bluuebunny/crossref_metadata_2025 huggingface dataset:
SEX DIFFERENCES IN A CARDIOVASCULAR DISEASE RISK SCORE AND ITS COMPONENTS AS PREDICTORS FOR MULTIMORBIDITY IN THE UK BIOBANK
Authors: Harris Katie , Wang Wendy , Carcel Cheryl , Peters Sanne , Woodward Mark , Chalmers John
Published: May 2024

Objective:

This study will examine sex differences in the association of a cardiovascular disease risk score and its components (age, treated or untreated systolic BP, total and HDL cholesterol, diabetes and smoking) with cardiovascular and other outcomes (myocardial infarction (MI), stroke, dementia, ESKD, death and multimorbidity).

Design and method:

This study uses the UK Biobank - a prospective population-based cohort study, that recruited over 500,000 (aged 40 to 69 years) women and men between 2006 and 2010, with continuing follow up for outcomes. The Pooled Cohort Risk Equation, designed to estimate 10-year atherosclerotic cardiovascular disease (ASCVD) risk, was applied to predict 10-year risk of MI, stroke, dementia, ESKD and multimorbidity. Participants with any of these diseases at baseline were excluded from these analyses.

Cox regression models were used to model the sex specific association (hazard ratio (HR) with 95% confidence interval (CI)) of the ASCVD risk score and each of the components separately with outcomes. C-statistics were used to determine the predictive ability of the ASCVD risk score compared with the individual components on outcomes.

Results:

There were 355,466 UK Biobank participants (55% women) eligible for inclusion in these analyses.

Compared with having an ASCVD risk score <=2.5% (low risk), the risk of multimorbidity for those with an ASCVD risk score >7.5% (intermediate – high risk) was higher in women (HR 2.60; 95%CI (2.52, 2.69)) than men (2.17 (2.08, 2.27)). Corresponding results were 7.08 (6.13, 8.18) and 4.01 (3.54, 4.54) for MI; 3.53 (3.04, 4.41) and 2.69 (2.24, 3.22) for stroke. The corresponding risks for dementia, ESKD and death were also higher in women than men.

ASCVD risk score was a better predictor of multimorbidity than each of the separate individual components, for women and men. This finding held for all other outcomes apart from dementia where age yielded the highest c-statistics.

Conclusions:

Utilisation of cardiovascular risk scores may provide utility in predicting other diseases individually and in combination (multimorbidity). Clinicians should also be cognisant of a higher risk of events in women compared to men with comparable ASCVD risk scores.
THE IMPORTANCE OF CARDIAC MAGNETIC RESONANCE IMAGING IN THE ASSESSMENT OF THE RISK OF CARDIAC ARRHYTHMIAS IN PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Wysocki Andrzej , Gac Pawel , Poreba Rafal , Michalek-zrabkowska Monika , Kraik Krzysztof , Poreba Malgorzata , Martynowicz Helena , Mazur Grzegorz , Dziadkowiec-macek Barbara , Fulek Michal , Macek Piotr
Published: May 2024

Objective:

Arterial hypertension leads to organ changes, including left ventricular hypertrophy. The increased mass of left ventricle increases the risk of cardiac arrhythmias, which enhances the risk of sudden cardiac death. Cardiac magnetic resonance imaging (CMRI) can identify the presence of myocardial fibrosis by assessing late gadolinium enhancement (LGE). The aim of the study was to assess the relationship between the presence of late gadolinium enhancement at the right ventricular insertion point (RVIP) determined by CMRI and the occurrence of cardiac arrhythmias in patients with arterial hypertension.

Design and method:

30 patients with essential hypertension were qualified for the study, 18 men and 12 women, the average age of the subjects was 55.5 ± 12.4 years. All subjects underwent cardiac magnetic resonance imaging and 24-hour Holter ECG monitoring. Based on the presence of LGE at the right ventricular insertion point, assessed by CMRI, the subjects were divided into two subgroups. The first subgroup consisted of subjects with LGE at the right ventricular insertion point (RVIP + subgroup), while the second subgroup consisted of subjects without LGE at the right ventricular insertion point (RVIP - subgroup).

Results:

Subjects with LGE at the right ventricular insertion point were characterized by higher maximum and minimum heart rates in 24-hour Holter ECG recordings compared to subjects without LGE at the right ventricular insertion point (p < 0.05). In subjects with LGE at the right ventricular insertion point, Holter ECG evaluation revealed a statistically significantly higher number of single premature supraventricular beats, single premature ventricular beats and supraventricular tachycardias compared to subjects without LGE at the right ventricular insertion point (p < 0.05). The regression analysis performed showed that a longer time from the diagnosis of hypertension and the occurrence of LGE at the right ventricular insertion point assessed using CMRI are independent risk factors for cardiac arrhythmias (p < 0.05).

Conclusions:

Cardiac magnetic resonance imaging by identifying of late gadolinium enhancement at the right ventricular insertion point may be a useful diagnostic method in assessing the risk of cardiac arrhythmias in a group of patients with arterial hypertension.
THE IMPACT OF THE COVID-19 PANDEMIC ON OFFICE AND 24-HOUR BLOOD PRESSURE PHENOTYPES (ESH ABPM COVID-19 STUDY)
Authors: Ostrowska Aleksandra , Wojciechowska Wiktoria , Rajzer Marek , Reinhold Kreutz , Weber Thomas , Bursztyn Michael , Persu Alexandre , Stergiou George , Kielbasa Grzegorz , Parati Gianfranco , Bilo Grzegorz , Grassi Guido , Mancia Giuseppe , Januszewicz Andrzej
Published: May 2024

Objective:

The COVID-19 pandemic had a huge impact on access to healthcare and on the presence of follow-up visits in ambulatory care. This study evaluated the influence of the COVID-19 pandemic on blood pressure (BP) control and phenotypes as assessed by office and 24-hour ambulatory BP monitoring (ABPM).

Design and method:

Clinical and BP data were collected from 33 centers including Excellence Centers of the European Society of Hypertension. Two groups of patients with treated hypertension were compared. Group1 (pandemic): including participants who had ABPM twice - at visit 2 during the COVID-19 pandemic and visit 1 performed 9-15 months prior to visit 2. Group2 (pre-pandemic): had ABPM in two visits, performed before the pandemic within 9-15 months interval. In the current analysis we determined BP phenotypes among all patients. The following phenotypes were distinguished: masked uncontrolled hypertension (MUCH), white coat uncontrolled hypertension (WUCH), sustained controlled hypertension (SCH) and sustained uncontrolled hypertension (SUCH), according to ESH 2023 Guidelines. We analyzed whether these phenotypes changed between visits.

Results:

Of overall 1620 patients included in the study, we excluded those with missing ABPM or clinical data precluding to define BP phenotypes. Patients with uncontrolled hypertension on both visits and patients switching between MUCH and WUCH were also excluded. Finally, data of 983 patients, 423 (43%) in the pandemic group and 560 (57%) in the pre-pandemic group were analyzed. At baseline (visit 1), BP phenotypes prevalence did not differ between groups. In the pandemic group, the prevalence of SUCH increased during follow up (9% vs 20.8%, p<0.001), while the prevalence of SCH remained unchanged between visits (43.7% vs 46.3%, p=0.45). In contrast, in the pre-pandemic group, the prevalence of the SCH increased during follow-up (41.3% vs 55%, p <0.001). On visit 2 in the pandemic group, the prevalence of SCH was lower than in the pre-pandemic group (46.3% vs 55%, p=0.007). In multivariable adjusted analysis, the only significant factor influencing the negative changes of BP phenotypes was the COVID-19 pandemic period.

Conclusions:

These results indicate a negative impact of the COVID-19 pandemic on BP control assessed by BP phenotypes.
LEFT VENTRICULAR REMODELING IN RELATION TO INTERACTION BETWEEN BLOOD PRESSURE AND SODIUM RENAL HANDLING AND INTAKE IN UNTREATED CHINESE PATIENTS
Authors: Cheng Yi -BANG , Chan Chak -MING , Xu Ting -YAN , Li Yan , Wang Ji -GUANG
Published: May 2024

Objective:

Whether or not renal sodium handling was associated with left ventricular remodeling independent of blood pressure (BP) is uncertain.

Design and method:

Consecutive untreated patients referred for ambulatory BP monitoring were recruited. Two-dimensional echocardiography was performed to measure left ventricular properties. Fractional excretion of lithium (FELi) and fractional distal reabsorption rate of sodium (FDRNa) were calculated as markers of proximal and distal sodium handling, respectively.

Results:

The 952 untreated patients (51.0% women; mean age, 50.8 years) included 614 (64.5%) ambulatory hypertension and 138 (14.5%) with left ventricular hypertrophy. FELi and FDRNa averaged 21.5% and 95.9%, respectively. In multivariable-adjusted analyses, per 1-SD increment in systolic/diastolic BP (+12.4/9.0 mm Hg) and reduction in FELi (-11.3%) and FDRNa (-2.4%) were associated with 0.19/0.19 and 0.19/0.20 mm higher interventricular septal wall thickness (IVS), respectively, 0.10/0.12 and 0.18/0.22 mm higher left ventricular posterior wall thickness (LVPW), respectively, and 2.99/2.68 and 2.17/1.95 g/m2 higher left ventricular mass index (LVMI), respectively. Associations of IVS and LVPW with FELi and FDRNa were tighter than with BP (P<0.001), whereas the opposite trend was observed for LVMI (P<0.001). There was significant (P<0.045) interaction between urinary sodium excretion and FELi in relation to LVPW and LVMI. Only in tertile 1 of FELi, LVPW and LVMI were positively associated with urinary sodium excretion (P<0.040). The interaction between urinary sodium excretion and FDRNa in relation to left ventricular structure was nonsignificant (P>0.25).

Conclusions:

Renal sodium handling as assessed by FELi and FDRNa, were independently associated with left ventricular remodeling, particularly with ventricular wall thickening.
LARGE DIVERGENCES IN TARGET GROUPS OF ESH 2023 BP-LOWERING STRATEGIES IN OLDEST-OLD PATIENTS ACCORDING TO THEIR FUNCTIONAL AND/OR FRAILTY STATUS
Authors: Jagiello Kacper , Piotrowicz Karolina , Grodzicki Tomasz , Gasowski Jerzy , Kujawska-danecka Hanna , Zdrojewski Tomasz
Published: May 2024

Objective:

Treatment individualization is part of good clinical practice. Part of it is medication de-escalation in older adults with limited life expectancy or advanced frailty syndrome. The 2023 ESH guidelines for treatment of hypertension, for the first time made provision for tailored medication use based on functionality and age of the patient.

We aimed to assess whether the 2023 ESH Guidelines strategy for antihypertensive treatment individualization aligns with the widely adopted treatment strategy based solely on frailty status.

Design and method:

We used data from a cross-sectional, nationwide survey of health determinants in non-institutionalized older persons in Poland that was conducted from 2018 to 2019 (PolSenior2). For the current analysis, we extracted data for hypertensive persons aged 80 years and older. Based on Fried criteria we categorized participants into fit, pre-frail, and frail. The Mini-Mental State Examination was used to screen for cognitive impairment, and the basic Activities of Daily Living for functional screening. We also checked the classification-assignment based on the ESH 2023 functional categorization (fit, slowed but autonomous for most activities, severely dependent) that is proposed for assessment of eligibility to tailored antihypertensive treatment. We then checked the concordance between the classifications.

Results:

The mean (SD) age of 1458 participants (52% women) was 86.0 (4.7). According to Fried’s definition, 47.9% were pre-frail and 46.4% frail, respectively. Based on the ESH 2023 approach, 10.3% of participants were classified as severely dependent who required treatment individualization and prioritization (91.3% of them frail) and 66.3% as fit who should be treated as usual (59.2% of them pre-frail and 33.1% frail, according to Fried’s frailty criteria). We found the correlation between the two classifications to be low (Spearman’s r=0.39, p<0.05) with the kappa coefficient of 0.11 (p<0.05).

Conclusions:

In the community-dwelling hypertensives, aged 80+ years, who are candidates for individualized antihypertensive therapy, there was discrepancy between frailty status and the ESH 2023 functional criteria for antihypertensive treatment individualization. A thoughtful approach should be taken to standardize the methodological concepts and fine-tune them according to specific clinical needs.
GLYCOSYLATED FIBRONECTIN AS A NOVEL PREDICTOR FOR THE MATERNAL AND FETAL COMPLICATIONS OF PREECLAMPSIA
Authors: Kluivers Anna , Neuman Rugina , Saleh Langeza , Visser Willy , Danser Jan
Published: May 2024

Objective:

The aim of this study was 1) to evaluate glycosylated fibronectin (GlyFn) as a novel predictor for preeclampsia (PE)-related maternal and fetal complications, and 2) to compare the predictive value of GlyFn versus that of the soluble Fms-like tyrosine kinase-1/placental growth factor (PlGF) (sFlt-1/ PlGF) ratio.

Design and method:

This was a secondary analysis of a prospective multicenter cohort study involving 524 pregnancies either suspected of (but not confirmed with) PE, with gestational hypertension (GH), or with confirmed PE and/or HELLP syndrome (PE/HELLP). In all patients sFlt-1, PlGF and GlyFn were measured at the time of inclusion. Logistic regression was conducted to study the association between GlyFn and PE-related complications. A traditional model (incorporating gestational age at biomarker measurement, parity, diastolic blood pressure and proteinuria at inclusion), to which GlyFn and the other biomarkers were added, was used for multivariable analysis.

Results:

In GH and PE/HELLP, GlyFn levels were significantly elevated (P=0.002 and P=0.02, respectively), compared to women with suspected PE. GlyFn correlated positively with sFlt-1 and the sFlt-1/PlGF ratio, and negatively with PlGF. GlyFn alone performed better than the traditional model with regard to the prediction of maternal but not fetal complications, and this was also true for sFlt-1, PlGF and their ratio. Combining the traditional model with GlyFn increased the C-index for maternal complications further, and on top of the traditional model the GlyFn/PlGF ratio yielded the best results for predicting fetal complications in the overall cohort, while in women with a gestational age <37 weeks this was also true for the prediction of maternal complications.

Conclusions:

GlyFn is a novel biomarker for PE diagnosis and its complications, and its role might be particularly relevant in patients with PE below 37 weeks of gestation.
SURVEY OF THE ADHERENCE TO THE ANTIHYPERTENSIVE THERAPY IN URBAN BULGARIAN POPULATION
Authors: Gruev Ivan , Garkov Kiril
Published: May 2024

Objective:

Adherence to the therapy is the Achilles heel of the management of the arterial hypertension. The aim of our study was to address the problem from the patient's perspective.

Design and method:

We asked 497 urban Bulgarian patients (aged between 35 and 70 years) with arterial hypertension, about their attitude and adherence to the prescribed therapy.

80% of the survey was done online and 20% were computer-assisted personalized interviews among older subjects. Quality control was done by GPS tracking of the interviewer, control of the duration of the survey, logical control of the interviews and 10% phone calls for confirmation with the patients.

Results:

We found out that 61% of the patients take 2 or more tablets daily for the treatment of hypertension.

The preferred intake time was in the morning in 69% of the answers, but the predominant therapeutic regime was twice daily among 56% of the patients.

In 56% of patients the number of pills remained the same during their follow up visits and in 26% -the number increased.

83% of patients with hypertension declared positive attitude towards their therapy, but 55% of them, admitted that they miss some of the doses of the prescribed medications. Asked about the reason for that, most of them- 63% answered: “I forgot to take them”. 30% of the hypertensive patients repeatedly perform “pill holidays”- stopping their therapy usually in the summer.

Only 25% of the studied population were fully aware about the risks of non compliance.

Being asked about how to improve their adherence, 44% of the patients answered they would prefer 1 tablet per day.

Conclusions:

Conclusion: Many Bulgarian urban patients experience difficulties to adhere to their antihypertensive treatment. Reducing the number of pills by increasing the use of SPCs could be one of the answers to the problem.
EFFECT OF ESTRADIOL / NORETHINDRONE ACETATE ON 24-HOUR BLOOD PRESSURE PROFILE IN POSTMENOPAUSAL WOMEN
Authors: Stojanovic Milos , Ivovic Miomira , Gajic Milina Tancic , Miletic Marija , Marina Ljilja , Arizanovic Zorana , Boskovic Andjela , Pavlovic Natalija , Petkovic Tijana , Vujovic Svetlana
Published: May 2024

Objective:

Framingham Heart Study found increased risk of cardiovascular events that occurs after menopause. Staessen found that menopause is associated with elevated blood pressure (BP), increased left ventricular wall thickness, decreased systolic performance, and decreased nocturnal BP fall. In the Italian population of SIMONA study, a significant increase in both systolic BP and diastolic BP was found in more than 18 000 Italian postmenopausal women, aged 46–59 years, compared to premenopausal and perimenopausal women. A growing body of evidence indicates that hormone replacement therapy (HRT) is beneficial in postmenopausal women. It is associated with symptomatic improvement: regulation of dysfunctional uterine bleeding, prevention of atrophic changes in the urogenital tract, a lower risk of osteoporosis and Alzheimer's disease, reduction of arterial stiffness, improvement in endothelium-dependent vasodilatation, a normalization of lipid profile, reduction of BP.

Design and method:

Design of the ongoing study in our Infertilty Center at the Institute of Endocrinology, we examined the effects of estradiol / norethindrone acetate on 24-h ambulatory blood pressure (ABPM) in 221 hypertensive postmenopausal women (HPMW, 51+/-2 [mean+/-SE] years, BMI 22.72±2.87kg/m2). Validated, Meditech ABPM 05 ambulatory blood pressure monitor was used to obtain 24-h BP before and after six months therapy with estradiol / norethindrone acetate. Most women did not change antihypertensive treatment during the study.

Results:

After six months on HRT BP was lowered by an average of 1 mmHg systolic and 2 mmHg diastolic per day and per night BP was lowered by an average of 2 mmHg systolic and 1 mmHg diastolic. BP reductions were not significantly lower with regard to systolic or diastolic BP before initiation of HRT nor to action on day and night-time BP.

Conclusions:

BP reduction in HPMW after six months receiving estradiol / norethindrone acetate may lower the physicians concern that hypertension might worsen if they prescribe estradiol / norethindrone acetate. We propose a large international prospective study to confirm that an appropriate HRT in postmenopausal women lowers ABPM values and normalize a blunted nocturnal BP decline.
FEATURES OF BLOOD PRESSURE DAILY PROFILE IN HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES
Authors: Srojidinova Nigora , Saidakbarova Feruza , Duysenbayeva Aziza
Published: May 2024

Objective:

To study the blood pressure daily profile in patients with hypertension (HNT) depending on the presence of type 2 diabetes mellitus (DM2).

Design and method:

We observed 412 hypertensive patients. The ambulatory BP monitoring (ABPM) was recorded with Medicom-combi device (Russia) using the oscillometric method. Statistical analysis was performed using the SPSS 24.0 software package.

Results:

Patients were divided into 2 groups: the first group consisted of hypertensive patients with DM2 (n = 121), and the second group consisted of hypertensive patients without DM2 (n = 291). Groups were comparable in office SBP: 133.7±20.19 mm Hg and 134.42±19.74 mm Hg, respectively. However, DBP was significantly higher in patients with DM2: 84.08±10.89 mmHg vs. 82.96±9.34 mmHg, p=0.02. Analysis showed that patients with DM2 had significantly higher average daily SBP (122.89± 13.38 vs. 119.467± 14.02 mmHg, respectively, p = 0.023) and DBP (71.401± 9.4 vs. 70.47± 7.40 mmHg, respectively, p = 0.021) compared to patients without DM2. Mean daily SBP (124.26±13.46 vs. 121.4±12.72 mmHg, respectively, p = 0.046) and mean daily DBP (29.19±25.76 vs. 24.11±27.22 mmHg, respectively, p = 0.012) were also higher in patients with DM2. SBP and DBP variability didn’t differ between the groups. Moreover, the load index of SBP in the daytime and nighttime was higher in the second group. Load index of daytime SBP –19.00±25.15% vs 12.89±19.49%, respectively, p=0.009 and load index of nighttime SBP - 35.03±34.78%–vs 24.71±30.08%, respectively, p=0.003. Nocturnal fall of SBP was deficient in-group with DM2 in comparison with one without DM2: nocturnal fall of SBP was 3.72±6.44% vs. 6.17±10.62%, p = 0.019, but nocturnal fall of DBP did not differ: 5.10±8.33% vs. 6.72±8.21%, respectively, p = 0.069. Dipping status was significantly lower in patients with DM2 (9.6 ±5.7%, x2 = 8.91, p = 0.03). The number of non-dippers (63.5% vs. 55%) and night-pickers (26.3% vs. 16.8%) was also higher in the second group without statistical significance. The number of over-dippers in both groups didn’t differ.

Conclusions:

Hypertensive patients with DM2 have more disturbances in the daily BP profile, which contribute to an increased risk of developing cardiovascular complications.
THE AGREEMENT BETWEEN HEART RATE MEASURED USING UNATTENDED AUTOMATED BLOOD PRESSURE MEASUREMENT AND OTHER METHODS OF BLOOD PRESSURE ASSESSMENT
Authors: Sobieraj Piotr , Lesniewski Mateusz , Sinski Maciej , Lewandowski Jacek
Published: May 2024

Objective:

The trial was aimed to assess the agreement between resting heart rate (HR) measured using unattended automatic (uAOBPM) and office (OBPM) or 24-h ambulatory blood pressure measurement (ABPM).

Design and method:

A total of 110 participants were included in the study. All underwent measurements using uAOBPM, OBPM, and ABPM. Results of ABPM were analysed in 3 periods: 24h (24h-ABPM), day activity (aABPM) and night rest (nABPM). Continuous variables were presented as means with standard deviation, while categorical variables were expressed as numbers and percentages. The comparisons were conducted using the paired t-test and Bland-Altman statistics.

Results:

Mean age was 56.5 ± 18.3 years. Mean HR measured using uAOBPM (70.8 ± 12.5 b.p.m.) was lower than measured using OBPM (72.8 ± 12.6 b.p.m., p<0.001), higher than measured using 24h-ABPM (67.5 ± 10.2 b.p.m., p<0.001) or nABPM (62 ± 8.7 b.p.m., p<0.001). There was no difference between HR measured using uAOBPM and aABPM (70.3 ± 11.2 b.p.m., p=0.5).

Bland-Altman analysis showed smallest bias when HR was measured using uAOBPM and ABPM 0.4 (95% CI:-0.8 to 1.6) b.p.m. and -2 (95% CI:- 2.8 to -1.3) b.p.m., though the range between lower and upper limits of agreement was higher when uAOBPM has been compared with aABPM and not with OBPM. The largest bias between limits of agreement was found when uAOBPM was compared with nABPM 8.8 (95% CI:7.2 to 10.4) b.p.m. Also the largest range between lower and upper limits of agreement was when agreement between uAOBPM and nABPM was assessed.

The results of Bland-Altman analysis is presented using Figure 1.

Conclusions:

The best agreement between HR measurements was observed when uAOBPM was compared with OBPM or aABPM.
SURVEY INDICATES GREATER PATIENT PREFERENCE FOR AKTIIA'S CUFFLESS MONITOR OVER TRADITIONAL AMBULATORY BLOOD PRESSURE MONITOR IN A CARDIAC REHABILITATION PROGRAM
Authors: De Almeida Tiago Paggi , Perruchoud David , Alexandre Jérémy , Vermare Pascale , Sola Josep , Shah Jay , Marques Luisa , Pellaton Cyril
Published: May 2024

Objective:

Cuffless blood pressure (BP) monitors have the potential to improve hypertension management and facilitate remote BP monitoring. The success and long-term adoption of these devices will significantly depend on patient preferences and their perceptions of using such technology. In the present work, we report patients’ preferences regarding a continuous cuffless BP monitor and cuff-based ambulatory BP monitoring (ABPM) during a 12-week cardiac rehabilitation (CR) program.

Design and method:

63 subjects (NCT04548986, mean age 53.1±7.2 years, 21.2% female, arm circumference 29.0±2.5 cm) were enrolled in a 12-week CR program at RHNE – Réseau Hospitalier Neuchâtelois, Switzerland. Subjects wore a cuffless BP monitor (Aktiia SA, Switzerland) during the entire CR program, and conducted 24-h ABPM (Dyasis 3, Novacor, France) during the first and last days of CR. The analysis was conducted on experience surveys completed by subjects who successfully finished the CR program.

Results:

57 subjects completed the CR program and filled the survey at the end of the program (Figure 1). From an open question for 3 adjectives regarding experience with the Aktiia monitor, the most cited terms were “discreet” (53% of the subjects), “light” (47%) and “comfortable” (28%), with more than 15% of the subjects describing it as “practical” and “pleasant”. For ABPM, the most cited terms were “bulky” (41%), “noisy” (26%) and “uncomfortable” (17%), with approximately 10% of subjects describing it as “embarrassing”, “unpleasant” and “heavy”. Nearly all subjects felt no discomfort when using the Aktiia monitor, and almost 90% of the subjects would repeat night measurements with Aktiia. Subjects were equally confident in the precision for both devices, and few subjects reported any disruption in their daily activities due to wearing Aktiia's bracelet.

Conclusions:

Among patients who used both the Akiia bracelet and ABPM and during the 12-weeks CR program, the vast majority found the cuffless monitor more convenient, more comfortable and with a similar perception of performance compared to ABPM. The results suggest that cuffless BP devices may facilitate continual 24-h BP monitoring compared to an ABPM setup and enhance patients’ adherence to BP monitoring.
CURRENT STATUS OF USE OF VALIDATED DEVICES FOR HOME BLOOD PRESSURE MONITORING AMONG PATIENTS WITH HYPERTENSION
Authors: Lee Ji Eun , Yoo Seungwon , Kim Dae-Young , Shin Sung-Hee , Na Jin Oh , Shin Jinho , Park Kiho , Lee Eun Mi
Published: May 2024

Objective:

Hypertension is the most important modifiable risk factor for cardiovascular diseases. Nevertheless, the control rate (<140/90 mmHg) in hypertensive patients is lower than 50% in Korea. The implementation of Home Blood Pressure Monitoring (HBPM) improves the diagnosis and treatment of hypertension. Current clinical guidelines advocate the use of validated HBPM devices. However, there are few studies about the current use of validated devices for HBPM. We aimed to investigate the present status of use of validated HBPM devices in real-world hypertensive patients.

Design and method:

This study was conducted on Korean hypertensive patients using CareforMe®, a smartphone healthcare application which allows the patients to record their HBPM data. HBPM devices included upper-arm and wrist devices. According to the STRIDE BP, validated devices included 3 categories: Preferred devices (published within the last 10 years and used a recently established protocol of device validation), Validated devices (have passed established validation procedures that have been checked and approved by the STRIDE BP Scientific Advisory Board), and Equivalent devices (equivalent to a device that has fulfilled the criteria for validated devices).

Results:

From May 2021 through December 2023, a total of 2,539 patients inputted model numbers of their HBPM devices. 112 devices and 32 different manufacturers were identified. 96.9% (n=2,461) of patients used upper-arm devices and 3.1% (n=78) used wrist devices. Out of 112 devices, 12 Preferred upper-arm devices, 5 Validated upper-arm devices, 5 Equivalent devices and 2 Validated wrist devices were identified. Only 17.8% (n=453) our of 2,539 patients were using Preferred HBPM devices, 2.3% (n=58) used Validated upper-arm devices, and 25.7% (n=652) were using Equivalent devices. Among patients using wrist devices, 17.9% (n=14) used validated devices.

Conclusions:

To the best of our knowledge, this is the first study to analyze the current status of use of validated HBPM devices among hypertensive patients in Korea. 96.9% patients used upper-arm devices, and among them, only 47.3% patients were using validated devices. Our results proposed the urgent need of patient education on accurate HBPM and public accessibility on validated devices to better management of patients with hypertension.
MAY MEASURE MONTH 2022 IN ITALY: RESULTS OF A NATIONWIDE SURVEY
Authors: Del Pinto Rita , Rosei Claudia Agabiti , Borghi Claudio , Cottone Santina , Fabris Bruno , Giannattasio Cristina , Minuz Pietro , Mulè Giuseppe , Nazzaro Pietro , Parati Gianfranco , Rattazzi Marcello , Sarzani Riccardo , Veglio Franco , Vulpis Vito , De Giorgi Giuseppe Antonio , Di Guardo Antonino , Dugnani Maurizio , Saladini Francesca , Ferri Claudio , Muiesan Maria Lorenza , Serio Leandra
Published: May 2024

Objective:

By affecting approximately 45% of the world's population, hypertension is the main risk factor for cardiovascular diseases (CVD). Of note, only half of hypertensive patients manage to have good blood pressure (BP) control. Relevant reasons for the persistence of uncontrolled BP during treatment are lack of compliance on the patients’ side, and therapeutic inertia on physicians’ side.

Design and method:

During the global BP screening campaign “May Measure Month” (MMM) (May 1st to July 31st, 2022), a nationwide, cross-sectional, opportunistic study endorsed by the Italian Society of Hypertension was conducted on volunteer adults >= 18 years to raise awareness of the health issues surrounding high BP. A questionnaire on demographic/clinical features and questions on the use of fixed-dose single-pills for the treatment of hypertension was administered. BP was measured with standard procedures.

Results:

A total of 1612 participants (mean age 60.0±15.41 years; 44.7% women) were enrolled. Their mean BP was 128.5±18.1/77.1±10.4 mmHg. About one in two participants was sedentary, or overweight/obese, or hypertensive. 55.5% individuals with complete BP assessment had uncontrolled hypertension; not being on a fixed-dose combination of antihypertensive drugs and not measuring their BP at home were common features in this setting. Self-reported adherence to BP medications was similar between individuals with controlled and uncontrolled BP (95% vs 95.5%).

Conclusions:

This survey identified a certain degree of therapeutic inertia and poor patients’ involvement in the therapeutic process and its monitoring in the examined population, underlining the importance of prevention campaigns to increase risk factors awareness to reduce CV risk.
A LINEAR RELATIONSHIP OF ANKLE-BRACHIAL SYSTOLIC BLOOD PRESSURE INDEX FOR COGNITIVE FUNCTION DECLINE AMONG OLDER ADULTS WITHOUT PERIPHERAL ARTERY DISEASE: THE HALST STUDY
Authors: Chuang Shao-YUAN , Chung Ren-Hua , Lai Chia-Hung , Liu Wen-Ling , Chang Hsing-Yi , Hsiun Chao Agnes , Chuang Shu-Chun , Wu I-Chien , Hsu Chih-Cheng
Published: May 2024

Objective:

Peripheral artery disease is associated with higher cognitive impairment. However, the association between ankle-brachial index (ABI) and cognitive function decline remains unclear. We aimed to investigate the association of ABI with cognitive function decline among older adults.

Design and method:

A total of 3662 people aged more than 55 years old (Men: 1702 and Women: 1960) without peripheral artery disease (0.9 < ABI < 1.4) from the Healthy Aging Longitudinal Study in Taiwan was evaluated for cognitive function using MMSE in baseline (2009∼2013) and 2nd wave (2014∼2019).

Ankle-brachial index was measured by the ratio of supine ankle and brachial systolic blood pressure. Cognitive function decline was calculated by MMSE at baseline mines MMSE at 2nd wave. Linear regression was used to investigate the associations of baseline ABI with future cognitive function and cognitive function decline.

Results:

The average of MMSE at baseline, at 2nd wave and the change during the follow-period were 26.9 (standard deviation[s.d.]=3.17), 25.5 (s.d.=4.28) and -1.42 (s.d.=2.94), respectively. Baseline left-ABI (beta = 1.50, p=0.0060) was positively associated with future MMSE, independent of age, gender, education and baseline MMSE, but right-ABI (Beta=0.80, p=0.1517) was not. Furthermore, the MMSE score change (from baseline to 2nd wave) was -0.36 (p=0.0084) for the 1st (Lowest), -0.25 (p=0.00736) for the 2nd, and -0.211 (p=0.1296) for the 3rd Left-ABI, compared to the referent group (highest) of Left-ABI, respectively, in the multivariable model.

Conclusions:

Baseline higher ankle-brachial index was positively associated with future cognitive performance and with a lower decline rate of cognitive function among older adults.
PREVALENCE OF MASKED HYPERTENSION IN ATTENDED VS. UNATTENDED OFFICE BLOOD PRESSURE MEASUREMENT
Authors: Bertram Sebastian , Bauer Frederic , Shadi Rohni , Rieckmann Sonja , Seidel Maximilian , Doevelaar Adrian , Seibert Felix , Babel Nina , Westhoff Timm
Published: May 2024

Objective:

There is a controversial debate, whether unattended blood pressure (BP) measurement should be regarded as the new gold standard of office BP measurement, since it eliminates the white-coat effect and reduces external influences on the patient. On the other hand, it might underestimate real life BP. The present study compares the prevalence of masked hypertension using attended vs. unattended office BP measurement.

Design and method:

We performed a cross-sectional study in 213 patients in a general practioners outpatient clinic and compared attended and unattended office BP with 24h-ambulatory blood pressure monitoring (24h-ABPM). Masked hypertension was defined as pressure >=135/85mmHg in daytime ABPM with office systolic BP<140/90mmHg.

Results:

Median attended and unattended office BPs were 140/86 and 134/80mmHg with median 24h-BP of 129/79mmHg and daytime-ABP of 133/82mmHg. The number of patients with masked hypertension was 45/213 (21.2%) using unattended and 23/213 (10.8%) using attended office BP measurement (p<0.0001). Bland-Altman analysis revealed biases of 7.4mmHg systolic and 6.2mmHg diastolic between the attended vs. unattended office BP and biases of 2 systolic and -1.7mmHg diastolic between unattended office BP and daytime ambulatory BP. In linear regression analysis an unattended office BP of 134mmHg corresponded to 140mmHg in attended BP measurement. Using a cut-off of 135/85mmHg instead of 140/90mmHg in unattended office BP measurement the rate of masked hypertension was 26/213 (12.2%).

Conclusions:

Thus, unattended office BP measurement results in a substantial increase in the prevalence of masked hypertension using the traditional definition of hypertension. The present findings suggest that it might be reasonable to use a definition of 135/85mmHg.
VALIDATION OF A NOVEL PROFESSIONAL AUTOMATED AUSCULTATORY BLOOD PRESSURE MONITOR KOROT V2 DOCTOR IN GENERAL POPULATION ACCORDING TO THE AAMI/ESH/ISO UNIVERSAL STANDARD
Authors: Theodosiadi Aikaterini , Menti Ariadni , Ntousopoulos Vasileios , Ntineri Angeliki , Stathopoulou Panagiota , Kyriakoulis Konstantinos , Kollias Anastasios , Stergiou George
Published: May 2024

Objective:

A novel automated auscultatory upper arm-cuff blood pressure (BP) monitor KOROT V2 Doctor was developed for professional use. This device is equipped with an electronic stethoscope integrated into the cuff to enable recording of Korotkoff sounds. These auditory signals are graphically displayed during the deflation process, offering to the healthcare professionals a visual tool for assessing the quality of each automated reading. The device was validated according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2:2018) and its Amendment 1.2020-01.

Design and method:

Participants were recruited to fulfil the age, sex, BP, arm circumference and cuff distribution criteria of the Universal Standard and its Amendment in a general population using the same arm sequential measurement method. Three cuffs of the test device were tested for arm circumference 23-28, 28-35 and 33-42 cm.

Results:

Data from 85 individuals were analyzed (mean age 56.4±16.0 [SD] years, 50 men, arm circumference 23-42 cm). For validation Criterion 1, the mean difference ±SD between the test device and reference BP readings (N=255) was -1.3±6.0/1.5±5.0 mmHg (systolic/diastolic; threshold <= 5±8 mmHg). For Criterion 2, the SD of the averaged BP differences per individual (N=85) was 4.61/3.48 mmHg (systolic/diastolic; threshold <= 6.82/6.78 mmHg).

Conclusions:

The KOROT V2 Doctor electronic device developed for professional use, which provides automated auscultatory measurements with visual display of the Korotkoff sounds, comfortably fulfilled all the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) in a general population and can be recommended for clinical use. This novel device offers potential additional advantages for clinical practice, as it simulates the gold standard manual auscultatory method and allows healthcare professionals to visually assess Korotkoff sounds during each measurement, allowing the rejection of poor-quality readings.
RELATIONSHIP OF PARAMETERS OF CENTRAL HEMODYNAMICS AND ARTERIAL STIFFNESS WITH COGNITIVE FUNCTIONS IN PATIENTS WITH ESSENTIAL HYPERTENSION
Authors: Yusupova Khafiza , Abdullaeva Guzal , Khamidullaeva Gulnoz , Mashkurova Zaringiz , Masharipov Shukhrat
Published: May 2024

Objective:

To conduct a correlation analysis of central hemodynamics and arterial stiffness parameters with cognitive functions in patients with essential hypertension (EH).

Design and method:

The study included 111 male and female patients with grades I–III AH according to the classification (ESC/ESH, 2018). The average age of the patients was 54.6±10.8 years, the average duration of AH was 8.8±5.52 years. The state of arterial stiffness was assessed by applanation tonometry using the SphygmoCor apparatus (AtCor Medical, Australia). Cognitive functions were assessed using neuro-psychological tests: the Mini-Cog test (drawing a clock, reproducing words) and the Montreal Cognitive Assessment Scale (MOCA).

Results:

The correlation analysis between the parameters of central hemodynamics and arterial stiffness revealed a negative correlation between the pulse wave velocity (PWV) and the severity of cognitive impairment, in particular, with the overall Mini-Cog score (R=-0.24, p=0.01), as well as central pulse pressure (CPP) with a total score on the Mini-Cog test (R=-0.27, p=0.007).

Conclusions:

Thus, an increase in pulse wave velocity and central pulse pressure correlates with the severity of cognitive impairment in EH patients.
THE WHITE MATTER INTEGRITY AND COGNITIVE PERFORMANCES OF HYPERTENSIVE PATIENTS ARE ASSOCIATED TO CIRCULATORY INFLAMMATORY RISK BIOMARKERS AND CIRCULATING WHITE BLOOD CELLS
Authors: Carnevale Lorenzo , Maffei Angelo , Carnevale Daniela , Lembo Giuseppe
Published: May 2024

Objective:

The role of the immune system and inflammation in establishing target organ damage in cardiovascular diseases and hypertension is widely recognized. While this has been well characterized in hypertension-induced cardiac and renal damage, preclinical studies pointed out its role in cerebral injury, but it is less known whether this can be verified in hypertensive patients. In particular, no study has investigated how inflammatory mediators and circulating immune cells can be used as risk biomarkers for cerebral injury parameters obtained by neuroimaging in hypertensive patients

Design and method:

We have subjected hypertensive patients to cerebral MRI, elaborated with advanced neuroimaging techniques as diffusion tensor imaging (DTI)-MRI to assess white matter injury. We subjected patients to neuropsychological tests such as the Montreal Cognitive Assessment (MoCA) to evaluate cognitive function, measured circulating high sensitivity C-reactive protein (hs-CRP) as a general inflammatory biomarker and counted white blood cells (WBC).

Results:

We found a widespread association between white matter tract loss of integrity and elevation of inflammatory and immune biomarkers (Figure A). Specifically, the regions surrounding and crossing the corpus callosum like Forceps Major and Minor, the Anterior Commissure show a correlation between the microstructural loss of integrity and hs-CRP levels. On the other hand, the integrity of tracts situated across the temporal lobe, as the Superior Longitudinal Fasciculus, the Arcuate Fasciculus and other associative tracts is correlated with the WBC. Finally, tracts connecting the temporal lobe and traversing the white matter near the corpus callosum, and specifically the Frontal Aslant and the Uncinate Fasciculus, show associations with both inflammatory and immune markers (Figure B).

Conclusions:

We leveraged advanced neuroimaging to show that the immunoinflammatory risk in hypertensive patients is associated with white matter alterations in the corpus callosum, associative and projection fibers. Furthermore, our previous work identified that white matter damage in the Forceps Minor and Superior Longitudinal Fasciculus was a typical trait of hypertensive patients. Our data further show that the inflammatory risk associates with lower score at cognitive tests, suggesting a clinical relevance in terms of damage evidenced by advanced MRI in hypertensive patients.
HYPERTENSION AND DEXTROMETHORPHAN POISONING IN PATIENTS AGED BETWEEN 0 TO 18 YEARS- A 7 YEAR RETROSPECTIVE CASE SERIES
Authors: Stratula Andreea- Catalin , Popescu Alexandru- Mihai , Ulmeanu Coriolan Emil , Vivisenco Iolanda , Nitescu Gabriela Viorela
Published: May 2024

Objective:

Coughing is a common symptom in the pediatric population. The wide variety of preparations available in pharmacies allows easy access to over-the-counter use. Dextromethorphan inhibits the cough reflex through an antagonistic mechanism at the NMDA-glutamate opioid receptor. Its effects are similar to those of drugs of abuse (phencyclidine and ketamine). In high doses, it produces tachycardia, hypertension, altered consciousness to coma, and neurological symptoms (agitation, hallucinations, seizures). According to the literature, patients between the ages of 12 and 20 years account for 50% of all dextromethorphan poisoning emergencies. The aim of our study is to determine the presence of arterial hypertension, its characteristics and the course of its development in dextromethorphan intoxication.

Design and method:

We present a series of 18 cases of acute dextromethorphan poisoning that were admitted to the Pediatric Antitoxic Center in Bucharest between January 2017 and November 2023.

Results:

The age range in the series of 18 patients is from 1 to 17 years. Voluntary intoxication was recorded in 13 cases (72.22%) Hypertension was noted in 15 cases (83.33%). Hypertension was present at the onset of symptoms. The poisoning severity score(PSS) showed that most of the cases were moderate (77.77%)

Conclusions:

Hypertension is a common symptom of dextromethorphan intoxication in patients between 0 and 18 years of age and may be accompanied by palpitations and precordialgia. It is mild to moderate in severity and does not require any specific treatment, as general management of the intoxication is sufficient. Severe cases or death are a rare event, while moderate cases are the most common.
DETERMINATION OF WAIST CIRCUMFERENCE IN ADOLESCENTS AS A PREDICTION TOOL OF CARDIOVASCULAR RISK FACTORS
Authors: Ospanova Ainur , Kerimkulova Aiman , Veber Viktor , Markabayeva Akbayan , Nurpeissova Riza , Adiyeva Madina
Published: May 2024

Objective:

to assess the efficiency of WC at teenagers in prognostication of cardiovascular risk factors

Design and method:

Cross-sectional study developed with 1519 adolescents aged 12-13 years (average age, standard deviation 12.3 + 0.46 years). The prevalence of hypertension was assessed and its relationship with waist circumference. Criteria for assessing blood pressure of adolescents are identified by the following data: normal blood pressure (systolic and dyastolic blood pressure <89 percentile); high normal blood pressure (systolic and dyastolic blood pressure < 90 and 94 percentile); hypertension (systolic and dyastolic blood pressure 95 percentile). The analysis and processing of statistical data were carried out using the SPSS (version 22) program. The Pearson Chi squared test was used for comparison between groups and the presence of relationships between them or Fisher test for the difference between the proportions. The criterion for the statistical significance of the obtained results was considered the value of p <0.05. ROC analysis was used to study the relationship between waist circumference and overweight/obesity. The distinctive impact of waist circumference on the development of these states was expressed as the area under the curve (AUC 95% CI)

Results:

From 1519 studied teenagers of 12-13 years, boys were 49.1% (n=745), girls 50.9% (n=774) respectively. Population with normal BP composed 62.7%, normal raised blood pressure - 24.8%, Hypertension-12.4%. There were conducted measurements of waist circumference as a method of indirect assessment of abdominal obesity. There was revealed WC 90P 98.5% (n=939) of teenagers that shows insignificant number of the adolescents suffering from abdominal obesity. The distribution by sex was: with a normal waist circumference value 98.8% among boys, 94.7% girls respectively, girls are more likely to have abdominal obesity than boys, (Chi squared test = 19.940, df = 1, P 0.001)

Conclusions:

waist circumference rates are not as popular among children and adolescents in comparison with adults. According the obtained data of high sensitivity and specificity, it is possible to recommend active use of waist circumference in clinical practice for the early detection for the assessment of the risk of developing cardiovascular diseases regarding maturity