bluuebunny/crossref_metadata_2025_split huggingface dataset:
SLEEP BLOOD PRESSURE AND SLEEP BLOOD PRESSURE SURGE IN PATIENTS WITH SLEEP DISORDERED BREATHING AND HEART FAILURE
Authors: Mizuno Hiroyuki , Hoshide Satoshi , Kario Kazuomi 
Published: April 2021

Objective:
In patients with sleep disordered breathing (SDB), sleep apnea episode causes an acute transient blood pressure (BP) elevation (ie, BP surge). The SOMNO touch, a new full polysomnography device which can measure beat-to-beat BP by pulse transit time (PTT), can reveal whole of sleep BP and sleep BP surge non-invasively.
The aim of this study was to evaluate whether sleep BP and sleep BP surge in HF patients were higher or not compared with those in non-HF patients.

Design and method:
We enrolled 24 patients with SDB. Heart failure patients were defined as patients with past history of congestive heart failure. Office BP was the average of three consecutive brachial BP (Oscillometric). Full polysomnography and pulse transit time sleep BP (beat-to-beat BP) were measured by SOMNO touch.

Results:
We analyzed 13 HF patients (age 72.2 ± 14.2, BMI 24.1 ± 5.3) and 11 non-HF patients (age 66.6 ± 9.9, BMI 25.8 ± 3.4). There was no significant difference in age and BMI between the two groups. Left ventricular ejection fraction (47.8 ± 13.5 vs. 64.3 ± 13.4, p = 0.007) was significantly lower, and NT-proBNP (2971.7 (1821.0 to 4848.4) vs. 697.9 (307.5 to 1584.1), p = 0.002) was significantly higher in the HF group compared with the non-HF group. Concerning SDB, there was no significant difference in obstructive apnea index (AI) (10.2 ± 7.9 vs. 10.4 ± 5.1, p = 0.956), central AI (5.5 ± 8.7 vs. 5.6 ± 6.0, p = 0,965), apnea hypopnea index (AHI) (22.5 ± 15.9 vs. 23.2 ± 11.0, p = 0.904), and the lowest oxygen saturation (84.5 ± 6.4 vs. 84.2 ± 4.0, p = 0.874) between the two groups.
Office systolic BP (SBP) (111.0 ± 19.8 vs. 106.8 ± 13.6, p = 0.560) was similar. Concerning PTT BP, the highest sleep SBP (138.9 ± 10.2 vs. 132.5 ± 14.7, p = 0.217) and the largest increase in sleep SBP (20.6 ± 9.2 vs. 29.1 ± 15.6, p = 0.137) were similar, whereas mean sleep SBP (116.7 ± 10.0 vs. 105.3 ± 8.0, p = 0.006) and the lowest sleep SBP (104.3 ± 13.3 vs. 87.2 ± 13.7, p = 0.008) were significantly higher in the HF group compared with the non-HF group.

Conclusions:
The highest sleep SBP and the largest sleep BP surge were similar, whereas the mean sleep SBP and the minimum sleep SBP were significantly higher in the HF group compared with those in the non-HF group.
A HYPERTENSIVE RESPONSE TO EXERCISE IS ASSOCIATED WITH ALTERED CARDIAC STRUCTURE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Moore Myles , Climie Rachel , Otahal Petr , Sharman James , Schultz Martin 
Published: April 2021

Objective:
A hypertensive response to exercise (HRE) is a risk factor for cardiovascular disease and may reveal high blood pressure (BP) not detected by standard assessment at rest. Structural cardiac disease may underlie the association between HRE and cardiovascular risk, although this has not been fully elucidated. This study aimed to assess the relationship between HRE and cardiac structure via systematic review and meta-analysis of previously published literature.

Design and method:
Three online databases were searched from inception to July 2019 for studies that included associations between exercise BP and cardiac structural variables including left ventricular mass index (LVMI), relative wall thickness (RWT) and left atrial (LA) diameter. Pooled correlations between exercise BP and cardiac variables were calculated using random effects. Pooled mean differences (random effects) in LVMI, RWT and LA size between individuals with and without HRE were also calculated. Univariable meta-regressions were performed to assess differences in pooled mean differences by resting hypertension status, health status, exercise intensity at the time BP was measured and exercise modality.

Results:
A total of 47 studies with 23,090 participants (aged 44 ± 4 years; 62% male) were included. Exercise systolic BP had a moderate association with LVMI (22 studies, pooled r = 0.4, p < 0.001) and RWT (3 studies, r = 0.4, p < 0.001). On average, those with HRE had higher LVMI (24 studies, pooled mean difference 9.34 ± 1.7 g/m2; p < 0.001), RWT (13 studies, 0.02 ± 0.004, p < 0.001) and LA diameter (10 studies, 1.97 ± 0.49 mm, p < 0.001) compared to those without HRE. Meta-regression for pooled mean difference in LVMI indicated results were similar irrespective of resting hypertension status, health status and exercise intensity at BP measurement, but was greater among studies using treadmill testing (n = 18) compared to cycling (n = 6, p = 0.003). Meta-regression for pooled mean difference in RWT were similar irrespective of resting hypertension status, health status and test modality, but were greater during submaximal compared to peak intensity exercise (p = 0.02).

Conclusions:
HRE is associated with altered cardiac structure, including increased LVMI, RWT and LA diameter. Whilst associations varied across exercise intensity and testing modality, these results highlight potential mechanisms underlying cardiovascular risk associated with HRE.
HIGHER PREVALENCE OF EXAGGERATED EXERCISE BLOOD PRESSURE IN PEOPLE WITH TYPE 2 DIABETES CAN BE EXPLAINED BY CARDIOVASCULAR RISK FACTORS: THE EXERCISE STRESS TEST COLLABORATION (EXERTION)
Authors: Schultz Martin , Kovacevic Ann-Marie , Otahal Petr , Roberts-Thomson Philip , Stanton Tony , Wahi Sudhir , La Gerche Andre , Hare James , Selvanayagam Joseph , Maiorana Andrew , Venn Alison , Sharman James 
Published: April 2021

Objective:
Exaggerated exercise blood pressure (EEBP) during clinical exercise testing is associated with elevated cardiovascular disease (CVD) risk. Type-2 diabetes (T2DM) is thought to be associated with higher prevalence of EEBP, but this has never been determined in a large clinical population, which was the aim of this study.

Design and method:
Clinical exercise test records were analysed from 15,994 people (mean age 53 ± 13 years, 59% male) referred for the Bruce treadmill protocol (stages 1–4 + peak) at 4 Australian public hospitals. Exercise records including blood pressure (BP) were linked to administrative datasets (hospital and emergency admissions) to define clinical characteristics and classify prior history of T2DM (n = 1,345) vs. no-T2DM (n = 14,649). EEBP was defined > 90th centile for each exercise stage. Exercise BP was regressed on T2DM history, adjusted to consider CVD risk factors.

Results:
EEBP prevalence (stage-1: + 4.1%; stage-2: + 4.4%; stage-3: + 4.9%; stage-4: + 4.8%; peak: + 1.9%, P < 0.05 respectively) and exercise systolic BP (stage-1: + 4.25, stage-2: + 4.52, stage-3: + 4.43, stage-4: + 3.08, peak: + 0.75 mmHg, P < 0.05 respectively) were higher across all exercise stages in T2DM vs. no-T2DM. However, all differences were abolished by adjustment for either: age, sex, peak workload, CVD history, or pre-exercise BP. Restricting analyses to those with normal pre-exercise BP (<140/90 or < 130/90 mmHg) revealed no differences in exercise BP or EEBP prevalence between T2DM and no-T2DM.

Conclusions:
This is the first study to confirm higher prevalence of EEBP in T2DM, but this is explained by accompanying CVD risk factors. Identification of EEBP should prompt aggressive CVD risk factor modification in T2DM.
HOW TO MAXIMIZE POST-EXERCISE HYPOTENSION? IS A BOUT OF HIGH INTENSITY EXERCISE BETTER THAN A BOUT OF MODERATE CONTINUOUS EXERCISE?
Authors: Marçal Isabela Roque , Goessler Karla F. , Buys Roselin , Casonatto Juliano , Ciolac Emmanuel G. , Cornelissen Véronique A. 
Published: April 2021

Objective:
Post-exercise hypotension (PEH) is an important tool in the daily management of patients with hypertension. Varying the exercise parameters is likely to change the blood pressure (BP) response following a bout of exercise. In recent years, high-intensity interval exercise (HIIE) has gained significant popularity in exercise-based prevention and rehabilitation of clinical populations. Yet, to date, it is not known whether a single session of HIIE maximizes PEH more than a bout of moderate-intensity continuous exercise (MICE). We aimed to compare the effect of HIIE vs. MICE on PEH by means of a systematic review and meta-analysis.

Design and method:
A systematic search in the electronic databases MEDLINE, Embase, and SPORTDiscus was conducted from the earliest date available until February 24, 2020. Randomized clinical trials comparing the transient effect of a single bout of HIIE to MICE on office and/or ambulatory BP in humans (> 18 years) were included. Data were pooled using random-effects models with summary data reported as weighted means and 95% confidence interval (CIs).

Results:
Data from 14 trials were included, involving 18 comparisons between HIIE and MICE and 276 (193 males) participants. The immediate effects, measured as office BP at 30- and 60-minutes post-exercise, were similar for a bout of HIIE and MICE (p > 0.05 for systolic and diastolic BP). However, HIIE elicited a more pronounced BP reduction than MICE [(-5.3 mmHg (-7.3 to -3.3)/ -1.63 mmHg (-3.00 to -0.26)] during the subsequent hours of ambulatory daytime monitoring. No differences were observed for ambulatory nighttime BP (p > 0.05).

Conclusions:
HIIE promoted a larger PEH than MICE on ambulatory daytime BP. However, the number of studies was small, patients were mostly young to middle-aged individuals and only a few studies included patients with hypertension. Therefore, there is a need for studies that involve older individuals with hypertension and use ambulatory BP monitoring to confirm HIIE's superiority as a safe BP lowering intervention in today's clinical practice.
EFFECTS OF FIXED DOSE COMBINATION AZILSARTAN MEDOXOMIL/CHLORTALIDONE ON THE CENTRAL BP IN HYPERTENSIVE PATIENTS WITH HFPEF
Authors: Gudieva Khyadi , Medovschikov Vadim , Eshniyazov Nurlan , Kravchenko Alina , Safarova Ayten , Kobalava Zhanna 
Published: April 2021

Objective:
We aimed to study the effects of a fixed AZL-M/CLD combination on central BP in patients with AH and HFpEF.

Design and method:
This 12-week study evaluated effects of a fixed-dose combination AZL-M/CLD (n = 30) vs non-fixed-dose combinations of iACE/ARB and thiazide/ thiazide-like diuretics (n = 30) on central BP (cBP), arterial stiffness and pulse wave velocity (PWV) in patients with AH and HFpEF. Patients with EF < 50%, significant valvular disease, ACS, permanent AF, neoplasm, eGFR < 30 ml/min/1.73 m2, BMI > 40 kg/m2 were not included. The initial doses could be titrated to meet BP targets during weeks 4 to 12: in 1 group to 40/25 mg, in the control group up to the maximum daily dose.

Results:
The mean age in the study group was 67 ± 11 years (M ± SD), 36% (10 /30) males, SBP/DBP 140 ± 12/84 ± 9 mmHg (M ± SD), DM 30% (9/30), obesity 61,2% (18/30), paroxysmal AF 20% (6/30), CKD 57% (16/30), eGFR 63 [44.1;72.8]. In the control group: 66 ± 10 years (M ± SD), 40% (12 /30) males, SBP/DBP was 141 ± 11/82 ± 10 mmHg (M ± SD), DM 30% (9/30), obesity 55 % (16/30), paroxysmal AF 26% (7/30), CKD 61% (18/30), eGFR 65 [46.3;76.1]. During observation, the level of pBP in the study group decreased from 140 ± 12/84 ± 9 mmHg to 120 ± 15/71 ± 12 mmHg (p < 0.05); cBP from 131 ± 15/84 ± 10 to 117 ± 14/78 ± 9 mmHg (p < 0.05) and PWV from 11.7 (9.4;13.4) to 10.1 (8.7;12.3) m/s (p < 0.05). The levels of pBP in the control group decreased from 141 ± 11/82 ± 11 mmHg to 128 ± 16/79 ± 9 mmHg (p < 0.05), cBP from 132 ± 14/85 ± 9 to 127 ± 16/82 ± 13 mmHg (p < 0.05), PWV from 11.5 (9.5; 13.6) to 10.2 (9.2.;12.8) m/s p < 0.05. The t-test indicated significant differences between this two groups in peripheral BP, cBP and PWV (p = 0.004, p < 0.01, p < 0,05 respectively).

Conclusions:
There is significant antihypertensive effect and reduction of arterial stiffness in patients with AH and HFpEF treated with AZL-M/CLD.
HYPERTENSION CONTROL IN RUSSIAN RESIDENTS WITH MULTICOMPONENT ANTIHYPERTENSIVE THERAPY
Authors: Tolkunova Kristina , Rotar Oxana , Alieva Asiyat , Boiarinova Maria , Erina Anastasia , Solntsev Vladislav , Konradi Aleksandra 
Published: April 2021

Objective:
To assess the hypertension control depending on the number of antihypertensive drugs in Russian sampling in terms of MMM19 screening.

Design and method:
An opportunistic cross-sectional survey of volunteers the age of 18 from 21 Russian Regions (n = 5274) was performed in terms of international campaign MMM19. 1,834 of the residents were men (34.8%). 49.2% of the respondents were younger than 25 years, therefore, considering significant differences in age, further analysis of the data was performed among participants over 25 years (n = 2681). The questionnaire was being completed on presence of diabetes mellitus, history of cardiovascular complications, smoking and drinking. Information regarding intake and omission of antihypertensive medication were clarified. Blood pressure (BP) was measured three times with automated and manual sphygmomanometers.

Results:
Average age of the participants was 49.3 ± 16.2 years (17–96 years old). 51.5% of the participants had history of hypertension (n = 1343), while 73.6% (n = 989) received antihypertensive therapy. 44.8% of patients (n = 444) achieved target BP of less than 140/90 mm Hg, and only 20.5% (n = 203) - less than 130/80 mm Hg. The percentage of achieving the target BP depending on medication number is illustrated in Figure 1.

Conclusions:
In Russian screening sample older 25 years the level of hypertension control remains low, especially when the criteria of target blood pressure is tightened. Half of patients achieved blood pressure level of less than 140/90 mm Hg and only one fifth of the participants achieved blood pressure level of less than 130/80 mm Hg. Despite multicomponent therapy, only 20–30% of patients in this category achieved target blood pressure level even they were less likely to miss medication.
IMPLEMENTATION OF URINARY DRUG DETECTION FOR ASSESSMENT OF ADHERENCE TO ANTIHYPERTENSIVE DRUGS IN DAY-TO-DAY CARE IN A TERTIARY HYPERTENSION CLINIC IN PARIS AREA
Authors: Kably Benjamin , Billaud Eliane M , Belmihoub Ines , Madjalian Anne-Marie , Lorthioir Aurélien , Amar Laurence , Boutouyrie Pierre , Azizi Michel 
Published: April 2021

Objective:
Non-adherence to antihypertensive drug (AHD) therapy is a major health challenge contributing to uncontrolled/resistant hypertension and major adverse cardiovascular events. We report here the results of implementation of AHD screening in spot urine samples in day-to-day care of patients with severe resistant hypertension (RHTN) in a tertiary hypertension clinic of Paris area.

Design and method:
Urine AHD screening was performed using ultrahigh performance LC-MS/MS in patients with apparent RHTN (office BP>140/90 mmHg despite 3 AHD including a diuretic) when poor adherence was clinically suspected. Full adherence (FA) was defined as the presence of all prescribed AHD, and partial adherence (PA) or complete nonadherence (NA) as the absence of at least one or all prescribed AHD, respectively.

Results:
We included 119 patients with RHTN (53.8% men), aged 54.9 years, with office SBP/DBP of 168/96 mmHg despite prescription of a median of 4.0 AHD. There were 58 (48.7%) FA patients, 41 (34.5%) PA patients, and 20 (16.8%) NA patients. In decreasing order of prescription, we detected ARB/ACEI in 60.4% of the patients (n = 58/96), CCB in 55.4% (n = 46/80), thiazides in 50.0% (n = 40/80), alpha-blockers in 66.7% (n = 34/51), beta-blockers in 72.9% (n = 35/48), spironolactone in 51.1% (n = 23/45), centrally acting AHD in 78.0% (32/41), furosemide in 76.2% (16/21) and amiloride in 81.8% of the patients (n = 9/11). Poor adherence (PA+NA, n = 61) was associated with younger age (53 vs. 58 yrs, p = 0.09), female sex (54% vs. 38%, p = 0.08), higher SBP/DBP (174/102 vs. 162/90mmHg, p = 0.001/0.02), higher eGFR (79 vs. 66 ml/min, p = 0.02), more AHD (5 vs. 4, p < 0.001) but not to less single pill combination prescription (66% vs. 57%, ns) compared to full adherence.

Conclusions:
Urine AHD screening allows to detect that < 50% of the patient with RHTN are FA and 16.8% are completely NA. The AHD recommended by the ESH guidelines for RHTN (ACEI/ARB, thiazides, CCB and spironolactone) were only detected in 50 to 60% of the patients which explains the persistence of uncontrolled severe hypertension. However, in FA patients, BP remained high suggesting inadequate use of AHD by physicians or white coat adherence by patients.
FACTORS AFFECTING ADHERENCE TO MEDICAL APPOINTMENT AMONG HYPERTENSIVE PATIENTS OF PUBLIC HEALTH FACILITIES IN PUNJAB, INDIA
Authors: Das Bidisha , Neupane Dinesh , Kunwar Abhishek , Kaur Prabhdeep , Mukhtar Qaiser 
Published: April 2021

Objective:
Objective: Regular visit to health facilities is important for hypertension control. Under India Hypertension Control Initiative, hypertensive patients are enrolled in public hospitals and provided with patient-specific monthly medication for regular treatment at home and advised to return to the health facility after a month. However, at least 50% -60% of registered patients were not visiting the health facility for 3 to 6 months following their last visits. This article aims to document the major reasons for missed appointments and to characterize the patient and health system barriers.

Design and method:
We used a telephonic interview for collecting information from the patients who missed the appointments for more than 3 consecutive months. Out of 300 randomly selected patients, 206 were interviewed with a pre-structured questionnaire to explore patients’ experiences along with medical record reviews from the patient database. Interviews were conducted during the last quarter of 2019 and analyzed in both descriptive statistics and textual descriptions.

Results:
Not feeling sick or not experiencing any bodily symptoms due to hypertension (18.4%) followed by far distance between the health facility and the patient's home (16.5%) were the major reasons reported by the patients. Among other reasons, lack of proper instructions/guidance from the facility (11%), acute health conditions of patients (6%) and long waiting time at the public health facilities (5%) are also documented as the reasons for poor follow up. These factors cumulatively shifting a patient towards private sectors as 54% patients who were continuing their treatment are preferring private sectors.

Conclusions:
The results suggest the need for a more patient-centric care model such as guiding the patient properly at the health facility, saving patients time in the clinic, personalized care for acutely ill and aged patient and addressing the distance barriers between a patient's home and the health facility. Further, introducing reminder system by means of phone calls/SMS/visit may help to retain the higher follow-up of the patient.
STATIN THERAPY IS ASSOCIATED WITH BETTER 24-HOUR AND NIGHT-TIME BLOOD PRESSURE CONTROL IN HYPERTENSIVE PATIENTS
Authors: Spannella Francesco , Filipponi Andrea , Giulietti Federico , di Pentima Chiara , Sarzani Riccardo 
Published: April 2021

Objective:
Hypertension and dyslipidemia often coexist. Statin therapy was associated with lower blood pressure (BP) in some but not all studies. Aim: to evaluate the association between statin therapy and 24-hour BP in a large hypertensive population, using propensity score matching analysis.

Design and method:
Retrospective study on 1827 consecutive essential hypertensives evaluated with 24 h ambulatory BP monitoring. Anti-hypertensive treatment intensity (ATI) was calculated to compare different drug associations. We used a propensity score matching to compare two equally-sized cohorts of patients (369 patients in each group) with similar characteristics according to statin therapy (age, sex, body mass index, smoking habit, diabetes mellitus, total cholesterol, high-density lipoprotein cholesterol, triglycerides, low-density lipoprotein cholesterol, estimated glomerular filtration rate, glycaemia, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, calcium channel blocker, diuretic, mineralocorticoid receptor antagonist, beta-blocker, alfa-blocker, ATI, 24 h pulse pressure). Matching was performed on log-transformed propensity score in a 1:1 fashion with a caliper of 0.1, in order to account for the different baseline characteristics between statins and non-statins groups.

Results:
Mean age: 58.1 ± 13.8 years; male sex: 55%. Patients on statin therapy: 402 (22%). The different statins were taken as follows: atorvastatin (39.8%), simvastatin (35.8%), rosuvastatin (15.7%), pravastatin (5.6%), lovastatin (2.3%) and fluvastatin (0.8%). Patients on statins showed lower 24 h BP (-2.8/-7.1 mmHg), daytime (-3.3/-7.6 mmHg) and night-time BP (-2.5/-6.0 mmHg, all p < 0.001). They also showed better ambulatory BP control, even after adjustment for confounders. The analyses on the groups derived from the propensity score matching (369 patients in each group) confirmed these results (OR 1.8 for 24 h BP control; OR = 1.6 for daytime BP control; OR = 1.7 for night-time BP control, all p < 0.001).

Conclusions:
Conclusions: Statin therapy is associated with lower ABPM values in hypertensive patients. This result is not affected by the anti-hypertensive treatment intensity or by the several cofactors analyzed, but may depend on greater adherence to prescribed drug therapies as suggested by the assumption of a nocebo-tainted drug class. The cardiovascular benefit of statins is due to the reduction of blood cholesterol and effects on blood pressure may be just indirect.
ADDITIVE BLOOD-PRESSURE LOWERING EFFECT OF AEROBIC TRAINING ON ANTIHYPERTENSIVE MEDICATION IN METABOLIC SYNDROME INDIVIDUALS
Authors: Jimenez Miguel Ramirez , Morales-Palomo Felix , Moreno-Cabañas Alfonso , Alvarez-Jimenez Laura , Ortega Juan F. , Mora-Rodriguez Ricardo 
Published: April 2021

Objective:
In hypertensive individuals with metabolic syndrome (MetS), antihypertensive medications (AHM) are prescribed in conjunction with lifestyle advice (i.e., exercise) to reduce blood pressure (BP). However, if the combination of both treatments results in better BP control remains unknown. The objective of this study was to analyze the separated and combined effects of AHM and exercise training on ambulatory blood pressure (ABP).

Design and method:
Thirty-six hypertensive individuals with MetS under long-term prescription with AHM targeting the renin-angiotensin-aldosterone system (RAAS) were recruited. Before and after a 4-month aerobic interval training their AHM prescription was withdrawn during 3 days (i.e., PLAC trials) and 24-h ABP compared to when individuals held their habitual dose of medication (i.e., AHM trial) using a double-blind, randomized design. Plasma renin activity (PRA) and aldosterone concentration were measured to confirm withdrawal effects on RAAS. Urine albumin and creatinine ratio (UACR) was measured to assess kidney function.

Results:
Before the intervention AHM reduced 24-h mean arterial pressure (MAP) by -5 ± 5 mmHg (P < 0.001, Figure 1). After 4-months of aerobic training AHM reduced MAP an additional -3 ± 5 mmHg (92 ± 9 to 89 ± 8 mmHg; P = 0.014). However, BP lowering effect was not observed when AHM was withdrawn after training (97 ± 8 vs 96 ± 8 mmHg; P = 507). AHM increased PRA before and after training (P < 0.005) whilst had no effect on plasma aldosterone concentration (P = 1.000). Aerobic training did not significantly reduced RAAS hormones or the UACR.

Conclusions:
Aerobic training and AHM in conjunction reduce BP to a higher extent than each treatment in isolation. These findings support the combination of habitual AHM with exercise training with the goal to reduce BP in hypertensive MetS individuals.