bluuebunny/crossref_metadata_2025 huggingface dataset:
RENIN-ANGIOTENSIN-ALDOSTERONE BLOCKADE AND ITS PREDICTION OF LATE RECURENCE OF ATRIAL FIBRILLATION AFTER RADIOFREQUENCY ABLATION
Authors: Labr Karel , Mieresova Marie
Published: June 2023

Objective:

Hypertension is one of the main triggers of atrial fibrillation. Patients with hypertension have 1.7 times higher risk of developing atrial fibrillation. Opinions differ on the use of RAAS blockers in atrial fibrillation. The aim is to evaluate the effect of RAAS blockers in the prevention of atrial fibrillation on the post-ablation prognosis of the patient.

Design and method:

A retrospective analysis of 221 patients who underwent radiofrequency ablation of atrial fibrillation at the First Department of Internal Medicine - Cardioangiology of St. Anne's University Hospital in Brno from 1 January to 31 December 2019 was performed. Recurrence within the first three months was designated as early, and in the following months as late.

Results:

The median age of the study population (N = 221) was 63 years, with 67.4% of men. According to pre-ablation transesophageal echocardiography, the mean left atrial dimension was 45.3mm and left ventricular ejection fraction was 59.8%.

Among the comorbidities, hypertension (63.3%) and dyslipidaemia (41.6%) were the most common, followed by diabetes mellitus (14.0%), ischemic heart disease (7.2%), history of stroke (6.3%), chronic obstructive pulmonary disease (5.0%). 33.0% had a history of nicotinism.

Among the baseline antihypertensive groups, beta-blockers were the most represented (69.2%) followed by angiotensin-converting enzyme inhibitors (37.5), angiotensin-receptor blockers (20.4%), calcium channel blockers (32.1%) and diuretics (32.1%). There was not a significant difference in the representation of each group of antihypertensives between the populations.

n the group of patients treated with ACEis/ARBs (57.9%), the mean blood pressure resulting from pre- and post-ablation measurements was the same 149/81mm Hg. No significant differences in left atrial size or capture of early or late postablation recurrence (HR 1.26, 95% CI 0.84-1.90, p = 0.265) were detected in the RAAS inhibitor group relative to patients without ACEis/ARBs in therapy.

Conclusions:

Conventionally administered ACEis/ARBs before ablation procedure did not lead to a reduction in the detection of late postablation recurrence of atrial fibrillation. Despite the documented benefit of RAAS blocker therapy in atrial fibrillation patients, their routine administration before ablation procedure aimed at improving postablation prognosis was not evaluated as justified.
ATRIAL FIBRILLATION CAUSED BY ISOLATED TRICUSPIDE REGURGITATION
Authors: Chamtouri Ikram , Jomaa Walid , Hamda Khaldoun Ben
Published: June 2023

Objective:

Atrial fibrillation (AF) may be the cause or the consequence of funcionnal tricuspide regurgitation (TR). Predectifs factors of AF occurence secondary to TR and its prognosis are unclear

Aim: to invastigate predective factors of AF induced by severe TR and its prognosis.

Design and method:

All patients presented isolated moderate to severe TR with sinus rythm were enrolled prospectively in this study. A follow-up at 6 to 12 months was performed in all patients by clinical examination, electrocardiogramm and echocardiography.

Results:

Among 182 patients prensenting moderate to severe isolated TR with sinus rythm, 113 (62%) presented AF at 6 to 12 months follow-up. Predective factors of AF onset were female gender, chronic kidney failure, anemia and the presence of right bundle branch block (RBBB) at electrocardiogram. Right ventricle dysfunction and rehospitalization were significantly higher in patients experienced AF with no difference in mortality at follow-up.

Conclusions:

AF induced by isolated TR is not rare. It is associated with female gender and anemia. Prognosis of patients with TR is worsen by AF onset leading to a high prevalence of right ventricule dysfunction. AF should be early screened and treated .
ATRIAL FIBRILLATION AND LEFT VENTRICLE SYSTOLIC FUNCTION IN MODERATE HYPERTENSIVE PATIENTS WHO COME TO THE EMERGENCY ROOM DUE TO INADEQUATE CONTROL OF BLOOD PRESSURE
Authors: Solé Ricardo Cabrera , Turpin Caridad , Estephan Erick Luekpe , Aguilera Manuel
Published: June 2023

Objective:

To determine the percentage of cases of atrial fibrillation (AF) and left ventricular systolic function (LVEF) documented in hypertensive patients (PH) who come to the emergency room due to poor blood pressure control and those who do not attend.

Design and method:

From July 2020 to July 2021, we have studied 100 patients with hypertension, 60 women and 40 men with an average age of 72±8 years, who have previously been diagnosed and treated for hypertension. Of these PH, 22 had gone to the emergency room due to poor control of the BP. All underwent a standard echocardiogram and ABPM within 6 months of being seen in consultation with the cardiology specialist. The following parameters were measured: systolic and diastolic blood pressure (TAS, TAD), left ventricle systolic function (LVEF), left atrial size (LA) -The results were compared between those who went to the Emergency Department (PHER) and those who did not attend (PH) and we showed them.

Results:

TABLE:

Conclusions:

The PH that come to the Emergency Department have higher blood pressures and a higher frequency of atrial fibrillation, although the LVEF does not present significant differences. The size of the LA is also larger in the worst controlled patients, which indicates that we should follow this PH group more closely because of the important risk they have.
COMPARATIVE STUDY OF CENTROID DEFUZZIFICATION AND MAXIMUM DEFUZZIFIER MODEL MEAN OF MAXIMA ALGORITHM FOR CORONARY ARTERY DISEASE DIAGNOSIS
Authors: Fajar Rifaldy , Bern Roy , Mendoza Dewz , Kurnia Nana
Published: June 2023

Objective:

Cardiovascular, especially coronary artery disease (CAD), is the number one cause of death globally. Every year, more people die from cardiovascular disease than any other disease. There are several factors and symptoms of coronary artery disease that are easily recognized. To find out the severity of CAD, a diagnosis of CAD is needed to facilitate medical treatment. This study aims to explain the diagnostic process for CAD using a fuzzy system and to determine the accuracy of the fuzzy system.

Design and method:

This study uses a fuzzy system to diagnose the severity of coronary artery disease. Input variables used in the study were gender, age, pulse, systolic blood pressure, cholesterol, blood sugar, triglycerides, electrocardiogram (ECG), chest pain, shortness of breath, and cough. In making the system, 90 data were used which were then divided into two types of data, namely 70 training data and 20 testing data. The fuzzy inference system used in this study is the Mamdani inference system which uses centroid defuzzification and maximum defuzzifier mean of maxima (MOM). This defuzzification process is used to diagnose types of coronary artery disease, namely: CAD level 1 (Asymptomatic), CAD level 2 (Angina Pectoris), and CAD level 3 (Acute Myocardial Infarction).

Results:

The results of the research on the application of the fuzzy system for diagnosing coronary artery disease were the accuracy of the defuzzification centroid method of 98.5% for training data and 95% for testing data, while for the MOM defuzzification method, the accuracy level of training data was 98.5% and 90% for testing data.

Conclusions:

Based on the research results, it can be concluded that the centroid defuzzification method is better than the MOM defuzzification system for the coronary artery disease diagnosis system, so, it can be said that by using a fuzzy system with centroid defuzzification, the probability of correctly diagnosing one patient is 95%.
A CLINICAL RISK PREDICTION TOOL FOR CARDIOVASCULAR EVENTS FOLLOWING RESPIRATORY INFECTIONS
Authors: Lee Joseph , Wright-Drakesmith Cynthia , Koshiaris Constantinos , Hobbs Richard , Sheppard James
Published: June 2023

Objective:

The risk of cardiovascular (CVD) events increases for four weeks following a respiratory infection. This short-term increase in risk may be an opportunity for clinical intervention, providing one could predict the risk of infection-related CVD. We therefore sought to develop and validate a risk prediction model for use in patients with respiratory infections in primary care.

Design and method:

We used routinely collected data from two UK general practice databases, provided by Clinical Practice Research Datalink (CPRD). We used cohorts of patients without pre-existing CVD, starting from their first respiratory infection after the age of 40. We followed patients for 28 days. Our outcome was a composite of cerebral and cardiac events. We used logistic regression to develop risk prediction models in CPRD Aurum, and validated it in CPRD Gold. We selected predictors by asking clinicians to prioritize a list of potential predictors. This model uses ten variables.

Results:

The development cohort comprised 3.8 million patients with respiratory infections, and 7,081 CVD events in the following 28 days (0.18%). The validation cohort comprised 2.6 million patients with infections, and 6,868 events (0.26%). In external validation, we estimated a C statistic of 0.86. Using a 1% threshold of risk as a cut off, the positive predictive value was 3% (3.2 to 3.4%), with a negative predictive value close to one.

Conclusions:

It is possible to predict risk of primary infection-related CVD. Identifying patients at greatest risk of infection-related CVD opens up possibilities for further research applications.
BASELINE CARDIAC BIOMARKER ANALYSIS FROM THE BASEL POSTPARTUM HYPERTENSION REGISTRY
Authors: Socrates Thenral , Piattini Leana , Strobel Noémie , Schaffhauser David , Schumacher Christina , Mayr Michael , Vischer Annina , Burkard Thilo
Published: June 2023

Objective:

Postpartum hypertension (PPHT) is defined by elevated blood pressure measurements after birth of more than 140 mmHg systolic and more than 90 mmHg diastolic, that persist or develop directly after pregnancy and is associated with adverse cardiovascular and renal outcome. Aim of the current analysis was the evaluation of different prognostic cardiac and stress related biomarkers like cardiac troponin T (cTnT), N-terminal pro-Brain Natriuretic Peptide (NT-proBNP) and growth differentiation factor 15 (GDF-15) in the setting of PPHT.

Design and method:

Enrollment for the prospective observational Basel Postpartum Hypertension Registry began in June 2020 at the University Hospital Basel. Women with preexisting hypertension, hypertensive disorders of pregnancy (HDP), and de novo postpartum hypertension were enrolled and followed up in structured management program. Clinical history and lab values were collected out of the electronic health records. Additional blood samples were stored for further evaluation. The present analysis contains biomarker analysis of a subset of 58 out of 288 patients using blood samples taken within one week of giving birth. Serum samples were analyzed for detectable levels of cTnT, NT-proBNP and GDF-15 at the department for Laboratory Medicine at University Hospital Basel using electrochemiluminescence immunoassay Elecsys on the Cobas e 801 platform (Roche Diagnostics, Rotkreuz, Switzerland).

Results:

Mean age of the patients from whom we measured biomarkers at baseline was 34±4.7. Mean troponin was 8.5 ng/l ±2.2 with normal cuttoffs for this age group being 14ng/l and sex specific cutoffs at 9ng/l. NT-proBNP was 229.86ng/l ±80.4, with 125ng/l being the normal cut off in an acute disease setting. Mean GDF-15 was 1895.8ng/l ±323.5 with correlating normal values in healthy populations in the same age range being 564 ± 223 ng/l.

Conclusions:

This first biomarker analysis shows a trend of elevated NT-proBNP and GDF-15 which are associated with cardiovascular disease or stress. Cardiac troponin T was not elevated in most of the patients, but in a subset of 13 patients. Further analysis and long term outcome correlations remains to be established and may be part of the follow-up analyses of the Basel PPHT cohort.
WHAT IS THE SMALLEST CHANGE IN PULSE WAVE VELOCITY MEASUREMENTS THAT CAN BE ATTRIBUTED WITH CERTAINTY TO CLINICAL CHANGES IN ARTERIAL STIFFNESS? A RANDOMIZED CROSS-OVER STUDY
Authors: Podrug Mario , Sunjic Borna , Koren Pjero , Dogas Varja , Mudnic Ivana , Boban Mladen , Jeroncic Ana
Published: June 2023

Objective:

Pulse wave velocity (PWV), a direct measure of arterial stiffness, is a promising biomarker of cardiovascular risk and a cardiovascular surrogate outcome. However, there is no general agreement on the expected reproducibility of PWV which hampers identification of the smallest change in PWV that is clinically significant. The objectives of this study were to estimate the reproducibility of PWV measurements over the course of two weeks in a diverse group of participants and under experimental conditions that are clinically relevant (two observers, morning/afternoon sessions, different number of visits); and to investigate factors that could reduce this reproducibility.

Design and method:

Using the SphygmoCor CvMS and Arteriograph devices, we were able to estimate the level of PWV reproducibility as the range of intra-subject values that were observed during the study. Every participant was recorded a total of 12 times with each device, spread out over the course of three visits spaced one week apart, with each visit consisting of two morning and two afternoon recordings. Multilevel mixed-effect models were used to identified factors affecting large discrepancies between consecutive PWV measurements for each device.

Results:

We show that current guidance on PWV-estimation (at least two PWV measurements, and if their difference exceeds 0.5 m/s, a third measurement) is suboptimal because PWV range for most participants was outside 1 m/s threshold, which has been proposed as minimal clinically-important-difference. The best reproducibility was yielded with median of 4 measurements and 1.1 m/s threshold. Regarding PWV reproducibility and repeatability, which are frequently used interchangeably in studies, while the range showed distinct difference between them, commonly used relative measures of variability, such as coefficient of variability, were comparable. We also found that different physiological variables were predictors of discrepancy between consecutive measurements for two devices, which is likely due to their distinct modes of operation.

Conclusions:

The evidence base for PWV reproducibility is limited, and more research is needed to deepen our understanding of variation in arterial stiffness over time, as well as fluctuations within a population group and in an intervention setting.
SERUM PROTEOMIC PROFILING OF CAROTID ATHEROSCLEROSIS: A POPULATION OUTCOME STUDY
Authors: Cauwenberghs Nicholas , Verheyen Astrid , Sabovcik Frantisek , Ntalianis Evangelos , Brguljan Jana , Kuznetsova Tatiana
Published: June 2023

Objective:

Circulating proteins linked to atherosclerosis may improve cardiovascular (CV) disease prediction. Here, we applied proteomic profiling, feature selection and unbiased clustering to identify proteins associated with carotid atherosclerosis and integrate them in a protein-based classification system for prediction of future CV events.

Design and method:

491 community-dwelling participants (mean age, 58±11 years; 51% women) underwent carotid ultrasonography and proteomic profiling (CVD II panel, Olink Proteomics) at baseline. Subsequently, we collected cardiovascular outcome for a median follow-up period of 10.2 years. We applied partial least squares (PLS) and a machine learning algorithm (Random Forest, RF) to identify proteins associated with carotid intima-media thickness (cIMT) and the presence of atherosclerotic plaques. Next, we assessed the association of future CV events with protein-based phenogroups defined by unbiased clustering (Gaussian Mixture modelling) based on influential proteins in PLS and RF.

Results:

Of 92 measured proteins, 13 were labelled as important by PLS and RF and were independently associated with cIMT and/or the presence of plaques after multivariable adjustment: pro-adrenomedullin, agouti-related protein, brother of CDO, CD40 ligand, CD84, GLO1, HB-EGF, HSP27, lipoprotein lipase, lymphotactin, PAR-1, PDGF subunit B and TGM2. Based on these proteins, the clustering algorithm subdivided the cohort into two distinct phenogroups. Compared to the first (n = 174), participants in the second phenogroup (n = 317) had: i) a more unfavourable lipid profile with higher total cholesterol and triglycerides and lower HDL cholesterol (P<0.014 for all), but no differences in other CV risk factors such as age, blood pressure, smoking status and diabetes mellitus (P>0.061 for all); ii) higher cIMT (P = 0.0020); and iii) a significantly higher risk for future CV events during follow-up (multivariable-adjusted hazard ratio (95% CI) versus cluster 1: 2.63 (1.25 to 5.56); P = 0.01).

Conclusions:

Carotid atherosclerosis was linked to proteins reflecting haemostasis, angiogenesis, blood pressure regulation and inflammation. Focused proteomic phenomapping adequately identified individuals at high risk for future CV events and may thus complement current CV risk stratification strategies.
IMPROVEMENT OF PREDICTIVE UTILITY OF NATRIURETIC PEPTIDE FOR HEART FAILURE WITH PRESERVED EJECTION FRACTION WITH APELIN IN TYPE 2 DIABETES MELLITUS PATIENTS
Authors: Berezin Alexander , Fushtey Ivan , Berezin Alexander
Published: June 2023

Objective:

Apelin plays a pivotal role in adverse cardiac remodeling and the occurrence of heart failure (HF) with reduced ejection fraction in type 2 diabetes mellitus (T2DM). The purpose of the study was to investigate whether serum levels of apelin predict HF with preserved ejection fraction (HFpEF) in patients with T2DM

Design and method:

The study was retrospectively involved 76 T2DM individuals aged from 41 to 65 years (48 patients with overt HFpEF and 28 non-HFpEF patients). Healthy control group was consisted of 25 individuals matched with age and sex. Serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), apelin, and high sensitive C-reactive protein (hs-CRP) were determined by ELISA

Results:

Serum levels of apelin and NT-proBNP were significantly increased in patients with HFpEF (7.74 ng/mL, 95% CI = 6.31-8.25 ng/mL and 954.8 pmol/mL, 95% CI = 476.2-1764.3 pmol/mL, respectively) when compared with non-HFpEF diabetics (2.26 ng/mL; 95% CI = 1.70-2.90 ng/mL; and 113.5 pmol/mL, 95% CI = 75.4-144.9 pmol/mL, respectively) and healthy volunteers (1.52 ng/mL 95% CI = 1.12-2.13 ng/mL and 67.8 pmol/mL, 95% CI = 49.1-87.4 pmol/mL; respectively). Apelin levels correlated positively with body mass index (r = 0.32, P = 0.001), serum uric acid (r = 0.30, P = 0.016), HDL cholesterol (r = 0.28, P = 0.001), hs-CRP (r = 0.26, P = 0.001) and were negatively associated with ejection fraction (r = 0.34, P = 0.002), and age (r = -0.30, P = 0.001). The ROC curve showed that the best fitted cut-off point for the apelin to NT-proBNP ratio was 0.82 units (area under curve = 0.76; sensitivity = 69.5%, and specificity 94.2%, P = 0.001). In multivariate logistic regression analysis the apelin to NT-proBNP ratio < 0.82 × 10-2 units independently predicted (odds ratio = 1.44; 95% confidence interval: 1.18 – 2.77; P = 0.001) HFpEF in T2DM patients.

Conclusions:

Apelin to NT-proBNP ratio < 0.82 × 10-2 was independent predictor for HFpEF in T2DM patients
ASSOCIATION OF ANGIOTENSIN-CONVERTING ENZYME I/D POLYMORPHISM AND HYPERTENSION AMONG YOUNG ADULTS: A PILOT STUDY FROM DELHI
Authors: Suokhrie Seyielenuo , Devi Naorem Kiranmala
Published: June 2023

Objective:

Angiotensin converting enzyme (ACE) gene is a potent vasoconstrictor and directly involved in cell proliferation, differentiation, apoptosis and angiogenesis. Studies have reported that ACE gene activates the conversion of angiotensin I to angiotensin II and also inactive bradykinin. Bradykinin is a vasodilator which bring about its proteolysis which binds to the plasma membrane receptor and helps to produce the arteriolar constriction resulting in the rise of systolic and diastolic blood pressure. Blood pressure is additionally influenced by the interaction of genetic and other environmental factors, therefore this study tries to find an association between angiotensin-converting enzyme I/D polymorphism and hypertension among young adults

Design and method:

The present study was a cross sectional study conducted among young adults either sex from the age group of 18-30 living in Delhi, India. Standardized questionnaire was administered to collect data on demographic and physiological measurement. Overnight fasting intravenous blood of 5ml was collected on non-EDTA coated tube which were subjected to DNA extraction by salting out process (Miller, 1988). The extracted DNA was then aliquoted and amplified by allele-specific PCR followed by genotyping on 2% agarose gel (Rigat et al. 1990). The DNA was then screened for ACE I/D gene polymorphism. Statistical analysis was done using SPSS 2022 version.

Results:

The overall prevalence of hypertension in the given population was 25.3%. There was no significant difference in the distribution of ACE I/D genotypes wherein 17.4% of hypertensives were of the II genotype, 47% of ID genotype and 34.8% of the DD genotype.

Conclusions:

Although there was no significant association of ACE genotype with hypertension, which may be due to the small sample size but the significance of this study hints towards the importance of early detection and modifying lifestyle to improve overall health.of the individual as well as on the community level.
DESIGNING A CLINICAL TRIAL PROTOCOL INCLUDING PHYSICAL AND MENTAL ACTIVITIES TO EXPLORE BLOOD PRESSURE DYNAMICS FOR MEDICAL DEVICE DEVELOPMENT
Authors: Villeneuve Emma , Anglade Daniel , Sandre-Ballester Caroline , Auclair Loïc , Mastrosimone Marine , Bonnet Stéphane , Delalleau Alexandre , Gerbelot Rémi , Perriollat Mathieu , Blandin Pierre
Published: June 2023

Objective:

Cuff blood pressure monitoring is uncomfortable, limited for daily-routine and it provides sparse measurements in time. To enable continuous non-invasive monitoring, a new cuffless blood pressure (BP) meter based on photoplethysmography (PPG) is assessed in a first clinical trial. It aims at exploring the relationship between BP variations and optical features, including a wide range of intra-individual BP variations.

Design and method:

The initial cohort of the clinical trial (NCT05393401, approved by Human Research Review Board (CPP SM I) and Health French Ministry) includes five healthy subjects (1F/4M, age [37-60] years). Each subject is monitored with a medical-grade continuous BP meter, and a multi-sensing homemade platform integrating gold standard cuff measurements. The latter gathers PPG sensors, an ECG, a nasal cannula. The subject undertakes the following exercises: rest, static and dynamic strength exercises with a Pilates fitness ring, mental calculation, guided relaxation, and wall sit exercise. Each phase lasts 3 minutes, except the relaxation (10 minutes) and is followed by a 3-minute recovery.

Results:

The impact of each activity is quantified by the range of mean arterial pressure (MAP), i.e. the difference between the initial value and the extremum during the interval. As the table shows, the highest median impact is achieved with the dynamic ring (+39 mmHg) and the wall sit (+33mmHg). The static ring and the stress occurred by the calculation exercise have a lower impact with an increase of 21mmHg and 19mmHg. Finally, the effect of the relaxation is verified with a median decrease of 13 mmHg.

Conclusions:

These preliminary results (trial still running) show that building an accurate BP meter requires exploring the full range of BP in response to various physiological mechanisms. Therefore, it is necessary to combine relaxing and physical activities. Their impact vary among subjects and activities and illustrate that special care should be taken using real-time monitoring.
HIGH PREVALENCE OF NEW HYPERTENSION AND EARLY VASCULAR AGING: A REPORT FROM MAY MEASUREMENT MONTH 2019 SCREENING PROGRAMME IN BULGARIA
Authors: Postadzhiyan Arman , Yotov Yoto , Tisheva Snezana , Nikolov Fedya , Ramchev Konstantin , Raev Dimitar , Gruev Ivan
Published: June 2023

Objective:

Hypertension remains a major public health issue with inadequate control worldwide. The May Measurement Month (MMM) initiative by the International Society of Hypertension was implemented in Bulgaria in 2019 aiming to raise hypertension awareness and control. Increased arterial stiffness may indicate high cardiovascular risk, but little is known about its prevalence at the population level.

Design and method:

Adult volunteers (>18 years) were recruited through opportunistic screening in 21 of 28 administrative areas in the country. Information on medical history and triplicate sitting blood pressure (BP) measurements were obtained using validated automated upperarm devices. Aortic pulse wave velocity (aoPWV) was estimated, using age, systolic BP, and waveform characteristics. Using age-specific percentiles from a nonhypertensive group, we defined healthy (HVA) and early (EVA) vascular aging.

Results:

A total of 3678 participants were analyzed [mean age 58.8±16.5 years, men 37.2%, 71.2% had BP measurement in the last 12 months]. Mean BP was 135/82 mm Hg. In all, 45.4% of participants had elevated BPs (>140/90 mm Hg), 58.3% out of 1910 participants with known hypertension, and 31.4% out of 1768 participants without known hypertension. In all, 4,67% of participants had aoPWV below 10th reference percentile (HVA), with a negligible proportion above 50 years. In total, 40.5% were above the 90th reference percentile (EVA), with proportions rising from one-quarter in youngest partcipants bellow 50 to one-half in oldest participants. In participants with EVA, BP was elevated during the measurement in 82.6%. Among participants without established HTN, according to European guidelines in 18.4 % BP was elevated, when measured during the campaign. The lowest proportion of newly diagnosed hypertension was found in HVA group – 4.8% and the highest 30% in EVA group. Figure 1 gives information for blood pressure measured according to quintiles of vascular aging groups.

Conclusions:

The prevalence of hypertension in Bulgaria is high, with considerable potential for improving awareness, treatment, and control. The high prevalence of early vascular aging and higher incidence of newly diagnosed hypertension in this group of patient at early age is alarming.
ASSOCIATION OF MORTALITY OUTCOMES WITH ARTERIAL PARAMETERS DERIVED FROM THE 24-HOUR AMBULATORY BLOOD PRESSURE MONITORING
Authors: Li Mingxuan , An Dewei , Cheng Yibang , Huang Jianfeng , Sheng Changsheng , Huang Qifang , Zhang Dongyan , Wang Ying , Guo Qianhui , Xu Tingyan , Wang Jiguang , Li Yan
Published: June 2023

Objective:

Arterial stiffness, as a subclinical target organ damage, was an independent predictor of cardiovascular events. Parameters calculated from the 24-hour ambulatory blood pressure monitoring (ABPM), such as ambulatory arterial stiffness index (AASI), symmetrical AASI (sAASI), the 24-hour pulse pressure (PP) and its components expressed as elastic PP (elPP) and stiffening PP (stPP), can be used to indirectly assess arterial stiffness. Up to now, few studies have compared the associations of health outcomes with these parameters.

Design and method:

Out-patients who completed 24-hour ABPM (Mobil-O-Graph, Germany) at Ruijin Hospital (Shanghai, China) from 2017 to 2020 were recruited. All-cause and cardiovascular mortality (ICD10 codes I00-I99) was ascertained according to the death registry in Shanghai Municipal Center for Disease Control and Prevention. Standardized hazard ratios (HR) and 95% confidence intervals were computed with Cox regression models and adjusted for 24-hour mean arterial blood pressure and other confounders.

Results:

Among the 29,519 participants (mean age 52.9 years, 46.8% males) followed up for a median of 2.8 years, 244 participants died, and 78 died from cardiovascular events. In unadjusted analyses, all studied ambulatory arterial parameters were all associated with all-cause (HR, 1.41-1.87; P<0.001) and cardiovascular (HR, 1.55-2.17; P<0.001) mortality. After multivariable adjustment, AASI, the 24-hour PP, elPP and stPP remained significantly associated with all-cause (HR, 1.18-1.35; P<0.014) and cardiovascular (HR, 1.28-1.38; P<0.048) mortality, while the associations became non-significant for stPP in relation to cardiovascular death, and for sAASI with all-cause and cardiovascular outcomes.

Conclusions:

Arterial parameters derived from the 24-hour ABPM were independently associated with mortality outcomes, with some differences in the associations among different parameters.
SHOULD WE REALLY STOP OFFICE BLOOD PRESSURE MEASUREMENT? A QUALITATIVE STUDY
Authors: Jean-Marc Boivin , Manon Grocolas , Savy Dy , Joelle Kivits
Published: June 2023

Objective:

To assess patients’ perception of Office Blood Pressure (OBP) measurement during a General Practitioner (GP) visit.

Design and method:

Qualitative study conducted by semi-directed individual interviews of 31 patients, from November 2020 to October 2021 in the Eastern region of France, using a thematic and comprehensive analysis.

Results:

Patient attachment to OBP measurement was high. It was an expected act, allowing the evaluation of their health status and therefore a source of reassurance, and furthermore deemed an integral part of the visit and «check-up ». Patients trusted GPs’ BP measurements with the latter being perceived as falling within their role and competence. A lack of OBP measurement was considered as an omission of the GP's duty. It was moreover considered as a gold-standard by hypertensive patients performing Home Blood Pressure Measurements (HBPM).

Conclusions:

OBP measurement remains an essential act for patients, both from a medical and practitioner-patient relationship standpoint. Although the expansion of connected medicine will lead to a better acceptance of electronic devices in the management of hypertension, OPB measurement should be continued with the view of maintaining the quality of the physician-patient relationship.
HUNGARIAN AMBULATORY BLOOD PRESSURE MONITORING REGISTRY REVEALED THAT HYPERTENSION IS HIGHLY PREVALENT BOTH IN ALREADY DIAGNOSED AND TREATED PATIENTS AND IN SUSPECTED HYPERTENSIVES
Authors: Jarai Zoltan , Nemcsik Janos , Pall Denes , Takacs Johanna , Koller Akos
Published: June 2023

Objective:

In 2021 the Hungarian Society of Hypertension initiated a program to promote the nationwide use of ambulatory blood pressure (BP) monitoring (ABPM) (Hungarian ABPM Registry) aiming to increase the awareness of high BP and to monitor the efficacy of therapies. The goal was to collect and analyze the ABPM values of treated hypertensive (HT) and newly diagnosed patients (nHT) and assess the influence of other risk factors, comorbidities and patient characteristics.

Design and method:

Adults (18-100 years old) can be included into this ongoing, multicenter, open-label, observational study. Data collection to an electronic case report form is performed by GPs, internists, and cardiologists. Meditech ABPM-06 monitors are used. Data of the current analysis were collected between 21.02.2021-5.10.2022. 15 835 ABPMs were performed; due to missing data or protocol deviation 1018 patients were excluded from the analysis.

Results:

10212 patients were HTs, 4571 were nHTs (69% and 31%, respectively). 76% of nHT patients were untreated during ABPM. Mean 24-hour systolic and diastolic BP was 134.03±14.6 mmHg and 79.3±10.1 mmHg, respectively. There was no difference in the 24-hour mean systolic BP between nHT and HT patients (134.08±14.9 mmHg vs. 133.91±14.6 mmHg, respectively, p = NS). Two-third of the patients (all: 68.2%, HT: 68.5%, nHT: 67.6%) were hypertensive according to ABPM measurements. Obesity (BMI>30 kg/m2) doubled the risk of hypertension in both groups (OR = 2.18 [2.03;2.34] for 24-hour average), but it had a higher impact in nHTs (OR = 2.57[2.22;2.98] for 24-hour average in nHT and OR = 2.12[1.94;2.30] for 24-hour average in HT patients). Snoring increased the risk of hypertension in both group of patients (OR = 1.45[1.34;1.56] for 24-hour average) irrespectively of gender, and – interestingly – it had a greater impact on the daily values of BP (day: OR = 1.51[1.40;1.62] and night: OR = 1.32[1.22;1.42]).

Conclusions:

The new ABPM Hungary Registry revealed hypertension in the majority of screened individuals, regardless of gender or treatment. In addition, in both gender, obesity, snoring, increased the risk of hypertension. These data underline the importance of ABPM in the screening for and treatment of hypertension leading to the earlier and more effective treatment.
ASSESSING WORKFLOW, SATISFACTION, AND POTENTIAL COST REDUCTION WHEN USING A CUFFLESS AMBULATORY BLOOD PRESSURE MONITOR
Authors: Eisenkraft Arik
Published: June 2023

Objective:

Hypertension is a major risk factor for cardiovascular diseases. Ambulatory blood pressure monitoring (ABPM) is used for the diagnosis of hypertension, however, currently-used devices have several drawbacks complicating their use and accuracy. We tested the workflow of a wearable photoplethysmography (PPG)-based cuffless device when compared to the traditional cuff-based ABPM device.

Design and method:

Patients were recruited in a single community clinic and randomly assigned to either a cuff-based or a PPG-based 24-hour ABPM test. An assessment team recorded the time to complete each workflow component with each device. Questionnaires on user experience and workflow were filled by physicians, nurses, and recruited patients.

Results:

Workflow assessment of onboarding patients showed that it was faster with the PPG-based device than with the cuff-based device (301.17±58.39 seconds vs 1185±172.34 seconds on average, respectively). The PPG-based device received a higher score in all aspects of usability. The direct manpower cost reduction was calculated as 108,000 USD per year for 4,500 tests.

Conclusions:

The PPG-based device has several advantages when compared to the traditional cuff-based ABPM device, potentially increasing both patient and medical staff satisfaction, and as a result, increasing compliance. This could help improve the diagnosis and treatment of hypertension in the community.
ANTIHYPERTENSIVE THERAPY INTAKE IN THE PURE COLOMBIA COHORT 2005-2021
Authors: Mora Paola Natacha Lanza , Lopez-Lopez Jose , Otero Johanna , Martinez-Bello Daniel , Castañeda-Hernandez Alvaro , Gonzalez Ana Maria , Camargo Karol Lizeth Vega , Lopez-Jaramillo Patricio
Published: June 2023

Objective:

Describe changes in antihypertensive therapy in prevalent hypertension (HT) cases in the PURE cohort (The Prospective Urban Rural Epidemiology) Colombia in 2005-2021.

Design and method:

A prospective cohort study including 7552 participants from the baseline PURE Colombia cohort from 11 departments (Atlántico, Bolívar, Caldas, Casanare, Cauca, Cesar, Cundinamarca, Nariño, Quindío, Santander, Tolima). We conducted a descriptive analysis of the change in antihypertensive therapy between the 2005 baseline and the cut-off point to 2021.

Results:

At baseline, 2846 (37.7%) hypertensive participants were identified, 65.7% of which were women, with a mean age of 55.2 (SD 9.2) years. After 13 years of follow-up, 902 incident cases of HT were reported, 67.2% of which were women, increasing the prevalence within the cohort to 50.2%

Regarding the prevalences of antihypertensive drug use, in 2005 vs 2021 the observed changes were: angiotensin-converting enzyme inhibitors (ACEI) 23.7% vs 9.2%, thiazide diuretics (TD) 10.1% vs 6.0%, angiotensin receptor antagonists (ARBs) 4.5% vs 28.8% and lastly, dihydropyridine calcium channel blockers (DCCB) 4.0% vs 5.2%. The differences in the use of antihypertensive drugs between baseline and follow-up were significant, 55.7% of the patients reported no use of antihypertensive drugs at baseline vs 59.8% at follow-up, 20.0% were on monotherapy and the proportion dropped to 18.9%, 24.3% reported use of 2 or more drugs at baseline and 21.3% at follow-up.

Conclusions:

The significant increase in hypertension suggests the need to adopt recommendations for drug consumption that have abandoned the use of monotherapy; however, the changes in the management of hypertensive patients in the cohort show no improvement. There is a need to undertake strategies that encourage access to fixed-dose combination antihypertensive therapy.
IS IT REASONABLE TO DECREASE THE DEFINITION OF DIASTOLIC HYPERTENSION FROM 90 MMHG TO 80 MMHG IN THE ELDERLY? THE NORTHERN SHANGHAI STUDY
Authors: Hou Jingjing , Yu Shikai , Shi Jieying , Zhang Yi
Published: June 2023

Objective:

The 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines decreased the definition of diastolic hypertension to 80 mmHg from 90 mmHg. However, this action may not be appropriate in the elderly, considering the limited value of increased DBP in predicting future cardiovascular risk and the worse prognosis associated with significant lower DBP in the elderly.

Design and method:

A total of 1178 participants with SBP<130 mmHg derived from the Northern Shanghai Study, a prospective study focusing on the cardiovascular risk of the community-dwelling elderly Chinese in the northern Shanghai, China, were included. Study participants were divided into Group 1 (DBP<80 mmHg) and Group 2 (80<DBP<90 mmHg) according to DBP level. Survival analysis and Cox proportional hazard regression were used to study the future cardiovascular risk of the two groups.

Results:

After 5.8 years of follow-up, a total of 172 events were observed. Survival analysis showed no significant difference in the rates of the primary endpoints between two groups (14.9%vs14.0%, P = 0.80). In multiple COX proportional hazard regression, after adjusted for covariates, participants in Group 2 showed similar future cardiovascular risk (Hazard Ratio 1.05, 95% Confidence Interval 0.75-1.48, P = 0.78), as compared with Group 1.

Conclusions:

No increased cardiovascular risk observed in the elderly with SBP<130 mmHg and DBP between 80-90 mmHg, compared with those with DBP<80 mmHg. Therefore, it is maybe unreasonable to downregulate the definition of the diastolic hypertension in the elderly.
RELATIONSHIP BETWEEN LONG-TERM VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY AND CHRONIC KIDNEY DAMAGE
Authors: Yuan Yue , Sun Wei , Kong Xiangqing
Published: June 2023

Objective:

To assess the age- and sex-specific association between long-term visit-to-visit blood pressure variability (BPV) throughout adulthood and the development of chronic kidney damage (CKD).

Design and method:

A total of 1277 participants aged over 18 years old enrolled in the China Health and Nutrition Survey from 1991 to 2009 were included in the analysis. Long-term visit-to-visit BPV was evaluated by BP during seven visits. Renal damage was evaluated by estimated glomerular filtration rate.

Results:

After the eighteen-year follow-up, there were 110 (8.6%) participants with CKD. Adjusted analyses showed that renal function changes differed according to BPV. After full adjustment for the clinical characteristics plus cumulative exposure to BP from visit 1 to visit 7, subjects with higher standard deviation (SD)SBP had a significantly higher risk of renal damage (OR [95% CIs] = 1.05 [1.01–1.09]), average real variability (ARV)SBP (OR[95% CIs] = 1.04 [1.00–1.08]) and maximum and minimum difference (MMD)SBP (OR[95% CIs] = 1.02 [1.00–1.03], all P<0.05). Similar trends existed in the relationship when adjusting for the clinical variables plus mean BP across 7 visits. Subjects in late adulthood with higher SDSBP, DBP, MAP, PP, ARVSBP, DBP, MAP, PP, and MMDSBP, DBP, MAP, PP had significantly higher risks of chronic renal damage ( all P<0.05). Only females with higher SDSBP, DBP, MAP, PP, ARVSBP, DBP, MAP, PP and MMDSBP, DBP, MAP, PP had significantly higher risks of renal damage.

Conclusions:

This study suggested that long-term visit-to-visit BPV plays a predictive role in the development of renal impairment, especially in females and in subjects in late adulthood. Such evidence may help to direct potential strategies for preventing renal damage.
NIGHT-TIME BLOOD PRESSURE AND BLOOD PRESSURE VARIABILITY IN HYPERTENSIVE PATIENTS WITH OR WITHOUT INSOMNIA. A PILOT STUDY
Authors: Sartorio Andrea , Benedetti Elisa , Pont Chiara Dal , Bonafini Sara , Ferrante Lorenzo , Minuz Pietro , Fava Cristiano
Published: June 2023

Objective:

Recent studies found that insomnia is an independent risk factor for cardiovascular diseases, particularly arterial hypertension. Among the hypertensive population, insomnia could contribute to a worse blood pressure (BP) profile. In a sample of hypertensive patients, we compared those with and without insomnia with the aim of evaluating possible differences in BP, its variability, and breathing pattern.

Design and method:

We conducted a case-control study on patients with and without insomnia, based on the Insomnia Severity Index (ISI) questionnaire. Patients were recruited from the general practitioner's registry and were sent an invitation e-mail. All of them had long-lasting hypertension. One-hundred-and-fifty patients replied to the ISI questionnaire. Among them, twenty people with insomnia were selected (ISI greater than or equal to 15) and matched, based on their gender and age (±3 years), to 20 controls (with ISI lower than 15). All participants underwent night-time cardiorespiratory and 24-hour blood pressure monitoring by using a new cuff-less device that can estimate beat-to-beat BP (SomnoTouch-NIBP).

Results:

Comparing the two groups (insomnia vs. non-insomnia), no differences were observed in BP profile and all the respiratory indices, including the apnea-hypopnea index(AHI), the number of desaturations, and peripheral oxygen saturation (SpO2) values. Even the average BP and the indices of BP variability, such as the standard deviation (SD), the pressure coefficient of variation (CV), the BP dipping, and the nocturnal BP fluctuations (NBPF), were similar between the groups. Interestingly, to obtain the same average BP control, the insomnia group required a greater number of antihypertensive drugs (2,85 ± 0,88 vs. 1,95 ± 1,00 in the non-insomnia group; p<0.01).

Conclusions:

Patients with insomnia may need more antihypertensive medications to achieve the same average BP as patients without insomnia. Anyhow, they did not show, as expected, higher BP variability. How much beat-to-beat BP estimations are reliable compared to BP measurements by standard cuff-based devices is still under debate.
A STUDY OF 24HOUR CENTRAL BLOOD PRESSURE VARIABILITY WITH MEASURES OF MACRO- AND MICROVASCULAR FUNCTION IN A POPULATION OF UNTREATED HYPERTENSIVE AND NORMOTENSIVE INDIVIDUALS
Authors: Malliora Anastasia , Lazaridis Antonios , Triantafyllou Areti , Anyfanti Panagiota , Zarifis Ippokratis , Mastrogiannis Konstantinos , Karamaounas Polykarpos , Zabulis Xenophon , Doumas Michalis , Gkaliagkousi Eugenia
Published: June 2023

Objective:

Central blood pressure (cBP) has been more closely associated with target-organ damage compared with brachial BP, although a bidirectional interplay between central and peripheral arteries exists. Brachial short term BP variability (BPV) has been increasingly related to impaired macro- and microvascular function. However, scarce data exists regarding 24hour central BPV (cBPV) and its impact on organ damage. This study aimed to measure 24h cBPV in a population of untreated essential hypertensive (UHTs) and normotensive (NTs) individuals and evaluate its association with measures of macro- and microvascular function.

Design and method:

Newly-diagnosed UHTs and NTs were enrolled. 24hour cBP and 24h pulse wave velocity (PWV) were measured with the Mobil-O-Graph device. BPV including average real variability (ARV) of 24h central systolic BP (cSBP) and diastolic BP (cDBP) was calculated according to a standardized formula based on the ambulatory BP monitoring (ABPM) measurements. Urine albumin excretion (UAE) was measured in 24h samples.

Results:

We recruited 119 individuals including 79 UHTs and 40 NTs that didn’t differ in baseline characteristics. As expected, PWV was increased in UHTs compared to NTs [7.7 (1.5) vs 6.7 (1.2) m/s, p<0.001]. Similarly, in a subset of 60 individuals, UAE was increased [12.1 (9.7) vs 6.4 (4.5) mg/24h, p = 0.008]. UHTs presented higher ARV of 24h, daytime and nighttime cSBP/cDBP compared to NTs (p<0.05 for all comparisons). In total population, 24h PWV positively correlated with ARV of 24h cSBP (r = 0.353, p<0.001) and cDBP (r = 0.235, p = 0.010), ARV of daytime cSBP (r = 0.342, p<0.001) and cDBP (r = 0.235, p = 0.010), and nighttime cSBP (r = 0.297, p = 0.007). Furthermore, UAE correlated with ARV of nighttime cDBP (r = 0.372, p = 0.017). In multivariate analysis after adjusting for age, sex, and hypertension, ARV of 24h cSBP remained an independent predictor of PWV (beta = 0.109, p<0.001). Likewise, ARV of nighttime cDBP independently predicted UAE (beta = 0.480, p = 0.002).

Conclusions:

In a population of untreated hypertensives and normotensives, cARV indices are significantly and independently associated with measures of macro- and microvascular function including PWV and UAE, respectively. Further studies are warranted to ascertain the clinical value of cARV in terms of risk stratification and management.
MACHINE LEARNING CLASSIFICATION ON BLOOD PRESSURE VARIATION FOR THE RISK OF COGNITIVE IMPAIRMENT: A CROSS-SECTIONAL STUDY FROM A BLOOD PRESSURE MANAGEMENT COHORT IN HONG KONG
Authors: Jia Pingping , Yu Ruby , Chen Aaron , Yiu Karen , Tsoi Kelvin
Published: June 2023

Objective:

The evidence for the association between blood pressure variability (BPV) with cognitive impairment is still uncertain in the Asia population. This study explored whether a machine learning classification on BPV is associated with cognitive impairment among the elderly in Hong Kong.

Design and method:

Random samples of 573 participants were selected from a community-based cohort for blood pressure management in July 2021. Participants regularly measured blood pressure. K-means clustering methods were applied to group the standard deviation of BPV into high, medium, and low variations. This method considered both systolic and diastolic blood pressure variations. For cognitive functions, participants were assessed by the shorted version of the Montreal Cognitive Assessment Version, i.e., 5-min MoCA (Hong Kong validated version). Mild cognitive impairment (MCI) was defined with adjustment of age and education according to the 5-min MoCA. BPV was defined as the standard deviation of systolic and diastolic blood pressure values. Logistic and quantile regression models were conducted to explore the association of MCI with systolic or diastolic BPV and a combined BPV classification. Odds ratios (OR) were adjusted for age, gender, educational background social economic status, and other medical histories, including hypertension, hyperlipidemia, diabetes, and stroke.

Results:

The 573 participants had a mean age of 72 years with 86% of females. The median follow-up period was eight months with a median number of 19 blood pressure records. Systolic BPV increases the risk of MCI (adjusted OR, 95% CI = 1.18, 1.05 to 1.31), but not diastolic BPV. The quantile regression found that the magnitude of association is more substantial among the population with lower cognitive function (Figure 1). With reference to the machine learning classification, participants with high BPV were shown to have a 5.5 times higher risk of MCI than those with low BPV.

Conclusions:

Participants with higher systolic BPV are shown to be associated with poorer cognitive function, and therefore, long-term management of blood pressure variability is also important to reduce the risk of cognitive impairment.