bluuebunny/crossref_metadata_2025 huggingface dataset:
THE ROLE OF BLOOD PRESSURE LEVEL IN THE DEVELOPMENT OF ATRIAL FIBRILLATION AFTER CORONAVIRUS INFECTION
Authors: Stasushena Oksana
Published: June 2022

Objective:

It is known, that arterial hypertension (AH) is the main cause of atrial fibrillation (AF).

The aim of our study was to assess the parameters of systemic hemodynamics as a predictor of AF development after coronavirus infection (CI).

Design and method:

We examined 118 patients with AF, at the age of 62.5 + 0.09 years with AF, who, on average, 6.2 + 0.5 months had undergone CI. Of these, 14 people (8.4%) also had atrial flutter. 72 people (61 %) had AF before CI (1st group of patients). The remaining 46 patients (39 %) had no history of this arrhythmia (2nd group of patients). Office blood pressure was measured according to the generally accepted method.

Results:

In the 1st group, the indicators of systolic blood pressure (SBP) were significantly lower than in the 2nd group (131.4 + 1.72 and 139.5 + 2.99 mm Hg, p < 0, 05), indicators of diastolic blood pressure (DBP) (81.5 + 0.74 and 87.9 + 2.41 Hg, p < 0.05), and heart rate (HR) (83, 0 + 1.86 and 98.0 + 2.4 bpm, p < 0.05). This difference in the groups was more significant between patients with hypertension: SBP, respectively (134.7 + 1.5 and 143.9 + 3.8 mm Hg, p < 0.05), DBP (83.3 + 1.1 and 90.5 + 2.6 Hg, p < 0.05), and heart rate HR (83.0 + 1.86 and 98.0 + 2.4 bpm, p < 0.001). In addition, in group 1, AH was found significantly less frequently (in 59 out of 72 patients, 81.9%) than in patients in group 2 (in 42 out of 46 patients, 91.3%), p < 0.05.

Conclusions:

An increase in SBP, DBP HR and AH, are predictors of the development of AF in patients after CI.
CARDIOVASCULAR EFFICACY OF SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITORS AND ANGIOTENSIN RECEPTOR NEPRILYSIN INHIBITORS IN PATIENTS WITH HEART FAILURE ACCORDING TO MINERALOCORTICOID R
Authors: Patoulias Dimitrios , Katsimardou Alexandra , Siskos Fotios , Imprialos Konstantinos , Stavropoulos Konstantinos , Toumpourleka Maria , Koutsampasopoulos Konstantinos , Papadopoulos Christodoulos , Doumas Michael
Published: June 2022

Objective:

Recent European heart failure guidelines recommend the use of four drug classes in patients with heart failure (HF) with reduced ejection fraction: andom-angiotensin system (RAS) inhibitors [angiotensin-converting enzyme inhibitors (ACEi), angiotensin-receptor blockers (ARBs), angiotensin receptor neprilysin inhibitors (ARNIs)], beta-blockers, mineralocorticoid receptor antagonists (MRAs) and sodium-glucose co-transporter-2 (SGLT-2) inhibitors. All these drug categories exert impressive cardiovascular and survival benefits. However, the potential synergistic effects of newer categories (ARNIs and SGLT-2 inhibitors) in patients receiving or not MRAs have not been clearly evaluated.

Design and method:

We searched PubMed for andomised controlled trials (RCTs) assessing the effect of SGLT-2 inhibitors and sacubitril/valsartan versus placebo or active comparator on surrogate cardiovascular endpoints among subjects with HF. We extracted data corresponding to subgroup analyses according to prior treatment with MRAs. We set as primary endpoint the composite of andomisedtion for HF or cardiovascular death.

Results:

We pooled data in a total of 14,462 subjects with HF assigned either to a SGLT-2 inhibitor or placebo and 13,195 subjects with HF andomised either to sacubitril/valsartan or a RAS inhibitor. Prior treatment with a MRA did not affect the cardiovascular efficacy of SGLT-2 inhibitors compared to placebo (p = 0.74). When we assessed the cardiovascular efficacy of sacubitril/valsartan versus RAS inhibitors, we did not identify a subgroup difference between subjects receiving a MRA or not (p = 0.94).

Conclusions:

Collectively, despite being reasonable, a treatment combination of SGLT-2 inhibitors or sacubitril/valsartan with MRAs does not provide additional cardiovascular benefits for patients with HF with reduced or preserved ejection fraction. Potentially synergistic effects of these drug classes have to be confirmed.
EVALUATION OF ATRIAL FIBRILLATION BURDEN AFTER THE FIRST ECG-DOCUMENTED EPISODE VIA IMPLANTABLE LOOP RECORDERS
Authors: Papakonstantinou Panteleimon , Chlouverakis Gregory , Vardas Panos , Kochiadakis George , Simantirakis Emmanuel
Published: June 2022

Objective:

The natural history of paroxysmal atrial fibrillation (AF) after the first clinical AF episode is not well known. AF burden is of clinical significance as it may have clinical implications concerning the long-term management of the arrhythmia and the decision-making on AF patients. We studied the natural history of AF in patients after their first clinical AF episode.

Design and method:

Thirty consecutive patients (age 66.9 ± 10 years; 14 men) received an implantable loop recorder (ILR) (Reveal XT 9529; Medtronic, Minneapolis, Minnesota, USA) after their first symptomatic paroxysmal AF episode. We recorded the AF recurrences and burden (clinical and subclinical AF) during a follow-up period of three years. We excluded patients with persistent or permanent AF and patients with AF attributed to reversible or transient causes.

Results:

Eight patients (26.6%) did not present any AF recurrence during the first year of the follow-up period. Five patients (16.6%) did not also suffer any AF episode during the second year, while in three patients (10%) no AF episode was recorded during the three-year follow-up period. In 16 patients (53.3%) the AF burden was increased during the second year of follow-up period while in 9 patients (30%) the AF burden was decreased. During the third year of follow-up period the AF burden was increased in 19 patients (63.3%), decreased in 7 patients (23.3%) and remained almost the same in 4 patients (13.3%). Five patients (16.6%) presented at least one episode of persistent AF during the follow-up period. Seven patients (23.3%) suffered only from symptomatic AF episodes, while in nine patients (30%) only asymptomatic AF episodes were recorded. Eleven patients (36.7%) had both types of AF episodes (symptomatic and asymptomatic).

Conclusions:

The AF recurrences and burden increased in most AF patients during the three-year follow-up period. However, some patients did not suffer any AF recurrence or they presented a decrease in AF burden. Paroxysmal AF clinical profile differs among the AF patients significantly and this indicates that an individualized approach via long-term rhythm monitoring may be of clinical significance, at least in some newly diagnosed AF patients.
IRON DEFICIENCY MANAGEMENT IN HYPERTENSIVE SUBJECTS WITH ACUTE HEART FAILURE: FROM CLINICAL TRIALS TO CLINICAL PRACTICE
Authors: Mazza Alberto , Baracca Andrea , Schiavon Laura , Torin Gioia , Aquilone Alessandra , Camerotto Alessandro , Cuppini Stefano
Published: June 2022

Objective:

Iron deficiency (ID) is common in heart failure (HF) and independently increases the risk of re-hospitalisation for HF. Intravenous ferric carboxymaltose (FCM) has been shown to improve symptoms and quality of life in patients with chronic HF and ID deficiency. We aimed to evaluate the effect of FCM on outcomes in hypertensive patients (HTs) who were stabilised after an episode of acute HF.

Design and method:

From november 2020 to july 2021, in 148 HTs consecutively admitted in our Hypertension Unit for acute HF with ejection fraction < 50%, a ID was found in 39 of them (51% men, mean age 71.1 ± 18.5 yrs). ID was defined as serum ferritin < 100ng/mL or serum ferritin 100–299ng/mL with transferrin saturasion < 20%. Before hospital discharge, HTs received FCM dose according to the extent of ID and then reapeated it at 4-week interval. The primary outcome was to assess first HF hospitalisation or cardiovascular (CV) death at 4 and at 12 weeks after discarged. The analysis of variance for repeated measures assesed the differences in the values of systolic blood pressure (SBP), diastolic blood pressure (DBP), N-terminal pro-B-type-natriuretic peptide (NT-pro-BNP, (in pg/mL) and haemoglobin (in g/L) from baseline to the follow-up (FU).

Results:

At 4 and 12-week SBP and DBP values were not different from baseline (123.2 ± 13.8 and 124.4 ± 13.2 vs. 124.1 ± 14.1, NS and 70.9 ± 9.8, 71.0 ± 10.0 vs. 71.8 ± 10.2 mmHg, NS, respecively). NT-pro-BNP values significantly decreased from baseline to the FU (8.100 ± 8.132 vs. 6.244 ± 4.280 and 4.126 ± 3.485, p < 0.05). Haemoglobin values significantly increased from baseline to the FW (9.5 ± 1.2 vs. 11.9 ± 1.3 and 12.2 ± 1.4, p < 0.005). At 4-week no patient was re-admitted for HF, while at the 12-week a re-hospitalisation was observed in 17,9% of cases. No CV death was observed during the FW.

Conclusions:

Administration of FDC is effective to prevent first HF re-hospitalization and as recommended in 2021 ESC HF-guidelines, iron supplementation with FDC should be considered for the reduction of HF re-hospitalizations also in HTs with LVEF < 50% recently hospitalized for worsening HF. However, our results must be confirmed in studies involving a greater number of subjects, and with a longer FW.
EFFECT OF CALCIUM CHANNEL BLOCKERS ON HEART FAILURE: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS
Authors: Alsanosi Safaa , Roos Nur Aishah Binti Che , Alsieni Mohammed , Lip Stefanie , Mccallum Linsay , Shahzad Naiyer , Padmanabhan Sandosh
Published: June 2022

Objective:

Hypertension is a major risk factor for heart failure (HF). Antihypertensive therapy, in general, has a protective effect on incident HF with diuretics, ACEI, and ARBs particularly effective. Previous systematic reviews have produced inconsistent results about the effect of CCBs on HF. We conducted a systematic review and network meta-analysis to evaluate patients with hypertension treated with CCBs and incident HF.

Design and method:

Publications of head-to-head andomised controlled trials (RCTs) of CCBs were retrieved from MEDLINE, EMBASE, Web of Science, and Cochrane (January 2000- August 2021). We included RCTs with at least 100 participants and with a minimum follow-up of one year. Two authors independently selected the included trials, evaluated the risk of bias, and retrieved the data on HF. Fixed effect meta-analyses were performed to summarise the pooled risk ratios (RRs) of HF between treatment arms followed by network meta-analyses incorporating direct and indirect data.

Results:

The initial literature search identified 4740 records. After duplicates were excluded, there were 2602 records. Totally, 652 RCTs were excluded after a full-text review of the 674 eligible studies. In the end, 22 RCTs with a total of 164,834 participants were included in our meta-analysis. As to the effect of CCBs on HF, ACEIs, ARBs, DIs, and BBs are all superior to CCBs in the prevention of HF. In comparison to the placebo, the point estimate for CCB was less than 1 but it did not reach statistical significance in the overall analysis, but it attained statistical significance in the sensitivity analysis. (The pooled RR in the fixed effect model was 0.74 [95% CI: 0.59, 0.92; I2 = 22%; X2 p = 0.007]). The relative risk of HF compared with CCB was 0·88 [0 8–0·97] for ACEI, 0·84 [0 75–0·95] for ARB, 0·87 [0 77–0·98] for BB, 0·75 [0 69–0·82] and 1.11 [0 94–1.32] for placebo.

Conclusions:

The findings of our systematic review and meta-analysis do not support the hypothesis that CCBs are effective in the prevention of HF. However, to gain a greater understanding of the potential effect of CCBs, further clinical studies and meta-analyses are needed to pool study results and strengthen statistical validity.
PREDICTION OF ABNORMAL LEFT VENTRICULAR GEOMETRY ON THE ECG THROUGH MACHINE LEARNING WITH A FOCUS ON OBESITY
Authors: Zervakis Stylianos , Aggelaki Eleni , Marketou Maria , Barmparis George , Maragkoudakis Spyros , Danelatos Christos , Plevritaki Anthoula , Pateromichelakis Themistoklis , Kampanieris Emmanouil , Kalomoirakis Petros , Peponaki Eirini , Fragkiadakis Kostas , Savva Eirini , Kochiadakis George , Tsironis Giorgos
Published: June 2022

Objective:

Although electrocardiogram (ECG) is of paramount importance in the initial evaluation of cardiac emodelling, it is not a sensitive method of detecting left ventricular hypertrophy (LVH), and it cannot detect changes in left ventricular geometry (LVG) at early stages. Its sensitivity is particularly low for obese patients. We used a machine learning (ML) classifier to detect abnormal LVG from ECG parameters/markers, even before it becomes LVH and looked at the results of our model for obese patients.

Design and method:

We enrolled 594 consecutive subjects, aged 30 years or older (mean age: 61.6 ± 12 years old) with and without essential hypertension and no indications of cardiovascular disease. All patients underwent a full echocardiographic evaluation and were classified into 2 groups; those with normal geometry (NG) vs. those with concentric emodelling (CR) or LVH defined as concentric hypertrophy (CH) and eccentric hypertrophy (EH). Abnormal LVG was identified as increased relative wall thickness (RWT) and/or left ventricular mass index (LVMi). We trained a Random Forest machine learning model to classify subjects with abnormal LVG and calculated SHAP values to perform feature importance and interaction.

Results:

71.3% of all patients were hypertensive. Hypertension, age, body mass index divided by the Sokolow-Lyon voltage (BMI/S-L), QRS-T angle, and QTc duration were among the most important parameters (Figure 1) identified by the model as being predictive of abnormal LVG (AUC/ROC = 0.84, sensitivity = 0.94, specificity 0.61). Specifically for obese patients, whose prevalence in our population was 60.3%, our model performed well (sensitivity = 0.71, specificity = 0.92. When we tried our model without the the BMI/S-L parameter, the specificity dropped to 0.88. We also found that a cut-off point of 18 kgr/ m2mV for the BMI/S-L marker predicted the patients who were more probable to have developed abnormal LVG.

Conclusions:

Specific clinical and ECG parameters can predict early pathological changes of LVG in patients without established CVD and detect the population who will benefit from a detailed echocardiographic evaluation. We also proved the hypothesis that ECG parameters can be useful in detecting abnormal LVG in obese patients.
MACHINE LEARNING CLASSIFICATION OF CORONARY HEART SYNDROME BASED ON ELECTROCARDIOGRAM (ECG) IMAGE USING CONVOLUTIONAL NEURAL NETWORK (CNN) ALGORITHM
Authors: Fajar Rifaldy , Hanoman Bartelia , Zuova Rozella
Published: June 2022

Objective:

Electrocardiogram (ECG) is one of the most important examination models used to diagnose various abnormal heart rhythms. Early examination of heart defects can improve quality of life through appropriate treatment. One of the abnormalities in the heart is coronary heart disease. CHD is a heart disease that is mainly caused by narrowing of the coronary arteries due to atherosclerosis or spasm or a combination of both. In this study, a system was designed to classify coronary heart disease from the results of ECG images.

Design and method:

The study consisted of several stages, starting with the collection of ECG image data for cardiac abnormalities which were used for training images and testing images. The next step is pre-processing using a grayscale process to show the intensity value. Furthermore, at the segmentation stage, a thresholding process is used which aims to divide the image into two parts, namely between the object and the background by forming a binary image. The next stage is the process of taking feature values from the segmentation results using Invariant Moment. The final stage is classification using the Convolutional Neural Network. The data used in this study are images obtained from Beecardia - physiobank. There are four classifications of images processed in this system, namely Normal, Asymptomatic, Angina Pectoris, and Acute Myocardial Infarction. The amount of data used is 126 where the image is divided into two, namely, 101 training data and 25 testing data.

Results:

The Convolutional Neural Network method is able to classify coronary heart disease from the results of ECG images very well. The results of the classification process for coronary heart disease from the results of ECG images are able to achieve an accuracy of 92%.

Conclusions:

The classification system can perform its performance well, as evidenced by the percentage obtained, including a height exceeding 90%. Suggestions for the future, more training data can be used so that at the time of testing, the test data can get higher accuracy.
VASCULAR BIOMARKERS IN RELATION TO INDICES OF AORTIC STIFFNESS AND RENAL FUNCTION IN PRIMARY HYPERTENSION
Authors: Jekell Andreas , Lundwall Kristina , Spaak Jonas , Kahan Thomas
Published: June 2022

Objective:

Degradation of the glycocalyx (GC), the innermost layer protecting the vascular endothelium, and up-regulation of adhesion molecules is associated with subclinical atherosclerosis and endothelial dysfunction, while aortic stiffness is related to early structural vascular changes and decline in renal function. However, few studies have investigated vascular biomarkers in relation to central and peripheral hemodynamics, and renal function in hypertension.

Design and method:

107 patients (58 ± 13 years) with hypertension (mean 149/87 mmHg; 31% on antihypertensive treatment) and a wide range of renal function (eGFR 130 to 21 ml/min x 1.73 m2, mean 74 ml/min), were investigated. Indices of aortic stiffness were central systolic blood pressure (cSBP), central pulse pressure (cPP), carotid/brachial pulse pressure ratio (cPP/brPP), augmentation index (AIx), carotid-femoral pulse wave velocity (PWV), and aortic-brachial PWV ratio, assessed by applanation tonometry (SphygmoCor, AtCor Medical). Endothelial function was studied by forearm post-ischemic flow mediated vasodilatation. The GC glycoproteins hyaluronan (HA) and syndecan-1 (Syn-1), and adhesion molecules (ICAM-1, VCAM-1, and E-selectin), were analysed with ELISA.

Results:

Median[range] HA, Syn-1, ICAM-1, VCAM-1, and E-selectin were 15 [11–20], 38[27–54], 302[264–345], 347[304–408], and 32[26–41] ng/mL, respectively. HA was related to cPP (r = 0.31; P = 0.002), cPP/brPP (r = 0.21; P = 0.002), AIx (r = 0.21; P = 0.034), PWV (r = 0.31; P = 0.003), and aortic-brachial PWV ratio (r = 0.27; P = 0.011). Syn-1 was inversely related to cSBP (r = –0.17; P = 0.043). E-selectin tended to be inversely related to cSBP (p = 0.10) and to cPP (p = 0.071). HA and VCAM-1 were inversely related to eGFR (r = –0.45 and r = –0.43; both P < 0.001). All vascular biomarkers were unrelated to flow-mediated vasodilation.

Conclusions:

Vascular biomarkers were associated with indices of aortic stiffness, and impaired renal function, but was unrelated to peripheral endothelial function. HA showed association with increased stiffness, compared to Syn-1 that was unrelated to stiffness, and both HA and VCAM-1 were inversely related to renal function, where elevation of HA and VCAM-1 may reflect endothelial dysfunction of the kidneys. Thus, our results suggest that functional vascular biomarkers may relate to early structural and functional vascular changes in uncomplicated hypertension with impaired renal function.
CENTRAL SYSTOLIC BLOOD PRESSURE PREDICTS BIOMARKERS OF ENDOTHELIAL DYSFUNCTION AND THROMBOINFLAMMATION IN A LARGE COHORT OF PATIENTS WITH VARIOUS DEGREE OF CARDIOVASCULAR BURDEN
Authors: Gavriilaki Eleni , Lazaridis Antonios , Nikolaidou Barbara , Dolgyras Panagiotis , Anyfanti Panagiota , Vasileiadis Ioannis , Margouta Anastasia , Alexandrou Maria Eleni , Goulas Kyriakos , Yiannaki Efthalia , Triantafyllou Areti , Markala Dimitra , Zarifis Ioannis , Sarafidis Pantelis , Douma Stella , Gkaliagkousi Eugenia
Published: June 2022

Objective:

Circulating microvesicles (MVs) emerge as biomarkers of endothelial injury and thrombosis, primarily in cardiovascular (CV) disease. Therefore, we measured endothelial (EMVs), platelet (PMVs) and erythrocyte MVs (RMVs) in patients with various degree of CV burden. We then sought to compare them to coronary artery disease (CAD), as positive, and to healthy subjects, free from CV risk factors, as negative controls. We finally identified independent predictors of MVs.

Design and method:

We enrolled consecutive patients from our Cardiology, Hypertension, Diabetic, Rheumatic, and Nephrology Outpatient Units with available MVs measurements. Central blood pressure (BP) was measured by either applanation tonometry or Mobil-O-graph device, while MVs by a previously described, standardized flow cytometry protocol.

Results:

We studied 369 participants with increased CV risk: 63 with CAD equivalent (47 diabetes mellitus type II/DM and 16 end-stage renal disease), 92 with chronic inflammatory disorders and 73 with essential hypertension/EH. We further included 53 subjects with CAD as positive and 87 otherwise healthy as negative controls. All MVs were lower in patients with increased CV risk as compared to positive controls (p < 0.001 for all). In addition, PMVs (p = 0.045) and EMVs (p = 0.028) were increased in patients with increased CV risk as compared to negative controls. Between patients with increased CV risk, those with CAD equivalent had increased EMVs versus EH (p = 0.002) and chronic inflammatory disorders (p = 0.021).

In the whole cohort, RMVs were associated only with the presence of EH (beta = 0.119/p = 0.029). In univariate analysis, PMVs were significantly associated with body mass index/BMI (beta = 0.192/p < 0.001), office and central systolic BP (beta = 0.114/p = 0.031 and beta = 0.131/p = 0.015, respectively). EMVs were associated with age (beta = 0.195/p < 0.001), BMI (beta = 0.108/p = 0.042), office and central systolic BP (beta = 0.159/p = 0.003 and beta = 0.172/p = 0.001, respectively), DM (beta = 0.302/p < 0.001), EH (beta = 0.171/p = 0.002), and dyslipidemia (beta = 0.176/p = 0.001).

In multivariate analysis, central systolic BP (beta = 0.150/p = 0.006) predicted PMVs, independently of BMI. Age (beta = 0.141/p = 0.011), central systolic BP (beta = 0.219/p < 0.001), and diabetes mellitus (beta = 0.236/p < 0.001) predicted EMVs, independently of age and dyslipidemia.

Conclusions:

In a large cohort of patients with divergent CV risk, MVs emerge as potential biomarkers. Central systolic BP is a strong predictor of MVs levels highlighting its predictive value for CV outcomes.
MID-REGIONAL PROADRENOMEDULLIN (MR-PROADM) AS A BIOMARKER IN PATIENTS WITH CHRONIC KIDNEY DISEASE AND HYPERTENSION - STUDY CONTINUATION
Authors: Czajkowska Katarzyna , Zbroch Edyta , Bielach-Bazyluk Angelika , Koc-Zorawska Ewa , Kakareko Katarzyna , Rydzewska-Rosolowska Alicja , Hryszko Tomasz
Published: June 2022

Objective:

Assessment of MR-proADM serum concentration as a biomarker in patients with CKD and arterial hypertension.

Design and method:

Our study included a single-center cohort of 160 patients admitted to the Second Department of Nephrology and Hypertension with Dialysis Unit Medical University of Bialystok with CKD treated conservatively. The concentration of MR-proADM were measured in the serum of patients and the control group (27 healthy volunteers). The statistical analysis included past medical history, the stages of CKD, the presence and degree of control of arterial hypertension, and the presence of cardiovascular diseases.

Results:

Patients with CKD had higher serum MR-proADM concentrations compared to the control group (62,61 [45,67–81,39] vs 224 [143,95–293,35] pg/mL, p < 0,0001). The median MR-proADM concentration in each stage was not statistically different.

There was a significant positive correlation between MR-proADM and the dimension of the left ventricle (R = 0,25; p = 0,009) with glucose concentration (R = 0,19; p = 0,017) and a negative correlation with serum iron concentration (R = -0,20; p = 0,03). There were no significant differences in the plasma concentration of MR-proADM depending on the degree of hypertension control.

Conclusions:

In larger group of CKD patients, an increased serum concentration of MR-proADM was confirmed. Left ventricular hypertrophy found in echocardiography was associated with higher serum concentrations of MR-proADM. To assess the usefulness of this hormone as a prognostic biomarker of CKD or cardiovascular risk, further studies in larger groups still are required.
COMPARISON OF BLOOD PRESSURE AND PULSE PRESSURE VALUES IN THE BRACHIAL ARTERY AND IN CENTRAL AORTA MEASURED BY OUTPATIENT NON-INVASIVE METHODS IN DIFFERENT PATIENT POPULATION GROUP
Authors: Vujicic Bozidar , Margeta Tea Vrdoljak , Vujic Sofija , Petrac Nevia , Devcic Bosiljka , Racki Sanjin
Published: June 2022

Objective:

The aim of our study was to compare the values of blood pressure (BP) and pulse pressure (PP) in the brachial artery and in the central aorta by outpatient non-invasive methods in different patients age groups and according to the presence of chronic renal disease and diabetes.

Design and method:

The study included 110 outpatients older than 18 years of age with diagnosed and treated arterial hypertension (AH), under the care of Clinical Hospital Centre Rijeka in the period from June 1 to December 1, 2021. Peripheral BP, PP, and central aortic pressure (CAP) were measured in all patients on the same day. The average values of peripheral arterial pressure and the corresponding PP were obtained by the method of continuous blood pressure monitoring (CBPM). CAP and associated PP were measured on the same day by the method of radial arterial tonometry. Patients were divided into three groups according to the age (18–44 years, group I; 45–64 years, group II, and > 65 years, group III). Systolic and diastolic peripheral blood pressure (SPBP, DPBP), systolic CAP and diastolic CAP (SCAP, DCAP), and both peripheral and central PP (PPP, CPP) were nalysed among groups and according to the presence of chronic kidney disease (CKD).

Results:

In total, 98 patients were nalysed (mean age 55,08 ± 15,52 years; 79,6% essential hypertension; diabetics 12,23%; 26,53% CKD; 48,98% men). There were significant positive correlations between SPBP and SCAP, DPBP and DCAP, and PPP and CPP in group I and group III. There was no significant correlation between SPBP and SCAP (r = 0,268), and there were significant correlations between DPBP and DCAP, and PPP and CPP in group II. According to the presence of CKD, there was no significant correlation between SPBP and SCAP (r = 0,104), and there were positive correlations between DPBP and DCAP, and PPP and CPP.

Conclusions:

There was no significant correlation between SPBP and SCAP in 45–65 years old and CKD group, which tells us in favor of the atherosclerosis variability in these patient groups, which was expected. Further research on greater number of patients should be done.
COMPARISON OF BLOOD PRESSURE VALUES FROM SEQUENTIAL CONVENTIONAL AND AVERAGE MODE MEASUREMENT
Authors: Da Silva Marco Antonio Vieira , Antonio Luiz , De Resende Pertili R. , Dias Valdo Jose , Vieira Livia Marchiori , Mesquita Mariana Dornfeld Soffiati , Segawa Maria Eduarda Fernanes , Ferreira Pedro Paulo Soares , De Freitas Rocha Nogueira Marianna , Dos Santos Flavia Hermano Rodrigues , Dos Santos Giovanna C. Ferreira , Oliveira Guilherme Rodrigues , Rodovalho Euler De Oliveira , Filho Andre Breda Bauab , Pasquar Danilo R. Goulart , Martins Maria Julia Sousa
Published: June 2022

Objective:

To compare blood pressure (BP) values from conventional sequential measurements against average mode measurements.

Design and method:

We selected two samples of individuals with non-treated suspected hypertension. A trained nurse filled a standardized questionnaire with demographic, clinical data, measured BP, weight, height, and waist circumference, and installed an AMBP. We conducted sequential measurements in both. In one, we used an automatic device without average mode (Microlife-BP3BTOA (Onbo Electronics Co., Shenzhen, China). The individuals measured their BP in a conventional way (group-1); seven times, with an interval of 1 minute between them. Unlike the other (group-2), a device with average mode (Micro life- BP3AC1–1PC - Onbo Electronics Co., Shenzhen, China) measured blood pressure twice (BP1–3, BP4–6); in each measurement, and automatically took 3 BP every 15 seconds and delivered a mean. We calculated in group-1 the mean of tree first measures (BP1–3) and from four to six (BP4–6). We calculated proportions and means to characterize the samples and the t-test and chi-squared to show a significant difference between them. Also, the Bland Altman plot considered the agreement BP1–3 and BP4–6 with awake BP (ABP) in two groups.

Results:

Table 1 shows the main clinical characteristics and BP values of both groups. The proportion of women was higher in group-2 than group-1. Diastolic BP4–6 from group-2 87.8 ± 10.7 mmHg was significant higher than group-1 85.0 ± 10.7 mmHg (P = 0.0001). There wasn’t any difference for other comparisons.

Figure 1 shows the Bland Altman plot of the agreement between BP1–3, BP4–6, and ABP in two groups. The BP1–3 and BP4-6 indicate a good agreement with ABP in both groups.

Conclusions:

Our data shows that the BP values delivered in the average mode are as precise as those in a conventional method. And spend less time to conclude the measurements.
SYSTOLIC VERSUS DIASTOLIC BLOOD PRESSURE AS PREDICTORS OF CARDIOVASCULAR EVENTS AMONG TREATED HYPERTENSIVE PATIENTS: A 6-YEAR PROSPECTIVE STUDY
Authors: Kouremeti Maria , Konstantinidis Dimitrios , Andrikou Ioannis , Terentes-Printzios Dimitrios , Leontsinis Ioannis , Polyzos Dimitrios , Drogkaris Sotirios , Manta Eleni , Tatakis Fotis , Zamanis Ioannis , Siafi Eirini , Dimitriadis Kyriakos , Grigoriou Kalliopi , Fragoulis Christos , Iliakis Panagiotis , Tsioufis Konstantinos
Published: June 2022

Objective:

Little is known regarding the association of systolic versus diastolic BP with CV outcomes especially in hypertensive patients under treatment. The aim of this retrospective study was to investigate the risk of CV event among different components of BP in treated hypertensive patients.

Design and method:

We followed up 1362 treated hypertensive patients, without history of CV disease, aged 40 to 80 years old (mean age 60years old), for a mean period of 6 years. Patients were classified into 4 groups, controlled hypertension, uncontrolled systolic BP (SBP), uncontrolled diastolic BP (DBP), uncontrolled SBP and DBP. All subjects had at least one visit per year and at baseline underwent blood sampling, echocardiographic study. The primary endpoint was CV events, which included coronary artery disease and stroke.

Results:

Patients of the uncontrolled SBP group were older than the other groups (p < 0.0001), with higher prevalence of dyslipidemia, diabetes and chronic kidney disease. Hypertensive patients with uncontrolled systolic-diastolic BP were more often males by 57% (p = 0.003), with higher BMI (29.2 ± 4.3, p = 0.003), resting HR (77.2 ± 11.4, p < 0.0001), LDL-chol (137.9 ± 35.2) and eGFR (80.6 ± 18.6, p = 0.004) in comparison with the others. Patients with uncontrolled DBP were younger than the other groups (53 ± 9years). Patients who belong in uncontrolled systolic-diastolic BP and uncontrolled SBP groups had greater LVMi and LVH than patients with uncontrolled DBP. The incidence of cardiovascular morbidity over the follow-up period was 3,6% (n = 54). In Cox regression models all BP phenotypes were related to increased CV risk apart from isolated DBP. More specifically, after adjustment, compared to controlled BP, uncontrolled SBP was associated with a 2.14 times greater CV risk (p = 0.04), while patients with both uncontrolled systolic and diastolic BP showed the worse prognosis (HR:2.88, p = 0.005).

Conclusions:

SBP is a significant predictor of adverse cardiovascular events in treated hypertensive patients in contrast to DBP, the levels of which seem to influence the cardiovascular prognosis only when combined with high SBP levels. Our results indicate that in clinical practice a well-controlled SBP should be the primary goal of antihypertensive treatment.
AUTOMATED OFFICE BLOOD PRESSURE MEASUREMENT ASSITED BY INSTRUCTIONAL VIDEO IN HYPERTENSIVE PATIENTS
Authors: Toba Ayumi , Ishikawa Joji , Harada Kazumasa
Published: June 2022

Objective:

Automated office blood pressure (AOBP) is a better estimate of true blood pressure (BP) than clinic BP by physicians; however, measurement is complicated and requires some assistance by medical staffs especially for elderly patients. Video instruction explaining how to measure AOBP would be helpful to guide patients to measure AOBP by themselves.

Design and method:

We enrolled 75 hypertensive patients. AOBP was measured 3 times with one minute interval after 5 minutes of rest by automated BP device (A&D UM-212BLE) with assistance of instructional video. Instructional video was designed originally to describe the way to attach the cuff, press the button, and stay quiet and measure BP in appropriate position. Clinic BP by physician was measured 3 times using the same device. The sequence of AOBP and clinic BP was andomised. Perceived stress when measuring AOBP and clinic BP were evaluated by visual scale analogue. Home BP was taken 5 consecutive days using A&D UA-651BLE Plus.

Results:

Mean age was 74.5 ± 10.6 (57% men), and 96% of the patients were taking antihypertensive drugs. Mean AOBP, clinic BP, home BP were 135.2 ± 17.2/81.3 ± 11.1, 139.3 ± 16.3/78.6 ± 10.9, 129.2 ± 16.7/72.7 ± 8.9 mmHg respectively. Mean systolic AOBP was significantly lower than clinic BP (4.1 ± 12.2, p = 0.005), and significantly higher than home BP (6.1 ± 17.5, p = 0.004). Mean diastolic AOBP was significantly higher than clinic BP (-2.7 ± 6.0, p < 0.001), and significantly higher than home BP (8.6 ± 8.8, p < 0.001). Difference between AOBP and home BP was associated with magnitude of mental stress when measuring AOBP (r = 0.289, p = 0.013). In a multivariate analysis, mental stress when measuring AOBP was a predictor of difference between AOBP and home BP after adjusting for age, sex, body mass index, and average of home BP (p < 0.001). AOBP and clinic BP were higher among patients who felt stressed when measuring AOBP (r = 0.386, p < 0.001 for AOBP, r = 0.308, p = 0.008 for clinic BP).

Conclusions:

AOBP measured with assistance of instructional video were significantly lower than clinic BP and higher than home BP, and the differences were determined by magnitude of mental stress associated with AOBP and clinic BP measurement.
HIGH VERSUS LOW MEASUREMENT FREQUENCY DURING 24-HOUR AMBULATORY BLOOD PRESSURE MONITORING: A RANDOMIZED CONTROLLED CROSSOVER STUDY
Authors: Thomsen Martin , Nyvad Jakob Tobias , Reinhard Mark , Christensen Kent Lodberg , Buus Niels Henrik
Published: June 2022

Objective:

We investigated whether the cuff inflation interval affects 24-hour ambulatory blood pressure monitoring (ABPM) values in patients with hypertension (HT).

Design and method:

HT patients (18+ years), typically with office BP above treatment target, were recruited from the hospital hypertension clinic and from 2 private cardiology clinics. Using a crossover study design, the participants were andomised to either a high or a low measurement frequency ABPM (HF-ABPM and LF-ABPM, respectively). HF-ABPM measured 3 times hourly during daytime and 2 times hourly during nighttime, while LF-ABPM measured BP once hourly throughout 24-hours. A second ABPM with opposite protocol was performed within 2–14 days after the first ABPM. Patients were instructed to keep daily activities alike on both days, and no changes in medication were allowed between measurements. To investigate the cuff inflation frequency on different BP levels, patients were assigned into 3 groups based on daytime systolic BP (SBP): normotension (<135 mmHg), mild HT (135–154 mmHg), and moderate/severe HT (>154 mmHg).

Results:

Data from 112 patients were andomis: 38 with normotension, 47 with mild HT, and 27 with moderate/severe HT. Mean age was 57.4 years (SD 14.5) and 45.6% were women. The percentage of successful measurements were 93.7% for HF-ABPM and 94.4% for LF-ABPM. Overall mean SBP was 137.1 mmHg (SD 15.5) for HF-ABPM and 138.0 mmHg (SD 16.3) for LF-ABPM with a difference of -0.9 mmHg (95% CI = -2.4; 0.5). The range in individual differences was however large, with 95% limits of agreement being -16.0;14.1 mmHg (Fig. 1). Mean SBP differences were -1.2 mmHg (95% CI = -3.5;1.2) for normotensives; 0.1 mmHg (-2.2; 2.4) in mild HT and -2.4 mmHg (-5.3; 0.5) in moderate/severe HT. These differences were not statistically different nor of relevant clinical significance.

Conclusions:

This is the first andomised study investigating whether cuff inflation frequency affects BP during a full 24-hour ABPM. In an adequately sized cohort, we found no difference between the two measurements strategies. Fewer measurements during ABPM could reduce discomfort and possibly increase acceptance of repeated ABPM recordings.
BLOOD PRESSURE ESTIMATION VIA THE OPTIBP MOBILE APPLICATION - PERFORMANCES ACROSS DIFFERENT BODY MASS INDEX
Authors: Caillat Mary , Degott Jean , Wuerzner Arlène , Proença Martin , Bonnier Guillaume , Knebel Jean-François , Stoll Chloé , Christen Urvan , Durgnat Virginie , Burnier Michel , Wuerzner Grégoire , Schoettker Patrick
Published: June 2022

Objective:

The association between overweight-obesity and hypertension is well known with both pathologies considered as public health priorities. The current reference techniques for Blood Pressure (BP) measurement represent a challenge in the obese population since the cuff may not be fully adapted to patient’s anatomy. OptiBP mobile application is a cuffless approach that estimates BP with the patient’s fingertip on the camera of a smartphone that could improve access to the measure while decreasing the challenges related to the cuff-based technique.

Design and method:

This study assessed the accuracy of OptiBP across different Body Mass Index (BMI) categories via a dedicated analysis of an existing dataset from a previously published clinical study (NCT038752488). The study protocol followed the ISO 81060–2:2018 standard for “Non-invasive sphygmomanometers - Clinical investigation of intermittent automated measurement type’’ adapted for a cuffless device. The performance of OptiBP was assessed with ISO 81060–2 Criterion 1 - the mean error value between the reference BP value and the estimated BP - and Criterion 2 - standard deviation of the patients’ mean error on 414 valid recordings obtained from 95 patients. Patients were divided in three BMI categories according to WHO classification (Table 1).

Results:

Data processing shows an acceptance of OptiBP recordings of 82% suggesting a high quality dataset. Results show that OptiBP estimations ulfil Criterion 1 with a mean error lower than ± 5 mmHg and SD < = 8mmHg for systolic BP and diastolic BP in each subgroup (Table 2) and Criterion 2 with all calculated values under the passing threshold (Table 3). The accuracy of these estimations are strengthened by absolute error proportions in accordance with the recommendations of the European Society of Hypertension and clinically relevant margin of error (error-grid analysis; at least 98% of “no risk’’ range).

Conclusions:

Altogether these results illustrate the accuracy of OptiBP estimation regardless of the patient’s BMI. This is a further step toward reliable, comfortable and inclusive medical care for all population diversity. Further research is in progress to improve the algorithm and validate it across other population diversities and pathologies.
FOREARM COPMARED TO UPPER ARM BLOOD PRESSURE READINGS
Authors: Stojanovic Milos , Vujovic Svetlana , Ivovic Miomira , Gajic Milina Tancic , Marina Ljilja , Miletic Marija , Nedeljkovic Biljana Beleslin , Stojkovic Mirjana , Ciric Jasmina , Parapid Biljana , Zarkovic Milos
Published: June 2022

Objective:

Studies comparing forearm and upper-arm blood pressure (BP) readings have given varied results. It is likely that higher blood pressure readings are obtained with forearm measurement when compared with upper-arm blood pressure readings. In order to evaluate values of forearm blood pressure in population we nalysed sample of patients with normal ambulatory blood pressure monitoring (ABPM) values.

Design and method:

Two hundred and fifty-seven patients with normal ABPM values were studied. Mean body mass index was 23 +/-6 kg/m2. Patients had three upper-arm and three forearm BP taken by Microlife validated device. Appropriate cuff was used. Mean BP was calculated from three BP consecutive measurements. Student’s t-test was used to analyze the data.

Results:

The mean age was 42.4+/-11.6 years. There were 127 females. Mean forearm and upper- arm systolic BPs were 142.7 +/- 16.5 mmHg, and 122.3 +/- 16.6 mmHg. Mean forearm, and upper- arm diastolic BPs were 86.8 +/- 13.4 mmHg, and 72.8 +/- 11.6 mmHg.

Systolic and diastolic upper-arm BP measurements were significantly lower than forearm BP measurements.

Conclusions:

This study revealed that we need forearm blood pressure reference values because there is significant difference between forearm and upper-arm BP measurements. The increasing number of obese people presents a very serious clinical challenge to doctors being faced with the inaccurate measuring blood pressure (BP) in patients with very large arms.
CAN IMPARED SYSTOLIC FUNCTION BE DETECTED FROM PRESSURE WAVEFORMS?
Authors: Orter Stefan , Hametner Bernhard , Wassertheurer Siegfried , Danninger Kathrin , Argyris Antonis , Protogerou Athanase , Kaniusas Eugenijus , Binder Ronald , Weber Thomas
Published: June 2022

Objective:

Heart failure with reduced ejection fraction (HFrEF) is a significant health problem. Early diagnosis, using widely available, cheap methods, remains an important goal. Therefore, we investigated whether individuals with normal left ventricular ejection fraction (EF) can be discriminated from patients with reduced EF with contemporary, automated analysis of pressure pulse waveforms.

Design and method:

Left ventricular EF was measured prospectively in 78 patients with HFrEF (15 females) with echocardiography (apical 4 chamber view, Simpson`s method, on a Philips EPIQ system). The control group was matched for age, sex, height, weight, and brachial blood pressure. Pressure waveforms were acquired from the radial artery (SphygmoCor system, AtCor medical) and processed with ARCSolver algorithms to derive Wave Intensity Analysis (WIA) parameters S and D and their ratio (SDR). Additionally, left ventricular ejection time index (iLVET) was calculated using a method based on numerical derivatives. Clinical characteristics between patients and controls were compared, using t-tests or Mann Whitney U test, as appropriate. Receiver-operating-curves (ROC) analysis was performed to investigate the discriminative ability of the pulse waveform parameters.

Results:

Patients with HFrEF (mean EF░=░28%) and controls (mean EF░=░66%) were well matched, according to age (56 vs. 56░years, p░=░0.597), sex, height (1.74 vs. 1.73 m, p░=░0.576), weight (86 vs. 83░kg, p░=░0.590), brachial systolic (127 vs. 129░mmHg, p░=░0.359) and diastolic (79 vs.79░mmHg, p░=░0.763) blood pressure, and the presence of hypertension (51 vs. 51%) respectively. Mean heart rate of patients and controls differed slightly (65 vs. 61 BPM, p░=░0.040). Diabetes, coronary artery disease, and the use of ACE-inhibitors/Angiotensin Receptor Blockers/Angiotensin Receptor Neprilysin Inhibitors were more prevalent in patients, as compared to controls. SDR (2.4 vs. 5.7 %, p░<░0.001) and iLVET (0.39 vs. 0.42, p░<░0.001) were significantly lower in HFrEF patients, as compared to controls. Moreover, SDR (AUC░=░0.93, 95% CI░=░[0.96, 0.88]) and iLVET (AUC░=░0.90, 95% CI░=░[0.94, 0.83]) were highly discriminative between HFrEF patients and controls – fx30.

Conclusions:

Parameters derived from pressure pulse waveforms, obtained non-invasively and processed automatically, may be suitable for early diagnosis of severely impaired EF.
VALIDATION OF THE OPTICAL AKTIIA BRACELET IN DIFFERENT BODY POSITIONS FOR THE PERSISTENT MONITORING OF BLOOD PRESSURE
Authors: Sola Josep , Vybornova Anna , Fallet Sibylle , Polychronopoulou Erietta , Wurzner-Ghajarzadeh Arlene , Wuerzne Gregoire
Published: June 2022

Objective:

The diagnosis of hypertension and the adjustment of antihypertensive drugs are evolving from repeated isolated measurements performed at the physician offices to the full phenotyping of patients in real-life conditions. Indeed, epidemiologic data show that prediction of risk is largely improved when blood pressure (BP) is measured out of the doctor’s office. Today, out-of-office measurements of BP are mostly performed by a series of self-measurements done at home over several days (HBPM monitoring), or automatically for 24 hours (ABPM monitoring). None of these approaches allow assessing and tracking the 24 hour hypertensive phenotype of patients in the long term. The aim of this study was to demonstrate that a wearable BP monitor (the CE-marked Aktiia Bracelet) can accurately estimate BP in the most common body positions of daily life and thus become a candidate solution for the long-term BP phenotyping of patients.

Design and method:

We recruited 91 patients with BP ranging from low to hypertensive levels and compared BP values from the Aktiia Bracelet against auscultatory reference values for four weeks at different body positions according to an extended and adapted ISO 81060-2 protocol.

Results:

The observed means and standard deviations of differences for systolic BP were of 0.46 ± 7.75 mmHg in the sitting position, -2.44 ± 10.15 mmHg in the lying, -3.02 ± 6.10 mmHg in the sitting with the device on the lap, and -0.62 ± 12.51 mmHg in the standing position. Differences for diastolic BP readings were respectively of 0.39 ± 6.86 mmHg, -1.93 ± 7.65 mmHg, 4.22 ± 6.56 mmHg and -4.85 ± 9.11 mmHg. For the sitting and relax position (for which the ISO 81060–2 performance criteria are applicable) the Aktiia Bracelet met criterion 1 and criterion 2.

Conclusions:

This study demonstrates that the optical Aktiia Bracelet can accurately estimate BP in the most common body positions compared to auscultation, although precision varies across positions. These findings pave the way to the use of this wearable device for the persistent monitoring of BP, and the further identification of individual BP phenotypes at scale.