bluuebunny/crossref_metadata_2025 huggingface dataset:
CLINICAL EVENT REDUCTIONS IN HIGH-RISK HYPERTENSION PATIENTS TREATED WITH RENAL DENERVATION: 10-YEAR PROJECTIONS BASED ON 3-YEAR FOLLOW-UP FROM THE GLOBAL SYMPLICITY REGISTRY
Authors: Esler Murray , Cao Khoa , Lobo Melvin , Sharp Andrew S. P. , Kandzari David E. , Mancia Giuseppe , Böhm Michael , Schmieder Roland E. , Pietzch Jan B.
Published: June 2022

Objective:

Clinical event rates over 3 years have been published for patients with uncontrolled hypertension treated with radiofrequency renal denervation (RDN) in the Global SYMPLICITY Registry (GSR). We estimated 10-year clinical event reductions following RDN vs. a simulated control group without RDN, for two high-risk subgroups and the full GSR cohort.

Design and method:

A Markov model was used to compare projected 10-year clinical events [stroke, myocardial infarction (MI), cardiovascular death (CVD), heart failure (HF), all-cause death (ACD), and a composite of major adverse cardiac events (MACE, calculated as sum of stroke, MI, and CVD)] for RDN patients vs. a hypothetical control for the high atherosclerotic vascular disease risk (ASCVD) subgroup (n = 737; 69 ± 8 years), the type-2 diabetes mellitus (T2DM) subgroup (n = 1,007; 64 ± 10 years), and for all GSR patients (n = 2,651; 61 ± 12 years). The simulated control assumed maintenance of baseline office systolic blood pressure (oSBP) over time. The model was calibrated to 3-year stroke and MI events reported in the GSR and used published meta-regression data to calculate risk reduction based on cohort-specific changes in oSBP from baseline. Relative risks (RRs), events avoided, and numbers needed to treat (NNTs) were calculated at 3 and 10 years, along with the ratio of 10- vs. 3-year projected events avoided.

Results:

10-year MACE events were 35.8% vs. 48.5% (-12.7%, RR = 0.74) for RDN vs. control for all GSR patients, 37.8% vs. 52.4% (-14.6%, RR = 0.72) for the high ASCVD risk cohort, and 40.5% vs. 54.0% (-13.5%, RR = 0.75) for the T2DM cohort. Across all three cohorts, events avoided were highest for stroke and lowest for MI. 10-year NNTs for MACE were comparable between the three cohorts, estimated between 7 to 8. The ratio of model-projected MACE at 10- vs. 3-years was 5.20, 5.46, and 5.03 for the full GSR, high ASCVD risk, and T2DM cohorts, respectively.

Conclusions:

Model-based projections based on 3- year events observed in the GSR suggest meaningful event reductions after treatment with radiofrequency RDN at 10 years that might be up to 5-times higher than the projected events avoided at 3 years under the assumption of maintained treatment effect versus baseline.
PREDICTING LONG-TERM SURVIVAL AFTER AN ISCHEMIC STROKE. THE ESH-STROKE SURVEY
Authors: Wohlfahrt Peter , Krajcoviechova Alena , Jr Otto Mayer , Vanek Jiri , Hlinovsky David , Kielbergerova Lenka , Lanska Vera , Cifkova Renata
Published: June 2022

Objective:

To identify factors influencing long-term survival after ischemic stroke is of utmost importance. The aim of the present study was to analyze long-term survival and to assess factors associated with increased mortality following ischemic stroke.

Design and method:

Consecutive patients enninlised between March 2009 and January 2012 for their first-ever ischemic stroke in 2 large tertiary hospitals in the Czech Republic were enrolled in this survey.

Results:

In total, 736 patients (mean age 66 ± 11 years; 58% men) were included in this analysis. The cumulative risk of death at 1, 3, 5 and 10 years was 13.6%, 20.8%, 29.3% and 48.3%, respectively. After adjusting for age and gender, patients with discharge systolic blood pressure between 120 and 140 mmHg showed the lowest mortality risk (Figure 1.) Higher age, higher NIHSS on admission and more severe functional impairment, diabetes and current smoking were associated with higher mortality risk, while the reperfusion therapy, and ennin-angiotensin system blockers were associated with a lower mortality (Figure 2).

Conclusions:

Despite several advances in stroke management, the mortality remains high. Timely reperfusion therapy use together with ennin-angiotensin system blockers may decrease the risk of mortality.
INDIVIDUAL ANTIHYPERTENSIVE MEDICATION AND SKIN CANCER RISK: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Heisel Annalena , Vuurboom Mart D. , Daams Joost G. , De Rie Menno A. , Vogt Liffert , van den Born Bert-Jan , Engberink Rik H.G. Olde
Published: June 2022

Objective:

The use of hydrochlorothiazide has recently been linked to skin cancer in observational studies. This may be explained by its enninnsitising properties, but photosensitivity has also been reported for other antihypertensive drugs. We conducted a systematic review and meta-analysis to compare skin cancer risk among antihypertensive drug classes and between individual blood pressure lowering drugs.

Design and method:

We searched Medline, Embase and the Web of Science and included studies that investigated the association between antihypertensive medication exposure and non-melanoma skin cancer (NMSC) or cutaneous malignant melanoma (CMM). We combined the extracted the adjusted odds ratios (OR) using a random effects model. We performed sensitivity analyses comparing study type, population and studies with and without correction for important covariates.

Results:

We included 37 studies. Diuretics (n = 16,625,573), in particular hydrochlorothiazide (n = 16,068,501), and calcium channel blockers (CCB, n = 13,176,689) were examined more frequently than beta-blockers (n = 94,872) or ennin-angiotensin system inhibitors (n = 2,014,579). Exposure to diuretics (OR 1.33, 95% CI [1.10–1.61]) and CCB (OR 1.06, 95% CI [1.04–1.09]) was associated with an increased risk for NMSC. No antihypertensive drug class was associated with an increased risk for CMM. Within every drug class, at least 1 individual drug was associated with an increased risk for NMSC: nifedipine, hydrochlorothiazide, sotalol, verapamil, enalapril and bendroflumethiazide. Increased NMSC risk was only observed in case-control studies, specific populations (such as non-Hispanic whites, patients with coronary heart disease or veterans) and studies that did not correct for important covariates. No increased NMSC risk was observed in cohort studies, the general population, and studies that did correct for the covariates sun exposure, skin phototype or smoking (Figure). Only 2 out of 37 studies provided information about antihypertensive co-medication. Egger's test revealed a significant publication bias for the subgroup of diuretics and hydrochlorothiazide concerning NMSC (both p < 0.0001).

Conclusions:

Of all antihypertensive drugs, diuretics and calcium channel blockers may be associated with an increased risk of NMSC, but causal inferences remain difficult to make because of substantiation limitation of the available data.
COST-EFFECTIVENESS OF INTENSIVE VERSUS STANDARD BLOOD-PRESSURE CONTROL IN OLDER PATIENTS WITH HYPERTENSION
Authors: Liao Chia-Te , Toh Han Siong , Yang Chun-Ting , Wei Dongmei , Melgarejo Jesus , Chen Zhih-Cherng , Shih Jhih-Yuan , Zhang Zhen-Yu
Published: June 2022

Objective:

In the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial, Chinese patients aged 60 to 80 years who received intensive systolic blood-pressure control (target, 110 to 130 mmHg) had a significantly lower incidence rate of cardiovascular events than did those who received standard control (target 130 to 150 mmHg). Based on these data, we aimed to examine the lifetime cost-effectiveness of intensive versus standard blood-pressure control from the different healthcare providers’ perspectives.

Design and method:

A microsimulation model was employed to apply STEP treatment effects and medical costs and utility from national sources or published data to a hypothetical cohort of STEP-eligible patients in China. Incremental cost-effectiveness ratio (ICER) against willing-to-pay threshold was used to evaluate whether intensive versus standard blood-pressure control was a cost-effective option. A series of sensitivity, subgroup, and scenario analyses in other countries (the US and UK) were performed to account for the generalisability and uncertainties arising from study assumptions and parameters.

Results:

The ICER values of intensive versus standard blood-pressure control were approximate ¥ 48,000, $32,300, £10,055 per QALY gained from the perspective of healthcare providers in China, the US and the UK. Simulation results indicated that intensive treatment would be cost-effective (54.6% and 70.1% below the willing-to-pay thresholds of ¥ 80,000 and ¥240,000). The scenario analyses presented that intensive treatment would be cost-effective in the US and UK settings (63.9% and 80.4% below the willing-to-pay thresholds of $50,000 and $150,000 in the US; 75% and 82.1% below the willing-to-pay thresholds of £30,000 and £90,000 in the UK)

Conclusions:

In this simulation study, intensive blood-pressure control in the older Chinese population produced fewer cardiovascular events and acceptable costs per QALY gained, commonly below the willing-to-pay threshold. Given the STEP treatment effects in other populations, the cost-effectiveness of intensive blood-pressure control in older patients was likely consistent across different countries.
BALKAN ENDEMIC NEPHROPATHY, PULSE WAVE VELOCITY AND INCREASED TELOMERE LENGTH-ASSOCIATED CARDIOVASCULAR MORTALITY IN PATIENTS UNDERGOING CHRONIC HEMODIALYSIS
Authors: Premuzic Vedran , Toupance Simon , Stipancic Zelimir , Bukal Nikolina , Jelakovic Ana , Brzic Ivan , Benetos Athanase , Jelakovic Bojan
Published: June 2022

Objective:

Balkan endemic nephropathy (BEN) is characterized with later onset, milder forms of hypertension and lower pulse wave velocity (PWV)). We hypothesized that telomere length (TL) would be longer in BEN patients and associated with lower PWV and less cardiovascular (CV) mortality.

Design and method:

On total 124 hemodialysed (HD) patients (68 BEN, 56 non-BEN; 48.4% men; 65 ± 14 years) were enrolled and followed-up for 25 months. Blood pressure and PWV were determined before mid-week dialysis. TL was determined by telomere restriction fragment analysis.

Results:

Age-sex adjusted TL was significantly longer in the BEN group (7.19 vs 6.79; p < 0.001) despite being significantly older. In the BEN group TL was associated with PWV (beta = -0.373, p < 0.05), and in the non-BEN group with age (beta = -0.680, p < 0.01). In the full-adjusted model of multivariate linear regression analyses significant predictors of TL were systolic BP/PWV, and age in the BEN and the non-BEN group, respectively. BEN patients died significantly less frequently from CV events than non-BEN patients (p < 0.001) and lived significantly longer (log-rank p = 0.04). Patients who died had significantly shorter TL than survivors (p < 0.001). In the Cox Regression analysis older age, diagnosis of non-BEN and shorter TL were determinants of shorter survival in the entire cohort. In the BEN group shorter TL was the only determinant of shorter survival (HR 0.11 [95% CI 0.03, 0.35]). To analyze the diagnostic value of TL for CV mortality we used ROC analysis that revealed TL < 6.21 Kb to be useful for prediction of CV mortality in patients undergoing chronic HD.

Conclusions:

Shorter TL is associated with CV mortality in patients undergoing chronic HD. BEN patients had longer TL and longer survival than other ESKD patients. PWV was significant predictor of TL in BEN patients. This study confirmed our hypothesis that BEN is associated with slower vascular aging.
EPISODES OF HYPOTENSION AND DEGREE OF HBP CONTROL IN THE ELDERLY WITH ANTIHYPERTENSIVE DRUG TREATMENT
Authors: Carbonell Ana M. Piera , Anton Pilar Rodriguez , Carrasco Rodrigo Orellana , Suarez M. Jesus Campomanes , Robert M. Angeles Gavalda , Diaz Miguel Angel Prieto , Lozano Juan Eugenio Forcada , Sanchez Vicente Martín , Rodriguez Angel Diaz , Garrote Juan Antonio Divison , Valdés Ana Patricia Niembre , Carratala Vicente Pallarés
Published: June 2022

Objective:

To determine the prevalence of episodes of hypotension in the elderly receiving antihypertensive treatment and its relationship with the number of drugs and associated symptoms, during 24-hour blood pressure monitoring.

Design and method:

Multicenter cross-sectional descriptive study in hypertensive patients aged 75 or over. It was designed for a sample of 117 people, calculated for 8% hypotensive episodes, with a 95% confidence interval, 5% precision, and 25% losses.

Non-proportional stratified random sampling was performed, excluding patients with modified antihypertensive treatment in the last month and/or arrhythmias.

Through 24-hour ambulatory blood pressure monitoring, the incidence of hypotensive episodes was observed.

Associated comorbidities, antihypertensive treatment, and sleep quality during ABPM were recorded from the interview and clinical history.

Percentages, means, confidence intervals were obtained and the chi square test was performed in the bivariate analysis.

Results:

Of 117 monitored patients, 100 completed the study, with a mean age of 79.2 years (SD 3.9 years) and 59% women. 91.5% of women and 58.6% of men were overweight or obese. Some type of heart disease was associated with 31% of patients, and 33% had DM2, 38% anxiety-depressive disorder, and vertigo, 16%. 50.8% of the women and 61% of the men did not have good control of the mean TAS figures in the 24-h ABPM. However, DBP was controlled in 84.7% and 80.5% of women and men, respectively. 34% of the patients presented a dipper pattern.

76% of the patients presented at least one episode of hypotension, which was accompanied by symptoms in 11.8% of the cases, with headache and dizziness being the most frequent. No significant association has been observed between the number of antihypertensive drugs and the occurrence of hypotensive episodes.

Conclusions:

Most of the patients presented at least 1 episode of hypotension, rarely being symptomatic and not related to the number of antihypertensives. the low frequency of the dipper pattern, the high prevalence of obesity, and the poor control of systolic blood pressure require greater control of cardiovascular risk in the study population.
META-ANALYSIS OF DEDICATED HEART FAILURE TRIALS EVALUATING THE EFFECT OF SACUBITRIL/VALSARTAN ON MAJOR CARDIAC RHYTHM DISORDERS
Authors: Patoulias Dimitrios , Kassimis George , Katsimardou Alexandra , Imprialos Konstantinos , Stavropoulos Konstantinos , Koutsampasopoulos Konstantinos , Toumpourleka Maria , Siskos Fotios , Papadopoulos Christodoulos , Doumas Michael
Published: June 2022

Objective:

The important role of major cardiac rhythm disorders in the prognosis of subjects with heart failure (HF) has been discussed extensively. Sacubitril/valsartan has revolutionized treatment strategy for patients with HF with reduced left ventricular ejection fraction (HFrEF), while it is cardiovascular safe -but not efficacious- in patients with HF with preserved ejection fraction (HFpEF). Anti-arrhythmogenic effect of sacubitril/valsartan has been demonstrated in several, recent experimental studies, however the clinical implications of that observations remain largely unknown.

Design and method:

We sought to determine the effect of sacubitril/valsartan compared to active comparator on major cardiac rhythm disorders in patients with HF, pooling data from the dedicated HF outcome trials. We evaluated the following outcomes of interest: atrial fibrillation, atrial flutter, ventricular tachycardia, ventricular fibrillation and cardiac arrest. The latter outcome was assessed in the light of recent evidence that arrhythmias account for almost 7% of cardiac arrest cases, both in in-hospital and out-of-hospital settings.

Results:

We pooled data from 3 trials in a total of 14,128 enrolled subjects with HF regardless of LVEF, assigned either to sacubitril/valsartan or valsartan.Sacubitril/valsartan compared to valsartan alone did not result in a significant risk reduction for atrial fibrillation (RR = 1.05, 95% CI; 0.89–1.24, I2 = 0%), atrial flutter (RR = 1.01, 95% CI; 0.55–1.86, I2 = 34%), ventricular tachycardia (RR = 0.92, 95% CI; 0.53–1.58, I2 = 32%) and ventricular fibrillation (RR = 0.79, 95% CI; 0.47–1.32, I2 = 0%). However, we demonstrated that sacubitril/valsartan compared to valsartan conferred a significant risk reduction in cardiac arrest by 47% (RR = 0.53, 95% CI; 0.38–0.76, I2 = 0%).

Conclusions:

Therefore, despite the cardiovascular efficacy and safety of sacubitril/valsartan among patients with HF, and its established role in the treatment of patients with HFrEF, it does not prevent major cardiac arrhythmias. However, its preventive role against cardiac arrest is of utmost importance and should be assessed in future randomized controlled trials as a surrogate outcome.
RENAL EFFECTS OF SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITORS IN PATIENTS WITH HEART FAILURE WITH REDUCED OR PRESERVED EJECTION FRACTION
Authors: Patoulias Dimitrios , Katsimardou Alexandra , Boulmpou Aristi , Siskos Fotios , Imprialos Konstantinos , Stavropoulos Konstantinos , Zografou Ioanna , Papadopoulos Christodoulos , Doumas Michael
Published: June 2022

Objective:

SGLT-2 inhibitors confer cardiovascular protection for patients with heart failure (HF) regardless of diabetes mellitus (DM) or chronic kidney disease (CKD) status at baseline. However, it has not been extensively studied whether SGLT-2 inhibitors exert reno-protective effects in patients with heart failure (HF), either with reduced or preserved ejection fraction (HFrEF and HFpEF, respectively). Declining of renal function is of utmost importance for patients with HF; thus, development of optimal treatment strategies to prevent or delay this progression to renal failure is required.

Design and method:

We sought to evaluate whether SGLT-2 inhibitors confer reno-protection in patients with HF, pooling data from relevant trials. We evaluated the following surrogate outcomes: the composite renal outcome, as defined across the 3 included trials, and the > 40% decrease in estimated glomerular filtration rate (eGFR) from baseline. Definition of composite renal endpoint is as follows: time to first occurrence of: (1) chronic dialysis; (2) renal transplantation; (3) sustained reduction of > 40% in estimated GFR; or (4) sustained estimated GFR of less than 15 ml per minute per 1.73 m2.

Results:

We pooled data from 3 randomized, controlled trials for a total of 14,462 enrolled subjects with HFrEF or HFpEF, assigned either to SGLT-2 inhibitor treatment or placebo. Overall risk of bias was evaluated as low across all trials. SGLT-2 inhibitor treatment resulted in a non-significant decrease in the risk for the primary composite outcome by 27% (RR = 0.73, 95% CI; 0.50–1.08 I2 = 66%, p = 0.11). In addition, SGLT-2 inhibitor treatment led to a non-significant decrease in the risk for > 40% decrease in eGFR from baseline, compared to placebo (RR = 0.70, 95% CI; 0.48–1.03, I2 = 54%, p = 0.07). No difference was identified between HFpEF and HFrEF enrolled subjects.

Conclusions:

SGLT-2 inhibitors provide significant cardiovascular benefits in patients with HFrEF or HFpEF; however, they do not exert significant reno-protection among patients with HF.
PR INTERVAL DURATION AS A RISK FACTOR FOR NEW-ONSET ATRIAL FIBRILLATION IN PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Papakonstantinou Panteleimon , Andrikou Ioannis , Konstantinidis Dimitrios , Tsioufis Konstantinos
Published: June 2022

Objective:

Hypertension (HTN) is one of the most important risk factors associated with atrial fibrillation (AF). Prolongation of the PR interval has been associated with an increased risk of incident AF, while PR interval is a component of the Framingham risk score for AF. However, the results regarding PR prolongation as a risk factor for AF are inconsistent. We aim to evaluate the predictive role of the PR interval for AF development in a large cohort of HTN patients.

Design and method:

Consecutive patients with essential hypertension without known AF at baseline were followed up for a mean period of 5.3 ± 3.3 years. A 12-lead ECG and an echocardiography study were performed on each patient at baseline and annually, and 24 h Holter rhythm monitoring was used in the event of arrhythmia symptoms. Routine clinical and paraclinical examinations as well as medications were implemented during the follow-up period according to the European Society of Cardiology/ European Society of Hypertension guidelines for HTN management. The PR interval and P wave duration were obtained from the baseline ECG.

Results:

We included 1807 hypertensives (mean age 57 ± 11 years; 49% males) with office systolic blood pressure (SBP)/ diastolic blood pressure (DBP) 144 ± 17/89 ± 11mmHg. During the follow-up period, 65 cases (3%) of new-onset AF were recorded. Patients with new-onset AF (n = 67) compared to those without AF (n = 1740) had greater baseline P wave duration (115 vs 110 ms) and PR internal (174 vs 157 ms). Multivariable Cox regression analysis showed that higher baseline PR internal is significantly associated with the development of AF (HR 1.01, 95% CI 1.01–1.02; p = 0.01), while there was no significant predictive value for baseline P wave duration on the incidence of new-onset AF. Baseline increased DBP was associated with a higher incidence of AF (HR 1.05, 95% 1.003–1.091; p = 0.037).

Conclusions:

Baseline PR internal is a significant predictor of new-onset AF in hypertensive patients. The PR prolongation could be considered as a marker for cardiovascular degenerative aging caused by vascular inflammation and myocardial fibrosis.
BIOMARKERS OF FIBROSIS AND INFLAMMATION IN PATIENTS WITH METABOLIC SYNDROME AND ATRIAL FIBRILLATION: WHAT ARE THE DIFFERENCES IN MOLECULAR MECHANISMS IN HYPERTENSION AND OBESITY?
Authors: Ionin Valery , Elizaveta Barashkova , Viktorya Pavlova , Georgy Borisov , Ksenya Averchenko , Elena Baranova
Published: June 2022

Objective:

To determine the concentration of blood fibrotic and inflammatory biomarkers in patients with atrial fibrillation (AF) associated with metabolic syndrome (MS) components.

Design and method:

The study included 646 patients aged 35–65 years: patients with AF and MS (n = 142), those with AF and without MS (n = 113), those with MS and without AF (n = 175) and the control group consisted of healthy subjects without cardiovascular and metabolic diseases (n = 107). All participants underwent anthropometric and laboratory investigations. Profibrogenic (aldosterone, galectin-3, TGF-beta1, CTGF) and proinflammatory (CT-1, IL-6) factors were determined in serum and plasma by ELISA.

Results:

The highest concentrations of fibrotic and inflammatory biomarkers were found in patients with AF in combination with MS. In MS patients without AF, the concentration of aldosterone, galectin-3, TGF-beta1, CTGF, CT-1, and IL-6 was also higher than in healthy subjects. In patients with AF and hypertension (HTN), but without abdominal obesity (AO), higher values of aldosterone (108,1 ± 70,3 pg/ml and 89,3 ± 32,2 pg/ml, p = 0,003) and TGF¬beta1 (3680,1 ± 1863,3 pg/ml and 1968,1 ± 1611,5 pg/ml, p = 0,015) in serum than in AF patients without HTN and without AO. In the group of patients with AF and AO, but without HTN, higher concentrations of IL-6 (2,9 ± 0,7 pg/ml and 1,9 ± 0,6 pg/ml, p = 0,001) and CTGF (162,9 ± 92,2 pg/ml and 116,3 ± 63,4 pg/ml, p = 0,0001). Correlation analysis made it possible to establish a stronger relationship between aldosterone and TGF¬beta1 with systolic blood pressure (r = 0,493, p < 0,0001 and r = 0,530, p < 0,0001), and CT¬1, CTGF and IL¬6 in a greater degree correlated with waist circumference (r = 0,563, p < 0,0001; r = 0,626, p < 0,0001; r = 0,480, p < 0,0001).

Conclusions:

It can be assumed that hypertension through the aldosterone system and TGF-beta1, as well as abdominal obesity through the cytokine system CT-1 and IL-6 activate various mechanisms and pathways for myocardial emodelling. Integral molecules galectin-3 and CTGF mediate their interactions, in particular in patients with a combination of several MS components and contribute to a higher AF risk.
CORRELATION OF DIABETES REMISSION WITH REDUCTIONS IN BLOOD PRESSURE AND CARDIOVASCULAR RISK SCORES: RESULTS OF SIX MONTHS OF RANDOMISED TRIAL WITH DIGITAL TWIN TECHNOLOGY
Authors: Shamanna Paramesh , Joshi Shashank , Shah Lisa , Dharmalingam Mala , Vadavi Arun , Damodaran Suresh , Mohammed Jahangir , Mohamed Maluk , Poon Terrence , Keshavamurthy Ashok , Thajudeen Mohamed , Bhonsley Suchitra
Published: June 2022

Objective:

Twin precision treatment improves metabolic parameters using a whole-body digital twin platform powered by artificial intelligence and internet of things

Design and method:

We evaluated 6 month data of RCCT (n = 128). Diabetes remission was defined as HbA1c < 6.5% for at least 3 months without Anti-Diabetic Medication (ADM)

Results:

Mean age and duration of diabetes (yrs) was 43 (±9.4, 95% CI 42 to 45) and 3.5 (±2.7, 95% CI 3 to 4). 88.3% (n = 113) achieved diabetes remission. At enrolment 76% (n = 97) were on ADM, of which 90% (n = 87) were off ADM. There was a significant change (change, % reduction) in HbA1c % (8.9 to 5.6, -38.2), SBP mmHg (128 to 118, -8.5), DBP mmHg (84 to 78, -7.8), waist circumference cm (97 to 86, -11.2), body weight kg (78 to 67, -12.7), BMI (27.2 to 23.5, -13.6), HOMA2IR (1.9 to 1.02, -48.4), Framingham Risk Score (FRS) (15.4 to 6.6, -56.4), Atherosclerotic Cardiovascular Disease (ASCVD) (7.9 to 3.1, -60.7), [p < 0.0001], QRISK3 (12.8 to 9.3, -27.3) scores, [p = 0.0027], at six months. (Table). There was a significant positive correlation between HbA1c reduction, and reductions in SBP (r 0.2, 95% CI 0.03 to 0.36, p = 0.03), HOMA2IR (r 0.23, 95% CI 0.06 to 0.39, p = 0.0074), ASCVD (r -0.17, 95% CI 0.004 to 0.34, p = 0.04), FRS (r 0.22, 95% CI 0.056 to 0.38, p = 0.0097). 57% (n = 73) were hypertensives. At 6 month, 33% (n = 6/18) were off anti-hypertensive medication

Conclusions:

Digital twin technology enables a significant reduction in BP, CV risk scores and insulin resistance which correlates with the remission of T2DM
INVESTIGATING THE QUALITY OF MACHINE LEARNING RESEARCH AND REPORTING IN HYPERTENSION
Authors: Du Toit Clea , Tran Tran , Aryal Sachin , Lip Stefanie , Manandhar Ishan , Sykes Robert , Pattnaik Harsha , Deo Neha , Alsanosi Safaa , Sionakidis Aristeidis , Ngoc Le Nhu , Mccallum Linsay , Mehta Dhruven , Kassi Maria , Rostron Maggie , Stevenson Leah , Tummala Ramakumar , Kashyap Rahul , Joe Bina , Padmanabhan Sandosh
Published: June 2022

Objective:

Artificial intelligence and machine learning (AI/ML) are increasingly being applied to big clinical data to tackle research questions that cannot be answered with traditional statistical methods. The field is still in its nascent stages and there is a paucity of guidelines for conducting and reporting AI/ML research in hypertension. The objective was to apply the HUMANE checklist to survey the present landscape of AI/ML in hypertension to inform the development of hypertension-specific guidelines and recommendations.

Design and method:

The HUMANE checklist was developed by global clinical and AI/ML experts through the Delphi method. It assesses the quality of medical AI/ML articles based on whether they cover subjects expected in any peer-reviewed, clinical or AI/ML research publication. A cooping review was carried out to identify articles presenting original research in AI/ML and hypertension published in 2019–2021. Two independent reviewers applied the checklist to each article and in the case of discordance, the response was adjudicated by an AI/ML expert. Results were analysed to assess compliance with the survey (% of papers satisfying checklist requirements).

Results:

A total of 63 manuscripts was reviewed. A summary of results is shown in Figure 1. Highest compliance was seen for items relating to general article presentation, with compliance ranging from 68% to 98% (description of statistical analysis methods and background context, respectively). Lowest compliance was seen with checklist items relating to clinical research and AI/ML methods. 44% of reviewed articles described the demographics of their dataset and 48% stated their inclusion/exclusion criteria. Nonetheless, datasets were deemed appropriate for investigative aims in 93% of articles. 30% of manuscripts reported their calibration measures, while 73% stated their performance metrics. Internal validation was carried out in 75% of studies, but external validity was assessed in only 14% of cases. Algorithmic bias was addressed in 11% of papers.

Conclusions:

Application of AI/ML methods in hypertension research is growing, but the majority of current work has major shortfalls in reporting quality, model validation and algorithmic bias. Our study identifies areas of improvement to enable the full realisation of the potential of AI/ML in hypertension.
ASSOCIATION OF SERUM RENALASE WITH THE RISK OF HYPERTENSION IN CHINESE ADULTS WITH NORMAL KIDNEY FUNCTION
Authors: Wang Keke , Chu Chao , Wang Yang , Yu Yan , Liao Yueyuan , Ma Qiong , Wang Dan , Zheng Wenling , Hu Jiawen , Mu Jianjun
Published: June 2022

Objective:

Renalase, a novel flavoprotein with oxidoreductase activity secreted from kidney and heart into the circulation, plays a crucial role regulating blood pressure. However, research on the relationship between serum renalase and hypertension is controversial. This cross-sectional study is to evaluate the relationship of serum renalase and the risk of hypertension in Chinese adults with normal kidney function.

Design and method:

We conducted follow-up of the long-term hypertension study cohort established in Hanzhong, Shaanxi Province from April to July 2017. Blood and urine samples were collected and blood pressure was measured. Serum renalase levels were determined using a commercial enzyme-linked immunosorbent assay (ELISA) kit. Data from 2263 subjects was included and nalysed.

Results:

Serum renalase levels were higher in hypertensive subjects than in normal BP subjects with normal kidney function (2.09 ± 0.55 g/ml vs. 2.17 ± 0.52 g/ml, P < 0.01). Simple correlation analysis revealed that renalase was positively associated with SBP (r = 0.10, P < 0.01) and DBP (r = 0.11, P < 0.11). However, after adjusting confounding factors, logistic regression analysis suggested there was no significant relationship between serum renalase and the risk of hypertension.

Further investigation revealed that renalase had a significant interaction effect on hypertension for gender (P for interaction < 0.001), BMI (P for interaction < 0.001) and smoking (P for interaction < 0.001). Those with a BMI above 25 and a renalase above 2.48 g/ml had a higher risk of hypertension. In male and current smokers, subjects with 1.76–2.09 g/ml renalase were more prone to develop hypertension.

Conclusions:

Our findings suggest that the renalase level in specific populations has heterogeneous effects on blood pressure. Further clinical trials are needed to assess the potential role of renalase as a biomarker of hypertension.
THE EFFECTS OF SURGICAL AORTIC VALVE REPLACEMENT ON ARTERIAL STIFFNESS
Authors: Sigala Evangelia , Terentes-Printzios Dimitrios , Andreas Katsaros , Nikolaos Baikoussis , Nikolaos Koumallos , Vasileios Lozos , Nikolaos Giakis , Konstantinos Filis , Konstantinos Tsioufis , Vlachopoulos Charalambos
Published: June 2022

Objective:

Assessing arterial properties in patients with aortic valve stenosis undergoing surgical aortic valve replacement (SAVR) is difficult, and the results to date have been inconclusive. We sought to investigate how SAVR affects vascular stiffness in the short and long term.

Design and method:

We included 55 patients (mean age 70 ± 8 years, 69% men) with severe symptomatic aortic stenosis who underwent SAVR. Arterial stiffness was assessed using the carotid-femoral pulse wave velocity (cfPWV) and brachial-ankle pulse wave velocity (baPWV). Measurements were conducted at baseline, in the acute phase, and 1 year after the operation.

Results:

Immediately after SAVR there was an increase in cfPWV (7.66 ± 1.63 m/s vs 8.27 ± 2.06 m/s, p = .010) that was sustained at 1 year (7.66 ± 1.63 m/s vs 8.98 ± 2.31 m/s, p = <.001, figure 1). Similarly, baPWV increased in the acute phase (1597 ± 455 cm/s vs 1954 ± 658 cm/s, p < .001) and persisted 1 year postoperatively (1597 ± 1833 cm/s, p < .001, figure 2).

Conclusions:

After SAVR the arterial system shows an increase of stiffness in response to the acute relief of the obstruction, which is retained in the long term.
HEMATOLOGICAL BIOMARKERS ASSOCIATED WITH INFLAMMATION AND CARDIOVASCULAR RISK IN PSORIASIS SEVERITY
Authors: Santos Ana Carolina , Gil Ângela , Ferreira Joana , Filipe Paulo , Bicho Manuel
Published: June 2022

Objective:

Psoriasis is a chronic inflammatory disease charactered by abnormal proliferation of keratinocytes and infiltration of immune cells and is associated with increased cardiovascular risk. Psoriasis Area and Severity Index (PASI) is a clinical tool used to assess the severity of psoriasis. Circulating biomarkers, such as those of complete blood count (CBC) derived ratios such as platelet-lymphocyte (PLR) and lymphocyte-monocyte (LMR), have been shown to be associated with autoimmune diseases and have been identified as indicators of systemic inflammation surrogate biomarkers.

This study aims to evaluate the impact of CBC biomarkers on psoriasis and their clinical severity (PASI).

Design and method:

Sixty-three psoriasis patients with a mean age of 52.50 ± 12.81 years. Sociodemographic, hemodynamic and routine blood laboratory data were collected. Patients were stratified based on PASI: < 5 (Group I) and > or equal to 5 (Group II).

Biochemical parameters were determined in serum according to standardized methods.

For statistical analysis SPSS program was used and a significant value for p < 0.05.

Results:

Compared patients between the group I and II it were observed higher levels in this last group of: hemoglobin (p = 0.049), mean corpuscular hemoglobin concentration (p = 0.027), leukocytes (p = 0.012), neutrophils (p = 0.006), erythrocyte sedimentation rate (p = 0.032), Gamma-glutamyltransferase (p < 0.001), alkaline fosfatase (p = 0.046), triglicerides (p = 0.038), PLR (p = 0.012) and lower values of: ymphocytes (p = 0.010), LMR (p = 0.018), chloride (p = 0.035), cholesterol-HDL (p = 0.003) and tumour Necrosis Factor alpha (p = 0.030).

Conclusions:

Routine CBC, derived indices and biochemical parameters related to inflammation and cardiovascular risk appear to be inexpensive and easily accessible biomarkers to psoriasis severity.
MAJOR IMPACT PREDICTION CARDIOVASCULAR RISK IN YOUNG ADULTS
Authors: Da Silva Oliveira Alda Pereira , Gomes Paula , Matos Andreia , Miguel José Pereira , Freitas Graça , Bicho M. Clara , Bicho Manuel
Published: June 2022

Objective:

Apparently healthy young adults may have risk factors associated with arterial hypertension (HBP) and atherosclerosis. The objective was to evaluate the presence of HBP, obesity and other anthropometric or metabolic cardiovascular (CV) risk parameters in young adults and their association to inflammation connected blood count parameters, as possible earlier determinants for the path of CV future disease.

Design and method:

A sample of 250 students (76 men, 174 women; aged 22.1 ± 2.79 years; 94.8% Caucasians; 82.3% eutrophic) was studied. Body Mass Index (BMI Kg/m2), waist circumference (WC cm) and blood pressure (BP mmHg) were measured according to standard methods. Blood count parameters, glucose, cholesterol, HDL and triglycerides (mmol/L) determined according to standard hospital laboratory. Statistics: t-student, ANOVA or equivalent non-parametric, Chi-square and Pearson/Spearman correlations according normality distribution.

Results:

Most subjects (91.5%) had normal BP (mean ± SD systolic 116.7 ± 14.0; diastolic 69.6 ± 9.4). HBP frequency showed no differences between gender (p = 0.154), but an association between BMI (p < 0.000) with HBP was observed, as 92.9% of hypertensive patients were also obese or overweight. In male compared to women, higher glucose values (p = 0.000), BMI (p = 0.011) and WC (p = 0.000) but lower HDL values (p = 0.000) were observed. BMI and WC were also higher (respectively p = 0.005 and p = 0.004) in hypertensive subjects. WC adjusted for BMI was a risk factor for HBP (p = 0.043; OR = 1.059; 95% CI = 1.002–1.119). Regarding BMI classes (<18.5, 18.5–25, > 25) values were higher in overweight/obese subjects for the following ratios to HDL: monocytes (p = 0.045), monocytes X LDL (p = 0.006), platelets X LDL (p = 0.002), monocytes X platelets X LDL (p = 0.005), monocytes X platelets (0.032). In hypertensive subjects, monocyte X platelet to HDL ratio was higher (p = 0.03) compared to normotensive and a correlation was also observed between glucose and the following ratios to HDL: monocytes X LDL (p = 0.033), monocytes X platelets (p = 0.045) and monocytes X platelets X LDL (p = 0.034).

Conclusions:

Even in younger age groups a major impact prediction cardiovascular risk is possible. Anthropometric, metabolic and blood count parameters and its association could be early biomarkers associated with hypertension and should be considered as indicators of present and/or future cardiovascular disease.
SERUM BIOMARKERS, SKIN AUTOFLUORESCENCE AND OTHER METHODS. WHICH PARAMETER BETTER ILLUSTRATES THE RELATIONSHIP BETWEEN ADVANCED GLYCATION END PRODUCTS AND ARTERIAL STIFFNESS
Authors: Gelzinský Július , Filipovský Jan , Mayer Otto , Mlíková-Seidlerová Jitka , Mares Stepan
Published: June 2022

Objective:

Impaired glucose metabolism plays an important role in the stiffening of large arteries. Advanced glycation end-products (AGEs) are responsible for the onset of specific complications in diabetic subjects; however, they may exert harmful effects on cardiovascular system also in non-diabetics.

AGEs bind to specific receptor (RAGE) expressed in various cells. The AGEs-RAGE complex participates in various stages of atherosclerosis and arterial stiffening. Circulating soluble isoform of RAGE (sRAGE) captures circulating AGEs, thus preventing their patophysiological consequences.

We aimed to investigate the associaton between aortic pulse wave velocity and multiple paramaters of glucose metabolism.

Design and method:

1061 subjects were examined in the Pilsen subsample of Czech Post-MONICA study (= 1% random sample of general population aged 25–74 years). Pulse wave velocity (PWV) was measured using the Sphygmocor device (AtCor Medical Ltd., Australia). Following markers of glucose metabolism were assessed: fasting glucose level, glycated hemoglobin, carboxy-methyl lysine (marker of circulating AGEs), sRAGE (circulating soluble isoform of RAGE), skin AGEs (autofluorescence method). Since ratios may better describe the balance between harmful and protective factors, following risk factors ratios were calculated: CML/sRAGE, skin AGEs/sRAGE.

Results:

Aortic PWV was strongly associated with fasting glucose, sRAGE, skin AGEs and the skin AGEs / sRAGE ratio. Only weak association with HbA1c was found.

All parameters of glucose metabolism were included simultaneously in a stepwise regression of pulse wave velocity. Besides age, mean arterial pressure and male sex, fasting glucose and skin AGEs were positively associated with PWV, while there was a negative association with sRAGE (significant in non-diabetic population only). In contrast, neither CML, nor its ratio to sRAGE showed any association with arterial stiffness.

Conclusions:

Autofluorescence method allows to assess easily and quickly the contents of skin AGEs, which were associated with aortic stiffness in general population sample. sRAGE level had a negative association with PWV, thus reflecting its protectivity against arterial stiffening. These two parameters influence aortic stiffness over and above fasting glucose level which is per se a strong determinant of aortic PWV even in non-diabetic population.
AGREEMENT BETWEEN DIFFERENT TYPES OF BLOOD PRESSURE MONITORING: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS
Authors: Yeh Jiunn-Tyng , Lee Chun-Wei , Chen Yu-Jen , Huang Shao-Li , Wang Wei-Ting , Huang Chi-Jung , Chiu Tzu-Jung , Chen Chen-Huan , Chiang Chern-En , Cheng Hao-Min
Published: June 2022

Objective:

An accurate blood pressure measurement (BPM) is important for diagnosing and managing hypertension. Several monitoring techniques of BPM, including office BPM (OBPM), ambulatory BPM (ABPM), and home BPM (HBPM) have been widely utilized; however, the corresponding agreement and conversion between these modalities remained elusive. With emerging evidence suggesting the utility of out-of-office blood pressure (BP) for hypertension management, an investigation into the relationship between BPMs is crucial. Therefore, we performed a systematic review and network meta-analysis from published studies and compared the reported BP values between different BPM modalities.

Design and method:

We searched MEDLINE and Scopus for observational studies and andomised controlled trials reporting more than one type of BPM by Apr 6, 2021. Studies with participants that were over 18 years old and received at least two different BPM within a week were included. The risk of bias of included studies was assessed by the quality of the study and BPM techniques. We calculated the mean differences (MD) between modalities and pooled the measurements using random-effects network meta-analysis. Furthermore, the agreement between BPMs within different BP levels was investigated using network meta-regression.

Results:

We identified 10970 studies and included 486/482 studies (467654/466167 individuals) for SBP/DBP measurements. With reference to OBPM, the MDs of SBP of casual OBPM, HBPM, 24 hours ABPM, daytime ABPM, and night time ABPM, were 2.8, -5.5, -10.0, -6.4, -19.5mmHg, respectively. For DBP the MDs were 1.3, -3.0, -6.3, -3.19, and -13.76mmHg. Network meta-regression (see figure) showed that the MDs between OBPM and casual OBPM were rather fixed; however, those between OBPM/HBPM or OBPM/ABPM followed a negatively associated linear relationship across BP levels. The diagnostic thresholds of different BPMs corresponding to OBPM 140/90mmHg and 130/80mmHg were generally in agreement with current guidelines.

Conclusions:

Our study demonstrated the agreement between common BPM modalities by synthesizing the body of evidence from a comprehensive search. Furthermore, the regression model showed that the MDs of measurements between modalities may vary depending on the mean BP. Our systematic review supports the diagnostic thresholds for different BPM recommended by current guidelines.
VITAL SIGNS GUIDED THERAPY AT THE CARDIAC CARE UNIT: INTERVENTIONS BY A CARDIOLOGY PHARMACIST
Authors: Yaseen Israa Fadhil , Farhan Hasan Ali
Published: June 2022

Objective:

To identify the role of a cardiology pharmacist in ptimisation of cardiovascular treatment depending on vital signs including heart rate (HR) and blood pressure (BP) for patients with acute coronary syndrome (ACS)

Design and method:

A prospective interventional study conducted at the cardiac care unit (CCU) over 3 months (July-October 2021). A senior consultant cardiologist noticed frequent uncontrolled vital signs of patients at the CCU particularly those with ACS, therefore, he asked the cardiology pharmacist to observe the missed uncontrolled HR and BP without optimum treatment for all patients at the CCU after completing the daily morning round and make drug interventions collaboratively. The drug intervention for this group of patients was called ‘Vital Signs Guided Therapy’.

Results:

Among 147 patients who got drug interventions by the pharmacist over 3 months, 41 (28%) of patients included in the vital signs guided therapy cohort, the main diagnosis of the patients: ACS 88%, complete heart block 5%, atrial fibrillation 5%, and acute decompensated heart failure 2%. Mean HR (79 ± 15) beat per minute, systolic BP (136 ± 28) mmHg, and diastolic BP (86 ± 14) mmHg. HR control was done for 56% of patients and BP control for 61% of patients. Control of both HR and BP were done for 20% of the cohort. Types of drug interventions and ptimisation are shown in Figure 1.

Conclusions:

Team work; including a cardiology pharmacist, is essential for drug therapy ptimisation guided by vital signs for patients at CCU.
REVERSE WHITE-COAT EFFECTS ACCORDING TO THE ACHIEVED BLOOD PRESSURES BELOW THE TARGET BLOOD PRESSURES FOR INTENSIVE BLOOD PRESSURE CONTROL
Authors: Shin Jinho , Shin Jeong-Hun , Park Sungha , Kim Ju-Han , Ihm Sang-Hyun , Pyun Wook-Bum
Published: June 2022

Objective:

In the application of nalysedd controlled trial data for intensive blood pressure (BP) control into clinical practice, the corresponding BPs among office, home, and ambulatory BPs were suggested to be similar if achieved clinic systolic BP (SBP) become 130 mmHg or lower. But the magnitude and its clinical implication of reversed white-coat effect (WCE) was not clearly reported.

Design and method:

From the 1843 data of treated hypertension patients in Korean ambulatory blood pressure monitoring (Kor-ABP) registry, WCE were calculated according to the range of achieved clinic SBPs, < 120 mmHg (group1), 120~130 mmHg (group2), 130–140 mmHg (group3), and > = 140 mmHg (group4). The factors related to WCE were nalysed using multivariable regression analysis. WCE was defined by clinic SBP minus daytime ambulatory SBP.

Results:

Mean age was 59 years and the proportion of female was 55%. Significant factors for the WCE were BMI (beta = -0.342), smoking (beta = -3.394), good sleep quality (beta = 0.872 per each 4 point likert scale), and clinic SBP(beta = 0.578). Mean SBPs for group 1 to 4 were 111.4 mmHg, 124.0 mmHg, 134.1 mmHg, and 157.5 mmHg, respectively. WCEs for the group were -8.3 mmHg for group1, -4.5 mmHg for group2, -1.9 mmHg for group3, and 9.9 mmHg for group4. The difference in WCEs between the group 4 and untreated hypertension patients (SBP, 155.6 +/-13.6) was not statistically significant (9.9 +/- 16.1 mmHg 9.0 +/-16.8, p = 0.2).

Conclusions:

Reverse WCE should be considered to estimate the safety of intensive BP control when SBP lowered below 120 mmHg. The presence of reverse WCE instead of WCE highlights more reassuring aspect than previously thought when the patient is asymptomatic or tolerable.