing the effects of the Dietary Approaches to Stop Hypertension (DASH) vs. the Mediterranean diet (MedDiet) on metabolic syndrome prevalence are currently lacking. Thus, we aimed to assess the effects of a 3-month intensive dietary intervention implementing salt restriction either alone or on top of the DASH and MedDiet compared to no/ minimal intervention on metabolic syndrome prevalence in never drug-treated adults with high normal blood pressure (BP) or grade 1 hypertension.

Design and method:

We randomly assigned individuals to the control group (CG, n = 60), salt restriction group (SRG, n = 60), DASH diet with salt restriction group (DDG, n = 60), or MedDiet with salt restriction group (MDG, n = 60). All patients were followed monthly for 3 months in individual sessions. Patients in the CG received general advice on dietary principles for BP control. For the patients in all three intervention groups, the goal was to limit sodium intake to 2,000 mg/ day (equivalent to 5,0g salt/ day). In addition, patients in the DDG and the MDG received an individualized dietary plan with six daily sample menus to facilitate the adoption of the assigned dietary pattern. Anthropometric indices, dietary intake, office BP, and fasting blood samples were evaluated pre- and post-intervention.

Results:

According to the intention-to-treat analysis, at 3 months post-intervention, the DDG and the MDG had lower odds ratio (OR) (95% CI) of metabolic syndrome compared to the CG [0.29 (0.12, 0.72), and 0.15 (0.06, 0.41), respectively], whereas the SRG and the CG did not differ regarding the odds of metabolic syndrome. Moreover, comparisons among the three intervention groups revealed that only the MDG had lower odds of metabolic syndrome compared to the SRG [0.25 (0.09, 0.67)].

Conclusions:

On a background of salt restriction, only the MedDiet was superior to salt restriction alone for metabolic syndrome prevalence reduction, but the DASH and MedDiet reduced the prevalence of metabolic syndrome to the same extent.
CHARACTERIZATION OF EARLY FUNCTIONAL, STRUCTURAL AND MOLECULAR ALTERATIONS IN A RAT MODEL OF CARDIORENAL SYNDROME TYPE IV: ROLE OF BMP-2
Authors: Sanz-gómez Marta , Vázquez-sánchez Sara , Manzano-lista Francisco Javier , Palma-guzmán Paloma , Guzmán-aguayo Ana Karen , Bragado-garcía Elvira , Kreutz Reinhold , Ruiz-hurtado Gema , Fernández-alfonso María S.
Published: May 2024

Objective:

Cardiorenal Syndrome type IV (CRS-IV) is a common complication of chronic kidney disease (CKD) and a high-risk syndrome with poor prognosis. However, pathogenic mechanisms remain elusive. Our objective was to characterize early cardiac structural, functional, and molecular alterations in Munich Wistar Frömter (MWF), a rat model with established CKD.

Design and method:

Cardiac function, rhythm and structure were analyzed in aging 22- and 45-week-old Wistar and MWF rats (n=8/group) by electrocardiogram (ECG) and cardiac magnetic resonance imaging (CMRI). Hearts were dissected after the sacrifice and ventricle mRNA was extracted for q-RT-PCR.

Results:

From 22 weeks of age, MWF showed a defective ventricular repolarization (longer QT, QTc, JT and Tpeak-Tend) compared to Wistar rats. These ventricular electrical alterations relate to the presence of left ventricular (LV) hypertrophy supported by increased heart weight, LV wall thickness and higher expression of atrial and brain natriuretic peptides (Anp and Bnp). MWF rats also exhibited significantly lower systolic, diastolic and stroke volumes and a reduced cardiac output with no changes in the ejection fraction compared to Wistar rats.

At 45 weeks of age, the PR interval and P duration were increased in MWF rats compared to Wistar, indicating the development of atrial conduction dysfunction. LV expression of bone morphogenetic protein 2 (Bmp-2), which has been proposed as an antifibrotic cytokine, was 4-fold higher in MWF, whereas Tgf-beta was significantly lower and negatively correlated with Bmp-2 in MWF.

Conclusions:

During aging CKD evolves into CRS-IV through the development of LV hypertrophy and dysfunction followed at later ages by atrial damage. Since Bmp-2 downregulates profibrotic Tgf-beta expression it appears that the observed upregulation of Bmp-2 may represent an adaptive, however non-compensatory, cardiac response in the development of CRS-IV in this model.
HEALTHY METABOLIC STATUS: HOW FREQUENT IS THE TRANSITION TO A METABOLICALLY UNHEALTHY PHENOTYPE?
Authors: Palatini Paolo , Saladini Francesca , Mos Lucio , Vriz Olga , Mazzer Adriano , Garavelli Guido , Berton Giuseppe , Rattazzi Marcello
Published: May 2024

Objective:

The clinical significance of metabolically healthy overweight/obesity (OwOb) is controversial. One main issue not yet resolved is whether a healthy metabolic status is stable or just temporary. Conversion to a metabolically unhealthy phenotype may imply a considerable increase in cardiovascular risk. Aim of the present study was to determine the frequency of the transition from metabolically healthy to metabolically unhealthy status and vice versa over the long term.

Design and method:

We examined 965, 18-to-45-year-old participants from the HARVEST study. Mean age was 33.1±8.6 years and BP 145.5±10.6/93.5±5.7 mmHg. Participants were classified into four groups according to whether they had normal weight or OwOb and were metabolically healthy (no abnormal metabolic syndrome parameter) or unhealthy (one or more abnormal parameter). After baseline assessment, non-pharmacological measures were implemented following the recommendations of current international guidelines. Changes in body weight and metabolic status were evaluated after a 7.5-year follow-up.

Results:

At baseline, 132 participants (13.7%) were normal-weight metabolically healthy, 331 (34.3%) normal-weight metabolically unhealthy, 91 (9.4%) OwOb metabolically healthy, and 411 (42.6%) OwOb metabolically unhealthy. At follow-up end, these percentages were, 10.3%, 28.2%, 9.4%, and 52.1%, respectively (p<0.0001). Only 32.6% of metabolically healthy normal-weight subjects remained metabolically healthy, while 36.4% transitioned to unhealthy status, and 31.1% to OwOb. Follow-up changes in body weight (mean±SEM) were +1.9±0.8, 2.6±0.7, and 8.6±0.8 Kg, respectively, in the three groups (p<0.001). Similarly, among the metabolically healthy OwOb participants only 31.9% remained metabolically healthy. Among the metabolically unhealthy OwOb subjects, 79.6% remained metabolically unhealthy, 8.3% transitioned to healthy status and 12.2% achieved normal weight. Body weight changes in the three groups were +2.3±0.3, +2.2±1.1, and -9.4±0.9 Kg, respectively (p<0.001).

Conclusions:

These data show that metabolically healthy status is a highly unstable condition in either normal-weight or OwOb individuals. Lifestyle counselling produced significant beneficial effects in one fifth of metabolically unhealthy OwOb patients, who achieved healthy metabolic status and/or normal weight. Given the instability of healthy metabolic status, it is important to advise also metabolically healthy people to maintain or adopt a healthy lifestyle and to decrease body weight in OwOb individuals.
ASSOCIATION OF LONG-TERM TIME IN TARGET RANGE FOR SYSTOLIC BLOOD PRESSURE SINCE CHILDHOOD WITH ARTERIAL STIFFNESS IN MIDLIFE: A 36-YEAR PROSPECTIVE COHORT STUDY
Authors: Wang Yang , Qi Han , Jia Hao , Wang Dan , Sun Yue , Du Ming -Fei , Hu Gui -Lin , Man Zi -Yue , Chu Chao , Chang John , Delles Christian , Zhang Ling , Mu Jian -Jun
Published: May 2024

Objective:

Elevated blood pressure (BP) in childhood is associated with adult hypertension and arterial stiffness. We aimed to determine the independent association of time in target range (TTR) for systolic blood pressure (SBP) from childhood to midlife with arterial stiffness in midlife.

Design and method:

Using data from the ongoing cohort of Hanzhong Adolescent Hypertension study, 1959 children and adolescents aged 6 to 18 years were enrolled at baseline. We assessed SBP-TTR from childhood to adulthood for 36 years, with the target range of SBP defined as 90th – 95th percentile for age, sex, and height in childhood, and 110 to 130 mmHg in adulthood.

Results:

During the 36 years of follow-up, the risk of arterial stiffness gradually decreased with increasing TTR for SBP. After fully adjustment for traditional cardiovascular risk factors, comparing the highest vs. lowest quartiles of TTR for SBP, the odds ratios (ORs) [95% confidence intervals (CIs)] were 0.642 (0.452-0.911) for the risk of arterial stiffness in adulthood. TTR remained significantly associated with arterial stiffness despite adjustment for mean SBP or SBP variability. In addition, males with highest quartile of SBP-TTR was significantly associated with a decreased risk of arterial stiffness [OR 95% CI, 0.432 (0.262-0.710)], while no significant difference was found in females compared with the lowest TTR group.

Conclusions:

Higher long-term TTR for SBP from childhood to adulthood was associated with a decreased risk of arterial stiffness in adulthood independent of mean BP or BP variability. Therefore, SBP-TTR from an early age might serve as a modifiable risk factor for future cardiovascular diseases in later life.
SYSTEMATIC REVIEW OF MEDICATION ADHERENCE IN PATIENTS WITH HYPERTENSION IN INDIA
Authors: Agarwal Annika , Osman Hanad , Patel Prashanth , Mathur Sandeep Kumar , Bernieh Dennis , Gupta Pankaj
Published: May 2024

Objective:

It is estimated that there are around 220 million adults in India with hypertension and only 12% have their blood pressure under control. Non-adherence in hypertension is a key factor that contributes to uncontrolled blood pressure. The extent of non-adherence in people with hypertension in India is currently unknown.

Design and method:

A systematic review was carried out using PubMed/MEDLINE to identify relevant studies from inception until July 2022 and included all articles in English of adults with hypertension and any study which had adherence (or equivalent terms) in the title or abstract. Data was analysed using SPPSS28.

Results:

The initial search identified 433 papers and on screening, 49 papers were found to meet the inclusion criteria. A total of 15,577 patients were studied. The mean age ranged from 26.1 to 69.3 yr. The median percentage of males was 37.5% (range 0% to 86.7%). The median value of patients that had less than primary school education was 25.2% (range 2.3% to 98.5%). The median of patients that had the condition for over 5 years was 40.0% (range 33.6% to 63.0%). 83.35% (30/36) studies took place in tertiary care and 53.3% (8/15) were in a rural setting and rest were either in urban or mixed setting.

The vast majority 84.4% (38/45) used standardised questionnaires to assess nonadherence. 45 studies had quantifiable data on non-adherence with the median non-adherence rate of 54.0% (range 4%- 98.5%).

Non-adherence was not significantly associated with mean age (P = 0.310), gender (P = 0.800), level of education (P = 0.468), duration of condition (P = 0.823), rural vs. urban setting (P = 0.805) or primary vs. tertiary care setting (P = 0.089).

Conclusions:

This is the first systematic review to evaluate the extent of non-adherence in patients in India with hypertension. The median nonadherence rate was more than 50% with a wide variation in rates across the studies. There were no factors identified that correlated with the extent of non-adherence. Further standardised studies are needed to understand and address this important issue in India.
ADHERENCE TO HYPERTENSION GUIDELINES AMONGST GENERAL PRACTITIONERS - A CASE BASED QUESTIONARY
Authors: Moczar Csaba , Tóth-szeles Roland
Published: May 2024

Objective:

Hypertension is one of the most prevalent cardiovascular diseases. General practitioners have an important role in the treatment, which is why being up-to-date on treating this common disease is crucial.

Design and method:

Our goal was to measure general practitioners’ adherence to national hypertension treatment guidelines. We used a case-based questionnaire to represent the real-life practice as much as possible. We reached the general practitioners of the country via a Google questionnaire. In the first part, we obtained consult and asked about sociodemographic data. After these, we presented 5 cases separately. Each case had different cardiovascular risk factors, anamnesis, physical, laboratory, and diagnostic findings with different blood pressure values. GPs had to decide whether they would treat the case with drug(s), if so, with which drug type, for what systolic and diastolic target values, and what risk factors they would consider before choosing the treatment. These were multiple-choice questions.

Results:

We managed to reach out to 88 general practitioners. Most of them were familiar with the national hypertension guidelines; however, less so with the Hungarian Cardiovascular Consensus Conference recommendations. The indication of whether or not to treat a person was adequate in almost every case. The drugs to go with were coherent with the recommendations, although a tiny group started the therapy with combinations. There was also a significant number of those who chose beta-blockers as the first line of therapy. Among the target values, however, there was a considerable amount of uncertainty. The concomitant risk factors were considered when choosing the drug in most cases.

Conclusions:

Although the number of participants in our study was low, there were some trends that we could withdraw from it. Most colleagues are familiar with the guidelines for hypertension treatment. Most choose correctly whether to treat a patient. There was considerable uncertainty regarding the target values for different cardiovascular-risk patients. The doctors consider most of the risk factors upon choosing the starting drug treatment. There is still a meager percentage who start with combination therapy despite its superiority to monotherapy.
RISK DRIVERS FOR NON-ADHERENCE IN PATIENTS TREATED FOR HYPERTENSION
Authors: Dolgin Kevin , Jaegly Alexandre , Dabasinskas Linas , Pociute Simona , Drumea Dumitru
Published: May 2024

Objective:

Adherence to treatment remains an unmet need in hypertension with important clinical and financial consequences for patients, HCPs, and health systems.

The objective of this study is to identify the behaviors of patients treated for hypertension, and specially the drivers of risk of non-adherence across 3 European countries: UK, Spain, and France.

Design and method:

Two questionaries were utilized for data collection: a sociodemographic and medical patient questionnaire and the SPUR questionnaire, a validated Patient-Reported Outcome Measurement tool developed by Observia.

The questionnaires were taken by 122 patients with hypertension who were recruited through patient panels on random basis to avoid selection bias.

Results:

The recruited patient population presented following characteristics: mean age 57 years, 60% male, with the most common comorbidities being diabetes (40% of patients), dyslipidemia (33%), and depression (25%).

The transversal analysis in three countries showed the most important behavioral drivers of non-adherence:

- Time (score∗: 53-66) - patients underestimating future benefits of the treatment over the burden of taking it today.

- Treatment risks (score∗: 44-45) – patients are concerned about potential side effects of the treatment.

- Societal (score∗: 40-44) - patients worry about the impact that hypertension has on their social life (i.e., at work, social activities, interaction with acquaintances).

The next three drivers for the RNA were the underestimation by the patient of the disease gravity, financial difficulties, and family life (immediate driver). This was common for all the countries of the study.

Conclusions:

The results provide insights on the main behavioral drivers of non-adherence to hypertension treatment.

These results should be confirmed in a larger population to be used as the basis for developing patient engagement programs to increase adherence. These should be co-constructed with HCPs and patients themselves to efficiently target identified main drivers of non-adherence in hypertension.

∗The drivers of risk of non-adherence are scored using Observia's proprietary SPUR algorithm, more information can be found in publications on SPUR.
DEVELOPMENT OF AN APPLICATION AS AN AUXILIARY TOOL FOR VERIFICATION OF AN ELECTROCARDIOGRAM CONCLUSION
Authors: Vizir Maryna
Published: May 2024

Objective:

Electrocardiography (ECG) is a key step in the diagnosis of cardiovascular pathology. Interpretation of the ECG is carried out by the doctor in the first minutes of severe patient admission and often determines further tactics of management. However, such an important diagnostic method is quite subjective, since it is highly dependent on the knowledge, and experience of the doctor and even on his attention to detail.

The objective is to develop an application for automatic verification of various ECG criteria (exceptionally as an addition to the subjective interpretation of the doctor).

Design and method:

The desktop application was developed in Python (v3.10.5) by implementing its object-oriented programming concepts. Tkinter was chosen as a Graphical User Interface framework. The set of standard libraries has been supplemented by OpenCV (v4.6.0.66) for recognizing and digitizing ECG images, Pillow (v9.3.0) for manipulating the image and its metadata, NumPy (v1.23.5) for further analysis, and others.

The initial version of the program includes STEMI recognition. Real ECGs printed on graph paper were used for debugging and testing.

Results:

When launching the application, the user is prompted to select a file containing an ECG image (a). After the required image has opened, the user should indicate the requested ECG-leads in the picture, following the simplest instructions (b).

Then processing of the leads automatically starts. This phase is hidden from the user, and only a progress bar is displayed on the screen (c). Meanwhile, a number of manipulations are performed, such as converting the picture to a binary state, recognizing the ECG-line, and storing the coordinates of each pixel in the database. Objects of such classes as Isoline, and Cardiac Cycle with R wave, ST segment, etc. are created for each of the objects of the Lead class (d).

Further geometric study of the pixel base and checking for the pathological ECG-signs on the backend form the final conclusion for the user (e).

Conclusions:

The developed application is relevant for use as an additional tool in the work and training of doctors. It can be expanded to cover a wide range of pathologies.
CAN PATIENTS WITH CARDIOVASCULAR RISK FACTORS AND DIFFERENCE BETWEEN OFFICE AND OUT-OF-OFFICE BP MEASUREMENTS BENEFIT FROM ABPM?
Authors: Ztriva Eleftheria , Andronogloy Markos , Kachtsidis Vasileios , Kontana Anastasia , Gogou Christiana , Savvopoulos George , Dimas Grigorios , Savopoulos Christos
Published: May 2024

Objective:

Blood pressure (BP) is a dynamic parameter characterized by fluctuations during the 24-hour period. During the nighttime hours, BP drops 10-20% in normotensive and untreated hypertensive patients - a dipping phenomenon, followed by a rapid and gradual increase during waking hours. The dipping phenomenon can be checked by Ambulatory Blood Pressure Measurement (ABPM). The main clinical indications for ABPM, suggested by the available studies, are white-coat phenomena, masked hypertension, and nocturnal hypertension.

Design and method:

Our study involved 45 patients with over 20% difference between office and out-of-office blood pressure measurements. We checked their medical history for other cardiovascular risk factors, such as Dyslipidemia, Diabetes Mellitus, Coronary Disease. Our patients were under 24 hour- ABPM and they were classified according to the rate of fall in systolic BP during 24-hour recording into four categories: the extreme-dippers drop >20%, dippers drop >10% and <20%, non-dippers drop <10% and >0%, and reverse-dippers or risers drop <0%. The purpose of our study is to consider the significance of ABPM in specific target groups of patients with cardiovascular risk factors.

Results:

In our study 44 patients participated (56,8% men) with mean age 55,9 and mean value of systolic BP 120,7mmHg. 40,9% of the patients had a history of hypertension, 36,4% dyslipidemia, 15,9% diabetes mellitus and 11,4% coronary disease. 77,3% of the patients were judged to be normotensive, but 35,3% of them had a history of hypertension and were under medication, only 11,4% were judged to be hypertensive, 6,8% with isolated diastolic hypertension and 4,5% with isolated systolic hypertension. According to ABPM, we changed medication in 29,5% of the patients. 76.9% of them had already history of hypertension and were under medication, 38,5% had dyslipidemia and 30,7% diabetes mellitus and coronary disease.

Conclusions:

In our study we were not able to demonstrate that patients with difference between office and out-of-office BP measurements and cardiovascular risk factors could benefit most from ABPM but we demonstrated that patients with a history of hypertension could benefit form ABPM, so that physician could choose the appropriate treatment.
BLOOD PRESSURE MEASUREMENTS IN COMMUNITY PHARMACIES IS STILL UNDERSUED IN CROATIA
Authors: Zdilar Ana Marija , Abramovic Inga , Alagic Marieta , Ivankovic Iva , Andelic Ana Marija , Horvat Petra , Domislovic Marija , Soldo Ana , Glavic Mihaela Marinovic , Jelakovic Bojan
Published: May 2024

Objective:

The growing significance of hypertension worldwide emphasizes the crucial role of early diagnosis and prompt initiation of treatment. This study aimed to determine the prevalence of individuals measuring blood pressure (BP) in community pharmacies and to identify their characteristics.

Design and method:

In this study, we analyzed data from 1779 participants (a random sample of the general adult population in Croatia included in the ’Epidemiology of Hypertension in Croatia -2’ project). The participants completed questionnaires and were divided into two groups; individuals who occasionally monitor BP in the community pharmacy and those who do not.

Results:

Out of 1779 participants, 1634 individuals (91.8%) do not measure their BP regularly in the community pharmacy. More women than men measure BP in pharmacies (55.4%). Subjects living in rural areas measure more frequently BP in the community pharmacies than those living in urban parts of Croatia. Most of those who measure BP in pharmacies had their own BP device at home (68.3%), and already have been diagnosed with sustained arterial hypertension (75.6%). However, the majority (71%) believe that pharmacists should not have a greater role in the treatment of arterial hypertension.

Conclusions:

Community pharmacists are still unrecognized and underused healthcare workers in Croatia. Their knowledge and skill should be used more frequently, not only in teamwork for treatment and follow-up of patients with hypertension but also in primary prevention. They might have a particularly important role in remote areas where standard health care is lacking.
MONOTHERAPY VERSUS DOUBLE-AGENT COMBINATION THERAPY AS A FIRST-LINE TREATMENT FOR HYPERTENSIVE ADULTS: A CROSS-SECTIONAL STUDY
Authors: Tsoutsouli Vasiliki , Chaniotaki Maria , Nikoli Aikaterini , Kazineris Dimitrios , Papadimos Georgios , Foutsitsakis Dimos , Sachla Zacharo
Published: May 2024

Objective:

Worldwide, an estimated 1.28 billion adults between the ages of 30 and 79 suffer from hypertension. Only 42% of them are diagnosed and receive treatment. Hypertension is considered to be a major cause of premature death. WHO guidelines for hypertensive adults requiring pharmacological treatment suggest an initial therapy with a single-agent, while double-agent combination therapy is considered preferable when target blood pressure is not reached with a single-agent treatment.

Design and method:

The present study included 2000 patients, divided by gender, randomly selected with up to Grade II Hypertension, who attended consultations in the out-patient clinic of Hypertension in the General Hospital of Thessaloniki “G. Papanikolaou” between February 2018 and December 2023. The exclusion criteria included patients with secondary causes of hypertension. The patients were divided in two equal groups according to their treatment plan: Monotherapy group and Combination group.

Results:

In total, 693(34.6%) of patients, both men and women, with no comorbidities other than hyperlipidemia or hypothyroidism, followed the same treatment plan using a single agent treatment and achieved the target levels of blood pressure. It is imperative to point out that these patients had no signs of atherosclerosis by carotid ultrasound. On the contrary, patients with medical history of diabetes mellitus, obesity, cancer, stroke, intracranial bleeding, aneurysm and coronary artery disease, required combined treatment with two drugs or more to reach the acceptable Blood Pressure levels. There was no statistical significance between men and women.

Conclusions:

This study demonstrates that patients with hypertension can be treated with monotherapy and reach the target Blood Pressure levels only when no comorbidities exist. When atherosclerosis exists being the cause of many of the forementioned comorbidities, a combination double-agent drug is necessary.
EFFECTIVENESS OF POLYPHENOL SUPPLEMENTATION ON BLOOD PRESSURE MANAGEMENT IN PATIENTS WITH HYPERTENSION
Authors: Tasic Danijela , Petrovic Masa , Bozovic Sladjana , Despotovic Biljana , Bogicevic Zorana , Tasic Nebojsa
Published: May 2024

Objective:

Globally, arterial hypertension and its associated complications are the leading cause of cardiovascular mortality. The potential of polyphenols, known for their robust antioxidant properties, in preventing cardiovascular diseases has been extensively studied. Among these, grape seed extract stands out as a significant source of polyphenols. The aim of our study was to evaluate the efficacy of a polyphenol-based supplement, which is rich in grape seed extract-derived polyphenols, in managing prehypertension and hypertension and its impact on blood pressure regulation.

Design and method:

The study included 111 patients, monitored over a 24-week period. The patients were divided into three groups: prehypertensive (120/80–139/89 mmHg), stage I hypertensive (140/90–149/109 mmHg), and stage II hypertensive (150 or above/110 or above mmHg). Blood pressure was measured across three consecutive measurements in both sitting and standing positions at intervals of 5 minutes, with the mean value of these readings considered valid. The patients were prescribed a polyphenol-based supplement (500 mg once daily) during the first visit, with follow-ups at 12 and 24 weeks for blood pressure and heart rate monitoring. The statistical analysis included descriptive methods, difference analysis (chi-squared, t-test, ANOVA), correlation assessment (agreement test), and regression models (binary logistic regression), with SPSS 19.0 for data processing.

Results:

The study consisted of 58 males (52.3%) and 53 females (47.7%), with an average age of 47.52 ± 12.67 years. A statistically significant reduction in systolic and diastolic blood pressure, as well as heart rate, was observed throughout the follow-up period, particularly notable in the third visit. The analysis also showed that obese patients might require a longer duration of polyphenol-based supplementation compared to normoweight patients to achieve target blood pressure levels.

Conclusions:

The results demonstrate that polyphenol-based supplementation effectively controls blood pressure in patients with prehypertension and stage I hypertension. Future research should focus on the mechanisms and action modes of grape seed extract polyphenols in hypertension control, particularly in special patient populations like obese hypertensive patients.
ASSESSMENT OF HYPERTENSION MANAGEMENT IN BULGARIA: DEMOGRAPHICS, CARDIOVASCULAR RISK, AND BLOOD PRESSURE CONTROL DISCREPANCIES (SNAPSHOT STUDY)
Authors: Postadzhiyan Arman , Garkov Kiril
Published: May 2024

Objective:

To assess the prevalence of hypertensive patients controlled on blood pressure (BP), cardiovascular (CV) risk and comorbidities in Bulgaria.

Design and method:

The cross-sectional observational multicenter epidemiological SNAPSHOT study involved 129 general practitioners in Bulgaria and included 3366 hypertensive patients. BP control and CV risk were assessed by investigators and compared to the assessment based on recommendations from European guidelines (SCORE chart 2&OP).

Results:

A total of 3363 patients were analyzed, with a mean (standard deviation [SD]) age of 67.2 (10.8) years. Most patients were female (60.9%), educated at secondary-school level (63.4%), overweight or obese (77.9%), and non-smokers (76.5%). Patients had no (7.7%), one (41.5%), 2 (38.2%), 3 or more (12.6%) risk factors for hypertension. Additionally, patients had comorbidities including dyslipidemia (55.8%), coronary artery disease (32.5%), and diabetes mellitus (27.4%). Mean (SD) systolic and diastolic BP were 143.1 (18.4) mmHg and 84.3 (11.8) mmHg, respectively. Almost all patients (99.5%) had their hypertension treated, took their treatment once (44.4%) or twice daily (50.3%) and had their BP monitored at home (95.6%). Patients predominantly utilized beta blockers (61.2%), diuretics (57.5%), and/or angiotensin-converting enzyme inhibitors (48.6%). The combination of these treatments and/or other BP lowering drugs occurred in groups of 2 and 3 in 32.2% and 36.4% of patients, respectively. Single-pill combination was used in 58.5% of patients. BP was considered controlled according to the investigators in 77.3% of patients, but according to guidelines in 22.8% of patients (39.1% systolic BP/ diastolic BP <140/90 mmHg). CV risk was assessed as mainly moderate (43.0%) or high (31.4%) by investigators, whereas it was high (9.0%) or very high (91.0%) in most patients according to recent guidelines. The concordance between both risk assessments was true in 19.1% of cases, while for 80.5% patients the risk was underestimated by the investigators.

Conclusions:

While this study provided valuable insights into the demographic and clinical characteristics of a sizable patient population, there was a discordance in CV risk and BP control assessment between investigators and guidelines. This highlighted the importance of aligning assessments with guidelines for hypertension management.
HOME BLOOD PRESURE MEASUREMENT IN RURAL SUB-SAHARAN AFRICA
Authors: Lucinde Ruth Khadembu , Jobe Modou , Awori Juliet O , Perkins Alexander D , Oyando Robinson , Leon David A , Herrett Emily , Prentice Andrew M , Tsofa Benjamin , Shah Anoop Sv , Perel Pablo , Etyang Anthony O
Published: May 2024

Objective:

Self-home blood pressure (BP) measurement has been reported to be superior to office BP measurements (attended or unattended) in diagnosing hypertension. However, it is not readily available in rural sub-Saharan Africa (SSA) due to the cost of the measurement devices and the literacy it requires to correctly measure and record BP. Consequently, the diagnostic performance of self-home BP measurement in rural sub-Saharan Africa remains unclear. Trained community health workers (CHWs) with home BP measurement devices may improve the availability and use of these devices by providing and training community members to use them

Design and method:

We are conducting a cross-sectional study to determine the diagnostic performance of self-home BP measurement in identifying individuals with hypertension in rural Kenya and The Gambia. A random age-stratified random sample of 1250 participants aged 30 years and above from the Kilifi Health and Demographic Surveillance System and the Kiang West Demographic Surveillance System are being enrolled into the study. Trained CHWs avail the measurement devices to enrolled participants and train them to measure and record their BP for seven consecutive days. Primary data of BP measurements are then downloaded from the measurement devices. Additionally, participants undergo ambulatory BP monitoring (reference standard).

Results:

Recruitment is ongoing. We have enrolled and completed BP measurements for 154 participants, all from the Kenya study site (12% of the total sample). Of these 106 (69%) are female with an average age of 57 years (standard deviation 15 years). Based on home and ambulatory BP respectively, 49 (32%) and 66 (43%) of included participants are hypertensive. Of the included participants, 26 (17%) have masked hypertension and were not detected by home BP while 9(6%) are normotensive but considered hypertensive based on home BP. The preliminary sensitivity and specificity of self-home BP measurement is 0.61 (0.49, 0.72) and 0.90 (0.81, 0.95) respectively while its diagnostic odds ratio (DOR) is 13.5 (likelihood ratio positive 5.93 (3.10, 11.34)). Further analyses will be conducted when recruitment is complete.

Conclusions:

Self-home BP measurement has modest diagnostic utility in the general population in rural SSA.
EVALUATION OF A PROTOTYPE CUFFLESS MULTI-SENSOR DEVICE TO TRACK BLOOD PRESSURE CHANGES
Authors: Hove Christine , Sæter Frode , Stepanov Alexey , B⊘tke-rasmussen Kasper Gade , Seeberg Trine M. , Westgaard Espen , Heimark Sondre , Waldum-grevbo Bård , Hisdal Jonny , Larstorp Anne Cecilie K.
Published: May 2024

Objective:

Accurate measurements are essential if cuffless blood pressure (BP) devices are to be used in hypertension care. The aim of the present study was to evaluate the ability of a prototype cuffless device (XXXXX) to track changes in BP compared to a non-invasive, continuous BP monitor (reference BP; Human NIBP Nano system, ADInstruments, Dunedin, New Zealand) in an experimental laboratory set up.

Design and method:

After ethical approval, three external techniques (Figure 1) to induce BP changes via different physiological mechanisms, were applied in 23 healthy subjects. Continuous data from the prototype cuffless device on the upper arm was obtained simultaneously with reference BP measurements. The cuffless device measures skin temperature, 3D acceleration, 3D angular velocity and photoplethysmography. Data from 16 of the participants were used to train a machine learning model, which was then used to estimate BP (15-second resolution) on data from 7 other participants. The cuffless BP device was calibrated once using brachial cuff BP measurement (WatchBP O3, Microlife, Cambridge, United Kingdom). The present study provides preliminary results from a larger on-going study designed to evaluate performance of the cuffless device according to ISO 81060-3:2022 standard.

Results:

A timeseries plot displaying BP measurements from the cuffless and the reference device is displayed in Figure 2. The mean error (± corrected standard deviation of error) was 2.4 (± 7.9) mmHg for systolic blood pressure (SBP) and 1.7 (± 7.4) mmHg for diastolic blood pressure (DBP) for the accuracy requirement. The corresponding errors for stability requirements were 1.9 (± 8.1) and 1.9 (± 6.0) mmHg for SBP and DBP.

Conclusions:

The present study demonstrated that the prototype cuffless BP device could track BP changes with high accuracy in healthy subjects in a laboratory setting. The cuffless device fulfilled the acceptance criteria (± 6 (± 10) mmHg) for the accuracy and stability requirements from the ISO 81060-3:2022 standard. Further research is necessary to determine accuracy of the prototype cuffless BP device during real-life conditions as described in the 2023 ESH recommendations for the validation of cuffless devices.
A SENSING MODULE WITH TWO DIFFERENT SENSING CHANNELS AIMS AT DIRECT MEASUREMENT OF PERIARTERIAL PRESSURE FOR WEARABLE TONOMETRY BLOOD PRESSURE DEVICE
Authors: Xu Man , Dong Renpeng , Wu Dongming , Zhan Bingpeng , Liu Weiting
Published: May 2024

Objective:

This work focuses on development a new mini sensing module to directly measure periarterial pressure and reduce the effect of muscle action induced artifacts on blood pressure measurement.

Design and method:

The coupling of blood pressure signal with disturbances such as motion artifacts makes blood pressure measurement unreliable. It is significant to directly measure periarterial pressure and reduce the effect of motion artefacts in the applications of wearable blood pressure monitoring in daily life. The mini sensing module consists of two independent sensing channels (Fig.1). The two channels are closely aligned with the spacing only 1 mm in order to guarantee the blood pressure signal under the channels are same. The two channels have different sizes, one with 5 mm length and 3 mm width and the other one with 8 mm length and 3 mm width. The channels are filled with silicon oil, in the which a silicon die is fixed as pressure sensor unit. The channels are sealed by TPU flexible film with 0.2 mm thickness, which serves as the stimulation interface. Attach the sensor module to wrist and the channel direction is transverse to the arterial path. Specific design endows both channels with same sensitivity to global mechanical excitation and different sensitivity to local excitations. During BP measuring, external pressure and muscle motion artifact act on the entire channel surface serving as global excitation, so both channels have the same sensitivity to them. However, because the width of the radial artery is smaller than the length of the channel, the BP signal act on partial channel surface serving as local excitation. The BP signal has different sensitivity in two channels. The influence of motion artifacts is reduced by differential processing of the output signals of two channels, which also is presented in Fig.2.

Results:

Experiments have proved the effectiveness of the scheme.

Conclusions:

By comparison with the BP signal under optimal condition. The sensing module can directly measure periarterial pressure on blood pressure measurement.
MONITORING OF ACUTE TENSION (BLOOD PRESSURE) INCREASES DETECTED IN HOSPITAL EMERGENCIES
Authors: Ortega Melissa Lilibeth Arteaga , Pinzon Luis Eduardo Suarez , Lopez Beatriz Arnal , Ferre Kilian Griñan , Sole Sara Graell , Borrell Joan Torras
Published: May 2024

Objective:

To assess whether, after an acute increase in blood pressure in the hospital emergency department, the control objectives are subsequently achieved in primary care.

Design and method:

Cross-sectional descriptive study assessing blood pressure figures in the Emergency Department, the days elapsed until the first visit to the Primary Care Center since the incident and until the visit in which minimal control has been obtained (defined as blood pressure <140/90 mmHg).

Results:

96 patients were preselected, of which only 85 met the inclusion criteria for the study, 49 women, mean age was 69 years, 72 had a previous diagnosis of Hypertension with a mean of 10 (standard deviation +/- 9) years of evolution, 66 with previous pharmacological treatment, 20 had been referred from Primary Care. The mean systolic blood pressure on arrival at the emergency room was 181 mmHg (standard deviation +/- 20) and at discharge 152 mmHg (standard deviation +/-18.5), the diastolic blood pressure on arrival at the emergency room was 91 mmHg (standard deviation +/- 16) and at discharge 82 mmHg (standard deviation +/-11.7). From the 85 patients included, 84 followed primary care controls (98%) and 60 achieved control of arterial hypertension (70.5%), with a median in days of 12 (interquartile range 3-35) and 90 respectively (interquartile range 26.5-147.5).

Conclusions:

This study allows us to know that a high percentage of patients consult the Primary Care after an acute increase in blood pressure but interventions could be proposed to further reduce the time of this coordination in some cases. The blood pressure goal was achieved in 70.5% of the patients, so the causes of suboptimal control in the remaining patients would have to be reviewed.
PREVALENCE, AWARENESS AND TREATMENT OF CARDIOVASCULAR RISK FACTORS IN HEALTH PROFESSIONALS IN THE CARDIOVASCULAR FIELD: THE PROTECTO ESH-SIIA STUDY
Authors: Rosei Claudia Agabiti , Del Pinto Rita , Giannattasio Cristina , Bombelli Michele , Dell’Oro Raffaella , Muiesan Maria Lorenza , Grassi Guido , Ferri Claudio
Published: May 2024

Objective:

Physicians and researchers in the cardiovascular (CV) field are constantly engaged in the promotion of guidelines-directed preventive measures, but whether they are themselves adherent to the same recommendations was only sporadically assessed.

Design and method:

During the annual meeting of the Italian Society of Hypertension (SIIA, October 2022) and the European Society of Hypertension (ESH, June 2023), an observational study on consecutive volunteer health professionals was conducted. Participants underwent three standard sitting and two standing (1-3 minutes) blood pressure (BP) measurements and answered a questionnaire regarding demographic features, modifiable/non-modifiable CV risk factors and related treatments. Hypertension was defined as BP > 140 and/or 90 mmHg or as a pre-existing diagnosis. Orthostatic hypotension was defined as a decrease of systolic BP > 20 mmHg or of diastolic BP > 10 mmHg; orthostatic hypertension was defined as an increase of systolic BP > 20 mmHg or of diastolic BP > 11 mmHg.

Results:

In total, 62 participants from SIIA 2022 (30F, mean age 43.2±14.8 years) and 129 participants from ESH 2023 (65F, mean age 36,6±12.5 years) were enrolled; 49 participants were non-Italian (26 F e 23 M). 80,1% reported regular physical activity; and only 22.5% were on a low-salt diet. Dyslipidemia was the most common risk factor (13.1%), but only 56% participants were on a statin; 9.3% had high BP, of whom 83.3% were unaware; 1.6% and 16.4% had orthostatic hypo- and hypertension, respectively. No significant differences were found regarding the degree of physical activity between Italian or non-Italian participants. Italian women were more often on a low-salt diet than non-Italian women (31% vs 4% p=0.005).

Conclusions:

Despite the specific professional involvement, self-awareness and management of CV risk factors can be improved in the examined exploratory, international sample of health professionals.