bluuebunny/crossref_metadata_2025_split huggingface dataset:
FOREARM VASCULAR RESPONSES TO MENTAL STRESS AND DEVICE GUIDED BREATHING ASSOCIATE WITH PLASMA CONCENTRATIONS OF NORMETADRENALINES IN SUBJECTS WITH ESSENTIAL HYPERTENSION
Authors: Farukh Bushra , Faconti Luca , Mcnally Ryan , Chowienczyk Phil 
Published: April 2021

Objective:
Forearm vasodilator responses to mental stress (MS) are impaired in hypertensive compared to normotensive individuals by a mechanism that may relate to peripheral alpha-adrenergic activity antagonising that of neuronal nitric oxide. We investigated whether the response to MS may be dependent on the level of basal sympathetic activity as measured by plasma concentrations of normetadrenaline (NM) and how responses to slowing respiratory rate by device guided breathing (DGB, which reduces sympathetic activity) vary according to NM concentrations.

Design and method:
Subjects with essential hypertension were stratified according to concentrations of plasma NM into those with low NM (< or = 500pmol/L) and high NM (> or = to 750pmol/L). Forearm blood flow (FBF) was measured by venous occlusion plethysmography after 15 minutes of rest, during MS elicited by the Stroop word-colour test and during supervised DGB with breathing rate < 10 breaths/minute.

Results:
Subjects with high NM (n = 30, 15 men) had greater body mass index than those with low NM (n = 30, 17 men): (mean ± SD) 31 ± 7 vs 27 ± 4 kg/m2 (P < 0.05), but the two groups were similar with respect to age and brachial blood pressure (BP). During MS and DGB, changes in BP were similar in subjects in both low NM and high NM groups. MS increased FBF in both groups but the response in high NM was impaired as compared to subjects with low NM (34 ± 3 vs. 49 ± 3 %, P < 0.05). DGB increased forearm vascular resistance to a lesser extent in subjects with high compared to low NM (1.21 ± 7.95 vs 5.50 ± 6.32 mmHg.100 mL/mL, P < 0.05).

Conclusions:
These results are consistent with greater sympathetic vascular tone in patients with higher NM that antagonises forearm vascular responses to MS. Circulating concentrations of NM may identify subjects with impaired neuronal nitric oxide signalling.
IMPACT OF MARATHON RUNNING ON ENDOTHELIAL FUNCTION AND SUBCLINICAL ATHEROSCLEROSIS
Authors: Terentes-Printzios Dimitrios , Vlachopoulos Charalambos , Kardara Despoina , Anastasakis Aris , Vogiatzi Georgia , Xaplanteris Panos , Georgakopoulos Christos , Lazaros Georgios , Tousoulis Dimitrios 
Published: April 2021

Objective:
Aerobic exercise has beneficial effects on the cardiovascular system. Marathon running is both an aerobic but also an extremely vigorous exercise. Endothelial function and carotid subclinical atherosclerosis are independent predictors of cardiovascular risk. We sought to investigate the chronic alterations of these indices in marathon runners.

Design and method:
We studied 30 marathon runners and 20 age- and sex-matched recreationally active control subjects. Endothelial function was evaluated with brachial flow-mediated dilatation (FMD) and early atherosclerosis with carotid intima-media thickness (cIMT).

Results:
Marathon runners had significantly higher systolic and pulse pressure compared to controls. They also had reduced body-mass index, waist to hip ratio and heart rate compared to controls (p < 0.05, for all). Common cIMT was significantly lower in athletes than controls (0.56 ± 0.11 vs. 0.63 ± 0.07, p = 0.029), while there was no difference in carotid bulb IMT between groups. FMD was higher in marathon runners compared to controls and nitrate-mediated dilatation (NMD) was similar in the two groups (9.0 ± 3.7 vs. 6.4 ± 1.7 and 12.6 ± 5.7 vs. 12.3 ± 3.4; p = 0.002 and p = 0.821, respectively). (Figure) We also observed a reverse U-shaped curve between endothelial function and amount of exercise. FMD was significantly inversely associated with the number of training days per week (r = -0.430, p = 0.018).

Conclusions:
Marathon runners have higher FMD compared to controls, indicating better vascular endothelial function, and also have lower cIMT compared to controls. Increased amount of exercise training seems to eradicate the beneficial effect of exercise on endothelial function. These findings provide further insights in the effects of marathon running on cardiovascular risk.
ACUTE EXERCISE CHANGES THE FOURIER-TRANSFORM INFRARED SPECTRA PROFILE IN INDIVIDUALS WITH HYPERTENSION AND OTHER CARDIOVASCULAR RISK FACTORS: EFFECT OF THE SESSION DURATION
Authors: Teixeira Manuel , Lima Suiane , Gouveia Marisol , Duarte Ana , Ferreira Miriam , Simões Maria I. , Conceição Maria , Costa Mariana , Nunes Alexandra , Vieira Sandra I. , Ribeiro Fernando 
Published: April 2021

Objective:
Evaluate the acute effects of two sessions of moderate exercise with different durations, on the metabolomic profile of adults with cardiovascular risk factors or established cardiovascular disease.

Design and method:
15 adults (age: 66.5 ± 7.6 years; BMI: 26.8 ± 3.7 kg/m2; 80% women) were recruited in a community exercise program of a primary health care centre. They performed two sessions of moderate intensity aerobic (endurance) exercise with different duration periods (30 versus 45 min). Venous blood was collected before and after each exercise session. Samples were centrifuged and the plasma was used for Fourier-transform infrared (FTIR) spectroscopy analysis. The spectra were acquired, and multivariate analysis applied.

Results:
FTIR analysis showed good discrimination between pre- and post- the 30 min session in the 1700–1600 cm-1 region (Amide I band) and 1500–900 cm-1 region (fingerprint region). Principal component analysis of the fingerprint region revealed that the post-exercise samples presented peaks related to glycogen (1079 cm-1) and collagen (1458 cm-1, 1339 cm-1), which reflect the exercise training. Pre-exercise samples had peaks related to ribose (996 cm-1) and carbohydrates (1045 cm-1) that are sources of energy that are ready to be used during the session. Partial least squares regression of the Amide I region also showed differences after exercise. In the baseline, the participants seem to have higher levels of antiparallel β-sheets (1690 cm-1) and side chains (1611 cm-1), which are linked with proteins prone to aggregate. However, after exercise, the participants showed a peak related to random coils (1639 cm-1), which may indicate a transitional state for the β-sheet rich protein to a more stable profile. In the 45 min session no differences were observed after the session in the amide I region.

Conclusions:
A single aerobic exercise, irrespective of the duration, does not induce deleterious changes in the metabolomic profile. Only the 30 min session promoted a positive alteration in the quality of the proteins; this change in the quality of the proteins and the fingerprint region indicates a possible alteration associated with the duration of the exercise.
EXERCISE TRAINING PROTECTED CARDIAC DAMAGE FROM DOXORUBICIN-INDUCED HEART FAILURE IN SPRAGUE-DAWLEY RATS
Authors: Pei Zuowei , Zhu Huolan , Yang Chenguang , Ren Yirong , Meng Xuyang , Li Yi , Wang Fang 
Published: April 2021

Objective:
Heart failure is a complex end stage result of various cardiovascular diseases, and has a poor prognosis. Exercise training according to oxidative stress, myocardial fibrosis, inflammation pathways improve cardiac function. The aim of this study was to investigate the possible protective effects of exercise training against cardiac damage in doxorubicin (DOX)-induced heart failure in Sprague-Dawley Rats.

Design and method:
This study used 45 male Sprague-Dawley (SD) rats weighing 150 ± 20 g that were randomly divided into a control group (normal saline), doxorubicin (DOX) group and DOX plus exercise (DOX + E) group. Heart failure was induced experimentally by intraperitoneal injections of the cardiotoxic agent DOX. All groups received different treatment for 8 weeks. Blood samples were obtained from the inferior vena cava and collected in serum tubes; the blood samples were stored at minus 80°C until use. Heart tissues were fixed in 10% formalin and then embedded in paraffin for histological evaluation. The heart was stored in liquid nitrogen for immunoblotting or mRNA analysis.

Results:
Left ventricular fractional shortening and ejection fraction were higher in DOX + E group rats than in DOX group rats on an echocardiographic examination (Figure 1 and Table 1). Significant cardiac tissue damage (haematoxylin and eosin, Masson's trichrome staining) was seen in rats of the DOX group compared to those of the DOX + E group (Figure2). Exercise inhibited DOX-induced cardiac fibrosis (transforming growth factor, smooth muscle actin, collagen I, and collagen III) and oxidative stress (Nox4, p53) in an immunoblotting analysis (Figure 3 and 4).

Conclusions:
These results indicate that exercise training may be a potential therapeutic target for cardiac damage caused by DOX-induced heart failure.
BARRIERS OF BEING ACTIVE: GENDER DIFFERENCES IN YOUNG POPULATION
Authors: Rosselli Martina , Mascherini Gabriele , Boddi Maria , Stefani Laura , Toncelli Loira , Galanti Giorgio , Modesti Pietro Amedeo 
Published: April 2021

Objective:
Regardless of any weight change. adopting and maintaining a healthy lifestyle has been shown to lead to meaningful improvements in cardiometabolic risk factors. including fasting insulin. and blood pressure. Although adolescent-specific lifestyle recommendations have been developed. many adolescents do not meet lifestyle behavior recommendations. The study aimed to investigate gender differences in perceived barriers to exercise in a young population.

Design and method:
A cross-sectional study was conducted among high school students (n = 368). Participants underwent measurements of anthropometric parameters (weight. waist. and hip circumferences). blood pressure. and administration of standardized questionnaire (Barriers to Being Active quiz and Mediterranean Diet Score quiz). Gender differences were assessed with multivariate logistic regression (adjusted for age and BMI).

Results:
Prevalence of overweight (BMI > 25 kg/m2) was lower among girls than among boys (3.9 % and 8.3%. OR.720; 95% CI 0.645 to 0.803) with no difference in the adherence score of Mediterranean diet (31.4 ± 4.0 and 30.8 ± 4.3. OR 1.036; 95% CI 0.984 to 1.090). The number of perceived barriers to physical activity was higher among girls than among boys (OR 1.519; 95% CI 1.286 to 1.793). Lack of energy for exercise and lack of willpower were the two barriers most frequently reported by girls (see table; n = 368 included in analysis; ∗adjusted also for age and BMI)

Conclusions:
Exercise professionals should be aware of the barriers that young girls can face during exercise prescription and be able to contrast them with useful individual strategies. Furthermore, analysis of young people life-style habits can help finding social strategies to promote healthy behaviors.
ARE PATIENTS WITH RESISTANT HYPERTENSION COMPLIANT WITH DAILY PHYSICAL ACTIVITY RECOMMENDATIONS?
Authors: Bastos Jose Mesquita , Lopes Susana , Garcia Catarina , Teixeira Manuel , Carvalho Pedro , Gonçalves Ana C. , Ribeiro Ilda P. , Melo J. Barbosa de , Oliveira Jose , Oliveira Daniela , Polonia Jorge , Alves Alberto J. , Ribeiro Fernando 
Published: April 2021

Objective:
Objective: To describe the physical activity (PA) levels and relation with blood pressure, and endothelial function and inflammatory biomarkers in patients with resistant hypertension.

Design and method:
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, ambulatory blood pressure, daily physical activity, cardiorespiratory fitness, circulating levels of hs C-reactive protein (hs CRP), and the levels of endothelial progenitor cells (EPCs), circulating endothelial cells (CECs) and hematopoietic stem cells (HSCs) quantified by flow cytometry. Sedentary time, and time spent at light and moderate-to-vigorous physical activity (MVPA) was assessed by accelerometers over 7 days. Correlation analysis was conducted to assess the association between variables; independent t-test was used for testing differences in blood pressure, VO2peak, hs CRP, EPCs, HSCs and CECs, according to the compliance with physical activity recommendations (< 150 versus > = 150 minutes/week of MVPA).

Results:
Results: Patients spent an average of 475.1 ± 75.7, 341.0 ± 35.8 and 46.4 ± 8.1 min/day in sedentary, light and moderate to vigorous PA, respectively. More than half (52.5%) of the patients met the recommended 150 min of moderate to vigorous physical activity per week. However, there were no differences regarding 24 h systolic and diastolic ambulatory blood pressure (p = 0.876) and (p = 0.130), VO2peak (p = 0.654), hs CRP (p = 0.381) and number of antihypertensive medications (p = 0.490) between patients that met and did not meet the PA recommendations. Sedentary time correlated positively with CECs (0.245, p = 0.05).

Conclusions:
Conclusions: The compliance with daily physical activity recommendations does not seem to have a major influence in blood pressure, hs CRP, and cardiorespiratory fitness of patients with resistant hypertension. Sedentary time is associated with higher endothelial injury/damage in patients with resistant hypertension.
This work is financed by FEDER Funds through the Operational Competitiveness Factors Program - COMPETE and by National Funds through FCT - Foundation for Science and Technology within the project PTDC/DTP-DES/1725/2014.
EXPLORING ASSOCIATIONS BETWEEN HEART RATE VARIABILITY AND EXERCISE TOLERANCE IN INDIVIDUALS WITH PERIPHERAL ARTERY DISEASE
Authors: Marçal Isabela Roque , Cornelis Nils , Buys Roselin , Fourneau Inge , Ciolac Emmanuel G. , Cornelissen Véronique A. 
Published: April 2021

Objective:
Lower-extremity artery disease (LEAD) characterized by a progressive atherosclerotic build-up in leg arteries affects more than 200 million people worldwide. LEAD is often associated with autonomic dysfunction as evidenced by a reduced heart rate variability (HRV). We aimed to investigate whether the autonomic function is associated with ambulatory capacity and exercise capacity in patients with LEAD.

Design and method:
Thirty-four patients (age > 17 years) diagnosed with LEAD (ABI < 0.9 and/or 20% decrease after a maximal treadmill test) suffering from intermittent claudication (Rutherford I-III) were recruited in the PROSECO-IC trial. Patients were grouped based on beta-blocker medication (B-blocker and non-B-blocker). Intervals between R waves (i-RR) obtained by heart rate (HR) signal were acquired beat-to-beat (Polar®H10) during 15 min of supine rest and were used for 5-minute HRV analysis. Time-domain indexes (mean i-RR, SDDD)and frequency domains (high-frequency band (HF), low frequency (LF, very LF (VLF)), and the ratio (LF/HF). Ambulatory capacity was assessed by a submaximal treadmill test, graded maximal treadmill test using Gardner protocol (GTM), and 6 minutes walking test (6MWT); exercise capacity was assessed by graded maximal cardiopulmonary exercise test (HR, blood pressure (BP) and peak oxygen uptake (VO2peak)) at resting, 2 minutes and the peak of exercise.

Results:
Pearson test showed that sympathetic modulation indexes were moderately associated with pain-free distance in GTM (LF/HF: r = 0.52, p = 0.04) and pain-free time in 6MWT (LFlog: r = -0.62, p = 0.01; VLF: r = -0.52, p = 0.04), respectively, in patients without B-blocker. Similar HR associations with HRV (time and frequency domain) were observed during the submaximal treadmill test and cardiopulmonary exercise test (p < 0.05). Test-t demonstrated a significantly increased response intra-groups in HR and BP during both tests (p < 0.05). Average BP was positive associated with the earlier stages of the cardiopulmonary test (resting to 2 min) with LFlog (r = 0.70, p = < 0.001) in B-blocker while non-B-blocker were associated from 2 min to peak with LFabs (r = 0.67, p = < 0.001) and LF/HF (r = 0.52, p = 0.03).

Conclusions:
Sympathetic modulation was correlated with a longer pain-free walking capacity in non-B-blockers. Yet, individuals treated by -B-blockers showed an earlier sympathetic modulation through exercise pressor response during the first stages of cardiopulmonary exercise compared to non-B-blockers.
COMPARISON OF HOSPITALIZATION EVENTS AND ESTIMATION OF HAZARD RATIO FOR PATIENTS WITH HYPERTENSIVE EMERGENCIES AND HYPERTENSIVE URGENCIES AFTER 12 MONTH FOLLOW UP A GREEK REGISTRY
Authors: Fragoulis C. , Tsioufis K. , Tzorovili E. , Dimitriadis K. , Siafi E. , Leontsinis I. , Konstantinidis D. , Kakouri N. , Nihoyannopoulos P. , Tousoulis D. 
Published: April 2021

Objective:
The purpose of our registry was to record the prevalence and clinical characteristics of patients with hypertensive urgencies (HU) and emergencies (HE) assessed in the emergency department (ED) and during hospitalizationand a 12 month follow-up to record new events in a Greek General Hospital.

Design and method:
The study population consisted of patients presenting at the emergency department with acute increase in blood pressure (BP)(systolic BP > or = 180mmHg and/or diastolic BP > or = 120mmHg) and depending on the presence or absence of acute hypertension-mediated target organ damage, participants weredivided into the HE and the HU group, respectively. In all patients the demographic andclinical parameters were recorded for 12 monthsand there was a 12 month follow-up for new hospitalizations.

Results:
Out of 38,589 patients assessed in the ED during a period of 12 months, 353 (0.91%) had HU and HE, out of which 256 (72.5%) hadHU and 97 (27.5%) had HE. The mean age of patients was 67.4 ± 12.9years, 49% were males and 80% had history of hypertension. Patients with HE compared to HU were older (72.7 ± 12.1 vs 61.4 ± 12.7years, p < 0.0001). At baseline 91 patients with HE and 25 with HU were admitted in the hospital and remained for 6.4 ± 5.6days. During the study period82 patients were excluded for not completing the follow-up. Comparing the 2 groups, 51 patients from HE and 39 from HUgroup were hospitalized (p < 0.0001, HR for HE 2.3,95% CI 1.5–3.7). 29patients from HE and 9 from HU group were hospitalized for cardiovascular disease (p < 0.0001, HR for HE 3.8,95%CI 1.7–8.6). 32 patients from HE and 34 from HU group were hospitalized for non cardiovascular disease (p < 0.05, HR for HE 1.7,95% CI 1.02–3.02). Cox regression models were adjusted for age, gender, cardiovascular disease, chronic kidney disease, heart failure and diabetes mellitus.

Conclusions:
Our registry emphasizes the elevated hazard ratio for hospitalizations in the group of HE compared with HU, the necessity for more intensive follow-up for the first group and the need for further research in this setting.
COMPARISON OF DEATH EVENTS AND ESTIMATION OF HAZARD RATIO FOR PATIENTS WITH HYPERTENSIVE EMERGENCIES AND HYPERTENSIVE URGENCIES AFTER 12 MONTH FOLLOW UP A GREEK REGISTRY
Authors: Fragoulis C. , Tsioufis K. , Tzorovili E. , Dimitriadis K. , Siafi E. , Leontsinis I. , Konstantinidis D. , Kakouri N. , Nihoyannopoulos P. , Tousoulis D. 
Published: April 2021

Objective:
The purpose of our registry was to record the prevalence and clinical characteristics of patients with hypertensive urgencies (HU) and emergencies (HE) assessed in the emergency department (ED) and during hospitalizationand a 12 month follow-up to record new events in a Greek General Hospital.

Design and method:
The study population consisted of patients presenting at the emergency department with acute increase in blood pressure (BP) (systolic BP > or = 180mmHg and/or diastolic BP > or = 120mmHg) and depending on the presence or absence of acute hypertension-mediated target organ damage, participants weredivided into the HE and the HU group, respectively. In all patients the demographic andclinical parameters were recorded for 12 months and there was a 12 month follow-up for deaths.

Results:
Out of 38,589 patients assessed in the ED during a period of 12 months, 353 (0.91%) had HU and HE, out of which 256 (72.5%) hadHU and 97 (27.5%) had HE. The mean age of patients was 67.4 ± 12.9years, 49% were males and 80% had history of hypertension. Patients with HE compared to HU were older (72.7 ± 12.1 vs 61.4 ± 12.7years, p < 0.0001). At baseline 91 patients with HE and 25 with HU were admitted in the hospital and remained for 6.4 ± 5.6days.2 patients from HE group died from nosocomial infection. During the study period82 patients were excluded for not completing the follow-up. Comparing the 2 groups, 11 patients from HE and 3 from HUgroup died (p < 0.0001, HR for HE 4.8,95% CI 1.2–18.6). 8patients from HE and 1 from HU group died from cardiovascular disease (p < 0.0001, HR for HE 13.9,95%CI 1.6–121.1). 3 patients from HE and 2 from HU group died fromnon cardiovascular disease (p = 0.222, HR for HE 2.9,95% CI 0.5–17.3). Cox regression models were adjusted for age, gender, cardiovascular disease, chronic kidney disease, heart failure and diabetes mellitus.

Conclusions:
Our study highlights the elevated hazard ratio for deaths in the group of HE compared with HU, the commitment for more intensive follow-up for the first group and the requirement for further research in this pathological entity.
EFFECT OF A REFERRAL LETTER ON THE DAY OF THE HEALTH CHECKUP TO INCREASE THE CLINICAL FOLLOW-UP RATE IN JAPANESE HYPERTENSIVE EMPLOYEES: A CLUSTER-RANDOMIZED CONTROLLED TRIAL
Authors: Shima Azusa , Arima Hisatomi , Miura Katsuyuki , Tatsumi Yukako , Ohkubo Takayoshi , Kawatsu Yuichiro , Morino Ayumi , Kimura Takashi , Godai Kayo , Azuma Saori , Miyamatsu Naomi 
Published: April 2021

Objective:
To investigate whether a referral letter to general physician given in workplace health checkup increased clinical follow-up rate in the employees who detected grade II or III hypertension.

Design and method:
We conducted a cluster randomized controlled trial at a retail company in which every employee who works for more than 6 hours a day had annual health checkup. A total of 107 supermarket stores were randomly assigned to the control arm (outpatient visit was recommended by a leaflet as usual) or the intervention arm (outpatient visit was recommended by a referral letter to a general physician together with the leaflet). Employees who met the following eligibility criteria were enrolled: (i) BP > = 140/90 mmHg in 2016, (ii) BP > = 160/100 mmHg in 2017, and (iii) not receiving medication in 2017. The primary outcome was the presence of clinical follow-ups for hypertension in outpatient visit within six months after the health checkup, which was assessed using health insurance claim data. Odds ratio (OR) and 95% confidence interval (CI) for the presence of clinical follow-ups in the intervention arm compared with the control arm was estimated using multilevel logistic regression, accounting for the store's level effect.
Study protocol was registered at the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR, ID = 000025411)

Results:
We analyzed 273 participants (mean age was 50.3 years, 55% women) from supermarket stores (control: 135 patients in 52 stores, intervention: 138 patients in 55 stores). Mean systolic blood pressure (standard deviation) was 165 (10) mmHg in the control arm and 164 (10) mmHg in the intervention arm. Clinical follow-up rate was 19.3% (24/135) in the control arm and 34.1% (47/138) in the intervention arm. OR and 95% CI for the presence of clinical follow-ups in the intervention arm compared with the control arm was 2.33 (1.12–4.84).

Conclusions:
Among employees who detected grade II or III hypertension at their health checkups, giving a referral letter to a general physician on the day of the health checkup increased the clinical follow-up rate within six months.