bluuebunny/crossref_metadata_2025 huggingface dataset:
CLINICAL EFFICACY AND SAFETY OF AMLODIPINE/BISOPROLOL/PERINDOPRIL SINGLE-PILL AND FREE COMBINATION THERAPY IN PATIENTS WITH UNCONTROLLED ESSENTIAL HYPERTENSION
Authors: Konradi Alexandra , Hassan Hasnaa , Lefay Didier , Isachenko Elena , Jamois Aude
Published: June 2022

Objective:

Efficacy and safety of the triple therapy amlodipine 5 mg, bisoprolol 5 mg and perindopril 5 mg in single pill combination (SPC) and in free combination, over a 12-week period.

Design and method:

Multicenter, randomized, open-label, controlled, phase III study. Patients with uncontrolled hypertension (Systolic Blood Pressure (SBP) > = 140 and < 160mmHg and Diastolic Blood Pressure (DBP) > = 90 and < 100 mmHg) treated either by monotherapy at maximal dose or bitherapy at initial dose were randomized to the SPC (group A), or to the free combination (group B). Previous antihypertensive treatment was discontinued. Efficacy assessments: SBP, DBP, response to treatment (rate of patients with BP normalized and/or decrease of SBP > = 20 mmHg and/or decrease of DBP > = 10 mmHg from baseline) and BP control rate (SBP < 140 mmHg and DBP < 90 mmHg). Patient-reported outcomes were evaluated using the TSQM-9 (Treatment Satisfaction Questionnaire for Medication) to assess treatment effectiveness, convenience and global satisfaction at the end of the study.

Results:

150 patients were randomized (mean age 55.2 ± 10.1 years). At baseline, mean SBP/DBP in the included population were 149.71 ± 5.09/94.92 ± 2.78 mmHg. After 12 weeks of treatment, important SBP/DBP decrease was observed in both groups (-22.01 ± 10.04/-13.79 ± 7.47 mmHg in group A and -21.81 ± 9.41/-15.06 ± 8.31 mmHg in group B). High response to treatment was observed in both groups (90.91% in group A, 93.06% in group B) but higher proportion of patients were controlled with SPC (91.89% in group A, 87.5% in group B). Treatments were well tolerated. Less treatment-related adverse events were reported in group A (1.3%) versus in group B (6.9%). Most of the patients were satisfied with treatment in both groups, with a better convenience for the group A.

Conclusions:

In case of uncontrolled BP despite monotherapy at maximal dose or bitherapy at initial dose, switching to triple therapy of amlodipine 5mg+bisoprolol 5mg+perindopril 5 mg leads to a significant decrease of BP (p < 0.001), an improvement of response to treatment and better BP control rate. For similar efficacy, treatment by SPC showed lower rate of treatment-related adverse events and was assessed as more convenient by patients as compared to free combination.
PHARMACOLOGICAL TREATMENT OF ARTERIAL HYPERTENSION GUIDED BY PERIPHERAL OR CENTRAL BLOOD PRESSURE: COMPARISON OF THE TWO STRATEGIES IN THE INCIDENCE OF INTERMEDIATE OUTCOMES
Authors: Filho Gilberto Guimaraes , Inuzuka Sayuri , Vitorino Priscila , Sousa Ana Luiza Lima , Coca Antonio , Barroso Weimar Sebba
Published: June 2022

Objective:

To compare the parameters of central and peripheral blood pressure measurements, arterial stiffness, target organ damage (TOD), biochemical and renal profiles among participants who had the therapeutic strategy guided by central (CG) and peripheral (PG) blood pressure values.

Design and method:

Randomized study in two groups: CG and PG. Five visits were carried out, the first (V1) being selection and randomization followed by intermediate visits, every 3 months, to assess blood pressure and adjust antihypertensive drugs. The procedures performed in the initial and final visit (V5) were: measurement of central arterial pressure and pulse wave velocity (PWV) (mobil-o-graph) and peripheral (OMRON HEM1100), carotid ultrasound, echodopplercardiogram and laboratory tests. Paired and unpaired t and chi-square tests were used. Adopted significance level of 5% and a confidence interval of 95%.

Results:

A total of 59 participants were evaluated (30 from the CG and 29 from the PG). Age, BMI, central and peripheral blood pressure measurements, PWV, left ventricular mass index (LVMI), carotid intimal mean thickness, biochemical profile and glomerular filtration rate did not differ between the two groups (p > 0.05) in randomization. The augmentation index (AIx) was higher in the CG than in the PG at randomization (27.3% ± 12.2% vs 20.3% ± 13.3% p 0.041). After 1 year of follow-up, in the analysis between the groups, the central diastolic pressure was lower in the CG (78.9mmHg ± 9.7mmHg vs 84.3 ± 10.4mmHg, p 0.024) and the difference in AIx between the groups ceased to exist. When intra-group comparisons were made before and after the intervention, a reduction in the PWV (p < 0.001) and LVMI (p = 0.018) was observed in the CG. In PG there was an increase in PWV (p < 0.001) and LVMI (p = 0.003).

Conclusions:

The intervention guided by central pressure, after 1 year of follow-up, was able to reduce the central diastolic pressure and correct the AIx parameter and, in the intra-group analysis, it promoted a reduction in PWV and LVMI. There was no difference between the two groups regarding the improvement of outcomes related to central and peripheral blood pressure, cardiac and vascular TOD, biochemical and renal profile.
ANTIHYPERTENSIVE TREATMENT IN MASKED HYPERTENSION FOR TARGET ORGAN PROTECTION (ANTI-MASK): A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL
Authors: Huang Jian-Feng , Zhang Dong-Yan , An De-Wei , Li Ming-Xuan , Chen Xin , Feng Ying-Qing , Zheng Qi-Dong , Li Yan , Wang Ji-Guang
Published: June 2022

Objective:

Masked hypertension is associated with target organ damage and adverse outcomes. However, up to now there is no interventional evidence that antihypertensive therapy will be beneficial to the patients.

Design and method:

The ANTIhypertensive treatment in MASKed hypertension for target organ protection (ANTI-MASK) trial is a multicenter, randomized, double-blind, placebo-controlled clinical trial (NCT02893358). Eligible patients were 30 to 70 years old, had untreated masked hypertension and at least one sign of target organ damage (TOD). Masked hypertension was defined as a normal office blood pressure (BP, < 140/90 mmHg) and an elevated 24-hour (> = 130/80 mmHg), daytime (> = 135/85 mmHg) or nighttime BP (> = 120/70 mmHg) at both screening visits. TOD included electrocardiogram diagnosed left ventricular hypertrophy (LVH), brachial-ankle pulse wave velocity (ba-PWV) > = 1400 cm/s, or a random urinary albumin-to-creatinine ratio (ACR) > = 2.5 mg/mmol in men and > = 3.5 mg/mmol in women. Randomized patients were treated with alisartan 80 mg per day or placebo. If ambulatory BP was uncontrolled, drug dosage was doubled at the 2-month visit, and amlodipine 2.5 mg or matching placebo was added at the 4-month visit. The primary endpoint was the improvement rate of TOD after 12 months treatment, defined as the reverse (yes to no) of TOD or a significant decrease of ba-PWV or ACR by > = 20% of the baseline level.

Results:

From Feb 2017 to Oct 2020, 317 patients with masked hypertension (43.2% women, mean age 54 years) were randomized in 13 hospitals in China. Overall, baseline office, 24-h, daytime and nighttime BPs averaged 130/81, 137/85, 141/87, and 126/77 mmHg, respectively. At baseline, 98% had an elevated ba-PWV, 12% microalbuminuria, and 8% LVH. 252 patients completed the 12-month treatment and 65 (20.5%) withdrew from the trial. In the intention-to-treat analyses, the improvement rate of TOD was significantly higher in the antihypertensive treatment group than the placebo group (47.4% vs 26.1%, P < 0.0001), as well as the decrease of the 24-h systolic/diastolic BPs (-9.1/-5.7 vs -1.5/-1.0 mmHg, P < 0.0001).

Conclusions:

Antihypertensive treatment was beneficial for patients with masked hypertension in terms of TOD protection.
MULTIPLE DRUG INTOLERANCE IN PATIENTS WITH ARTERIAL HYPERTENSION: PREVALENCE AND DETERMINING FACTORS
Authors: Polaczyk Magdalena , Olszanecka Agnieszka , Wojciechowska Wiktoria , Rajzer Marek , Stolarz-Skrzypek Katarzyna
Published: June 2022

Objective:

One of the reasons for patients’ poor medication compliance is the occurrence of drug-induced adverse events. The aim of this study was to determine the prevalence of Multiple Drug Intolerance Syndrome (MDIS), defined as adverse events after 3 or more drug classes, in a group of patients with arterial hypertension and to assess the predisposing factors.

Design and method:

The study population comprised hospitalized patients diagnosed with arterial hypertension as well as patients undergoing chronic treatment in an outpatient hypertension clinic. A structured proprietary questionnaire was used, which focused on demographic and clinical data, including current or past incidences of adverse drug reactions.

Results:

The study population comprised a total of 1000 patients, including 560 women. The mean age was 62.84 ± 14.96 years. Eighty patients (8%) suffered from MDIS. A significantly higher percentage of patients with MDIS were women (71% vs. 55%, p = 0.006) and patients with longer-lasting hypertension (median 15 vs. 10 years, p = 0.008). Moreover, among patients with MDIS, the following disorders were more frequent: respiratory (21% vs. 11%, p = 0.013), gastrointestinal (25% vs. 13%, p = 0.003), rheumatic (24% vs. 9%, p < 0.001) and endocrine (29% vs. 16%, p = 0.007). The risk of MDIS was highest in the case of concomitant use of analgesics, OR = 65.59, p < 0.001, followed by beta-blockers, OR = 48.42, p < 0.001, antiplatelet drugs, OR = 47.26, p < 0.001 and antibiotics OR = 30.04, p < 0.001.

Conclusions:

MDIS in patients with hypertension is common and affects more frequently women and patients with a longer disease duration. Comorbidities increase risk of MDIS. The risk of MDIS is most strongly associated with the use of analgesics, beta-blockers, antiplatelet drugs and antibiotics.
RESISTANT HYPERTENSION IMPROVED AFTER 3 AND 6 MONTHS BY MEASURING DRUG LEVELS TO IDENTIFY NON-ADHERENCE
Authors: Peeters Laura , Kappers M.H.W. , Hesselink D.A. , Net J.B. Van Der , Hartong S.C.C. , Bahmany S. , Massay E. , Dijk L. Van , Gelder T. Van , Koch B.C.P. , Versmissen J. ,   Rhyme-Rct Research Group
Published: June 2022

Objective:

Identification of non-adherence to antihypertensive drugs is crucial to improve resistant hypertension (RH). For this measuring drug levels is the most reliable method.

The primary objective of this analysis is to determine whether drug levels measured with a dried blood spot (DBS) sampling method combined with personalized feedback leads to a decrease in prevalence of RH after 3 and 6 months due to an increase in adherence.

Design and method:

This is a multi-center single-blinded randomized controlled trial (RHYME-RCT, NL6736). Patients went to an eligibility visit, where DBS sampling and a 24-hour ambulatory blood pressure measurement (ABPM) was performed simultaneously. Patients with a daytime systolic blood pressure (SBP) > 135 and/or diastolic blood pressure (DBP) > 85 mmHg were randomized to standard treatment (control) or intervention. The intervention was performed by the treating physician and included information on drug levels and a personalized feedback conversation based on a feedback tool. The follow-up period was one year and included visits at 3, 6 and 12 months after the eligibility visit. At each visit an ABPM and DBS were performed.

Results:

A total of 78 patients (mean age of 59 ± 11 years, 75.6% male) with at least six months of follow-up were included. The prevalence of RH decreased from 100% in both arms to 60.0% in the intervention arm (p < 0.001, n = 35) and 58.1% in the control arm (p < 0.001, n = 43) after 6 months of follow-up. Adherence rates also improved over time, but only significantly improved in the intervention group after 3 months (p = 0.020). Furthermore, no statistically significant differences were found after six months between the two groups in the degree of RH (p = 0.868), SBP (p = 0.759) or adherence (p = 0.841).

Conclusions:

Measuring blood pressure and drug levels led to a decrease in the prevalence of RH. However, this improvement could not be linked to the actual intervention or improvement of adherence.

Note: In June 2022 data from the 12 months follow-up will also be complete and presented.
BELIEFS IN HEALTH AND ADHERENCE TO TREATMENT IN HYPERTENSIVE PATIENTS IN BARRANQUILLA- COLOMBIA
Authors: Montealegre Leslie , Navarro Gema , Amador Eulalia , Arteta Martha , De Oro Carlos
Published: June 2022

Objective:

The objective was to establish health beliefs and adherence to treatment in patients with hypertension in a health service in the District of Barranquilla, Colombia

Design and method:

Bonilla Ibáñez’s questionnaire version 3 with a Cronbach alpha of 0.851 was used to determine the adherence index and health beliefs of a sample of 400 patients from the cardiovascular risk program subprogram Hypertension attended in a health service of the subsidized regime of Barranquilla/Colombia

Results:

The mean age of the participants was 63.52(SD:12.70), 76% female, average evolution time of hypertension was 9.6 years (SD: 8.29). El 54.75% was found in adherence advantage (VADH),32.5% in risk of non-adherence (RNoADH) and 12.75% in nor adherence (NoADH). VaDH and RNoADH patients considered that their treatment did not create dependence and should be taken in 94% and 86.9% respectively, in contrast to 56.9% of NonADH who do not consider it, P(<0.001). To the belief of whether the treatment is beneficial and that is why it continues, the VADH and RNoADH always consider it in 97.7% and 87.7%, compared to 88.2% who sometimes consider it from the NoADHgroup, P(<0.001). When informed by the family’s beliefs about treatment and changes in customs if they were contrary to their faith and values, the VADH and RNoADH never consider it 97.3% and 87.7%, compared to 60.8% who sometimes consider it from the NoADHgroup, P(<0.001). Beliefabout hard-to-change habits about food and exercise is sometimes considered by patients VADH (61.6%), in RNoADH (56.2%) and in NoADH (56.9%), P(<0.001). VADH patients (95.9%), in RNoADH (78.5%) and NoADH (76.5%) believe it is convenient for their health to control weight, through diet and exercise, P(<0.001). VADHpatients (97.7%), NonADH (94.6%) and NoADH (54.9%) believe it is important to continue their treatment to improve their health, P(<0.001)

Conclusions:

Health beliefs may influence the rate of adherence to pharmacological and non-pharmacological treatment of patients with hypertension. The understanding and management of these variables by health personnel can help strengthen follow-up programs, addressing early the doubts and concerns that treatments may generate.
ESTIMATE OF ANTI-HYPERTENSIVE DRUG ADHERENCE THROUGH SERIAL MEASUREMENTS OF ALDOSTERONE-TO-RENIN RATIO
Authors: Buffolo Fabrizio , Sconfienza Elisa , Burrello Jacopo , Losano Isabel , Mengozzi Giulio , Priolo Gabriella , Avataneo Valeria , D’Avolio Antonio , Veglio Franco , Rabbia Franco , Mulatero Paolo , Monticone Silvia
Published: June 2022

Objective:

Inadequate adherence to anti-hypertensive prescription is one of the major obstacles for blood pressure control in patients with arterial hypertension. It is estimated that 40% of patients with hypertension have partial or absent compliance, with more than 80% of non-adherence when blood pressure targets are not achieved. However, in clinical practice the assessment of therapeutic adherence is still challenging. The available methods for the assessment of anti-hypertensive compliance are costly, low accurate or time consuming.

Design and method:

We designed a prospective observational study to evaluate the therapeutic adherence to inhibitors of renin-angiotensin-aldosterone system (RAAS) in patients with hypertension through serial measurement of aldosterone-to-direct renin ratio (ARR), before and after treatment.

We enrolled 80 patients, including 40 patients with arterial hypertension and 40 healthy controls. Patients with arterial hypertension underwent three visits: at baseline and 2 and 8 weeks after initiation of RAAS inhibitors. Patients of the control group underwent two visits: at baseline and after 2 weeks. At each visit we collected blood specimens for hormonal assays and therapeutic drug monitoring, used as gold standard for therapeutic adherence. We used delta ARR (ARR), defined as the relative change in ARR before and after treatment, for assessment of therapeutic compliance.

Results:

After initiation of RAAS inhibitor, aldosterone significantly decreased and renin levels significantly increased, with consequent ARR reduction. The use ARR provided high accuracy for determination of therapeutic compliance, with an area under the curve (AUC) of 0.900 and 0.886, at 2 and 8 weeks respectively. A cut-off of -48% of ARR was adopted, providing 90% sensitivity and 75% specificity, both at 2 and 8 weeks.

Conclusions:

The ARR measurement, is an innovative, cheap and highly sensitive method to predict compliance to RAAS inhibitors in patients with hypertension. We hence propose the implementation of ARR as screening test for identification of patients suspected to be non-adherent, reserving therapeutic drug monitoring for non-adherence confirmation.
DRUG ADHERENCE AND PSYCHOLOGICAL FACTORS MATTER IN PATIENTS WITH RESISTANT HYPERTENSION - YES BUT WHICH ONES?
Authors: Pappaccogli Marco , Georges Coralie Mg , Petit Geraldine , Ritscher Sabrina , Lopez-Sublet Marilucy , Fanelli Elvira , Rabbia Franco , Wallemacq Pierre , De Timary Philippe , Toennes Stefan W. , Persu Alexandre
Published: June 2022

Objective:

Altered psychological profiles are associated with drug adherence and drug resistance in patients with resistant hypertension (RHTN). However, treatment resistance may also result from increased arterial stiffness and target organ damage. The aim of this study was to assess the association of psychological factors with both drug adherence and drug resistance in two subtypes of patients with RHTN: younger patients without cardiovascular complications versus older or vascular patients.

Design and method:

Ninety-seven patients with RHTN were enrolled and split in two groups: patients 60y or older or with previous cardiovascular diseases (VRHTN), and younger patients without cardiovascular complications (NVRHTN). Drug adherence was assessed by urinary Liquid Chromatography coupled with tandem Mass Spectrometry. Drug resistance was evaluated by 24-hour ambulatory blood pressure adjusted for the number of antihypertensive drugs and drug adherence. Psychological profile was assessed using five validated questionnaires: the Brief Symptom Inventory (BSI), the Toronto Alexithymia Scale (TAS-20), the Emotion Regulation Questionnaire (ERQ), the Cognitive Emotion Regulation Questionnaire (CERQ) and the Post Traumatic Diagnostic Scale (PDS).

Results:

The proportion of fully adherent, partly adherent, and totally non-adherent patients was significantly different between NVRHTN (37, 39 and 24%) and VRHTN (67, 26 and 7 %) respectively (p-value = 0.010). After multiple regression analysis, independent predictors of poor drug adherence in NVRHTN were “adaptive strategies’’, male gender and family history of hypertension, accounting for 39.2% of the variability. Independent predictors of drug resistance were difficulties in planification and somatization, accounting for 39.0% of the variability. In the VRHTN group, predictors of drug adherence were yearly number of visits at the emergency department for hypertension and family history of cardiovascular events, accounting for 28.1% of the variability in drug adherence. Predictors of drug resistance were the number of visits at the emergency department and the total number of drugs prescribed per day, accounting for 35.0% of the variability in drug resistance.

Conclusions:

Poor drug adherence and altered psychological profiles appear to play a major role in younger patients with RHTN without cardiovascular complications. This subset of patients should be prioritized for assessment of drug adherence and psychological evaluation.
SACUBITRIL/VALSARTAN IMPROVES SEXUAL FUNCTION AND FIBROSIS OF THE CLITORAL AND VAGINAL TISSUES IN FEMALE SPONTANEOUSLY HYPERTENSIVE RATS
Authors: Zhuang Chenchen , Wang Wenjuan , Sun Runmin , Qi Miaomiao , Yu Jing
Published: June 2022

Objective:

Female sexual dysfunction is common in hypertension. The effects of sacubitril/valsartan (SAC/VAL) as a potential therapy for hypertension and heart failure have not been studied in relation to sexual function and genital fibrosis in female spontaneously hypertensive rats (SHRs). To evaluate the effect of SAC/VAL on sexual function and genital fibrosis in female SHRs.

Design and method:

Thirty female SHRs were administered VAL (30 mg/kg/day), SAC/VAL (60 mg/kg/day) or saline. Ten normotensive female Wistar-Kyoto (WKY) rats were included in the control group. We assessed estrous cyclicity and sexual behavior in the female rats. In addition, the morphology of clitoral and vaginal tissues was evaluated by histological analyses. Western blotting and enzyme-linked immunosorbent assays were used to assess the levels of fibrotic markers in vaginal and clitoral tissues. Furthermore, the protein levels of phosphatase and tensin homolog deleted from chromosome 10 (PTEN), phosphoinositide-3-kinase (PI3K) and AKT expression were measured by western blotting. We investigated the effect of SAC/VAL on the fibrosis of vaginal and clitoral tissues, estrus cyclicity and sexual behavior, including sexual receptivity (lordosis quotient and intensity), plus the number of proceptive and aggressive events.

Results:

SAC/VAL treatment improved hypertension-induced sexual dysfunction, exhibited as a prolonged estrus phase, increased receptivity and proceptive events, and decreased aggressive events, compared to those of VAL treatment and control SHRs without treatments. In addition, SAC/VAL-treated SHRs had lower levels of fibrotic markers than the levels of VAL-treated SHRs or SHRs without treatment. Moreover, SAC/VAL decreased p-PTEN expression and increased p-PI3K and p-AKT expression at the protein level compared to those in VAL treatment alone.

Conclusions:

SAC/VAL treatment is superior to VAL treatment in attenuating sexual dysfunction and fibrosis of vaginal and clitoral tissues, which may be related to the PTEN/PI3K/AKT pathway.
GENDER DIFFERENCES IN THE REGULATION OF BLOOD PRESSURE ASSESSED BY AMBULATORY BLOOD PRESSURE MONITORING – A SINGLE-CENTER EXPERIENCE
Authors: Stojanovic Milovan , Ilic Marina Deljanin , Ilic Stevan , Petrovic Dejan
Published: June 2022

Objective:

It has been shown a significant difference in clinical characteristics of HTN and treatment response to antihypertensive therapy between males and females. The purpose of our article was to examine gender differences in the regulation of blood pressure (BP) by using ambulatory blood pressure monitoring (ABPM).

Design and method:

Two hundred seventy-five consecutive hypertensive patients were included in the study (146 females, mean age 64.11 ± 10.47 and 129 males, mean age 61.69 ± 13.59). All patients were on antihypertensive treatment for more than one year (average duration of HTN was 11.07 ± 8.24 years for women, and 10.31 ± 7.5 years for men). In all pts, AMBP was performed. The values obtained by AMBP were compared between the two groups.

Results:

There were no significant differences in the presence of coronary artery disease, obesity, diabetes mellitus, or heredity between the groups. There were more smokers among male patients (p = 0.007), while dyslipidemia was more present in female pts (p = 0.005). Male pts had higher values of systolic (124.05 ± 13.89 vs. 119.5 ± 16.58, p = 0.015) and diastolic BP (72.77 ± 8.42 vs. 69.24 ± 8.23, p = 0.001) and larger burden of high BP during the night (56.54 ± 35.52 vs. 33.11 ± 35.27, p = 0.000) compared to female pts. There were no significant differences in pulse pressure (PP) values between the male and female groups (51.17 ± 11.33 vs. 50.72 ± 10.38, p = 0.730). However, pathological values of PP (<40 mmHg or > 60 mmHg) were found in almost 1/3 of pts (34.92% in men and 28.57% in women). Also, there was no significant difference in dipping pattern but only 40 (31.01%) male and 50 (34.25%) female patients had dipper status. There was no statistically significant difference in antihypertensive therapy between the groups. The most commonly used drugs were the angiotensin-converting enzyme inhibitors (82.21% of all pts) and beta blockers (78.78%), while the angiotensin receptor blockers were the least used (15.98%).

Conclusions:

Results indicate that women have better BP control than men. However, a high frequency of pathological PP values and disturbed dipping status detected by ABPM, in women as well as men, should highlight the importance of better BP management in both genders.
REACHING OF THERAPEUTICS GOALS IN PATIENTS WITH HYPERTENSION AND DIABETES MELLITUS. DO MULTIPLE THERAPY WORKS?
Authors: Barragan Adriana Cecilia Puente , Leiva Veronica Gomez , Espejel Lilian Delgado
Published: June 2022

Objective:

To analyze the efficacy of multiple pharmacological therapy on blood pressure control and therapeutics goals in a group of high-risk patients.

Design and method:

Blood pressure levels were analyzed in a group of 156 hypertensive patients with diabetes mellitus under pharmacological treatment, reviewed in the outpatient cardiology office. Blood pressure levels were classified according to the AHA and ESC classifications. Sociodemographic data, cardiovascular risk factors, number of drugs and therapeutic goals were recorded. Blood pressure measurement was performed using an digital manometer according to AHA and ESC guidelines. Results are shown in terms of measures of central tendency.

Results:

Average age was 55 ± 16 [20–93], 40% (62) were women. Smoking was the most common cardiovascular risk factor with 40% (62), followed by obesity 20% (31), CKD 10% (15), 25% (39) of the women were postmenopausal. The mean systolic blood pressure (SBP) obtained in the measurements was 124.27 mmHg (240–10 mmHg) and 74.7 mmHg (110–30 mmHg) of diastolic blood pressure (DBP), both in men and women (p = 0.06). Antihypertensive drug treatment was: 37% monotherapy, 42% dual,19% triple and 2% quadruple. Only 67% (104) were in therapeutics goals according to the ESC guidelines and 33% (52) according AHA guidelines respectively.

Conclusions:

Goal achievement is poor in this group of high-risk patients. Even though 63% of the patients had multiple pharmacological treatments, more than a third of patients were not reaching therapeutics goals in blood pressure control. This percentage doubles when more stringent goals are used, following the AHA guidelines.
AMBULATORY BLOOD PRESSURE MONITORING PARAMETERS IN HYPERTENSIVE PATIENTS WITH ABDOMINAL OBESITY IN THE DYNAMICS OF OLMESARTAN/ AMLODIPINE THERAPY
Authors: Koval Sergiy , Penkova Marina , Mysnychenko Olga , Reznik Larisa , Starchenko Tatyana , Lytvynov Vadym , Lytvynova Olga
Published: June 2022

Objective:

Study the ambulatory blood pressure monitoring (ABPM) parameters in patients with arterial hypertension (AH) with abdominal obesity (AO) in the dynamics of antihypertensive therapy.

Design and method:

60 AH patients with AO were examined. All patients were prescribed a fixed combination of drugs: olmesartan and amlodipine once a day in the morning at doses: 20 mg / 5- 40 /10 mg. ABPM was performed according to the standard method before and after 6 months of treatment.

Results:

24-hour systolic BP (SBP) and diastolic BP (DBP) in patients were 150 (140–159) / 98 (82–105) mm Hg. 24-hour pulse BP - 58 (50–64) mm Hg. Daytime SBP variability in patients was 19 (12–25) mm Hg, daytime DBP variability was 15 (9–19) mm Hg. SBP variability at night was 15 (9–17) mm Hg, DBP variability at night was 13 (8–15) mm Hg. As a result of treatment, the target BP level was achieved in 80% of patients according to the office BP and in 60% -according to the ABPM. The number of patients with pathological variability of BP decreased from 49% to 23% (p < 0.05). An excessive morning rise in SBP at the beginning of the study was noted in 32% of patients, and at the end of the observation - in 11% (p < 0.05). The number of patients with nocturnal hypertension decreased from 42% to 15% after 6 months of treatment (p < 0.001). The distribution of patients by BP profiles revealed that at the beginning of the study «dipper» was in 40% of the patients, «over-dipper» - in 12%, «non-dipper» - in 38%, and «night-picker»- in 6%. After 6 months of treatment the number of patients with the «dipper» profile of ABPM increased to 88%, and with «over-dipper» decreased to 6%. The number of patients with unfavorable «non-dipper» and «night-picker» profiles of ABPM decreased to 5%(p < 0.05) and 1% (p > 0.05), respectively.

Conclusions:

The fixed combination of olmesartan/ amlodipine led to the normalization of parameters of the ABPM profile in hypertensive patients with AO.
BLOOD PRESSURE CONTROL WITH BITHERAPY VERSUS MONOTHERAPY IN OLDER PATIENTS IN THE AREA OF BLIDA (ALGERIA)
Authors: Cherif Abdelghani Bachir , Bennouar Salam
Published: June 2022

Objective:

To describe hypertensive subjects over 60 years old, according to their bioclinical characteristics and their treatments by comparing monotherapy and combination therapy.

Design and method:

This is a cross-sectional study of 120 hypertensive patients aged over 60 between January 2021 and May 2021. The data were collected with a pre-established information sheet, from standardized files.

Results:

The mean age of the patients was 69,85 ± 7,82 years, 68 (56,7%) of the patients were men. The mean systolic/diastolic blood pressure was (137,45/76,06 ± 17,24/10.13 mmHg). The majority of patients (70%) were treated with dual antihypertensive therapy. The ARBs was the most prescribed class (72,5%). BP was controlled (reduced to < 140/90 mm Hg) in (64; 53,33%) patients, of whom 64,04% were on combination therapy. The comparison between the two groups under monotherapy and combination therapy was without significant difference.

Conclusions:

Few patients are treated with monotherapy, which reflects the recommendations of the European guidelines to treat with combination therapy. In summary, this study confirms the effectiveness of combination therapy for blood pressure control in the elderly.
Novel imaging techniques for sacroiliac joint assessment
Authors: Morbée Lieve , Jans Lennart B.O. , Herregods Nele
Published: June 2022

Purpose of review

Imaging of the sacroiliac joints is one of the cornerstones in the diagnosis and monitoring of axial spondyloarthritis. We aim to present an overview of the emerging imaging techniques for sacroiliac joint assessment and provide an insight into their relevant benefits and pitfalls.

Recent findings

Evaluation of structural and active inflammatory lesions in sacroiliitis are both important for understanding the disease process. Dual-energy computed tomography (CT) can detect inflammatory bone marrow edema in the sacroiliac joints and provides an alternative for magnetic resonance imaging (MRI). Three-dimensional gradient echo sequences improve the visualization of erosions on MRI. Susceptibility weighted MRI and deep learning-based synthetic CT are innovative MRI techniques that allow for generating ‘CT-like’ images and better depict osseous structural lesions than routine MRI sequences.

New imaging innovations and developments result in significant improvements in the imaging of spondyloarthritis. Advanced MRI techniques enhance its potential for the accurate detection of structural and active inflammatory lesions of sacroiliitis in one single imaging session.
Quo vadis reactive arthritis?
Authors: Zeidler Henning , Hudson Alan P.
Published: June 2022

Purpose of review

We provide an overview of recent articles which describe new thinking regarding HLA-B27-associated reactive arthritis (ReA), including those additional infection-related arthritides triggered by microbes that often are grouped under the term ReA.

Recent findings

With the advent and continuation of the pandemic, an increasing number of cases and case series of post-COVID-19 arthritis have been reported and classified as ReA. Further, arthritis after COVID-19 vaccination is a new entity included within the spectrum of ReA. New causative microorganisms identified in case reports include Clostridium difficile, Mycoplasma pneumoniae, Giardia lamblia, Leptospira, and babesiosis. SARS-CoV-2 is emerging as a significant etiologic agent for apparent ReA.

It is now clear that comprehensive clinical and laboratory investigations, synovial fluid analyses, and close follow-up of patients all are essential to differentiate ReA from diseases that may present with similar clinical attributes. Further, and importantly, additional research is required to define the wide diversity in causative agents, epidemiology, and rare case presentations of these arthritides. Finally, new classification and diagnostic criteria, and updated treatment recommendations, are essential to the advancement of our understanding of ReA.
Coracoclavicular Ligament Reconstruction Using TightRope for Delayed Grade III Acromioclavicular Joint Injury After Ipsilateral Diaphyseal Clavicle Fracture Fixation: Surgical Technique and Review of Current Literature
Authors: Fulton Zachary W. , Singleton Amy , Miller Richard M.
Published: June 2022

Athletes commonly sustain high-energy direct impact injuries to the shoulder, with acromioclavicular joint (ACJ) injuries accounting for over half. Ipsilateral ACJ injury and diaphyseal clavicle fracture occur nearly 7% of the time. There is limited literature offering treatment suggestions for this unique injury pattern and limited evidence providing guidance to suggest which injury patterns should be treated operatively or nonoperatively. Here, we present successful treatment of a high-level athlete utilizing a Knotless TightRope XP placed through a superior clavicle plate with successful return to full activity at 6 months postoperation. The TightRope technique offers the ability to augment through a preexisting superior clavicular plate in a low-profile manner and promote easy suture tensioning to obtain and maintain reduction of the injured ACJ.
Arthroscopic Trapeziectomy
Authors: Tosti Rick
Published: June 2022

Several methods of resection arthroplasty for the thumb basal joint exist, yet one commonality of these procedures is the removal of the trapezium. My preference is to achieve total trapeziectomy through a less invasive approach and encourage immediate mobilization in order to expedite return to function. Herein I present a step by step method of arthroscopic total trapeziectomy without suspensionplasty.
Simultaneous Limited Incision Carpal Tunnel Release and Flexor Digitorum Superficialis Opponensplasty Using a Transverse Carpal Ligament Pulley: Surgical Technique and Case Series
Authors: Dalberg Ryan , Mikola Elizabeth , Mercer Deana , Moneim Moheb S.
Published: June 2022

Severe thenar muscle atrophy resulting in dysfunctional thumb abduction and opposition is a well-documented finding associated with long-standing severe carpal tunnel syndrome. This problem has been addressed in the past through various opposition tendon transfers. Historically, the Camitz procedure, or its modifications using the palmaris longus tendon, were recommended. However, this procedure requires a long incision in the palm, extensive dissection including the wrist area, and may not produce active thumb pronation. Our surgical technique describes an open limited palmar-only carpal tunnel release with ring finger flexor digitorum superficialis opponensplasty using a slit through the released transverse carpal ligament as a pulley and dual insertion of the tendon in both the extensor hood and the tendon of the abductor pollicis brevis. The Kapandji evaluation of thumb opposition was used to determine the outcome after surgery.
Effect of the COVID-19 Pandemic on Accredited Continuing Medical Education in the United States
Authors: McMahon Graham T.
Published: June 2022

Introduction:

The pandemic created new demands on the accredited continuing medical education (CME) community. Facing economic, resource, and personal challenges, educators had to cancel or repurpose in-person learning, and design and deliver effective online education. This short report analyzes the effect of this pandemic on CME in the United States.

Methods:

Organizations accredited by the Accreditation Council for Continuing Medical Education are required to submit detailed data about their educational programs annually. This report compares 2019 and 2020 data sets to evaluate pandemic-related changes in the availability, formats, and participation in CME.

Results:

After years of comparative stability, 2020 saw significant shifts in CME. Compared with 2019, the number of accredited organizations, activities, hours of instruction, and revenue declined in 2020. In contrast, engagement in CME by physicians and other health care professionals increased to the record levels. Virtual learning formats predominated. Almost half of accredited organizations delivered activities addressing pandemic-related topics, mostly in online formats.

Discussion:

Educators anticipate continuing to offer activities in online and hybrid formats. This transformation presents new challenges and opportunities for CME. It is important that institutional leaders appropriately resource CME staff and faculty to design and deliver education targeting ongoing pandemic-related issues such as vaccine hesitancy, medical misinformation, and clinician burnout.
Frameworks for Integrating Learning Analytics With the Electronic Health Record
Authors: Pusic Martin V. , Birnbaum Robert J. , Thoma Brent , Hamstra Stanley J. , Cavalcanti Rodrigo B. , Warm Eric J. , Janssen Anna , Shaw Tim
Published: June 2022

The information systems designed to support clinical care have evolved separately from those that support health professions education. This has resulted in a considerable digital divide between patient care and education, one that poorly serves practitioners and organizations, even as learning becomes ever more important to both. In this perspective, we advocate for the enhancement of existing health information systems so that they intentionally facilitate learning. We describe three well-regarded frameworks for learning that can point toward how health care information systems can best evolve to support learning. The Master Adaptive Learner model suggests ways that the individual practitioner can best organize their activities to ensure continual self-improvement. The PDSA cycle similarly proposes actions for improvement but at a health care organization's workflow level. Senge's Five Disciplines of the Learning Organization, a more general framework from the business literature, serves to further inform how disparate information and knowledge flows can be managed for continual improvement. Our main thesis holds that these types of learning frameworks should inform the design and integration of information systems serving the health professions. An underutilized mediator of educational improvement is the ubiquitous electronic health record. The authors list learning analytic opportunities, including potential modifications of learning management systems and the electronic health record, that would enhance health professions education and support the shared goal of delivering high-quality evidence-based health care.
Using Administrative Data in Primary Care to Evaluate the Effectiveness of a Continuing Professional Development Program Focused on the Management of Patients Living With Obesity
Authors: Zevin Boris , Morkem Rachael , Soleas Eleftherios , Dalgarno Nancy , Barber David
Published: June 2022

Introduction:

There are guidelines for referral to medical and/or surgical weight loss interventions (MSWLI) in Ontario; however, only about one-third of eligible patients in our region are being referred for consideration of MSWLI.

Methods:

A planning committee, including a registered dietician, psychiatrist, endocrinologist, bariatric surgeon, family physician, and educationalists, developed an interdisciplinary continuing professional development (CPD) program focused on practical approaches to the management of patients living with obesity. The Kirkpatrick model was used to evaluate the educational outcomes of the CPD program specifically focusing on Level-2, -3, and -4 outcomes based on self-reported questionnaire and health administrative data.

Results:

Eighteen primary care providers from the CPD program agreed to participate in this study, and 16 primary care providers (89%) completed the postintervention questionnaire and granted us access to their MSWLI referral data; 94% of study participants reported changes to their knowledge, comfort, and confidence (Level 2), as well as expected change in their future behaviour (Level 3) following the CPD program. However, there was no change in Kirkpatrick Level-4 outcomes, despite more than 90% of participants indicating that they will be making changes to their practice after the program.

Discussion:

The CPD program in our study was overwhelmingly well received and participants reported knowledge (Level 2) and behavioural (Level 3) changes following participation; however, there was no detectable change in their clinical practice (Level 4). The methodology described in our proof-of-concept study can be modified and adopted to evaluate Level-4 outcomes in other studies of effectiveness of CPD interventions.
A Phase I Study of Apolizumab, an Anti-HLA-DR ß-chain Monoclonal Antibody, in Patients With Solid Tumor Malignancies
Authors: Fracasso Paula M. , Goodner Sherry A. , Wildi Jonathan D. , Naughton Michael J. , Linette Gerald P. , Govindan Ramaswamy , Tan Benjamin R. , Blum Kristie A. , Jones Gary J. , Pearce Tillman E. , Levitt Daniel J. , Clamon Gerald H.
Published: June 2022

Background:

Human leukocyte antigen (HLA)-DR, a member of the major histocompatibility complex class II antigen family, is a target for antibody-based therapeutics. Apolizumab (Hu1D10, Remitogen), a humanized IgG1 monoclonal anti-HLA-DR ß-chain antibody targets the antigen, 1D10, expressed on a wide variety of hematologic and solid tumor malignancies. In this Phase 1 trial, the maximum tolerated dose and dose-limiting toxicity of weekly apolizumab in patients with advanced solid tumor malignancies were determined.

Patients and Methods:

Eligible patients with refractory solid tumors were initially screened for ID10 Ag on their tumor. Patients whose tumors expressed 1D10 were administered apolizumab 0.5, 1.0, 1.5, or 3.0 mg/kg intravenously over 90 minutes weekly for 4 consecutive weeks, followed by a 4-week break, and assessment of response. Patients whose disease had not progressed were offered additional treatment.

Results:

Tumors from 75 patients were screened for 1D10 Ag of which 17 patients were positive and underwent treatment. The first 3 dose levels were well-tolerated. Dose-limiting toxicities of grade 3 infusion-related hypersensitivity reactions and grade 3 headache and hypertension occurred in 2 patients, respectively, at apolizumab 3.0 mg/kg. Four patients, 1 each with breast carcinoma, melanoma, renal cell carcinoma, and sarcoma had stable disease for a median of 15 weeks (range: 12 to 19 wk).

Conclusion:

Apolizumab can be administered safely at a maximum tolerated dose of 1.5 mg/kg for 4 consecutive weeks. Adverse events and limited clinical data in both hematologic and solid tumor malignancies resulted in discontinuation of clinical development of apolizumab. HLA-DR remains an interesting immunotherapeutic target.
Toward a Clearer Definition of Selection Bias When Estimating Causal Effects
Authors: Lu Haidong , Cole Stephen R. , Howe Chanelle J. , Westreich Daniel
Published: June 2022

Selection bias remains a subject of controversy. Existing definitions of selection bias are ambiguous. To improve communication and the conduct of epidemiologic research focused on estimating causal effects, we propose to unify the various existing definitions of selection bias in the literature by considering any bias away from the true causal effect in the referent population (the population before the selection process), due to selecting the sample from the referent population, as selection bias. Given this unified definition, selection bias can be further categorized into two broad types: type 1 selection bias owing to restricting to one or more level(s) of a collider (or a descendant of a collider) and type 2 selection bias owing to restricting to one or more level(s) of an effect measure modifier. To aid in explaining these two types—which can co-occur—we start by reviewing the concepts of the target population, the study sample, and the analytic sample. Then, we illustrate both types of selection bias using causal diagrams. In addition, we explore the differences between these two types of selection bias, and describe methods to minimize selection bias. Finally, we use an example of “M-bias” to demonstrate the advantage of classifying selection bias into these two types.
Prevalence of Mendosal Suture Patency in Infants Up to the Age of 18 Months
Authors: Escandón Joseph M. , Duarte-Bateman Daniela , Mantilla-Rivas Esperanza , Ichiuji Brynne A. , Rana Md Sohel , Manrique Monica , Oh Albert K. , Siampli Eleni , Linguraru Marius G. , Rogers Gary F.
Published: June 2022

Background:

The mendosal suture joins the interparietal and inferior portions of the occipital bone. Persistent patency of this suture can result in bathrocephaly, an abnormal occipital projection. This study aims to determine normal temporal fusion of the mendosal suture and cranial shape of the patients with persistent suture patency.

Methods:

A retrospective review of head CT scans in patients aged 0–18 months who presented to the emergency department between 2010 and 2020 was completed. Presence and patency of the mendosal suture were assessed. Cranial shape analysis was conducted in the cases that presented with 100% suture patency and age-matched controls. An exponential regression model was used to forecast the timing of suture fusion.

Results:

In total, 378 patients met inclusion criteria. Median age at imaging was 6.8 months (IQR 2.9, 11.6). Initiation of mendosal suture fusion was observed as early as 4 days of age and was completed in all instances except one by age 18 months. Most patients had either a complete or partial suture fusion (66.7% versus 30.7%, respectively), and 2.6% of patients had 100% suture patency. Cranial shape analysis demonstrated increased occipital projection in patients with 100% suture patency compared with their controls. Exponential regression model suggested that the mendosal suture closure begins prenatally and typically progresses to full closure at the age of 6 months.

Conclusions:

Prevalence of a patent mendosal suture was 2.6% overall. Mendosal suture fusion initiates in-utero and completes ex-utero within the first 18 months of life. Delayed closure results in greater occipital projection.