bluuebunny/crossref_metadata_2025 huggingface dataset:
Ideational robustness in turbulent times
Authors: Carstensen Martin B , Sørensen Eva , Torfing Jacob
Published: May 2024

The concept of robustness has received increasing scholarly attention regarding public policy and governance, where it has enhanced our understanding of how policies and governance are adapted and innovated in response to disruptive events, challenges, and demands associated with heightened societal turbulence. Yet, we know little about the robustness of the ideas undergirding the efforts to foster robust policymaking and public governance. Based on a review of recent strands of governance theory and the ideational turn in public policy research, we define a new ideational robustness concept, which can help us to explain why some governance and policy ideas persist, while others disappear. As the contributions to this special issue demonstrate, studying ideational robustness opens new avenues for reflecting on how the robustness of ideas may affect the robustness of public policy and governance.
Effectiveness of Photobiomodulation in Reducing Pain and Disability in Patients With Knee Osteoarthritis: A Systematic Review With Meta-Analysis
Authors: Oliveira Sofia , Andrade Renato , Valente Cristina , Espregueira-Mendes João , Silva Filipe S , Hinckel Betina B , Carvalho Óscar , Leal Ana
Published: May 2024

Objective

Photobiomodulation (PBM) is not implemented in routine clinical management for knee osteoarthritis. This study aims to systematically investigate the effects of PBM in patients with knee osteoarthritis, comparing with placebo to understand its true clinical effects.

Methods

PubMed, EMBASE, Web of Science, and Cochrane databases were searched up to October 2023. Randomized placebo-controlled trials applying PBM versus placebo were included. Study characteristics, intervention parameters, and patient-reported and physical examination outcome measures were collected. The risk of bias was judged using the Cochrane risk-of-bias tool for randomized trials (version 2) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to interpret the certainty of results.

Results

Ten studies were included comprising 542 participants. All studies were judged with unclear to a high risk of bias. Meta-analysis for pain at rest (6 studies) showed that PBM significantly reduced pain at rest as compared to placebo (−0.7 [95% CI = −1.1 to −0.2]), moderate effect, very low certainty of evidence, whereas for the Timed “Up & Go” Test (three studies), no significant effect was detected. Statistically significantly within-group (PBM) mean improvement was detected for pain, Lequesne Index, and gait performance outcomes, but not always clinically relevant or significant when compared to placebo.

Conclusion

PBM reduces pain intensity in patients with knee osteoarthritis and may improve disability. However, the very low certainty of evidence does not allow to recommend its isolated use but may be used to complement other widely recommended therapies. More rigorous clinical trials and the revision of the recommended dosage guidelines are warranted to increase the strength of evidence.

Impact

The findings indicate that photobiomodulation can reduce pain and improve disability in patients with knee osteoarthritis. However, researchers should continue to investigate isolated photobiomodulation intervention versus placebo and extend the dosage guidelines to other types of light emitters.
Fintech as invasive infrastructure: a critical discourse analysis of corporate newswires and press releases, 1995–2021
Authors: Friedline Terri , Stewart Kimberlee , Bolinger Carson , Wood Anna K
Published: May 2024

Financial technologies or ‘fintech’—an array of digital technologies ranging from mobile banking and digital payment systems to cryptocurrencies and blockchain technologies—are heralded for solving problems of access to financial products and services and improving people’s participation in the economy. However, we contend that fintech is an invasive infrastructure by learning from Indigenous theorizing of oil and gas pipelines alongside concepts of predatory inclusion and obfuscation. We use critical discourse analysis to study finance, technology and social media companies’ language over nearly three decades of newswires and press releases that promote new retail financial products and services. We develop themes of new products old promises, benevolent exploitation, efficient obfuscation and information extraction. Similar to oil and gas pipelines within the project of settler colonialism, our findings show how fintech operates as invasive infrastructure by serving as a key link for connecting oppressed and marginalized peoples to companies for predation and extraction.
Cross-National Social and Environmental Influences on Life Satisfaction
Authors: Suchyta Mark , Dietz Thomas , Frank Kenneth A
Published: May 2024

Scholars and policymakers are increasingly interested in subjective well-being as a development indicator. However, sociological research on this topic is quite limited, as is research that considers the effects of the biophysical environment on subjective well-being. In this study, we address these gaps in the literature by examining social and environmental influences on life satisfaction, a core component of subjective well-being. We employed multi-level regression analysis using data from over 97,000 individuals living across ninety-six countries. The results demonstrated significant effects of several individual-level variables on life satisfaction, in particular respondents’ satisfaction with their local air and water quality and the efforts being made to preserve the environment in their country, as well as numerous social variables, such as income, gender, and employment status. Among the country-level variables, national gross domestic product per capita was positively associated with higher individual life satisfaction. Income inequality had a negative effect on life satisfaction, while wealth inequality, on the other hand, had a positive effect, a surprising finding we contemplate in some detail. The carbon intensity of a nation’s economy as well as the proportion of a nation’s land in protected areas only influenced life satisfaction when not controlling for the other variables. We conclude by discussing the implications of this research for sustainable development, including the promise of life satisfaction and other measures of subjective well-being as sustainable development indicators.
Tranexamic Acid to Prevent Obstetrical Hemorrhage After Cesarean Delivery
Authors: Pacheco L.D. , Clifton R.G. , Saade G.R. , Simhan H.N. , Macones G.A.
Published: May 2024

(N Engl J Med 2023;388(15):1365–1375)

Postpartum hemorrhage is the second leading cause of pregnancy-related death in the United States, and accounts for up to 27.1% of global maternal deaths. Tranexamic acid has been previously associated with a reduction in overall mortality in several different settings, but majorly in obstetrical contexts. Research has not discovered, however, if the use of tranexamic acid is beneficial when it comes to its prophylactic use to prevent significant blood loss after birth or related other outcomes such as incidence of blood transfusion products or need for additional intervention to control bleeding. This study was a randomized trial to assess the effectiveness of tranexamic acid administered immediately after umbilical cord clamping in reducing the risk of maternal death or blood transfusion compared to placebo.
The Need for Maternal Critical Care Education, Point-of-Care Ultrasound and Critical Care Echocardiography in Obstetric Anesthesiologists Training
Authors: Padilla C. , Ortner C. , Dennis A. , Zieleskiewicz L.
Published: May 2024

(Int J Obstet Anesth 2023;55:103880/https://doi.org/10.1016/j.ijoa.2023.103880/0208-5216/)

The rise in complex obstetric cases is a global phenomenon. In high-income countries, medical issues, particularly cardiovascular conditions, contribute to maternal morbidity and mortality, challenging traditional educational and clinical approaches. Obstetric critical care principles warrant standardized education, including ultrasound applications like POCUS for real-time assessment of cardiac, pulmonary, airway, and gastric parameters. Despite the increasing need for maternal critical care, formal certification programs are lacking globally. The United States and the UK lack specific educational standards for maternal critical care in anesthesiology.
Obstetric Clinical Trial Diversity
Authors: Steinberg J.R. , DiTosto J.D. , Turner B.E. , Roque D.R. , Yee L.M.
Published: May 2024

(Obstet Gynecol. 2023;142:840–843)

Clinical trials are typically considered the highest quality evidence that informs clinical practice; however, there are gaps in reporting patient demographics, as well as in the diversity of groups enrolled in clinical trials. Obstetrics in particular has much to lose from underrepresentation, as there are high-impact racial and ethnic disparities in obstetric care that represent life and death situations for many individuals. This article is a research letter focusing on systemic racism and its impact on Asian American health in obstetrics and gynecology.
Peripartum Cardiomyopathy
Authors: Arany Z.
Published: May 2024

(N Engl J Med. 2024;390:154–164)

Pregnancy induces cardiovascular physiological changes and can sometimes lead to severe complications. Severe cardiac degeneration leading to clinical heart failure during pregnancy or in the early postpartum period defines peripartum cardiomyopathy (PPCM), but little is known about its causes. This condition occurs in ∼1 in 2000 births globally, with more common diagnoses in Haiti (1 in 300) and Nigeria (1 in 100), and less commonly in other areas. Peripartum cardiomyopathy is a leading cause of maternal death and is responsible for up to 60% of cases of peripartum cardiogenic shock. This article is a review of what is known about PPCM, its clinical presentation, pathogenesis, management, outcomes, and future directions for research.
Use of Intraoperative Red Cell Salvage in the Contemporary Management of Placenta Accreta Spectrum Disorders
Authors: Flores-Mendoza H. , Shehata N. , Murji A. , Allen L.M. , Kingdom J.C. , Windrim R.C. , Carvalho J.C.A. , Ravi Chandran A. , Papalia N. , Hobson S.R.
Published: May 2024

(Can J Anesth/J Can Anesth. 2023;70:1544–1546)

Management of hemorrhage after cesarean delivery or cesarean hysterectomy is complex. Intraoperative red cell salvage (IOCS) is commonly used in other surgical settings and is increasingly used in obstetrics. The potential risks such as amniotic fluid embolism, bacteremia, sepsis, and coagulopathy in obstetrics remain poorly understood. This study assessed the use of IOCS in the management of placenta accreta spectrum (PAS) disorders.
The Effect of Placement and Management of Intrathecal Catheters Following Accidental Dural Puncture on the Incidence of Postdural Puncture Headache and Severity: A Retrospective Real-World Study
Authors: Binyamin Y. , Azem K. , Heesen M. , Gruzman I. , Frenkel A. , Fein S. , Eidelman L.A. , Garren A. , Frank D. , Orbach-Zinger S.
Published: May 2024

(Anaesthesia. 2023;78:1256–1261)

Previous studies have come to different conclusions about whether insertion of an intrathecal (IT) catheter after accidental dural puncture (ADP) during epidural anesthesia reduces complications. The most common complication is postdural puncture headache (PDPH), which can have short-term and long-term effects, including decreased breastfeeding and increased risk for postpartum depression, chronic headache, and backache. The usual treatment for PDPH is an epidural blood patch (EBP), which itself can have serious complications. Accidental dural puncture occurs in ∼0.5% to 1.0% of all epidurals. The authors of this study investigated whether IT catheter insertion was associated with a decreased risk of PDPH and a decreased need for EBP.
Two Randomized Trials of Low-Dose Calcium Supplementation in Pregnancy
Authors: Dwarkanath P. , Muhihi A. , Sudfeld C.R. , Wylie B.J. , Fawzi W.W.
Published: May 2024

(N Engl J Med. 2024;390:143–153)

Many maternal deaths across the globe are associated with hypertensive disorders of pregnancy (HDP), including pre-eclampsia. Many interventions to prevent and treat HDP have been developed, one of which is calcium supplementation. The World Health Organization (WHO) recommends calcium supplementation in individuals with low dietary calcium intake, which has been previously shown to reduce the risk of pre-eclampsia by more than 50%, as well as reducing the risk of preterm birth by 24%. Studies have additionally shown at small sample sizes that low-dose calcium compared with higher doses has similar benefits. Despite the WHO recommendation, few countries have implemented calcium regimens as part of routine prenatal care, and few studies have been done in large samples to validate its efficacy. This study was designed to assess low-dose calcium supplementation and its effect on the risk of pre-eclampsia and preterm birth in a large sample.
The Effect of Prophylactic Steroids on Shivering in Adults Undergoing Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Misra S. , Singh S. , Sarkar S. , Behera B.K. , Jena S.S.
Published: May 2024

(Anesth Analg. 2023;137(2):332–344)

Shivering is a common side effect to numerous things, such as hypothermia and often anesthetic drugs. Shivering is often an involuntary contraction of the skeletal muscles. It is often unwarranted and during surgery or delivery a patient can shiver due to general anesthetic drugs. Up to 65% of patients shiver when given general anesthetics and up to 60% also have it with spinal anesthesia. Certain nonpharmacological interventions have been attempted to decrease shivering for patients. Corticosteroids and anti-inflammatories may be given to help constrict the shivering effect of an anesthetic. To assess patients and decrease the risk of shivering for those undergoing surgery, additional studies have been made in using these types of drugs and research in randomized trials in perioperative shivering.
Hyperemesis Gravidarum: Associations With Personal and Family History of Nausea
Authors: Lindström V. , Laitinen L. , Nurmi J.M. , Koivisto M. , Polo-Kantola P.
Published: May 2024

(Acta Obstet Gynecol Scand. 2023;102:1176–1182)

Nausea and vomiting are prevalent in early pregnancy, with 3.6% experiencing severe symptoms termed hyperemesis gravidarum (HG). Characterized by early onset, impaired eating, and impactful daily life restrictions, HG leads to dehydration and weight loss, becoming a primary cause for early pregnancy hospitalization. Unfortunately, health care recognition of HG is insufficient, resulting in underdiagnosis and undertreatment. The condition’s multifactorial origins include vestibular, olfactory, hormonal, and gastrointestinal factors. General nausea links to various situations and a family history of HG suggests a genetic component. Research indicates that women with a history of nausea may be more susceptible to HG. Identifying such connections can aid health care professionals in recognizing and managing HG risk.
Tranexamic Acid, as an Adjunct to Oxytocin Prophylaxis, in the Prevention of Postpartum Hemorrhage in Women Undergoing Elective Cesarean Section: A Single-Center Double-Blind Randomized Controlled Trial
Authors: Lee S.H. , Kwek M.E. , Tagore S. , Wright A. , Ku C.W. , Teong A.C.A. , Tan A.W.M. , Lim S.W.C. , Yen D.Y.T. , Ang C.Y.X. , Sultana R. , Lim C.H.F. , Mathur D. , Mathur M.
Published: May 2024

(BJOG. 2023;130(9):1007–1015)

Postpartum hemorrhage (PPH) is the main cause of maternal morbidity and mortality worldwide. The World Health Organization (WHO) recommends administration of uterotonics including oxytocin to prevent PPH, but uterotonics alone may not fully prevent PPH from other causes. The World Maternal Antifibrinolytic Trial (WOMAN Trial) reported that tranexamic acid (TXA) reduced PPH-related mortality in PPH cases, and as a result the WHO has included the administration of TXA into their recommendations for PPH treatment. There is speculation about the potential role of prophylactic TXA in preventing PPH.
Alternative Routes for Tranexamic Acid Treatment in Obstetric Bleeding (WOMAN-PharmacoTXA Trial): A Randomized Trial and Pharmacological Study in Cesarean Section Births
Authors: Shakur-Still H. , Roberts I. , Grassin-Delyle S. , Chaudhri R. , Geer A. , Arribas M. , Lamy E. , Mansukhani R. , Lubeya M.K. , Javaid K. , Kayani A. , Israr N. , Mazhar S.B. , Urien S. , Bouazza N. , Foissac F. , Prowse D. , Carrington L. , Barrow C. , Onandia J.G. , Balogun E.
Published: May 2024

(BJOG. 2023;130(10):1177–1186)

Many maternal deaths due to severe postpartum bleeding (PPH) occur in middle-income or low-income countries. A widely practiced method for reducing postpartum bleeding is administration of tranexamic acid (TXA); methods of administration vary, with the drug being available as an intravenous (IV) infusion, intramuscular (IM) injection, and oral solution. The previous WOMAN-PharmacoTXA trial showed that IV TXA administered within 3 hours of delivery reduced PPH deaths by one-third, but IV administration is a barrier for care in low-income and middle-income countries. Therefore, it is important that such other administration options for such an integral lifesaving medication be evaluated in settings where IV infusion is difficult or impossible. This study was designed to evaluate the population pharmacokinetics (PK) and pharmacodynamics (PD) of TXA administered by IV infusion, IM injection, and oral routes in women having cesarean delivery (CD). This included evaluation of safety, adverse events, the concentration of TXA that crosses the placenta and its clearance, and the effect of administration route on D-dimer concentration.
Topical Negative Pressure Wound Therapy to Prevent Wound Complications Following Cesarean Delivery in High-Risk Obstetric Patients: A Randomized Controlled Trial
Authors: Gonzalez M.G. , Barske M.E. , Kjellsson K.B. , Saboda K. , Reed H.A. , Hill M.G.
Published: May 2024

(Aust N Z J Obstet Gynaecol. 2023;63:516–520)

The prevalence of cesarean deliveries (CD) has surged in recent decades, paralleling an uptick in medical complications during pregnancy linked to delayed childbearing and rising obesity rates. Consequently, post-CD wound complications have become a significant health concern. Mitigating these complications is a priority, with various wound vacuum systems available. While concerns persist about their effectiveness compared to standard treatments, some evidence suggests modest benefits, particularly in nonobstetric settings. The PICO wound vacuum system has shown promise for clean, noninfected surgical wounds, including cesarean incisions, though data is mainly from small trials or retrospective cohorts. Our study explores the use of PICO in preventing wound infections and breakdown in women with risk factors for complications postcesarean delivery.
Management and Outcomes of Pulmonary Artery Hypertension and Eisenmenger Syndrome During Pregnancy: A Prospective Observational Cohort Study
Authors: Jha N. , Divya M.B. , Jha A.K.
Published: May 2024

(BJOG. 2023;130(10):1258–1268)

Pregnancies complicated by pulmonary arterial hypertension (PAH) and Eisenmenger syndrome often result in severe maternal and fetal morbidity and mortality. Clinicians often counsel women with these conditions to avoid pregnancy or terminate a pregnancy. Multidisciplinary specialty centers, however, have seen good outcomes in these high-risk women and their babies.
Automated Identification of Landmarks During Preprocedure Lumbar Ultrasound for Spinal Anesthesia in Obese Parturients: A Prospective Cohort Study
Authors: Tan H.S. , Chan J.J.I. , Oh T.T. , Lim M.J. , Tan C.W. , Sultana R. , Sng B.L.
Published: May 2024

(Eur J Anaesthesiol. 2023;40(9):710–714)

Traditional neuraxial procedures, relying on palpation, face a notable 27% failure rate. The integration of preprocedure ultrasonography offers a potential solution, although challenges arise in obese parturients, resulting in a 76% procedural success rate compared to over 90% in nonobese counterparts.
Ondansetron for the Prevention of Pruritus in Women Undergoing Cesarean Delivery With Intrathecal Opioid: A Systematic Review and Meta-Analysis
Authors: Cadd M. , Jackson P. , Ewnetu B.
Published: May 2024

(Anesth Analg. 2024;138(1):70–84)

Intrathecal opioids are effective for postoperative analgesia following CD, but they also have unpleasant side effects including shivering, nausea, vomiting, respiratory depression, and pruritus. The mechanisms of intrathecal opioid-induced pruritus are largely unknown. It is unknown if ondansetron has an antipruritic effect when administered with neuraxial analgesia. This study is an up-to-date systematic review that addressed the effectiveness of ondansetron for the prevention of pruritus that is associated with intrathecal opioids in women having CD.
INCREASED BLOOD PRESSURE VARIABILITY AND DECREASED HEART RATE VARIABILITY IN OLDER VS. YOUNGER INDIVIDUALS: MARKERS OF DISTURBED CARDIOVASCULAR AUTONOMIC MODULATION WITH AGEING?
Authors: Stoenoiu Maria S , Zhao Yanling , Zhang Zhen -Yu , Lopez-sublet Marilucy , Manolache Narcis -George , Zhang Jennie , Pasquet Agnès , Varnavas Varnavas , Beauloye Christophe , Parati Gianfranco , Stergiou George , Persu Alexandre
Published: May 2024

Objective:

Cardiovascular regulation is affected by ageing through different mechanisms, including arterial baroreflex dysfunction and increased arterial stiffness, with an impact on blood pressure (BP) and heart rate (HR) variability (V), established risk factors for cardiovascular morbidity and mortality. The aim of this study was to compare BPV and HRV in older vs. younger individuals.

Design and method:

1080 hypertensive patients (704 younger, 40-55yrs, YH and 376 older, >=75yrs, OH) underwent 24h BP monitoring (ABPM) from 2018 to 2023. Patients with known dysautonomy, Parkinson or other neurodegenerative diseases were excluded. Short-term BPV indexes including standard deviation (SD), weighted standard deviation (wSD), average real variability (ARV), coefficient of variation (CV), and variability independent of mean (VIM) were estimated over 24h. HRV was assessed by SD and CV of heart rate measured during ABPM. The same analysis was replicated in a sample of 343 untreated individuals from the general population (309 YH; 34 OH).

Results:

As compared to YH, (mean age: 49.5±4.5yrs), OH (mean age: 80.2±4.5yrs) had significantly higher 24h systolic BPV (SD: 15.7±4.6 vs.13.6±4.0; wSD: 15.5±4.6 vs.13.5±4.0; ARV: 12.3±2.9 vs.10.0±2.7; VIM: 15.8±4.5 vs.13.9±4.0 mm Hg; CV: 12.2±3.5 vs.10.8±3.1%; p<0.001). In contrast, 24h HRV was significantly lower in OH than in YH group (SD: 7.2±3.0 vs. 9.1±3.4 beats/min; CV: 11.5±4.5 vs. 12.8.1±4.5%; p<0.001). Higher tertiles of BPV were associated with higher mean pulse pressure and higher pulsatility (pulse pressure normalized for mean arterial pressure), in both YH and OH. Similar results were obtained when comparing OH vs. YH individuals in the general population sample, both for 24h systolic BPV (SD: 14.7±3.1 vs.12.2±2.8; wSD: 14.9±3.1 vs.12.7 ±3.0; ARV: 11.5±2.1 vs.9.2±2.0; VIM: 13.6±2.5 vs.12.3±2.4 mmHg; CV: 11.4±2.1 vs.10.1±2.0%; p<0.01) and HRV (SD: 8.8±3.2 vs. 11.3±3.4 beats/min; CV: 12.7±4.5 vs. 15.1±4.3%; p<0.01).

Conclusions:

Increased BPV was associated with decreased HRV in older compared to younger individuals, both in a hypertensive cohort and in a general population sample. The respective contribution to these changes of age-related dysfunction of autonomic cardiovascular modulation and increased arterial stiffness and their prognostic implications deserve further investigation.
DAY-TO-DAY REPRODUCIBILITY OF NOCTURNAL BLOOD PRESSURE FALL (DIPPING) EVALUATED WITH WEARABLE AND HOME DEVICES IN HYPERTENSIVE PATIENTS
Authors: Martino Pengo , Alessandro Croce , Ettore Brenna , Davide Soranna , Enrico Gianfranceschi , Elisa Nardin , Debora Rosa , Carolina Lombardi , Grzegorz Bilo , Antonella Zambon , Gianfranco Parati
Published: May 2024

Objective:

Non-dipping status has been associated with increased risk of heart failure and cardiovascular events. However, its reproducibility when evaluated by means of ambulatory blood pressure monitoring (BPM) is often suboptimal. Wearable devices (WD) and home BPM devices equipped with nocturnal measurement function (HBPMN) offer the opportunity of estimating dipping status over different days thus potentially increasing precision owing to statistical averaging.

We aimed to determine the reproducibility of nocturnal BP dipping estimated through a combined use of WD and HBPMN devices for daytime and night-time BP estimation within one week.

Design and method:

We recruited treated and untreated adult patients with hypertension. Patients underwent one week of home BP monitoring through a HBPMN device (NightView, OMRON Healthcare, HEM9601T-E3) and with an oscillometric WD (HeartGuide, OMRON Healthcare, HEM-6411T-MAE). Patients were asked to measure BP over one week with WD according to ESH-HBPM guidelines for daytime measurements and with HBPMN according to standard device settings for night-time measurements. Interclass correlation coefficient (ICC) was calculated to evaluate reproducibility.

Results:

76 patients were included in the study. The main characteristics are summarised as follows: age (61±11.84 years), 32 (42%) females, BMI (28.12±4.90 Kg/m2). Most of them (98%) were treated hypertensives. Office systolic and diastolic BP were 134±4.43 mmHg and 80±4.84 mmHg, respectively. The average one-week systolic BP dipping was 16.14±9.44%. When we considered patients who had dipping assessment over at least the first 5 days (37 patients), intra-individual variability in the categorical definition of dipping status was observed (Figure 1) with a suboptimal reproducibility of average nocturnal BP fall (ICC 0.60).

Conclusions:

Nocturnal BP dipping estimated as continuous variable through the combined use of WD and HBPMN exhibits suboptimal reproducibility resulting in a variable day-by-day classification of patients according to their dipping status. Whether this reflects technical issues, or rather depends on the physiological variability of BP and sleeping patterns needs to be determined by future studies.
MAY MEASUREMENT MONTH 2023 IN CROATIA, CLOSE TO GUINNESS RECORD
Authors: Jelakovic Bojan , Soldo Ana , Skopic Olgica Velkovski , Abramovic Inga , Jelakovic Ana , Josipovic Josipa , Lang Valerija Bralic , Mihalic Mirjana , Domislovic Marija , Capak Krunoslav , Bubas Marija
Published: May 2024

Objective:

According to recent nationwide study EHUH 2 the crude prevalence of hypertension in Croatia is 50.9%. Although significant improvement in treatment and control of hypertension was achieved in last two decades, health literacy is still very poor. May Measurement Month was venue to collect new information which could help us in preparing future public health activities.

Design and method:

Croatian Hypertension League joined the MMM 2023. We decided to collect data during our permanent public health action – Hunting the Silent Killer, and together with Croatian Pharmacy Chamber to include 329 community pharmacists (still underused health professionals). Most of examinations and measurements were done in local pharmacists (83%). In total 10 488 subjects were examined (64% women, average age 58 ys), and in 8614 blood pressure (BP) was measured three times (average value od 2nd and 3rd measurement was used for analyses-132.6/79.1 mmHg and 75.7 b/min). All measurements were done using the same BP device (Microlife BP B3).

Results:

A high number of subjects was diagnosed with high BP before action (41.3%), and 14% did not know whether they have hypertension. BP was measured never or before than 12 months in 15.4%. The average number of antihypertensive drugs was 1.8. Surprisingly, only 5.2% answered that they often forget or took drugs only when they needed it. There were 19.9% smokers and 16.3% ex-smokers. We found 3% to vape, but also there were 2.9% ex-vapers. No physical activity was reported by 43.3%. Alcohol was consumed daily or at least once per week in 11.2%. Low birth weight (< 2.5 kg) was reported by 9% of participants.

Conclusions:

Data we have collected during MMM action are very valuable, albeit some answers probably do not reflect the truth. One of the greatest achievements was establishment of community pharmacists network what is in line with our aim of including pharmacists more in treatment of hypertension and all other chronic non-communicable diseases.

Acknowledgement: We are thankful to Salvus Microlife for donation of BP devices
HIGHER INCIDENCE OF CARDIOVASCULAR EVENTS IN A LARGE REAL-WORLD DATABASE IN THE TRIENNIUM 2020-2022 COMPARED TO A PRE-COVID TRIENNIUM IS INDEPENDENT OF CARDIOVASCULAR RISK FACTORS
Authors: Battistoni Allegra , Gallo Giovanna , Morisco Carmine , Piccinocchi Gaetano , Piccinocchi Roberto , Fini Massimo , Proietti Stefania , Bonassi Stefano , Trimarco Bruno , Volpe Massimo
Published: May 2024

Objective:

We evaluated the incidence and relative risk of major cardiovascular events in a large real-world population from a primary care database in a region at moderate cardiovascular risk in the period 2020-2022 (e.g. during COVID-19 pandemic).

Design and method:

This is a retrospective cohort analysis using the whole database of a cooperative of general practitioners in the city of Naples, Italy (COMEGEN). All individuals aged >18 were followed up to three years. These data were compared with those derived from the same database in the years 2017-2019, considered as a pre-COVID 19 period.

Results:

Anonymized data from of 228,266 patients in the period 2020-2022 were considered for statistical analysis (these included 31,764 subjects with a molecular diagnosis of COVID 19). In the 2020-2022 population demographic features and the prevalence of major cardiovascular risk factors (hypertension, diabetes, hypercholesterolemia and smoking) did not differ from those reported in the 2017-2019 cohort (Table 1). On the contrary, the incidence of individuals with a new diagnosis of major adverse cardiovascular and cerebrovascular events was significantly higher in the 2020-2022 compared to the 2017-2019 triennium (Table 1).

Conclusions:

We report a substantial increase of cardiovascular events during the COVID-19 triennium which is independent of risk factors. Whether this is caused to direct cardiovascular consequences of SARS-CoV-2 (diagnosed or undiagnosed) infection or to other factors such as the reduced access to healthcare facilities cannot be clarified by our present study.
STOPPING ANTIHYPERTENSIVE TREATMENT AMONG HYPERTENSIVE PATIENTS IN PRIMARY CARE: THE STOP-TRIAL
Authors: Jean-marc Boivin , Ferreira Joao , Duarte Kevin , Lamiral Zohra , Rossignol Patrick , Girerd Nicolas
Published: May 2024

Objective:

Objective: Frequently antihypertensive therapy (AHT) is initiated without the confirmation of high blood pressure (BP) outside the office. Such AHT initiation based solely on office BP measurements may lead to overtreatment of otherwise non-hypertensive people who do not have a clinical indication for AHT. Therefore, identifying people in whom AHT can be safely discontinued is clinically important. The STOP-Trial aimed to identify factors associated with one-year normal BP maintenance after discontinuation of monotherapy or low-dose dual AHT among people with controlled BP and no cardiovascular target-organ damage.

Design and method:

Design and Method: We performed a multicenter non-randomized open-label trial screening people without target organ damage on AHT. AHT could be discontinued if BP was confirmed as controlled based on repeated home blood pressure measurements (HBPM) (i.e.,<135/85mmHg). The primary endpoint was one-year normal BP maintenance as assessed by HBPM.

Results:

Results: Among 401 screened individuals, 218(54.4%) were included after confirming they had controlled BP in HBPM and AHT was consequently discontinued. Among these 218 individuals, 73(33%) exhibited normal BP in HBPM at one year without any AHT (Figure).

In univariable analysis, baseline office BP measurements were not significant predictors of the primary outcome whereas HBPM were.

On multivariable analysis, higher average SBP and DBP on HBPM prior to AHD stop was associated with lower rates of one-year normal BP (OR for 5 mmHg of respectively, SBP=0.72, 0.56-0.94, p=0.014, and DBP=0.56, 0.41-0.77, p=0.0003).

The best cut-offs of SBP and DBP on HBPM prior to AHD stop to predict the primary outcome was SBP=122.5mmHg and DBP=74.5mmHg. Patients with SBP<122.5 and DBP<74.5mmHg at HBPM prior to AHD stop had 65% chance of normal one-year BP without treatment.

Regarding safety, one patient had a severe adverse event (ischemic stroke).

Conclusions:

Stopping AHT was feasible in patients without cardiovascular damage who had mono or low-dose dual AHT and maintained at one year in 33% of the population. HBPM measurements under treatment predicted well the success of AHD removal and HBPM consequently appears to be an efficient tool to select patients in whom AHD discontinuation may be safely considered.
AWARENESS, TREATMENT, AND CONTROL OF HYPERTENSION USING OPPORTUNISTIC SCREENING PROGRAMS: EVIDENCE FROM THE MAY MEASUREMENT MONTH CAMPAIGN, 2017-2019
Authors: Razo Christian , Beaney Thomas , Poulter Neil R. , Prabhakaran Dorairaj , Schutte Aletta E. , Johnson Catherine , Roth Gregory A.
Published: May 2024

Objective:

To evaluate adult (>18 years) hypertension awareness, treatment, control, and comorbidities using three years of May Measurement Month (MMM) data (2017-2019).

Design and method:

Up to three sitting blood pressure (BP) readings as well as lifestyle and comorbidity data (self-reported diabetes, myocardial infarction, stroke and overweight/obesity) were collected from participants. Missing BP readings were imputed through multiple imputation, leveraging available BP measurements and sociodemographic variables. Hypertension was defined using the average of the second and third BP readings (systolic BP >140 mmHg and/or diastolic BP >90 mmHg or taking antihypertensive medication). For those with hypertension, hypertension awareness was defined as self-report of previous diagnosis or current medication use, while control was defined as BP <140/90 mmHg among people on medication. Logistic regression models were used to analyze lifestyle factors and main comorbidities associated with hypertension awareness, treatment and control.

Results:

Among 2,907,848 participants from 95 countries, 34.2% had hypertension. Among those with hypertension, 60.1% were aware, 57.0% were medicated, 32.0% were controlled and 22.8% had at least one additional chronic condition. Of those with hypertension who were on medication, 57.0% were controlled. Europe had the highest proportion of individuals with hypertension while Sub-Saharan Africa had the lowest awareness, treatment and control rates (Figure 1). Hypertension treatment and control were higher in individuals with comorbidities (Figure 2-3). Adjusting for age, sex and survey year, those with comorbidities were more likely to be aware of their hypertension while participants from low-income countries and smokers were less likely to be aware. Individuals from low-income countries and smokers were less likely to receive treatment, while those with comorbidities were more likely to get treated. Middle-income individuals were more likely to receive treatment but less likely to be controlled than high-income individuals (Figure 3).

Conclusions:

MMM provides a means of measuring hypertension, awareness, treatment, and control rates, particularly in resource-limited countries. Data suggests heterogeneity in awareness, treatment and control and poorer hypertension management in individuals without comorbidities, informing global strategies for improved hypertension prevention, detection and management.
CHRONIC KIDNEY DISEASE INCIDENCE AND CARDIORESPIRATORY FITNESS ASSOCIATION IN HYPERTENSIVE PATIENTS
Authors: Kokkinos Peter , Pittaras Andreas , Faselis Charles , Samuel Immanuel , Patel Samir , Doumas Michael , Gollie Jared , Grassos Harris , Myers Jonathan
Published: May 2024

Objective:

Chronic hypertension (HTN) is considered a strong risk factor for developing chronic kidney disease (CKD). Increased cardiorespiratory fitness (CRF) is associated with lower CKD risk. However, the CRF-CKD association in patients with HTN has not been assessed. Thus, we examined the the association between CRF and the risk of developing CKD in hypertensive patients.

Design and method:

Hypertensive individuals (n=471,579; age 63.0+8.8 years) with normal kidney function prior to HTN and no evidence of ischemia indicated by a maximal standardized exercise treadmill test (ETT). The cohort was part of the ETHOS study (n=750,302). We established five CRF categories based on age-and-gender-adjusted peak metabolic equivalents (METs) achieved: Least-Fit (4.5±1.2 METs; n=106,955); Low-Fit Fit (6.9±1.1 METs; n=122,612); Moderate-Fit (8.3±1.2 METs; n=91,995); Fit (10.3±1.2 METs; n=111,472); and High-Fit (13.2±1.6 METs; n=38,545). CKD risk across CRF categories was assessed by multivariable Cox Regression analysis, adjusted for age, blood pressure, body mass index (BMI), alcohol abuse, traditional risk factors, and medications.

Results:

During 6,146,773.0 person-years of follow-up (median 12.9 years), 58,701 individuals developed CKD (9.6 events/1,000 person-years of observation). The CRF-CKD association was inverse, independent of comorbidities and graded. The risk of developing CKD was 9% lower for each 1-MET increase (Hazard Ratio [HR] 0.91; 95% confidence interval [CI] 0.90-0.93). When CKD risk was assessed across CRF categories using the Least-fit category as the referent, the risk was 20% lower (HR 0.80; CI 0.78-0.81, p<0.001) for those in the Low-fit category (6.9±1.1 METs). The risk declined progressively with increased CRF and was 49% lower for those in the highest CRF category (HR 0.49; CI 0.47-0.51, p<0.001). Similar findings were observed in the subgroup of hypertensive patients with diabetes mellitus (n=192,966).

Conclusions:

We noted an inverse and dose-response association between CRF and CKD incidence. The risk was attenuated significantly beyond a MET level of 6.9±1.1 METs, suggesting that moderate increases in exercise capacity lowers the risk of developing CKD in hypertensive patients.
RESIDENCE AT HIGH ALTITUDE IS ASSOCIATED WITH LOWER CONVENTIONAL AND AMBULATORY BLOOD PRESSURE THAN LIVING AT SEA LEVEL IN THE GENERAL POPULATION OF PERU. HIGHCARE-LAPS STUDY
Authors: Bilo Grzegorz , Villafuerte Francisco C. , Zanotti Lucia , Soranna Davide , Nava Sara , Rusconi Valentina , Pengo Martino F. , Croce Alessandro , Lombardi Carolina , Macarlupu Jose Luis , Bermudez Daniela , Sosa Jose’ Manuel , Carcamo Cesar P. , Zambon Antonella , Parati Gianfranco
Published: May 2024

Objective:

Acute exposure to hypoxia at high altitude (HA) leads to an increase in blood pressure (BP) in healthy individuals and in hypertensive patients. Little is known, however, about the effect of long-term HA residence on BP. Available data based on conventional BP measurements are inconsistent and no general population studies using 24-h ambulatory BP monitoring (ABPM) have been conducted.

Aim of HIGHCARE-LAPS was to compare BP levels and cardiovascular risk profile among population-based samples of subjects residing in Peruvian communities living at different altitudes. BP-related data are reported in this paper.

Design and method:

Study participants were recruited by sex- and age-stratified random multistage cluster sampling from the general adult population residing permanently in urban areas at different altitudes in Peru (Lima, <500m, Huancayo 3287m, Juliaca 3824m, Cerro de Pasco 4330m). In all participants questionnaire-based information, conventional BP (3 seated measurements with a validated oscillometric device, HEM7121 OMRON, Japan), 24-hour ambulatory BP (A&D TM2430, Japan) and laboratory variables were obtained.

Results:

The study included 206 lowlanders and 595 highlanders. Highlanders were slightly younger, had lower BMI, oxygen saturation and prevalence of antihypertensive medication use and higher haematocrit. In highlanders all conventional and ambulatory BP values were lower and heart rate values higher than in lowlanders. Comparisons between lowlander and highlander samples and for individual sites at different altitudes are reported in the Table.

The difference in 24-hour systolic BP between highlanders and lowlanders remained significant (7.2 mmHg, p<0.001) in a linear multiple regression model adjusting for age, sex, BMI, 24-hour heart rate, respiratory rate, and haematocrit. These covariates were selected by LASSO method from a set also including lifestyle-related variables.

Conclusions:

Permanent residence at high altitude is independently associated with lower conventional and ambulatory BP levels than low altitude residence in the general population of Peru. This relationship does not seem to be explained by lifestyle differences. Mechanisms behind this difference and its impact on cardiovascular risk should be further investigated. Also, comparative studies with other highland populations with different adaptive characteristics would allow to understand better the effects of HA residence on cardiovascular health.
U-SHAPED RELATIONSHIP BETWEEN BLOOD PRESSURE AND ALL-CAUSE MORTALITY IN OLDER ADULTS: THE SHIZUOKA STUDY
Authors: Asahina Aya , Usui Takeshi , Tabara Yasuharu
Published: May 2024

Objective:

Not only high blood pressure (BP) but also low BP was suggested to be associated with all-cause mortality in older adults. However, the actual mechanism responsible for the association between low BP and mortality has not been identified. This study aimed to investigate a possible confounding of antihypertensive drug use, potential comorbidities, and functional disability, as well as random error in BP measurement, in the association between low BP and all-cause mortality. A possibility of reverse causation (i.e., lower BP was caused by cardiovascular frailty at the end of life) was also investigated.

Design and method:

We use the Kokuho Database in a local government, which is a prefecture-wide large dataset including data on annual health checkup and health and care insurance claims. This longitudinal observational study analyzed 337,988 individuals aged ≥ 65 (mean age: 73.5) years. The earliest day of participation in the annual health checkup during the study period from 2012 to 2020 was defined as baseline. Data on comorbidities, prescribed antihypertensive medications, functional disability levels, and incidence of stroke and all-cause mortality were obtained from the insurance claims database.

Results:

During a mean follow-up period of 5.3 years, there were 27,497 cases of all-cause mortality and 11,090 cases of stroke. A U-shaped association was observed between systolic BP and all-cause mortality in participants aged ≥ 75 years. The hazard ratio of systolic BP <110 mmHg for all-cause mortality was 1.14 (95% confidence interval: 1.07–1.21, P < 0.001). Meanwhile, the hazard ratio of BP ≥ 150 mmHg was 1.16. The U-shaped association remained significant in the subanalyses of individuals without severe comorbidities, antihypertensive drug use, or functional disability. Similar results were also observed in the analysis excluding early-mortality cases within 3 years after the baseline, as well as in the analysis using the average systolic BP measured during at least two different occasions within a 3-year period as a baseline value. In contrast, stroke risk increased linearly with increasing BP.

Conclusions:

Low BP was associated with all-cause mortality in older adults. The U-shaped association may not be attributed to the previously suggested factors.
ASSOCIATION BETWEEN BLOOD PRESSURE LEVELS AND COGNITIVE IMPAIRMENT IN PATIENTS WITH HEART FAILURE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Zhang Fangjing , Zhang Yong , Zhang Kefan , Di Xiaofan , Yu Jing , Bai Feng , Wang Qiongying
Published: May 2024

Objective:

The prevalence of cognitive impairment in heart failure patients is up to 43%. The study showed that that the risk of cognitive impairment in heart failure is 1.67 times that in the non-heart failure population. Similarly, high blood pressure is strongly associated with an increased risk of cognitive impairment. However, it is unclear whether the blood pressure level participates in the development of cognitive impairment in patients with heart failure. The objective of this Meta-analysis was to explore the effect of blood pressure levels on cognitive function in patients with heart failure.

Design and method:

Using keywords to search online literature on all studies on heart failure and cognitive function between January 1950 and December 2022. The investigator screened the literature by inclusion exclusion criteria. Statistical analysis of the findings of the studies included in the meta-analysis was performed using the Revman.

Results:

(1)A total of 80 studies on patients with heart failure were cognition through literature screening, and 20 studies met the inclusion and exclusion criteria in the meta-analysis. (2) Meta-analysis data on the correlation between blood pressure level and cognitive function in heart failure patients indicate that: In patients with heart failure, patients with concurrent hypertension showed a greater cognitive decline compared with the normal blood pressure group. At different blood pressure control levels, the odds ratio for cognitive impairment in heart failure patients with blood pressure control within the target range was 1.72 (95% confidence interval 1.15–2.42). In the same level of blood pressure control range, there was no statistically significant difference in cognitive function in patients with preserved ejection fraction compared with patients with reduced ejection fraction.

Conclusions:

This meta-analysis showed that blood pressure in heart failure is at different levels and the degree of cognitive impairment varies, indicating that there has a degree of influence on their cognitive function. However, after analyzing and comparing cognitive function in patients with heart failure with preserved ejection fraction, there was no significant statistical difference between the effects of blood pressure levels on cognitive function in the two groups.