bluuebunny/crossref_metadata_2025 huggingface dataset:
CONICAL CUFFS SHOULD BE USED AS REFERENCE STANDARD FOR VALIDATION OF BLOOD PRESSURE MEASURING DEVICES IN OBESE PEOPLE WITH ARM CIRCUMFERENCE OF MORE THAN 42 CM
Authors: Palatini Paolo , Fania Claudio , Saladini Francesca , Battista Francesca , Ermolao Andrea , Benetti Elisabetta , Rattazzi Marcello
Published: June 2023

Objective:

Previous research suggested that tronco-conical cuffs and bladders should be used for accurate blood pressure (BP) measurement in the very obese. However, criteria about size and shape of the reference cuff that should be used for device validations in people with arm size > 42 cm have not yet been established by regulatory bodies. Aim of this study was to investigate the performance of a tronco-conical versus a rectangular (cylindrical) cuff in obese subjects with mid-arm circumference of 43 cm or larger.

Design and method:

In 90 adults with upper arm circumference > 42 cm (X-large group), 90 subjects with arm circumference between 36 and 42 cm, and 211 subjects with arm circumference < = 35 cm, cylindrical and tronco-conical cuffs were compared. Five cylindrical cuffs of appropriate size in relation to arm circumference and 5 tronco-conical cuffs having the same length and width on the midpoint were used. In the X-large group, the cuffs had 20 cm width and 40 cm length. The tronco-conical cuff had an 85.0̊ slant angle. In each subject, BP was measured in triplicate by two observers using the cylindrical and tronco-conical cuffs in a random order.

Results:

The mean±SEM upper arm slant angle was 84.7±0.07̊ in the X-large group, 85.6±0.07̊ in the 36-42 cm group, and 87.1±0.05̊ in the < = 35 cm group (all between-group differences, p<0.0001). In the X-large group, the cylindrical cuff overestimated BP measured with the tronco-conical cuff by 4.4±0.3/3.1±0.2 mmHg, in the 36-42 cm group by 1.5±0.3/1.6±0.2 mmHg, and in the < = 35 cm group by 0.8±0.2/0.1±0.2 mmHg (X-large versus both smaller arm subgroups, p<0.0001/<0.0001). In the whole population (1173 BP readings), both arm circumference and conical shape were independent predictors of the between-cuff SBP and DBP discrepancies. Skinfold thickness improved the predictive model for diastolic (p = 0.004) but not systolic BP.

Conclusions:

In obese people with arm size > 42 cm, a cylindrical cuff causes an important overestimation of BP measured with a tronco-conical cuff. We suggest that the reference cuff for validation studies in this special population should have a conical shape with an 85̊ slant angle.
CLINICAL SIGNIFICANCE OF ELECTROCARDIOGRAPHIC LEFT VENTRICULAR HYPERTROPHY AS A POTENTIAL INDICATOR OF MASKED HYPERTENSION AMONG THE KOREAN ELDERLY
Authors: Lee Dongyoung , Park Sungkeun
Published: June 2023

Objective:

Although masked hypertension links to adverse cardiovascular outcomes, it is challenging to distinguish individuals with masked hypertension. Studies have demonstrated a significant association between left ventricular hypertrophy (LVH) and masked hypertension. However, it remains unclear whether electrocardiographic LVH has the predictability for masked hypertension.

Design and method:

The study participants were 511 Korean elderly with well-controlled blood pressure (BP) or normotension who underwent electrocardiography and ambulatory blood pressure monitoring (ABPM). We categorized them into two groups by presence or absence of electrocardiographic LVH. We conducted Pearson correlation analysis (beta coefficient [95% confidence interval] and logistic regression analysis (odd ratio (OR) [95% CI]) to evaluate the association of electrocardiographic LVH with components of ABPM. The area under the receiver operator curve (AUC) was calculated to assess the predictability of electrocardiographic LVH for 24-hour average masked hypertension.

Results:

Electrocardiographic LVH significantly correlated with 24-hour mean systolic blood pressure (SBP) (5.83 [2.16-9.51]), daytime SBP (5.0 [1.27-8.72]), and nighttime SBP (7.89 [3.49-12.30]). Electrocardiographic LVH showed the increased OR for masked hypertension in 24-hour average BP (2.18 [1.17-4.07]), in daytime average BP (2.03 [1.09-3.79]), and nighttime average BP (1.83 [0.86-3.88]). The receiver operating curve indicated the significant predictability of electrocardiographic LVH for 24-hour average masked hypertension (area under the curve: 0.706 [0.604-0.809]).

Conclusions:

Electrocardiographic LVH is potentially effective in distinguishing individuals with masked hypertension.
PREVALENCE OF THE WHITE COAT EFFECT IN A POPULATION OF HYPERTENSIVE PATIENTS
Authors: Hamdani Achref , Bayar Mohamed Fehmi , Ajra Zaineb , Gheni Refaat , Rashikou Lamia , Hmida Riadh Ben , Ounissi Taha , Elhadj Zied Ibn
Published: June 2023

Objective:

The white coat effect (WCE), defined as elevated office blood pressure (BP) and normal out-of-office BP, is of great importance in medical practice since it leads to overestimate the degree of BP figures. The objective of the study is to determine the prevalence of WCE in treated and untreated hypertensive patients.

Design and method:

we conducted an analytical cross-sectional study including 100 patients aged > 18 years, followed at the outpatient cardiology clinic of the Mohamed Taher Maamouri university hospital in Nabeul over a six months period (July-December 2021). The BP measurement in the office was performed on the day of inclusion.

Patients were asked to measure BP at home as instructed by the physician using validated blood pressure self-measurement devices (MICROLIFE BP A3 PLUS, MICROLIFE BP A2 Basic and Beurer BM 40 ). These devices were loaned to the patient who had to return them on the day of the ABPM installation. Laying of ABPM was performed immediately after the HBPM using a Bravo Mini validated device from Sun Tech Medical.

The comparisons of percentages were carried out by the Chi-square test.

Results:

The average age of our population was 59.14±13.12 years (range 21-92 years), composed of 47 women and 53 men. 84% of the population has treated hypertension. The prevalence of WCE was 30% in HBPM and 27% in ABPM, 26 patients (31%) and 21 patients (25%) were objectified in treated hypertension respectively by HBPM and ABPM. The difference between these two methods was not statistically significant (p = 0.198).

Conclusions:

The prevalence of WCE was high in this population. HBPM and ABPM are two effective methods for diagnosing and confirming this phenomenon.
KOROTKOFF SOUNDS DO NOT PROVIDE AN ACCURATE ESTIMATE OF SYSTOLIC AND DIASTOLIC PRESSURE IN SPHYGMOMANOMETRY AND CANNOT BE USED AS A CALIBRATION STANDARD FOR NIBP DEVICES
Authors: Celler Branko , Yong Andy , Rubenis Imants , Butlin Mark , Argha Reza , Rehan Rajan , Avolio Alberto
Published: June 2023

Objective:

Noninvasive blood pressure (NIBP) devices are calibrated against validated auscultation sphygmomanometers using Korotkoff sounds. This study aimed to investigate the timing of Korotkoff sounds in relation to pulse appearance in the brachial artery and values of intra-arterial blood pressure.

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. Intra-arterial brachial artery pressure (IABP) was measured below the cuff with a fluid-filled catheter inserted via the radial artery and an external transducer. Finger photoplethysmography was used to measure brachial pulse wave velocity (PWV). Korotkoff sounds were processed electronically and custom algorithms identified the cuff pressure (CP) at which the first and last Korotkoff sounds were heard. PWV and max slope of the IABP pressure pulse were recorded to estimate arterial stiffness.

Results:

The brachial artery closed at a CP of 132.0±17.1 mmHg. Systolic (SBP), and diastolic (DBP) pressure were 147.6±14.3 and 72.7±10.1mmHg; mean pressure (MP, 100.1±10.4 mmHg) was similar to MP derived from the peak of the oscillogram (98.5±13.6 mmHg). Difference between IABP and CP recorded at first and last occurrence of Korotkoff sounds were, SBP: 18.9±8.3 (range 2-29) mmHg, DBP: 4.0±4.3 (range -1.6 -12.4) mmHg. Multiple linear regression showed that differences increase with arterial stiffness and can be compensated for using a prediction equation for calculation of true SBP (tSBP) using heart rate (HR) and Korotkoff derived systolic (SBPk) and diastolic (DBPk), at least over the limited age range for this study cohort.

Conclusions:

SBP and DBP derived from the onset and termination of Korotkoff sounds can underestimate IABP by up to 29 mmHg. Since Korotkoff sounds are the recommended method mandated by the universal standard for the validation of blood pressure measuring devices, these errors are propagated through to all NIBP measurement devices irrespective of whether they use auscultatory or oscillometric methods thus explaining the well known differences recorded between NIBP measurements and intra-arterial BP measurements.
AN EQUIVALENT MEASUREMENT PERFORMANCE OF THE AKTIIA BRACELET IS OBSERVED IN THE ADULT AND ELDERLY POPULATIONS
Authors: Almeida Tiago Paggi de , Damianaki Aikaterini , Sola Josep , Theiler Kenji , Alexandre Jérémy , Vermare Pascale , Perruchoud David , Shah Jay , Wuerzner Grégoire
Published: June 2023

Objective:

It remains unclear whether non-occlusive blood pressure (BP) monitoring devices yield equivalent performance across different age categories. We sought to compare the performance of BP measurements conducted by the Aktiia cuffless monitor in the adult and elderly populations, in different body positions.

Design and method:

Two cohorts of patients (adult, 21-65 years; elderly, 65-85 years) were recruited for a prospective clinical study (NCT04027777, Lausanne University Hospital, Switzerland, August/2019–March/2022). During 4 visits spread over a month, systolic/diastolic BP (SBP, DBP) measurements obtained by the cuffless Aktiia G1 Bracelet (Aktiia SA, Switzerland) were compared to double-blinded auscultation in sitting, standing and lying positions after initial calibration. The two ISO 81060-2 criteria were used to compare BP measurements by Aktiia and auscultation (BP-reading-level – criterion 1; subject-level – criterion 2) in the sitting position – as no ISO criteria exists so far for other body positions.

Results:

96 adult (38±12 years)/35 elderly (73±6 years) were included in the study. Of those, 84 adult/35 elderly patients were investigated in sitting position; 91 adult/35 elderly in all body positions. Average SBP and DBP were higher in the elderly cohort (SBP 133.9±17.7 vs. 116.4±20.3 mmHg, P<0.0001; DBP 77.9±11.7 vs. 74.5±12.0 mmHg, P<0.0001). On sitting position at BP-reading-level, SBP and DBP for both cohorts were within ISO targets for mean error and SD (Table 1). At subject-level, the SD of the mean paired differences per subject were within individual ISO targets for SBP and DBP on both cohorts. Statistically significant differences between cohorts were found only at BP-reading-level for all body positions (SBP: P = 0.0127; DBP: P = 0.0199). Figure 1 highlights the biases and correlations of SBP and DBP readings between the cuffless BP monitor and auscultation for both adult and elderly cohorts.

Conclusions:

The investigated cuffless BP monitor yielded equivalent BP measurements compared to auscultation, with similar performance in the adult and elderly populations.
IMPACT OF CELIPROLOL THERAPY ON BLOOD PRESSURE AND HEART RATE IN PATIENTS WITH VASCULAR EHLERS-DANLOS SYNDROME
Authors: Buso Giacomo , Paini Anna , Ciuceis Carolina De , Rosei Claudia Agabiti , Bertacchini Fabio , Stassaldi Deborah , Aggiusti Carlo , Orlando Maria , Ritelli Marco , Venturini Marina , Salvetti Massimo , Colombi Marina , Muiesan Maria Lorenza
Published: June 2023

Objective:

Vascular Ehlers-Danlos syndrome (vEDS) is an inherited connective tissue disorder characterized by arterial fragility. Celiprolol is a beta1-adrenoceptor antagonist with partial beta2 agonist activity that has been shown to reduce rates of vascular events in this setting, though the underlying mechanisms are not yet fully understood. Aim of the present study was to assess the impact of Celiprolol on blood pressure (BP) and heart rate (HR) in patients with vEDS.

Design and method:

Patients with genetically confirmed disease referred to our Institution between 2011 and 2022 were divided into two groups according to whether or not they were on Celiprolol therapy. The former were included if on Celiprolol at the dose of 400 mg daily for at least 12 months. Each participant underwent office blood pressure (BP) measurement, 24-h ambulatory BP monitoring (ABPM), and pulse wave analysis (PWA) of the radial artery with calculation of central pulse pressure (PP) and augmentation index (AIx).

Results:

Overall, 18 patients (11 females) were included. Mean age was 36 years and mean body mass index (BMI) was 22.1 kg/m2. Eleven patients were on Celiprolol therapy. No significant differences were found between groups in terms of age, sex, BMI, and presence of hypertension (p>0.05). Patients on Celiprolol therapy displayed higher values of systolic BP (SBP) (124 vs 113 mmHg; p = 0.128), diastolic BP (DBP) (76 vs 67 mmHg; p = 0.236), mean BP (92 vs 83 mmHg; p = 0.173), and HR at office BP measurement, as well as lower AIx (126 vs 140%; p = 0.176) at PWA, although the difference was not statistically significant. Similarly, no significant difference was found for all ABPM parameters (24-h, day-time, and night-time SBP, DBP, mean BP, and HR), as well as central SBP, central DBP, central mean BP, and PP at PWA between groups (p>0.05).

Conclusions:

Our study suggests little impact of Celiprolol therapy on both BP and HR in patients with vEDS, which hints additional mechanisms behind its protective effect in this clinical setting. Further studies on larger cohorts are needed to clarify these aspects.
COMPARISON BETWEEN CENTRAL AND AUTOMATED PERIPHERAL BLOOD PRESSURE MEASUREMENT FOR EARLY DETECTION OF KIDNEY DYSFUNCTION IN HYPERTENSIVE PATIENTS
Authors: Abdel-Galeel Ahmed , Fawzy Nader , Ali Wageh , Fouad Doaa
Published: June 2023

Objective:

To assess the difference of blood pressure measurements using central and automated peripheral blood pressure measurement (oscillometric) devices among patients with primary hypertension for early detection of kidney dysfunction and the validity of automated BP measurement device compared with non-invasive central BP measurement device for diagnosis of hypertension.

Also, to link between parameters such as augmentation index and pulse wave velocity index and early kidney dysfunction markers.

Design and method:

The study is a case-comparative study that included 201 patients with primary hypertension (108 patients with chronic kidney disease and 93 patients without kidney disease). Exclusion criteria were patients presenting with secondary hypertension, diabetes mellitus (DM), end stage renal disease (ESRD) on regular dialysis, young patients below 40 and above 70 years old and patients with collagen diseases. All patients underwent blood pressure measurement by OMRON M2 and Mobil-O-Graph devices, kidney function assessment and abdominal ultrasonography.

Results:

Patients with chronic kidney disease were significantly older (60.02±9.1 vs. 55.33±8.5; P < 0.001), with longer duration of hypertension (7.56±5.9 vs. 6.05±5.8; P = 0.020) in comparison to those without chronic kidney disease. Automated peripheral measurement of systolic blood pressure, diastolic blood pressure and pulse pressure were significantly higher in comparison to central blood pressure. Patients with chronic kidney disease had significantly higher augmentation index (24.06±12.6 vs. 19.02±10.8; P < 0.001) and pulsed wave velocity (8.66±1.5 vs. 8.69±6.8; P = 0.004) in comparison to those without chronic kidney disease. Augmentation index had positive correlation with pulse wave velocity (r = 0.183, P = 0.005). There was negative correlation between both pulse wave velocity and augmentation index and estimated glomerular filtration rate (r = -0.318, P < 0.001), and (r = -0.236, P < 0.001), respectively. Hence, arterial stiffness parameters are good positive test for prediction of chronic kidney disease.

Conclusions:

There is a strong agreement between non-invasive centrally and automated peripherally measured blood pressure in diagnosis of hypertension. But non-invasive central measurements are preferred over automated measurements for early prediction and detection of renal impairment.
ASSOCIATION OF HIGH NORMAL BLOOD PRESSURE DEFINED BY DIFFERENT CRITERIA WITH ALL-CAUSE AND CARDIOVASCULAR MORTALITY
Authors: Zhao Yifan , Li Moran , Zhang Yi , Han Jun
Published: June 2023

Objective:

To evaluate the association of the all-cause and cardiovascular mortality with the guideline-based classification criteria and systolic blood pressure (SBP)-based classification for high normal blood pressure.

Design and method:

We collected data from the NHANES Database,which is a large, serial, cross-sectional survey designed to be nationally representative of the civilian adult population in the United States

Inclusion Criteria: SBP > 90mmHg; Without any antihypertensive treatment; Having complete record for a history of major cardiovascular-related disease including hypertension, coronary heart disease, myocardial infarction, heart failure, stroke, diabetes and hyperlipemia.

All the participants were divided into 3 groups according to the latest guidelines or systolic blood pressure.

Group1: Normotensivel; Group2: High normal blood pressure; Group3: Hypertension

Results:

By grouping population according to guideline definition, in terms of all-cause mortality and cardiovascular death, there was no significant difference between population with normal blood pressure (NT) and with high normal blood pressure (HNBP). But both groups had significantly lower risk compared with hypertension group (HTN). Multivariate Cox regression results indicated the lowest risk of all-cause mortality in the HNBP group and no difference in risk of all-cause mortality between the NT and HTN groups, which was illogical and inconsistent with real-world clinical practice.

By grouping population according to SBP, we found that the grouping better distinguished all-cause and cardiovascular mortality among groups. Multivariate COX regression analysis found that NT and HNBP groups had no difference in risk of all-cause and cardiovascular death.

The restricted cubic spline curve of DBP showed the lowest HR were found when DBP was between 83 and 95 mmHg, which were defined as high normal blood pressure or hypertension according to guideline-directed classification. This result may be the primary reason for the difference between guideline and SBP-directed classification.

Conclusions:

In this study, our analysis showed that the blood pressure based on SBP had a higher association with both all-cause mortality and cardiovascular mortality than the guide-directed definition. DBP inclusion could be a confounding factor for the classification. People with high normal blood pressure did not show a worse prognosis than those with normal blood pressure.
ANTIHYPERTENSIVE EFFICACY OF A STRATEGY FOR SWITCHING FROM FREE COMBINATIONS TO A FIXED TRIPLE COMBINATION AS ASSESSED BY VASCULAR STIFFNESS PARAMETERS
Authors: Zbyshevskaya Elizaveta , Makeeva Tatiana , Erinchek Vadim , Zheming Wang , Jalolov Faridun
Published: June 2023

Objective:

To evaluate the 24-hour blood pressure (BP) control and the effect of the triple fixed combination (TFC) amlodipine/indapamide/perindopril on the arterial stiffness parameters according to 24-hour blood pressure monitoring (ABPM) data in patients with uncontrolled hypertension (HTN).

Design and method:

The study involved 78 patients with insufficient BP control, against the background of previous combination therapy. All patients received TFC amlodipine/indapamide/perindopril. The patients were divided into three amlodipine/indapamide/perindopril therapy groups: 1-5/1.25/5mg, 2-5/2.5/10mg, 3-10/2.5/10mg. Control visits were after 4 weeks, 12 weeks, 24 weeks of therapy. At each visit, the achievement of the target BP level <130/80mmHg was assessed, as well as the effect of therapy on the parameters of arterial stiffness (pulse wave velocity (PWVao), pulse pressure (PP), agumentation index (Aix), arterial stiffness index (ASI) and central aortic pressure parameters (systolic aortic pressure (SBPao), diastolic pressure in the aorta (DBPao), central pulse pressure (PPao)) according to ABPM.

Results:

When screening, AHT included 2 drugs - 12 (15.3%) patients, 3 or more - 66 (84.6%), free combinations of drugs 56 (71.8%), FC - 32.1%, respectively. Data analysis showed a decrease PWVao (11.39 ± 1.32 m/s vs 9.98 ± 0.91 m/s, p < 0,05) as well as ASI (174 (138,253) vs 139 (107,196) mmHg; p <0.001) and Aix -29,9(-41,12) vs - 33,7(-53, 9) p<0,05. There was a statistically significant decrease in the parameters the central pressure in the aorta.

In the analyzed group of patients, the initial blood pressure was 160.8 ± 10.3/91.5 ± 8.1 mm Hg, after 24 weeks the blood pressure decreased to 121.3 ± 3.5/73.6 ± 4.2mm Hg.st. (p <0.001). According to ABPM data, daily BP significantly (p <0.001) decreased from 153.9 ± 9.04/8.38 ± 9.18 to 120.3 ± 4.7/73.4 ± 4.7 mm Hg after 24 weeks of TFC therapy. Similar patterns were received for the night BP.

Conclusions:

Indicators of vascular stiffness, together with target BP figures, can serve as criteria for monitoring the quality of blood pressure and have been used to assess the effectiveness of antihypertensive therapy when switching patients to TFC amlodipine/indapamide/perindopril.
REMISSION OF HYPERTENSION AT SIX MONTHS OF WHOLE BODY DIGITAL TWIN TECHNOLOGY
Authors: Paramesh Shamanna , Mohammed Jahangir , Mohamed Maluk , Poon Terrence , Thajudeen Mohamed , Keshavamurthy Ashok , K Ranjita , Patil Shashikiran , Joshi Shashank
Published: June 2023

Objective:

Twin Precision Treatment (TPT) is a novel Whole-Body Digital Twin (WBDT) enabled precision nutrition which has been shown to reverse diabetes, that uses AI and the Internet of Things, to integrate multidimensional data, from non-invasive sensors, to give precision nutrition and health recommendations via the TPT app and by coaches

Design and method:

We conducted a pilot, prospective randomized trial (n = 20) to evaluate the impact of TPT on the blood pressure in hypertensives. Remission of hypertension was defined as conversion to normotensive status (SBP < 140mmHg and DBP < 90mmHg and no use of antihypertensive medication) at the follow-up visit. We did not enroll people with diabetes.

Results:

Mean age 49 years (±7.9, 95% CI 45 to 52). There were 12 males and 8 females. There was a significant change at 6 months in the SBP (mmHg) 140.2±15.8 reduced to 127.1±8.3, decrease by 13.1, p = 0.02, DBP 94.7±11.7 reduced to 86.8±6.4, decrease by 8, p = 0.014, body weight (kg) 83.4±17.2 reduced to 73±14.9, decrease by 10, p<0.001, BMI (kg/m2) 30.9±4.8 reduced to 26.7±3.9, decrease by 4.2, p<0.001 and waist circumference (cm) 103.8±13 reduced to 94.1±11.4, decrease by 9.7, p<0.001. There were 12 patients who discontinued the medications that were needed to manage hypertension, with a remission rate of 60% (12/20).

Conclusions:

Our initial results of the pilot, prospective study demonstrate that TPT has the potential to induce remission of hypertension at six months. However, the continuity of this study in terms of a larger number of patients and longer duration will further provide insights into the consistency and the scalability of the novel TPT to achieve remission of hypertension.
BLOOD PRESSURE REDUCTION WITH 3 FIXED- SINGLE PILL COMBINATION TREATMENTS OF RAS-BLOCKERS PLUS CCB AMONG PREDIABETIC HYPERTENSIVE PATIENTS. A RANDOMIZED 12-WEEK OPEN-LABEL STUDY
Authors: Liontos Angelos , Biros Dimitrios , Papagiannopoulos Christos , Tsiakas Ilias , Christaki Eirini , Liberopoulos Evangelos , Elisaf Moses , Milionis Haralampos , Liamis George
Published: June 2023

Objective:

The effect of various antihypertensive drugs on both SBP and DBP levels has been studied extensively. Dual combination treatment is advised with current guidelines as first treatment step. Herein, we present comparative data of the effect of delapril/manidipine versus valsartan/amlodipine versus telmisartan/amlodipine combination treatments on blood pressure levels, before and after a 12-week treatment, in hypertensive prediabetic patients.

Design and method:

Data were collected from 158 patients from the outpatient clinic for patients with lipid disorders, hypertension and diabetes of our hospital, during the period 2014-2018 with stage II arterial hypertension and prediabetes. A total of 53 patients was randomized in the delapril/manidipine group 30/10 mg per day while 51 persons had been randomized in the group of telmisartan/amlodipine 80/5mg per day and 54 patients in the valsartan/amlodipine 160/5 mg per day. All patients successfully completed the study. Baseline characteristics are presented in Table 1A.

Results:

The resulting alternations on BP levels, before and after the 12-week treatment are presented on Table 1B for the 3 treatment groups.

Conclusions:

there was a statistically significant difference observed in SBP levels, at the end of the 12-week treatment, for each treatment group (p-value<0,001) with a change of -18 mmHg for DEL/MANI treatment group (reduction rate: -11.54%), -24 mmHg for TEL/AMLO treatment group (decrease rate of -14.72%) and -22 mmHg for VAL/AMLO treatment group (reduction rate: -13.58%). DBP levels showed a significant difference at the end of the treatment, for each group (p-value<0,001) with a change of -12 mmHg for DEL/MANI treatment group (reduction rate:-12%), -15 mmHg for TEL/AMLO treatment group (reduction rate: -15%) and -13 mmHg for VAL/AMLO treatment group (reduction rate: -13%).

In comparison between treatment groups, a statistically significant difference was observed in the change of SBP levels from the start of treatment to its end, for DEL/MANI treatment group, compared to VAL/AMLO (p-value<0.05) as well as compared to TEL/AMLO treatment group (p-value <0001). The smallest decrease in SBP levels was observed In DEL/MANI treatment group, of all the 3 treatment groups.
BASELINE DATA OF A 3-YEAR RANDOMIZED CONTROLLED TRIAL ASSESSING THE EFFECTS OF THE REDUCTION OF ANTIHYPERTENSIVE TREATMENT IN NURSING HOME RESIDENTS >80 YO. THE RETREAT FRAIL TRIAL
Authors: Gautier Sylvie , Freminet Anne , Metz Alice , Georgiopopulos Ioannis , Labat Carlos , Rossignol Patrick , Benetos Athanase , Consortium Retreat Frail
Published: June 2023

Objective:

Although the benefits of blood pressure (BP) lowering treatments in patients over 80 years with preserved functional status have been shown, the benefits in treated hypertensive patients of this age-group with several co-morbidities and loss of functionality, remain controversial: data from observational studies show rather inverse relationships between BP and prognosis, whereas there is a total lack of interventional trials in these subjects.

Design and method:

RETREAT FRAIL is a multicenter randomized controlled trial aiming to evaluate the effect of the step-down of antihypertensive medications on all-cause mortality (mean follow-up, 36 months) in nursing home (NHs) residents over 80 years, treated with >1 antihypertensive drug and presenting an SBP<130 mmHg. The only clinical exclusion criterion was an estimated life expectancy <3 months. Enrolled patients were randomized into one of the 2 groups: treatment step-down or control group. In both groups, the follow-up is performed in the NHs every 2 months, including a comprehensive geriatric assessment every 6 months.

Results:

Between April 2019 and July 2022, 1048 patients (842 women), mean age 90±5, from 108 NHs were randomized (528 step-down and 520 controls). They were receiving at mean 9.4±3.4 different medications including 2.5±0.7 antihypertensive medications. Mean SBP: 118±11mmHg, DBP: 65±10 mmHg and HR: 71±12 bpm. Based on ADL, MMSE, and mobility criteria, 52% had severe loss of autonomy, 32 % partial loss of functionality and autonomy and 16% had preserved autonomy and functionality. No differences were observed for all these parameters between the 2 randomization groups. The 3-year follow-up of this trial will be completed June 2024.

Conclusions:

Despite the difficulties in NHs dramatically aggravated during the COVID-19 pandemic, we were able to complete the enrolment of the residents and to respect the follow-up protocol. RETREAT FRAIL will be the first randomized trial to provide information concerning the long-term effects of a progressive standardized down-titration of the BP lowering treatment in very old frail patient i.e. those who have so far been completely excluded from clinical trials.
HOW DOES THE ANTIHYPERTENSIVE THERAPY OF EVERYDAY PATIENTS FOLLOW THE DIFFERENT GUIDELINES?
Authors: Fejes Imola , Kiss Dávid , Ábrahám György , Légrády Péter
Published: June 2023

Objective:

The different guidelines have got therapeutic recommendations for different conditions with hypertension. It sounds perfect. But what is the situation in the real life? How does the antihypertensive therapy of everyday patients follow the different guidelines?

Design and method:

Medications of alltogether 453 patients were analysed retrospectively from case reports. The selection of the patients was not based on specific criteria, but they arrived for their next visit at one of the Hypertension Outpatient Clinics of the Nephrology-Hypertension Center of the University of Szeged between 06/01/2021 and 31/12/2021. The authors used the guidelines valid in 2021 of the European Hypertension Society, the Hungarian Hypertension Society, the American Heart Association, the Hypertension Canada and the NICE as a base. Diabetes mellitus, angina pectoris, acute myocardial infarction, atrial fibrillation, congestive heart failure, chronic kidney disease without proteinuria, renal failure with proteinuria and stroke/TIA were the analysed conditions.

Results:

The rates of recommendation follow-up are summarized in the table.

Conclusions:

The antihypertensive medication of the patients proved to follow recommendations well. There were only non-significant differences between the following recommendations. In cardiovascular conditions, which can be considered more serious, it was completely the same.
A STUDY OF BRACHIAL AND CENTRAL 24HOUR BLOOD PRESSURE VARIABILITY ACROSS DIFFERENT HYPERTENSION PHENOTYPES
Authors: Lazaridis Antonios , Anyfanti Panagiota , Malliora Anastasia , Triantafyllou Areti , Zarifis Ippokratis , Mastrogiannis Konstantinos , Doumas Michalis , Gkaliagkousi Eugenia
Published: June 2023

Objective:

Masked hypertensives (MHs) are considered a group of increased cardiovascular risk similar to sustained hypertensives. Brachial short term blood pressure (BP) variability (BPV) has been increasingly related to a higher risk of hypertension-mediated damage. Accordingly, central BP (cBP) has been considered to be more closely associated with target-organ damage. Limited data exists regarding BPV in MHs whereas no study has ever investigated BPV of 24hour cBP in MHs. Therefore, this study aimed to investigate and compare brachial and central BPV measures across different hypertension phenotypes.

Design and method:

Untreated essential hypertensive patients (UHTs) including MHs and normotensive individuals (NTs) were included in the study. Ambulatory BP was measured with the Mobil-O-Graph device, according to standard guidelines. The BPV parameters including the weighted standard deviation (wSD) and average real variability (ARV) of 24hour brachial and central systolic BP (SBP) and diastolic BP (DBP) were calculated according to a standardized formula based on the ambulatory BP monitoring (ABPM) measurements.

Results:

A total of 141 participants were studied (49.4±8.6 years; 62.4% males) including 79 UHTs, 22 MHs and 40 NTs. Baseline characteristics were similar between groups. As expected, groups differed significantly in terms of office and ABPM-derived BPs. Remarkably, all markers of 24h brachial BPV and 24h central BPV were comparable between MHs and UHTs and significantly higher compared to NTs (Table 1).

Conclusions:

Brachial and central BPV parameters in MHs don’t differ compared to UHTs, but are significantly higher compared to NTs. Whether this observation is clinically meaningful in terms of cardiovascular risk and target organ damage prediction, merits further investigation.
INTEREST OF TROPONIN ASSAY IN BREAST CANCER PATIENTS ON ANTHRACYCLINES
Authors: Nawal Habak , Nadjet Rouibah , Ammar Chikouche
Published: June 2023

Objective:

anthracyclines objectives sont des médicaments anticancéreux utilisés dans le traitement de différents types de cancer, principalement lors de la chimiothérapie du cancer du sein. Les lésions cardiaques secondaires peuvent entraîner des problèmes cardiaques asymptomatiques ou symptomatiques pendant et après le traitement du cancer, ce sont les principaux effets secondaires des anthracyclines. La toxicité peut entraîner une toxicité aiguë ou chronique.

L’objectif de nos travaux est de déterminer l’intérêt de mesurer la troponine chez les patientes atteintes d’un cancer du sein traitées par anthracycline, dans la détection des lésions cardiaques.

Design and method:

Nous avons recruté 16 femmes du service d’oncologie médicale du CPMC, atteintes d’un cancer du sein sous antracyclines, Des échantillons de sang ont été prélevés dans un tube héparinisé lors des différents traitements de chimiothérapie. Nous avons mesuré les paramètres : urée, créatinine sur l’appareil de Cobas Roche ; Troponine par immunofluorescence (Tosoh).

Results:

Nous avons trouvé un équilibre rénal normal chez tous les patients : sauf pour le patient n̊ 12 : l’urée est passée de 0,35 à 0,48 g/L ; La créatinine augmente de 16 à 23 mg/L. Pour la troponine, tous les résultats sont normaux

Chez Deux Patients:

- Chez le patient n̊ 12; Les taux de troponine étaient normaux à l’inclusion à 0,02 ng / mL, puis ont augmenté à 0,04, puis 0,11 au troisième rendez-vous de suivi.

- Chez le patient n̊ 16; Les taux de troponine étaient normaux au départ, puis ont augmenté à 0,04 et 0,08 au troisième rendez-vous de suivi.

Ces résultats positifs à la troponine sont en corrélation avec la présence d’une lésion cardiaque confirmée par un électrocardiogramme ECG et un scanner cardiaque. Les deux patients sont suivis dans le service de cardiologie. Pour la patiente n̊12, elle a développé une néphrotoxicité et une cardiotoxicité

Conclusions:

de la troponine comme biomarqueur pour la détection des lésions cardiaques a été démontrée dans plusieurs études. La combinaison de la troponine et du test Pro-bnp augmenterait la spécificité de la détection de la cardiotoxicité, qui est l’une de nos prochaines perspectives.
CARFILZOMIB-BASED REGIMEN AND CARDIOTOXICITY IN MULTIPLE MYELOMA: INCIDENCE OF CARDIOVASCU-LAR EVENTS AND ORGAN DAMAGE IN CARFILZOMIB-DEXAMETHASONE VERSUS CARFIL-ZOMIB-LENALIDOMIDE
Authors: Astarita Anna , Mingrone Giulia , Airale Lorenzo , Cesareo Marco , Leone Dario , Colomba Anna , Catarinella Cinzia , Gay Francesca , Bringhen Sara , Veglio Franco , Milan Alberto , Vallelonga Fabrizio
Published: June 2023

Objective:

Cardiotoxicity is a known adverse effect of Carfilzomib therapy, nevertheless few data are available on cardiovascular complications induced by different Carfilzomib-regimens in a real-life setting. The aim of this perspective study was to investigate the difference in incidence and time of onset of cardiovascular adverse events between Kd and KRd in MM patients in real-life conditions. Furthermore, we investigated differences in subclinical organ damage (both cardiac and vascular ) induced by the two regimens, and offer a discussion on how these data might support different follow up strategies for patients treated with Kd or KRd regimen

Design and method:

In this prospective study, adults with MM who had haematological indication to Kd or KRd, were consecutively enrolled. They underwent a baseline cardiovascular assessment before treatment initiation and a follow-up evaluation at 6 months, including office blood pressure measurements, ambulatory blood pressure monitoring, 12-leads EKG, trans-thoracic echocardiography with global longitudinal strain assessment (GLS), and estimation of arterial stiffness by the carotid-femoral pulse wave velocity (cfPWV) measurement.

Results:

A total of 109 patients were enrolled, 47 (43%) received Kd and 62 (57%) KRd. All-types of cardiovascular and hypertensive events occurred more frequently in Kd group compared to KRd (59% vs 40% and 55% vs 35.5% patients, respectively, p<0.05), with higher incidence of hypertensive urgencies. Furthermore, the time of onset of all-type of CVAEs, major and hypertensive event was shorter in Kd regimen compared to KRd (3.6 vs. 10.2 months, 4.0 vs. 10.8 months and 8.6 vs. 14.6 months, respectively (p < 0.05)). At follow-up, Kd patients developed more frequently signs of cardiac as decline of global longitudinal strain (-19.7 vs -21.3, p = 0.009) and vascular organ damage demonstrated by a rise of pulse wave velocity (8.5 vs 1.9, p = 0.009), with respect to KRd.

Conclusions:

In conclusion, Kd regimen showed greater cardiovascular toxicity with respect to KRd and earlier onset of events. Thus, a closer and careful follow-up should be considered.
ASSOCIATION OF DIABETES AND DYSLIPIDEMIA IN HYPERTENSIVE PATIENTS IN NEPHROLOGY CONSULTATION: PREVALENCE AND CARDIOVASCULAR COMPLICATIONS
Authors: Triqui Chifa , Khadhar Mariem , Jerbi Mouna , Hadded Sarra , Gaied Hanene , Aoudia Raja , Goucha Rim
Published: June 2023

Objective:

Diabetes, dyslipidemia and hypertension are increasing in prevalence worldwide and they are among the most cardiovascular factors.

The aim of this work was to know the cardiovascular complications found in hypertensive patients with diabetes and dyslipidemia followed in nephrology consultation.

Design and method:

We conducted a descriptive retrospective study over a period of two years (January2020- January2022) including hypertensive patients aged over 18 years followed in nephrology consultation. Cardiovascular risk was estimated by calculating the Framingham score. The stage of chronic kidney disease (CKD) was defined according to the KDIGO 2012 classification.

Results:

Our study included 73 patients followed in our nephrology consultation for hypertension associated or not with nephropathy. The mean age was 69.62+/-9.59 [30-96] with a sex ratio M/F = 1.35. Diabetic patients were 44(60.27%) and dyslipidemic patients were 25 (34.24%). Diabetes associated with dyslipidemia were found in 21 patients (28.76%).

Among the diabetic patients, hypertension was diagnosed before diabetes in 24 patients (54.54%) and it was considered as diabetic macro angiopathy in 20 patients (45.45%).

Diabetic nephropathy was found in 32 patients (72.72%) and diabetic retinopathy in 20 patients (45.45%). The average Framingham score was (22.94%) and (21.52%) in diabetic and dyslipidemic patients respectively.

Obesity was found in 15 patients of our population (20.54%), of which, 12 patients were diabetic (80%) and 7 patients were dyslipidemic (46.66%). Coronary artery disease was found in 14 patients in our population (19.17%) of whom 8 were diabetic (57.14%) and 3 were dyslipidemic (21.42%).

Heart failure was found in 8 patients, 6 of whom were diabetic (75%) and 3 of whom were dyslipidemic (37.5%). Six patients in our population had a stroke (8.21%), 5 of whom were diabetic (83.33%) and 2 were dyslipidemic (33.33%).

Regarding the renal impact, we noted the presence of chronic kidney disease stage 3 or more in 55 patients (75.34%) among which 19 patients had dyslipidemia (34.54%).

Conclusions:

We noted a multitude of cardiovascular events in patients with diabetes and/or dyslipidemia associated with hypertension.

Early identification and management of these risk factors are necessary to prevent cardiovascular complications.
ARTERY ELASTICITY INDICES AND TESTOSTERONE- LONGITUDINAL STUDY IN VARA- SKÖVDE COHORT
Authors: Szalo Gabor , Hellgren Margareta , Lindblad Ulf , Daka Bledar
Published: June 2023

Objective:

To determine the associations between testosterone, sex hormone-binding globulin (SHBG) and arterial elasticity in men in a longitudinal observational study.

Design and method:

2816 randomly selected individuals were examined (Men = 1400) between 2002 and 2005. After excluding participants with known hypertension and without data for arterial elasticity and testosterone, we include 1202 men in cross-sectional analyses. After a mean follow-up of 9.7 ± 1.4 years, a representative sample of 1327 original participants was re-examined. In the longitudinal analysis, 473 men were included. Body height, weight, heart rate and blood pressure were measured. Total testosterone (TT) and SHBG were analyzed using RIA. Bioavailable testosterone (BioT) is calculated by the Vermeulen coefficient. Arterial elasticity was measured based on pulse contour analysis of arterial waveform using the HDI/Pulse WaveTM CR2000 and C1 and C2 were obtained. Linear regression models were used to investigate these associations in three models: in model 1 adjusting for age, in model 2 we added heart rate, systolic blood pressure and in model 3 we added BMI. Multivariable general linear models were used to investigate the differences in C1 and C2 based on testosterone deficiency.

Results:

Mean age at baseline was 46.2±10.9 years. In cross-sectional analysis, an increase in TT and BioT was associated with an increase of C1 (beta = 0.08, CI: 0.02-0,14, p = 0.01 resp beta = 0.14, CI: 0.001-0.272, p = 0.05) in model 1, but not in the other models. In model 1 participants with testosterone deficiency had significantly lower C1 (C1 in TD: 17.6±5, C1 in the normal level of TT: 18.2±5, delta C1: 0.6, CI: 0.06- 1.1; p = 0.05), but not in the other models. Other associations between TT, BioT, SHBG, TD and C1 respective C2 were not significant in the models.

Conclusions:

We found weak associations between artery elasticity indices and testosterone levels. Surprisingly these associations were not significant after adjustments for pulse and blood pressure, even though the sample was large enough to reveal clinically significant associations.
PRESCRIPTIVE APPROPRIATENESS OF CHOLESTEROL-LOWERING DRUGS AMONG PATIENTS ATTENDING CARDIAC REHABILITATION AFTER ATHEROSCLEROTIC CARDIOVASCULAR DISEASE. RETROSPECTIVE STUDY
Authors: Saladini Francesca , Baggio Stefania , Marcato Federica , Campisi Francesco , Ferri Nicola , Verlato Roberto
Published: June 2023

Objective:

Cardiovascular (CV) diseases still represent one on the main causes of death. The promotion of a healthy lifestyle and active treatment of CV risk factors such as cholesterol level is mandatory to reduce risk of unfavourable outcome. Aim of the present study was to investigate the prescriptive appropriateness of cholesterol-lowering drugs among patients who experienced an atherosclerotic CV disease (ASCVD).

Design and method:

We investigate 155 patients who experienced an ASCVD and underwent cardiac rehabilitation in 2020. The ESC 2021 guidelines on CVD prevention and 2019 ESC Guidelines on dyslipidaemias were followed to detect appropriateness; SCORE2 and SCORE2-OP risk estimation were used to detect patients’ CV risk profile. For the analysis patients were divided into two groups: 1 (n = 118) patients admitted for the first CV event, 2A (n = 18) patients who experienced a previous CV event and were admitted for a second event, 2B (n = 19) patients within a previous CV event within 2 years. LDL cholesterol (c-LDL) was detected at admission to hospital, during rehabilitation and at the first visit after rehabilitation, within 6 to 12 months.

Results:

Mean age of study participants was 66 years (41-88), 88.4% were males, 72% were overweight/obese, 25% diabetic, 37% smokers, 60% hypertensives, 57% dyslipidemic. Among group 1 patients, with no previous CV events, only 5.1% had low/moderate risk, 44.1% high risk and 50.8 very high risk according to SCORE2 or SCORE2-OP calculator. Mean c-LDL at admission to hospital was 121.5 mg/dl, 58.8 mg/dl during rehabilitation 58mg/dl at the subsequent medical visit. 32.6% reached c-LDL<55 mg/dl, 96.6% with high intensity statin (as monotherapy or associated to ezetimibe). 67.4% did not reach c-LDL<55mg/dl, despite 93.3% were treated with high intensity statin alone or plus ezetimibe. Among group 2A patients 47.1% reached c-LDL<55 mg/dl by mean of high intensity statin (87.5%), while among 2B patients only 3 subjects reached c-LDL<40 mg/dl.

Conclusions:

This retrospective study confirmed the importance of primary prevention and the utility to calculate CV risk profile. The main limitations for the efficacy lipid lowering drugs resulted: patient's compliance, drugs side effects, lifestyle habits and collaboration with general practitioner.
CORONARY MICROVASCULAR DISEASE IS ASSOCIATED WITH ARTERIAL STIFNESS IN PATIENTS WITH ISCHEMIA AND NO OBSTRUCTIVE CORONARY ARTERIES
Authors: Sakalidis Athanasios , Dimitriadis Kyriakos , Konstantinidis Dimitrios , Dri Irene , Leontsinis Ioannis , Bora Margarita , Iliakis Panagiotis , Mantzouranis Emmanouil , Vlachakis Panagiotis K. , Siafi Irene , Manta Eleni , Kariori Maria , Mavroudis Andreas , Tsioufis Panagiotis , Fragkoulis Christos , Aznaouridis Konstantinos , Thomopoulos Konstantinos , Tsioufis Konstantinos
Published: June 2023

Objective:

There is a gap in the literature regarding the association between stiffness and myocardial ischemia. Arterial stiffness (AS) is an independent risk factor for cardiovascular disease, directly related to coronary atherosclerosis, an entity with an unfavorable cardiovascular prognosis frequently encountered in patients with hypertension.

The aim of this study was to investigate the relationship between AS and Coronary Microvascular Dysfunction (MVD).

Design and method:

We examined 23 hypertensive patients [10 female, 43%, mean age: 61.5±10.1 years, mean office blood pressure (BP): 147/88±10/9 mmHg] and 28 MVD patients (19 female, 68%, mean age: 58.3±4.6 years, average office BP: 139/81±16/13 mmHg). In the group of patients with angina, MVD was defined by a standardized systematic protocol in which coronary flow reserve (CFR) and index of microvascular resistance (IMR) were measured in the left anterior descending coronary artery using a temperature/pressure sensor-tipped guidewire. MVD patients were classified into 2 groups, structural and functional endotype, based on commonly used cut-offs (impaired CFR < 2.5, increased IMR > 25). In addition, in all participants, arterial stiffness was assessed using the aortic augmentation index (AIx), derived from the analysis of central pulse waveforms, recorded by applanation tonometry directly from the radial artery.

Results:

In the MVD group, the coronary flow reserve (CFR) was 1.4±0.9 and the index of microvascular resistance (IMR) was 43.9±30 IU. Of the 28 patients with impaired CFR, 8 (28%) had normal IMR consistent with functional CMD endotype, and 20 (71%) had abnormal IMR associated with structural alterations of the microvasculature. AIx was found to be increased in MVD patients compared to hypertensives (35.4±10.8 vs 27.4±12.6%, p = 0.031). This difference in AIx between the CMD and asymptomatic hypertensive controls was found to be statistically significant after adjustment for gender and age (p<0.05). No statistically significant difference was found in body mass index, renal function, history of dyslipidemia, diabetes mellitus, and smoking between groups.

Conclusions:

Arterial stiffness was found to be increased in patients with MVD compared to asymptomatic hypertensive individuals. These results suggest that therapies targeting vascular stiffening could provide additional clinical benefit in patients with impaired coronary microvasculature.