bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anticoagulation for mechanical aortic valve replacement: an international survey
Authors: Gupta S , Belley-Cote E , McEwen C , Hou W , Eikelboom J , Whitlock R 
Published: November 2020

Abstract

Introduction
Mechanical valves are preferred over biologic valves in younger patients because they are more durable but require long-term anticoagulation which increases the risk of bleeding. For patients with a mechanical aortic valve, the ACCP guidelines recommend a target INR of 2.5 (range 2.0–3.0) for all patients, whereas the ACC/AHA and ESC guidelines recommend a higher target for selected patients with additional risk factors for thromboembolism (TE). Data supporting the guideline recommendations are largely historical and of low quality.

Purpose
We surveyed physicians who manage anticoagulation for patient with mechanical heart valves to determine their usual practice, perceptions regarding guideline recommendations, and interest in participating in a randomized controlled trial (RCT) comparing lower with higher INR targets in patients with a mechanical aortic valve.

Methods
A 33-question web-based survey was sent to 75 cardiologists, cardiac surgeons and thrombosis specialists at centres in Canada and internationally (western Europe, South America, and the United States) who participated in previous anticoagulation trials led by investigators at McMaster University.

Results
Of the 55 respondents (73.3% response rate), 77.8% worked in academic teaching hospitals. Respondents had been in practice for a mean of 23.6 years; 40.9% followed AHA/ACC guidelines, 34.1% followed the ACCP guidelines and 22.7% followed the ESC guidelines. In patients with a mechanical aortic valve and no additional TE risk factors, 80% of respondents targeted an INR of 2.5 (range 2.0–3.0); among patients with additional TE risk factors, 48% targeted an INR of 2.5 (range 2.0–3.0) and 44% targeted an INR of 3.0 (range 2.5–3.5). With respect to guidelines: 57.1% of respondents agreed or strongly agreed that that the evidence for the guidelines was contemporary, 53.1% agreed or strongly agreed that the evidence was derived from patients with modern bi-leaflet mechanical valves, and 57.2% of respondents agreed or strongly agreed that the evidence was not of high quality. A majority of respondents (65.9%) reported that they would accept an increase in TE risk to reduce the risk of a major bleeding event; 86.4% are willing to randomize patients with a mechanical aortic valve to a target INR of 2.0 (range 1.5–2.5) if they had no risk factors for TE and 36.4% would randomize patients to a target INR of 2.0 with additional risk factors for TE.

Conclusions
Clinicians who participated in the survey followed different guidelines and employed different INR targets for patients with a mechanical aortic valve. A majority of respondents would be willing to randomize these patients to lower INR targets.
Mechanical Aortic Valves and INR Targets

Funding Acknowledgement
Type of funding source: None
Haplotype of receptor for advanced glycation end products is associated with arterial stiffness in essential hypertension
Authors: Mahmud A , Zhou S , Yasmin Y , Spiers J.P , Feely J , Silke B 
Published: November 2020

Abstract

Background
What causes us to age has been extensively explored. The receptor for AGEs (RAGE) expression is up-regulated in atherosclerotic plaques and its activation leads to oxidative stress, cytokine and adhesion molecule formation, activation of nuclear factor-κB and cell apoptosis. We hypothesized that genetic variation in the RAGE receptor may be associated with arterial stiffness.

Methods
309 untreated hypertensive subjects were tested for genotypes of –374T&gt;A and –429T&gt;C polymorphisms with polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP). Arterial stiffness was measured as pulse wave velocity (PWV), augmentation index (AIx) and central aortic blood pressure (BP). Data was analysed using JMP Version 13 (SAS for Windows).

Results
Both polymorphisms were in Hardy-Weinberg equilibrium. The –374A A allele carriers had significantly lower aortic systolic BP (143±2 vs. 154±1, p&lt;0.001) while –429C allele carriers had lower aortic systolic BP (151±1 vs. 157±2, p&lt;0.01) compared with T carriers. –429C allele carriers had lower PWV compared to 429TT individuals (8.86±1 vs. 10.70±2.5). –374A allele carriers had lower PWV compared to 374TT individuals (9.7±1.43 vs. 10.65±2.6). Subjects with the AC haplotype had the lowest and those with the TT haplotype the highest PWV and aortic BP than any of the other haplotypes containing one or more of the at-risk alleles.

Conclusions
The combined effect of the two genotypes was additive with AA homozygotes of –374T&gt;A and C allele carriers of –429T&gt;C and the haplotype AC, associated with lowest aortic BP and arterial stiffness.
PWV & RAGE haplotypes

Funding Acknowledgement
Type of funding source: None
What is the optimal blood pressure level for kidney in the general population?
Authors: Ohno K , Takase H , Machii M , Nonaka D , Takayama S , Sugiura T , Ohte N , Dohi Y 
Published: November 2020

Abstract

Background/Introduction
Hypertension induces kidney dysfunction, and vice versa. Furthermore, kidney dysfunction can be a risk factor for cardiovascular diseases as well as end-stage of kidney disease. Although blood pressure (BP) control is necessary to prevent deterioration of kidney function, strict BP control may deteriorate kidney function.

Purpose
The present observational study investigated effects of BP levels on the incidence of chronic kidney disease (CKD) in the general population.

Methods
A total of 12,753 subjects with normal kidney function (estimated glomerular filtration rate [eGFR] ≥60 mL/min per 1.73 m2) (male 7,707, mean age 51.8 years) who visited our hospital for an annual physical check-up from April 2010 to March 2018 were enrolled. After baseline examination, subjects were followed up until March 2019 (median 1769 days) with the endpoint being the development of CKD (eGFR&lt;60 mL/min per 1.73 m2). The modified MDRD formula for Japanese was used to calculate eGFR. Hypertension was defined as BP ≥140/90mmHg or the use of antihypertensive medication.

Results
During the follow-up period, 1,604 subjects developed CKD (26.9 per 1,000 person-years) with the incidence being more frequent in hypertensive (n=3,098) than normotensive (n=9,655) subjects at enrollment (44.2 vs. 21.5 per 1,000 person-years, respectively; hazard ratio [95% confidence interval] from multivariate Cox proportional analysis 1.205 [1.061–1.369]). Hazard ratio of systolic BP at baseline was 1.006 [1.002–1.010] in a multivariate Cox proportional hazard regression model adjusted for possible risk factors. The incidence was lower in subjects without hypertension throughout the follow-up period (normotension group, n=7,866) than those who were diagnosed as having hypertension at least once during the period (hypertension group, n=4,887) (23.1 vs. 32.3 per 1,000 person-years, p&lt;0.001). In the normotension group, subjects with average BP &lt;120/80mmHg had lower incidence of CKD than in those with BP ≥120/80mmHg (17.2 vs. 36.1 per 1,000 person-years, p&lt;0.001). In contrast, in the hypertension group, the incidences of CKD in subjects with average BP &lt;120/80, 120–139/80–89 and ≥140/90mmHg were 34.3, 25.8, and 54.4 per 1,000 person-years, respectively (p&lt;0.001). Moreover, in hypertensive subjects under medication (n=2,002) with average BP &lt;120/80, 120–139/80–89 and ≥140/90mmHg, the incidence of CKD was 65.5, 41.3, and 64.3 per 1,000 person-years, respectively (p&lt;0.01).

Conclusions
The incidence of CKD was higher in hypertensive than in normotensive subjects. The lower BP was associated with the lower incidence of CKD in normotensive subjects, while strict BP control may increase the risk of CKD in hypertensive subjects.

Funding Acknowledgement
Type of funding source: None
The impact of resting heart rate measured on cardiovascular events in subject with hypertension
Authors: Sobieraj P , Lewandowski J , Sinski M 
Published: November 2020

Abstract

Background
Available evidence does not indicate whether resting heart rate (RHR) is an independent risk factor or just marker of elevated risk. None of the studies assessed impact of RHR on cardiovascular events, when RHR was measured using automated blood pressure measurements (AOBPM).

Purpose
To assess the relationship between RHR (measured using AOBPM) and cardiovascular events risk in subjects with hypertension.

Methods
The data of SPRINT trial obtained via NHLBI were used to perform the analysis. SPRINT trial assessed intensive lowering of systolic BP to a target &lt;120 mm Hg in comparison to standard goal (&lt;140 mm Hg).
RHR was measured using AOBPM device and calculated as an average of 3 measurements during the baseline visit of the study.
Clinical composite endpoint (CE) of the study was defined as: myocardial infarction, acute coronary syndrome, decompensation of heart failure, stroke or cardiovascular death.
The relationship between RHR and CE was assessed according to presence of cardiovascular disease (CVD) in past medical history.
The statistical methods included t-test and chi-square test, Cox proportional risk models. The Cox models were adjusted for adjusted for age, sex, current smoking status and mean SBP during the trial. Restricted cubic splines were used to describe the relationship between RHR and hazard ratio.

Results
Data of 1877 participants with CVD and 7484 participants without CVD were analyzed. Subjects with cardiovascular disease were older (69.7±9.5 vs 67.5 years ± 9.4, p&lt;0.001), more often were men (72.8% vs 62.3%, p&lt;0.001) and had prior chronic kidney disease (34.3% vs 26.8%, p&lt;0.001) than subjects without CVD. CE was more than twice often when CVD was present (10.9% vs 4.8%, p&lt;0.001). RHR was lower in subjects with CVD disease than in subjects without CVD (63.6±11 vs 66.9±11.6 bpm, p=0&lt;00.1). Elevated RHR was associated with increased risk both in subjects with and without CVD (Figure 1).
The multivariable Cox proportional hazard risk model revealed that RHR&gt;80 bpm is an independent risk factor for CE in subjects without CVD (hazard ratio 1.37, 95% CI 1.01–1.85, p=0.043) while not in subjects with CVD (hazard ratio 0.99, 95% CI 0.57–1.71, p=0.98).

Conclusion
Elevated RHR (&gt;80 bpm) measured using AOBPM is an independent risk factor for cardiovascular events in subjects with hypertension and without CVD.
Figure 1. Heart ratio vs hazard ratio.

Funding Acknowledgement
Type of funding source: None
Haemodynamic characteristics and blood pressure evolution of hypertension subtypes in young to middle age adults
Authors: Saladini F , Fania C , Mos L , Mazzer A , Vriz O , Garavelli G , Palatini P 
Published: November 2020

Abstract

Aim
The prognostic significance of different hypertension subtypes in young hypertensives, in particular of isolated systolic hypertensives (ISHs) is still debated. The aim of the present study was to investigate clinical and haemodynamic characteristics and blood pressure (BP) evolution of different hypertension subtypes in young stage I hypertensives.

Methods
We investigated 1206 young subjects from the HARVEST study: 81 normotensives (NTs), 146 ISHs, 281 isolated diastolic hypertensives (IDHs) and 698 systolic-diastolic hypertensives (SDHs) according to office BP values at baseline. Data on baseline haemodynamic and metabolic characteristics, BP and heart rate changes during follow-up (mean 7 years) were collected. ANCOVA analysis was used for all comparisons adjusting for age and sex.

Results
Males were more frequent among ISHs (90.4%) compared to other categories (70.4, 67.3, 71.5% among NTs, IDHs, SHDs). Moreover, ISHs were younger compared to the others (25.6±6.6 years, p&lt;0.001) and thinner compared to SDHs (24.6±.2.6 vs 25.8±3.6 kg/m2, p=0.028). Heart rate was higher among ISHs (75.7±9.4 bpm) and SDHs (75.8±9.7) compared to other categories (p&lt;0.001). Metabolic characteristics were not significantly different among groups. ISHs were more active in sports (55.5%) and drank less alcohol compared to others (p&lt;0.001, p=0.05 respectively). Systolic white coat effect was higher among ISH (17.6±12.4 mmHg) compared to others (p&lt;0.001), as was cardiac output ISH (6.3±1.2 ml/min) compared to NTs and IDHs (p&lt;0.001); Peripheral resistances were similar in ISHs and NTs and were lower than in IDHs and SDHs (p&lt;0.001). Small and large artery compliance was higher, central systolic BP and augmentation index were lower among NTs and ISHs compared to IDHs and SDHs, even if these differences were not statistically significant. During follow-up systolic BP decreased (−7.6±14.4 mmHg) among ISHs, while it increased among NTs and IDHs (p&lt;0.001). Heart rate decreased in all categories but to a higher extent among ISHs (−3.8±10.9 bpm) and SDHs (−3.4±10.8 bpm) (p=0.002 vs others). Changes in diastolic BP were similar among ISHs and NTs and higher than those observed among IDHs and SDHs (p&lt;0.001). The percent of patients who started pharmacological treatment during follow-up was 70.6% among SDHs, 54.1% among IDHs, 41.1% among ISHs, and 39.5% among NTs (p&lt;0.001).

Conclusions
ISHs had increased cardiac output and white coat effect and lower peripheral resistances compared to other hypertension subtypes while distensibility parameters did not differ significantly among groups. The percent of patients who developed hypertension needing treatment was lower among ISHs than other hypertensives. This was due to a favourable time course of BP during follow-up. Longer follow-ups are needed to confirm the lower risk profile of ISH of the young

Funding Acknowledgement
Type of funding source: None
The associations among arterial stiffness, endothelial dysfunction and the progression of carotid atherosclerosis in hypertensive subjects with/without carotid atherosclerosis
Authors: Nakano H , Tomiyama H , Fujii M , Iwasaki Y , Matsumoto C , Shiina K , Chikamori T , Yamashina A 
Published: November 2020

Abstract

Background
While arterial stiffness and endothelial dysfunction, which are diffuse vascular damage, are phenotypes of vascular damage, their associations with the progression of atherosclerosis, which is focal vascular damage, has not been fully clarified. The present prospective observational study was conducted to examine whether arterial stiffness and endothelial dysfunction predict the progression of carotid atherosclerosis in subjects medicated for hypertension with/without carotid atherosclerosis.

Methods and results
In 617 subjects receiving antihypertensive treatment, we conducted flow-mediated vasodilatation (FMD), brachial-ankle pulse wave velocity (baPWV) and common carotid artery intima-media thickness mean and maximal (IMTmean and IMTmax) at the baseline and the end (3 years' later) of study periods. During the study period, FMD was decreased and baPWV, IMTmean and IMTmax were increased significantly. In subjects without carotid atherosclerosis (IMTmax &lt;1.1mm, n=416), baPWV, but not FMD, at baseline had significant associations with IMTmean and IMTmax at both the baseline and end of study period. As shown in Figure, the changes of IMTmean and also IMTmax during the study period were higher in the highest tertile ranges of baPWV at the baseline than in the lowest tertile range of baPWV. On the other hand, in subjects with carotid atherosclerosis (IMTmax &gt;1.1mm, n=201), both baPWV and FMD were not associated with any markers of carotid atherosclerosis and also their changes during the study period.

Conclusion
In subjects with hypertension, arterial stiffness rather than endothelial dysfunction may be associated with the progression of carotid atherosclerosis, and this association may be significant in the premature stage of atherosclerosis.
Figure 1

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Omron Healthcare, Asahikasei Calpis
Elevation of pulse pressure in middle age is associated with the risk of dementia: data from a population-based cohort
Authors: Kim D , Jung H , Yang P.S , Yu H.T , Kim T.H , Jang E , Sung J.H , Pak H.N , Lee M.Y , Lee M.H , Lip G.Y.H , Joung B 
Published: November 2020

Abstract

Aims
Pulse pressure (PP) is a well-known risk factor for cardiovascular disease. However, the association between the PP and dementia is not well identified. This study aimed to determine the effect of PP on the risk of dementia development in different age subgroups using a longitudinal, population-based, and stroke-free cohort from the general population.

Methods
The association of PP with the development of incident dementia was assessed from January 1, 2005, to December 31, 2013, in 433,154 participants without a history of dementia or stroke from the Korea National Health Insurance Service-Health Screening cohort. The diagnosis of dementia was defined using the 10th revision of the International Classification of Disease codes.

Results
The mean age of the cohort was 55.7±9.2 years, 45.7% were women. Hypertension was 23.6%. The mean systolic and diastolic blood pressure of the entire cohort were 125.9±16.6 and 78.4±10.7 mmHg, respectively. Mean PP was 47.5±10.9 mmHg. In the middle-age group (40 to 50 year-old), increasing of 10 mmHg of PP was associated with incident dementia after adjusting mean blood pressure and clinical variables with a hazard ratio (HR) of 1.21 (95% confidence interval [CI]: 1.19–1.23, p&lt;0.001). The association was still significant even after censoring for stroke (HR: 1.16, 95% CI: 1.08–1.22, p&lt;0.001). In the older population, elevation of PP was not associated with dementia development (HR: 0.98, 95% CI: 0.95–1.01, p=0.247)

Conclusion
PP was associated with increased risk of dementia only in middle-aged population beyond that of mean arterial pressure.

Funding Acknowledgement
Type of funding source: None
Defining the electrocardiographic and echocardiographic abnormalities in a population of older adults with cardiovascular disease in rural south africa
Authors: Ferro E.G , Abrahams-Gessel S , Wagner R , Montana L , Gomez-Olive X , Tollman S , Gaziano T 
Published: November 2020

Abstract

Background
The African continent is undergoing an epidemiologic transition from infectious to cardiovascular (CV) diseases. National health systems face a critical shortage of population-level data to target the growing burden of hypertension (HTN). Very little is known on the impact of HTN on the rural population in many African countries, where over 85% of the rural population will migrate to cities and shape the modern CV disease spectrum of Africa in the next decade.

Purpose
To characterize the prevalence of HTN and HTN-related EKG and TTE abnormalities in a rural cohort in South Africa (n=5,059).

Methods
Between 2014 and 2015, 804 EKGs and 158 TTEs were performed on participants aged 40 or older randomly sampled from a longitudinal cohort residing in the Agincourt sub-district of rural South Africa. EKGs and TTEs were interpreted by two blinded physicians, and clinically meaningful variables defined using the Minnesota code (EKG) and European Association of Cardiovascular Imaging guidelines (TTE). Chi-square tests were conducted to define the association of EKG/TTE abnormalities with HTN, and stratify by gender.

Results
Over 55% of the sample (n=810) met blood pressure criteria for HTN, with a high prevalence of obesity (29%). On EKG, 36.5% participants had left ventricular hypertrophy (LVH), 13.6% T wave abnormalities, 7.5% Q wave abnormalities and 18.8% prolonged QT interval. Males (n=291) had more LVH (45% vs 30.8%, p&lt;0.01) and Q wave abnormalities (10% vs 5.9%, p=0.04) than females. Instead, females (n=438) had more prolonged QT intervals (28.8% vs 21%, p=0.02). Compared to those without HTN, participants with HTN had more LVH (45.4% vs 22.1%, p&lt;0.01), ST segment abnormalities (17.4% vs 10.7%, p&lt;0.01) and prolonged QT interval (23.4% vs 11.4%, p&lt;0.01). On TTE, there was a high prevalence of moderate (31%) / severe (25.8%) diastolic dysfunction, and concentric LVH (31.6%). Females had more concentric LVH (40.8% vs 13.5%, p&lt;0.01), and high relative wall thickness (70% vs 18.1%, p&lt;0.01) than males. Participants with HTN had more concentric LVH (42.5% vs 8.2%, p&lt;0.01), LV mass (58.5% vs 20.4%, p&lt;0.01) and LV mass index (52.8% vs 30.6%, p&lt;0.01), than those without HTN.

Conclusions
The rural population in South Africa is already affected by a high burden of HTN and high obesity levels. Within this cohort, patients with HTN have significantly more EKG and TTE abnormalities that predict adverse CV outcomes. EKG and TTE evaluation can be used to identify high-risk groups that national health systems should prioritize with frequent monitoring and more aggressive medical treatment.

Funding Acknowledgement
Type of funding source: Private hospital(s). Main funding source(s): Brigham and Women's Hospital
Combined lack of blood pressure and lipid control is a major risk factor for mortality in hypertensive patients: a single-center study
Authors: Magkas N , Georgiopoulos G , Konstantinidis D , Manta E , Kouremeti M , Dilaveris P , Chrysochoou C , Tzorovili E , Antoniou C , Tsiamis E , Tousoulis D , Tsioufis C 
Published: November 2020

Abstract

Background
Hypertension and dyslipidemia are well-known risk factors for cardiovascular disease (CVD). In such patients, lowering blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) and targeting to values below pre-specified cut-offs prevents CV events and improves prognosis. However, the impact of both BP and LDL-C control as compared to control of only one and/or none of these two risk factors is not well-studied.

Methods
Among 2,380 treated patients with hypertension and no overt CVD at baseline, we assessed the trajectory of BP control in 1,142 subjects with 4 or more follow up visits; BP control was defined as BP&lt;140/90 mmHg in half or more visits. In the same subgroup, data on lipid control according to LDL-C goals were available in 1,032 patients in 2 or 3 visits. The HeartScore was used to estimate the risk of all-cause death at baseline.

Results
Across a median follow up of 108 months, 26 deaths (2.44%) were recorded. Despite appropriate anti-hypertensive treatment, 376 patients (32.92%) did not achieve conventional BP control in half or more of follow-up visits. Respectively, 59.83% of the study population did not meet the LDL-C goals in at least one assessment. Patients with suboptimal BP control had almost 3-fold increased risk for all-cause mortality (HR=2.85, 95% CI 1.31–6.21, P=0.008) as compared to subjects with effective control. This association was not attenuated after taking into account age, gender, body mass index, smoking, and diabetes mellitus (adjusted HR=2.54, 95% CI 1.13–5.72, P=0.025). Ineffective LDL-C control was not related to death (HR=1.31, 95% CI 0.688–2.48). However, patients who did not reach treatment goals for both BP and LDL showed substantially increased risk for all-cause mortality (HR=5.42, 95% CI 1.09–26.9, P=0.039). Importantly, suboptimal BP control in our cohort of hypertensive patients was associated with death independently of the HeartScore (adjusted HR=2.65, 95% CI 1.22–5.77, P=0.014) and conferred incremental reclassification value on top of the baseline risk (continuous NRI=0.467, P=0.016).

Conclusions
Suboptimal BP control was related to all-cause mortality in our cohort of hypertensive patients; importantly, this association was substantially stronger in concurrent presence of LDL-C values above treatment targets, thus, highlighting the need for combined achievement of BP and LDL-C control. Moreover, association of suboptimal BP controlwith death was independent of the HeartScore, suggesting that BP control should be considered in risk stratification of hypertensive patients

Funding Acknowledgement
Type of funding source: None