bluuebunny/crossref_metadata_2025 huggingface dataset:
THE LONG-TERM REPRODUCIBILITY OF THE WHITE-COAT EFFECT ON BLOOD PRESSURE AS A CONTINUOUS VARIABLE: THE OHASAMA STUDY
Authors: Satoh Michihiro , Yoshida Tomoya , Metoki Hirohito , Murakami Takahisa , Tatsumi Yukako , Hirose Takuo , Takabatake Kyosuke , Tsubota-Utsugi Megumi , Hara Azusa , Nomura Kyoko , Asayama Kei , Kikuya Masahiro , Hozawa Atsushi , Imai Yutaka , Ohkubo Takayoshi
Published: June 2023

Objective:

White coat hypertension is defined as a condition in which office blood pressure (BP), but not out-of-office BP, is elevated. However, the hypertension phenotype categorized by a determined threshold is generally fluctuant in individuals with BP readings close to the hypertension threshold. Furthermore, there is little information about the reproducibility of the white coat effect, which was a continuous variable, over more than a 1-year interval. The present study investigated the long-term interval reproducibility of the white coat effect.

Design and method:

We used the repeatedly measured white coat effect (office BP and home BP) at a 4-year interval in 153 participants not undergoing antihypertensive treatment (men, 22.9%; mean age, 64.4 years) from the general population of Ohasama, Japan. The reproducibility of the white coat effect as a continuous variable was assessed by testing the Bland–Altman plot and intraclass correlation coefficient (two-way random effect model single measures).

Results:

At baseline, the mean values were 127.5±15.8 mmHg for office systolic BP, 120.3±11.3 mmHg for home systolic BP, and 7.2±12.8 mmHg for the white coat effect based on systolic BP. The white coat effect for systolic BP decreased by 0.17±14.53 mmHg at the 4-year visit. The Bland–Altman plots showed no significant systemic error for the white coat effect (P > = 0.24) (Figure). The intraclass correlation coefficient (95% confidence interval) of the white coat effect for systolic BP, office systolic BP, and home systolic BP were 0.41 (0.27–0.53), 0.64 (0.52–0.74), and 0.74 (0.47–0.86), respectively. The difference in office systolic BP strongly contributed to the large change in the white coat effect. The agreements between hypertension phenotypes at baseline and the 4-year visit were minimal (kappa = 0.36; 95% confidence interval, 0.25–0.48).

Conclusions:

Long-term reproducibility of the white coat effect is limited in the general population not undergoing antihypertensive treatment. The change in the white coat effect is mainly caused by office BP variation.
PREVALENCE AND RISK FACTORS OF ORTHOSTATIC HYPOTENSION IN THE POPULATION-BASED SWISS LONGITUDINAL COHORT STUDY (SWICOS)
Authors: Schoenenberger-Berzins Renate , Hess Stephanie , Radovanovic Dragana , Muggli Franco , Bianchetti Mario , Gallino Augusto , Parati Gianfranco , Suter Paolo , Erne Paul , Schoenenberger Andreas
Published: June 2023

Objective:

The prevalence of orthostatic hypotension (OH) ranges from 5% to 30%. Most of these previous studies embraced highly selected study populations and there is scare data obtained in population-based studies. Therefore, we examined the prevalence and correlates of OH in the population-based SWICOS study.

Design and method:

The 496 SWICOS participants underwent blood pressure (BP) measurements after adequate rest as well as 1 and 3 minutes after standing up with a validated oscillometric device. OH was defined as a reduction of systolic BP of at least 20 mmHg and/or diastolic BP of at least 10 mmHg within 3 min of standing up from the sitting position. To assess the associations between baseline characteristics and OH, multivariate logistic regression models were performed, adjusted for age, sex, and other variables that showed a significant association with OH in univariate analysis.

Results:

Among 496 participants, 72 (14.5%) had OH. Participants with OH were significantly older than participants without [mean age 62y vs. 48y; p<0.001)]. Among the participants older than 60 years (n = 129), 38 individuals (30%) had OH. Participants with OH were more often affected by arterial hypertension (32% vs 13%; p<0.001) diabetes (10% vs 3%; p = 0.009), obesity (22% vs. 12%; p = 0.023), their muscle mass was lower (65% vs. 71%; p<0.001), and shorter walking distance (160 m vs. 170 m ; p<0.001). Participants with OH had a higher seated systolic (148mmHg vs. 129mmHg) and diastolic BP (88mmHg vs. 80mmHg) (both p<0.001). From 28 participants with OH who were on a prescription for antihypertensive drugs, 12 (43%) were taking more than one antihypertensive drug and/or a diuretic. Independent predictors for OH were increased systolic BP (OR per mmHg increase 1.05 (95%CI 1.03-1.07; p<0.001), higher number of prescribed antihypertensive drugs (OR 3.35; 95%CI 1.17-9.56; p = 0.024) and reduced walking distance (OR 0.99; 95%CI 0.98-1.00; p = 0.037).

Conclusions:

In our study, a higher systolic blood pressure, more intensive antihypertensive drug treatment as well as reduced walking distance were associated with OH. Adequate BP measurement, adequate selection of antihypertensive drug classes and regular physical activity may be effective preventive measures to reduce OH.
PRETERM BIRTH IS ASSOCIATED WITH INCREASED CENTRAL SYSTOLIC PRESSURE IN PRIMARY HYPERTENSION - SINGLE CENTER EXPERIENCE
Authors: Prelevic Vladimir , Jelakovic Ana , Radunovic Danilo , Gallineo Lana , Domislavic Marija , Gasparovic Kristina , Josipovic Josipa , Jelakovic Bojan
Published: June 2023

Objective:

Preterm birth (PB) and lower birth weight (LBW) are associated with higher risk for hyprtension, chronic kidney disease and cardiovascular (CV) morbidity and mortality in adulthood.

Our aim In this study was to analyze the association of PB and LBW with the parameters of arterial stiffness obtained during 24h measurement, with special focus on parameters of central hemodynamic (central aortic pressure).

Design and method:

In this study we included 154 adult patients (mean age 32, predominantly women (69.5%) with primary hypertension. In all of them we collected the data about term of birth and birth weight, and different antropological paramaters were measured. We determined various different laboratory data. Parameters of arterial stifness were measured in the office using Sphygmocor, and during the 24h using Mobil-o-Graph and Arteriograph.

Results:

In the whole group, 39 patients (25.5%) were born before the term. The corellation between pulse wave velocity (measured in office ambulatory during 24h) and term of birth was not found. The term of birth had low negative and statistically significant correlations with systolic central aortic pressure measured by Arteriograph during the night (r = -0.164, p < 0.05), as well as measured by Mobil-o-Graph during 24h (r = -0.167, p < 0.05), day (r = -0.172, p < 0.05) and night (r = -0.186, p < 0.05).

Conclusions:

Our findings suggest that preterm born is associated with increased systolic aortic pressure. We found this association fot the night time using two different devices. It could be speculated that this association might contribute to the global CV and kidney risk in subjects born before term. Further results are needed to answer whether ambulatory measurement of central hemodynamics have clinical importance.
ACCURACY OF FIXED 24-H AMBULATORY BLOOD PRESSURE RECORDINGS FOR DIAGNOSING HIGH 44-H AMBULATORY BLOOD PRESSURE IN HEMODIALYSIS PATIENTS: A DIAGNOSTIC TEST STUDY
Authors: Theodorakopoulou Marieta , Iatridi Fotini , Pella Eva , Karpetas Antonios , Georgiou Areti , Sampani Erasmia , Karkamani Eleni , Tsitouridis Alexandros , Papagianni Aikaterini , Sarafidis Pantelis
Published: June 2023

Objective:

Hypertension is highly prevalent in hemodialysis patients. Ambulatory-BP-monitoring (ABPM) during the 44-h interdialytic interval is recommended for hypertension diagnosis and management in these subjects. This study assessed the diagnostic accuracy of fixed 24-h ABPM recordings with 44-h BP in hemodialysis patients.

Design and method:

242 Greek hemodialysis patients that underwent valid 48-h ABPM (Mobil-O-Graph NG device) were included in the analysis. We used 44-h BP used as reference method and tested the accuracy of the following BP metrics: 1st 24-h without HD period (20h-1st), 1st 24-h including HD period (24h-1st) and 2nd 24-h (24h-2nd).

Results:

All studied metrics showed strong correlations with 44-h SBP/DBP (20h-1st: r = 0.973/0.978, 24h-1st: r = 0.964/0.972 and 24h-2nd: r = 0.978/0.977, respectively). In Bland-Altman analysis, small between-method differences (-1.70, -1.19 and +1.45 mmHg) with good 95% limits-of-agreement ([-10.83 to 7.43], [-11.12 to 8.74] and [-6.33 to 9.23] mmHg, respectively) for 20h-1st, 24h-1st and 24h-2nd SBP were observed. The sensitivity/specificity and ↓-statistic for diagnosing 44-h SBP grater or equal to 130 mmHg were high for 20h-1st SBP (87.2%/96.0%, ↓-statistic = 0.817), 24h-1st SBP (88.7%/96.0%, ↓-statistic = 0.833) and 24h-2nd SBP (95.0%/88.1%, ↓-statistic = 0.837). Similar observations were made for DBP. In ROC-analyses, all studied BP metrics showed excellent performance with high Area-Under-the-Curve values (20h-1st: 0.983/0.992; 24h-1st: 0.984/0.987 and 24h-2nd: 0.982/0.989 for SBP/DBP respectively).

Conclusions:

Fixed 24-h ABPM recordings during either the first or the second day of interdialytic interval have high accuracy and strong agreement with 44-h BP in hemodialysis patients. Thus, ABPM recordings of either the first or the second interdialytic day could be used for hypertension diagnosis and management in these subjects.
24HOUR, HOME AND CLINIC BLOOD PRESSURE FOR THE PREDICTION OF LEFT VENTRICULAR HYPERTROPHY IN UNTREATED HYPERTENSIVE POPULATION
Authors: Antza Christina , Chovarda Eleni , Anagnostis Panagiotis , Kitsios Konstantinos , Trakatelli Christina , Stabouli Stella , Kotsis Vasilios
Published: June 2023

Objective:

The aim of this study was to investigate which way of measuring blood pressure (BP), clinic, home or 24h-ABPM, can predict better left ventricular hypertrophy in the untreated hypertensive population.

Design and method:

175 consecutive subjects (42% male) aged 57.9±14.9 years were included in the study. Subjects were never treated before for hypertension. All subjects underwent 24h-ABPM on a usual working day. Home BP monitor was provided to all patients for 7 days, while office BP was measured in the clinic using a mercury sphygmomanometer. Left ventricular hypertrophy was evaluated by a cardiologist with the use of a 3D echocardiography.

Results:

In the univariate analysis, only home systolic and diastolic BP were independently associated with left ventricular hypertrophy, while both clinic and 24hour systolic and diastolic BP found not to be. From ROC curves for left ventricular hypertrophy, AUC of home systolic BP monitor (0.758, p<0.05) was larger than that of 24h (0.538, p>0.05) and clinic BP (0.497, p<0.05). As regards DBP, the ROC curves suggest no discrimination for the different ways of BP measurement.

Conclusions:

Home systolic BP can be a better predictor of left ventricular hypertrophy in untreated population, when compared to 24h and office systolic BP. This result shows the importance of home monitoring for the prediction of left ventricular hypertrophy, even in the untreated population.
ASSOCIATION OF OFFICE AND RESIDENTIAL BLOOD PRESSURE, PRESSURE CONTROL RATE AND NUMBER OF ANTI-HYPERTENSIVE AGENTS IN A BRAZILIAN MULTICENTRIC
Authors: Magalhaes Fabricio Galdino , Sousa Andrea Cristina , Batista Sandro Rodrigues , Amorim Kécia Cristina Faria De Oliveira , Inuzuka Sayuri , Barrroso Weimar Kunz Sebba , Sousa Ana Luiza Lima
Published: June 2023

Objective:

Compare systolic (SBP) and diastolic (DBP) blood pressure, control rate, number of antihypertensive drugs (AH) and age group among hypertensive patients.

Design and method:

Analytical cross-sectional study, using the TeleMRPA platform database. Variables used: sex, age, SBP and DBP obtained by HBPM, office BP (PAc) and number of AH: 1 monotherapy, double, triple combination or with four or more. Elderly > = 60 years old and non-elderly <60 years old were considered. The chi-square test was used to compare proportions and the t-student test to compare means, 95% confidence interval and significance level p<0.05.

Results:

25,543 participated, 54.6% elderly (n = 13938; p<0.001), more women in the elderly group (66.9%) than among non-elderly (58.6% - p<0.001). The elderly group (71±8.0 years old) had a mean SBP of 136.7(±21.3) mmHg and DBPc of 80.6(±11.8) mmHg and MRPA SBP 129.0(±16) .0) mmHg and DBP 76.4(±9.6) mmHg. The non-elderly group (47±8.6 years old) had SBP of 129.6(±18.4) mmHg and DBPc of 86.4(±11.5) mmHg and by MRPA SBP 122.9(±14.6) mmHg and DBP 81.5(±9.5)mmHg; significant mean differences (p<0.001) in both groups. Controlled BP rate (HBPM) among the elderly was 56.2% and among non-elderly 43.8%. The number of antihypertensive drugs in the elderly group was 38.2%, 38%, 18.5% and 5.3% for monotherapy, double, triple combination or with four or more AH respectively; among non-elderly people it was 47.8%, 36.6%, 12.3% and 3.3% (p<0.001). Among the elderly, the BP control rate (HBPM) was 43.8% in monotherapy and 35.9% in four or more combinations (p<0.001); among the non-elderly, the rate of BP control (HBPM) was 41.7% in monotherapy and 25.8% in combination with four or more drugs (p<0.001).

Conclusions:

The elderly group had higher systolic values, both in the office and at home, and lower diastolic values, and a higher frequency of antihypertensive therapy in combination. The BP control rate was higher among the elderly and the greater the number of drugs used, the lower the BP control rate in both groups.
USEFULNESS OF AMBULATORY BLOOD PRESSURE MEASUREMENTS IN HAEMODIALYSIS PATIENTS: A MONOCENTRIC CROSS-SECTIONAL STUDY EXTENDED TO A 5- YEAR FOLLOW-UP
Authors: Huart Justine , Vanderweckene Pauline , Seidel Laurence , Bovy Christophe , Delanaye Pierre , Dubois Bernard , Grosch Stephanie , Xhignesse Patricia , Saint-Remy Annie , Krzesinski Jean -Marie , Jouret Francois
Published: June 2023

Objective:

Blood pressure (BP) control in haemodialysis (HD) patients is crucial given their very high cardiovascular risk. Per-dialytic BP levels do not accurately predict the cardiovascular mortality. Here, we compare the prognostic yield of 2 ambulatory BP measurement techniques in prevalent HD patients.

Design and method:

We recruited adult patients who had been on chronic HD for more than 3 months. Seven-day home BP monitoring (HBPM) (values of Day 1 discarded) and 44-h interdialytic ambulatory BP monitoring (iABPM) were performed. Pre- and post-dialysis BP levels were measured during the 6 dialysis sessions prior to iABPM. A 5-year follow-up was carried out to assess all-cause and cardio-vascular mortality.

Results:

We recruited 43 patients including 15 women. Mean age was 68.3±13 years, mean body mass index was 24.1±3.8 kg/m2, median dialysis vintage was 2.4 years [0.25;11], and 67% of patients were under anti-hypertensive medications. In patients considered as normotensive in pre-dialysis (n = 17), masked hypertension was found in 24% (11.6% of the entire cohort) and 29%, based on iABPM and HBPM, respectively. Conversely, among hypertensive patients in pre-dialysis (n = 26), “white-coat” hypertension was noted in 23% (14% of the entire cohort), either by iABPM or HBPM. In treated hypertensive patients, ambulatory techniques detected a higher proportion of uncontrolled hypertension (76% of cases in iABPM and HBPM) compared to pre-dialysis measurements (65% of cases). Focusing on the first 24 hours of iABPM underestimated the proportion of hypertensive patients (49% of the entire cohort) compared to the 44-h coverage (58% of the entire cohort). Restricting HBPM for only 3 days decreased the concordance with iABPM from 86% (k = 0.79) to 76.7% of cases (k = 0.67). After a 5-year follow-up, 25 patients were deceased including 6 patients from cardiovascular causes. All-cause mortality was associated in an adjusted model for age and gender with day-time systolic BP measured by iABPM (p = 0.045).

Conclusions:

In chronic HD patients, 44-h iABPM and 7-day HBPM show a reliable concordance and help to re-classify ∼25% of cases miscategorised on the basis of pre-dialysis measurements. Day-time systolic BP levels using iABPM were significantly associated with 5-year all-cause mortality.
BENEFITS OF ANTIHYPERTENSIVE TREATMENTS IN PATIENTS WITH TYPE 2 DIABETES
Authors: Taleb/Abdelhalim Taleb , Nadia Dammene Debbih , Farah Hamida , Yousra Djebbar , Abdelghani Bachir Chérif
Published: June 2023

Objective:

the objectives of this study are to describe the results of blood pressure obtained in a cohort of patients followed in consultation in the hospital center of blida, to compare them with the representative sample and to evaluate the conformity of the prescriptions of antihypertensive treatments.

Design and method:

this retrospective survey focused on t2dm patients seen in consultation between june and december 2022 in the internal medicine department of chu. On the occasion of this annual assessment of the complications of diabetes, an automated measurement of blood pressure is carried out.

Results:

the analysis covers 625 patients (men: n = 189 (54 ± 18 years); women: n = 436 (58 ± 17 years): the association of t2d and arterial hypertension (hta) is frequent (68%)

This situation is associated with cardiovascular and renal complications for respectively 18% and 33% of patients. Mean arterial pressure is 131.3/70.4 mmhg. The objective < 130/80 mmhg is achieved in 47.6% of patients. Anti-hta monotherapies are 95% compliant with standards (median ap = 130/72.5 mmhg). Anti-hta dual therapies are compliant in 99.5% (median = 132.5/74 mmhg) and triple therapies in 83% (median = 133.6/74 mmhg).

Conclusions:

the hypertensive patient should be considered a patient at risk of c-v complications. Diabetes is common in these patients. Although various dietary and pharmacological interventions targeting modifiable cardiovascular risk factors have largely proven their worth in terms of cardiovascular morbidity and mortality, the control of these risk factors remains very suboptimal in clinical practice. And this due both to an under-implementation of recommendations at the medical level but also to the low adherence of patients.
CARDIOLOGICAL HYPERTENSIVE EMERGENCIES: REAL WORD DATA COMPARED TO GUIDELINES INDICATIONS
Authors: Maloberti Alessandro , Elisa Andrian , Filippo Leidi , Massimiliano Monticelli , Michele Galasso , Valentina Colombo , Cristina Giannattasio
Published: June 2023

Objective:

The 2018 ESH guidelines have revised the therapeutic goals of cardiological Hypertensive Emergencies (HE). Cardiac acute organ damage during HE includes acute myocardial infarction, pulmonary edema, unstable angina pectoris and aortic dissection. However, how much these indications have been applied in clinical practice to date it's unknown.

Design and method:

The first purpose of our study is to analyze the prevalence and clinical characteristics of cardiological HE in our institution. The second purpose is to compare the year before the release of the 2018 guidelines (2017) with the subsequent years (2019) trying to verify adherence to guidelines.

This is a single-center retrospective study conducted at the Niguarda Hospital. All patients aged > 18 years with Systolic BP > 180 mmHg and/or a Diastolic BP > 120 mmHg with Cardiological Emergency were enrolled. From the Emergency Department (ED) data clinical, anamnestic, blood pressure, symptoms, drug treatment and target achievement were registered.

Results:

Patients with BP > 180/120 mmHg in 2017 were 706 out of a total of 73795 accesses (0.96%) and 601 over 67273 (0.89%) in 2019. 246 (34.84%) in 2017 were HE of which 144 (58.53%) were cardiological: aortic dissection 1 (0.69%), acute coronary syndrome 52 (36.11%), acute pulmonary edema 35 (24.30%), cardiac decompensation 91 (63.19%). During 2019 similar figures were founded with 286 (47.58%) HE of which 286 (47.58%) were cardiological: aortic dissection 2 (1.43%), acute coronary syndrome 43 (30.93%), acute pulmonary edema 20 (14.39%), cardiac decompensation 76 (54.68%). The reduction in BP obtained in ED was significantly greater in 2017 than in 2019 (44.7±31.4 vs 35.4±24.5 mmHg, p = 0.011) with a lower target reaching in 2019 (28.9 vs 51.4%, p<0.001). Pulmonary edema is the cardiological HE on which a greater pressure reduction is obtained and therefore in which the target set by the guidelines is more frequently reached.

Conclusions:

The recommendation for a more intense and rapid BP reduction in cardiological HE seems to be not accepted from ED clinicians that persist to reduce BP accordingly to previous guidelines.
RECORDING OF BLOOD PRESSURE IN PATIENTS WITH DELIRIUM AND HISTORY OF MENTAL ILLNESS
Authors: Anagnostaki Maria-Emmanuela , Anagnostaki Ismini , Irini Kourambie
Published: June 2023

Objective:

Psychiatric diseases are often manifested by delirium either at the diagnosis or during the course of the disease. As is well known, delirium, due to the activation of the sympathetic nervous system, is characterized by Arterial Hypertension (AH) which can reach the limits of a hypertensive crisis, endangering the health of the patient.

PURPOSE To record BP in delirious patients, in relation to history, previous values and treatment.

Design and method:

136 patients hospitalized in the Psychiatric hospital with the diagnosis of delirium were retrospectively studied. BP was recorded with a mercury manometer at least three times a day, depending on the patient's clinical picture, and the maximum and average values were recorded. Percentage and absolute change from pre- and post-delirium values were also recorded. The comparison of values during and outside of delirium was done with X2 and the level of significance was considered p<0.05.

Results:

90% of delirious psychiatric patients had BP above normal while only 42% had a history of BP. 28% of them had SBP > 100mmHg. Mean BP during the acute episode was 176/93 while before or after treatment it was 155/84 mmHg. BP rose on average 9/21 mmHg. 4% of patients experienced a major cardiovascular complication. The rise was greater in patients with higher baseline BP values

Conclusions:

BP elevation is a frequent finding in delirium. Sometimes it is pronounced and contributes to cardiovascular mortality. The greater vulnerability of already hypertensive patients indicates the need for better regulation
HYPERTENSIVE URGENCIES AND EMERGENCIES. A QUESTIONNAIRE AMONG EXCELLENCE CENTERS OF THE EUROPEAN SOCIETY OF HYPERTENSION
Authors: Muiesan Maria Lorenza , Weber Thomas , Paini Anna , Salvetti Massimo , Fragouilis Christos , Tsioufis Konstantinos
Published: June 2023

Objective:

The diagnostic approach as well as drug treatment algorithms for hypertensive urgencies(HU), hypertensive emergencies(HE) and malignant hypertension(MH)may be different across Europe,which may also be true for the knowledge of recently updated scientific information. We aimed to explore these items in the Excellence Center(EC)network of the European Society of Hypertension.

Design and method:

We conducted an anonymized electronic survey among our ECs

Results:

Overall, 65 ECs from 17 European and 5 non-European countries participated, mostly residents, clinical specialty was mainly Internal Medicine, Cardiology and Nephrology. The definition of HU was correctly identified by 46.1%, the definition of MH was correctly identified in 27.7%. The use of COX-1 antagonists, COX-2 antagonists, steroids and illicit drugs (cocaine, meth) is regularly investigated in 63.1, 69.2, 87.7 and 89.2%, respectively. Small, standard, large and extra large cuffs are available in 73.8, 93.8, 95.4 and 63.1 %, respectively. BP is measured more than once in almost all centers. Common measures/investigations of organ damage performed are renal function(96.9%), electrocardiogram (95.4%), urinary protein(89.2%), echocardiography(80%), fundoscopy(69.2%), myocardial injury markers (64.6%), and chest radiography(53.8%). Dedicated protocols for management of HU/HE are available in 70.8% of centers. HUs are treated with oral antihypertensives in 70.8%, with i.v. antihypertensives in 20%, and combinations of both in the remainder. HEs are treated with i.v. antihypertensives in 84.6%, with oral antihypertensives in 4.6%, and combinations of both in the remainder. Commonly used antihypertensives in HE are i.v. nitrates(73.8%), i.v. furosemide (64.6%), i.v. labetalol(61.5%), i.v. nitroprusside(41.5%), i.v. urapidil (38.5%), i.v./i.m. clonidine (27.7%), i.v. nicardipine(24.6%), oral captopril(26.2%) and s.l. nifedipine (24.6%), while some of these drugs are not available in up to one quarter of ECs. BP reduction goals in HE have a tendency to depend on the clinical presentation in 44.6%, while achieving less than 25% of BP decrease in 36.9%. Reasons to admit patients to hospital include signs of acute organ damage(90.8%), and inability to decrease BP inspite of i.v. medications(47.7%), whereas a hypertension specialist is consulted in 10.8%.

Conclusions:

This survey higlights the need to further spread the updated scientific information on the management and treatment of HE and HU.
KIDNEY TRANSPLANTATION AND KIDNEY DONATION DO NOT AFFECT SHORT-TERM BLOOD PRESSURE VARIABILITY
Authors: Xagas Efstathios , Sarafidis Pantelis , Iatridi Fotini , Theodorakopoulou Marieta , Pella Eva , Korogiannou Maria , Argyris Antonis , Protogerou Athanase , Boletis Ioannis , Marinaki Smaragdi
Published: June 2023

Objective:

Blood pressure variability (BPV) is an independent cardiovascular risk factor in CKD. Kidney transplantation (KTx) is associated with improved BP levels for kidney transplant recipient (KTRs), without evoking significant changes in donors. The aim of this study was to assess the short- and mid-time effects of KTx and donation on short-term BPV in KTRs and their respective living kidney donors.

Design and method:

Forty KTRs and their respective donors were evaluated with 24-h ABPM (Mobil-O-Graph-NG) at baseline (1 month before), 3-months and 12-months after KTx. Standard-deviation (SD), weighted-SD (wSD), coefficient-of-variation (CV), average-real-variability (ARV) and variability independent of mean (VIM) for SBP/DBP were calculated with validated formulas.

Results:

All 24-h systolic and diastolic BPV indexes studied did not change significantly from baseline to 3-month (SBP-wSD: 12.8±3.0 vs 13.2±3.4 mmHg, p = 0.608; SBP-ARV: 10.3±2.4 vs 10.8±2.6 mmHg, p = 0.463) and 12-month evaluation (SBP-wSD 12.8±3.0 vs 12.1±2.8; p = 0.424 and SBP-ARV: 10.3±2.4 vs 10.2±2.5; p = 0.615) after kidney transplantation in the KTRs. In kidney donors, all 24-h systolic BPV indices displayed a trend towards higher values at 3 months compared to baseline, but without reaching statistical significance (SBP-wSD: 12.2±2.8 vs 13.6±4.2 mmHg, p = 0.107 and SBP-ARV: 10.1±2.1 vs 11.2±3.1 mmHg, p = 0.099), the levels of 24-h systolic SBP indices at 12-months were almost identical to baseline values. 24-h diastolic BPV indices at 3-month and 12-month evaluation were similar to baseline.

Conclusions:

Short-term BPV did not change significantly 3 and 12 months after kidney transplantation/donation neither in KTRs nor in living kidney donors. Longitudinal studies examining associations of BPV with adverse outcomes in these individuals are needed.
ASSOCIATION OF LOW RENIN ACTIVITY WITH UNCONTROLLED NIGHT-TIME AND MORNING BLOOD PRESSURE AS RESIDUAL RISK IN GOOD BLOOD PRESSURE CONTROLLED ELDERLY SUBJECTS
Authors: Nishizawa Masafumi , Hoshide Satoshi , Kario Kazuomi
Published: June 2023

Objective:

To achieve optimal nighttime blood pressure (BP) and morning BP is often challenging especially in elderly subjects. Although low renin revels are seen especially in the elderly, data are sparse about the association between renin-angiotensin-aldosterone (RAA) system and uncontrolled nighttime and morning BP.

Design and method:

Ambulatory BP (ABP) was assessed in 315 Minamisanriku Study participants with aldosterone and plasma renin activity (PRA). Multivariable linear and logistic regression analyses were used to analyze the association of aldosterone and PRA with awake and asleep ABP and hypertension defined by ABP, adjusting for important confounders included the use of RAA inhibitors. We divided them into non-elderly (<80 years, n = 164) and elderly group (>80 years, n = 151).

Results:

In total participants, 95% was treated hypertension and average 24-hour BP was 114.2±8.9/67.5±5.9 mmHg. The prevalence of uncontrolled 24-hour (>130 mmHg), daytime (>135 mmHg), nighttime (>120 mmHg) and morning systolic BP (SBP) (>135 mmHg) was 5.6%, 7.4%, 8.6%, 26.8%, respectively. In elderly group, Lower log-PRA was associated with higher 24-hour, daytime, nighttime, and SBP (all P<0.01) after adjusted confounders. These associations were also observed in non-elderly group except for nighttime and morning SBP. Lower log-aldosterone was associated with higher 24-hour and daytime SBP only in elderly group (both P<0.01). A 1-unit higher log-PRA was associated with lower odds of uncontrolled nighttime SBP (odds ratio [OD] 0.19 [95%CI, 0.06-0.64) and uncontrolled morning SBP (OR, 0.43 [95%CI, 0.21-0.91]) but not in uncontrolled 24-hour and daytime SBP in elderly group, while these findings were not seen in non-elderly group. Similar results were observed in log-aldosterone. There was no association between aldosterone/PAC ratio and the presence of uncontrolled ABP.

Conclusions:

Suppressed renin activity and aldosterone were associated with uncontrolled nighttime and morning SBP in treated and good 24-hour BP controlled elderly population. Even in good 24-hour BP, low renin activity may be associated with residual ABP risk in elderly population.
SEASONALITY IN NIGHT-TIME BLOOD PRESSURE AND ITS ASSOCIATIONS WITH TARGET ORGAN DAMAGE
Authors: Cheng Yi , Sheng Chang-Sheng , Huang Jian-Feng , Zhang Dong-Yan , Li Ming-Xuan , Cheng Yi-Bang , An De-Wei , Guo Qian-Hui , Wang Ying , Huang Qi-Fang , Xu Ting-Yan , Li Yan , Wang Ji-Guang
Published: June 2023

Objective:

There is some evidence that nighttime blood pressure varies between seasons. And it is unclear if the higher nighttime blood pressure in summer than in other seasons would be associated with target organ damage and if the associations would be different between summer and other seasons.

Design and method:

In 1054 untreated patients referred for ambulatory blood pressure monitoring, we performed measurements of urinary albumin-to-creatinine ratio (ACR, n = 1044), carotid-femoral pulse wave velocity (cfPWV, n = 1020) and left ventricular mass index (LVMI, n = 622). We investigated seasonality in nighttime blood pressure in our untreated outpatient sample and then its associations with various measures of target organ damage in comparison with those in other seasons.

Results:

Patients referred in spring (n = 337, 32.0%), summer (n = 210, 19.9%), autumn (n = 196, 18.6%) and winter (n = 311, 29.5%) had similar 24-h ambulatory systolic/diastolic blood pressure (P>0.25). However, both before and after adjustment for confounding factors, nighttime systolic/diastolic blood pressure differed significantly between seasons (P<0.001), being highest in summer and lowest in winter (adjusted mean values 117.0/75.3 mm Hg vs. 111.4/71.1 mm Hg). After adjustment for confounding factors, nighttime systolic/diastolic blood pressure were significantly and positively associated with ACR, cfPWV and LVMI (P<0.006). In season-specific analyses, statistical significance was reached for all the associations of nighttime blood pressure with target organ damage in summer (P<0.02), and for some of the associations in spring, autumn and winter. The association between nighttime systolic blood pressure and ACR was significantly stronger in patients examined in summer than those in winter (standardized beta, 0.31 vs 0.11 mg/mmol, P for interaction = 0.03).

Conclusions:

There is indeed seasonality in nighttime blood pressure level, as well as in its association with renal injury in terms of urinary albumin excretion.
OFFICE BLOOD PRESSURE VARIABILITY: WITHIN SESSION STABILITY ACROSS CONSECUTIVE MEASUREMENTS USING OSCILLOMETRIC DEVICES
Authors: Dekie Luc , Connor Kalvin , Heilbraun Jeff , Rudo Todd
Published: June 2023

Objective:

Blood pressure (BP) is routinely monitored by healthcare providers and during drug development. For improvement in accuracy, several oscillometric devices perform multiple sequential inflations, rather than relying on a single inflation, to determine a mean systolic and diastolic blood pressure (SBP, DBP). Blood pressure is known to vary physiologically throughout a day, and over the course of days and weeks, due to intrinsic and extrinsic factors. Little data has been published describing the variability of SBP and DBP recorded minutes apart using oscillometric methods (i.e. within session variability).

Design and method:

We investigated the stability of within session SBP and DBP across 4 datasets by evaluating differences between 3 consecutive inflations recorded 1-2 minutes apart using a clinically validated oscillometric BP monitor that passed the ANSI/AAMI/ISO 2013, ESH-IP 2002 and BHS 1993 protocols (Table 1). These datasets included patients with controlled or uncontrolled hypertension.

Results:

Data were available from over 10.000 measurement pairs. The differences between inflation 1 and 2 were within ±10, 20 and 30 mmHg for 78.1, 94.4 and 97.9% of the SBP measurements, respectively. For the DBP, 90.7, 95.5 and 97.3 % of the differences between inflation 1 and 2 were within ±10, 15 and 20 mmHg, respectively. A similar trend was seen between inflation 2 and 3.

Table 1: Categorical Analysis of BP changes between consecutive inflations.

Conclusions:

Our data demonstrate substantial variability between consecutive oscillometric BP measurements performed a few minutes apart. Over 20% of the time, consecutive inflations show an absolute change in SBP of at least 10 mmHg. It is unclear whether this represents true physiologic changes in BP or is partly artefactual due to failure of a device's algorithm to determine BP accurately from the oscillometric waveform. These data suggest that criteria for within session variability for automated oscillometric blood pressure devices should be established, including a threshold for repeating the session after 10 minutes of rest.
CARDIOVASCULAR RISK STRATIFICATION AND CORRELATION BETWEEN SUBCLINICAL ORGAN DAMAGE IN BOTH GENDERS OF HYPERTENSIVE PATIENTS
Authors: Posadzy-Malaczynska Anna , Woznicka-Leskiewicz Lucyna
Published: June 2023

Objective:

Assessment of correlation between subclinical organ damage and cardiovascular risk stratification in both genders of hypertensive patients.

Design and method:

We divided 50 patients with arterial hypertension in two groups: A: 25 women; B: 25 men. The average age of them [yrs]: 55 yrs and 57 yrs.

Pulse wave velocity (PWV), ankle-brachial index (ABI) and carotid intima-media thickness (IMT) were evaluated. We assessed cardiovascular risk according to: SCORE2 and SCORE2- OP scales.

Statistical calculations were performed in the StatSoft Statistica 10. The t-student test was used for the statistical analysis, ⇑ Spearmana was taken to analyze the correlation of statistically significant values.

Results:

We revealed following results in both groups: A (women) and B (men) respectively (SD) [*for p< = 0,05; **for p<0,001; NS- negligible statistically]: ABI: 0,94(0,16) NS 1,01(0,14); IMT [mm]: 0,73(0,15) * 0,81(0,17); PWV [m/s]: 10,68(2,29) * 12,54(3,01); SCORE2/ SCORE2-OP: 3,16(2,49) ** 7,00(5,10).

In the group with hypertension women were characterized by a lower IMT and PWV. The cardiovascular risk according to risk SCORE2/ SCORE2-OP scales in men was significantly higher than in women.

In this group the parameters were correlated with the cardiovascular risk according to SCORE2 and SCORE 2 OP scales.

In the women there were significant correlations between: ABI and SCORE2/ SCORE2-OP scale, IMT and SCORE2/SCORE2-OP scale.

Conclusions:
SEX DIFFERENCES AND SUBCLINICAL ORGAN DAMAGE IN CARDIOVASCULAR RISK STRATIFICATION IN PATIENTS WITH OR WITHOUT HYPERTENSION
Authors: Posadzy-Malaczynska Anna , Woznicka-Leskiewicz Lucyna
Published: June 2023

Objective:

Assessment of sex differences and subclinical organ damage in cardiovascular risk stratification in patients with or without hypertension.

Design and method:

We divided 100 patients in two groups: A: HT+: patients with arterial hypertension (25 women and 25 men); B: HT-: patients without arterial hypertension (25 women and 25 men). The average age of them [yrs]: 56 and 53 (*p<0,05).

Pulse wave velocity (PWV), ankle-brachial index (ABI) and carotid intima-media thickness (IMT) were evaluated. We assessed cardiovascular risk according to SCORE2 and SCORE 2-OP scales.:

Statistical calculations were performed in the StatSoft Statistica 10. For comparison of variables with a normal distribution and equal variances we used the t-test for unrelated samples.

Results:

We revealed following results in both groups: CAD-HT+ and CAD-HT- respectively [*for p< = 0,05; **for p<0,001; NS- negligible statistically].

In the group with hypertension women were characterized by a lower IMT and PWV than men. The cardiovascular risk according to risk SCORE2 and SCORE2-OP scales in men was significantly higher than in women in both groups.

Conclusions:
CHARACTERISTICS OF DYSLIPIDEMIA IN THE CROATIAN RURAL AREA DAMAGED BY AN EARTHQUAKE. “THE SILENT KILLER HUNT” - CROATIAN SOCIETY OF HYPERTENSION PROJECT
Authors: Vuksan-Cusa Zrinka , Bogdanic Jakov Emanuel , Jurkovic Ana Marija , Bosnic Klara , Brcic Alojzija , Bozic Katarina , Jelakovic Bojan
Published: June 2023

Objective:

Dyslipidemia is one of the most prevalent cardiovascular risk factors, making its detection and control essential due to the risk of serious complications. Prevention and sensible management of dyslipidemia can markedly alter cardiovascular morbidity and mortality.

This study aimed to determine the prevalence of dyslipidemia among the adult population in a rural part of Croatia seriously damaged by the earthquake and evaluate the gender-associated differences in lipid profiles.

Design and method:

Blood samples of 244 subjects (188 women) (opportunistic screening) were collected under fasting conditions. The bloodwork results were analyzed using descriptive statistics and t-tests were used for checking differences between the sexes.

Results:

The average age of the whole group was 61.9 ± 14.3 years. Prevalence of hypercholesterolemia, hypertriglyceridemia, elevated LDL cholesterol levels and low HDL cholesterol levels were 59.0%, 34.8%, 57.0%, and 32.0%, respectively. Average values of total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol were 5.4 ± 1.7mmol/l, triglyceride 1.8 ± 1.1 mmol/l, 1.4 ± 0.3 mmol/l, and 3.3 ± 1.02 mmol/l. We failed to find a significant difference in total cholesterol and LDL cholesterol between men and women (p>0.05). There was a statistically significant difference in triglyceride and HDL cholesterol levels between men and women with men showing higher levels of triglycerides (t = 2.08, p<0.05) and lower levels of HDL cholesterol (t = -4.1, p<0.05) than women.

Conclusions:

The prevalence of dyslipidemia in this rural area is high, higher than in other rural parts of Croatia indicating that stressful life after the earthquake and an unhealthy diet might contribute to this. Primary prevention i.e. education and regular examination of this vulnerable population should be in focus and even more intensive than in other rural, remote areas.
THE PLASMA HDL-SUBFRACTION PROFILE IN HYPERTENSIVE PATIENTS WITH HIGH HDL-CHOLESTEROL LEVELS
Authors: Triantafyllidi Helen , Benas Dimitrios , Tellis Constantinos , Tselepis Alexandros , Iliodromitis Efstathios
Published: June 2023

Objective:

The evaluation of cardiovascular risk (CVR) in arterial hypertension includes the estimation of high density lipoprotein (HDL-C). Although HDL-C is considered as a favorite CVR factor, the exact role that HDL-C subfraction profile play in the pathogenesis of atherosclerosis, especially in higher than usual HDL-C levels (>60 mg/dl) is currently under investigation. The aim of this study was to evaluate the plasma HDL subfraction profile of high HDL-C levels in hypertensive patients compared to normotensive subjects.

Design and method:

We studied 74 hypertensive patients (60 + 13 years, 62 females) and 24 normotensives, apparently healthy subjects (49 + 14 years, 22 females) with HDL-C equal or above 55 mg/dl. Cholesterol, HDL-C, and TG were determined enzymatically while LDL-C was calculated using the Friedewald formula. Plasma HDL particles were separated and determined electrophorically using Lipoprint System HDL Subfractions Kit. Aortic stiffness (c-f PWV) and central BP (cBP) were evaluated by carotid-femoral pulse wave velocity (Complior apparatus).

Results:

We found that hypertensive patients had increased age, BMI, office systolic and diastolic BP, PWV compared to normotensives. Regarding HDL, 10 HDL fractions were separated: fractions 1-3 were denoted as Large-HDL (L-HDL), fractions 4-7 constituted the Intermediate-HDL (I-HDL), and fractions 8-10 were denoted as Small-HDL (S-HDL) subfraction. Although HDL-C levels were similar between groups (76 + 13 vs. 81 + 17 mg/dl, p = 0.10), the percent distribution (%) of L-HDL was lower in hypertensives compared to normotensives (29.8±4.7% vs. 36.6±6.3%, p<0.001), % I-HDL was similar while % S-HDL was increased (27.3±3.7% vs. 20.4±4.4%, p<0.001). We found a significant negative correlation between L-HDL and SBP (rho = -0.48, p = 0.01) as well as cBP (rho = -0.52, p = 0.008) in younger hypertensive females before menopause (n = 26, 49 + 5 years).

Conclusions:

L-HDL particles, the most antiatherogenic HDL-C subfraction, were reduced in hypertensive patients with high HDL-C levels compared to normotensive subjects, suggesting that these patients are probably less protected against CV disease compared to normotensive subjects with similar HDL-C and LDL-C levels. Therefore, plasma HDL-subfraction profile might replace the HDL-C evaluation as a better biomarker of CVR in hypertensive patients, especially females before menopause.
DIABETES INDUCED LIPID PANEL PARTICULARITIES IN HYPERTENSIVE PATIENTS: A PILOT NMR SPECTROSCOPY STUDY
Authors: Stanciulescu Laura , Nicolescu Alina , Duduianu Catalin , Deleanu Calin , Dorobantu Maria
Published: June 2023

Objective:

Cardiovascular diseases are the leading cause of death globally, despite significant advances in diagnosis and treatment. Among the multiple already well-known cardiovascular risk factors, hypertension, diabetes mellitus type II and dyslipidaemia are the most frequent and show the best correlations with the risk of further developing a major cardiovascular event.

The main objective consists in identifying the potential particularities that diabetes could have on the lipid profile in hypertensive patients, while also discovering bio-markers with a higher potential accuracy of predicting further major cardiovascular events, using NMR spectroscopy.

Design and method:

We have selected a group of 30 hypertensive patients and a control group of 17 otherwise healthy individuals in order to assess the influence of diabetes on the lipid panel in hypertensive patients. A blood sample of 6 mL was collected before and after meals and 5 types of NMR spectroscopy experiments were performed for each sample.

Results:

It was noted that the fasten triglycerides levels, VLDL and IDL particle number, apolipoprotein A1, A2, B100 levels, as well as the ratio apolipoprotein B100/apolipoprotein A1 are all potentially useful markers that could be successfully used to differentiate between the strictly hypertensive patients and the ones that associate type II diabetes mellitus. The study also confirmed once more our previous reports that the fasting status upon sampling has little influence on the lipid panel final values.

Conclusions:

We have evaluated the lipid panel differences induced by diabetes mellitus type II in hypertensive patients and we have compared the results with an otherwise healthy control group. We have identified the NMR spectroscopy markers that could be able to spot subtle differences in the lipid profiles of the two study groups (two hypertensive groups, one consisting in strictly hypertensive patients, the other one including hypertensive patients with already known type II diabetes mellitus), even when LDL levels have been lowered to normal levels due to statin treatment. We have once more concluded that the patient's fasting status has no influence on the final analysis.
CLINICAL RISK FACTORS FOR SEVERE ESSENTIAL ARTERIAL HYPERTENSION IN PATIENTS WITH VITAMIN D DEFICIENCY
Authors: Semianiv Marianna , Sydorchuk Larysa , Biletsky Semen , Petrynych Oksana , Kazantseva Tatyana , Repchuk Yuliya , Semianiv Ihor , Sokolenko Alina , Yarynych Yuliya , Voroniuk Ksenia , Dzhuriak Valentyna
Published: June 2023

Objective:

The aim of this study was to establish the role of clinical complains and symptoms as risk factors for severe essential arterial hypertension (EAH) in patients with vitamin D deficiency.

Design and method:

100 EAH patients with target-organ damage, moderate, high-very high cardiovascular risk were involved in the case-control study. 79.0% females and 21.0% males, mean age 59.87 ± 8.02. They were tested for total serum 25-hydroxyvitamin D concentration (immune luminescent test “MAGLUMI”, “SNIB”, China). All recruited patients were taken history, underwent complex examination and divided into groups depending on level of vitamin D and BP. Control group included 60 practically healthy persons of relevant age.

Results:

Hypertensive patients with vitamin D deficiency complained on heart pain 14.23% (⇙2 = 2.17; p>0.05), arrythmias – 20.86% (2 = 3.86; p = 0.049), headache – by 27.89% (⇙2 = 7.34; p = 0.007), sleep disturbance – by 29.77% (⇙2 = 7.97; p = 0.005), weakness and fatigue – by 20,59% (⇙2 = 3.88; p = 0.049) more frequent, than patients with normal 25-hydroxyvitamin D concentration. The frequency of patients with fatal cardiovascular risk SCORE >5.0 with vitamin D deficiency prevailed the ones with a normal level of vitamin D – by 20.94% (⇙2 = 3.98; p = 0.046). The risk for arrhythmias, weakness and fatigue increases 1.5 times [OR–2.36; 95% CI OR:1.0–5.61; p0.049 and OR–2.40; 95% CI OR:1.0-5.79; p = 0.049], sleep disturbance, headache and overweight increases 1.7-2.35 times [OR–3.43; 95% CI OR: 1.43-8.22; p = 0.005 and [OR–3.63; 95% CI OR:1.39-9.49; p = 0.007] and [OR–11.50; 95%CI OR:1.33-99.33; p = 0.038], respectively) in patients with 2nd-3d degree of BP elevation and vitamin D deficiency. The fatal cardiovascular risk SCORE >5.0 increases 1.5 times [OR–2.34; 95% CI OR:1.01-5.45; p = 0.046] in hypertensive patients with vitamin D deficiency.

Conclusions:

Vitamin D deficiency in patients with EAH is associated with severe clinical symptoms: the risk for arrhythmias increases 1.5 times [OR–2.36; p = 0.049], weakness risk increases 1.7 times [OR–2.40; p = 0.049], sleep disturbance risk elevates almost twice [OR–3.43; p = 0.005], risk for headache escalates 2.35 times [OR–3.63; p = 0.007], fatal cardiovascular risk SCORE >5.0 is 1.5 times high [OR–2.34; p = 0.046], respectively.