bluuebunny/crossref_metadata_2025 huggingface dataset:
Lipidomic markers for the prediction of progression from mild cognitive impairment to Alzheimer's disease
Authors: Li Wenjing , Zhou Yinhua , Luo Zhaofan , Tang Rixin , Sun Yuxuan , He Qiangsheng , Xia Bin , Lu Kuiqing , Hou Qinghua , Yuan Jinqiu
Published: June 2023

Dementia is a well‐known syndrome and Alzheimer's disease (AD) is the main cause of dementia. Lipids play a key role in the pathogenesis of AD, however, the prediction value of serum lipidomics on AD remains unclear. This study aims to construct a lipid score system to predict the risk of progression from mild cognitive impairment (MCI) to AD. First, we used the least absolute shrinkage and selection operator (LASSO) Cox regression model to select the lipids that can signify the progression from MCI to AD based on 310 older adults with MCI. Then we constructed a lipid score based on 14 single lipids using Cox regression and estimated the association between the lipid score and progression from MCI to AD. The prevalence of AD in the low‐, intermediate‐ and high‐score groups was 42.3%, 59.8%, and 79.8%, respectively. The participants in the intermediate‐ and high‐score group had a 1.65‐fold (95% CI 1.10 to 2.47) and 3.55‐fold (95% CI 2.40 to 5.26) higher risk of AD, respectively, as compared to those with low lipid scores. The lipid score showed moderate prediction efficacy (c‐statistics > 0.72). These results suggested that the score system based on serum lipidomics is useful for the prediction of progression from MCI to AD.
CAROTID-FEMORAL PULSE WAVE VELOCITY AND STIFFNESS INDEX MEASURED 5-15 YEARS EARLIER WERE SIGNIFICANTLY HIGHER IN DECEASED THAN IN STILL LIVING TREATED FINNISH HYPERTENSIVE PATIENTS
Authors: Kantola Ilkka , Kantola Taru
Published: June 2023

Objective:

To clarify if there is a difference in pulse wave velocity (PWV) measured in the years 2006-2014 (n = 251) comparing in the years 2015-2022 deceased (n = 40) and in the beginning of the year 2023 still living (n = 211) Finnish drug-treated hypertensive patients participating that PWV measurement.

Design and method:

A Doppler ultrasonography device (Micro Medical PulseTrace PWV and PCA, Micro Medical Ltd, Rochester, Kent, UK) was used to measure carotid-femoral (C-F) PWV and photoplethysmographic transducer of the same machine to measure stiffness index (SI) and resistance index (RI) in 251 Finnish drug-treated hypertensive patients (126 females and 125 males) during the years 2006-2014. At the time of measurement the mean age of the patients was 64.0 (8.3) years.

Results:

The age at death of the deceased patients was 79.6 (SD 8.14, median 82, range 62-91) years (n = 40). The age in 01Jan2023 living patients was 75.1 (SD 7.6, median 76, range 45-91) years (n = 211), p = 0.0001 between the two groups.

The mean C-F PWV was 12.5 (3.6) in deceased and 10.4 (2.2) m/s (p = 0.0001) in living and SI respectively 11.0 (3.4) and 9.6 (2.9) m/s (p = 0.007). No significant difference between the groups was seen in RI. Mean office systolic blood pressure was 150.0 (18.8) mmHg in deceased and 137.5 (14.5) in living (p = 0.003) and respectively mean office diastolic pressure 86.4 (9.2) and 83.4 (9.2) mmHg (p = 0.058).

The three most common causes of death were malignancy (n = 13), sudden death (n = 10) and high age (n = 9). Dementia was noticed before death in 13 patients.

Conclusions:

Carotid-femoral PWV and stiffness index measured 5-15 years earlier were significantly higher in deceased than in still living treated Finnish hypertensive patients

Deceased patients were older and their systolic blood pressure was higher which may explain the difference. Malignancies were a common cause of death as also diagnosed dementia in these hypertensive patients. More studies are needed concerning the predictive value of PWV in hypertensive patients.
APPLICABILITY OF THE SPRINT TRIAL IN A REAL WORLD SAMPLE OF HYPERTENSIVE OLDER ADULTS
Authors: Capacci Marco , Rivasi Giulia , Turrin Giada , Ceolin Ludovica , Gentileschi Diego , Corsi Carolina , Tortù Virginia , Rafanelli Martina , Mossello Enrico , Ungar Andrea
Published: June 2023

Objective:

The SPRINT trial demonstrated the benefits of intensive blood pressure (BP) control in older hypertensive adults, including frailer patients. However, how those results can be applied in the geriatric population remains doubtful, due to the highly selective inclusion criteria and low levels of clinical frailty in the aforementioned series. This study aimed to assess the applicability of SPRINT inclusion criteria in a real world sample of hypertensive older adults and analysed the association between BP and functional decline by SPRINT eligibility.

Design and method:

We applied SPRINT inclusion and exclusion criteria to a sample of hypertensive patients aged 75 or older, evaluated at the Hypertension and Memory Clinics of the Geriatric Department of Careggi Hospital, Florence. Cox analysis was used to test the association between BP and functional decline (according to Barthel Index) by SPRINT eligibility.

Results:

Among 123 patients (mean age 81, 59% women), only 39 (32%) complied with the SPRINT inclusion criteria. Frailty prevalence was found to be significantly higher in the ineligible group (46% vs 26%, p = 0.028), along with worse physical performance (reduced walking speed 43% vs 22%, p = 0.027) and disability either in basic (25% vs 5%, p = 0.009) or instrumental activities of daily living (61% vs 33%, p = 0.005). Moreover, they had a higher comorbidity burden (median Charlson Index 5 [4 - 6] vs 4 [3 - 5], p < 0.001), whereas there was no tangible difference between BP values in the two subgroups. At 13 months, ineligible subjects experienced significantly higher incidence of functional decline (48% vs 21%, p = 0.012). In age- and sex-adjusted Cox analysis, ambulatory BP was associated with functional decline only in eligible subjects (24h-systolic BP HR 1.193, 95% CI 1.009 - 1.411).

Conclusions:

In a real world sample of hypertensive older adults, only one third of subjects complied with the SPRINT inclusion criteria. Higher levels of frailty and disability were observed in ineligible subjects, in whom BP values seem to have a limited prognostic impact.
ASSOCIATION OF MAJOR ADVERSE CARDIOVASCULAR EVENTS AND ALL-CAUSE MORTALITY WITH LEFT VENTRICULAR GEOMETRY IN ELDERLY: THE NORTHERN SHANGHAI STUDY
Authors: Maimaitiaili Rusitanmujiang , Zhao Song , Meng Weilun , Tang Jiamin , Teliewubai Jiadela , Yu Shikai , Chi Chen , Xiong Jing , Zhao Yifan , Xu Yawei , Zhang Yi
Published: June 2023

Objective:

To investigate the association of major adverse cardiovascular events and mortality with left ventricular geometry in elderly.

Design and method:

We prospectively recruited 3363 community-dwelling elderly (43.6% male, aged 71.1 ± 5.9 years; 56.4% female, aged 71.1 ± 6.1 years) from local community. Echocardiographic parameters were collected, left ventricular mass index (LVMi) above 115 g/m2 in male or 95 g/m2 in female, relative wall thickness (RWT) above 0.42 were considered as abnormal. Participants then were classified into 4 mutually exclusive groups as: normal geometry (normal LVMi and normal RWT), concentric remodeling (normal LVMi and increased RWT), eccentric hypertrophy (increased LVMi and normal RWT), concentric hypertrophy (increased LVMi and increased RWT). Cardiovascular death, non-fatal myocardial infarction including non-fatal ischemic stroke were recorded as incident MACE. Adjusted Cox regression models were used to evaluate the hazard ratios of MACE and all-cause mortality.

Results:

Mean LVMi and RWT were 87.0 ± 28.4 g/m2 and 0.39 ± 0.08. During a median follow-up of 5.4 years, we identified 224 incident MACE cases and 233 deaths. All-cause mortality was significantly greater in participants with eccentric hypertrophy (adjusted hazard ratio [HR]: 1.649; 95% confidence interval [CI]: 1.143-2.379) compared with normal geometry in multivariate analyses after adjusting for baseline covariates. Incident MACE was significant both in concentric hypertrophy (HR: 1.982; 95% CI: 1.239-3.170) and eccentric hypertrophy (HR: 1.846; 95% CI: 1.266-2.692) but not in concentric remodeling (HR:1.101; 95% CI: 0.759-1.597). Baseline LVMi was a significant predictor of all-cause mortality (HR: 1.047 per 10g/m2 increase in LVMi; 95% CI: 1.004-1.093). Similar results were observed with non-fatal myocardial infarction, non-fatal ischemic stroke and cardiovascular death.

Conclusions:

Increased baseline LVMi and abnormal left ventricular geometry portend an increased risk for incident MACE and all-cause mortality in community dwelling elderly. From the pathophysiology point of view, per 10 g/m2 increase in LVMi add 5% risk for all-cause mortality.
CAMERA-BASED REMOTE PHOTOPLETHYSMOGRAPHY TO PREDICT BLOOD PRESSURE IN CLINIC PATIENTS WITH CARDIOVASCULAR DISEASE
Authors: Curran Theodore , Liu Xin , Mcduff Daniel , Ma Chengqian , Narayanswamy Girish , Patel Shwetak , Yang Eugene
Published: June 2023

Objective:

Remote photoplethysmography (rPPG) uses a camera to capture peripheral blood flow. It remains to be seen if rPPG can accurately predict blood pressure (BP). Most studies have included healthy, normotensive subjects. This is the first investigation of rPPG to predict BP for patients with cardiovascular disease (CVD).

Design and method:

132 patient visits were completed in a cardiology clinic between March and December, 2022 (Table 1). Patients were seated while a digital camera recorded two 2.5 minute videos of the face and palm. BP was measured by an oscillometric cuff from the left arm at the beginning, midpoint, and end of the session. Continuous heart rate and rhythm were measured by a single-lead ECG from electrodes on the right and left wrists. Continuous PPG was measured by a contact sensor on the left index finger.

Videos were cropped and spatially-averaged to extract the green channel, which serves as a proxy for the rPPG signal. Pulse segmentation and selection were used to identify five high-quality consecutive beats. Raw rPPG signal was analyzed with its first and second derivatives into a one-dimensional convolutional neural network. The network is trained to predict systolic and diastolic BP by minimizing the mean squared error between the predicted video-based contactless BP and cuff-based BP measurement. A 5-fold subject independent cross-validation was performed.

Results:

There is modest correlation between rPPG-predicted and measured systolic BP (r = 0.47, mean error -0.47 ± 15.5 mm Hg), but weaker correlation for diastolic BP (r = 0.16, mean error -0.80 ± 8.1 mm Hg).

Conclusions:

rPPG shows potential for BP prediction in real-world patients with CVD. Future work will leverage larger data driven machine learning methods to improve the rPPG signal quality and examine the impact on BP measurements. Robust training data, including extreme values of blood pressure and a variety of patient demographics, are needed to improve these models. Major limitations include lack of guideline-directed protocols for rPPG validation for BP prediction and inability to assess temporal correlation between rPPG signal and BP.
THE NATURAL COURSE OF HYPERTENSIVE PHENOTYPES OVER TIME – THE HELIUS STUDY
Authors: Vriend Esther M.C. , Bouwmeester Thomas A. , Franco Oscar H. , Galenkamp Henrike , Charante Eric P. Moll Van , Collard Didier , Born Bert-Jan H. van den
Published: June 2023

Objective:

Hypertension can be classified into different phenotypes according to systolic and diastolic blood pressure (BP). We assessed the natural course of BP phenotypes over time in younger adults and identified risk factors predisposing to the development of sustained hypertension in a diverse population.

Design and method:

We used baseline and follow-up data from all participants aged below 40 years without antihypertensive medication at baseline from the ongoing multi-ethnic HEalthy LIFe in an Urban Setting (HELIUS) study. Participants were stratified according to baseline office BP: normotensive (NT; < 140/< 90 mmHg), isolated systolic hypertension (ISH; > = 140/< 90 mmHg), isolated diastolic hypertension (IDH; < 140/> = 90 mmHg) and combined systolic and diastolic hypertension (SDH; > = 140/> = 90 mmHg). Sankey diagrams were created stratified by sex to visualise change in phenotypes over time and risk of sustained hypertension (defined as BP > = 140/90 mmHg or use of antihypertensive medication) was assessed using logistic regression models adjusted for age, sex, ethnicity and follow-up time. In further adjusted models we added BMI, smoking, baseline eGFR, glucose, and total cholesterol levels to assess risk factors.

Results:

We included 2,818 participants aged 30.1 years (SD 6.0), 44% male, who attended the follow-up visit with a median follow-up time of 6.2 years (SD 1.1). Of all participants, 91.5% was normotensive at baseline, whereas 2.8%, 2.8% and 2.9% had ISH, IDH and SDH, respectively. In males the prevalence of ISH decreased over time, while in females the prevalence increased (figure). Compared to normotensive individuals, the adjusted odds ratios for developing sustained hypertension were 4.5 (95% CI 2.5 – 7.9) for ISH, 17.4 (95% CI 10.7 - 28.4) for IDH and 33.5, (95% CI 19.7 – 58.9) for SDH. Higher BMI was the most important predictor for development of sustained hypertension.

Conclusions:

Participants with SDH had the highest risk for developing sustained hypertension, followed by participants with IDH. The risk for sustained hypertension in individuals with ISH was much lower and differed between males and females, suggesting differences in pathophysiology and management.
MYOCARDIAL MECHANO-ENERGETIC EFFICIENCY AND CLINIC AND 24 HOURS BLOOD PRESSURE VALUES IN PATIENTS ATTENDING THE OUTPATIENT CLINIC AT AN ESH EXCELLENCE CENTRE IN ITALY
Authors: Aggiusti Carlo , Paini Anna , Bertacchini Fabio , Stassaldi Deborah , Capellini Sara , Muiesan Maria Lorenza , Salvetti Massimo
Published: June 2023

Objective:

It has been demonstrated that low myocardial mechano-energetic efficiency index (MEEi),estimated as stroke volume/heart rate ratio per g of left ventricular(LV) mass(LVM) is an independent predictor of cardiovascular(CV) events. Out of office blood pressure (BP) is better correlated to hypertension mediated organ damage(HMOD) and to CV events as compared to BP measured in the office.

Design and method:

Aim of the study was to evaluate the relationship between myocardial mechano-energetic efficiency index and both clinic and 24 hours BP values in 839 consecutive uncomplicated patients attending the outpatient at an ESH Excellence Centre in Italy. Methods BP values were measured by the physician with an automated oscillometric device, after 5 minutes of rest. ABPM was performed in all subjects with a Spacelabs BP monitor. All patients underwent transthoracic echocardiography, and standard indices of systolic function were calculated. Furthermore in all patients myocardial mechanoenergetic efficiency (MEE) was calculated as stroke volume/heart rate and indexed to LV mass (MEEi=MEE/LVM) (de Simone et al, 2016).

Results:

Mean age was 53 ± 14 yrs, 53% female, BMI 26 ± 5, 34 % were overweight, 18% obese, 8% % diabetics, 64 % with a previous diagnosis of hypertension(71 % treated). MEEi was lower in males (0.41 ± 0.14 vs 0.52 ± 0.15), and in patients with diabetes(0.40 ± 0.11 vs 0.48 ± 0.16). MEEi was inversely -correlated with age(r = -0.146, p < 0.0001) and BMI(r = -0.353, p < 0.0001). MEEI was similarly correlated to 24 hours SBP and clinic SBP(respectively r = -0.267, p < 0.0001 and r = -0.196, p < 0.001, Steiger's Z test for the comparison p ns) and to 24 hours DBP and clinic DBP(r = -0.249, p < 0.0001 and r = -0.248, p < 0.001, Steiger's Z test for the comparison p ns). However, at receiver operating curves(ROC) the area under the curve(AUC) for 24 hours SBP(0.627, 95 % CI 0.593 - 0.659) was superior in predicting low MEEI (defined as < 0.35) as compared to the AUC of clinic SBP(0.582, 95 % CI 0.548 - 0.615)(p for the comparison < 0.05).

Conclusions:

In a large sample of uncomplicated patients attending the outpatient clinic at an ESH Excellence Centre in Italy 24 hours BP is a better predictor of reduced myocardial myocardial mechanoenergetic efficiency than clinic BP.
UNDERSTANDING MEASUREMENT OF POSTURAL HYPOTENSION: A NATIONWIDE SURVEY OF PRIMARY CARE PRACTICE IN ENGLAND
Authors: McDonagh Sinead , Cross Rosina , Masoli Jane , Konya Judit , Abel Gary , Sheppard James , Jakubowski Bethany , Bhanu Cini , Fordham Jayne , Turner Katrina , Lamb Sallie , Payne Rupert , McManus Richard , Campbell John , Clark Christopher
Published: June 2023

Objective:

Postural hypotension (PH), the drop in blood pressure (BP) on standing, is associated with falls, all-cause mortality and cognitive decline. PH diagnostic criteria require lying-to-standing BP measurements. PH is common, with prevalence estimated at 19% in older primary care patients, yet it is infrequently (<1%) recorded in routine English primary care data, suggesting PH testing and/or recording is under-utilised in this setting; reasons for such limited PH testing and/or recording have not yet been explored in detail.

The aim of this study was to understand current PH measurement and management strategies in primary care practices across England.

Design and method:

Clinical Research Networks circulated an online survey to primary care staff involved in measurement of BP from 10th August until 8th December 2022. Responses were summarised as percentages and/or median (inter-quartile ranges (IQR)) and chi2 tests. Modelling is underway to explore response variations according to professional and practice characteristics. Final analyses will be presented at the conference.

Results:

Replies from 703 practitioners in 242 practices were received; predominantly from doctors (51%), nurses (28%) and healthcare assistants (HCAs; 11%), plus pharmacists, paramedics and other roles; median age 45 (IQR 38 to 53) years, 72% female. Overall, doctors (97%) and nurses (92%) reported checking for PH more often than HCAs (82%) or pharmacists (80%; p < 0.001). They all usually check when symptoms are present (97%). Other reasons for checking - patients aged over 80 years (24%); hypertension reviews (17%); medication reviews (12%) or diabetes reviews (11%) – were all more commonly undertaken by allied health professionals than by doctors (p < 0.001). Standing BP measurements are regarded as feasible, usually (77%) following sitting; only 22% use lying-to-standing measurements. 64% observe a rest period (median 5 (2 to 5) minutes) before sitting or lying measurements and 1 (IQR 1 to 2) standing BP measurements are made, usually (66%) within the first minute of standing.

Conclusions:

Findings suggest that most PH assessments in primary care do not meet current guideline criteria. Results from this survey will inform future national guidelines to support PH detection.
WHICH SYSTOLIC BLOOD PRESSURE SHOWS CLOSEST ASSOCIATIONS WITH LEFT VENTRICULAR MASS? THE INTERNATIONAL 24 HOUR AORTIC BLOOD PRESSURE CONSORTIUM (I24ABC)
Authors: Danninger Kathrin , Weber Thomas , Wassertheurer Siegfried , Protogerou Athanase , Sherman James E. , Sala Enrique Rodilla , Muiesan Maria Lorenza , Giannattasio Cristina , Hametner Bernhard , Ortner Stefan , Li Yan , Pascual Jose Maria , McEniery Carmel , Stergiou George S. , Gomes Marco Antonio Mota , McDonnell Barry , Sierra Alejandro De La , Piskorz Daniel , Perl Sabine , Zhang Yi
Published: June 2023

Objective:

Central systolic blood pressure (cSBP) may be closer associated with hypertensive organ damage, namely left ventricular mass (LVM) and hypertrophy (LVH), as compared to brachial SBP (bSBP), and 24hour ambulatory SBP may be closer associated with LVM and LVH, as compared to office SBP. We sought to address this by pooling data from 21 centers worldwide.

Design and method:

In all centers, bSBP and cSBP was measured with the same validated oscillometric upper arm device (Mobil-O-Graph, I.E.M., Germany), using a transfer function for central pressure, and systolic/diastolic pressure (cSBPC1) or mean/diastolic pressure (cSBPC2) calibration. LVM was determined by echocardiography, and indexed to body surface area (LVMi).

Results:

We studied 2367 participants (45.5% women), 31.3% treated with antihypertensives. Mean age of 50.8 years (range 10-104 years). Average brachial office BP was 137/89 mm Hg, average brachial 24hour BP was 126/80 mm Hg. Average LVMi was 89.9 g/m2, and 24.1% had LVH.

The correlation coefficients between LVMi and office bSBP, office cSBPC1, office cSBPC2, 24hour bSBP, 24hour cSBPC1, and 24hour cSBPC2 were 0.21, 0.20, 0.29, 0.31, 0.29, and 0.38, respectively. Based on z-statistics, the relationship between LVMi and office /24hour cSBPC2 was closer than with the other office/24hour SBPs (p = 0.0001 and 0.0002 for comparison with bSBPs, respectively). These findings were consistent in men and women, across all age groups, in lean, overweight and obese individuals, and in individuals with or without antihypertensives. In ROC analysis, the area under the curve (AUC) for detection of LVH was 0.626, 0.632, 0.668, 0.659, 0.653, and 0.687 for office bSBP, office cSBPC1, office cSBPC2, 24hour bSBP, 24hour cSBPC1, and 24hour cSBPC2, respectively – Figure). The AUC for office/24hour cSBPC2 was significantly larger, as compared to office/24hour bSBP (p < 0.0001 for both comparisons).

Conclusions:

In a large international research consortium, we observed that 24hour cSBP, measured with an oscillometric cuff, shows a significantly closer association with hypertensive cardiac organ damage than the related brachial SBPs. In addition, the method of waveform calibration is crucial.
THRESHOLDS FOR WHITE-COAT AND MASKED BLOOD PRESSURE EFFECTS: AN AMBULATORY BLOOD PRESSURE MONITORING STUDY
Authors: Pont Christian Dal , Feitosa Audes D. M. , Viana Gustavo M. , Starke Siegmar , Azevedo Guilherme S. A. , Mota Marco A. , Barroso Weimar S. , Miranda Roberto D. , Barbosa Eduardo C. D. , Brandão Andréa , Bezerra Rodrigo , Feitosa Camila L.D. M. , Gonçalves Thales A. T. , Nobre Fernando , Jr Decio Mion , Sposito Andrei , Nadruz Wilson
Published: June 2023

Objective:

The values used to define white-coat and masked blood pressure (BP) effects are usually arbitrary. This study aimed at investigating the accuracy of various thresholds based on the differences (DBP) between office BP (OBP) and 24h-ambulatory BP monitoring (ABPM) to identify white-coat (WCH) and masked (MH) hypertension, which are phenotypes assumed to carry adverse prognosis.

Design and method:

This cross-sectional study included 11,350 [Derivation cohort; 45% men, mean age = 55.1 ± 14.1 years, OBP = 132.1 ± 17.6/83.9 ± 12.5 mmHg, ABPM = 121.6 ± 11.4/76.1 ± 9.6 mmHg, 25% using antihypertensive medications (AH)] and 7,220 [Validation cohort; 46% men, mean age = 58.6 ± 15.1 years, OBP = 136.8 ± 18.7/87.6 ± 13.0 mmHg, ABPM = 125.5 ± 12.6/77.7 ± 10.3 mmHg; 32% using AH] unique individuals who underwent OBP and ABPM measurements. We compared the sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and area under the curve (AUC) of 8 different ↗BP thresholds to detect WCH (↗systolicBP/↗diastolicBP = +28/+17, +20/+15, +20/+10, +16/+11, +15/+9, +14/+9 mmHg and ↗systolicBP = +13 and +10 mmHg) and eight different ↗BP thresholds to detect MH (↗systolicBP/↗diastolicBP = -14/-9, -5/-2, -3/-1, -1/-1, 0/0, +2/+2 mmHg and ↗systolicBP = -5 and -3 mmHg), built from formerly reported criteria in the literature. WCH was defined as OBP> = 140/90mmHg and ABPM < 130/80mmHg, and MH was defined as OBP < 140/90mmHg and ABPM> = 130/80mmHg.

Results:

The +20/+15 mmHg threshold showed the best AUC (0.804, 95%CI = 0.794 - 0.814) to detect WCH in the Derivation cohort, with sensitivity, specificity, PPV and NPV of 80.6%, 80.2%, 42.3%, and 95.8%, respectively. The +2/+2 mmHg threshold showed the highest AUC (0.741, 95%CI = 0.728 - 0.754) to detect MH, with sensitivity, specificity, PPV and NPV of 78.9%, 69.3%, 22.0% and 96.8%, respectively. Both threshold values also had the best accuracy to detect WCH (0.767, 95%CI = 0.754 - 0.780) and MH (0.767, 95%CI = 0.750 - 0.784) in the Validation cohort. In secondary analyses, these thresholds had the best accuracy to detect WCH and MH in individuals using or not AH, and to detect individuals with higher and lower office-than-home BP stages, respectively, in both cohorts.

Conclusions:

The +20/+15 and +2/+2 mmHg ↗BP thresholds had the best accuracy to detect hypertensive patients with WCH and MH, respectively, and may be indicators of marked white-coat and masked BP effects.
CAN RECORDING KOROTKOFF SOUNDS DURING BRACHIAL CUFF INFLATION PROVIDE MORE ACCURATE NON-INVASIVE ESTIMATES OF INTRA-ARTERIAL BLOOD PRESSURE?
Authors: Celler Branko , Yong Andy , Rubenis Imants , Butlin Mark , Argha Reza , Rehan Rajan , Avolio Alberto
Published: June 2023

Objective:

We have previously demonstrated that recording onset and termination of Korotkoff sounds as markers of systolic (SBP) and diastolic (DBP) during brachial cuff deflation results in underestimation of true SBP. In this study we explore whether recording Korotkoff sounds during cuff inflation provides more accurate non-invasive estimates of intra-arterial blood pressure (IABP).

Design and method:

Experiments were carried out on 15 participants, (14 males, 64.3 ± 10.4 years; one female, 86 yo), undergoing coronary angiography. A conventional (oscillometric) BP cuff, with a microphone for Korotkoff sounds, was placed on the upper arm. The cuff was inflated at rate of approximately 2.5mm Hg/sec and deflated at the same rate. Inflation and deflation cycles were randomised and separated by 2 - 3 minutes. IABP was measured below the cuff with a fluid-filled catheter inserted via the radial artery and an external transducer. Korotkoff sounds were processed electronically, and custom algorithms identified the cuff pressure (CP) at which the first and last Korotkoff sounds were heard.

Results:

Systolic (SBP), and diastolic (DBP) pressure were 147.7.6 ± 12.7 and 70.7 ± 9.7mmHg. The CP at which the brachial artery closes during rapid (∼20mmHg/sec) cuff inflation (132.0 ± 17.1) was similar to that of slow (2.5mmHg/sec) inflation (132.0 ± 16.3 mmHg). However, peak Korotkoff sound energy was significantly reduced (P = 0.003) from 0.19 ± 0.1 to 0.15 ± 0.09 RMS volts and the Korotkoff sounds were often observed to disappear prematurely before brachial artery closure. Difference between intra-arterial SBP and CP at the last recorded Korotkoff sound (27.5 ± 9.3 mmHg) during cuff inflation was significantly higher (P = 0.0025) than during slow cuff deflation (18.9 ± 8.3 mmHg). In contrast, DBP recorded at first onset of the Korotkoff sounds (70.5 ± 11.1 mmHg) was consistently similar to intra-arterial DBP (70.7 ± 9.7 mmHg).

Conclusions:

SBP estimates derived from the last Korotkoff sound recorded as the cuff inflates generates greater errors than when Korotkoff sounds are first recorded as the cuff deflates. In contrast, the estimate of DBP derived from the first onset of the Korotkoff sound as the cuff inflates, appears to reflect accurately the true intra-arterial DBP.
THE INFLUENCE OF BASELINE DIASTOLIC BLOOD PRESSURE ON THE EFFECTS OF INTENSIVE BLOOD PRESSURE LOWERING: RESULTS FROM THE STEP RANDOMIZED TRIAL
Authors: Yang Ruixue , Cai Jun
Published: June 2023

Objective:

The Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial reported cardiovascular benefits of intensive systolic blood pressure (SBP) lowering. However, the influence of baseline diastolic blood pressure (DBP) on the effects of intensive SBP lowering on cardiovascular outcomes has not been fully elucidated.

Design and method:

In this post hoc analysis of the STEP trial, participants were randomly assigned to receive intensive (110 to <130 mmHg) or standard SBP treatment (130 to <150 mmHg) and categorized by baseline DBP into subgroups: <70, 70 - 79, and > = 80 mmHg. The primary outcome was a composite of stroke, acute coronary syndrome, acute decompensated heart failure, coronary revascularization, atrial fibrillation, or death from cardiovascular causes. A competing risk proportional hazards regression model was used in the analysis. We compared results across subgroups stratified by baseline DBP levels by including a multiplicative interaction term between SBP treatment arms and subgroups (treatment arm* subgroup).

Results:

Of the 8,511 participants, 960, 2,474, and 5,077 had baseline DBP divided in intervals of <70, 70 - 79, and > = 80 mmHg, respectively. A reduction in the primary outcome was observed among those randomized to intensive SBP lowering in each DBP subgroup but was significant only in the subset of participants with baseline DBP > = 80 mmHg (<70 mmHg: adjusted hazard ratio, 0.81 [95% confidence interval, 0.43 - 1.51]; 70 - 79 mmHg: 0.80 [0.55 - 1.15]; > = 80 mmHg: 0.73 [0.54 - 0.97]). There were no significant interactions between SBP treatment and baseline DBP subgroups for the primary and secondary outcomes (all P for interaction >0.05). The sensitivity analyses showed consistent results with the main analysis.

Conclusions:

Baseline DBP levels did not modify the beneficial effects of intensive SBP lowering on cardiovascular outcomes.
REMNANT CHOLESTEROL AND INTENSIVE BLOOD PRESSURE CONTROL IN OLDER PATIENTS WITH HYPERTENSION: A POST HOC ANALYSIS OF THE STEP RANDOMIZED TRIAL
Authors: Yang Ruixue , Cai Jun
Published: June 2023

Objective:

Emerging evidence shows the close relationship between remnant cholesterol (RC) and hypertension. However, it is unknown whether RC is associated with the effect of intensive systolic blood pressure (SBP) lowering on cardiovascular outcomes. We aimed to determine the influence of baseline RC on the effect of intensive SBP lowering in hypertensive patients.

Design and method:

We performed a post-hoc analysis of the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial. Participants were randomly allocated to intensive SBP treatment (110 to <130 mmHg) or standard SBP treatment (130 to <150 mmHg). RC was calculated as total cholesterol minus high-density lipoprotein cholesterol minus low-density lipoprotein cholesterol. The median RC concentration was used to categorize participants into low and high RC groups. The primary outcome was a composite of stroke, acute coronary syndrome, acute decompensated heart failure, coronary revascularization, atrial fibrillation, or death from cardiovascular causes.

Results:

Of the 8,511 participants in the STEP trial, 8,276 participants had available baseline RC concentrations (low RC group: n = 4,200; high RC group: n = 4,076). After a median follow-up of 3.33 years, a reduction in the primary outcome was observed in participants allocated to receive intensive SBP lowering in both groups; however, the reduction was only significant in the high RC group (high RC group: adjusted hazard ratio [aHR] 0.62; 95% confidence interval [CI] 0.45–0.84; low RC group: 0.91 [0.67–1.24]; P for interaction = 0.09). Intensive SBP treatment decreased all-cause mortality in the high RC group (aHR 0.48; 95% CI 0.28 – 0.81) but increased it in the low RC group (aHR 2.51; 95% CI 1.47 – 4.28; P for interaction <0.001). Among the adverse events, only hypotension was slightly increased in the high RC group (adjusted relative risk 1.48; 95% CI 1.02 – 2.16).

Conclusions:

Patients with high RC experienced greater cardiovascular benefits with intensive SBP lowering.
SEX DIFFERENCES IN INDIVIDUALS WITH OFFICE HIGH NORMAL BLOOD PRESSURE WHO DEVELOPED HYPERTENSION IN 3-YEAR FOLLOW-UP
Authors: Kalos Theodoros , Dimitriadis Kyriakos , Konstantinidis Dimitrios , Siafi Eirini , Kakouri Niki , Iliakis Panagiotis , Liatakis Ioannis , Leontsinis Ioannis , Tsioufis Panagiotis , Polyzos Dimitrios , Filippou Christina , Drogaris Sotirios , Fragoulis Christos , Thomopoulos Costas , Tsioufis Konstantinos
Published: June 2023

Objective:

Recent data demonstrated that females develop target organ damage earlier than men. Normotensive individuals with office high normal blood pressure (BP) who remain at normotensive range for at least 3 years demonstrate hemodynamic differences according to their gender.

Design and method:

100 individuals with high normal BP were followed-up for 3 consecutive years. During enrolment they underwent ambulatory BP monitor (ABPM), electrocardiogram (ECG), echocardiogram, carotid-femoral pulse wave velocity (PWV), sympathetic drive was assessed by muscle sympathetic nerve activity (MSNA) to assess sympathetic drive, a negative for ischemia treadmill exercise stress test (TST) (Bruce protocol) and blood sampling. Follow-up was scheduled every 6 months for 3 consecutive years, where BP measurements were assessed in office and with ambulatory BP monitoring (ABPM). All participants offered lifestyle advise to lower their BP. Endpoint was development of hypertension (HTN). Then they divided into males and females (postmenopausal).

Results:

19 males and 21 females developed HTN. Men were younger than women (51vs58y, p = 0.03). Office and ABPM measurements did not differ significantly. Men exhibit higher waist to hip ratio (0.92vs0.86, p = 0.012), higher uric acid levels (5.6vs4.7mg/dL) and better kidney function according 2021 CKD-EPI GFR (97vs87,p = 0.03). Contrary HDL levels were lower (54vs66mg/dL, p = 0.048).

From those who remained normotensive (24 males and 36 females), men exhibit increased left ventricular mass index (90vs82, p = 0.045) compared to women. Interestingly to those who became hypertensive left ventricular mass index was similar (79vs81gr/m2, p = 0.53).

Women had greater sympathetic drive as recorded from MSNA levels (33vs36bursts/min,p = 0.012) and MSNA per 100bpm (47vs54burst,p = 0.041).

Arterial stiffness as recorded from c-fPWV (8.3vs8.2m/s) did not differ significantly among genders.

In TST (Bruce protocol) men exercised two extra minutes on average (9vs7min, p < 0.0001), achieving greater exercise duration and METs (11.2vs8.8, p = < 0.0001) accordingly. SBP at peak exercise was higher in men (208vs197mmHg, p = 0.03).

Conclusions:

Women who became hypertensive equalized their heart volume with men, demonstrate greater sympathetic activity and worsening of their kidney function. Additionally, their exercise capacity was significantly reduced in comparison with men. Overall, it seems there are structural alterations in heart and kidneys that demonstrates the need to prevent earlier the organ damage during high blood pressure stage in women.
DEFICIENCY OF COMPLEMENT C3A AND C5A RECEPTORS DOES NOT PREVENT ANGIOTENSIN II–INDUCED HYPERTENSION AND HYPERTENSIVE END ORGAN DAMAGE
Authors: Dreher Leonie , Bode Marlies , Herrnstadt Georg Rudolf , Ehnert Nicolas , Kirkerup Pia , Lindemeyer Maja T. , Meyer-Schwesinger Catharine , Ehmke Heimo , Köhl Jörg , Huber Tobias B. , Wiech Thorsten , Wenzel Ulrich O.
Published: June 2023

Objective:

Complement activation may play an important role in pathophysiology of hypertension and associated end organ damage through its effect on tissue integrity and immune responses. The anaphylatoxins C3a and C5a are highly active effectors of the complement system operating through binding to their receptors C3a3R and C5aR1. Recently it was suggested that regulatory T cells (Tregs) are downregulated in hypertension and that combined deficiency of C3aR and C5aR1 in lymphocytes upregulates Tregs and heals hypertension (Circ Res 122: 970-983, 2018).

Design and method:

To further address the role of C3aR, C5aR1 and Tregs in human and murine hypertension we used data from the European Renal cDNA Bank, renal single cell sequencing and renal immunohistochemistry of hypertensive patients.

Results:

Expression of C3aR and C5aR1 was mainly found in myeloid cells and almost absent in lymphocytes and resident renal cells. An increased expression of C3aR, C5aR1 as well as forkhead box protein 3 (FoxP3), a known marker for Tregs, was found in the kidney in hypertension.

Next we determined whether C3aR deficiency or C3aR/C5aR1 double deficiency decreases blood pressure and hypertensive injury in angiotensin (Ang) II infused mice.

No difference was found for blood pressure, renal injury (glomerular filtration rate, albuminuria, glomerular and tubulointerstitial injury, inflammation) and cardiac injury (cardiac fibrosis, heart weight, gene expression) between C3aR knockout and wildtype mice as well as C3aR/C5aR1 double knockout respectively. Ang II as well as DOCA salt induced hypertension resulted in an increased number of Tregs in the kidney. Isolation of a very pure (>99%) Treg population from a RORC x FIR double fluorescence reporter mouse revealed low abundance of C3aR and absence of C5aR1 in murine Tregs.

Conclusions:

In summary, hypertensive nephropathy in patients and mice is characterized by an increased expression of anaphylatoxin receptors and Tregs. However, deficiency of C3aR alone or C3aR and C5aR1 combined does not influence blood pressure or hypertensive end organ damage. Targeting the anaphylatoxin receptors C3aR alone or in combination with C5aR1 is not useful to treat cardiovascular disease in hypertension.
CARDIOVASCULAR RISK IN TREATED HYPERTENSIVE PATIENTS WITH ISOLATED DIASTOLIC HYPERTENSION AND ISOLATED LOW DIASTOLIC BLOOD PRESSURE
Authors: Chang Wei -Lun , Chen Ying -Fan , Chuang Shao -Yuan , Lee Yu -Hsuan , Shiu Ming -Neng , Guo Chao -Yu , Huang Chi -Jung , Chiang Chern -En , Chen Chen -Huan , Staessen Jan A. , Asayama Kei , Ohkubo Takayoshi , Niiranen Teemu J. , Boggia Jose , Cheng Hao -Min
Published: June 2023

Objective:

Antihypertensive therapy in the elderly often targets at systolic blood pressure (SBP) and excessive lowering of diastolic blood pressure (DBP) may occur. Evidence on the cardiovascular risk of isolated diastolic hypertension (IDH) is inconsistent. This study investigated whether IDH and isolated low diastolic blood pressure (ILDBP) were associated with major adverse cardiovascular events (MACE) in patients who were receiving antihypertensive therapy and had normalized SBP.

Design and method:

A total of 7582 hypertensive patients aged > = 50 years and with on-treatment SBP <130 mmHg from the Systolic Blood Pressure Intervention Trial (SPRINT) were analyzed. Average DBP of 60 mmHg during follow-up visits was determined as the lower boundary by a multivariate adaptive regression spline analysis for MACE. According to the on-treatment DBP, patients were divided into <60 mmHg (ILDBP, n = 1031), 60–79 mmHg (n = 5432), and > = 80 mmHg (IDH, n = 1119). Time-varying Cox proportional hazards model was used to estimate the MACE risk, comparing IDH or ILDBP with DBP 60–79 mmHg. External validation was carried out with a two-stage meta-analysis of individual participant data (IPD) for 3560 individuals from six cohorts.

Results:

The SPRINT participants had a median age of 68.2 years, and 64.9% of whom were men. During a median follow-up of 3.5 years, 512 patients had MACE. Incidence of MACE per 100 person-years was 3.9 case for ILDBP, 1.9 cases for DBP 60 – 79 mmHg, and 1.8 cases for IDH. Compared with DBP 60 – 79 mmHg, ILDBP was associated with a 1.32-fold increased MACE risk (95% CI: 1.05 – 1.66), but IDH was not (hazard ratio: 1.18, 95% CI: 0.87 – 1.59). Among the 50 – 64 years subgroup, IDH was associated with a 1.59-fold increased MACE risk (95% CI: 1.01 – 2.49), with effect modification by age (P for interaction 0.005). The IPD meta-analysis also suggested a significantly higher risk for MACE among patients with ILDBP (hazard ratio: 1.22, 95% CI: 1.03 – 1.46), compared to patients with DBP 60 – 79 mmHg.

Conclusions:

Among patients on antihypertensive medications with normalized SBP, excessively low DBP increased the MACE risk but IDH did not. More research is needed to develop appropriate treatment strategies for ILDBP.
CHANGES IN THE NORMAL BP PROFILE IN A PATIENT WITH HYPERTENSION DURING THE WAR IN UKRAINE
Authors: Torbas Olena , Progonov Serhii , Sirenko Yuriy
Published: June 2023

Objective:

To assess the influence of various external factors and stress due to a large-scale military invasion on the daily blood pressure (BP) profile in the population of patients with arterial hypertension (AH) in Ukraine.

Design and method:

This was a retrospective analysis of examined patients who underwent ABPM in the last 5 years. We conditionally divided the observation period into several time intervals: the ‘War’ group, the ‘Before the war’ group, the ‘Covid-19’ group, and the ‘Peace’ group, in which each of the 20 patients was selected by the method of random numbers. All patients underwent ABPM using the Watch BP 03 device (Microlife AG, Switzerland). The database was formed, and statistical analysis of the results was carried out using the IBM SPSS 26.0 software package.

Results:

All groups were comparable according to the age, gender, average daily BP, and heart rate parameters of participants. Patients of all groups were middle-aged, the number of men and women was equal in all groups, and groups were comparable according to the results of average daily SBP, DBP, PBP, and heart rate. We found that the ‘War’ group had a significantly lower percentage of SBP and DBP decrease at night compared to all other groups (7.6 ± 1.3% for SBP and 10.2 ± 1.4% for DBP). The standard deviation of SBP and DBP was significantly higher in the ‘Before the war’ group (19.8 ± 1.1 and 14.2 ± 0.7, respectively) compared to the ‘War’ group (16.0 ± 0.9 and 11 .7 ± 0.6, respectively) and ‘Covid-19’ (16.2 ± 0.7 and 11.8 ± 0.7, respectively). The highest frequency of non-dippers for SBP and DBP was observed in the ‘War’ group (60% and 45% respectively).

Conclusions:

During the war, the reduction of SBP and DBP at night in patients with hypertension was significantly lower than in the ‘Before the war’, ‘Covid’, and ‘Peace’ groups. There was also a higher number of non-dippers during the war in Ukraine.
VISIT-TO-VISIT 24 HOUR BLOOD PRESSURE VARIABILITY VS OFFICE BLOOD PRESSURE VARIABILITY UNDER ANTIHYPERTENSIVE DRUG TREATMENT
Authors: Trevano Fosca Quarti , Facchetti Rita , Dell’Oro Raffaella , Cuspidi Cesare , Grassi Guido , Mancia Giuseppe
Published: June 2023

Objective:

In any treated hypertensive patient office blood pressure (BP) values differ between visits and this variability (V) has an adverse prognostic impact. Almost no information is available on visit-to-visit 24-hour(h) BPV and the consistency of its therapeutic control.

Design and method:

In 1114 differently treated hypertensive patients of the ELSA and PHYLLIS trials we calculated 24-h BPV by the coefficient of variation of the mean BP from yearly measurements during a 3-4 year treatment period. Calculation was also made of yearly variation of the percentage of patients achieving 24-h BP control (<130/80mmHg). Calculations were extended to day and night BP. Data were compared with office visit-to visit BPV and yearly office BP control (<140/90mmHg) and variations .

Results:

Visit-to-visit 24-h BPV was 20% to 30% less than office BP variability, similarly for systolic and diastolic BP and consistently for different demographic, clinical and treatment conditions. BPV was considerably greater for the night than for the daytime (%, p < 0.01) . Yearly 24-h BP control was considerably less frequent and variable than yearly office BP control and was considerably than daytime BP control. In the whole study and subgroups there was a linear correlation between office and 24-h but the correlation coefficients were never >0.20, indicating that office BPV does not precisely correspond to it is impossible to precisely predict 24-h BPV from office in individual patients.

Conclusions:

24-h BPV across visits is noticeably more stable than across visit office BPV, although with a greater variability of night BP. The correlation between office and 24-h BPV is significant but the low correlation coefficient makes office BPV hardly predictive of the 24-h BP stability across visits.
SHORT TERM 24HOUR VARIABILITY OF BOTH BRACHIAL AND AORTIC BLOOD PRESSURE IS INCREASED IN PATIENTS WITH IMMUNE-MEDIATED INFLAMMATORY DISEASE
Authors: Anyfanti Panagiota , Triantafyllou Areti , Margouta Anastasia , Malliora Anastasia , Lazaridis Antonios , Chionidou Agapi , Theocharis Konstantinos , Lazaridou Elissavet , Patsatzi Aikaterini , Gkaliagkousi Eugenia
Published: June 2023

Objective:

Short term 24hour brachial blood pressure (BP) variability (24hbBPV) has emerged as an indicator of hypertension-mediated organ damage (HMOD) and a predictor of cardiovascular disease (CVD) events in highrisk populations. At the same time, the clinical significance of short term central BPV (24hcBPV) remains under investigation. To our knowledge, no study so far has assessed 24hbBPV and 24hcBPV in patients with psoriasis, who are characterized by subclinical chronic inflammation and increased CVD risk.

Design and method:

Patients with psoriasis and non-psoriasis individuals were recruited in the absence of diabetes and established CVD. 24h ambulatory BP was measured with the Mobil-O-Graph device. Both 24hbBPV and 24hcBPV during the whole 24h and the respective daytime and nighttime periods were extracted from the relevant ambulatory BP profiles. More specifically, in-house software was applied for the automated calculation of brachial and central average real variability (bARV/cARV) of systolic/diastolic BP (SBP/DBP), and the weighted standard deviation (wSD) of 24h SBP as a classic BPV index, using raw ambulatory BP monitoring data.

Results:

A total of 114 participants were studied (mean age 49.7 ± 12.1years; 39.5% females; 21.9% hypertensives). Patients with psoriasis (n = 74) did not significantly differ compared to controls (n = 40) in terms of age, sex, office BP, hypertension prevalence, and body mass index. Comparison of brachial and central 24hBP measurements showed lower 24h and nighttime brachial and central DBP in the psoriasis group compared to controls, but similar SBP values in the respective periods (Table 1a). By contrast, both bARV and cARV of 24h and daytime SBP, as well as bARV and cARV of 24h and daytime DBP, were significantly elevated in psoriasis patients (Table 1b).

Conclusions:

This is the first study reporting increased 24h BPV of both brachial and central SBP/DBP in patients with psoriasis. Whether 24hbBPV and 24hcBPV may be used as a subtle marker of preclinical HMOD warrants further investigation in patients with chronic immune-mediated inflammation.