bluuebunny/crossref_metadata_2025 huggingface dataset:
THE SPECIFICS OF POSTCOVID ATRIAL FIBRILLATION IN ELDERLY AND LATE-LIFE PATIENTS WITH ARTERIAL HYPERTENSION AND ISCHEMIC HEART DISEASE
Authors: Wang Zheming , Talibov Faiz , Zbyshevskaya Elizaveta , Mayer Mark , Makeeva Tatiana
Published: June 2023

Objective:

To study the frequency and conditions for the emergence of atrial fibrillation paroxysms (AFP) in elderly and late-life patients in the postcovid period on the background of comorbid pathology.

Design and method:

2 months after SARS-Cov-2-pneumonia, 124 people were examined, 66 of them (41 men and 25 women) aged 68±5.9 years (group 1) and 58 (33 men and 25 women) aged 81±4.3 years (group 2). According to computed tomography (CT) performed during SARS-CoV-2-pneumonia, in group 1, 12 patients (18.2%) had lung lesion volume < 25% (CT1); 34 patients (51.5%) 25-49% (CT2); 18 patients (27.3%) 50-74% (CT3); 2 patients (3%) > 75% (CT4). In group 2, 14 patients (24.1%) had CT1; 18 patients (31.1%) CT2; 21 patients (36.2%) CT3; 5 patients (8.6%) CT4. All patients had arterial hypertension (AH) and coronary heart disease (CHD) on the background of atherogenic dyslipidemia; 59 had type 2 diabetes mellitus (DM), 13 had chronic kidney disease (CKD). Holter monitoring (HM) was performed for all. The content of ferritin, D-dimer, and CRP in the blood plasma was measured for all.

Results:

According to the HM, in 13 of 66 (19.7%) group 1 patients, AFP were registered, of which 7 patients had 30-40 minutes seizures, 3 patients – about 2 minutes seizures. 3 patients were hospitalized, their sinus rhythm was restored by cardioversion. In 16 of 58 (27.6%) group 2 patients, HM revealed AFP, 2 of them were hospitalized due to the deterioration of their condition, the sinus rhythm was restored by cardioversion. In 7 patients, AFP did not exceed 30 minutes; in another 7 patients, AFP were short, no more than 2-3 minutes. Blood ferritin in group 1 was 175±66.2 ng/ml; in group 2 212±40.2 ng/ml (p = 0.012); D-dimer 501±50.3 ng/ml and 835±53.8 ng/ml, respectively (p = 0.0002); CRP 4.3±2.1 mg/l and 8±3.3 mg/l, respectively (p = 0.0009).

Conclusions:

2 months after SARS-CoV-2-pneumonia with a large area of lung damage, elderly and late-life patients with a very high cardiovascular risk have signs of inflammation, and a tendency to increased thrombosis, which probably causes the AFP emergence.
ARTERIAL HYPERTENSION AS A PREDICTOR OF THROMBOEMBOLIC EVENTS IN PATIENTS WITH ATRIAL FIBRILLATION TREATED WITH DIRECT ORAL ANTICOAGULANTS
Authors: Sinigoj Petra , Kabaklic Amela , Hitij Jana Brguljan , Mavri Alenka
Published: June 2023

Objective:

The aim of the study was to assess predictors of thromboembolic events in patients with atrial fibrillation treated with direct oral anticoagulants (DOAC).

Design and method:

From our single-centre prospective registry we enrolled 2792 consecutive atrial fibrillation patients that were started on dabigatran, rivaroxaban or apixaban. The mean duration of treatment exposure was 724 days. The primary outcome was the incidence of thromboembolic events. The incidence of bleeding events and death were also assessed. Potential risk factors for thromboembolic events were evaluated using Cox regression analysis.

Results:

During the follow-up, 94 patients experienced a thromboembolic event (1.9%/year). Twelve patients experienced two and one patient experienced three thromboembolic events. Considering only the first thromboembolic event, 39 patients experienced a stroke, 14 patients a transient ischaemic attack (TIA), 12 patients a systemic thromboembolism (SE), 19 patients myocardial infarction (MI) and 10 patients a venous thromboembolic event. Twelve thromboembolic events were fatal (0.2%/year). According to a multivariate Cox regression analysis (Table 1), significant predictors for a composite endpoint of stroke, TIA, SE and MI were age group (HR 1.27, 95% CI 1.04–1.56, p = 0.022), arterial hypertension (HR 2.86, 95% CI 1.15–7.12, p = 0.024) and history of stroke, TIA or SE (HR 2.6, 95% CI 1.66–4.05, p < 0.001). The incidence of major bleeding was 2.3%/year.

Conclusions:

In this prospective clinical study we have shown that age, arterial hypertension and history of stroke, TIA or SE were strong predictors of arterial thromboembolic events in patients with atrial fibrillation treated with DOAC. Among those, arterial hypertension had the highest hazard ratio. Since arterial hypertension presents a potentially modifiable predictor, it can be assumed that its treatment was not adequate.
EFFECT OF LOW BLOOD PRESSURE ON ACUTE HEART FAILURE PROGNOSIS ACCORDING TO HEART FAILURE CLASSIFICATION
Authors: Kim Hyun-Jin , Jo Sang-Ho
Published: June 2023

Objective:

Blood pressure (BP) management is complex in patients with heart failure (HF), but is important with respect to HF progression and clinical prognosis. We evaluated the actual prescribing patterns of angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB) and beta-blockers (BB) in patients with HF at discharge and clinical prognosis according to initial BP level in patients with acute HF.

Design and method:

Study data were obtained from a multicenter cohort that included patients hospitalized for acute HF. Patients who had available data regarding initial BP and left ventricular ejection fraction were included in this analysis. The patients were classified into two groups: heart failure reduced ejection fraction (HFrEF) group versus. HF mildly reduced ejection fraction (HFmrEF) and HF preserved ejection fraction (HFpEF) group. Initial systolic blood pressure (SBP) was classified into <100, 100-119, 120-139, 140-159, and > = 160mmHg, and diastolic blood pressure (DBP) into <50, 50-69, 70-89, 90-109, > = 110mmHg.

Results:

Among 2,778 patients, HFrEF patients used ACEi, ARB, or BB at discharge even if their SBP was as low as less than 100mmHg, and there was no significant difference in frequency of medication use by BP level. However, HFmrEF and HFpEF patients showed a tendency to significantly decrease the frequency of medication use as BP decreased. In HFrEF, the lower the initial BP, the higher the incidence of all-cause death and composite clinical events including HF readmission or all-cause death (Table). However, in HFpEF and HFmrEF, there was no significant difference in clinical outcome according to BP. In addition, initial SBP (<120mmHg) was independently associated with 1.81-fold increased risk of long-term mortality [Odds ratio (OR) 1.81, 95% confidence interval (CI) 1.349-2.417, p < 0.001], and initial DBP (<80mmHg) was also 2.24-fold increased risk [OR 2.24, 95% CI 1.645-3.053, p < 0.001].

Conclusions:

Poor clinical prognosis is expected if the initial BP low in patients with HFrEF, and low BP (<120/80mmHg) affects increased mortality independently of HF medication use. Clinicians should be aware of the effect of low BP in patients with acute HF and provide delicate BP control.
DAPAGLIFLOZIN MODULATES ADROPIN SERUM LEVELS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND CHRONIC HEART FAILURE
Authors: Berezin Alexander , Fushtey Ivan M. , Berezin Alexander A.
Published: June 2023

Objective:

To investigate an effect of sodium glucose linked transporter 2 (SGLT2) inhibitor dapagliflosin on the levels of adropin in patients with type 2 diabetes mellitus (T2DM) with chronic heart failure (HF).

Design and method:

The study is open label multicenter (private hospital Vita-Centre, Zaporozhye, Ukraine, EliteMedService, Zaporozhye, Ukraine and City Hospital #7, Zaporozhye, Ukraine) non-randomized cohort investigation. We prospectively enrolled 417 patients with T2DM and HF from entire cohort of 612 T2DM pa-tients. The eligible patients were treated with guided-recommended HF therapy de-pending on HF phenotypes, which included SGLT2 inhibitor dapagliflozin in a dose of 10 mg OD orally along with angiotensin receptor-neprilysin inhibitor (ARNI) / ACE inhibitors / angiotensin-II receptor blockers (ARBs), mineralocorticoid receptor antag-onist (MRA), beta-blockers. Anthropometrics, clinical data, Echocardiography / Doppler examinations and biomarkers assessments were performed at the baseline and over 6-month interval.

Results:

Over 6-month period after initial prescription of SGLT2 inhibitor dapagliflozin the levels of adropin in entire group demonstrated a significant growth up to 26.6% (from 237.4 [25%-75% IQR = 190.50–275.30] ng/mL to 300.2 [25%-75% IQR = 267.80–335.70] ng/mL, P = 0.04). In female subgroup, an increase in circulating level of adropin was sufficiently higher (from 269.5 [25%-75% IQR = 231.20–299.20] ng/mL to 365.2 [25%-75% IQR = 340.10–388.60] ng/mL, P = 0.01), when com-pared with male subgroup (from 211.2 [25%-75% IQR = 190.40–237.50] ng/mL to 259.6 [25%-75% IQR = 206.50–321.40] ng/mL, P = 0.16). Multivariate logistic regression analysis of entire group showed that relative changes of left ventricular (LV) ejection fraction (LVEF), left atrial volume index (LAVI), and E/e` were significantly associated with increased adropin levels. In fe-male subgroup, but not in male subgroup, relative changes of LVEF (P = 0.046), LAVI (P = 0.001) and E/e` (P = 0.001) exhibited their independent predictive values for adropin changes.

Conclusions:

The levels of adropin seem to be a predictor for favorable modification of hemodynamic perfor-mances that is independent from N-terminal brain natriuretic pro-peptide.
INFLAMMATION MARKERS AS POTENTIAL MEDIATORS FOR THE ASSOCIATION BETWEEN ARTERIAL STIFFNESS AND OBESITY
Authors: Trouvé Ryan , Wei Dongmei , Vanassche Thomas , Aelst Lucas Van , Verhamme Peter , Janssens Stafen , Zhang Zhen -Yu
Published: June 2023

Objective:

Arterial stiffness is a strong independent predictor of cardiovascular diseases. Obesity was closely associated with arterial stiffness. This study hypothesised that inflammatory markers mediated the association between obesity and arterial stiffness.

Design and method:

We performed a cross-sectional study in 965 Flemish individuals (mean age 49.4 ± 15.6 years, 51 % female). Carotid-femoral pulse wave velocity (PWV) was measured as indicator of arterial stiffness via application tonometry. Obesity was defined as BMI > = 30 kg/m2. Fourteen plasma inflammatory cytokines were determined, using an ELISA-based assay and composite inflammation scores were calculated using Crohnbach's alpha as an indicator of internal consistency reliability for measurement of inflammatory burden. Insulin resistance (IR) was calculated via the homeostasis model assessment (HOMA), and resistance was defined as HOMA > = 1.9.

Results:

An increased PWV was found in individuals with obesity, compared to those without obesity (8.1 vs. 7.4 m/s, p < 0.001). After adjusting for sex and age, the association between, PWV and obesity remained (0.35, 95% CI: 0.08 – 0.63, p = 0.011). Obesity was positively associated (p < 0.001) with CRP (0.059, 95% CI: 0.037 – 0.081), IL-6 (0.046, 95% CI: 0.023 – 0.068), leptin (0.147, 95% CI: 0.122 – 0.172) and PAI-1 (0.036, 95% CI: 0.015 – 0.058). Mediation analysis showed that the association between PWV and obesity was partially mediated by inflammatory burden scores (18.70 %, p < 0.05) and was borderline mediated by leptin (28.70 %, p = 0.060) and insulin resistance (15.44 %, p = 0.054).

Conclusions:

Our findings confirm the role of inflammation as major mediator in obesity associated arterial stiffness. Leptin and insulin resistance might also involve in arterial stiffness in obesity, which may provide potential treatment targets.
DIFFERENTIAL DETERMINANTS OF AMBULATORY VS. HOME MORNING BLOOD PRESSURE MEASURED BY A SINGLE MULTISENSOR BLOOD PRESSURE MONITORING DEVICE: THE HI-JAMP STUDY BASELINE DATA
Authors: Tomitani Naoko , Hoshide Satoshi , Kario Kazuomi
Published: June 2023

Objective:

Out-of-office blood pressure (BP) monitoring using ambulatory BP (ABP) monitoring (ABPM) and home BP (HBP) monitoring (HBPM) is recommended for hypertension management. However, BP level measured by ABPM and HBPM may not be consistent even when evaluated the same time-window, morning. This study investigated the determinants of the difference between ABP and HBP in the morning time measured by a multisensor BP monitoring device equipped with a high-sensitivity actigraph and a thermometer.

Design and method:

Medicated hypertension patients enrolled in the Home-Activity ICT-based Japan Ambulatory Blood Pressure Monitoring Prospective (HI-JAMP) Study consecutively underwent office BP monitoring, 24-h ABPM (with 30-min intervals), and 5-day HBPM (twice each morning and evening) using the same multisensor BP monitoring device (TM-2441; A&D Company, Tokyo). Morning ABP (average of 4 readings within 2-h after waking) and morning HBP (average of HBP readings measured in the morning over a HBPM period) were compared. In addition, this device recorded the wearer's fine-scale physical movement during a 24-h ABPM period and stored temperature data at the time of each BP measurement. Hourly averages of physical activity and temperatures at the time of HBPM (i.e., room temperature) were used for the analysis.

Results:

Among 2322 patients (males 53.2%, 69.2±11.5 years, average office systolic BP [SBP] 132.8±18.8 mmHg), morning home SBP was 2.4 mmHg higher than morning ambulatory SBP with standard deviation of 15.9 mmHg (ABP < HBP). In a multivariable analysis including conventional risk factors, older age and larger number of antihypertensive agents were significantly associated with [HBP > ABP], while history of cardiovascular disease (CVD) was significantly associated with [ABP > HBP]. In the analysis additionally including physical activity in the morning and room temperature at the morning HBP measurement, higher activity level was significantly contributed to [ABP > HBP] and lower room temperature was significantly contributed to [HBP > ABP].

Conclusions:

In treated hypertensive patients, HBPM is recommended especially if the patient is older, taking multiple antihypertensive agents, or living in an environment with lower room temperatures in the winter, while ABPM is recommended if the patient has a history of CVD.
RELIABILITY AND RELEVANCE OF 24H AMBULATORY BLOOD PRESSURE MONITORING IN DAY TO DAY TREATMENT OF ARTERIAL HYPERTENSION
Authors: Neumann Claas Lennart , Wietoska Torsten , Schulz Egbert G.
Published: June 2023

Objective:

Blood pressure measurements are the basis of diagnosis, treatment and research of arterial hypertension and its sequelae. All decisions hinge on the validity of the measurement method. Here, the ABPM is considered best practice. Evaluation of ABPM, notwithstanding known issues like availability and economy, regarding its validity, accuracy and applicability to clinical practice was investigated.

Design and method:

We retrospectively consider 450 ABPMs executed using validated devices from Nephrology Center Göttingen (ESH-Excellence-Center). This work evaluates the measurements’ adherence to diagnostic guidelines (ESH) with respect to sources of error, count of valid measurements and cancellation by patient.

Criteria for validity are:

- Minimum 24 h recording duration.

- At least 20 valid day and 7 valid night measurements

- Minimum of 70 percent valid measurements in total

Cancellation by the patient is assumed if:

- Recording duration is below 22h without indication of technical fault or measurement is stopped prior to 7 30 a.m.

Results:

23 % (n = 106) of 450 ABPM considered to meet all guideline criteria. Remaining 77 % of measurements failed at least one criterion. In 27 % (n = 120), measurement duration was below 24 h and for 22 % (n = 98) it was below 22 h. In 2.6 % (n = 12) minimum amount of daytime (n = 3) and night-time (n = 9) data points was not met. Requirement for at least 70 % of valid data points was failed by 23.5 % (n = 105). Here the source of error were motion artefacts in about 50 % of cases, pressurisation issues during the day in 17 % (n = 15) and 27 % (n = 11) at night and kinks in tubing in 14 % (n = 12) during daytime. About 20.6 % (n = 93) of ABPM were preliminary cancelled by the patient which amounts to approximately a quarter (25.4 %) of all measurements failing the guideline criteria.

Conclusions:

Value of ABPM hinges on guideline conforming execution of measurements and should therefore be explicitly discussed with the patient. Quality of data obtained by an ABPM needs to be examined for every case to ensure its validity to justify a course of action.
RELATIONSHIPS OF OFFICE, AMBULATORY, AND HOME BLOOD PRESSURE WITH ORGAN INJURY BIOMARKERS
Authors: Narita Keisuke , Hoshide Satoshi , Kario Kazuomi
Published: June 2023

Objective:

International guidelines recommend out-of-office blood pressure (BP) monitoring including ambulatory and home BP. Although the superiority of ambulatory and home BP is controversial, home BP is more prevalent in plactice and there is a gap with the guidelines. We assessed this issue by conducting the analysis of relationship of BP with clinical biomarkers.

Design and method:

We analyzed the relationship of office, ambulatory, and home BP with organ injury biomarkers including urine-albumin creatinine ratio (UACR), serum b-type natriuretic peptide (BNP), serum high-sensitive troponin T (hsTnT), echocardiographic left ventricular mass index (LVMI), and brachial-ankle pulse wave velocity (baPWV) in 1,172 outpatients who underwent both ambulatory and home BP measurements and examined serum and urine tests and others.

Results:

In the univariate analysis of Pearson's correlation, average of morning and evening home systolic BP (SBP) was strongly related with log-transformed BNP, log-transformed hsCRP, LVMI, and baPWV compared with 24-h ambulatory systolic BP (log-transformed UACR [n = 1432], r = 0.24 in home SBP versus r = 0.18 in ambulatory SBP, P = 0.17 in z-test for comparison of these correlations; log-transformed BNP [n = 1432], r = 0.17 vs. r = -0.04, P<0.01; log-transformed hsTnT [n = 1092], r = 0.19 vs. r = -0.03, P<0.01; LVMI [n = 1036], r = 0.23 vs. r = 0.10, P<0.01; baPWV [n = 1361], r = 0.31 vs. r = 0.08, P<0.01). In the multivariable linear regression models for log-transformed BNP, log-transformed hsTnT, and LVMI, the model-fit were improved when adding home SBP to the model including 24-h ambulatory SBP, but these relationships were not shown in vice versa. In addition, we also used Structural Equation Modeling for assessment of relationship of office, ambulatory, and home SBP with clinical biomarkers.

Conclusions:

Our findings suggested the superiority of home BP in the relationship with several biomarkers for hypertensive organ damage compared with ambulatory BP, which may provide a rationale for the management on hypertension using home BP monitoring in clinical practice conducted in many countries including Japan.
UNDERSTANDING THE REALITY OF HIGH BLOOD PRESSURE SCREENING AND MONITORING IN THE RURAL POPULATION FROM THE CROATIAN RURAL AREA DAMAGED BY AN EARTHQUAKE: “THE SILENT KILLER HUNT”
Authors: Kroflin Karla , Kristo Matej , Krstanovic Kristina , Luzaic Karla , Lasta Sven , Mijalic Lovro , Jelakovic Bojan
Published: June 2023

Objective:

Arterial hypertension (AH) is the most important independent risk factor for cardiovascular diseases. Unfortunately, less than half of adults with hypertension are diagnosed and treated. It is well known that home blood pressure (BP) monitoring is a useful method for follow-up and for detecting patients with asymptomatic hypertension. Home BP monitoring is inexpensive and well-accepted by patients, which are both great benefits for the screening method. The prevalence of AH in Croatia differs by region, in addition, residents of rural areas have poorer access to healthcare. The aim of this study was to find the prevalence of AH in subjects who did not report a medical history of AH and to find the prevalence of subjects who own home BP monitors in rural areas.

Design and method:

A total of 214 participants (opportunistic screening) were asked about previous AH diagnoses and whether they own a home BP monitor in our cross-sectional survey. BP was measured following ESH guidelines using Microlofe oscillometric device. AH stage 1 was considered if systolic BP was 130 mmHg or higher, or diastolic 80 mmHg or higher.

Results:

Out of a total of 214 respondents, 120 respondents (56%) reported that they had AH. In a group who answered that either they didn’t have or didn’t know if they had AH, high BP was measured in 61.96%.

Interestingly, only 46 (21.5%) reported that they do not have a home BP monitor, and 168 participants (78.5 %) confirmed having a BP monitor at home.

Conclusions:

Our results revealed poor awareness of AH and showed the utility of the AH screening intervention, particularly in rural areas. More research is needed to determine the best screening methods and further applications for the general population. Our findings may also help healthcare workers to understand the potential of home BP monitoring for their patients because a large number of survey respondents even in rural areas own a BP monitor. This discovery can enhance the quality of patient education, patient-physician relationship, and follow-up practice for successful BP monitoring.
THE FEASIBILITY OF CUFFLESS, NON-OCCLUSIVE BLOOD PRESSURE ASSESSMENTS USING THE NOVEL LIFELEAF WRISTWATCH AND PLATFORM
Authors: Almahmeed Wael , Kumar Dilip , Mbouombouo Benjamin , Banerjee Nilanjan , Sanyal Alodeep , Sen-Gupta Indranil
Published: June 2023

Objective:

Hypertension affects 1.3 billion people worldwide and is the leading cause of myocardial infarction and stroke. Successful treatment of hypertension continues to be a global challenge, likely given that the most common tool for assessment is the sphygmomanometer, which can be time-consuming and cumbersome to utilize on a consistently compliant basis. More straightforward means of blood pressure (BP) measurement may facilitate earlier detection and closer monitoring of hypertension, thereby helping to alleviate potential comorbidities. The ability to seamlessly collect longitudinal BP data could also enhance ambulatory blood pressure monitoring, which is preferred over in-office BPs for tracking hypertension and decisions regarding pharmacotherapy. BP measurements in the ambulatory setting may also be more representative of true BPs by eliminating white coat syndrome. We therefore investigated the reliability of performing BP measurements via a novel cuffless, non-occlusive photoplethysmography (PPG)-based wristwatch compared to a standard automatic BP cuff reference.

Design and method:

The LIFELEAF® wristwatch (LifePlus, Inc., San Jose, CA) utilizes novel signal processing and machine learning (ML) algorithms to predict real-time systolic and diastolic blood pressures (SBP and DBP) using features extracted from PPG signal at the wrist. 274 total subjects from 3 centers (Cleveland Clinic Abu Dhabi, UAE; Hospital Sebarang Jaya, Malaysia; and iKure Clinic, India) were enrolled. Subjects were outpatients 18 years of age or older; females who were gravid or actively trying to conceive were excluded. Automatic BP cuff reference measurement on the left arm was immediately followed by 1 minute of wristwatch PPG signal acquisition on that arm. An average of 10.77 paired data acquisitions per subject were collected. Datasets were randomly split for model training (60%) and prediction (40%).

Results:

There were no significant differences in mean SBP or mean DBP between cuff reference measurements and wristwatch predictions. The wristwatch-predicted SBPs and DBPs also demonstrated significant linear correlation with cuff reference values.

Conclusions:

Longitudinal SBP and DBP measurements are feasible via non-occlusive methods incorporating sophisticated signal processing and machine learning (ML) applied to wrist PPG. Further algorithmic improvements to accuracy may improve BP/hypertension tracking by facilitating assessments compared to conventional sphygmomanometers.
CORRELATION BETWEEN CLINIC AND AMBULATORY BLOOD PRESSURE MEASUREMENT
Authors: Hamdani Achref , Bayar Mmohamed Fehmi , Ajra Zaineb , Gheni Refaat , Rashikou Lamia , Hmida Riadh Ben , Ounissi Taha , Elhadj Zied Ibn
Published: June 2023

Objective:

Blood pressure (BP) measurements taken in the clinic provide limited information about the BP load. Ambulatory blood pressure monitoring (ABPM) provide a more comprehensive assessment of blood pressure over the course of a day. This study examined the correlation between clinic and ambulatory BP measurements.

Design and method:

We collated clinic and 24 hour ambulatory BP data of 100 patients aged > 18 years from the outpatient cardiology clinic of Mohamed Taher Maamouri University hospital in Nabeul (n = 100) over a six months period (July-December 2021).

Laying of ABPM was performed using a Bravo Mini validated device from Sun Tech Medical.

We used the Pearson correlation coefficient (r) to measure the strength of the relationship between these two measurements methods.

Results:

The mean age of our population was 59.14±13.12 years (range 21-92 years), composed of 47 women and 53 men. The most frequent reason for carrying out ABPM was the monitoring of hypertensive patients in 84% of cases, 16% were done to confirm the diagnosis of hypertension. ABPM confirmed the diagnosis of hypertension in 62.5% and detected 18.75% isolated nocturnal hypertension in patients with suspected hypertension and 14.3% masked uncontrolled nocturnal hypertension in hypertensive patients.

Concordance was found in 66% of cases between clinic measurement and the 24-hour ABPM data. There was a weak correlation between clinic systolic BP and 24-hour ambulatory systolic BP (P <0.001; r = 0.349; Curve A) and moderate correlation between clinic diastolic BP and 24-hour ambulatory diastolic BP (P <0.001; r = 0.566; Curve B).

Conclusions:

The correlation between these two methods isn’t important mainly explained by variation of BP especially at night detected by ABPM which remains the reference method for diagnosing and monitoring hypertension
PREVALENCE OF WHITE-COAT AND MASKED HYPERTENSION AT DIFFERENT OFFICE BLOOD PRESSURE LEVELS IN UNTREATED SUBJECTS
Authors: Dragonas Damianos , Spiliopoulou Sotiria , Tsoutsoura Nefeli , Lykka Aikaterini , Dimitriou Athina , Manios Efstathios
Published: June 2023

Objective:

The European Guidelines for the management of arterial hypertension support the use of out-of-office blood pressure (BP) measurements for confirming the diagnosis of hypertension and detecting BP phenotypes such as white-coat hypertension (WCH) and masked hypertension (MH), especially in patients with grade 1 hypertension and subjects with high normal BP. However, it is not clear enough, whether out-of-office blood pressure measurements should be performed in patients with higher grades of hypertension as well as in subjects with normal or optimal BP. The aim of our study was to investigate the prevalence of WCH in untreated patients with grade 1, grade 2 and grade 3 hypertension as well as the prevalence of MH in never treated subjects with high normal, normal and optimal BP values.

Design and method:

A total of 2357 untreated subjects referred to our Hypertension Unit for evaluation underwent 24-h ambulatory BP monitoring. According to their office BP levels were divided into 6 categories: optimal (<120/80mmHg), normal (120/80 – 129/84mmHg), high normal (130/85 – 139/89mmHg), grade 1(140/90 – 159/99mmHg), grade 2 (160/100 – 179/109mmHg) and grade 3 (> = 180/110mmHg). Subjects with office BP> = 140/90mmHg and 24-h BP<130/80mmHg were defined as WCHs and patients with office BP<140/90mmHg and 24-h BP> = 130/80mmHg as MHs. Statistical analysis was performed by means of chi-square test and one-way ANOVA.

Results:

The percentages of WCH were 53%, 31% and 24% for patients with grade 1, grade 2 and grade 3 hypertension, respectively. The percentages of MH were 34%, 29% and 17% for patients with high normal, normal and optimal BP, respectively.

Conclusions:

The prevalence of WCH is significantly higher in grade 1 hypertension, however patients with grade 2 and 3 hypertension present also high rates of WCH. Similarly, MH is more common in subjects with high normal BP, however high percentages are observed in subjects with normal and optimal BP. Our results support that out-of-office BP measurements should be performed across all office BP range for the optimal detection of WCH and MH.
EVALUATION OF DIAGNOSTIC ACCURACY OF NOCTURNAL HOME BP MONITORING IN HEMODIALYSIS PATIENTS: A PILOT STUDY
Authors: Leondifou Kalia , Kontogiorgos Ioannis , Kollias Anastasios , Vaios Vaslilios , Georgianou Eleni , Karpetas Antonios , Zebekakis Pantelis , Stergiou George S. , Liakopoulos Vassilios , Georgianos Panagiotis
Published: June 2023

Objective:

A unique advantage of ambulatory blood pressure monitoring (ABPM) is that this technique enables the assessment of blood pressure (BP) during the period of sleep, facilitating the diagnosis of nocturnal hypertension. This study aimed to compare ABPM with home BP monitoring (HBPM) performed with a novel device that is designed to obtain daytime and also automated nighttime BP recordings in the assessment of nocturnal hypertension and detection of non-dipping BP pattern among patients on hemodialysis.

Design and method:

Within a period of 2 weeks, 70 stable patients on thrice-weekly hemodialysis underwent assessment of BP with 2 methods: (i) 44-hour interdialytic ABPM (20-min intervals; Microlife WatchBP O3 device) and (ii) HBPM (duplicate morning and evening BP recordings for 7 days and 3 BP recordings per night for 3 nights over the 3-day interdialytic interval; Microlife WatchBP Home N).

Results:

The mean age of the patients was 65.3 (±13.3) years; 45 (64%) were males, and 62 (88.7%) were receiving antihypertensive therapy. The average ambulatory daytime and nighttime SBP/DBP were 122.8±15/68.7±10.5 mmHg and 117.2±16.5/63.4±10.2 mmHg, respectively. The mean [95% confidence interval (CI)] difference between home daytime SBP and ambulatory daytime SBP was 8.61 (6.1, 11.2) mmHg. Similarly, the mean (95% CI) difference between home nighttime SBP and ambulatory nighttime SBP was 5.94 (3.5, 8.4) mmHg. In receiver-operating-characteristics (ROC) analysis, the technique of HBPM provided high accuracy for the detection of an average ambulatory daytime SBP equal or higher than 135 mmHg [area under the curve (AUC): 0.934; 95% CI: 0.871-0.996] as well as for the detection of an average ambulatory nighttime SBP equal or higher than 120 mmHg (AUC: 0.876; 95% CI: 0.794-0.957). Of the overall population, 44 patients (63%) were classified as non-dippers by ABPM and 42 (60%) by HBPM. There was acceptable agreement between these 2 techniques in the identification of patients with a non-dipper BP pattern (77%, k-coefficient = 0.324).

Conclusions:

The present study shows that among patients on hemodialysis, HBPM serves as a reliable alternative to 44-hour interdialytic ABPM for the diagnosis of nocturnal hypertension and detection of non-dipping BP status.
FEWER ANTIHYPERTENSIVE DRUGS ACHIEVE STRICTER BLOOD PRESSURE TARGET IN LESS SEVERE HYPERTENSIVE PATIENTS: A RETROSPECTIVE STUDY IN A COMMUNITY IN BEIJING
Authors: Zhanyang Zhou , Shijie Yang , Miao Huanhuan , Zhang Yuqing
Published: June 2023

Objective:

Nowadays, it is not clear how many antihypertensive drugs should be used to achieve treatment goals from real-world studies. This study aims to analyze the BP control situation and the burden of anti-hypertensive drugs in a big community in Beijing.

Design and method:

We conducted a retrospective study of 4991 residents living in the Majiapu community and collected the baseline and the follow-up data including blood pressure (BP) and drug prescription. BP was analyzed by the mean average value. Hypertension is defined as office systolic BP > = 140mmHg and/or diastolic BP > = 90mmHg. We divided the patient with antihypertensive treatment into a strict control group (BP<130/80mmHg) and a standard control group (BP range from 130-139/80-89mmHg). The comparison of baseline and follow-up data were used to recognize the burden of anti-hypertensive drugs for residents with hypertension and estimate the BP control rate in this population.

Results:

Of 4991 residents, the prevalence of hypertension was 54%, 34.80% (939) of the patients were under 140/90mmHg and 14.46% (390) were under 130/80mmHg. The control rate of standards of 140/90mmHg and 130/80mmHg among the whole population was 64.7% and 35.3%. And the treatment rate in the whole group of hypertension was 62.5%. In the standard control group, the average number of antihypertensive drugs was 1.66 keeping their BP range from 130-139/80-89mmHg, and the mean BP was 132.1±5.39/79.6±6.71mmHg. However, in the strict control group, the average number of antihypertensive drugs was 1.55, and the mean BP was controlled at 118.8±8.45/71.6±5.79mmHg (P<0.05). There were no differences between the two subgroups by age and smoking status. BMI in the strict group (24.6±3.3 kg/m2) was lower than the mild group (25.5±3.3kg/m2, p<0.01). About 49.2% in the strict control group and 47.0% in the standard control group were combined with lipid-lowing drugs. The LDL levels in the standard control group (2.8±0.8mmol/l) tended to be higher than that in the strict control group (2.7±0.9mmol/l, p = 0.06).

Conclusions:

In the Majiapu community where BP controls were insufficient, patients had fewer antihypertensive drugs to achieve stricter targets may be due to the lower risk profile of the patients.
TREATMENT OF HYPERTENSION WITH COMBINATION OF IRBESARTAN AND AMLODIPINE: A REAL-LIFE OBSERVATION STUDY (ON-TRACK STUDY)
Authors: Halima Afef Ben , Khelifa Mariem Ben , Afrit Marouane El , Korbi Nedra , Ammar Asma Ben , Bani Fadwa , Talmoudi Khouloud , Laarousi Sami , Mathlouthi Najeh , Boukchim Houyem , Ayari Firas , Hassen Mohamed Ben , Ennaifar Khaled , Ajmi Rym Mansour , Malek Mohamed Ali Ben , Zidi Mongi
Published: June 2023

Objective:

The On-Track study (Old versus New blood pressure TaRget Achievement under Irbesatan/Amlodipine Combination: General Practice WorK experience) is a real life study conducted to evaluate the fixed combination of Irbesartan and Amlodipine. The aim of this study was to assess the efficacy of the fixed combination Irbesartan/Amlodipine in reducing blood pressure (BP) and achieving target BP and its safety profile.

Design and method:

This is an observational, prospective, multicenter study which included patients with newly diagnosed and untreated hypertension (BP higher or equal to 140/90 mmHg) or uncontrolled hypertension on monotherapy or uncontrolled hypertension with any two-drug combination other than irbesartan/Amlodipine. Patients included were prescribed the combination drug Irbesartan/Amlodipin at different doses and followed up for 6 months.

Results:

A total of 1012 patients were included in this study in the intention-to-treat analysis. 536 patients were treated with Irbesartan/Amlodipine 150/5, 421 patients with Irbesartan/Amlodipine 300/5, and 55 patients with Irbesartan/Amlodipine 300/10. Systolic and diastolic blood pressure (SBP and DBP) values were recorded for patients at inclusion and at each study visit. There was a significant decrease of mean SBP at 6 months compared to SBP at inclusion ( 167.4±16.8 mm Hg 128.6±8.5 mm Hg, p<0.001) and of DBP ( 91.7±10.0 mmHg vs 76.4±6.2 mmHg p < 0.001). At six months the target BP of < 140/90 mm Hg was achieved in 87.1 % of patients, and the target BP < 130/80 mm Hg was achieved in 39.5 % of patients. The rate of adherence to treatment was 88.5 %. Adverse events were reported in 22.3 % of patients mainly oedema in 11 % of cases. None of the patients in the study reported a serious adverse event that would have led to discontinuation of treatment

Conclusions:

This study confirms the efficacy of the irbesartan-amlodipine fixed-dose combination when applying the old targets of BP but more efforts should be done to achieve new target BP. We noticed a good tolerability and adherence to treatment of patients under this drug combination.
PROTECTIVE ROLE OF VITAMIN B9 AGAINST HIGH BLOOD PRESSURE: A POPULATION BASED STUDY FROM HARYANA, NORTH INDIA
Authors: Yadav Neha , Devi Naorem Kiranmala
Published: June 2023

Objective:

Prevalence of high blood pressure has increased tremendously among all age groups from the last four decades and a major risk factor for cardiovascular diseases (CVDs). Lifestyle risk factors like pattern of diet is likely to play a role in hypertension. Adequacy in the intake level of vitamin B9 has been reported to play a protective role against hypertension hence, the present study aimed to explore the relationship between intake proportions of vitamin B9 as per RDA and blood pressure among a vegetarian population.

Design and method:

A total of 250 participants including both males and females of age 30 years and above were recruited for the present study from Palwal, Haryana. Data on demography and dietary intake was collected by using pretested and modified interview schedule and validated food frequency questionnaire (ffq) respectively.

Results:

Blood pressure was measured using calibrated electronic equipment (OMRON). Statistical analyses was done by using SPSS software version 22.

Conclusions:

An inverse relationship between adequate dietary intake of vitamin B9 and hypertension was found. Adequacy in the intake level of vitamin B9 may play a crucial role in reducing the burden of hypertension.
ELEVATED GROWTH AND DIFFERENTIATION FACTOR 15 (GDF-15) LEVELS AMPLIFIES THE ASSOCIATION BETWEEN HOME BLOOD PRESSURE VARIABILITY AND CARDIOVASCULAR OUTCOME
Authors: Hoshide Satoshi , Kario Kazuomi
Published: June 2023

Objective:

Growth and differentiation factor 15 (GDF-15) is a marker of cell senescence. Although age is strongly determinant of GDF-15 level, several studies suggest that GDF-15 reflects biological age rather than chronological age. Since age is also associated with increased blood pressure variability, we hypothesized that the association between day-by-day home blood pressure variability (HBPV) and cardiovascular outcome may be steeper in patients with elevated GDF-15.

Design and method:

We analyzed 4030 patients from a practitioner-based population (mean±SD age 64.9±10.9 years: 79.0% taking antihypertensive medication) with at least one cardiovascular risk factor who underwent home blood pressure monitoring in the Japan Morning Surge-Home Blood Pressure Study. The standard deviation was assessed as indexes of day-by-day home systolic blood pressure variability. We divided patients into elevated (1200 ng/L or more) and non-elevated GDF-15 (less than 1200 ng/L) groups.

Results:

During a mean follow-up of 6.2 years, 247 cardiovascular events occurred. Participants with the highest HBPV tertile without elevated GDF-15 (hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.03-2.23) or those with elevated GDF-15 without the highest BPV tertile (HR, 1.52; 95%CI, 1.03-2.16) had approximately 1.5-fold higher risk of cardiovascular events compared with those with low HBPV without elevated GDF-15. Adjusted risk of cardiovascular events was approximately 2.3-fold higher among participants with elevated GDF-15 and the highest HBPV tertile, compared with those with low HBPV without elevated GDF-15 (HR, 2.34; 95%CI, 1.58-3.45).

Conclusions:

We conclude that elevated GDF-15 contributes to the association between home BP variability and cardiovascular events.
BLOOD PRESSURE VARIABILITY AND CIRCADIAN PATTERN AFTER RENAL DENERVATION - CROATIAN REAL-LIFE STUDY
Authors: Barisic Klara , Jelakovic Ana , Begic Zvonimir , Basic Matija , Perkov Drazen , Lovric Mila , Sarac Antonela , Vrkic Tajana Zeljkovic , Dika Zivka , Stambuk Sandra Karanovic , Zivko Marijana , Josipovic Josipa , Kacinari Patricia , Abramovic Ivana , Jelakovic Bojan
Published: June 2023

Objective:

Recent trials confirmed the lowering effect of renal denervation (RDN) on blood pressure (BP). We aimed to analyze the impact of RDN on BP variability and circadian rhythm.

Design and method:

Out of 31 truly resistant patients whose secondary forms of hypertension were ruled out and were enrolled into the Croatian Spyral RDN registry, 18 (10 m, 8 w, average age 49.3) were eligible for analyses. Office BP, ABPM, central BP, and PWV were measured with Omron M6, Mobilograph, and Sphygmocor devices. Sympathetic/parasympathetic activity was measured with ANX-3.0 ANSAR device. All RDN procedures (Spyral Medtronic) were done by one physician (average number of ablation spots was 41/procedure). Patients were examined the day before and that day, 1,3,6, and 12 months after the RDN. The response was a drop of office systolic BP by 10 mmHg or more 6 months after RDN. There were no differences in the RDN procedure between responders and non-responders.

Results:

Office and ABPM values dropped the day after RDN and remained significantly lower at the end of the follow-up (6.5/-5.5 and -16.2/9 mmHg, respectively). We failed to find changes in BP variability (SD) after RDN. However, a significant decrease in morning BP surge was observed immediately the day after RDN (-12.4) and was even lower at the end of the follow-up (-18.8 mmHg). Substantial number of patients who had an abnormal nocturnal BP pattern became dippers. Central systolic BP and PWV decreased (-6.3 mmHg and -0.72 m/s, respectively). LFa/RFa decreased the day after RDN and reminded lower during the follow-up period. After RDN morning BP surge remained stable and normal in responders; however, in non-responders, it decreased immediately after RDN (-21.2) and remained lower during the follow-up till the last visit (-33.3).

Conclusions:

Significant improvements in circadian rhythm and several parameters of central hemodynamics were observed after RDN indicating that RDN might be considered as a pathway to the complete, so-called perfect 24-hour BP control. Observed beneficial effects run in parallel with the observed decrease in sympathetic activity. Importantly, even in non-responders, RDN had a beneficial effect on morning BP surge.
PLASMA PLASMINOGEN ACTIVATOR INHIBITOR 1 ASSOCIATES WITH HYPERTENSION IN PROSTATE CANCER
Authors: Sirenko Oksana , Kuryata Olexandr , Tykhomyrov Artem , Yatsenko Tetyana
Published: June 2023

Objective:

The aim was to determine the activity of serum PAI 1 in men with prostate cancer and its relationship with hypertension characteristics.

Design and method:

39 men (median age 63.8 [52.7; 70.5]) with prostate cancer were enrolled. Serum PAI 1 activity levels were determined using a modified colorimetric method of plasminogen activator determination. We examined the association of plasma PAI 1 with incident hypertension by multivariate logistic regression, adjusting for age, obesity, lipids, fasting glucose, kidney function, inflammation, and follow-up years.

Results:

Arterial hypertension was detected in 26 (66.7 %) patients with prostate adenocarcinoma. The median PAI 1 activity level in patients with prostate cancer was 77.95 [64.72; 92.12] U/mL, in the control group – 64.54 [52.35;85.45] U/mL (p< 0.05). The PAI 1 activity level correlated with diastolic blood pressure (R = 0.69, p < 0.001), duration of prostate adenocarcinoma (R = 0.42, p < 0.001), and testosterone level (R = 0.60, p < 0.001). Higher level of log-transformed PAI 1 was associated with 1.29-fold increased risk of hypertension [odds ratio (OR) (95% confidence interval): 1.29 (1.09–1.53)].

Conclusions:

Men with prostate cancer are characterized by increased levels of PAI 1 associated with hypertension. More research is needed to establish a relationship between PAI 1 and hypertension in men with prostate cancer.
LINKAGE OF LEFT VENTRICLE HYPERTROPHIC GEOMETRIC MODELS WITH CLINICAL, METABOLIC-HORMONAL PARAMETERS AND MINERAL METABOLISM IN HYPERTENSIVE PATIENTS
Authors: Voroniuk Kseniia , Sydorchuk Larysa , Hinhuliak Oleksandr , Repchuk Yuliia , Semianiv Marianna , Sokolenko Alina , Biletsky Semen , Ivashchuk Sergiy , Petrynych Oksana , Kazantseva Tetiana , Dzhuriak Valentyna
Published: June 2023

Objective:

To analyze the association of hypertrophic geometric models of the left ventricle (LV) with changes in clinical, anthropometric and metabolic-hormonal parameters and of mineral metabolism data in patients with essential arterial hypertension (EAH).

Design and method:

The case-control study involved 100 patients with EAH stage II, 1-3 degrees of blood pressure value (BP), high and very high cardiovascular risk. Among the patients there were 21% (21) men, 79% (79) women, the mean age 59.86±6.22y.o. The control group consisted of 60 practically healthy individuals, relevant in age (49.13±6.28y.o.) and gender distribution (63% - women, 37% - men). The lipid panel parameters, such as: TC (Total cholesterol), TG (Triglycerides), LDL-C (Low-density lipoprotein cholesterol), HDL-C (High-density lipoprotein cholesterol) were investigated in blood plasma. All recruited subjects were tested for serum levels of fasting glucose, ionized calcium, parathyroid hormone (PTH), 25-hydroxyvitamin D (Vit D). LV hypertrophy (LVH) and LVH models were assessed by echocardiography.

Results:

Eccentric LVH (ELVH) in EAH patients is associated with higher blood pressure than Concentric LVH (CLVH): Systolic blood pressure and Diastolic blood pressure are higher by 3.29% and 3.95%(p<0,05-0,04). ELHV associates with higher body mass index and waist circumference in women - by 7.80% and 7.40% (p<0.05-0.048), respectively. In addition, the ELVH was characterized by a lower ionized Ca2+ level in the blood than CLVH by 2.54% (p = 0.021) with a compensatory higher concentration of PTH by 23.86% (p = 0.047), which indicates the calcium homeostasis intensity in EAH patients. The lipids and glucose serum concentration as well as Vit D level do not associate with any of hypertrophic models of myocardium.

Conclusions:

Lipid profile, blood glucose and Vit D concentration do not determine the development of any type of the LVH. ELVH is associated with lower Ca2+ level of and consequently with elevated PTH value.
CAROTID PLAQUE OFFSETS THE SEX DIFFERENCE IN CARDIOVASCULAR RISK IN YOUNG TO MIDDLE AGE HYPERTENSIVE PATIENTS: THE CAMPANIA SALUTE NETWORK
Authors: Mancusi Costantino , Fucile Ilaria , Lembo Maria , Manzi Maria Virginia , Luca Nicola De , Izzo Raffaele
Published: June 2023

Objective:

The aim of the present study is to assess whether presence of carotid artery plaque (CP) has a similar impact on the sex difference in risk for future cardiovascular events.

Design and method:

we studied 5209 women and men <65 years old with hypertension and free from prevalent cardiovascular disease enrolled in the prospective Campania Salute Network registry were followed over a mean of 5.9 years. Subjects were grouped according to the absence or the presence of CP identified by Doppler ultrasound (intima-media thickness>15mm). Main outcome was major cardiovascular events (MACE; combined acute coronary syndromes, stroke, hospitalization for heart failure and incident atrial fibrillation).

Results:

Among patients without CP (n = 3139), women were older, with higher systolic BP, cholesterol level and prevalent LVH but lower triglycerides and eGFR, compared to men (all p<0.001). Among patients with CP (n = 2070), women were older, taking higher number of antihypertensive drug, with higher cholesterol level and prevalent LVH but lower triglycerides and eGFR compared to men (all p<0.001). In Cox regression analysis adjusting for cardiovascular risk factors, LVH and antihypertensive treatment during follow up women without CP had lower hazard rate (HR = 0.41) for MACE (n = 107) than men (95% confidence interval [CI] 0.39–0.89, p = 0.01). In contrast, among patients with CP, women had similar HR for MACE (n = 132) as men (HR 0.79 [95% CI 0.54–1.14], p = 0.203).

Conclusions:

This study demonstrates that presence of carotid organ damage in hypertension contributes to offset the female sex-protection in cardiovascular risk. Thus, expanding previous finding, young to middle-age women and men with hypertension and carotid organ damage have comparable cardiovascular risk.