bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE RELATIONSHIP AMONG BRACHIAL SYSTOLIC BLOOD PRESSURE, MICROALBUMINURIA, AND 24-H URINARY EXCRETION ON CENTRAL SYSTOLIC PRESSURE IN RESISTANT HYPERTENSIVE PATIENTS
Authors: Cestario Elizabeth , Rubio Tatiane de Azevedo , Souza Maira Regina de , Mello Priscilla Gaisteu de , Gonsalez Elizangela Gianini , Costa Larissa Morete Caieiro da , Martin Jose Fernando Vilela , Toledo Juan Carlos Yugar 
Published: April 2021

Objective:
Resistant hypertensive patients have a high prevalence of target organ damage. Increased central systolic blood pressure (cSBP) is more relevant than the peripheral one in these patients, because heart, brain and kidneys are directly exposed to high cSBP levels. Moreover, it is directly related to left ventricular hypertrophy, left atrial size, ischemic heart disease, brain injury, and kidney dysfunction. Currently, assessing cSBP and Augmentation Index (Aix) can be helpful to stratify cardiovascular risk and there is evidence that an improvement on cSBP leads to reduction of cardiovascular events and guides the antihypertensive treatment with drugs that more effective on cSBP reduction.An open prospective study was conducted, to identify markers associated with high cSBP values in resistant hypertensive patients on antihypertensive treatment.

Design and method:
Seventy-two hypertensive patients were recruited in the Hypertension Outpatient Clinic of FAMERP (44 women/ 28 men). Clinical characteristics and biochemical data collected are shown in the Table 1. The central systolic arterial pressure (cSBP) and the augmentation index (AIx) were measured using Tonometry HEM 9000-A validated OMRON equipment (JAPAN).

Results:
Multiple regression (cSBP) showed positive correlation between cSBP and brachial SBP (p = 0,0243) and microalbuminuria (p = 0,0325) and negative correlation with 24-h urinary sodium (p = 0,0277). Table2 and Figures.

Conclusions:
In Resistant hypertensive patientes the microalbuminuria can be useful as a marker to Increased central systolic blood pressure (cSBP)
HYPERTENSIVE PATIENTS WITH GREATER GENETIC RISK RESPOND LESS EFFECTIVELY TO TREATMENT AND ARE MORE LIKELY TO BE TREATMENT RESISTANT
Authors: Warren Helen , Traylor Matthew , Garofalidou Tatiana , Ng Fu Liang , Gupta Ajay , Sever Peter , Caulfield Mark , Munroe Patricia 
Published: April 2021

Objective:
Patients with resistant hypertension (RHTN) have increased cardiovascular disease risk. It is believed there may be genetic causes, although robust associations remain to be validated.
Over 1,000 genetic loci have been discovered for BP from genome-wide association studies (GWAS), with application of genetic risk scores (GRS) enabling population risk stratification. However it is unknown whether genetic risk influences treatment response.
We investigated whether BP associated loci: (i) are associated with RHTN; (ii) mediate the effect of antihypertensives on BP lowering response.

Design and method:
We analysed 6,266 patients of European ancestry with genetic data from ASCOT.
BP-GRSs were constructed for systolic (SBP), diastolic BP (DBP) and pulse pressure (PP) using all available 1,167 pairwise-independent published BP-associated genetic variants, weighted by their effect estimates from our recent BP-GWAS in N∼750k individuals.
We tested the BP-GRS for association with: (i) RHTN, adjusted for known non-genetic predictors: sex, age, BMI, diabetes, randomization treatment arm and left ventricular hypertrophy; (ii) BP response to monotherapy treatment, adjusted for sex, age, baseline-BP, dose and baseline antihypertensive use. All analyses adjusted for 10 principal components of ancestry.

Results:
Each BP-GRS is significantly associated with RHTN (P = 1.13 × 10-13, 1.96 × 10-5, 1.21 × 10-14 for SBP, DBP, PP) with increased genetic risk leading to increased odds of RHTN. Patients in the top 20% of SBP-GRS have 1.74 times greater odds of RHTN than the lowest 20% (P = 6.96 × 10-10). Additional adjustment for baseline-BP does not change conclusions. The association even remains significant (P = 5.11 × 10-4) with stronger effect (OR = 2.52) when restricted only to 1,037 patients untreated at baseline.
The BP-GRS is also significantly associated with SBP and DBP response to amlodipine (N = 1,780): patients in the lowest 20% genetic risk group achieve better lowering response by 3.77mmHg mean difference between SBP pre and post treatment (P = 8.27 × 10-4).

Conclusions:
Our results confirm the hypothesis for a genetic contribution to RHTN, indicating RHTN patients are likely to be those with highest genetic risk of hypertension, which helps to explain the clinical challenge. We show that those with greater BP genetic risk respond less effectively to treatment and provide evidence that BP genes also influence treatment response.
ASSESSMENT OF RENAL DENERVATION IN THE TREATMENT OF RESISTANT HYPERTENSION IN A SPECIALIZED UNIT
Authors: Águila Fernando Jaén , Chamorro Ricardo Roa , Bustos Pablo González , García Juan Diego Mediavilla 
Published: April 2021

Objective:
Renal denervation (RDN) is indicated in patients despite the use of three or more anti-hypertensive drugs including a diuretic, which, having ruled out secondary causes of hypertension (HT), are not controlled and are classified as resistant hypertension (RHT). The approximate prevalence is 10% -20% of the hypertensive population and represents a high incidence of adverse cardiovascular events in these patients.
RND is a minimally invasive method, but the effectiveness of this technique has shown some contradictory data due to a heterogeneity in the design of these studies.
Our objective is to evaluate the clinical experience in patients undergoing RDN in our unit.

Design and method:
Retrospective record of the 2009–2019 period. 16 patients with RHT treated by RDN with Symplicity-Flex or Spyral devices have been included. The statistical study was made with Spss program.

Results:
56.3% were male. Mean age of 53 ± 8 years. The average preRDN clinical SBP 169 ± 19 mmHg; DBP clinical preRDN mean 101 ± 17 mmHg; Mean postRDN clinical SBP 149 ± 26 mmHg; DBP clinical postRDN mean 88 ± 11 mmHg; Average number of preRDN drugs 5.88 ± 0.8; Average number of postRDN drugs of 4.67 ± 1.4. 75% of the procedures were done with the spiral symplicity method. Average number of ablations 24 ± 9 per procedure. There was no deterioration of renal function or complications.

Conclusions:
Our data provide a decrease in clinical BP after RDN, with a decrease in the number of drugs used to control their BP, and there seems to be a better response to the spiral symplicity method with greater number of ablations. The RDN technique has been proven safe, with no relevant complications and preserved renal function. The data therefore guarantee the safety and efficacy of this technique, which coincide with the recent national registries published in real life and that support its use in selected patients and in experienced centers.
ESSENTIAL HYPERTENSION OR A MISSING CAUSE FOR SECONDAY HYPERTENSION?
Authors: Munteanu Alice Elena , Ionita Iulia Theodora , Casian Mihnea , Gurzun Maria Magdalena , Diaconescu Corina 
Published: April 2021

Objective:
The case highlights the importance of diagnosing secondary hypertension and adequate treatment in the setting of a patient with classical cardiovascular risk factors which would otherwise make primary hypertension the most likely diagnosis.

Design and method:
Clinical Case

Results:
A 57 year-old male with cardiovascular risk factors (smoking, dislypidemia), grade 2 essential hypertension (ESC/ESH) and G3a stage chronic kidney disease (CKD) presents to our clinic with fatigue and persistent high blood pressure values despite treatment with ACEi. Clinical exam was unremarkable except for a 10mmHg difference between the arm and foot systolic blood pressure. The 24-hour ambulatory blood pressure monitoring revealed a non-dipping profile, with a mean blood pressure value of 150/100mmHg. TTE was performed and the following were observed: bicuspid aortic valve with tight aortic stenosis (mean AV PG > 40mmHg, AVA = 1.12cm2) and LV systolic dysfunction (LVEF = 35%). TEE was also performed and confirmed the bicuspid aortic valve. Given the context of the patient, computed tomography angiography (CTA) was the investigation of choice in order to visualize the aorta. Postductal coarctation was detected with a hypoplastic thoracic aorta and multiple collateral vessels. The coronary angiogram was normal. The ACEi was stopped and the patient received a dihydropyridine calcium channel blocker in combination with an adolsterone receptor antagonist with a favourable course. Aortic valve replacement surgery with mechanical valve implantation was recommended. Considering the multiple collateral vessels and complex vascular morphology, surgical correction of the coarctation was considered no longer feasible

Conclusions:
CoA was the actual cause for the persistent high blood pressure values in an adult male with cardiovascular risk factors who was believed to have essential hypertension. In the setting of aortic stenosis with impaired LV systolic function, high blood pressure values are not typical. Taking into account the BAV, the clinical suspicion of CoA was high and prompted further investigations. The CKD is the result of the the underperfusion of the kidneys secondary to the CoA and the use of ACEi.
HEART RATE VARIABILITY IN RESISTANT HYPERTENSION WITH AND WITHOUT DISTURBANCE OF GLUCOSE METABOLISM
Authors: Manukyan Musheg , Shelemekhov Aleksey , Falkovskaya Alla , Mordovin Victor , Pekarskiy Stanislav , Zyubanova Irina , Lichikaki Valeriya , Kurlov Igor 
Published: April 2021

Objective:
To evaluate the differences in heart rate variability (HRV) among patients with resistant hypertension (RHTH) with and without disturbance of glucose metabolism.

Design and method:
A total of 87 patients with RHTN were included in the study: 39 patients without disturbance of glucose metabolism (RHTN group) (mean age 51.2 ± 8.5years, 20 (51%) men, 24-hour (24 h) blood pressure (BP) (systolic/diastolic) 162.3 ± 19.4/99.6 ± 13.5 mmHg); 34 patients with type 2 diabetes mellitus (RHTN + DM group) (mean age 59.2 ± 7.8 years, 11 (32%) men, 24 h BP 157.8 ± 17.4/80.1 ± 12.4 mmHg, mean HbA1c 6.9 ± 1.4%) and 14 patients with impaired glucose tolerance (RHTN + IGT group) (mean age 54.0 ± 10.0 years, 3 (27%) men, 24 h BP 156.6 ± 14.3/89.5 ± 15.6 mmHg). ABPM and 24-h Holter monitoring with analysis of time and frequency domain-based HRV were performed in all patients.

Results:
Patients of three groups had a comparable systolic BP level and number of antihypertensive drugs. At the same time, patients of the RHTN + DM group was older and had significantly higher level of 24h- diastolic BP (DBP) than patients without disturbance of glucose metabolism (p = 0.001 for age, and p = 0.001 for DBP). Low frequency (LF), HRV parameters that mainly reflect sympathetic overactivity, was significantly higher in patient of the RHTN + DM group compared with the RHTN group (52 (38;61) vs 23.1 (15.0;61) respectively, p = 0.03). High frequency (HF), HRV parameters that mainly reflect parasympathetic overactivity, was significantly higher in patients with disturbance of glucose metabolism compared with patient without it (37 (30;50) for the RHTN + DM group and 31 (24;42) for the RHTN + IGT group vs 14,8 (8,6;24) for the RHTN group, p = 0,00/0,01, respectively). Other measured HRV parameters (mean NN, SDNN, SDNN-I, SDANN-I, r-MSSD, pNN50) were comparable in all groups (p > 0,05).

Conclusions:
The presence of diabetes mellitus in patients with RHTN is associated with greater autonomic imbalance in the form of an increase in both the sympathetic and parasympathetic tone of the autonomic nervous system, while IGT is characterized by a significant increase in the parasympathetic tonus only to the same extent as in diabetes mellitus.
FEATURES OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN PATIENTS WITH RESISTANT HYPERTENSION AND TYPE 2 DIABETES MELLITUS
Authors: Manukyan Musheg , Falkovskaya Alla , Mordovin Victor , Zyubanova Irina , Pekarskiy Stanislav , Lichikaki Valeriya , Shelemekhov Aleksey , Ryabova Tamara , Gusakova Anna 
Published: April 2021

Objective:
To compare the features of diastolic function in diabetic and non-diabetic patients with resistant hypertension (RHTN) by tissue doppler echocardiography (TDE).

Design and method:
The study included 36 patients with RHTN and type 2 diabetes mellitus (DM) (mean age 61,4 ± 6,4 years, 14 men, mean 24-hour (24 h) blood pressure (BP) (systolic/diastolic) 158,6 ± 15,2/79,8 ± 12,7mmHg, mean HbA1c 7,2 ± 1,2%) and 33 age- and sex-matched patients with RHTN without DM - mean age 58.6 ± 5.6 years, 19 men, mean 24 h BP 159.2 ± 13.8 / 89.6 ± 10.9 mmHg. Office BP and ABPM, diastolic function aassessment (according to 2016 ASE/EACVI recommendations) and BNP level determination were performed in all patients.

Results:
Patients of two groups had a comparable systolic BP level despite of a more number of antihypertensive drugs in patients with RHTN + DM (4.5 ± 1.0 vs 4.0 ± 1.0). However, the mean level of 24 hour pulse BP was significantly higher in diabetic patients with RHTN than in the group without diabetes (79,8 ± 12,7 vs 89,6 ± 10,9 mmHg, p = 0.001). There were no significantly differences in the frequency of diastolic dysfunction (93,9 % vs100 %, p = 0,225) between two groups. At the same time, patients with RHTN and DM had significantly lower mean value of è lat (6.2 ± 1.7 vs 7.3 ± 2 p = 0.018) and significantly higher value of both Sep E/e (14.6 ± 4, 9 vs 12.5 ± 4.1; p = 0.049), Lat E / è (12.2 ± 4.3 vs 9.4 ± 3.4; p = 0.006) and the average ratio E / è (13, 4 ± 4.4 vs 10.9 ± 3.6; p = 0.014) than in patients with RHTN without DM. The difference in BNP level in patients with RHTN with and without DM was no significant (115.6 ± 96.5 vs 71.9 ± 54.5 pg/mL, p = 0.105).

Conclusions:
Patients with RHTN with DM had more pronounced diastolic function impairment than those without DM, which contributes the higher cardiovascular risk in this group.
DOUBLE PRODUCT CAN BE REDUCED BY CPAP IN SLEEP APNEA SYNDROME PATIENTS
Authors: Yamashita Sumiyo , Hashimoto Tomomi , Takase Hiroyuki , Mizoguchi Tatsuya , Sugiura Tomonori , Ohte Nobuyuki , Dohi Yasuaki 
Published: April 2021

Objective:
Sleep apnea syndrome (SAS) is associated with increased cardiovascular mortality mediated by intermittent hypoxia, oxidative stress, endothelial dysfunction, and sympathetic nerve activation. Continuous positive airway pressure (CPAP) therapy has been established as the treatment of SAS. Double product (W-P = systolic blood pressure x heart rate) was reported to be a good predictor for cardiovascular disease. This study was designed to test whether CPAP could reduce W-P in SAS patients.

Design and method:
Patients diagnosed as SAS by polisomnography (PSG) examined in our hospital from April 2016 to April 2018 were enrolled (N = 67, male 78.3%, 60.4 ± 14.3 years). 11 cases of the subjects had examined PSG under wearing CPAP. W-P was calculated by casual blood pressure and heart rate measured on the PSG enforcement day. The association between W-P and parameters including age, sex, BMI, abdominal circumference, blood tests date, urine albumin, and various SAS indexes were examined.

Results:
Casual blood pressure and heart rate were 124.8 ± 19.2/79.1 ± 15.9 mmHg and 78.6 ± 13.4 bpm. W-P in the group with CPAP (8786.7 ± 1451.7) was significantly decreased compared with the group without CPAP (10127.7 ± 2826.5, p < 0.05). The urine protein level (R = 0.43, p < 0.05) and the plasma BNP level (R = 0.45, p < 0.005) were related to W-P. Multivariate regression analysis adjusted for known risk factors also indicated that the urine protein level was independent factor to determine elevated W-P (beta = 0.57, p < 0.05).

Conclusions:
W-P was related to a hypertensive target organ damage in SAS patient. The CPAP therapy can decrease W-P and may reduce the risk of future cardiovascular disease.
INTER-ARM BLOOD PRESSURE DIFFERENCE IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA
Authors: Shiina Kazuki , Tomiyama Hirofumi , Chikamori Taishiro 
Published: April 2021

Objective:
Obstructive sleep apnea (OSA) is an independent risk for cardiovascular disease. On the other hand, inter-arm systolic blood pressure difference (IAD) is noted as a marker for future cardiovascular events. However, underlying mechanisms of IAD has not been fully clarified. The present study was conducted to examine whether OSA is associated with IAD.

Design and method:
In 2645 consecutive patients aged over 30 {age: 56 ± 13 years old, mean apnea-hypopnea index (AHI): 39 ± 23 /h}, who visited sleep clinic to perform polysomnography in 2005–2017, blood pressure in both arms were measured simultaneously by oscillometric methods. The IAD was defined as absolute value of the systolic blood pressure difference in both arms.

Results:
In all included patients, patients with IAD over 10 mmHg were noted in 3.7%. When patients were divided into two groups: severe OSA (AHI over 30) group and mild to moderate OSA (AHI < 30) group, the prevalence rate of IAD over 10 mmHg were higher in severe OSA group than those in mild to moderate group (4.6% vs 2.8%, P < 0.05)(Figure). Multiple linear regression analysis demonstrated that AHI was an independent (P < 0.05) determinant of IAD, even after the adjustments of age, gender, body mass index, hypertension, and another variables.

Conclusions:
OSA may be a risk for IAD. The plausible explanation is that pathophysiological abnormalities related with OSA, such as the negative intrathoracic pressure, may affect IAD.
OBSTRUCTIVE SLEEP APNEA AS A RISK FACTOR OF INSULIN RESISTANCE IN NONDIABETIC PATIENTS
Authors: Macek Piotr , Michalek-Zrabkowska Monika , Martynowicz Helena , Gac Pawel , Wojakowska Anna , Mazur Grzegorz , Poreba Rafal 
Published: April 2021

Objective:
Obstructive sleep apnea (OSA) is a common sleep-breathing disorder characterised by collapsing of upper airway during sleep. The aim of this research was to assess relationship beetwen prevalence and severity of OSA and insulin resistance in nondiabetic individuals among patients with increased risk of OSA without diabetes mellitus.

Design and method:
Our study group estimated 102 individuals with suspected OSA, 71 men and 31 women, mean age 53.02 SD ± 12.37. We excluded individuals with diabetes mellitus and taking hypoglycemic drugs. All patients underwent standardized full night polysomnography in sleep laboratory to diagnose OSA. The Epworth Sleepiness Scale was used to assess daytime sleepiness. Serum insulin and glucose levels were analyzed by Laboratory. The HOMA index was calculated.

Results:
OSA was diagnosed in 85 patients. Mean AHI in whole study group was 25.78 ± 24.84, mean AHI in group with diagnosed OSA amount to 30.49 ± 24.64, mean AHI in nonapneic patients stands up to 2.23 ± 1.49. The difference was statistically significant p < 0.001. The oxygen desaturation index (ODI) in our study sample estimated about 25 (24.99 ± 23.25), the difference between group with OSA (mean ODI 29.31 ± 23.14) and group without OSA (mean ODI 3.38 ± 2.42) was statistically relevant p < 0.001. The statistically significant differences have occured between patients with (AHI = 15 or AHI > 15) and AHI < 15 taking into account level of insulin and the Homa index p < 0.05, but no statistically significant difference was observed between patients with (ESS = 9 or ESS > 9) and ESS < 9.

Conclusions:
Individuals with moderate to severe obstructive sleep apnea without diabetes mellitus have higher insulin resistance estimated with HOMA- IR index. This study revealed that there is no evidence if the evaluation of daytime sleepiness using Epworth Sleepiness Scale is a predicting factor of developing IR. Higher AHI and ODI levels beyond individuals from our study sample are independent risk factors for higher fasting insulin levels and higher HOMA index. Increased duration of desaturation time below 90% is an independent risk factor for higher fasting glucose levels.
EFFECT OF CONTINUOUS POSITIVE AIRWAY PRESSURE TREATMENT ON GLYCEMIC AND LIPID PROFILES IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Cattazzo Filippo , Pengo Martino F. , Giontella Alice , Soranna Davide , Karalliedde Janaka , Gnudi Luigi , Minuz Pietro , Lombardi Carolina , Parati Gianfranco , Fava Cristiano 
Published: April 2021

Objective:
Continuous Positive Airway Pressure (CPAP) is the main therapy for obstructive sleep apnea (OSA); nevertheless, uncertainty remains about the effectiveness of CPAP not only in controlling OSA-related hypertension, but also in improving the metabolic dysregulation that characterizes OSA patients. This meta-analysis of randomized controlled trials (RCTs) aimed to investigate whether CPAP, compared to other control treatments (sham CPAP, oral placebo or standard care), could improve glucose metabolism (fasting plasma glucose [FPG] or glycated haemoglobin or fasting plasma insulin [FPI] or homeostasis model assessment [HOMA] of insulin resistance [IR]) and/or lipid metabolism (total, HDL, LDL-cholesterol or triglycerides) in OSA patients.

Design and method:
Relevant papers were searched in three different databases (MEDLINE, EMBASE and Web of Science) from inception to 31st Dec 2018 through specific search terms and selection criteria.

Results:
From 2,289 articles, 26 RCTs were included. Regarding glycemic metabolism, neither FPG nor glycated haemoglobin were reduced by CPAP. However, patients on CPAP showed an improvement in insulin sensitivity, as witnessed by a significant reduction of FPI (Standardized difference in means [SDM] = 0.205 [95%CI, 0.07–0.339], p = 0.003) and HOMA IR (SDM = 0.176 [95%CI, 0.056–0.296], p = 0.004). In sensitivity analysis the favourable effects of CPAP were maintained in prediabetic/type 2 diabetic patients and in those presenting an apnoea-hypopnea index > 30 events/h. Regarding lipid metabolism, OSA patients treated with CPAP showed a significant reduction in total cholesterol (TC; SDM = 0.138 [95%CI, 0.034–0.242], p = 0.009). In subgroups analysis, greater adherence to CPAP along with severe nocturnal oxygen desaturations at baseline (SpO2-nadir < 77%) was associated with a significant decrease of TC. Furthermore, dividing the primary studies according to the median TC at baseline (198 mg/dL), the positive effects of CPAP were maintained only in those that presented a TC above the median. Conversely, CPAP did not modify triglycerides, HDL- and LDL-cholesterol.

Conclusions:
CPAP treatment significantly improves insulin sensitivity and reduces TC in OSA patients but with a low effect size. The effectiveness of CPAP is higher in patients with greater CPAP usage, and with a greater number of apnoeic events and oxygen desaturations at baseline. Concerning TC, patients presenting higher levels at baseline benefit the most from CPAP.