bluuebunny/crossref_metadata_2025_split huggingface dataset:
CONDUCTING AN RCT IN THE COVID-19 PANDEMIC: TARGETING VULNERABILITY TO SEASONAL AND ACUTE WEATHER CHANGES TO KEEP AUSTRALIANS WITH CARDIOVASCULAR DISEASE OUT OF HOSPITAL - THE RES
Authors: Moini Nasreen , Patel Sheila K. , Ramchand Jay , Hook Jody , Mcdonald Christine F. , Stewart Simon , Burrell Louise 
Published: April 2021

Objective:
Australia is experiencing ever more frequent/provocative weather and environmental challenges, including more extreme heatwaves and catastrophic bushfires. Concurrently, the annual challenge of wintry conditions to a population adapted to warmer conditions persists. Remarkably, however, there are no proven interventions to reduce seasonal challenges to the cardiovascular health of vulnerable individuals. In a world-first, the REsilience to Seasonal ILlness and Increased Emergency admissioNs CarE (RESILIENCE) Trial will test the hypothesis that an individually tailored, intervention program will reduce the risk of re-hospitalisation and mortality in vulnerable individuals.

Design and method:
300 adult patients admitted to the Austin Hospital in Melbourne, Australia with heart disease and multimorbidity will be recruited and randomised (1:1) to standard care (SC) or the RESILIENCE program (RP) over 12-months. Applying a COVID-19 adapted protocol, the RP group will have their bio-behavioural profile and home environment assessed post-discharge, to determine their vulnerability to seasonal events. An individualised case-management program, including a virtual clinic review with a dedicated RP cardiac nurse and physician, will be applied to promote seasonal resilience. The primary end-point is all-cause days alive out of hospital (DAOH) during 12-month follow-up.

Results:
With study recruitment delayed due to COVID-19 restrictions, virtual screening of medical in-patients has confirmed the need and potential for the RP. Of 630 potential participants identified over a 6 week period, 196 patients (31%) met eligibility criteria – 85 women and 79 men, mean (±SD) age 79 ± 11 years. Non-eligibility was largely due to non-chronic form of heart disease (34%), no comorbidity (23 %), and inability to give informed consent (15%).

Conclusions:
Preliminary data suggest that once commenced, we will rapidly recruit the requisite number of trial participants and depending on the results, we will be able to determine the cost-effectiveness of the RP to reduce seasonally-induced admissions and mortality.
YOUNG PATIENTS WITH TYPE 1 DIABETES MELLITUS WITHOUT CARDIOVASCULAR DISEASES ARE CHARACTERIZED BY HIGH FREQUENCY OF UNFAVOURABLE BLOOD PRESSURE PHENOTYPES
Authors: Medvedev D. , Safarova A. , Troitskaya E. , Stavtseva Y. , Efimova V. , Kobalava Z. 
Published: April 2021

Objective:
Type 1 diabetes mellitus (T1DM) remains a disease with high risk of cardiovascular disease (CVD). Hypertension (HTN) may be underdiagnosed in this population. Data on ABPM profile in patients with T1DM are lacking. The aim of the study was to assess the prevalence of different BP phenotypes and dipping patterns in patients with T1DM without known CVD.

Design and method:
Study group included 125 patients with T1DM aged 18–44 years: 60% males, 29.2 ± 7.6 years, median DM duration 6.9 years). 24-hour ABPM of brachial BP was performed with BPLab Vasotens. BP levels and phenotypes were classified according to 2018 ESC/ESH HTN guidelines. p < 0.05 was considered significant.

Results:
Mean office BP was 120.9 ± 14.6/77.3 ± 9.3mmHg, daytime–120.7 ± 10.4mmHg, nighttime-112.8 ± 11.4/72.6 ± 9.9mmHg, 24-h BP–119.5 ± 9.3/75.2 ± 8.7mmHg. High normal BP was registered in 9.6% HTN in 4.8%. According to ABPM measurement sustained HTN was confirmed in 4.8%, true normotension–in 72% and masked HTN was found in 23.2%. Isolated nocturnal HTN was revealed in 14.4%. Patients with sustained HTN compared to masked HTN had longer median duration of DM (14.8 vs 5.3 years) and higher median urine albumin-creatinine ratio (UACR) (33.4 vs 18.1 mg/g), p < 0.05. For further analysis patients with sustained and masked HTN were united into one group. Patients with HTN compared to normotensives were older (31.5 ± 7.9vs29.1 ± 8.2 years), higher median UACR (23.8 vs 14.5 mg/g) and received higher insulin doses (41.3vs28.6 U), p < 0.01. Median SBP diurnal index (DI) in normotensives was 10.3%, in hypertensives –6.2% (p < 0.05). Dipping profiles of SBP in patients with HTN and normotensives were as follows: 57.1% non-dippers, 20% night-peakers and 22.9% dippers vs 37.8% non-dippers and 62.2% dippers respectively (p < 0.05). Non-dipping profile (DI < 10%) compared to dipping profile was characterized by a trend to higher median UACR (27.9 vs 16.7 mg/g), longer median DM duration (7.2 vs 6.1 years), p = 0.05.

Conclusions:
Young patients with T1DM have high frequency of masked HTN and non-dipping profile. Worse BP phenotypes were associated with higher albuminuria. Routine ABPM may be recommended in this population in order to reveal high-risk patients and optimize the treatment.
The publication was prepared with the support of the RUDN University Program 5-100
DECREASED POSTURAL CHANGES OF CARDIO-ANKLE VASCULAR INDEX IN HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES MELLITUS - THE COUPLING REGISTRY
Authors: Hashizume Toshikazu , Kabutoya Tomoyuki , Hoshide Satoshi , Kario Kazuomi 
Published: April 2021

Objective:
Aim: The cardio-ankle vascular index (CAVI) has been proposed as noninvasive marker of arterial stiffness independent of blood pressure. Usually CAVI is measured in supine position to evaluate arterial stiffness in patients with hypertension (HT), but changes of CAVI have not been evaluated at standing position. We investigated the postural changes of CAVI (standing/supine ratio = CAVI ratio) in hypertensive patients with and without type 2 diabetes mellitus (T2DM), (the HTDM group and the HT group).

Methods:
A total of 1414 hypertensive patients (779 males; age, 67 ± 11 years) were enrolled from the Coupling registry that was designed to determine the impact of CAVI on cardiovascular events in a Japanese cohort. CAVI measurements were performed in supine and standing position after 3 minutes. We compared CAVI ratio between the HTDM group and the HT group.

Design and method:
Supine and standing CAVI in HTDM group (n = 546) was significantly higher than in the HT group (n = 868) (supine; 9.3 ± 1.3 vs. 8.7 ± 1.4, p < 0.001, standing; 11.6 ± 1.6 vs. 11.2 ± 1.8, p < 0.001), but CAVI ratio in the HTDM group was significantly smaller than that in the HT group (1.25 ± 0.14 vs. 1.30 ± 0.17, p < 0.001). Moreover, all patients were divided into quartiles of CAVI ratio. The proportion of T2DM in the 4th quartile group (the lowest CAVI ratio group) was superior to that between the 1st to 3rd quartile groups (49.7% vs. 34.9%) (p < 0.001). Multivariate logistic regression model for contributors of low CAVI ratio (?25th percentile; third quartile) identified T2DM [odds ratios (95% confidence interval): 1.55 (1.19–2.02), p = 0.001], older age [1.04 (1.02–1.05), p < 0.001], past cardiovascular disease [1.42 (1.04–1.92), p = 0.025], high heart rate [1.02 (1.01–1.03), p < 0.001], and body mass index over 25 [1.49 (1.15–1.93), p = 0.003] as independent factors.

Results:
These results suggest that postural changes of CAVI in hypertensive patients with T2DM might be decreased and lower CAVI ratio might be one of the important clinical markers of arterial stiffness
IN NEWLY DIAGNOSED PATIENTS WITH TYPE 2 DIABETES MELLITUS FLOW-MEDIATED DILATATION IS IMPAIRED AND ASSOCIATED INDEPENDENTLY WITH THE DIAGNOSIS OF DIABETES
Authors: Nikolaidou Barbara , Anyfanti Panagiota , Gavriilaki Eleni , Lazaridis Antonios , Triantafyllou Areti , Mastrogiannis Kontantinos , Zarifis Hippocrates , Douma Stella , Gkaliagkousi Eugenia 
Published: April 2021

Objective:
Type 2 diabetes mellitus (T2DM) is associated with endothelial dysfunction that mediates long-term complications. However, it is still unclear whether endothelial dysfunction is evident from the early stages of the disease. We aimed to investigate endothelial dysfunction in newly diagnosed and untreated patients with T2DM.

Design and method:
We enrolled consecutive patients diagnosed with T2DM no longer than 6 months ago, as well as age and gender matched controls. We recorded a detailed medical history, laboratory exams, office and 24-hour blood pressure (BP) levels and ASCVD (Atherosclerotic Cardiovascular Disease) risk. Endothelial dysfunction was estimated with the gold standard non-invasive method, flow mediated dilatation (FMD).

Results:
We studied 70 individuals aged 56 ± 10 years (29 T2DM and 41 controls). Only 11 T2DM patients were on treatment with metformin and was administered for less than 3 months. T2DM patients had increased office BP (p < 0001) and systolic BP at night (p = 0.037) compared to controls. FMD was also impaired in T2DM (5.3 ± 2.5% versus 7.7 ± 4.5%, p = 0.014). FMD showed a negative association only with T2DM (p = 0.021), day systolic BP (p = 0.031), and positively with HDL (p = 0.038). In the multivariate analysis, T2DM diagnosis was the only independent predictor of FMD.

Conclusions:
Our results suggest that endothelial dysfunction is evident in newly diagnosed T2DM patients and independently associated with diabetes diagnosis. BP and cholesterol levels were also associated with FMD highlighting the need for early intervention in factors associated with endothelial dysfunction from the early stages of the disease.
UPDATED META-ANALYSIS OF TRIALS ASSESSING THE CARDIOVASCULAR EFFICACY OF SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITORS AND GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONISTS IN BLACK PATIENTS
Authors: Patoulias Dimitrios , Imprialos Konstantinos , Stavropoulos Konstantinos , Katsimardou Alexandra , Toumpourleka Maria , Mavridou Maria , Papadopoulos Christodoulos , Doumas Michael 
Published: April 2021

Objective:
Recent, large observational studies have demonstrated that black patients feature increased odds for suffering from type 2 diabetes mellitus (T2DM), while they experience an increased risk for the development of T2DM related cardiovascular co-morbidities, cardiovascular and all-cause mortality, compared to Caucasian patients. Therefore, appropriate treatment strategies are urgently required, in order to ameliorate these health disparities.

Design and method:
We searched PubMed from its inception to 30 September 2020. We sought to determine the effect of sodium-glucose co-transporter 2 (SGLT-2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1RAs) on cardiovascular outcomes of interest in black patients utilizing data from the “hallmark” cardiovascular outcome trials, extracting data from sub-analyses reported across the selected studies. We set as primary cardiovascular efficacy outcome the composite of major adverse cardiovascular events (MACEs), including cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke, as defined across all the selected cardiovascular outcome trials.

Results:
SGLT-2 inhibitor treatment resulted in a non-significant decrease in the risk for MACEs, equal to 3% (RR = 0.97, 95% CI; 0.61 to 1.53, I2 = 30%). Similarly, GLP-1RA treatment produced a non-significant decrease in the risk for MACEs, equal to 7% (RR = 0.93, 95% CI; 0.69 to 1.25, I2 = 49%).

Conclusions:
Neither SGLT-2 inhibitors nor GLP-1RAs provide significant cardiovascular benefit in black patients, in terms of MACEs incidence. Future trials enrolling a larger proportion of black patients will clarify whether these observations are due to inadequate power of present CVOTs, or due to true racial disparities with the use of novel antidiabetics.
DIGITAL PATH OF THE HYPERTENSIVE PATIENT BEFORE A FIRST VISIT IN A TERTIARY CARE HYPERTENSION UNIT: A REAL-LIFE PILOT STUDY
Authors: Postel-Vinay Nicolas , Gardini Margherita , Nogueira Lima , Lorthoir Aurelien , Amar Laurence 
Published: April 2021

Objective:
There is growing evidence that the information and communication technologies (ICT) can improve health care access, patient education, compliance or outcomes, particularly in chronic diseases such as hypertension. In this e-Health context, our group validated, several years ago, a standardized patient self-questionnaire (Hy-Quest) and a software system to help patients manage Home Blood Pressure Measurement (Hy-Result software). But to what degree can patients use ICT before any face to face contact with a health care professional?

Design and method:
Between October 2017 and October 2018, 304 patients booked an appointment through the website of an ESH Excellence Centre, (www.centre-hypertension.org). Among them, 81% were first-visiting patients and 75% declared owning a sphygmomanometer. A simple, short E-mail was sent to a sample of 63 of them asking them to complete two tasks before attending their first appointment: ie. complete the Hy-Quest questionnaire (Hy-Q)and self-measure their blood pressure (BP), communicating their readings using the Hy-Result software (Hy-R).

Results:
Patients who responded were 56 (19-86) years old, had a mean office BP of 143/90 mmHg, a mean home BP of 137/84 mmHg under 1.8 antihypertensive drug/person. The mean duration of hypertension was 9 years (0–46). Attending their first visit, 54% of patients were able to successfully get through the digital path (27% completing Hy-Q+Hy-R; 25.4% Hy-Q only; 1.6% Hy-R only). Different problems (unattended or delayed visit, neither Hy-Q nor Hy-R completed, refusal to participate, computer problems) led the remaining 46% of patients to an unsuccessful digital path [Fig.].

Conclusions:
This pilot study shows that approximately half of the patients can contribute to preparing their first visit by going through a digital path starting from the online reservation, to filling in
Hy-Quest and communicating their self-measured BP readings using the Hy-Result software. This study confirms the interest for continuing with a larger study to confirm these percentages, to gain a better understanding of the reasons that prevent the patient from preparing online for his first visit and subsequently, optimize the steps of the hypertensive patient's digital path.
A CASE OF ACROMEGALY COMPLICATED BY PRIMARY ALDOSTERONISM DIAGNOSED DURING THE COURSE OF HEART FAILURE
Authors: Kimura Miwa , Yamashita Kaoru , Ishikawa Toru , Saitou Fumiko , Kimura Shihori , Takano Noriyoshi , Seki Yasufumi , Masui Kenta , Bokuda Kanako , Sasaki Nobukazu , Yatabe Midori , Yatabe Junichi , Watanabe Daisuke , Amano Kosaku , Sawada Tatsuo , Kawamata Takakazu , Morimoto Satoshi , Ichihara Atsuhiro 
Published: April 2021

Objective:
[Case] A 32-year-old male was admitted to the Department of Cardiology of our hospital complaining of weight gain, exertional chest pain, dyspnea, and palpitation. He was pointed out hypertension at the age of 18 and started taking oral antihypertensive drugs at the age of 27. Although his high blood pressure was well-controlled with calcium channel blocker, angiotensin receptor blocker, and alpha-and beta-blocker, he had stopped taking medicines since the age of 30. He was diagnosed as congestive heart failure due to hypertensive heart disease and was transferred to our department for the further examination of suspected secondary hypertension after his heart failure was improved.

Design and method:
Aldosterone / renin activity ratio (ARR) was >= 200, and primary aldosteronism (PA) was suspected. In consideration of his impaired cardiac function, a captopril challenge test and a rapid ACTH stimulation test were conducted. Since both were positive, the diagnosis of PA was made. Although computed tomography (CT) scans revealed a left adrenal adenoma, adrenal venous sampling showed overproductions of aldosterone from both adrenal glands, and thus he was treated with eplerenone, a mineral corticoid receptor blocker.

Results:
He was also suspected to have acromegaly because he had protruded chin, thickened lips, enlarged nose, and enlarged hands and feet. Brain magnetic resonance (MR) imaging detected a macroadenoma in the pituitary gland. Endocrinological examinations showed high concentrations of serum GH of 7.78 ng/ml and insulin-like growth factor 1 (IGF-1) of 824 ng/ml (+8.8SD), and 75 g oral glucose tolerance test (OGTT) showed a nadir of GH as 5.22 ng/ml, indicating a failure of suppression of GH. Acromegaly was diagnosed and transsphenoidal sinus pituitary surgery was done after monthly intramuscular injections of octreotide 20 mg four times.

Conclusions:
[Discussion] We experienced a case of acromegaly complicated by PA diagnosed during the course of heart failure. Both acromegaly and PA may be involved in the development of heart failure, however, the combination of acromegaly and PA is rare. We will discuss Its pathophysiology with a literature review.
ACTUAL PREVALENCE OF ENDOCRINE DISORDERS ASSOCIATED WITH HYPERTENSION IN ADULT HYPERTENSIVES REFERRED TO AN ENDOCRINE HYPERTENSION CLINIC
Authors: Chiodini I. , Aresta C. , Ripepi F. , Bilo G. , Pengo M.F. , Persani L. , Parati G. 
Published: April 2021

Abstract

Objective:
Background: Although some guidelines suggest the screening for endocrine hypertension (eHy) in subjects at risk, the eHy actual prevalence and its causes in adult hypertensives at risk of endocrine disorders are still unknown. The aim of the present study is to evaluate the eHy prevalence in a group of adults at risk for endocrine disorders.

Patients and Methods:
We consecutively screened patients with hypertension (n = 120), referred to our outpatient clinic for suspected endocrine hypertension due to the presence of: malignant Hy, grade 3 or resistant Hy, sudden new onset of Hy or its unexpected worsening, Hy onset before 30 years without family history or cardiovascular risk factors and Hy with disproportionate organ damage. We excluded all subjects with known secondary hypertension and/or taking drugs interfering with cortisol secretion. Eventually, 47 patients (35 F, mean age 53.5 ± 14.7) fulfilling the inclusion and exclusion criteria have been enrolled. In all patients we performed: cortisol and aldosterone secretion levels, thyroid function, insulin-like growth factor 1, calcium-phosphate metabolism, urinary fractionated metanephrines and 24 h ambulatory blood pressure (BP) monitoring.

Design and method:
We found 24 patients with eHy (9, 8, 3, 1, 1, 1, 1 with primary hyperaldosteronism, subclinical hypercortisolism, pheochromocytoma, acromegaly, hyperthyroidism, hyperparathyroidism and still uncertain cause, respectively). eHy patients had higher BP levels (mean BP 110.7 ± 15.3 vs 100.8 ± 7.3 mmHg, p < 0.005) and a more frequently altered dipping pattern (non dipping or rising patterns) (60% vs 9.1%), as compared to those with essential Hy, while age, body mass index (BMI), familiar history of hypertension, gender, prevalence of diabetes and of obesity were comparable between the two groups. The altered dipping pattern was found to be independently and directly associated with eHy (odd ratio, OR, 28.9, 95% confidence interval, 95%CI, 1.26–667.2, p = 0.035), and age (OR 1.15, 95%CI1.01–1.3, p = 0.031, but not with BMI, family history of Hy and mean BP levels.

Results:
Among patients at risk for eHy, about 50% of individuals are in fact affected by an endocrine disease potentially causing Hy. In Hy patients, the presence of an altered dipping pattern may be considered highly suggestive for the presence of an otherwise asymptomatic endocrine disorder.
PHYSIOLOGICAL AND BIOCHEMICAL STUDIES OF AGEING RAT HEART WITH EXPERIMENTAL ARTERIAL HYPERTENSION
Authors: Revnic Cristian Romeo , Sonea Cosmin , Revnic Flory 
Published: April 2021

Abstract

Objective:
It has been shown that DOCA-NaCl dependent arterial hypertension appears before any kidney lesions and there are proofs which suggest the role of NaCl retention or sensitivity to this in etiology of essential arterial hypertension The aim of our study was concerned with evaluation of physiological and biochemical parameters of rat heart with arterial hypertension experimentally induced with (DOCA) as well as to investigate the antioxidant potential and lipid metabolism parameters.

Design and method:
16 white male Wistar rats (180 + 20 g), aged 20 months old, fed on standard chew, have been divided into two groups of 8 rats each: group A Controls and group B treated with DOCA for 4 weeks with 2 (i.m.) injections /week) with 10 mg/kg b.w. and two weeks afterwards drinking water has been replaced by saline solution (0.9%NaCl + 0.2%KCl). Evaluation of physiological parameters: heart rate (H.R.), coronary flow (C.F.) and left ventricle systolic pressure (L.V.S.P.) of heart from controls and hypertensive rats has been achieved on isolated heart in Langendorff perfusion system with Krebs Hanseleit bicarbonate buffer at a constant pressure. Oxidative stress has been imposed by applying a 45 minutes ischemia which has been followed by 120 minutes reperfusion. Biochemical studies of antioxidant system have been performed on plasma and left ventricle tissue by evaluating: SOD, GGT, Lipid peroxides, CK, LDH, Cholesterol, LDL, HDL with standard biochemical methods.

Results:
Our data have pointed out that for about one hour (C.F.) presented higher values as well as (LVSP) and (H.R). in DOCA treated rats, above the values from Controls. These data account for an intense cardiac activity imposed by the onset of arterial hypertension following DOCA treatment. A reduction in GGT in myocardium due to hypoxia generated by cardiac insufficiency following DOCA treatment is accompanied by a reduction of antioxidant potential and both HDL and CK markers of myocardial lesion exhibited higher values.

Conclusions:
Following 4 weeks DOCA treatment a pathological state is achieved similar with Essential arterial hypertension found in humans, accounted for by the following changes: an intensification of contractile activity, cardiac hypertrophy and the increase in lipid peroxides level, LDH and CK activity.
EFFECTS OF ESAXERENONE ON BLOOD PRESSURE, BAPWV AND CAROTID ARTERIAL ELASTICITY IN ESSENTIAL HYPERTENSIVE PATIENTS
Authors: Yamagishi Toshio 
Published: April 2021

Abstract

Objective:
Esaxerenone is a novel nonsteroidal mineralocorticoid receptor blocker being developed for hypertension treatment. We investigated the effects of esaxerenone on blood pressure (BP), baPWV, and carotid arterial intima-media thickness (IMT) and elasticity in essential hypertension.

Design and method:
Forty hypertensive patients (twenty-five males, aged 67 years) were assigned to receive esaxerenone (2.5 mg once daily) for 12 weeks. The 20 patients were added on previous drugs with esaxerenone and for 20 patients currently medicated with eplerenone, esaxerenone was substituted for that. Changes in home BP, estimated glomerular filtration rate (eGFR), baPWV, central blood pressure (cSBP) were evaluated. The carotid arterial IMT and elastic modulus in the circumferential direction (Eq) were simultaneously measured by the high-resolution Doppler technique, “Phased Tracking Method”.

Results:
Esaxerenone reduced home BP (systolic/diastolic, 141.1 ± 13.2/79.6 ± 11.4 to 130.8 ± 11.0/74.6 ± 11.1mmHg), heart rate (72.7 ± 11.9 to 67.8 ± 8.1 bpm), cSBP (146.1 ± 27.7 to 136.5 ± 26.4 mmHg), baPWV (17245 ± 323 to 1595 ± 287 cm/sec) significantly (p < 0.05) after 12weeks in both groups. The significant reduction of home BP (systolic/diastolic,) in group A and B were seen (-14.0 ± 4.7/-5.4 ± 2.6 mmHg and -6.2 ± 2.5/-4.5 ± 2.2 mmHg, respectively). There were no significant changes in eGFR (67.8 ± 23.0 to 67.4 ± 19.3 mL/min/1.73m2) nor serum potassium (3.9 ± 0.7 to 4.1 ± 0.6mEq/L). Eq (720 ± 34 to 400 ± 44) was reduced significantly without changes in IMT. The histogram analysis of the Eq data revealed the drug decreased harder components of the elasticity distribution, suggesting improvement of endothelial dysfunction.

Conclusions:
These data demonstrate that once-daily esaxerenone provides potent antihypertensive and antiatherosclerotic effects.