bluuebunny/crossref_metadata_2025_split huggingface dataset:
CIRCADIAN VARIABILITY AND CIRCADIAN HYPER AMPLITUDE TENSION AS A EARLY PREDICTIVE MARKER OF CHEMOTHERAPHY INDUCED CARDIOTOXICITY
Authors: Bhardwaj Shipra , Verma Narsingh , Bhatt M L B , Rastogi Madhup 
Published: April 2021

Objective:
Chemotherapeutic Medicines like Anthracycline antibiotics are effectively being used for breast cancer treatment in India. Despite of close clinical monitoring, the use of serological markers, such as troponins and BNP, and finally by using standard and novel imaging techniques like, nuclear imaging, echocardiograms etc some patients still develop severe left ventricular dysfunction. Also there are certain limitations of these techniques as these techniques can predict CV damages only after Cardiac function deterioration has become irreversible.

Design and method:
Therefore in this study Seven day continuous ambulatory blood pressure monitoring and CHAT (circadian hyper amplitude tension) have been evaluated to find out the variability in blood pressure and heart rate as a marker for cardiac function. Subjects who were fulfilling the inclusion criteria were enrolled for study. 24 hour /7days Ambulatory blood pressure monitoring, Left ventricular Ejection Fraction ratio (LVEF), Heart rate variability (HRV) and Cardiotoxicity Biomarkers viz Brain Natruitic peptide (BNP) and C- Reactive Protein (Hs CRP) and Troponin T were analyzed before receiving first Cycle of Antracycline Chemotherapy. All the parameters were repeated after first and Second Cycle of Chemotherapy.

Results:
Results shows significant increase in MESOR and Double Amplitude and Hyperbaric indexes of SBP, DBP and HR after Chemotherapy. Number of subjects diagonosed with CHAT (Circadian Hyper Amplitude Tension) increased after Chemotherapy while No Significant Changes were noted in LVEF (Left Ventricular ejection fraction) and serum biomarkers (i.e Troponin T, Hs CRP, and BNP). These data suggest that Anthracyclines Chemotheraphy treatment in Breast Cancer Subjects produces variations in 7 day circadian pattern of blood pressure and heart rate which can result into disturbed vascular events and thus are at greater risk of cardiovascular morbidity.

Conclusions:
long term monitoring of circadian pattern of blood pressure and heart rate in cancer patients will be an effective measure to prevent chemotherapy induced cardiotoxicity. Chronobiological screening parameters will be a novel approach in the context of chemotherapy induced cardiotoxity in order to identify or stratify risk in cancer patients that would potentially benefit from early cardio protective or other precautionary measures.
A COMPARATIVE STUDY OF AMBULATORY BLOOD PRESSURE LEVELS, TRAJECTORIES AND SHORT-TERM BLOOD PRESSURE VARIABILITY IN DIABETIC AND NON-DIABETIC PATIENTS WITH CKD STAGE 2, 3A, 3B AND 4
Authors: Loutradis Charalampos , Schoina Maria , Minopoulou Ioanna , Theodorakopoulou Marieta , Pyrgidis Nikolaos , Tzanis George , Papadopoulos Rafael , Intzevidou Eleni , Papagianni Aikaterini , Sarafidis Pantelis 
Published: April 2021

Objective:
Diabetic kidney disease is the leading cause of end-stage renal disease worldwide. Whether diabetes mellitus (DM) is an additional factor leading to elevated blood pressure (BP) levels and BP variability (BPV) in patients with chronic kidney disease (CKD) is unknown. This study aimed to compare ambulatory BP levels, BP trends and BPV in diabetic and non-diabetic patients with CKD.

Design and method:
This study included 48 diabetic and 48 non-diabetic adult patients (>18 years) with CKD (eGFR: < 90 and >15 mL/min/1.73m2), matched in a 1:1 ratio for age, sex and eGFR within each CKD stage (2, 3a, 3b and 4). All patients underwent 24-hour ambulatory BP measurement with the Mobil-O-Graph device. To evaluate the effect of diabetes and time on the trajectories of 24-hour BP levels, we performed two-way mixed ANOVA analysis for repeated measurements using hourly means. BPV was calculated using standard deviation (SD), weighted SD (wSD), coefficient of variation (CV) and average real variability (ARV) of BP during the 24-hour, day- and night-time periods.

Results:
In total, patients with DM had significantly higher 24-hour systolic BP (SBP) (132.13 ± 10.71 vs 124.16 ± 11.45 mmHg, p = 0.001) and similar 24-hour diastolic BP (DBP) (75.00 ± 8.43 vs 74.62 ± 6.86 mmHg, p = 0.809) compared to patients without DM. A similar trend was evident across all CKD stages. The effect of DM on BP trajectories during the recording period was significant for SBP [F = 18.766, p < 0.001, partial h2 = 0.261] and marginally significant for DBP [F = 3.782, p = 0.057, partial h2 = 0.067]. 24hour SBP SD, wSD and ARV (10.94 ± 2.75 vs 9.46 ± 2.10, p = 0.004), as well as 24hour DBP SD, wSD, CV and ARV (8.23 ± 2.10 vs 7.10 ± 1.32, p = 0.002) were significantly higher in diabetic compared to non-diabetic CKD patients.

Conclusions:
Ambulatory SBP levels are higher and SBP-profile is different in patients with diabetic compared to those with non-diabetic CKD. Systolic and diastolic BPV are also higher in diabetic subjects. These findings may signify a higher cardiovascular risk of diabetic CKD patients.
THE RELATIONSHIP BETWEEN BP-CONTROL, BP -VARIABILITY AND ANTIHYPERTENSIVE TREATMENT WITH THE LONG-TERM RISK OF CARDIOVASCULAR EVENT: LESSONS FROM THE ASCOT-LEGACY 20 YEAR FOLLOW-UP
Authors: Gupta Ajay , Whiteley William , Godec Thomas , Rostamian Somayeh , Mackay Judith , Whitehouse Andrew , Sever Peter 
Published: April 2021

Objective:
The long-term cardiovascular (CV) impact of a period of blood pressure (BP)-control and -variability (BPV) achieved on different BP-lowering treatments is unclear. The findings will inform the debate on BP-control targets, and explore the reason of legacy effects.

Design and method:
In the ASCOT-Legacy Study, 7092 hypertensive patients (assigned to either amlodipine- or atenolol-based treatment [3588 and 3504, respectively] and survived for the first 5.5 years [landmark period]), were evaluated using > 100,000 BP records to estimate 5-year mean SBP and standard deviation [SD] of all reported SBPs (denoting 5-year BPV). Patients were subsequently followed using electronic health records for up to16-years [IQR: 9.1–19.3 years] for the first occurrence of fatal/non-fatal heart failure, non-fatal myocardial infarction/fatal-coronary heart disease, total coronary events (TCE) and total CV events. Cox proportional hazards from the end of the landmark period were used to estimate the hazard ratio [HR] associated with mean BP-control, BPV, and assigned treatment after adjustments (see Table)

Results:
During the landmark period, those on amlodipine-based (vs. atenolol-based) treatment had lower mean SBP (-1.71 mm Hg, p < 0.001) and BPV (SD, -1.99, p < 0.001). Table 1 shows that increase in mean SBP and BPV was associated with a significantly increased risk of all 4 outcomes, with the magnitude of risk higher for each SD rise in the BPV vs. SD rise of mean SBP. Adjustment of mean BP for BPV and vice versa attenuated the magnitude of mean SBP but not that associated with BPV. Those on amlodipine-based (vs atenolol-based) treatment showed long-term beneficial legacy effect with a 7% significant reduction of CV events. However, this long-term treatment benefit (legacy effect) becomes insignificant after adjusting for BPV.
Those who have mean SBP > = 140 (vs SBP < 130) and BPV > = 15 mm Hg (vs < 10) continue to have a significant excess risk of TCE (45% [95%CI 1.28–1.63] and 62% [1.44–1.82], respectively) regardless of BP-treatment.

Conclusions:
Legacy effect of BP-lowering amlodipine-based treatment is primarily mediated by the reduction in BPV. Those with high mean SBP (>140) and/or high BPV (>15) and should be targeted to mitigate long-term CV risk.
PROGNOSTIC IMPORTANCE OF LOW VISIT-TO-VISIT SYSTOLIC BLOOD PRESSURE VARIABILITY IN HIGH-RISK HYPERTENSION
Authors: Del Pinto Rita , Pietropaoli Davide , Dobre Mirela , Ferri Claudio 
Published: April 2021

Objective:
Besides high blood pressure variability (BPV), low BPV was associated with adverse cardiovascular (CV) prognosis in selected high-risk patients. We explored this issue among high-risk, nondiabetic, nonstroke hypertensive adults from the Systolic Blood Pressure Intervention Trial (SPRINT).

Design and method:
Long-term SBPV (coefficient of variation, CoV %) was calculated on quarterly visits
from randomization until an outcome, excluding titration period and patients with missing visits. The primary outcome was any fatal/nonfatal CV event (myocardial infarction [MI]; acute coronary syndrome not resulting in MI; stroke, acute decompensated heart failure [HF], death from CV diseases [CVD]); secondary outcomes were all-cause mortality and the composite of CV events and mortality.
Multivariate (treatment arm, pulse pressure, age > = 75 years, gender, race, CVD, chronic kidney disease [CKD], smoke, n.BP medications) Cox proportional hazard models with penalized smoothing splines were used to explore the potential nonlinear relationship between the continuum of CoV and the HR (95%CI) for outcomes. Sensitivity analysis based on 1:1 propensity score matching (PSM) was performed.

Results:
The association of SBPV with CV events was J-shaped (lowest risk for CoV 5–10%), while that with all-cause mortality and with the composite outcome was linear. After multivariate adjustment, only low SBPV (CoV < 5%) was associated with CV events (HR 1.85, 95%CI 1.24–2.75), especially MI (HR 2.76, p < 0.001). High SBPV (CoV>10%) was associated with the risk of the composite outcome (HR 1.35, p = 0.037). PSM, matching 566 non-smoker, non-CVD/CKD participants having SBPV 5–10% with an equal number of patients having different SBPV, confirmed the inverse association of low SBPV with CV events (HR 3.33, p = 0.035).

Conclusions:
Nonlinear modeling indicates that low visit-to-visit SBPV has prognostic relevance in high-risk hypertensives from SPRINT. Unmeasured factors, like inflammatory and metabolic changes, might contribute to the observed results. We treated SBPV as a continuous variable calculated on 16 visits and included 60% of the SPRINT cohort, which might explain the limited analogy with earlier findings. Dedicated trials are needed to test these results and related implications.
HYPERTENSION MANAGEMENT DURING RAMADAN: RESULTS FROM THE NATIONAL TUNISIAN REGISTRY OF HYPERTENSION (NATURE HTN)
Authors: Chamtouri Ikram , Mejdoub Yousra , Hammami Rania , Amdouni Nesrine , Hamda Khaldoun Ben , Abdessalem Salem Ben , Zakhama Lilia , Maatouk Faouzi , Abid Leila 
Published: April 2021

Objective:
Ramadan fasting is a religious obligation practiced by Muslim population. No clear consensus and a paucity of evidence are published to guide patients and clinicians in management of hypertension during fasting Ramadan as well as fasting effects are not well studied. This study was performed to assess the impact of Ramadan fasting on hypertensive patients.

Design and method:
We performed a prospective multi centric Tunisian study from April, 15th to Mai, 15th 2019. We compared hypertensive patients who fasted Ramadan to those who did not fast. Life style, adherence to treatment and impact of fasting Ramadan were compared between two groups.

Results:
We analyzed 25609 patients with hypertension. Mean age was 64.4 ± 12.5 years old. More than 48% of patients were aged more than 65 years old. Female gender represented 54.7%. Prevalence of diabetes, obesity and coronary artery diseases were 39.5%, 27% and 18.5% respectively. Mean of systolic blood pressure (SBP) was 138.87 ± 19.62 mmHg. Prevalence of stroke, atrial fibrillation and hypertensive nephropathy were 6.6%, 7.4% and 33% respectively. Sixty four percent of patients fasted during Ramadan. In comparison to patients who did not fast during Ramadan, eating salty food was significantly lower in patients who fasted during Ramadan (42.1%vs. 60.1%; p < 0.001). There was an obvious change in the lifestyle activities and a significant increase of sport practice in patients who fasted Ramadan (19% vs. 7.5% p < 0.001). Anti-hypertensive drug adherence was significantly higher in patients who fasted Ramadan. A significant difference in blood pressure target was reported in hypertensive patients who fasted Ramadan (32.4% vs. 17.4%; p < 0.001).

Conclusions:
Ramadan Fasting could be beneficial in hypertensive patients to reach target blood pressure level provided that they should be carefully monitored during fasting and adhere to treatment and diet. Physician should adopt an educational program and avoid therapeutic inertia to prevent complications during fasting Ramadan.
EFFECT OF NIFEDIPINE GITS VERSUS RAMIPRIL ON HOME BLOOD PRESSURE VARIABILITY: PRELIMINARY RESULTS OF REVERENT RANDOMIZED TRIAL
Authors: Bilo Grzegorz , Kyriakoulis Konstantinos , Liu Chang -Yuan , Soranna Davide , Ceravolo Isabella , Cassago Silvia , Zhang Wei , Kollias Anastasios , Pengo Martino , Zambon Antonella , Wang Jiguang , Stergiou George S. , Parati Gianfranco 
Published: April 2021

Objective:
Blood pressure (BP) variability (BPV) was shown to independently predict adverse outcomes, making it a potential target for treatment. Preliminary data indicated a possible larger reduction of BPV with dihydropyridine calcium channel blockers (CCB). However, it is not clear whether different antihypertensive drug classes can differently affect BPV. Aim of REVERENT (Reducing blood pressure Variability in Essential hypertension with Ramipril vErsus Nifedipine GITS) Trial was to compare BPV changes after a period of treatment with a CCB (nifedipine GITS) or an ACEI (ramipril).

Design and method:
Patients with essential hypertension either treatment naïve or after washout from previous treatment were included. Participants were randomized according to a PROBE design to nifedipine GITS 30 mg or ramipril 10 mg in a single morning dose. We report preliminary data on day-to-day BPV (expressed as standard deviation; SD of all readings) estimated from home measurements (7 days; duplicate morning and evening measurements per day; AND UA-651BLE) at baseline and after 10 weeks of treatment.

Results:
153 patients successfully completed the study (table). Patient characteristics, home BP and BPV values at baseline and after 10-week treatment in all participants and separately in naïve (N = 121) and previously treated patients (N = 32) are reported (table). We observed no significant differences between treatment groups in the change (baseline to 10-week) of home BPV except for treatment naïve hypertensive patients in whom a small but significant difference in systolic BPV change was observed.

Conclusions:
These data, overall, did not show clear differences between nifedipine GITS and ramipril in reducing home BPV, except for treatment-naïve individuals in whom a small but significant difference in favour of the CCB was observed. The relevance of treatment induced BPV changes requires documentation in outcome studies.
THE EFFECT OF THYROID HORMONE NORMALIZATION ON AMBULATORY BLOOD PRESSURE MONITORING IN HYPOTHYROID PATIENTS
Authors: Colapietro Nina , Xodo Carlotta , Rovina Matteo , Grillo Andrea , Darin Anna , Giudici Fabiola , Carretta Renzo , Fabris Bruno , Bernardi Stella 
Published: April 2021

Objective:
It is well known that thyroid hormones regulate cardiovascular function. Thyroid disease is extremely common with a prevalence of 9–15% in the general population. The aim of our study was to assess the effects of thyroid hormones on the changes of blood pressure and pulse wave in a cohort of hypothyroid patients.

Design and method:
a total of 24 patients with severe hypothyroidism were enrolled in this study. Follow-up data are available for 11 patients, after normalization of their thyroid hormone profile. At baseline and after normalization of thyroid hormone profile, patients underwent an ABPM and an arterial tonometry. Data were analyzed with the statistical software R (version 3.0.3). In particular, patients were compared by Wilcoxon test for paired data, as they didn’t have normal gaussian distributions.

Results:
hypothyroid patients presented with overt thyroid disease (TSH 58,66 ± 47,50). Our preliminary data show that after euthyroidism restoration (TSH 2,21 ± 1,21), there weren’t any variations in global systolic and diastolic blood pressure, meanwhile their variability was reduced. In particular, this was observed for global sistolic variability (p value 0.05) and there was a decrease with borderline significance of global diastolic variability (p value 0.06). We did not observe any difference in terms of mean arterial pressure, PWV, and the other pulse wave analysis parameters

Conclusions:
our preliminary data suggest that euthyroidism restoration with levothyroxine can significantly reduce blood pressure variability in hypothyroid patients. This confirms the importance of thyroid hormones for blood pressure control.
EFFECTS OF GLYCOSYLATED HEMOGLOBIN LEVEL ON BLOOD PRESSURE VARIABILITY IN HYPERTENSIVE PATIENTS
Authors: Li Yuan , Guo Yuxuan , Hu Tao , Xia Ke 
Published: April 2021

Objective:
To investigate the effect of glycosylated hemoglobin (HbA1c) levels on blood pressure variability in hypertensive patients.

Design and method:
From September 2018 to April 2019, in the Xiangya Hospital of Central South University, 429 case of hypertensive patients with complete basic information, medical records, HbA1c measures and other biochemical indicators, as well as the 24-hour ambulatory blood pressure result were enroll in and divided into two groups (119 in the high HbA1c group with HbA1c more than 6.1 mg/dl and 310 in the normal HbA1c group with HbA1c less than 6.1 mg/dl). The blood variability, night drop rate, and fluctuations were compared between the two groups. Multivariate logistic regression analysis and Pearson correlation analysis were used to explore the relationship between HbA1c level and blood pressure variability.

Results:
In hypertensive patients, the level of systolic and diastolic pressure during 24-hour, daytime, nighttime and the proportion of non-dipping blood pressure in the high HbA1c group was higher than that in the normal HbA1c group (p < 0.05); There was no significant difference between the two groups in blood pressure load, variability, and nocturnal blood pressure drop rate (p > 0.05).Multivariate logistic regression analysis showed that nocturnal mean systolic blood pressure was a risk factor for increased HbA1c levels, with OR (95% CI) of 1.031 (1.017 to 1.045). Pearson correlation analysis implied that the level of HbA1c was positively correlated with the maximum, the minimum and the average value of 24-hour systolic pressure and mean systolic pressure of daytime and nighttime (r = 0.131, 0.129, 0.155, 0.151, 0.164; p < 0.05). Further analysis of grade 3 hypertensive patients, the high HbA1c group of had the higher value of night systolic pressure load and non-dipping blood pressure ratio. Multivariate logistic regression analysis showed that the mean nocturnal systolic pressure was a risk factor for elevated HbA1c levels, with OR (95% CI) being 3.774 (1.086 to 13.117).

Conclusions:
HbA1c is closely related to hypertension (especially systolic blood pressure). In the grade 3 hypertensive patients, the elevated HbA1c might increase the value of the nocturnal systolic blood pressure load.
METHOD OF PREVENTING CARDIOTOXIC EFFECT OF ANTITUMOR TREATMENT FOR BREAST CANCER
Authors: Natallia Natallia Kananchuk , Mitkovskaya Natalya Pavlovna Natalya , Mikulich Dmitriy Mikulich Dmitriy , Smirnov Sergey Smirnov Sergey , Gutkovskaya Ekaterinagutkov Ekaterina 
Published: April 2021

Objective:
In the Republic of Belarus cancer and cardiovascular disease are the leading causes of disability and mortality. Anthracyclines and radiation therapy have a high efficacy for the treatment of breast cancer. However, these treatments can also induce progressive cardiac remodelling as a late consequence of earlier myocyte damage, resulting in late cardiomyopathy.

Design and method:
97 women with breast cancer were included in the study. The patients received surgery, anthracycline chemotherapy and 47 women radiation therapy.
The patients were randomized into 3 groups: group 1- with antitumor treatment alone (54 cases), group 2 –patients with antitumor treatment who received carvedilol combined with valsartan and had no hypertension (24 cases); group 3- patients with antitumor treatment who received carvedilol combined with valsartan and had hypertension (19 cases).

Results:
After a full course of antitumor treatment left ventricular ejection fraction significantly decreased in group 1 (p < 0,05), which indicates deterioration of left ventricular systolic function. Group 1 also showed a significant increase in the sphericity index systole and diastole (p < 0,05), indicating the left ventricle remodeling during chemotherapy. This study revealed significant decrease of the ratio transmitral flows, which indicates deterioration of left ventricular diastolic function in group 1 (p < 0,05).
These changes were not revealed in groups 2 and 3.

Conclusions:
Chemotherapy with anthracyclines and radiation therapy cause left ventricle remodeling, deterioration of left ventricular systolic and diastolic functions.
The use of valsartan in combination with carvedilol can reduce acute and chronic cardiotoxicity of breast cancer chemotherapy.
MULTIPLE MYELOMA PATIENTS UNDERGOING CARFILZOMIB: VALIDATION OF A MANAGEMENT PROTOCOL FOR CARDIOVASCULAR RISK ASSESSMENT AND A NEW SCORE FOR EVENTS PREDICTION
Authors: Astarita Anna , Mingrone Giulia , Airale Lorenzo , Cesareo Marco , Vallelonga Fabrizio , Bruno Giulia , Leone Dario , Giordana Carlo , Rabbia Franco , Salvini Marco , Gay Francesca , Bringhen Sara , Veglio Franco , Milan Alberto 
Published: April 2021

Objective:
Cardiovascular adverse events (CVAEs) are closely related to Carfilzomib (CFZ) therapy in multiple myeloma (MM), however no validated management protocols are available. This perspective study investigated the effectiveness of the European Myeloma Network protocol (EMN) in cardiovascular risk assessment. A risk score to predict CVAEs was developed and the type and incidence of CVAEs were assessed.

Design and method:
116 MM patients scheduled for CFZ underwent a baseline evaluation including office and out-of-office blood pressure measurements, ECG, echocardiography (included GLS) and arterial stiffness estimation. The repeated evaluations every 3–6 months allow CVAEs detection.

Results:
During a median of 10.8 months of follow-up, 62 patients (53.4%) experienced one or more CVAEs: 17 (14.7%) had major CVEAs (41.2% arrhythmias, 23.5% acute ischemic cardiopathy as most frequent) and 45 (38.7%) had hypertensive CVAEs. 51.9% of CVAEs occurred within the first 3 months, with 30.9% grade 3 or greater in severity. At baseline the prevalence of uncontrolled blood pressure values (51.7%) and of subclinical organ damage, were substantial. Five baseline parameters have proved to be independent predictors for CVAEs: higher office systolic blood pressure (p = 0.003), higher 24-hours blood pressure variability (p = 0.004), left ventricular hypertrophy (p = 0.021), higher pulse wave velocity value (p = 0.002) and global longitudinal strain impairment (p = 0.033). The resulting CVAEs risk score allows to define a low- and high-risk group, obtaining a sensibility of 94% in detecting CVAEs in the high-risk (AUC 0.76).

Conclusions:
CFZ therapy is closely linked to CVAEs developing in MM patients. The application of the EMN protocol and the use of the CVAEs risk score might be useful to correctly estimate the cardiovascular risk profile and to identify the higher risk patients, enabling risk mitigation strategies.