bluuebunny/crossref_metadata_2025_split huggingface dataset:
ANTI-HYPERTENSIVE DRUGS AND PERINATAL OUTCOMES IN HYPERTENSIVE WOMEN ATTENDING A TERTIARY HOSPITAL
Authors: Hashmi Khamis Mohammed Al , Al-Ismaili Al Khattab , Dughaishi Tamima Al , Waili Khalid Al , Rasadi Khalid Al , Rajaibii Hajar Al 
Published: April 2021

Objective:
This study was aimed to determine the impact of hypertension and the used anti-hypertensive medications on perinatal (maternal and fetal) outcomes and to determine the most commonly used anti-hypertensive medications in order to compare their maternal and fetal outcomes.

Design and method:
The medical records of 484 hypertensive pregnant women attending a tertiary hospital, were evaluated. Singleton pregnancies of the women who were on anti-hypertensive medications and delivered in the hospital were included in the study. Multiple pregnancies, molar pregnancies and the women who were not on anti-hypertensive medications or did not deliver in the hospital were excluded from the study. Based on inclusion and exclusion criteria, 210 women were included. The data of types of hypertension, the used anti-hypertensive drugs, fetal and maternal outcomes were gathered from patient's medical records.
<SR>Results:</SR> The mean age of the studied population was 32.4 +/-5.6 years and the mean BMI was 34 +/- 8.1 Kg/m2. The most prevalent sub-type of hypertension was preeclampsia (41.4%). Low birth weight, preterm delivery, intrauterine growth restriction (IUGR), small for gestational age (SGA), respiratory distress syndrome and neonatal care unit admissions were significantly higher in women with preeclampsia than in the women with other types of hypertension. Labetalol was the most common prescribed anti-hypertensive drug. There were 101 (48.1%) women on combined therapy. Preeclampsia was significantly more prevalent in women who received labetalol alone than women who received methyldopa alone (50% Vs 16%, P = <0.001)). Low birth weight, preterm delivery, IUGR, SGA, respiratory distress syndrome, absent end diastolic flow and neonatal care unit admission of newborns were significantly higher in the women who received combined therapy. Preeclampsia and high dependency unit admissions were also significantly higher in women who received combined therapy.

Conclusions:
This study showed that that pregnant women on combined anti-hypertensive medications had significantly higher maternal and fetal outcomes. This could be due to more severe or uncontrolled hypertension in these women. T
IS DEPRESSION A RISK FACTOR FOR DEVELOPING HYPERTENSION IN TWO DIFFERENT HEALTH UNITS?
Authors: Reina Luisa Neves , Sousa Joao Teixeira , Da Silva Ines Maia 
Published: April 2021

Objective:
The aim was to evaluate if depression could be a risk factor for developing hypertension in two different health units.

Design and method:
We selected individuals from two different health units (USF Familias and USF Vale do Vouga) using the ICPC-2 codes for depression (P76) and for hypertension (K86/K87). Hypertension cases diagnosed before or on 2009 were excluded. On a second analysis we excluded patients with any of the following diagnoses: hypothyroidism, sleeping disorder, obesity, excessive weight and diabetes. The data were analyzed using the SPSS and Excel.

Results:
First we evaluated the effect of the covariates in the risk of developing hypertension, we used a logistic regression analysis in the 820 patients with depression without hypertension, and noted that having excessive weight, diabetes and sleeping disorder were significant (p < 0,05), and increased the risk of developing hypertension. When excluding all the covariates, we obtained 656 patients (83% are women) with depression of which 99 patients developed hypertension (mean age 54 years old) and 557 patients didn’t (mean age 44 years old). Using the t-test analysis (t = 7,39, p < 0,01) we found significant differences in age (T = 7,385, p < 0,001) between the group that developed hypertension and the group that didn’t develop hypertension. The group that developed hypertension was older (mean age 54) than the other group (mean age 44). The chi-square test found significant differences in gender (X2 = 5,510, p < 0,05), a higher ratio of women was noted in the group that didn’t develop hypertension. We selected a randomized sample of each health unit. Doing the analysis for each health unit, we didn’t find significant differences in those with depression (USF Familias: X2 = 1,16, p = 0,28; USF Vale do Vouga: X2 = 1,44, p = 0,23).

Conclusions:
We have to take in account the different methods of evaluating and therefore coding depression in 2009. We didn’t find depression as a risk factor for hypertension in this study. In further studies knowing the antidepressive treatment and if there was a history of alcohol and/or drugs abuse could be relevant.
AMBULATORY BLOOD PRESSURE MONITORING: ADVANTAGES AND OPPORTUNITIES
Authors: Amaral Teresa , Marinho José Carlos , Quina Cátia , Silva Mariana , Garcia José , Rua Inês 
Published: April 2021

Objective:
Ambulatory Blood Pressure Monitoring (ABPM) is a procedure used to diagnose hypertension, detect white-coat effect, masked hypertension and monitor blood pressure (BP) control. It offers additional and important data in opposite to office BP, such as the dipping status and circadian variability of ambulatory BP, and it is a better predictor of cardiovascular outcomes and morbid or fatal events. In our country, ABPM has limited availability in Primary Health Care. With that in mind, the health care team of our Primary Health Care Unit created an ABPM protocol in August 2017 in order to provide this procedure to its patients.

Design and method:
Descriptive, cross-sectional and observational study. Data collected from August 2017 to December 2019 regarding the results of ABPM and patient data. The ABPM protocol was designed following the most recent European Society of Hypertension guidelines.

Results:
In the described period, our unit performed 136 ABPM exams. The average age of patients submitted to ABPM was 53 years and 54% were of the male gender. The majority (67%) were referred for diagnosis purposes and 33% to monitor BP control. With the ABPM protocol we were able to diagnose 60 patients with sustained hypertension and 36 patients with uncontrolled hypertension, from which 10 presented resistant hypertension. Regarding the dipping status, 55% were dipper, 23% extreme dipper, 19% non-dipper and 3% reverse dipper. In 63% of cases, the ABPM results led to direct clinical decision-making by the family physician, such as pharmacology intervention, clinical investigation and lifestyle advice.

Conclusions:
Overall the ABPM is an accurate, cost-effective protocol that provides important information for the prediction of cardiovascular risk. Consequently, ABPM protocol implementation has been observed to have a direct positive impact in the diagnosis, monitoring and clinical decision-making ability of the physician regarding hypertension. With this presentation we wish to share the positive impact of ABPM usage on our Health Care Unit and to inspire and motivate others to create a similar protocol.
IMPLEMENTATION OF THE 2018 ESC/ESH GUIDELINES FOR THE TREATMENT AND CONTROL OF HYPERTENSION IN PRIMARY CARE IN GREECE: THE HYPEDIA STUDY
Authors: Kollias Anastasios , Foukarakis Emmanouil , Karakousis Konstantinos , Stergiou George S. 
Published: April 2021

Objective:
To evaluate office blood pressure (OBP) levels for antihypertensive drug treatment initiation/intensification, drug choices, and hypertension control in primary care in Greece.

Design and method:
A prospective nationwide non-interventional single-visit study was performed in consecutive untreated or treated hypertensives recruited by primary care doctors and hospital clinics. Participants’ characteristics, OBP measurements (triplicate; automatically transferred to PC; Microlife BPA3 PC) and treatment changes were recorded using an online cloud system. The study was supported by Menarini Hellas S.A.

Results:
A total of 3,122 patients were analyzed (mean age 64 ± 12.5 [SD] years, 52% males, 25% untreated). In untreated hypertensives (N = 772), drug treatment was initiated with monotherapy in 53% and with two-drug combination in 36%. ARB monotherapy was used for treatment initiation in 30%, ARB/CCB 20%, ARB/Thiazide 8%, ACEI-based 19%. Of the combinations used, single-pill were 97%. Among treated hypertensives aged <65 years (N = 977), 79% had OBP > = 130/80 mmHg (systolic and/or diastolic), whereas among those aged > = 65 years (N = 1,373) 66% had OBP > = 140/80 mmHg. ARBs were used in 69% of treated hypertensives, ACEIs 19%, CCBs 47%, diuretics 39%, b-blockers 19%. Single-pill combinations were administered in 85% of patients receiving drug combinations. Treatment intensification (mainly dose increase or drug addition) was performed in 54% of treated hypertensives aged <65 years with OBP > = 130/80 mmHg (systolic and/or diastolic), and in 62% of those > = 65 years with OBP > = 140/80 mmHg. Binary logistic regression in treated hypertensives aged <65 years showed that age (OR 3.2, 95% CI 1.0–9.9), BMI (OR 7.9, 2.8–22.8), male gender (OR 1.6, 1.1–2.2) and primary care (vs. hospital) setting (OR 1.5, 1.0–1.8) predicted OBP > = 130/80 mmHg. In treated hypertensives > = 65 years, BMI (OR 2.5, 1.1–5.7), primary care setting (OR 1.4, 1.0–1.7) and male gender (OR 1.3, 1.0–1.6) predicted OBP > = 140/80 mmHg.

Conclusions:
RAS blocker-based therapy, mainly ARBs, is the basis of antihypertensive drug treatment in the vast majority of patients in primary care, with single-pill combinations being widely used. In almost half of treated uncontrolled hypertensives treatment is not intensified (physician inertia), suggesting suboptimal implementation of the 2018 ESC/ESH targets in primary care.
USEFULNESS OF SHORTENED SALINE INFUSION TEST FOR PRIMARY ALDOSTERONISM DIAGNOSTICS
Authors: Yamashita Kaoru , Yatabe Midori , Seki Yasufumi , Bokuda Kanako , Watanabe Daisuke , Morimoto Satoshi , Ichihara Atsuhiro 
Published: April 2021

Objective:
Primary aldosteronism (PA) is a frequent and remediable cause of endocrine hypertension. Saline infusion test (SIT) is one of the most widely-accepted confirmatory tests for PA, but some patients may not tolerate the standard loading volume of 2 L saline over 4 h. Shortened SIT, loading only 1 L saline over 2 h, has been suggested to be useful and would be more acceptable across wider population if the diagnostic utility proves to be comparable to the standard SIT. Therefore, we compared the diagnostic values of plasma aldosterone concentration after 2 hours of 1 L saline loading (2 h PAC) and those after 4 hours of 2 L saline loading (4 h PAC) for the prediction of unilateral aldosterone hypersecretion and postoperative outcome.

Design and method:
The retrospective, single-center study involved 555 PA-suspected patients who underwent recumbent SIT, 153 of whom subsequently underwent adrenal vein sampling (AVS). Postoperative blood pressure outcome was also examined in 37 patients. We calculated the defined daily doses (DDD) of anti-hypertensive drugs according to those set by the World Health Organization, and compared the values between before and 1 year after the surgery.

Results:
The Youden Index of 2 h PAC for receiver operating characteristic (ROC) curves of 4 h PAC > 60 pg/mL (The SIT was considered positive if 4 h PAC was over 60 pg/mL according to the Japan Endocrine Society 2009 guidelines) was 66 pg/mL. The areas under the ROC curves of 2 h and 4 h PAC were comparable (0.80 vs.0.85, 95% CI -0.1035 – 0.0109, P = 0.11) for unilateral aldosterone hypersecretion defined as lateralization index >4. Postoperative reduction of anti-hypertensive drug use and 2 h PAC was significantly correlated (P = 0.04). The areas under the ROC curves of 2 h and 4 h PAC were comparable (0.82 vs.0.78, 95% CI -0.0949 – 0.1706, P = 0.58) for postoperative reduction of anti-hypertensive drug use.

Conclusions:
Shortened SIT may be similarly useful as standard SIT to select PA patients for AVS and also to predict postoperative blood pressure outcome with reduced burden on patients.
SERUM SOLUBULE (PRO)RENIN RECEPTOR CONCENTRATIONS ASSOCIATED WITH PROGRESSION OF HEART FAILURE IN HEMODIALYSIS PATIENTS
Authors: Morimoto Satoshi , Amari Yoshifumi , Iida Takeshi , Okuda Hidenobu , Yurugi Takatomi , Oyama Yasuo , Aoyama Naoki , Nakajima Fumitaka , Ichihara Atsuhiro 
Published: April 2021

Objective:
The (pro)renin receptor [(P)RR] is cleaved to generate soluble (P)RR [s(P)RR], which reflects the status of the tissue renin-angiotensin system. Hemodialysis (HD) patients have advanced atherosclerosis and a poor prognosis due to an increased prevalence of cardiovascular diseases. We have previously reported that serum s(P)RR levels were associated with arteriosclerosis independent of other risk factors. The present study aimed to investigate whether serum s(P)RR levels are associated with worsening of cardiac function.

Design and method:
A total of 258 maintenance HD patients were recruited and serum s(P)RR concentrations were measured. The patients were divided into lower (L) and higher (H) s(P)RR groups, and the background factors were compared between the two groups. Background factors were compared between those who survived (S) and who died (D group) during the 12-months-follow-up period. In the S group, the relationships between s(P)RR levels and changes in background factors including cardiac functions and atherogenic factors during the follow-up period were evaluated.

Results:
Serum s(P)RR concentrations were 29.8 ± 5.3 ng/ml. Age, CTR, TG, CRP, and visceral fat area (VFA) were significantly higher in H group than in L group. Twenty-four patients died during the follow-up period, and age, CTR, CRP, hANP, BNP, E/e’ were significantly higher and BMI, HDL-C, Cre, Alb, left ventricular ejection fraction (LVEF), subcutaneous fat area (SFA), and VFA were significantly lower in D group than in S group. In S group, changes in hANP or BNP were significantly higher in H group than in L group. Multiple regression analyses testing s(P)RR, LDL-C, LVMI, and LVEF, which were significantly correlated with changes in BNP, as independent variables revealed that s(P)RR was significantly positively correlated with changes in BNP.

Conclusions:
High serum s(P)RR levels were shown to be associated with increases in BNP independent of other risk factors, suggesting that increased expression of (P)RR may be associated with progression of heart failure in HD patients. Further studies are needed to determine whether serum s(P)RR levels are associated with prognosis in these patients.
SHORT-TERM VARIABILITY OF THE ALDOSTERONE-TO-RENIN RATIO IN AN ESSENTIAL HYPERTENSIVE POPULATION
Authors: Veldhuizen Gregory , Alnazer Rawan , Kroon Abraham , de Leeuw Peter 
Published: April 2021

Objective:
The aldosterone-to-renin ratio (ARR) is a commonly used metric in the screening of primary aldosteronism. However, insufficient high-quality research evaluating its precision and accuracy is available. In particular, limited information is known with regard to intra-patient short-term variability in the ARR. Highly variable intra-patient values could severely hamper the ability of the ARR to effectively screen for primary aldosteronism.

Design and method:
68 unmedicated, essential hypertensive participants (female n = 26, male n = 42), had two blood samples taken in the morning measuring plasma aldosterone and active plasma renin concentration within a 2-hour time window under strictly standardised conditions and while consuming a regulated sodium intake (3 g/day). Bland-Altman plots, mountain plots and correlation analysis were performed, comparing the mean values per participant with the difference between their measurements.

Results:
Using Bland-Altman plots, we found that renin, aldosterone and the ARR become increasingly variable as their mean values increase. Correlation analysis of the absolute difference in aldosterone-to-renin ratio values between measurements and their mean resulted in an R-squared value of 34.7% (p-value < 0.000)). This trend was also noted for plasma aldosterone (R-squared 9.6%; p-value 0.010) and active plasma renin concentration (R-squared 7.9%; p-value 0.021) separately. Taking an ARR value above 30 as abnormally high, 29.4% of the participants with a mean value above 30, had one measurement below 30. Conversely, 3.9% of those with mean values below 30 had one measurement above 30.

Conclusions:
Based on our findings, it can be concluded that spot measurements of the aldosterone-to-renin ratio have acceptable short-term variability in the lower ranges, but have increasingly doubtful reliability as aldosterone-to-renin values rise. Thus, in a clinical context, great caution should be taken in interpreting spot measurements of moderate to high aldosterone-to-renin ratio values, in particular when values are mildly elevated.
EFFECT OF SEQUENTIAL NEPHRON BLOCKING IN COMPARISON WITH THE DOUBLE BLOCKADE OF THE RENIN- ANGIOTENSIN SYSTEM + BISOPROLOL ON CENTRAL SYSTOLIC BLOOD PRESSURE AND ARTERIAL STIFFNESS
Authors: Cestari Elizabeth do Espirito Santo , Mello Priscilla Galisteu de , Rubio Tatiane de Azevedo , Souza Maira Regina de , Gonzales Eliangela Gianini , Costa Larissa Morete Caieiro da , Martin Luciana Neves Cosenso , Tacito Lucia Helena Bonalumi , Moreno Heitor , Vilela-Martin Jose Fernando , Yugar-Toledo Juan Carlos 
Published: April 2021

Objective:
The different classes of drugs routinely used in anti-hypertensive therapy promote different effects on markers of arterial stiffness and, consequently, on the central blood pressure. Arterial stiffness is the main determinant for the increase of the central blood pressure and considered an important predictor for myocardial infarction, stroke and congestive heart failure.

Objective:
The objective of this study was to compare the effect on the systolic central blood pressure and arterial stiffness in resistant hypertensive patients submitted to sequential nephron blockade (SNB) against double blockade of the renin-angiotensin-aldosterone system (DBRAS) plus Bisoprolol.

Design and method:
Fifty-five resistant hypertensive patients were recruited in the Hypertension Outpatient Clinic of FAMERP, twenty-nine in the SNB group (18F/11 M) and twenty-six in the DBRAS group (22F/4 M). Central systolic blood pressure (cSBP), incrementing index (AI) and AI75 were measured with Omron HEM9000-A. (Japan).

Results:
The main result showed significant reduction of the central systolic blood pressure in patients submitted to sequential blockade nephron treatment when compared with the double blockade of the renin-angiotensin system plus Bisoprolol group (128.8 ± 22.1 vs. 117.4 ± 17.9 mmHg - P = 0.03). Figure 1

Conclusions:
The sequential nephron blockade group, when compared with the double blockade of the renin-angiotensin-aldosterone system plus Bisoprolol, promotes significant higher reduction of the central systolic blood pressure in resistant hypertensive patients.
DIFFERENCE BETWEEN CLINICAL AND AMBULATORY BLOOD PRESSURE LEVELS CORRELATES WITH EMOTIONAL INTELLIGENCE SCALE SCORES IN PATIENTS WITH HYPERTENSION
Authors: Yana Koshelyaevskaya , Andreeva Galiya , Lyusin Dmitrij , Gorbunov Vladimir 
Published: April 2021

Objective:
The aim of study was to define relationships between emotional intelligence, quality of life (QL) scale scores and the difference between clinical and ambulatory blood pressure (BP) in patients with hypertension.

Design and method:
We assessed 90 ambulatory blood pressure monitoring (ABPM) data of patients with stable hypertension and white coat hypertension without serious concomitant diseases. ABPM monitor (Spacelabs 90207) was applied after the washout period. We defined daytime period as 8.00–23.00, nighttime – 23.00–6.00. The clinical-ambulatory BP discrepancy was assessed as the difference between mean clinical BP and mean daytime BP levels. After ABPM session patients completed the emotional intelligence questionnaire (EmIn) (Lyusin D.) and QL questionnaire (J. Siegrist et al.). We analyzed the following EmIn scale scores: I - emotion self-awareness; II - management of one's own emotions; III - control of emotional expression; IV - understanding others’ emotions; V- management of others’ emotions. We used Pearson correlation coefficient for statistical analysis.

Results:
The initial mean (M ± SD) daytime systolic BP (SBP) was 140.1 ± 12.8; diastolic (DBP) - 86.1 ± 10.5 mm Hg, age - 51,3 ± 15,3 years. We found the following significant negative correlations between III scale scores (control of emotional expression scale, of EmIn) and the difference between clinical and ambulatory BP for SBP (r = -0,25, p < 0,05). QL components did not correlate with the difference between clinical and ambulatory BP.

Conclusions:
The emotional self-control scores (III scale of EmIn) was negatively associated with the difference between clinical and ambulatory BP levels. Probably, a high level of the emotional expression self-control may prevent blood pressure rise at the doctor's visit, and as a result can reduce the clinical BP level and decrease of the clinical- ambulatory BP difference.
PREVALENCE OF SECONDARY HYPERTENSION IN PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION
Authors: Kvapil Tomas , Vaclavik Jan , Benesova Klara , Jarkovsky Jiri , Kocianova Eva , Kamasova Monika , Jelinek Libor , Vykoupil Karel 
Published: April 2021

Objective:
Resistant hypertension is defined as blood pressure that remains above therapeutic goal despite concurrent use of three antihypertensive agents (at full or maximum tolerated doses) of different classes, one of which is a diuretic. The prevalence of secondary hypertension among patients with resistant hypertension is not exactly known.

Design and method:
We retrospectively analysed the hospital records of patients with resistant arterial hypertension, who underwent complete laboratory and imaging examinations to exclude the secondary etiology of arterial hypertension. Standard descriptive statistics, Mann-Whitney U test and Fisher's exact test were used for statistical evaluation.

Results:
Among the 432 patients with resistant hypertension, secondary etiology of hypertension was found in 135 (31.1%). The most frequent cause was primary aldosteronism in 85 cases (63% relatively), followed by renovascular hypertension (21 cases, 15.6%), renal parenchymal hypertension (20 cases, 14.8%). Less common causes were hyperreninism (3.7%), hypercortisolism (1.5%), pheochromocytoma (0.7%) and adrenogenital syndrome (0.7%). Obstructive sleep apnoea has been found in 63 (14.7%) patients. Patients with secondary hypertension were more frequently male (70.4% vs. 52.2%, p < 0.001), had a higher left ventricular mass index (LVMI 119 vs. 106 g / m2, P = 0.037) and lower estimated glomerular filtration rate (69 vs. 75 ml/min/1.73m2, P = 0.009). Both groups did not differ in age, office blood pressure or albuminuria.

Conclusions:
Secondary etiology was much more frequent (31%) in our group of patients with resistant hypertension than in non-selected hypertensive population (5–15%). Patients with secondary hypertension had more advanced target organ damage.
This work was supported by the grant UP - IGA_LF_2019_036 a IGA_LF_2019_035.
This work was supported by the grant IGA_LF_2020_039