bluuebunny/crossref_metadata_2025 huggingface dataset:
INFLAMMATORY MARKERS AND REFRACTORY HYPERTENSION
Authors: Alves Hugo Farah Affonso , Santo Bruno Dussoni Moreira Dos , Vallap João Gabriel Rega Do Nascimento , Silva João Gabriel Bezerra Da , Gonçalves Larissa De Oliveira , Kimura Lucca Hiroshi De Sá , Nolasco Vitor De Melo , Carl Fernanda Oliveira De Carvalho , Cortez Arthur Fernandes , Chedier Bernardo , Muxfeldt Elizabeth
Published: April 2021

Objective:

Introduction: Refractory hypertension (RfHT) is defined as an uncontrolled blood pressure (BP) despite the use of 5 or more antihypertensives, including spironolactone and it is considered an extreme phenotype of resistant hypertension (RHT). High BP levels lead to RAAS stimulation, sympathetic hyperactivity and endothelial dysfunction with consequent production of pro-inflammatory cytokines.

Objective:

To evaluate the relationship between inflammatory markers and refractory hypertension in a large cohort of patients with RHT.

Design and method:

A cross-sectional study that evaluated 423 resistant hypertensives (30.5% male, mean age 63.9 ± 10.8 years), of which 62 (14.6%) diagnosed as RfHT. All of them were submitted to the dosage of inflammatory markers: TNF-alpha, MCP-1, E-selectin and PAI-1. Socio-demographic and anthropometric characteristics and cardiovascular risk factors (CV) were recorded. Variance analysis compared serum levels of the 4 inflammatory markers and bivariate analysis compared patients with RHT versus RfHT.

Results:

Patients with RfHT are younger, with higher prevalence of smoking, higher levels of albuminuria and higher prevalence of chronic cerebrovascular and renal disease stages 4 and 5. PAI-1 values (126 [108–162] vs 118 [94–153] were higher in those with RfHT, although they did not reach statistical significance. The other biomarkers evaluated showed no association with the diagnosis of RfHT.

Conclusions:

Among inflammatory markers, PAI-1 was the one that correlated most strongly with refractory hypertension. Our study is the first one to demonstrate PAI-1 association with treatment refractoriness
BIOMARKERS OF GLOMERULAR FILTRATION, BUT NOT TUBULAR DYSFUNCTION, ARE ASSOCIATED WITH UNCONTROLLED HYPERTENSION IN THE GENERAL POPULATION. THE TROMSØ STUDY
Authors: Brobak Karl Marius , Melsom Toralf , Norvik Jon Viljar , Andreassen Runa Marie , Solbu Marit Dahl
Published: April 2021

Objective:

Uncontrolled hypertension (UHT) and chronic kidney disease (CKD) are common and frequently overlapping entities with considerable health consequences. Little is known about the relationship between low-grade kidney dysfunction and UHT. The importance of tubular in contrast to glomerular dysfunction in cardiovascular disease and hypertension has been recognised, but tubular biomarkers have not been examined in population-based studies of UHT. We assessed the associations between biomarkers of low-grade kidney dysfunction and UHT in treated hypertensive individuals from a general population.

Design and method:

In a cross-sectional design, we included all participants of the Tromsø Study 2007–08, second visit, who reported the use of two ore more blood pressure (BP) lowering drugs. The cohort was dichotomised into controlled hypertension or UHT; UHT was defined as systolic BP >=140 mmHg and/or diastolic BP >=90 mmHg. We used logistic regression to examine the associations between cardiovascular risk factors and UHT. In multivariable models we added estimated glomerular filtration rate (eGFR), urate, two urinary biomarkers of glomerular dysfunction (albumin-creatinine ratio [U-ACR] and orosomucoid-creatinine ratio [U-OCR]) and one biomarker of tubular dysfunction (N-acetyl-beta -D-glucosaminidase -creatinine ratio [U-NAG-Cr]).

Results:

Of the 7308 participants, 1189 persons (mean age 68.0 [8.9] years), fulfilled the inclusion criterion. Among these, 65% had UHT. Subjects with UHT were older and more frequently non-smokers than subjects with controlled hypertension. They had lower eGFR and higher U-ACR and U-OCR, whereas the level of U-NAG-Cr was similar between the groups. In multivariable analyses, higher U-OCR was associated with UHT (OR 1.17; 95% CI 1.02, 1.34 per log unit), whereas U-NAG-Cr was not. U-ACR was significantly associated UHT in models that did not include U-OCR (OR 1.14; 95% CI 1.03, 1.25 per log unit ACR).

Conclusions:

Although tubulointerstitial function is important in BP regulation, and tubulointerstitial damage appears early in CKD, we found no independent association between U-NAG-Cr and UHT. However, biomarkers of glomerular dysfunction, including U-ACR and U-OCR, were independently associated with UHT in treated subjects from the general population. The cross-sectional design limits conclusions about cause and effect, and prospective studies should be undertaken.
VALIDATION OF THE VITA-D1 NONINVASIVE CONTINUOUS BLOOD PRESSURE MONITOR WITH PHOTOPLETHYSMOGRAPHY-ONLY TECHNOLOGY FOR SELF-MEASUREMENT AND CLINIC USE
Authors: Ang Jianning Zh , Tong Xinzhu , Qiu Yumin , Tao Jun
Published: April 2021

Objective:

Hypertension is still a prevalent health burden without adequate population awareness. As a diagnostic footstone and prognostic indicator, it is of great importance to precisely measure blood pressure (BP). The referenced methods to date for BP measurements are based on inflated cuff. However, stress may contribute to unanticipated BP increasements. Hence, conventional methods limit the efficiency of BP management. A promising BP measuring device with no cuff inflation is clinic practical. Yet, no robust devices with beat-to-beat photoplethysmography (PPG)-only technique have been validated.

Design and method:

Participants were recruited among out- and inpatients at the Department of Hypertension and Vascular Disease, from May 2019 to November 2019. Exclusive criteria mainly included age below 25 years old, pregnancy, arrythmia and poor quality Korotkoff sounds. Before initiation, an entrance BP measurement based on calibrated mercury sphygmomanometer was needed for each participant for test device calibration. The validation procedure was prospectively conducted following the European Society of Hypertension International Protocol (ESH-IP) revision 2010 in adults.

Results:

A total of 48 participants were screened and final 33 were enrolled (10 females, mean age 52.1 ± 11.3 years). 99 pairs of comparisons were obtained from 33 enrollees. The number of measurements within a difference range of up to 5 mmHg were 80 for systolic blood pressure (SBP) and 94 for diastolic blood pressure (DBP). All of the 99 SBP and DBP recordings were in a difference range of up to 15 mmHg. Mean observer-test device differences were −1.1 ± 4.2 mmHg for SBP and −1.3 ± 3.0 mmHg for DBP. Meanwhile, 28 and 32 enrollees had at least 2 out of 3 device-observers differences no more than 5 mmHg for SBP and DBP, respectively.

Conclusions:

The VITA-D1 passed the validation criteria according to the ESH-IP revision 2010 and may be recommended for clinical or self BP monitoring. Being innovative for its cuffless and user-friendly design, VITA-D1 is a promising device for reliable, convenient, and comfortable BP measurements.
COMPARISON OF BLOOD PRESSURE PARAMETERS WITH LEFT VENTRICULAR MASS IN YOUNGER MEN WITH GRADE 1 HYPERTENSION
Authors: Williams Bryan , Lacy Peter , Jedrzejewski Dawid , Mcfarlane Ewan
Published: April 2021

Objective:

Non-invasive measurement of central aortic systolic pressure (CASP) has been claimed to confer advantage over conventional clinic blood pressure (BP) in predicting cardiovascular risk, particularly in younger patients where amplification is variable. This study aimed to compare relationships between clinic BP, CASP and ambulatory BP (ABPM) with left ventricular (LV) mass in younger men with grade 1 hypertension and low cardiovascular risk.

Design and method:

155 men aged < 55 years with grade 1 hypertension confirmed by ABPM, underwent a cardiac magnetic resonance imaging (cMRI) scan. BP was assessed by clinic and 24-hour ABPM. CASP was evaluated using a high fidelity tonometer (BProâ) to capture radial artery waveforms calibrated to clinic systolic and diastolic or mean and diastolic (fixed form factor) and processed using a n-point moving average. LV mass indexed to body surface area (LVMI), was assessed by manual segmentation of the LV image stack acquired using a 1.5T cMRI scanner. Linear regression and receiver operator curve (ROC) analysis was used to evaluate the relationship between LVMI and BP measurement mode and whether relationships between CASP and LVMI were influenced by calibration mode.

Results:

In 155 men recruited from the general community (mean age 45 years) with grade 1 hypertension and low cardiovascular risk (10-year QRISKâ 5.4%), increasing BP was positively associated with LVMI. Relationships with LVMI was similar between BP measurement modes (clinic systolic BP r = 0.27, p < 0.001, 24-hour ABPM systolic BP r = 0.28 p < 0.001). The relationship of LVMI with CASP differed little for pressure waves calibrated using systolic and diastolic BP (r = 0.25, p < 0.001) or mean and diastolic BP at a form factor of 0.33 (r = 0.30, p < 0.001). ROC analysis for high LV mass detection (highest 20%), showed similar predictive value between BP modes.

Conclusions:

Carefully measured clinic BP confirmed by ABPM, is as good at predicting LVMI as 24-hour ABPM or CASP, irrespective of the calibration mode in younger men with grade 1 hypertension where amplification is variable. Furthermore recalibration of radial waveforms to mean and diastolic BP at a commonly used form factor (0.33) does not significantly improve this relationship.
HYPERTENSION AND INCIDENCE OF MORTALITY IN GENERAL POPULATION OF A MEDITERRANEAN REGION
Authors: Ruiz Adrian , Fernandez Antonio , Holgado Jose Luis , Lopez Cristina , Sauri Inmaculada , Uso Ruth , Trillo Jose Luis , Vela Sara , Bea Carlos , Martinez Fernando , Redon Josep
Published: April 2021

Objective:

Hypertension is the most relevant risk factor of mortality over the world. Assessment of the impact has been analysed in a great variety of studies, but the Electronic Health Recordings, including hole populations, provide a more precise information. The objective was to assess the mortality associated to adult hypertensive patients from a Mediterranean population. The associated impact of diabetes (DM) and chronic kidney disease (CKD) has been presented.

Design and method:

The sample was recruited from beneficiaries of the Valencian Health Agency's health care system, with a population of 3799884 people older than 25 years in 2012. The observational study was undertaken as part of routine clinical practice from 2012 until 2016. Hypertension was defined by a recorded physician diagnosis or antihypertensive medication use. Diabetes was defined as a non-fasting glucose higher or equal to 200 mg/dl, a recorded physician diagnosis, medication use or an HbA1c higher or equal to 6.5%. Estimated glomerular filtration rate (eGFR) was calculated from calibrated creatinine, age and sex using the CKD-EPI and CKD was defined when eGFR <60 ml/min/1.73m2. Participants were followed for all-cause mortality until 31st December 2016. Vital status was determined by matching records and death certificates from the Spanish National Death Index.

Results:

Among the total population, 1247467 hypertensives were included. Among them, 387590 (%) were diabetics and 272800 (%) CKD. A total de 204629 casualties were recorded (crude rate of 2.2% in the GP and 12% in HTN, 16% in DM and 23% in CKD. Mortality incidence per 10000 patients/year of general population and the hypertensives, in each decade of age and by sex, with and without diabetes and CKD are in the Table.

Conclusions:

The increment of mortality risk due to the presence of HTN increases in all age groups. Although the higher increment in risk occurs in population beyond 60 yr, the number of subjects in risk largely increases over 60 and extent until the ninety decade. Diabetes, and more CKD, further increases the risk in hypertensive subjects.
PHARMACISTS INTERVENTION FOR IMPROVING BLOOD PRESSURE CONTROL IN HYPERTENSIVE PATIENTS BY PHARMACEUTICAL INTERVIEWS: IS FRANCE READY?
Authors: Lopez-Sublet Marilucy , Pourrat Xavier , Bardet Jean Didier , Ruspini Eric , Sergent Sophie , Zaragoza Laura , Blacher Jacques , Halimi Jean Michel , Sallerin Brigitte , Allenet Benoit
Published: April 2021

Objective:

The French Society of Hypertension, in collaboration with the French Society of Clinical Pharmacy, published in 2016 a recommendation concerning the management of hypertension in pharmacies. Three years later, the objective of the study was to learn about pharmacist's daily practice regarding pharmaceutical interviews (PI) and their knowledge and vision of hypertension in PI.

Design and method:

187 pharmacists practising in French pharmacies answered our self-questionnaire (10 questions), generated by Google Forms with an automatic recording of responses.

Results:

In this population, 62.5% (n = 117) of pharmacists perform PI (for anticoagulants and asthma) and more than half (60.7%)(n = 71) do not produce more than one per month. The shared medication assessment is carried out by 60.4% (n = 113) of them, 48.7% (n = 55) of whom no more than one per month.

The existence of a PI recommendation for hypertension is unknown to most pharmacists (78.8%, n = 145). Although these PIs do not have an economic support in France, hypertension is considered very important for 80.7 % of the 151 respondents and 42.7 % (n = 79) of them estimate that 10 to 20 patients per month and per pharmacy could benefit from a PI for antihypertensive drugs. The majority of pharmacists surveyed (88.2%, or n = 165) are familiar with home blood pressure measurement (HBPM) and 75.5 % (n = 74) finds it interesting in their practice. According to them, the HBPM promotion in pharmacies could mainly help BP control (72.2%, n = 136) and patient adherence (72.2%, n = 135).

Conclusions:

Recent systematic review and meta-analysis have demonstrated that pharmacist interventions can significantly reduce the risk factors of cardiovascular such as hypertension. This pilot study confirms the need to disseminate more widely the recommendations for the practice of PI in hypertension, which remains unknown to a majority of pharmacists in France. HBPM known by the majority of pharmacists can be the key to improve BP control and adherence to treatment. Involving pharmacist as healthcare providers of multidisciplinary management of hypertension is no longer to be demonstrated but the effective economic model on which there involvement is based must be a priority for the BP control of patients.
ACCURACY OF SHORTER PROTOCOLS FOR AUTOMATED OFFICE BLOOD PRESSURE MEASUREMENTS
Authors: Burkard Thilo , Hug Rebecca , Meienberg Andrea , Socrates Thenral , Mayr Michael , Vischer Annina
Published: April 2021

Objective:

Blood pressure measurement (BPM) is one of the most often performed procedures in clinical practice but especially office BPM is prone to errors. Automated office BPM (AOBPM) is highly standardised and compares well to ambulatory BPM but is time and space consuming since the patient is placed alone during the procedure. With this analysis we compared the accuracy of different calculation methods to evaluate if an abbreviation of the AOBP protocol is possible.

Design and method:

In our retrospective single centre study, we used all AOBPM (AOBPM protocol of the SPRINT study), collected over 14 months. Three sequential BPM (after 5 minutes of rest, spaced 2 minutes) were automatically recorded with the patient alone in a quiet room resulting in three systolic (S1S2S3) and diastolic (D1D2D3) values. We compared the result of the first BPM (S1/D1) and the mean of the first two BPM (S1S2/D1D2) with the mean of all three BPM (S1S2S3/D1D2D3) which was regarded as goldstandard for AOBPM.

Results:

We analysed 413 AOBP sets from 210 patients with a median age of 52 years (IQR 38–66). Median mmHg (IQR) for S1, S1S2 and S1S2S3 were 128.0 (117.0–142.0), 127.5 (117.0–140.0), 127.7 (116.8–139.2) and for D1, D1D2 and D1D2D3 80.0 (75.0–86.5), 80.0 (75.5–86.5), 80.3 (75.7–86.5), respectively. A Wilcoxon signed rank test determined that there was a statistically significant median increase of systolic blood pressure (BP) applying S1 compared to S1S2S3 (0.3mmHg, z = 2.315, p = 0.021) but not for S1S2 vs S1S2S3. For diastolic BP there was a no statistically significant difference for D1 vs. D1D2D3 but for D1D2 vs. D1D2D3 (0.2mmHg, z = 2.05, p = 0.040). Regarding agreement absolute difference was within 2 mmHg in 85.5% of the AOBPM comparing S1S2 vs. S1S1S3 and 93.2% for D1D2 vs D1D2D3, respectively (for all comparisons see table). Bland-Altman plots for all comparisons are shown in the figure.

Conclusions:

Based on our results differences between S1S2 vs S1S2S3 and D1D2 vs D1D2D3 are minimal and within acceptable limits of agreement. Therefore the automated procedure may be shorted to 2 measurements.
AMBULATORY BLOOD PRESSURE MONITORING BY A NOVEL CUFFLESS DEVICE: POTENTIAL ROLE IN OVERWEIGHT PATIENTS
Authors: Margonato Davide , Scalise Filippo , Gallone Giuseppe , Fracchioni Ilenia , Bruni Fabio , Ballabeni Cinzia , Mancia Giuseppe
Published: April 2021

Objective:

Inappropriate cuff size can lead to erroneous blood pressure (BP) measurements and, therefore, to misclassification and potential unnecessary treatment; this problem has a particular relevance in overweight patients. We assessed whether a new cuffless BP device was equally effective for BP measurements over the 24 hours compared to a standard oscillatory BP device in overweight patients (BMI >25).

Design and method:

BP was measured simultaneously by the cuffless (CL-BP, Rooti RX TM) and by a standard device (C-BP, SpacelabsTM,90207) over the 24 hours in 100 consecutive patients. Calculations included 24 hour mean systolic (S) and diastolic (D) BP and heart rate (HR). Correlations between the CL-BP and C-BP measurements were sought using Pearson's correlation coefficients and Bland-Altman plots.

Results:

Using the C-BP device, the 24 hour SBP value was 125.4 ± 10.9 mmHg (mean  ± SD); the corresponding DBP value being 75 ± 8.3 mmHg. Mean SBP/DBP with the CL-BP device were 131.1 ± 15.9/80.2 ± 9.7 mmHg. The correlation coefficients between the two sets of values was significant (SBP: r = 0.58, p = 0.006 - DBP: r = 0.65, p = 0.0002). Mean absolute SBP and DBP disagreements between CL-BP and C-BP were 5.7 ± 13.1 mmHg and 5.2 ± 7.7 mm Hg, respectively. In the 54 patients classified as overweight, C-BP mean SBP value was 126.4 ± 10.6 and mean DBP value was 76,2 ± 8,5; in the CL-BP device arm SBP was 130 ± 14,1 and DBP was 80,9 ± 9,9. Better SBP and DBP correlations for SBP and DBP was found in patients with BMI > 25 (SBP: r = 0.65, p = 0.13 - DBP: r = 0.70, p = 0.009) compared to those with BMI <25 (SBP: r = 0.52, p = 0.02 - DBP: r = 0.51, p = 0.06).

Conclusions:

Our results show that a CL-BP device was accurate in estimating 24 hours BP in overweight patients, compared to a classical oscillometric device. Therefore, if confirmed on a larger population scale, CL-BP device could be used to provide accurate standardized BP measurements, independently by the arm size of the patients, and avoid a significant number of BP quantification mistakes.
DETECTING PATTERNS OF HYPERTENSION AMONG LIVE RELATED KIDNEY DONORS USING OFFICE AND AMBULATORY BP MONITORING: DATA FROM A TERTIARY CARE CENTER IN INDIA
Authors: Aditya Kapoor , Saklecha Abhishek , Bhadauria Dharmendra , Sahu Ankit , Khanna Roopali , Kumar Sudeep , Garg Naveen , Tewari Satyendra , Goel Pravin
Published: April 2021

Objective:

Live related renal donation is associated with significant benefits compared to cadaveric donations. Increase in BP, mild proteinuria, gestational HT, rare progression to ESRD and higher mortality among donors are important concerns. The aim of the study was to assess BP prior to surgery and 3–6 months later in healthy kidney donors using office BP measurement (OBPM) and ambulatory BP monitoring (ABPM).

Design and method:

Voluntary kidney donors (n = 50, age > 18 years, age 48.72+ 12.49, 92% F) at a tertiary care institute in India were studied 1 week before nephrectomy & 3–6 months post surgery. BP definitions for OBP and ABPM were based on ESC 2018 guidelines.

Results:

Baseline OBP was 121.2+8.53/77.2+3.12 mm Hg; mean 24 hour ABPM was 115.74+16.84/65.22+13.1 mmHg. None of the subjects had HT on OBPM while 3/50 (6%) had high ABPM values.

Three months post nephrectomy, mean OBP was 125.6+6.26/78.1+4.11 mm Hg; mean ABPM values were 118.21+14.61/67.11+ 12.4 mmHg. HT was documented in 8/50 (16%) on ABPM and two had HT by OBPM (grade 1 HT). Of the 3 subjects with high baseline ABPM, all had high ABPM at 3 months. Masked HT was observed in 6/50 (12%).

At 6 months, 1more subject demonstrated stage 1 HT on OBPM (n = 3) and 10 (20%) had high ABPM values. Masked HT was noted in 7/50 (14%) and white coat HT in 1/50 (2%)

Serum creatinine increased at 3 months (0.82 ± 0.13 vs 1.34 ± 0.18 mg/dl, p < 0.01), while at 6 months levels were similar to baseline (1.11 ± 0.16 mg/dl). A parallel trend in eGFR was observed (92.86 ± 19.1 ml/min, 79.9 + 15.4 ml/min, 87.8 + 14.5 ml/min, p = ns). Significant (>300 mg/day) proteinuria was noted in 5/50 donors at 3 months; all of them had hypertension on ABPM recordings. No new-onset proteinuria was observed at 6 months.

Conclusions:

High ABPM recordings are not uncommon in healthy kidney donors following surgery. At 3–6 months, 15–20% had high ABPM values; masked HT was observed in 14% and new onset proteinuria in 10%. Close follow up is mandatory in healthy kidney donors following surgery.
SEASONAL VARIABILITY OF PULSE WAVE VELOCITY IS ASSOCIATED WITH CARDIOVASCULAR OUTCOMES IN HYPERTENSIVE PATIENTS
Authors: Yana Koshelyaevskaya , Smirnova Marina , Gorbunov Vladimir , Deev Alexander , Volkov Dmitry , Furman Nikolay , Dolotovskaya Polina
Published: April 2021

Objective:

The seasonal changes of blood pressure in hypertensive patients have been investigated and attracted an increasing scientific interest during the past years, but seasonal changes of pulse wave velocity (PW) in hypertensive patients have not been studied. And it is unclear whether PW variations are related to cardiovascular risk.

The aim of the study was the examination of prognostic value of individual variability of PW in 24-hour, daytime and nighttime periods of hypertensive patients from two regions of the Russia (Ivanovo and Saratov).

Design and method:

Patients aged 40–79 years who visited ambulatory clinics for various reasons we. All participants provided written informed consent. The ambulatory blood pressure monitoring (ABPM) was performed with the BPLab device, twice in all patients: in winter (December-February 2012–2014) and in summer (June-August 2012–2014). The interval between ABPMs was 6 months ± 7 days. The selection criteria for ABPM records were: duration > = 23.5 hours, absence of data gaps >1 hour, and > = 56 readings per 24 hours. We analyzed the individual PW in 24-hour, daytime and nighttime differences in each patient. The participants were followed up until October 31-st 2019 (mean follow-up 6.4 ± 0.4 years). The complex endpoint included death (from any reasons), stroke, myocardial infarction, transient ischemic attack, angina pectoris, and development of heart failure. The preliminary analyses included ANOVA and descriptive statistics.

Results:

In total, 770 patients completed both visits. The outcome information was available in 528 patients: 335 from Ivanovo and 193 from Saratov (mean age 55 ± 10 years, 220 men). The endpoints were registered in 50 patients. We found the mean winter-summer PW difference in the group of patients with cardiovascular outcomes. In contrast, this difference was positive in the other group (see Table1).

Conclusions:

The inverse seasonal PW variability, which could reflect the abnormal biological response to outside temperature, may be associated with a higher risk of cardiovascular events, compared to patients with standard PW variability (PW is higher in winter, than in summer). Our data demonstrate the preliminary argument in favor of additional ambulatory BP and PW control. The problem of seasonal PW variability is needed further studying.
IN-HOSPITAL BLOOD PRESSURE VARIABILITY AS A PREDICTOR OF CARDIOVASCULAR OUTCOMES IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION: ONE-YEAR FOLLOW-UP STUDY
Authors: Konstantinou K. , Tsioufis K. , Koumeli A. , Dri E. , Kalos T. , Kouremeti M. , Vogiatzakis N. , Magkas N. , Mantzouranis M. , Kolokathis K. , Leontsinis I. , Tolis E. , Tousoulis D.
Published: April 2021

Objective:

The impact of blood pressure variability (BPV) on cardiac function has been examined through the prism of congestive heart failure and hypertension, but not in the setting of an acute coronary syndrome (ACS). The aim of this study is to determine the association between in-hospital short-term BPV and long-term cardiovascular morbidityin patients with myocardial infarction (MI).

Design and method:

A total population of 260 MI patients [82.2% male; mean age: 63.8 years;71.3% hypertensives, 29.5% with diabetes mellitus (DM), 48.1% with STEMI]underwent 24-h ambulatory BP measurement during hospitalization.At one year a follow-up visit was scheduled in order to assess major cardiovascular outcomes. These included hospitalization for heart failure (HF), stroke, ACS, life threatening arrythmias. BPV was assessed using the average real variability (ARV) of systolic and diastolic BP.

Results:

Univariate analysis demonstrated that both ARV SBP and ARV DBP were predictors of overall hospitalizations for cardiovascular events in the entire population[(HR = 1.045; 95% CI: 0.542–1.547; P = 0.001) and (HR = 0.991; 95% CI: 0.536–1.446; P < 0.001)] but also in the STEMI [(HR = 1.138; 95% CI: 0.487–1.789; P = 0.001) and (HR = 0.947; 95% CI: 0.318–1.576; P = 0.003) respectively] and NSTEMI [(HR = 1.035; 95% CI: 0.278–1.793; P = 0.008) and (HR = 1.061; 95% CI: 0.394–1.728; P = 0.002) respectively] groups separately. Regarding hospitalization for HF, both ARV SBP and ARV DBP emerged as predictors in the entire population [(HR = 1.027; 95% CI: 0.093–1.960; P = 0.031) and (HR = 1.798; 95% CI: 0.972–2.624; P < 0.001) respectively] and in STEMI patients [(HR = 1.664; 95% CI: 0.517–2.811; P = 0.005) and (HR = 2.408; 95% CI: 1.360–3.455; P < 0.001) respectively], but not in the NSTEMI group.Independency of all the above predictors was confirmed in multivariate models including gender, age, hypertension, DM, smoking, low density lipoprotein (LDL-C) and GFR.

Conclusions:

In the setting of MI, in-hospital ARV was associated with increasedcardiovascular morbidityduring one-year follow-up. These findings could suggest a closer monitoring of patients suffering a MI and exhibiting increased BPV during hospitalization.
NORMAL-TENSION GLAUCOMATOUS OPTIC NEUROPATHY IS RELATED TO BLOOD PRESSURE VARIABILITY IN THE MARACAIBO AGING STUDY
Authors: Melgarejo Jesus , Maestre Gladys E. , Mena Luis J. , Lee Joseph H. , Petitto Michele , Chavez Carlos A. , Calmon Gustavo , Silva Egle , Thijs Lutgurde , Al-Aswad Lama A. , Terwilliger Joseph , Moraes C. Gustavo De , Wei Fang -Fei , Vanassche Thomas , Verhamme Peter , Staessen Jan A. , Zhang Zhen-Yu
Published: April 2021

Objective:

Optic nerve hypoperfusion might play a role in the pathogenesis of normal-tension glaucomatous optic neuropathy. Although the ocular perfusion pressure is partly determined by blood pressure levels, no previous study have addressed the risk of glaucomatous optic neuropathy in relation to blood pressure (BP) variability, independent of the BP level. We aimed this study o assess reading-to-reading BP variability of mean arterial pressure (MAP) in 24 h ambulatory BP recordings as risk factor for normal-tension glaucomatous optic neuropathy.

Design and method:

The Maracaibo Aging Study is a population-based epidemiological study conducted to investigate age-related diseases and which currently includes more than 3000 participants =>40 years of age assessed between 1998 and 2015. For the present study, we selected 93 participants who underwent cross-sectional optical coherence tomography, visual field assessment and 24 h ambulatory BP monitoring (2011–2016). Glaucoma cases were defined as normal-tension glaucomatous optic neuropathy with and without visual field defects. BP variability was reading-to reading variability of 24 h MAP, a determinant of ocular perfusion pressure, captured by a variable independent of the BP level (VIMmap). ORs were expressed per 2 mm Hg (1 SD) increment in VIMmap. Odds ratios (ORs) were adjusted for BP level and confounders summarized or not in a propensity score.

Results:

Among the 93 participants (87.1% women; mean age, 61.9 years), 26 had open-angle glaucomatous optic neuropathy at both eyes; 14 with and 19 without visual field defects. The ORs ratios for glaucomatous optic neuropathy, expressed per 1 SD increment in VIMmap (2 mm Hg), were 2.17 (95% confidence interval, 1.33–3.53) unadjusted; 2.20 (1.35–3.61) adjusted for 24 h MAP level only; 1.93 (1.10–3.41) with additional adjustment for age, educational attainment, high-density lipoprotein cholesterol and office hypertension, and 1.95 (1.10–3.45) in models also including intraocular pressure.

Conclusions:

We confirmed our a priori hypothesis that BP variability, most likely operating via hypoperfusion of the optic nerve, is a risk factor for normal-tension glaucomatous optic neuropathy. 24-H ambulatory BP monitoring might therefore help in stratifying for risk of normal-tension glaucomatous optic neuropathy.
ASSOCIATION OF DIFFERENT TYPES OF BLOOD PRESSURE VARIABILITY WITH ARTERIAL STIFFNESS MARKERS IN CHRONIC KIDNEY DISEASE PATIENTS
Authors: Manousopoulos Konstantinos , Tsoutsoura Nefeli , Koromboki Eleni , Mitsikosta Efthalia , Spiliopoulou Sotiria , Malakou Anna , Zakopoulos Nikolaos , Manios Efstathios
Published: April 2021

Objective:

It is well known that blood pressure (BP) variability is associated with development of target-organ damage in hypertensive patients. However, the significance of this association in chronic kidney disease patients (CKD) remains unclear. Aim of the study was to examine the association between BPV indices derived from ambulatory and home BP monitoring and arterial stiffness markers such as pulse wave velocity (PWV) and augmentation index (AI) in CKD patients.

Design and method:

A total of 105 CKD patients, referred for evaluation at the Hypertension Unit of our department, underwent 24-h ambulatory BP monitoring, home BP monitoring and measurements of PWV and AI. Short-term BPV was expressed by standard deviation (SD), time rate (TR) of BP variation, average real variability (ARV) and coefficient of variation (CV) of systolic and diastolic BP for both 24-h, daytime and nighttime intervals. Mid-term BPV was expressed by SD and CV of systolic and diastolic BP for morning and evening BP measurements. Statistical analysis was performed by means of bivariate correlations, simple and multiple linear regression analysis.

Results:

The mid-term BPV indices of systolic home SD (r = 0.286, p = 0.003) and CV (r = 0.216, p = 0.027) were significantly correlated with AI. Regarding short-term BPV, nighttime systolic SD (r = 0.238, p = 0.016), nighttime systolic TR of BP variation (r = 0.194, p = 0.050) and nighttime systolic ARV (r = 0.264, p = 0.007) were significantly correlated with PWV.

Conclusions:

Short-term nighttime systolic BPV indices such as SD, TR of BP variation and ARV were significantly associated with PWV in CKD patients. The mid-term BPV indices of systolic SD and CV were significantly associated with AI.
INVERSE SEASONAL VARIATIONS OF AMBULATORY BLOOD PRESSURE ARE ASSOCIATED WITH CARDIOVASCULAR OUTCOMES IN HYPERTENSIVE PATIENTS
Authors: Gorbunov Vladimir , Smirnova Marina , Koshelyaevskaya Yana , Furman Nikolai , Dolotovskaya Polina , Slepchenko Iuliia
Published: April 2021

Objective:

The seasonal changes of blood pressure (BP) in hypertensive patients have been widely investigated and attracted an increasing scientific interest during the past two decades. However, it is unclear whether these BP variations are related to cardiovascular risk.

Design and method:

We included patients aged 40–79 years who visited ambulatory clinics for various reasons. The main inclusion criteria were office BP 130/85-139/89 mm Hg, hypertension stage 1, or long-term antihypertensive therapy. The ambulatory blood pressure monitoring (ABPM) was performed with the BPLab device (Nizhny Novgorod, Russia), twice in all patients: in winter (December-February 2012–2014) and in summer (June-August 2012–2014). The interval between ABPMs was 6 months ± 7 days. The selection criteria for ABPM records were: duration >23.5 hours, absence of data gaps >1 hour, and >55 readings per 24 hours. We analyzed the individual ambulatory and office seasonal BP differences in each patient. The participants were followed up until October 31st 2019 (mean follow-up 76.8 ± 5.1 months). The composite primary endpoint included death, myocardial infarction, stroke, transient ischemic attack, angina pectoris, and development of heart failure. The preliminary analyses included ANOVA, sensitivity analysis, and descriptive statistics.

Results:

770 patients completed both visits. The outcome information was available in 528 patients: 335 from Ivanovo and 193 from Saratov (mean age 55 ± 10 years, 220 men). The endpoints were registered in 50 patients. We found the inverse mean winter-summer BP difference in the group of patients with cardiovascular outcomes (see table). In contrast, this difference was positive in the other group (see table). The sensitivity analysis (the winter-summer BP difference classified into 4 groups: inverse (<0), small (0–5 mm Hg), medium (5–10 mm Hg), and large (>10 mm Hg) variation) confirmed the hypothesis for 24-hour diastolic BP. We found no significant associations for office BP.

Conclusions:

The inverse seasonal BP variability may be associated with a higher risk of cardiovascular events; compared to patients with standard BP variability (BP is higher in winter, than in summer). Our data provide the tentative argument in favor of additional ambulatory BP control. The problem of seasonal BP variability warrants further investigation.
THE RELATIONSHIP OF THE BLOOD PRESSURE VARIABILITY AND HEART RATE VARIABILITY: A CANONICAL CORRELATION STUDY
Authors: Li Yuan , Peng Liming , Deng Bin , Pei Zhifang , Xia Ke
Published: April 2021

Objective:

To determine the association of the blood pressure variability (BPV) and heart rate variability (HRV) derived from ambulatory blood pressure monitoring (ABPM).

Design and method:

2886 patients who perfected the 24 hours ABPM from September 2018 to January 2020 were enrolled and we performed Pearson correlation analysis and Canonical correlation analysis (CCA) to identify the relationship of the dynamic blood pressure (BP) and heart rate (HR) in singer variable aspect and whole set of variate respect, respectively.

Results:

Pearson correlation analysis described the strong connection between the mean value of the systolic and diastolic BP and average value of HR during nighttime and morning surge(r = 0.438,0.475,0.504,0.547,P-value less than 0.01).Results of CCA showed a canonical correlation of 0.934 in the first canonical pair (P-value less than 0.01). Moreover, standard canonical coefficient marked the mean value of BP and HR with the largest efficiency compared to maximum, minimum and standard deviation. The value of BP and HR during nighttime and morning surge with loading approaching 0.5 are key factor of their own variable set. The nighttime average systolic BP attached importance to HRV set and nighttime HR mean value to BPV set(crossing loading:0.533,0.504).Redundancy analysis represent the total interpretative quantity of 12 valued correlation of BPV and HRV set are 58.3% and 90.4%.Whereas,14.6% and 18.8% are the total redundancy accounted by the opposite variable set. In addition, the association more than the reference substance comprising of age and gender.

Conclusions:

With regard to the result of 24 hours ABPM, we cannot neglect the circadian rhythms and tight relationships of BPV and HRV. To better manage the BP and autonomic nervous function, respectively, mitigating the mean value of the BP and HR during nighttime and morning surge should be put on the agenda.
IMPACT OF BREAST CANCER ON OUTCOMES AMONG PHASE 2 CARDIAC REHABILITATION PARTICIPANTS
Authors: Lang Katherine , Van Iterson Erik , Khan Asad , Laffin Luke Joseph
Published: April 2021

Objective:

Treatment for breast cancer (BC) involves therapies with unclear long-term impacts on exercise physiology and prognosis. Additionally there is increasing support for the use of cardiac rehabilitation (CR) programs in patients with cancer. We sought to determine whether demonstrating a history of BC limits the physiological and clinical benefits of exercise training (ET) during cardiac rehabilitation (CR).

Design and method:

Between 2008 and 2017, 34 women with a history of BC participated in Phase 2 CR at a tertiary medical center. Patients were age-matched 1:1 with female CR participants without a BC history. Exercise capacity (EC) upon CR entry, rate of CR completion, and 5 year mortality differences were assessed.

Results:

Of CR participants with a BC history, 65% received chemotherapy and/or radiation, 32% also received adjuvant therapy (Table). Women with a BC history demonstrated increased EC compared to participants without BC (5.9 ± 1.8 vs. 4.9 ± 1.6 METs, respectively, p = 0.03). Only 18% of patients with BC completed CR compared to 38% of non-BC participants (p = 0.11). Twelve percent of BC patients died within 5 years of CR completion compared with 9% of matched counterparts (p = 0.71)

Conclusions:

CR participants with a history of BC demonstrate greater EC but similar 5 year mortality compared to age-matched patients without a history of BC. Although women with a history of BC benefit from CR, EC outcomes may not be an appropriate surrogate to reflect the impact of this therapy on mortality among this group of patients.
FREQUENCY AND IMPACT OF ADVERSE DRUG REACTIONS INDUCED BY CARDIOVASCULAR DRUGS AND AFFECTING CARDIOVASCULAR SYSTEM: A NATIONAL 10 YEARs OF SURVEILLANCE
Authors: Polonia Jorge , Marques Joana , Lobo Mariana , Vaz Ines , Oliveira Bruno
Published: April 2021

Objective:

Cardiovascular (CV) disorders are a leading cause of death. Adverse drug reactions (ADRs) are an important cause of morbidity and mortality. Drugs for treatment of CV disorders and antithrombotic drugs (AT) are commonly prescribed and a cause of serious ADR (SAR). CV system is also a target for non-CV prescribed drugs. In a national survey we identified the most reported ADR associated with CV and AT drugs and the non-CV drugs more prone to affect CV system.

Design and method:

From January 2006 to December 2015 in a observational retrospective study we analyzed all reports of ADRs (and their determinants) submitted to the National Medicines Regulatory Agency (NMRA).

Results:

In the study period, 10% (n = 2724) of all ADR reports submitted to the NMRA (N = 28061) were related to CV or Antithrombotic drugs, 73.9% of them were SARs and fatal, 55.6% (n = 1479) in women. Mean age was 62 years and 51% of the episodes occurred in subjects > 65 years. AT drugs were the class most frequently associated with SARS (mainly hemorrhages), 31.1% (n = 956, NOACs 251), followed by modulators of Renin-Angiotensin System (cough and dizziness), 19.97% (n = 544), and by lipid modifying agents (musculoskeletal disorders), 19.6% (n = 534). Reports/year to AT increased 7.7 from 2006 to2013 and 88.5 from 2013 to 2015. CV drugs also produced disorders at gastrointestinal (24,63%), skin (22,39%)and nervous system (20,74%). The most common CV ADR associated with non-CV drugs were hypotension (24.4%) and hypertension (16.5%) most commonly induced by antineoplastic, antibiotics and NSAIDs.

Conclusions:

Drugs used for treatment of CV disorders & antithrombotic are a common cause of serious ADRs. ADRS involving the CV system by non-CV drugs are also frequent. All can be detected and identified by current pharmacovigilance tools providing valuable information about the safety of post-marked drugs.
STUDYING THE SITUATION OF CAROTID ATHEROSCLEROSIS OF HYPERTENSIVE PATIENTS IN THE NORTH OF BINH DINH PROVINE, VIETNAM
Authors: Long Nhon Phan
Published: April 2021

Objective:

To evaluate the rate of carotid atherosclerosis in hypertensive patients and the correlations between age, blood pressure, BMI, total cholesterol and atherosclerotic plaque numbers.

Design and method:

A Cross-sectional descriptive study of 207 hypertensive patients in the North of Binh Dinh provine, Viet Nam (2019), examined by doppler ultrasound to evaluate atherosclerotic plaque numbers of the extra-cranial carotid arteries.

Results:

1. Carotid atherosclerotic results

- The rate of atherosclerosis in hypertensive patients: 69.6%

- The percentage of right carotid atherosclerosis is 14.6%.

- The percentage of left carotid atherosclerosis is 19.4%.

- The percentage of atherosclerosis on both of right and left carotid are 66%.

- Percentage of carotid atherosclerosis at before bifurcation: 75%

- The percentage of carotid atherosclerosis at bifurcation 46.52%.

- Percentage of carotid atherosclerosis at after bifurcation 4.16%.

- There are 29.2% of hypertension, have 01 atherosclerotic plaque, 54.2% have 02, 12.5% have 03, 3.5% have 04 vein and 0.7% have over 04 plaques.

2. Some correlation results

- There is no correlation between age, systolic blood pressure, diastolic blood pressure, height and atherosclerotic plaque numbers.

- There is a weak correlation between weight and atherosclerotic plaque numbers (r = 0.20), y = 47.9399 + 2,881 x, R = 0.22. p < 0.001.

- There is a weak correlation between total cholesterol and atherosclerotic plaque numbers (r = 0.18), y = 4.7018 + 0.2839 x, R = 0.19. p < 0.001.

Conclusions:

Carotid atherosclerotic injuries are 69.6% in hypertensive patients. That is very high rate. Should be examined early to treatment and prevent cardio-vascular complications.
FORTY-EIGHT HOUR AMBULATORY RECORDING OF ARTERIAL STIFFNESS IN PATIENTS ON HEMODIALYSIS
Authors: Matasin Marija , Premuzic Vedran , Katalinic Lea , Barisic Ivan , Mesar Ines , Jelakovic Bojan
Published: April 2021

Objective:

Our aim was to analyze circadian pattern of arterials stiffness by measuring 48-hours augmentation index (AIx) and pulse wave velocity (PWV) in patients undergoing chronic hemodialysis (HD).

Design and method:

We enrolled 85 HD patients (mean age 58 (21–86), 48m and 37w) and 75 healthy control subjects (mean age of 64 (20–84), 40m and 35). All patients were dialyzed by the European and KDIGO guidelines. PWV and AIx were measured for 48-hours with Arteriograph starting at the mid-week dialysis session. PWV dippers = nighttime PWV drop > 0.5 m/s; PWV risers = nighttime PWV rise > 0.5 m/s compared to the daytime period. Aix dippers = nighttime Aix drop > 10percentage; Aix risers = nighttime Aix rise > 10% compared to daytime period. ABPM was performed with (SpaceLab 90207) after mid-week dialysis.

Results:

Average values of PWV and Aix did not differ between dialysis and non-dialysis day. Significantly more patients were dippers and risers of Aix and PWV on non-dialysis day vs. dialysis day (Aix dippers 12 vs 3, risers 35 vs 17; non-dippers 38 vs 65,; PWV dippers 38 vs 17, risers 24 vs 18, non-dippers 2 vs 50).

PWV non-dippers and PWV risers had significantly higher ultrafiltration than PWV dippers.

On logistic regression age and duration of hypertension had increased OR of 1.03 and 1.01 for AIx rising pattern on non-dialysis day while age and iPTH had increased OR of 1.06 and 1.03 or PWV rising pattern on non-dialysis day. When AIx and PWV circadian patterns were compared with control group of patients we found that significantly more control subjects had both AIx and PWV dipping patterns than HD patients while significantly more HD patients had both AIx and PWV rising patterns on the non-dialysis day.

Conclusions:

This pattern is more frequently present the day before than after dialysis. Age, duration of hypertension and iPTH were associated with this pattern and those patients required more ultrafiltration. Our results should be confirmed with larger number of patients in a multicentric study.
MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION AND INCIDENT HYPERTENSION IN PREHYPERTENSIVE POPULATION: A CHINESE COHORT STUDY
Authors: Li Fei , Yan Guangyu , Lu Yao , Yuan Hong
Published: April 2021

Objective:

Aim to investigate the gender-dependent association of long-term mean corpuscular hemoglobin concentration (MCHC) with incident hypertension in prehypertensive population.

Design and method:

In this corhort study, a total of 7,753 participants without diabetes and cardiovascular disease were included. All the participants completed the medical examination every year during the follow up. MCHC was divided into groups by gender and quartile. A time-dependent, Cox proportional hazard model was applied to evaluate the association between the incident hypertension and MCHC.

Results:

Over a median follow-up of 5.02 years, 903 male participants and 607 female participants developed into hypertension, and hypertension incidence was 27.69% and 13.51% respectively. After multivarible adjustment, MCHC in the fourth quartile were significantly related to incident hypertension in male participants. Such an association was not found in female participants.

Conclusions:

Gender-dependent associations between MCHC and hypertension incidence exist in prehypertensive population. Mean corpuscular hemoglobin concentration is a risk factor in prehypertensive male participants.
COMPARING THE DISCRIMINATIVE ABILITY OF DIFFERENT ELECTROGRAPHIC CRITERIA FOR LEFT VENTRICULAR HYPERTROPHY IN PREDICTING CARDIOVASCULAR EVENTS IN HYPERTENSIVE PATIENTS
Authors: Harvey George , Godec Thomas , Kapil Vikas , Mackay Judith , Whitehouse Andrew , Poulter Neil , Sever Peter S. , Gupta Ajay
Published: April 2021

Objective:

Several ECG criteria are used clinically to define Left Ventricular Hypertrophy (LVH), but there is no consensus on which of these criteria is better at predicting cardiovascular (CV) events in hypertensive patients. In this post-hoc analysis, our objective was to compare the discriminative ability and strength of association of different LVH criteria to predict the risk of CV-morbidity and mortality.

Design and method:

We used the database of the Anglo-Scandinavian Cardiovascular Outcome Trial Our primary outcome was composite of fatal and non-fatal CV event including: coronary heart disease, stroke and coronary re-vascularisation. We developed several cox regression models, separately for each LVH criterion (Modified Sokolov, Cornell, Framingham, Strain Pattern, Cornell-Strain, Cornell-Product), after adjusting for a-priori confounders (age, sex, smoking status, diabetes, pulse pressure, chronic kidney disease stage 3) and other confounders found using stepwise selection (number of anti-hypertensives, previous vascular disease, metabolic syndrome, atrial fibrillation). We compared discriminative ability using c-statistic, goodness of fit of the model using Bayesian information criterion (BIC), hazard ratios (HR) and z-statistics for strength of association of each one of these LVH criteria in respective models.

Results:

9.7% to 17.2% of 17959 hypertensive patients had LVH at baseline as defined by one or more LVH criterion (see Fig. 1). During a median follow up of 5.6 Years (IQR 5.2–6.1) there were 2736 CV events. Figure 1 shows that, whilst c-statistics and accuracy of most criteria are similar, strain pattern and the Cornell strain are better in improving the prediction models and with a higher strength of association with the CV-outcomes (HR 1.52 95% CI: 1.35 - 1.71, Z-statistic 6.88 and HR 1.37 95% CI: 1.226 - 1.519, Z-statistic 5.70, respectively). Both criteria had excellent BIC too.

Conclusions:

In hypertensive patients, compared to other ECG criteria of LVH, strain pattern and Cornell-strain index are stronger and better predictor of the risk of CV morbidity and mortality.