bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of day-by-day blood pressure variability on neurological functional outcome after acute ischemic stroke
Authors: Yang C.Q , Chen X.P 
Published: November 2020

Abstract

Background
Increased blood pressure variability (BPV) might be a detrimental factor after acute ischemic stroke. Previous studies on the association between blood pressure variability in the acute ischemic stroke and neurological functional outcome have yielded inconsistent results.

Purpose
We aimed to investigate the impact of day-by-day blood pressure variability within 7 days of onset on neurological functional outcome at 3 months after acute ischemic stroke.

Methods
Total 367 patients hospitalized for ischemic stroke within 48 hours of onset were enrolled. The acute stage of ischemic stroke was defined as the time period from symptom onset to 7 days. During this period, day-by-day blood pressure variability, including standard deviation (SD) and coefficient variation (CV) were derived and compared to neurological functional outcome. A baseline severity-adjusted analysis was performed using 3-month modified Rankin Scale score as the neurological functional outcome. Unfavorable outcome was defined as mRS≥3.

Results
The patients with unfavorable outcome had significantly higher systolic BPV (within 7 days of onset) than those with favorable outcome (15.41±4.59 VS 13.42±3.95mmHg for SD, P&lt;0.001; 11.54±3.23 VS 10.41±2.82 for CV, P=0.001). Multivariable logistic regression analysis revealed that Systolic BPV was significantly and independently associated with the 3-month neurological functional outcome (odds ratio [OR] = 1.15, 95% confidence interval [CI]: 1.07–1.22, P&lt;0.001 for SD; OR=1.15, 95% CI: 1.06–1.26, P=0.001 for CV). In addition, After adjustment for multiple confounding factors, including age, gender, risk factors, stroke features, baseline severity, recanalized therapy, hemorrhagic transformation, pulmonary infection, white blood cell, estimated Glomerular Filtration Rate and mean BP, day-by-day BP variability was significantly correlated with an unfavorable outcome in the top versus bottom quartile of systolic BP variability (OR=3.33, 95% CI: 1.41–7.85, P=0.006 for SD; OR=2.27, 95% CI: 1.04–4.94, P=0.037 for CV) during 3-month follow-up. Similar trends were also observed for diastolic BP variability. More importantly, incorporating SD of systolic BP into the conventional prediction model significantly increased the AUC for prediction of 3-month unfavorable outcome after acute ischemic stroke (0.84 vs 0.86; P=0.041).

Conclusions
Increased day-by-day blood pressure variability of systolic or diastolic BP in the acute ischemic stroke was associated with higher risk for unfavorable outcome at 3 months independent of mean blood pressure. Combining SD of systolic BP with conventional risk factors could thus improve the prediction of unfavorable outcome.

Funding Acknowledgement
Type of funding source: None
Genetic markers for hypertension – a genetic epidemiological study of 5000 Romanian individuals
Authors: Ursu R.I , Iordache P , Radoi V.E , Ursu G.F , Cucu N , Chirica V , Iacob D , Sima C , Dragoi O.D , Poenaru E , Bohiltea L.C , Manolescu A , Jinga V 
Published: November 2020

Abstract

Background
During the past decades, genetic research has reached new heights as next generation sequencing has rapidly taken over and genome-wide association studies (GWAS) have broug.
The purpose of the research is to determin high-risk variants (Single-Nucleotide-Variants,SNVs) associated with hypertension (HTA) in the Romanian population.
The current presentation asseses the final results of a 3 part study comprising the first and the largest GWAS on hypertension in Romanians.

Material
Methods The total cohort includes a number of 5690 individuals, of which 2190 with hypertension and 3500 heathy controls.
Genetic testing was performed at in Iceland.
A multiple GWAS assay has been performed for the identification of variants associated with hypertension, hypertension risk factors and hypertension comorbidities.

Results
Environmental (lifestyle) risk factors, such as smoking, alcohol consumption and coffee consumption, and also pathological risk factors, as are obesity and ageing, were analyzed in association with hypertension.
Tissue-specific protein expression, gene function and gene-gene interactions have been analyzed for assessing a possible biological explanation of the association between the identified related variants and HTA. Expression quantitative trait loci (eQTL) were assessed for variants in the reported locations for a better understanding of their involvement in HTA.
The results of the analysis revealed a number of over 5000 genetic variants statistically correlated with hypertension in the studied cohort, some well documented and in genes known to be involved in hypertension pathophysiology (clusters on chromosomes 1p36, 1q24, 3q24, 4p16, 5q12, 7q36, 12p12, 15q, 17q, 20q12, a.o. or CRNKL1, C19Orf12, CCDC51, C20Orf26, ZNF420, ZNF571, a.o. intragenic variants). Approx. 4100 SNVs were identified in correlation with diabetes mellitus and obesity.
Variants correlated with both hypertension and DM were identified (TBX20,ANK2, a.o. genes). Two other variant clusters (p=10–4–10–3) on chromosomes 19 (19q12) and 20 (20p11.21) revealed statistical correlations with both hypertension and obesity.

Conclusions
The present study found some important loci and clusters associated with HTA, which migh provide insights into the genetic architecture of this pathology.
The validity of these results for the Romanian population need to be confirmed by replication studies.
The current research is part of the EU ProMark, ROMCAN and AppGenEdu projects.

Funding Acknowledgement
Type of funding source: None
Is 24 hour central aortic pressure superior to single measurement of central aortic pressure in well controlled hypertensive patients
Authors: Georgieva N , Borizanova-Petkova A , Kinova E , Goudev A 
Published: November 2020

Abstract

Background
Non-invasive measurements of 24 h ambulatory central aortic systolic pressure (24hCASP) is now feasible method than single measurement of CASP. There is growing interest in CASP as cardiovascular risk marker beyond conventional brachial blood pressure (BP). Pulse wave velocity estimates arterial stiffness, whereas CASP is representative of the BP in major organs.

Purpose
To evaluate non- invasive parameters for arterial stiffness using oscillometric method and to compare 24hCASP with single measurement of CASP in well-controlled hypertensive patients to detect target organ damage (TOD).

Methods
A total 95 patients (57±14 years) with hypertension, were separated in two groups: 22 patients with normal EA/Ees ratio (Arterial elastance (EA) and ventricular elastance (Ees)) and 73 hypertensive patients with decrease EA/Ees ratio, marker for ventriculo-arterial coupling. EA and Ees were calculated as and – systolic pressure/stroke volume and end-systolic pressure/end-systolic volume. Parameters for arterial stiffness – 24hCASP, ambulatory central systolic pressure (CASP), 24-hour pulse wave velocity (PWV24h) and ambulatory PWV were measured non-invasively with oscillometric method by Mobil-O-graph PWA.

Results
Statistically significant differences in parameters of vascular stiffness were found in patients with normal ventriculo-arterial coupling in comparison with disturbed EA/Ees: 24hCASP (107.64±9.19 vs. 116.64±16.7 mm Hg, p=0.02), CAP (117.45±9.26 vs. 128.42±16.15 mm Hg, p&lt;0.0001). There were no statistically significant differences in PWV and PWV24h. Multiple regression analysis demonstrated that CAP (B=−0.264 p=0.003; 95% CI: −0.003–0.014) is independent predictor of TOD in hypertensive patients, than 24 hour central aortic pressure.

Conclusion
There is no superiority of 24hCASP than single measurment of CASP. CASP could predict preclinical damage and cardiovascular outcome.

Funding Acknowledgement
Type of funding source: None
Association arterial stiffness reduction with improved left ventricular longitudinal and torsional deformation after 3 years of antihypertensive treatment
Authors: Tzortzis S , Ikonomidis I , Triantafyllidi H , Thymis J , Frogoudaki A , Vrettou A.R , Iliodromitis E 
Published: November 2020

Abstract

Background
We investigated the effects of antihypertensive treatment on vascular function, longitudinal and torsional deformation in hypertensives.

Methods
In 200 untreated patients with arterial hypertension (age 52.5±11.6 years, 56% females), we measured at baseline and after a 3-year of antihypertensive treatment (160 received ACEi± diuretics and 40 CCBs± diuretics): a) 24h ambulatory blood pressure b) Carotid-femoral pulse wave velocity (PWV) b) Coronary flow reserve (CFR), LV mass index (LVMI), the global longitudinal strain (GLS) and diastolic (LongSRSE) strain rate, peak twisting (Tw-deg) and untwisting at mitral valve opening (UtwMVO), at peak E (UtwE) and at the end of the E wave (UtwendE) of the mitral inflow as well as twisting (TwVel-deg/sec) velocity using speckle tracking imaging. We calculated the % change of LV untwisting as difference between peakTw and UtwMVO, UtwpeakE and UtwendE.

Results
Compared to baseline, there was an improvement of GLS (−19.9±3.4 vs. −18.7±3.1%), LongSRS (−1.08±0.22 vs. −0.98±0.26 1/s), LongSRE (1.09±0.36 vs. 0.99±0.31 1/s), peak Tw (16.2±5.1 vs. 18.7±5.9 deg), Tw velocity, and the %LV untwisting (31.04±19.28 vs 26.02±15.69% at MVO, 60.04±19.78 vs 53.96±19.76% at peakE and 79.98±14.24 vs 75.90±17.01% at endE) post-treatment. In parallel, CFR (2.72±0.61 vs. 2.55±0.64), PWV (10.34±1.93 vs. 11.2±2.08 m/s) and LVMI were improved (p&lt;0.01 for all comparisons). By ANOVA, the interaction term between changes of all the above parameters and antihypertensive treatment (ACE inhibitors vs calcium channel blockers) was not significant (p&gt;0.05). By multivariate analysis, the reduction of 24h meanBP and PWV independently determined the respective improvement of GLS (b=0.478 and b=0.248 respectively), LongS (b=0.428 and b=0.201 respectively) as well as Twisting (b=0.449 and b=0.294 respectively) after adjusting for changes in LV mass, CFR and atherosclerotic risk factors (p&lt;0.05).

Conclusions
Long-term optimal blood pressure control with ACE inhibitors and CCBs improves LV longitudinal and torsional mechanics in hypertensives in parallel with arterial stiffness and blood pressure. This improvement in LV deformation and twisting was independently related to changes in arterial blood pressure and arterial stiffness.

Funding Acknowledgement
Type of funding source: None
Motivational interviewing to reduce blood pressure in hypertensive patients: randomized clinical trial
Authors: Silveira L.C.J , Aliti G , Vellone E , De Souza R.H , Rabelo-Silva E.R 
Published: November 2020

Abstract

Background
Uncontrolled hypertension is the leading risk factor for cardiovascular disease. This factor is often due to poor self-care; however, patients find lifestyle modifications difficult to achieve. Motivational interviewing has been proposed as an approach to enhance intrinsic motivation to change, develop autonomy, and promote healthy behaviors, but few randomized controlled trials have explored this approach, especially in hypertension.

Purpose
To evaluate the effectiveness of motivational interviewing in reducing blood pressure and improving self-care behaviors and medication adherence in patients with hypertension.

Methods
Single-center, parallel, randomized clinical trial with outcome-assessor blinding. The study included 120 adult patients diagnosed with hypertension who received regular follow-up in an outpatient hypertension clinic in Southern Brazil. Patients were allocated to one of two groups: the intervention group (IG), which received motivational interviewing by a trained nurse, and the control group (CG), which received standard care. All patients in the IG and the CG were assessed face-to-face once monthly for 6 months. The primary outcome was the reduction in systolic blood pressure and changes in mean blood pressure measured by 24-hour ambulatory blood pressure monitoring; secondary outcomes included self-care behaviors, measured with the Self-Care of Hypertension Inventory, and medication adherence, measured with Medication Assessment Questionnaire. Outcomes of interest were measured at baseline and at 6-month follow-up.

Results
The sample consisted largely of white (72%) females (70%), with a mean age of 62 years (SD=10), and a median duration of hypertension of ≥13 years. There were no statistically significant differences between groups at baseline. Over time, a statistically significant decrease in blood pressure levels occurred in the motivational interviewing group, except for daytime systolic blood pressure. The magnitude of change was greatest for nighttime systolic blood pressure (−6.4 mmHg) and 24h systolic blood pressure (−5.3 mmHg). Furthermore, patients in the IG showed improvement in all dimensions of the self-care score (P&lt;0.05). Medication adherence improved in the IG (within-group analysis), but not in controls (P&gt;0.05).

Conclusion
Motivational interviewing is effective in reducing blood pressure and improving self-care and medication adherence in patients with hypertension.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Coordenação de Aperfeiçoamento de Pessoal de Nível Superior- Brasil (CAPES)- Finance code 001.
Fitness is associated with lower inflammatory markers in obesity: the FATCOR study
Authors: Midtboe H , Ulvik A , Meyer K , Ueland P.M , Halland H , Gerdts E 
Published: November 2020

Abstract

Background
Obesity is associated with chronic low-grade inflammation, but exercise has anti-inflammatory properties. It is unknown whether the anti-inflammatory effects of fitness may influence the obesity-associated inflammation.

Purpose
To assess levels of inflammatory markers in fit vs. unfit overweight and obese subjects without known cardiovascular disease.

Methods
Peak oxygen uptake (VO2max) was measured by treadmill cardiopulmonary exercise testing in 566 subjects (mean age 48±9 years, 60% women) with body mass index &gt;27.0 kg/m2 in the FAT associated CardiOvasculaR dysfunction (FATCOR) study. Fitness was defined from age- and sex adjusted reference levels of VO2max. Serum levels of C-reactive protein (CRP), serum amyloid A (SAA) and calprotectin were assessed by Matrix-Assisted Laser Desorption/Ionization Time-Of-Flight (MALDI-TOF) mass spectrometry and log transformed before inclusion in analyses.

Results
Fit subjects (n=147) were older and had less metabolic syndrome, obesity and hypertension compared to unfit subjects (n=419) (all p&lt;0.05). Serum levels of CRP and SAA were lower in fit subjects vs. unfit (p&lt;0.01), while serum calprotectin showed no difference (p=0.06). In multivariable logistic regression analyses, lower CRP (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.61–0.87, p&lt;0.001) and SAA (OR 0.61, 95% CI 0.40–0.93, p=0.02) remained associated with being fit after adjusting for age, sex, obesity, metabolic syndrome and hypertension. When looking at obese (n=357, fit n=53) and overweight subjects (n=209, fit n=94) separately, lower CRP (OR 0.60, 95% CI 0.46–0.78, p&lt;0.001) and SAA (OR 0.44, 95% CI 0.24–0.83, p=0.01) remained associated with being fit in obese, but not in overweight subjects after adjustment for age, sex and metabolic syndrome.

Conclusion
Fitness was associated with lower circulatory inflammatory markers in obesity independent of cardiometabolic risk factors. Our results suggest that fitness may promote cardiovascular benefit through the anti-inflammatory properties of exercise also in obesity.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Western Norway Regional Health Authority
Associations of grip strength with cardiovascular disease and all-cause mortality in people with and without hypertension: findings from the Prospective Urban Rural Epidemiology (PURE) China Study
Authors: Liu W , Li W , Wang C.S , Hu B , Wang Y , Liu X.Y 
Published: November 2020

Abstract

Background
Hypertension and grip strength (GS) are predictors of mortality and cardiovascular disease (CVD), but whether these risk factors interact to affect both CVD and all-cause mortality is unknown. The study aimed to examine whether the associations between hypertension and GS with the risk of major CVD incidence, CVD mortality, and all-cause mortality differed between people with and without hypertension.

Methods
GS was measured using a Jamar dynamometer in participants aged 35–70 years from 12 provinces in the Prospective Urban Rural Epidemiology (PURE) China study. Hypertension was defined as a baseline systolic and diastolic blood pressure of at least 140/90 mm Hg, a self-reported history of hypertension, or treatment with antihypertensive medications. Cox proportional hazards models were used to examine the associations of GS and hypertension and with the outcomes of all-cause mortality and CVD incidence/mortality, and to test the multiplicative interactions between hypertension and GS.

Results
Among 39,862 participants included in this study, 15,964 reported having hypertension at baseline and 9095 had high GS. After a median follow-up of 8.9 years [interquartile range (IQR) 6.7–9.9 years], 1822 participants developed major CVD, and 1250 deaths occurred (388 as a result of CVD). Compared with normotensive participants with high GS, hypertensive patients with high GS had a higher risk of major CVD incidence (HR 2.36 [95% CI: 1.84–3.02]; P&lt;0.0001) or CVD mortality (HR 3.05 [95% CI: 1.56–5.95]; P&lt;0.0001) but did not have a significantly increased risk of all-cause mortality (HR 1.23 [95% CI: 0.91–1.67]; P=0.181); these risks were further increased if hypertensive participants whose GS level was low (major CVD incidence (HR 3.33 [95% CI: 2.61, 4.24]; P&lt;0.0001), CVD mortality (HR: 5.20 [95% CI: 2.76, 9.82]; P&lt;0.0001), and all-cause mortality (HR 2.00 [95% CI: 1.53, 2.62]; P&lt;0.0001)).

Conclusions
The present study demonstrates that hypertensive patients with low GS are associated with the highest risk of major CVD incidence, CVD mortality, and all-cause mortality. High levels of GS appear to mitigate long-term mortality risk among hypertensive patients.
Association of adverse outcomes

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): The main PURE study and its components are funded by the Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, and through unrestricted grants from several pharmaceutical companies. Besides funding from global PURE, this work was also sponsored by CAMS Innovation Fund for Medical Sciences (CIFMS): 2016-I2M-2-004, Construction of Basic Information Technology Support System and Platform for National Prevention and Treatment of Cardiovascular Diseases.
Chlortalidone and bumetanide in advanced chronic kidney disease: HEBE-CKD Trial
Authors: Solis-Jimenez F , Valdez-Ortiz R , Perez-Navarro L.M , Reyes-Tovilla J.E 
Published: November 2020

Abstract

Introduction
Current treatment for hypertension and volume overload in chronic kidney disease consists of loop diuretics, nevertheless, chronic use leads to adaptive changes at the distal nephron, which in turn decreases their efficacy. The use of thiazide diuretics could be another treatment option in these patients, notwithstanding, there's not enough evidence to justify their use in this population.

Purpose
To evaluate the efficacy and safety of treatment with bumetanide plus chlorthalidone in in patients with advanced chronic kidney disease.

Methods
A double-blind randomized controlled trial was conducted at our hospital. Thirty-two patients with hypertension, chronic kidney disease stage IV/V, and chronic loop diuretic use where divided in two groups. The dual treatment group received bumetanide (4 mg QD) plus chlorthalidone (100 mg QD), while the control group was given bumetanide (4 mg QD) plus placebo, both for twenty-eight days. Systemic blood pressure, bioimpedance, and urinary electrolytes were measured at seven and twenty-eight days of treatment.

Results
There was a significant decrease of systemic blood pressure in the dual treatment group when compared with the control group; systolic blood pressure −26.1±15.3 vs. −10±23.3 mmHg (p=0.028), diastolic blood pressure −13.5±10.7 vs. −3.4±11.9 mmHg (p=0.018), and mean arterial pressure −18.1±8.7 vs. −5.4±14.3 mmHg (p=0.006). There was also a significant decrease of volume overload in the dual treatment group when compared to the control group; total body water −4.36±3.29 vs. +0.075±1.78 litres (p&lt;0.001), extracellular water −2.55±1.1 vs. +0.150±1.2 litres (p&lt;0.001), and extracellular water to total body water ratio −2.92±4.76 vs. −0.24±1.42 (p=0.039). The treatment group increased its fractional excretion of sodium, while the control group demonstrated an increase, though differences were non-significant. As for adverse effects, there was a non-significant increase of urea and creatinine levels in the dual treatment group when compared with controls.

Conclusions
In advanced chronic kidney disease plus hypertension patients whose treatment with loop diuretics is insufficient, combined use of bumetanide plus chlorthalidone can be useful for systemic blood pressure and volume overload control.
Figure 1

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Hospital General de México