bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE PSYCHOLOGICAL COMPONENT OF THE QUALITY OF LIFE WAS RELATED TO COMPOSITE ENDPOINT IN TREATED PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Yana Koshelyaevskaya , Andreeva Galiya , Smirnova Marina , Gorbunov Vladimir , Kurekhyan Armine 
Published: April 2021

Objective:
The aim of our study was to determine association between composite endpoint and quality of life (QL) scale scores in treated patients with arterial hypertension (AH).

Design and method:
We analyzed database of treated AH patients (n = 125) with concomitant chronic diseases without exacerbation. We assessed relationships between the initial ambulatory blood pressure monitoring (ABPM) data, socio-demographic indicators, QL scale scores, Asthma Control Questionnaire (ACQ) indices and composite endpoint (death for any reason, angina pectoris, transient ischemic attack, development of chronic heart failure, arterial revascularization, frequent ventricular extrasystoles, atrial fibrillation) after 30.1 ± 7.6 months from the inclusion visit. QL questionnaires (J.Siegrist et al.), ACQ (45 patients had asthma) was completed initially, after 6 months and after 12 months, the ABPM session was performed initially and after 12 months, antihypertensive therapy was corrected at all visits. We analyzed the following QL scale scores: 0 scale: mood at the doctor's visit, I scale: physical well-being; II scale: physical performance; III scale: positive psychological well-being; IV scale: negative psychological well-being; V scale: psychological performance; VI scale: social well-being; VII scale: social performance. We used ANOVA for statistical analysis.

Results:
The baseline mean daytime systolic BP (SBP) was 125.1 ± 10.5; diastolic (DBP) - 76.1 ± 7.3 mm Hg. We found negative correlations between composite endpoint and: III scale scores (positive psychological well-being) (F = -5.3, p < 0.05); 0 scale (mood at the doctor's visit) (F = -5.6, p < 0.05).
We identified a positive correlation between endpoint data and V scale scores (psychological performance) (F = 12.2, p < 0.001). The composite endpoint was not correlated with sex, age, BMI, smoking, ambulatory and clinical blood pressure, the number of drugs in concomitant therapy, pulmonary forced vital capacity. At the end of the study, we registered 21 cases included in the composite endpoint: death (2), transient ischemic attack (1), arterial revascularization (4), frequent ventricular extrasystole (3), atrial fibrillation (8), angina pectoris (3).

Conclusions:
Thus, psychological QL component such as good mood at the doctor's visit (scale 0), positive psychological well-being (scale III) had negative relationship with composite endpoint, at the same time the psychological performance (scale V) had positive correlation with composite endpoint results.
IMPLEMENTATION OF A STRUCTURED CARE PATHWAY FOR RESISTANT HYPERTENSION: PATIENT PROFILE AFTER 1 YEAR
Authors: Vanparys Joris , Deblaton Maite , Van Frachen Beatrice , Derwa Axel 
Published: April 2021

Objective:
Cardiovascular diseases remain a major cause of death. Arterial hypertension is an important risk factor, and although it is frequently screened for, it is often suboptimally treated. By implementing a structured care pathway for treatment-resistant hypertension, we aimed to improve diagnosis and treatment of these patients and identify patients at high risk for developing cardiovascular and renal complications.

Design and method:
Patients were referred to the hypertension clinic because of treatment-resistant hypertension despite 3 classes of antihypertensive drugs, or for hypertension diagnosed before the age of 40. All patients received 24 h ambulatory blood pressure monitoring (ABPM) and screening lab tests. Patients with inadequately treated hypertension (>130/80 mmHg/24 h) were evaluated via a structured pathway with a multidisciplinary approach including cardiac and renal ultrasound, nutritional education and additional screening for secondary causes of hypertension.

Results:
In the first year after implementing our structured care pathway, 51 patients were referred: 28 for hypertension diagnosed before the age of 40 and 23 for treatment-resistant hypertension.
Mean age was 51 (range 17–81). 55% were overweight or obese, 16% smoked, 25% had diabetes and 22% used lipid-lowering drugs.
ABPM identified 45 patients (88%) with inadequately treated hypertension. Their treatment regimen was intensified.
Screening for secondary hypertension suggested primary hyperaldosteronism in 3 patients.
Fibromuscular dysplasia was diagnosed in 1 patient.
Patients with treatment-resistant hypertension were on average taking 3,3 different classes of antihypertensive drugs, with ACEi/ARB being used by 96% of patients, and calcium-antagonist by 78%.
Cardiac ultrasound revealed left ventricular hypertrophy in 17 patients (33%). 4 patients had renal insufficiency (eGFR<45 ml/min/1,73m2), 3 had proteinuria.
In patients with treatment-resistant hypertension, the median 10 year risk of cardiovascular death (SCORE risk charts) was 4,25% (range 1–30%). The median 10 year risk of cardiovascular morbidity (Framingham general CVD risk score) was 26,18% (range 7,12–62,6%).

Conclusions:
Implementing a structured care pathway for treatment-resistant hypertension including ABPM is an important tool to identify patients requiring antihypertensive treatment optimization and to diagnose patients with secondary hypertension. Furthermore, it can identify patients with end-organ damage and a high cardiovascular disease risk.
FEATURES OF METABOLIC AND HEMODYNAMIC INDICATORS IN OBESE PATIENTS WITH RESISTANT HYPERTENSION
Authors: Shalimova Anna , Psarova V. , Kochuieva M. 
Published: April 2021

Objective:
To establish the features of metabolic and hemodynamic parameters in obese patients with true and pseudo-resistant arterial hypertension (AH).

Design and method:
The study included 200 patients with AH grade II and obesity I-II classes (age 45–55 years). Patients were initially prescribed dual antihypertensive therapy (ACEI and CCB). Those patients who did not reach target blood pressure (BP) levels after 3 months on dual therapy were additionally assigned a third antihypertensive drug (indapamide). Of the 98 patients who were assigned triple therapy, 48 patients did not reach target BP levels: 27 patients had pseudo-resistant AH (due to low compliance with treatment and insufficient adherence to the physician's instructions to ensure adequate levels of physical activity), and 21 patients had true resistant AH (did not have target BP levels with triple antihypertensive therapy and sufficient physical activity). These patients were additionally prescribed spironolactone. The effectiveness of the treatment in all groups was evaluated 6 months after the start of antihypertensive therapy.

Results:
Comparative assessment of obese patients in the presence and absence of resistant AH after 6 months of therapy showed that, unlike patients without resistance, individuals with resistant AH differed more pronounced cardiovascular remodeling and metabolic disorders, greater dysbalance of oxidative stress-antioxidant protection, greater proinflammatory activity and higher activity of the RAAS. When performing a comparative evaluation of the indicators in patients with pseudo-resistant and true resistant AH, it was found that patients with true resistance differed from pseudo-resistant patients with significantly lower (p = 0.0229) body mass index (BMI). In addition, in the absence of differences in BP levels, cardiovascular remodeling, lipid and carbohydrate profiles, patients with true resistance had significantly higher levels of aldosterone (p = 0.0449), higher activity of oxidative stress system (malondialdehyde, p = 0.0055 and diene conjugates, p = 0.0299), lower levels of general antioxidant protection (p = 0.0004), higher adiponectin levels (p = 0.0000), and lower leptin level (p = 0.0001), compared to pseudo-resistant patients

Conclusions:
Obese patients with true resistance differed from pseudo-resistant patients with significantly lower BMI, higher aldosterone level, higher activity of the oxidative stress system, lower activity of the antioxidant protection system, higher adiponectin level, and lower leptin level.
DRUG-RESISTANT HYPERTENSION IN PRIMARY ALDOSTERONISM
Authors: Rossi Gian Paolo , Rossitto Giacomo , Maiolino Giuseppe , Lenzini Livia 
Published: April 2021

Objective:
Drug-resistant arterial hypertension can derive from unrecognized forms of secondary hypertension of which primary aldosteronism (PA) is one of the most common. While available data suggest a high prevalence of PA in patients with resistant hypertension (RH), its rate in such population is unclear. This study sought to establish the rate of RH in patients with PA and the blood pressure outcome and resistance to treatment after adrenalectomy PA-RH patients subtyped by adrenal vein sampling (AVS).

Design and method:
Data from consecutive patients with unambiguous diagnosis of PA and seeking surgical cure, submitted to AVS in 19 tertiary referral centers located in Asia, Australia, Europe, and North America, were collected in an observational prospective registry from 2000 to 2015. Blood pressure outcome and resistance to treatment by the American Heart Association 2018 criteria or a local clinical definition were the main study outcomes. Inclusion criteria were age > 18 years, indication to perform AVS following current guidelines, center's agreement to participate and approval of the local Ethics Committee.

Results:
Of 1625 enrolled PA patients, 73.7% had conclusive information on presence or absence of resistant hypertension. Of these, 20.1% were judged to have RH, a rate that raised to 49.5% according to the clinical definition of each center lead investigator. RH was about twice as common in men as in women (p < 1x10-4). Fifty-three percent of the PA patients with RH underwent surgery, which resolved resistance to drug treatment in all.

Conclusions:
RH is a common presentation of PA in consecutive patients seeking surgical cure; AVS-guided adrenalectomy allowed to resolve resistance of high blood pressure to treatment. Hence, the optimal management of patients with PA and RH requires subtyping with adrenal vein sampling.
ARE SUBJECTIVE MEASURES THE ANSWER TO ASSESS PHYSICAL ACTIVITY ON A DAILY BASIS CLINICAL PRACTICE IN PATIENTS WITH RESISTANT HYPERTENSION?
Authors: Ribeiro Fernando , Lopes Susana , Garcia Catarina , Oliveira José , Figueiredo Daniela , Bertoquini Susana , Polónia Jorge , Alves Alberto , Mesquita-Bastos José 
Published: April 2021

Objective:
Physical activity is a vital sign for cardiovascular health. However, several factors, such as the duration of the protocol, equipment cost, and need for qualified professionals make the assessment of physical activity with objective measures impractical on a daily basis in a clinical practice. Hence, this study aims to examine the association between subjective and objective physical activity levels in patients with resistant hypertension.

Design and method:
Sixty-six patients (age: 59 ± 1.0 yrs; gender: 50.7% men; BMI: 29.8 ± 0.6 kg/m2; number of antihypertensive medications: 4.6 ± 0.1) were recruited. Outcome measures included clinical data, blood pressure, daily physical activity (questionnaire and accelerometry). Physical activity was objectively measured over a 7-day period with an accelerometer and sedentary time, and time spent at light and moderate-to-vigorous physical activity (MVPA) was computed. Physical activity was also subjectively (self-assessment) assessed from 2 questions regarding moderate and vigorous physical activity. The association between the objective and subjective physical activity measurement was tested, and the McNemar test was employed to examine differences between measures.

Results:
The proportion of patients reporting at least 20 min of continuous, moderate intensity physical activity per week was 60.9% (n = 39) compared to the 27% (n = 17) that were actually registered by the accelerometer (p < 0.05). The difference was also higher in the category of vigorous physical activity, where 1 patient (1.6%) did at least 20 minutes of vigorous activity, while 22 patients (34.4%) actually reported to have done it (p < 0.05). Self-reported moderate and vigorous physical activity were not correlated with objectively measured moderate and vigorous activity (rho = 0.116, p = 0.379; rho = -0.087, p = 0.508, respectively).

Conclusions:
Our findings highlight that despite being a valid, easy and inexpensive solution for assessing physical activity levels in adults with resistant hypertension, the subjectively (self- reported) measures are overestimating the physical activity levels. Findings suggest that self-reported physical activity should be interpreted with caution in adults with resistant hypertension and complemented by accelerometry data when possible.
CHRONIC KIDNEY DISEASE IN PATIENTS WITH RESISTANCE HYPERTENSION AND ACHIEVEMENT OF TARGET BLOOD PRESSURE
Authors: Rekovets Oksana , Torbas Olena , Kushnir Svitlana , Primak Galina , Krushynska Nina , Granich Vladimir , Sirenko Yuriy 
Published: April 2021

Objective:
Glomerular filtration rate (eGFR) drop in patients with resistant hypertension and how different factors can affect on achievement of target blood pressure in patients with resistant hypertension and chronic kidney disease (CKD). To evaluate factors related with achievement of target blood pressure in patients with resistant hypertension and CKD.

Design and method:
We included 1134 patients who taken 3 or more antihypertensive drugs: first group (n = 877) patients with RH and eGFR (CKD-EPI) > = 60 ml/min/1.73 m2 a mean age of 53.5 ± 7.1 years, and second group (n = 257) patients with RH and eGFR (CKD-EPI) < 60 ml/min/1.73 m2 a mean age 66.1 ± 8.5 years, SBP 172.8 ± 8.2 and DBP 101.2 ± 6.3mmHg. Patients with secondary arterial hypertension was excluded.

Results:
513 patients (58.5%) with eGFR > = 60 ml/min/1.73 m2 and achievement target office BP and 233 patients (41.5%) not achievement target office BP. 140 patients (54.5%) with eGFR < 60 ml/min/1.73 m2 and achievement target office BP and 117 patients (45.5%) not achievement target office BP. Patients with CKD-EPI > = 60 ml/min/1.73 m2 and achievement BP had higher blood renin (324.5 ± 23.3) ng/l vs not achievement BP (23.2 ± 3.5) ng/l (p < 0.05). Patients with CKD-EPI > = 60 ml/min/1.73 m2 and achievement BP had low blood cortisol level (47.8 ± 3.4) mkg/dl vs patients not achievement BP (163.7 ± 7.8) mkg/dl (p < 0.05). Aldosterone blood level was similar in both group 26.7 ng/dl vs 28.1 ng/dl respectively. Patients with CKD-EPI < 60 ml/min/1.73 m2 and achievement BP had low blood renin (34.1 ± 3.6) ng/l as patients not achievement BP (26.8 ± 2.5) ng/l (p > 0.05). Patients with CKD-EPI < 60 ml/min/1.73 m2 and achievement BP had low blood cortisol (6.0 ± 0.6) mkg/dl vs patients not achievement BP (127.7 ± 8.6) mkg/dl (p < 0.05).

Conclusions:
In patients with RH and CKD-EPI < 60 ml/min/1.73 m2 factors related with not achievement target BP was higher blood cortisol. In patients with RH and CKD-EPI > = 60 ml/min/1.73 m2 factors related with not achievement target BP was low blood renin level and higher blood cortisol.
IMPACT OF POLYPHARMACY AND COMORBIDITIES TO CLINICAL OUTCOMES IN RESISTANT HYPERTENSION RENAL DENERVATION GROUP
Authors: Juknevicius Vytautas , Berukstis Andrius , Jukneviciene Renata , Saule Ieva Marija , Laucevicius Aleksandras 
Published: April 2021

Objective:
To analyse impact of polypharmacy to blood pressure control in resistant hypertension renal denervation group.

Design and method:
This prospective study included 73 selected patients with resistant hypertension and RDN (Sympathetic Renal Denervation) performed. Routine follow up was performed subsequently 1, 3, 6, 12, 24 and 48 months after the RDN. Total numbers of pills, prescibed for all diseases was registered. Two groups of patients were defined: A group- patient whom less than 7 pills prescribed and group B -more than 7 pills. Number of antihypertensive medications was analysed separately Also various characteristics were registered: age, sex, comorbidities, 24h-ABPM, arterial stiffness etc. Statistical analysis was performed using SPSS 23.0 Statistical Software.

Results:
A total cases of 73 patients were included. 6 patients died, 18 failed to remain in the follow up during 4 years. Remaining 49 patients data were analyzed. Median age was 55 (33–72) years old with 53,1 % (n = 26) patients being male. Two groups were similar, acoording to age, weight, office blood pressure, heart rate (p > 0,05), but there was higher numbers of diabetes melitus and coronary artery disease in group B. Mean prescribed antihypertensive drugs (A- 4,75; B- 6,52; p > 0,05). In A group we observed significantly reduced BP (sABP 162,6mmHg to 149,6mmHg, p < 0,01; dABP 100,8mmHg to 90,24mmHg, p = 0,01) during 48 months. In B group: sABP 163,76 mmHg to 152,1mmHg, p = 0,13; dABP 89,7 mmHg to 85,1 mmHg, p = 0,54). In A group we observed significantly reduced carotid-femoral aortic pulse wave velocity (AoPWV) from 11.2 m/s to 10.0 m/s in 4 years (p = 0,01). In second group AoPWV increased from 11,8 m/s to 12,8 m/s, but not significantly (p = 0.34).

Conclusions:
Patients with more comorbidities and receiving more pills are at higher cardiovascular risk and their blood pressure is more difficult to control, even after renal denervation procedure.
THE DEVELOPMENT OF RESISTANT HYPERTENSION INDEPENDENT OF THE PRECEDING PERIOD OF THE BLOOD PRESSURE CONTROL IS ASSOCIATED WITH THE INCREASED RISK OF CARDIOVASCULAR EVENTS AND DEATH
Authors: Gupta Ajay , Rostamian Somayeh , Mackay Judith , Godec Thomas , Whitehouse Andrew , Poulter Neil , Sever Peter 
Published: April 2021

Objective:
Resistant hypertension (RH) is associated with the increased risk of cardiovascular events (CVEs); that excess risk is often attributed to the legacy of the previous period of uncontrolled blood pressures (BPs). We used the database of the ASCOT trial to evaluate the risk of CVEs (non-fatal myocardial infarction, fatal coronary heart disease, and fatal/non-fatal stroke) and death, after controlling for the cumulative mean of BPs for a preceding period of 2-years (using area-under-curve [AUC]).

Design and method:
18,926 hypertensive patients were initially followed up for the development of RH or not for a period of 2-years. During that period, we calculated the AUC of the cumulative mean BPs (AUCcmBPs) until the RH diagnosis or the end of the 2-year period if no-RH. These patients were then followed up from this new baseline for the risk of CVEs or death. We estimated incidence rates and developed a multivariable Cox regression model after adjusting for a-priori confounders (age, sex, socio-economic status, BMI, total cholesterol, HDL-cholesterol, systolic-BP at baseline, randomized treatment allocation, diabetes, other vascular diseases) and the AUCcmBPs. Interaction tests were done for those who were taking antihypertensive medications prior to the randomization or not.

Results:
About one-third (n = 5,660) developed RH by the end of 2-years. During the further median follow-up of 3.9 years, there were 1113 CVEs and 745 deaths. The incidence rate of CVE and death was higher in those with RH vs those without (34.8 and 18.9 per 1,000 person-years vs 24.0 and 15.4, respectively). In the multivariable model after controlling for the AUCcmBPs, those with RH, as compared to those without, had a significantly higher risk of CVE and death (HR: 1.15 [95% CI 1.03–1.27], p-value = 0.010, and 1.16 [1.02–1.33], p-value = 0.028, respectively). This excess in the risk didn’t differ significantly between those who were on prior antihypertensive therapy or not (interaction test p-value = 0.430 and p-value = 0.310, respectively).

Conclusions:
After accounting for prior BPs, the presence of RH is associated with the increased risk of CVEs and death; which could be because of the additional risk due to associated genotypical or phenotypical factors.
DIRECTLY OBSERVED ADMINISTRATION OF ANTI-HYPERTENSIVE MEDICATION PRIOR TO AMBULATORY BLOOD PRESSURE MONITORING – A USEFUL TOOL FOR INVESTIGATING ‘RESISTANT HYPERTENSION’
Authors: Lawson Gwyneth , Fish Richard 
Published: April 2021

Objective:
Non-adherence to anti-hypertensive medication is a well-recognized cause of apparent ‘resistant hypertension’. We investigated whether directly observed administration (DOA) of anti-hypertensive medications, immediately prior to 24-hour ambulatory blood pressure monitoring (ABPM), would help exclude ‘treatment resistance’ potentially caused by medication non-adherence.

Design and method:
Resistant hypertension was defined (as per UK guidelines) as a mean daytime blood pressure (BP) of 135/85 or more despite the use of three or more anti-hypertensives. All patients had 24-hour ABPM immediately after a morning clinic appointment. Patients attending our nurse-led hypertension clinic were requested in advance to not take their prescribed anti-hypertensives on the morning of their appointment, but to bring their medications with. Patients were then observed taking their medications prior to ABPM. Patients that did not follow these instructions or who had ABPM organised from a different clinic (without DOA) formed the control group. Proportions were compared with Chi-squares tests. Data analysis was performed using Microsoft EXCEL 2010.

Results:
From November 2018 – October 2019, 53 patients had DOA before ABPM and were compared with 136 controls (see Table 1 for characteristics of each group). In the DOA group the average daytime BP was 138/83 with 38% having BP <135/85. In the control group average daytime BP was 141/86 with 27% having BP < 135/85.
In total 54 patients were taking three or more anti-hypertensive medications. Table 2 compares the characteristics of these patients that underwent DOA (n = 14) compared with those that did not (n = 40). Of these patients, 50% that underwent DOA had a mean daytime BP of <135/85 compared with 20% in the control group (p = 0.03).

Conclusions:
Eliminating any effect of medication non-adherence by directly observed administration of prescribed anti-hypertensives immediately prior to ABPM leads to a lower rate of ‘resistant hypertension’ diagnoses. This strategy may therefore negate the need for further treatment and/or investigation in some patients.