bluuebunny/crossref_metadata_2025_split huggingface dataset:
COMPARISON OF WHITE COAT AND MASKED HYPERTENSION IN AN OUTPATIENT CARDIOLOGY POPULATION
Authors: Victor Andrew , Kumar Nikhil , Sheriff Rebecca , Kumar Naresh 
Published: April 2021

Abstract

Objective:
White coat hypertension and masked hypertension are two diagnoses that have opposite defining characteristics. White coat hypertension is defined as having an abnormally elevated blood pressure reading at the doctor's office however it is normal otherwise. Masked hypertension is defined as having a normal blood pressure reading in office while being hypertensive otherwise. White coat hypertension is well understood to be provoked by anxiety and stress when visiting a doctor's office. Masked hypertension is frequently under-diagnosed as patients with normal blood pressure readings likely do not have further investigations where masked hypertension can be identified. According to current literature, masked hypertension can be present in as much as 20% of the population. This study analyzes a sample of patients in an outpatient setting to determine the prevalence of such conditions in a typical Canadian population.

Design and method:
500 patients from a single outpatient cardiology practice were screened with a 24 hour ambulatory blood pressure monitor and results were analyzed the following day. Patients were diagnosed as having masked hypertension, white coat effect/hypertension or having normal blood pressures.

Results:
Of the 500 patients analyzed, 6.2% of the cohort was diagnosed as having masked hypertension. 23.6% of the cohort was diagnosed as having white coat effect. 60% of the screened patients were normotensive whereas the remaining 40% had some degree of hypertension, including masked hypertension.

Conclusions:
The data obtained from the analysis shows that in this typical segment of Canadian population, the diagnosis of masked hypertension is well below the current expected prevalence for this condition. This is noted as only 6% of the population was diagnosed as having masked hypertension. Almost 1/4 of the patients were appropriately shown to have white coat effect on their blood pressure recordings. The majority of the patients were identified as having normal blood pressure. The data suggests that masked hypertension may not be as significant a condition as previously suspected. White coat hypertension is especially prevalent and should be followed up on as white coat hypertension can sometimes turn into permanent hypertension.
UNSUPERVISED CLUSTER ANALYSIS OF HYPERTENSIVE INDIVIDUALS IDENTIFIES A ROBUST HIGH-RISK SUBGROUP
Authors: Vaura Felix , Salomaa Veikko , Kaaja Risto , Lahti Leo , Niiranen Teemu 
Published: April 2021

Abstract

Objective:
Despite hypertension being a crucial risk factor for cardiovascular disease, the current classification of hypertension does not reflect the heterogeneity or the wide variation in cardiovascular outcomes of hypertensive individuals. Our objective was therefore to identify subgroups of hypertensive individuals with distinct cardiovascular outcomes using data-driven cluster analysis.

Design and method:
To identify phenotypically distinct subgroups of hypertensive individuals, we performed unsupervised hierarchical clustering in participants with grade 2 hypertension from two population cohorts (FINRISK 2002 and 2012; n = 1971, mean age 59.8 years, 49% women) with up to 16 years of follow-up for incident cardiovascular events (n = 260). We defined hypertension as either systolic blood pressure (SBP) over 160 mmHg, diastolic blood pressure (DBP) over 100 mmHg, or use of antihypertensive medication. We computed the clusters separately for men and women based on eight factors related to hypertension and cardiovascular outcomes: mean arterial pressure (MAP; steady state pressure), pulse pressure (PP; pulsatile pressure), non-high-density lipoprotein cholesterol (non-HDLc), glycated hemoglobin (HbA1c), body-mass index (BMI), C-reactive protein (CRP), estimated glomerular filtration rate (eGFR), and alcohol consumption (rAlcohol). In analyses with men and women combined, we used Cox regression models adjusted for age and sex to assess the risk of cardiovascular outcomes between the resulting clusters.

Results:
We observed two comparable clusters for both sexes (Figure). These clusters had significantly different patient characteristics. Notably, mean HbA1c (5.5 ± 0.4 vs. 7.6 ± 0.9 in men; 5.5 ± 0.3 vs. 7.7 ± 0.8 in women) and BMI (29.0 ± 4.5 vs. 31.1 ± 4.3 in men; 29.4 ± 5.4 vs. 33.3 ± 5.5 in women) were higher in Cluster 2 than in Cluster 1. Individuals in Cluster 2 had 2.1-fold greater risk (95% CI 1.4–3.1, p < 0.001) of cardiovascular disease than individuals in Cluster 1.

Conclusions:
Using unsupervised hierarchical clustering, we stratified patients into two subgroups with differing disease progression and risk of complications. Substratification of hypertensive patients by low vs. high blood glucose and BMI could help to tailor and target early treatment to patients who would benefit most from it.
EFFECTS OF SMOKING ON CENTRAL BLOOD PRESSURE
Authors: Takase Hiroyuki , Machii Masashi , Nonaka Daishi , Ohno Kazuto , Takayama Shin , Sugiura Tomonori , Ohte Nobuyuki , Dohi Yasuaki 
Published: April 2021

Abstract

Objective:
Smoking is known to induce systemic vascular damage, leading to cardiovascular diseases. Recent studies demonstrated that central blood pressure has a greater impact on cardiovascular events than brachial blood pressure. We investigated effects of habitual smoking on central systolic blood pressure (CSBP) in the general population.

Design and method:
A total of 5630 subjects (male = 2622, 51.7 ± 12.0 year-old at baseline), who visited our hospital for a physical check-up at least twice during the last 10 years and underwent CSBP measurement at each visit, were enrolled, and effects of smoking on the average and yearly changes of CSBP (median follow-up 5 years) were analyzed. Brachial blood pressure (oscillometer) and radial artery pressure waveforms (tonometer) were recorded using an automated device, and the pressure corresponding to the second systolic peak of radial pressure waveforms was taken as CSBP (HEM-9000AI, Omron Healthcare, Kyoto). Hypertension was defined as brachial BP > = 140/90mmHg or the use of antihypertensive medications. A yearly change in CSBP was calculated in each subject by linear regression analysis using longitudinal data.

Results:
The average CSBP during the follow-up was higher in habitual smokers than in non-smokers when analyzed in normotensive (n = 4634, 109.1 ± 11.7 vs. 107.6 ± 12.8 mmHg, p < 0.001) and non-treated hypertensive subjects (n = 91, 150.7 ± 14.8 vs. 142.8 ± 16.7 mmHg, p < 0.05), whereas in hypertensive subjects under medication the average CSBP was lower in smokers than in non-smokers (n = 905, 124.6 ± 12.4 vs. 127.8 ± 13.6 mmHg, p < 0.01). Although smoking status did not affect yearly changes of CSBP in both normotensive (habitual smokers vs. non-smokers; 1.38 ± 6.00 vs. 1.44 ± 6.04 mmHg/year) and treated hypertensive subjects (-0.16 ± 7.08 vs. -0.66 ± 8.24 mmHg/year), the unfavorable effect of smoking on yearly increase of CSBP was found in non-treated hypertensive subjects (4.09 ± 15.1 vs. -0.53 ± 10.3 mmHg/year).

Conclusions:
Habitual smoking increases CSBP especially in subjects with hypertension, however, antihypertensive medications counteract the unfavorable effects of smoking on CSBP. These results imply a new pathway underlying the development of cardiovascular diseases in smokers. Unfavorable changes in the cardiovascular system caused by smoking may quite slowly progress that short period of observation in the present study could not have detected enhanced yearly increases of CSBP by smoking.
OPPORTUNISTIC SCREENING FOR HYPERTENSION VERSUS NATIONAL MULTISTAGE STRATIFIED HEALTH SURVEY: 2019 ISH/MMM IN GREECE VERSUS NATIONAL SURVEY EMENO
Authors: Stergiou George , Menti Ariadni , Papadakis Ioannis , Kalpourtzi Natasa , Doumas Michael , Kalaitzidis Rigas , Krokidis Xenophon , Chatzopoulos Michail , Marketou Maria , Gkaliagkousi Eugenia , Kallistratos Manolis , Katsi Vasiliki , Manios Efstathios , Papadopoulos Dimitrios , Sarafidis Pantelis , Touloumi Giota , Zebekakis Pantelis 
Published: April 2021

Abstract

Objective:
In 2019 the International Society of Hypertension screening project May Measurement Month (MMM) for hypertension collected data from 5,727 adults in 5 large cities in Greece. This analysis assessed the reliability of the MMM in reflecting the true prevalence and control of hypertension, by comparing its findings with those of a national health survey (National Morbidity and Risk Factors Survey EMENO 2013–16).

Design and method:
The 2019 MMM estimates were compared with those of EMENO 2013–16, in which a representative sample of 4,704 adults in Greece (> = 18 years) was selected. Both projects obtained blood pressure (BP) measurements and information on antihypertensive drug treatment. The prevalence of hypertension (BP > = 140/90 mmHg and/or use of antihypertensive drugs), awareness, treatment and control were compared.

Results:
In the MMM and EMENO participants’ mean age was in 52.7 ± 16.6 (SD) and 49.0 ± 18.5 years (p < 0.001) respectively, BMI 27.1 ± 5 and 28.1 ± 5.7 kg/m2 (p < 0.001) and men 46.5% and 48.5% (p < 0.001). The prevalence of hypertension was 41.6% in the MMM versus 40.5% in the EMENO (p = NS) (in men 51% vs. 44.6%, p < 0.001 and women 33.6% vs 36.6%, p < 0.05). Among hypertensive subjects, unaware were 21.3/33.6% in MMM/EMENO (p < 0.001), aware untreated 5.6/2.9%, treated uncontrolled 24.8/36.1% and treated controlled 48.3/27.5% (p < 0.001 for difference in control rate among treated subjects).

Conclusions:
These data suggest that the MMM opportunistic screening gave a reliable estimate of hypertension prevalence in Greece. However, the MMM largely underestimated the true prevalence of undiagnosed hypertension and overestimated the control rates.
HYPERTENSION AND POST-TRAUMATIC STRESS DISORDER: A STRONG ASSOCIATION IN AN AFRICAN POPULATION EXPOSED TO FREQUENT VIOLENCE
Authors: Bapolisi Achille , Maurage Pierre , Pappaccogli Marco , Georges Coralie , Petit Géraldine , Bisimwa Ghislain , De Timary Philippe , Persu Alexandre 
Published: April 2021

Abstract

Objective:
Our interdisciplinary team has recently documented a high prevalence of Post-Traumatic Stress Disorders (PTSD) in patients with treatment-resistant hypertension, altogether with emotion regulation deficits and a psychopathological expression. The objective of the current study was to look for the prevalence and nature of psychological abnormalities and PTSD in hypertensive patients from Bukavu, a city located in South-Kivu (Democratic Republic of Congo) and at war for the last 20 years.

Design and method:
We compared the levels of trauma exposure, psychiatric disorders including PTSD, emotion regulation strategies and social support of hypertensive patients vs. normotensive controls enrolled at the Internal Medicine Department of Bukavu General Hospital.

Results:
We compared 47 patients with hypertension (62% women, age: 41 ± 13 years, BMI: 24.5 ± 3.5 kg/m2, BP: 139 ± 12/83 ± 7 mmHg on a median of 1.7 antihypertensive drugs) with 55 normotensive subjects (73% women, age: 43 ± 14 years, BMI: 22.4 ± 3.5 kg/m2, BP: 122 ± 10/76 ± 8 mmHg) without cardiovascular or renal disease. Compared with normotensive controls, hypertensive patients had been exposed to more severe traumas (p < 0.001), more frequently due to physical aggression (p < 0.001), developed more frequent PTSDs (68% vs. 4%, p < 0.001), Major Depressive Disorders (60% vs. 27%, p = 0.001), and Alcohol Use Disorders (49% vs. 2%, p = 0.006). Hypertensive patients also presented with less adaptive emotion regulation strategies (more tendencies for anger in (p = 0.01), emotional suppression (p = 0.043), self-blame (p = 0.04), rumination (p = 0.012) and catastrophizing (p = 0.029) contrasting with less tendencies for acceptance (p = 0.017) and emotional reappraisal (p = 0.024)). Finally, hypertensive patients received less social support from companion, friends and the community (p < 0.05).

Conclusions:
Altogether, this study shows a striking association between trauma exposure, various psychopathological disorders, in particular PTSD and hypertension. Psychological and traumatic factors may be an important but underestimated contributor to the increasing prevalence of hypertension in Subsaharan African populations.
CONTROL OF HYPERTENSION BY ETHNICS IN COLOMBIA, A SECONDARY ANALYSIS OF COLOMBIA PURE STUDY
Authors: Parra-Gómez Laura Alejandra , Camacho Paul Anthony , Lopez-Lopez Jose Patricio , Gallo-Marín Grecia , Rangarajan Sumathy , Yusuf Salim , Lopez-Jaramillo Patricio 
Published: April 2021

Abstract

Objective:
Hypertension is the main cardiovascular risk factor and its prevalence varies among the countries according to their economic income and ethnicity. Colombia is a middle-high income country, with a variety of ethnic groups among the national territory. We aim to describe the prevalence and control of hypertension by ethnics in Colombia and its associated factors.

Design and method:
Prospective Urban Rural Epidemiology (PURE) study - Colombia is a prospective, population-based cohort study on persons aged 35–70 years. Ethnic group was assessed by phenotypic characters (skin, eyes and hair color) and self-definition of white, mestizo (mixture of white and indigenous) and afro-descendant. Descriptive and analytic analysis was performed, using STATA V.11.

Results:
4457 individuals were included, of those 73.5% (N = 3275) where mestizos, 14.1% (N = 626) white and 12% (N = 535) afro-descendant. The prevalence of hypertension was, (34.9%; CI 33.2–36.5) in mestizos, (37.3%; IC 33.5–41.1) in whites, and (43.5%; CI 39.3–47.7) in afro-descendant. The afro-descendant have the lower percentage of awareness (43.5%; CI 37.3–50.0) compared with (51.5%; CI 48.6–54.4) in mestizos and (52.3%; CI 45.9–58.7) in whites. The percentage of treatment was lower (43.1%; IC 36.9–49.6) in the afro-descendant in relation to (45.2%; CI 42.3–48.1) in mestizos and (47.2%; CI 40.8–53.6) in whites, but only (13.8%; CI 9.9–18.8) of afro-descendant have hypertension controlled in relation to (18%; CI 13.5–23.5) in whites and (17.9%; CI 15.7–20.2) in mestizos. On the univariate analysis we found that being afro-descendant is a risk factor to hypertension against being white 1.30 (CI 1.02–1.64). In the multivariate analysis it was maintained after adjustment by age, education level, socio-economic income, urban/rural and muscle strength 1.57 (IC 1.20–2.06).

Conclusions:
Afro-descendants have a higher risk of hypertension in Colombia. Moreover, the percentage of awareness, treatment and control of hypertension are lower in this ethnic group. The association with socio-economic or genetic factors remains to be determinate.
THE ASSOCIATION BETWEEN N-TERMINAL PRO-BRAIN NATRIURETIC PEPTIDE AND CARDIOVASCULAR DISEASE IS CONDITIONED BY PRESENCE OF INCREASED ARTERIAL STIFFNESS
Authors: Blicher Marie Kofoed , Olesen Thomas Bastholm , Pareek Manan , Rasmussen Susanne , Vishram-Nielsen Julie , Olsen Michael Hecht 
Published: April 2021

Abstract

Objective:
The aim of this study was to evaluate whether the cardiovascular risk associated with increased N-terminal pro-brain natriuretic peptide (NT-proBNP) is modified by arterial stiffness assessed as carotid to femoral pulse wave velocity (PWV) in apparently healthy individuals.

Design and method:
This was a population-based cohort study comprising of 1858 healthy subjects included in the 10-year follow-up of the MONItoring of trends and determinants in CArdiovascular disease (MONICA) study. The primary outcome was major adverse cardiovascular events (MACE) after 16 years of follow-up. MACE was defined as cardiovascular death, sudden death, heart failure, arrhythmia, myocardial infarction, chronic ischemic heart disease, cerebrovascular disease, peripheral or central arterial disease. The association between NT-proBNP and MACE was evaluated with Cox proportional-hazards regression stratified for presence of increased arterial stiffness (PWV > 12m/s) and adjusted for traditional risk factors for cardiovascular disease. NT-proBNP was evaluated both as a continuous variable (log transformed) and dichotomously using the 90th percentile as cut-off (110pg/ml) allowing for group-wise comparisons.

Results:
314 events were recorded during a median follow-up of 16.0 years (interquartile range: 14.7–16.0).
In multivariable regression with both log (NT-proBNP) and log (PWV) included in the model, we found that log (NT-proBNP) was associated with MACE: HR = 1.28 [1.13–1.45] (P < 0.001). There was a significant positive interaction between log (NT-proBNP) and log (PWW): HR = 1.53 [1.02–2.29] (P = 0.042). In subjects with PWV < 12m/s, log (NT-proBNP) was not associated with MACE: HR = 1.07 [0.91–1.26] (P = 0.429). In subjects with increased PWV, log (NT-proBNP) was associated with MACE, HR = 1.68 [1.39–2–04] (P < 0.001).
In multivariable categorical analysis using subjects with PWV < 12m/s and NT-proBNP < 110pg/ml as reference group we found: 1) Increased NT-proBNP without increased PWV was not associated with MACE: HR 0.92 [0.52–1.64] (P = 0.790). 2) Increased PWV and normal NT-proBNP showed borderline significant association with MACE HR 1.35 [0.99–1.84] (P = 0.052). 3) Increased PWV and increased NT-proBNP was associated with MACE: HR 3.21 [2.14–4.80] (P < 0.001).

Conclusions:
The association between increased NT-proBNP and MACE was positively modified by increased arterial stiffness. NT-proBNP was only associated with MACE in subjects with simultaneously increased arterial stiffness.
STUDY FOR BETTER BLOOD PRESSURE AND CARDIOVASCULAR RISK CONTROL IN A RURAL AREA OF RWANDA
Authors: Muggli Franco , Parati Gianfranco , Suter Paolo , Bianchetti Mario , Muvunyi Bienvenu , Ntaganda Evariste 
Published: April 2021

Abstract

Objective:
Also in Sub-Saharan Africa (SSA), the burden of hypertension and related cardiovascular (CV) complications is an health threat. Between October and November 2017 blood pressure (BP) was assessed in 372 subjects (>18y) at the Health Centre of Nyamyumba, a village of the rural District of Nyaruguru (Rwanda), where the MABAWA Association is active for more than 15 years as an integrated development project (www.mabawa.org). BP was determined by mean of oscillometric device. Systolic BP 140mmHg or more was detected in 136 subjects (68 females and 54 males). Hence we decided to perform a local study with the aim to exactly determine the prevalence of hypertension and to improve its control.

Design and method:
Phase 1 of the study aims to assess the incidence of hypertension and other CV risk factors. Phase 2 will focus the control of hypertension and associated CV risk factors with the aim of providing improved CV protection. The aim will be achieved by establishing a clinical consultation module which will be culturally and risk pattern adapted. The protocol of the project has the approval of the Rwanda National Ethic Committee and the endorsement of the World Hypertension League.
Subjects living in Nyamyumba will be visited at home by instructed health care providers and BP will be measured using a validated oscillometric device (OMRON HEM-7322U) according to a standardized protocol. Subjects with elevated BP will be asked to participate to the project. Those with confirmed hypertension will undergo a clinical examination including anthropometric measurements, electrocardiogram and laboratory test (blood count, creatinine, potassium, total-/, HDL-/ and LDL-cholesterol, triglyceride, HbA1c and microalbuminuria). Finally, they will be taught in a culturally adapted way to understand the risk associated with high BP and start appropriate life style and medical intervention.

Results:
expected for 2021

Conclusions:
High BP likely affects millions of people in Africa. It is the most important cause of heart disease and stroke. Only few SSA countries have a clear hypertension management strategy. Our purpose is to identify practical and feasible solution to improve control of BP and associated risk factors in Rwanda.
SUB-OPTIMAL HEALTH SYSTEM CAPACITY TO EFFECTIVELY MANAGE HYPERTENSION IN RURAL INDIA
Authors: Mohan Sailesh , Jarhyan Prashant , Sv Nikhil , Kumar Ganesh , Prabhakaran Dorairaj 
Published: April 2021

Abstract

Objective:
Despite the high burden of hypertension in rural India, limited information is available on the primary health system's capacity for its management. We aimed to determine the burden of hypertension and the health system's capacity to manage it in rural India.

Design and method:
We implemented a comprehensive diabetes and hypertension prevention and management program entitled “UDAY” in epidemiologically transitioning rural areas of North (Sonipat) and South (Vizag) India. Rural areas comprised a population of 200,000 and were being provided primary healthcare through six public primary healthcare facilities. A representative population based cross-sectional survey, using a multistage cluster random sampling technique among 6173 participants aged 30 years and above was done to determine the prevalence, awareness, treatment and control of hypertension. In addition, all the public primary healthcare facilities and all primary care providers (including private) were surveyed to assess the health system's capacity to manage hypertension according to the Indian Public Health Standards (IPHS) and other international/national standard guidelines. Data were obtained using an interviewer administered questionnaire, anthropometry, biosample collection, health facility survey and provider survey. Hypertension was measured using standard definitions and protocols.

Results:
The mean age was 48.0 (SD ± 12.7) years. Age-standardized prevalence of hypertension was 23.5% [95% CI: 22.5–24.6]. Among those with hypertension, awareness rate was 46.4% [43.8–49.0], treatment rate 35.3% [32.9–37.8] and control rate 26.3% [24.1–28.7]. Of all the public primary healthcare facilities (n = 6), none had the full sanctioned number of health staff, two did not have functional BP equipment, and no facility had all six classes of antihypertensive medicines available as recommended by the IPHS. Among 41 providers, only 9 (29%) reported using any standard guidelines for managing hypertension.

Conclusions:
Despite the high hypertension burden, public primary healthcare facilities relied upon by rural population, are inadequately equipped in terms of diagnostics, therapeutics, equipment and workforce to effectively manage hypertension. Health system strengthening along with providers’ training in guideline based hypertension management is imperative to improve management.