bluuebunny/crossref_metadata_2025_split huggingface dataset:
EFFECTS OF DAPAGLIFLOZIN IN HIGH AND LOW DIETARY SALT INTAKE PATIENTS WITH ALBUMINURIC DIABETIC KIDNEY DISEASE: A SUBANALYSIS OF THE Y-AIDA STUDY
Authors: Kinguchi Sho , Wakui Hiromichi , Misumi Toshihiro , Azushima Kengo , Yamanaka Takeharu , Terauchi Yasuo , Tamura Kouichi 
Published: April 2021

Objective:
Current guidelines recommend the intensive control of BP as well as blood glucose to reduce albuminuria and prevent the development of diabetic kidney disease (DKD). We reported that improved home BP profile with dapagliflozin is independently associated with amelioration of albuminuria in Japanese patients with DKD (Kinguchi, et al. Cardiovasc Diabetol. 2019). The aim of this subanalysis was to investigate the differences in home BP lowering effects between high and low dietary salt intake patients with albuminuric DKD.

Design and method:
The Yokohama Add-on Inhibitory efficacy of Dapagliflozin on Albuminuria in Japanese patients with type 2 diabetes (Y-AIDA) study was a prospective, multicenter, single-arm study. A total of 86 T2DM (HbA1c 7.0–10.0%) individuals with albuminuric DKD (UACR > = 30 mg/gCr, eGFR > = 45 ml/min/1.73m2) were enrolled, and 85 participants were administered with add-on dapagliflozin for 24 weeks. Subgroup analysis, in which patients were classified into 2 groups according to their urinary sodium excretion at baseline, was conducted to determine the change from baseline in home BP profile at week 24.

Results:
At baseline, office systolic BP and morning, evening, and nocturnal home systolic BP were comparable between high urinary sodium excretion group (high group) and low urinary sodium excretion group (low group) (144.0 ± 19.7 vs 140.4 ± 18.4, P = 0.4044; 138.5 ± 12.1 vs 136.4 ± 16.6, P = 0.5179; 137.4 ± 17.6 vs 134.4 ± 17.3, P = 0.4481; 124.7 ± 14.8 vs 125.9 ± 14.9, P = 0.7267). The change in evening home systolic BP was greater in high group than in low group (-13.1 ± 12.0 vs -6.4 ± 11.4, P = 0.0203). The change in office BP, and morning and nocturnal home BP were comparable between high group and low group.

Conclusions:
In albuminuric DKD patients who have high dietary salt intake, add-on dapagliflozin treatment resulted in a greater decrease in evening home BP than in those who have low dietary salt intake.
PREDIABETES, PREHYPERTENSION AND RISK FOR ALL-CAUSE AND CARDIOVASCULAR MORTALITY AMONG US ADULTS: RESULTS FROM THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEYS
Authors: Chen Chao-Lei , Liu Lin , Huang Jia -Yi , Yu Yu-Ling , Shen Geng , Lo Kenneth , Huang Yu -Qing , Feng Ying -Qing 
Published: April 2021

Objective:
Recent studies have suggested that prehypertension and prediabetes are associated with an increased risk for all-cause or cardiovascular mortality but the findings are inconsistent. The purpose of this study was to explore the associations of prehypertension alone, prediabetes alone, and prehypertension combined with prediabetes with risk for all-cause mortality and cardiovascular mortality among healthy US adults.

Design and method:
Data for this study were obtained from the 1999–2014 National Health and Nutrition Examination Surveys (NHANES), a representative survey of the civilian, non-institutionalized US population conducted by the Center for Disease Control and Prevention (CDC). A total of 23622 participants without baseline hypertension, diabetes and cardiovascular disease (CVD) were enrolled after applying the inclusion and exclusion criteria. Prehypertension was defined as systolic/diastolic blood pressure: 120–139/80–89mmHg. Prediabetes was defined as fasting glucose 100–125 mg/dL or a hemoglobin A1c (HbA1c) between 5.7% and 6.4%. Participants were followed for cardiovascular and all-cause mortality through 31 December 2015. Cox proportional hazards models, sensitivity analyses and Kaplan-Meier survival curves were performed.

Results:
Overall, 12272 (51.95%) of subjects at baseline did not have prehypertension and prediabetes, 5841 (24.73%) had prehypertension alone, 2757 (11.67%) had prediabetes alone, and 2752 (11.65%) had both prehypertension and prediabetes. During a median follow-up of 8.58 years, a total of 1039 (4.40%) all-cause deaths and 98 (0.41%) CVD-related deaths occurred. Compared with participants without either prediabetes or prehypertension, the multivariable adjusted hazard ratios for all-cause mortality among participants with prehypertension alone, prediabetes alone, and both prediabetes and prehypertension were 1.01 (95% CI 0.79, 1.3), 1.13 (0.83, 1.53), and 1.17 (0.89, 1.55) (P for trend= 0.199), as well as for cardiovascular mortality were 1.40 (95%CI 0.59, 3.32), 1.31 (0.45, 3.83), and 1.61 (0.64, 4.05) (P for trend= 0.365), respectively. Subgroup analyses by age, gender, race, BMI, smoke status, TG and HDL-C showed no significant interaction.

Conclusions:
Our findings suggested that neither prehypertension nor prediabetes, as well as prehypertension with concomitant prediabetes, was associated with an increased risk for all-cause and cardiovascular mortality.
THE EFFECT OF DAPAGLIFLOZIN ON 24-HOUR BLOOD PRESSURE AND ARTERIAL STIFFNESS IN PATIENTS WITH TYPE-2 DIABETES MELLITUS: A DOUBLE-BLIND RANDOMIZED CLINICAL TRIAL
Authors: Papadopoulou Eirini , Loutradis Charalampos , Tzatzagou Glyceria , Kotsa Kalliopi , Zografou Ioanna , Minopoulou Ioanna , Theodorakopoulou Marieta , Tsapas Apostolos , Karagiannis Asterios , Sarafidis Pantelis 
Published: April 2021

Objective:
Arterial hypertension is present in > 90% of patients and arterial stiffness is a prominent risk factor for heart failure and overall mortality in patients with type-2 diabetes mellitus (DM). Previous evidence suggests that sodium-glucose transporter 2 (SGLT-2) inhibitors can effectively manage hyperglycemia, but also reduce office blood pressure (BP) levels and the incidence of heart failure and death in these patients. The aim of this study is to evaluate the effects of dapagliflozin on ambulatory blood pressure (BP) levels and arterial stiffness parameters in patients with type-2 DM.

Design and method:
This is a double-blind, randomized, placebo-controlled clinical trial including 85 adult patients with type-2 DM on monotherapy or combination therapy with two of: metformin, sulphonylurea, DDP-4 inhibitor, or insulin. Patients were randomized in a 1:1 ratio to oral dapagliflozin 10 mg per day or placebo for 12 weeks. Study participants underwent 24-h ambulatory BP monitoring with the Mobil-O-Graph NG monitor at baseline and study-end.

Results:
Baseline demographic, clinical and laboratory parameters were similar in the two groups (age 61.74 ± 6.73 vs 60.64 ± 9.35; p = 0.534). During follow-up, 24-hour brachial SBP decreased in the active (128.97 ± 12.57 vs 123.17 ± 12.35; p < 0.001) but was similar in the control group (128.95 ± 12.41 vs 128.86 ± 13.45; p = 0.942). 24-hour central SBP/DBP significantly decreased only in the dapagliflozin (117.41 ± 10.52/78.88 ± 7.25 vs 113.30 ± 8.75/77.25 ± 6.54; p = 0.002/p = 0.047) group. Corresponding reductions of 24-hour central SBP (-4.12 ± 8.00 vs -0.65 ± 7.77; p = 0.046) were greater with dapagliflozin than placebo. Aortic pulse pressure (PP) decreased only in the dapagliflozin group (38.53 ± 7.44 vs 36.05 ± 6.59 mmHg; p = 0.004). 24-hour heart-rate adjusted augmentation-index significantly decreased with dapagliflozin. Importantly, there was a significant difference in the change of 24-hour PWV (-0.16 ± 0.32 vs 0.02 ± 0.27; p = 0.007) favoring dapagliflozin.

Conclusions:
Treatment with dapagliflozin produce statistically significant and clinically meaningful reductions in 24-hour brachial and central BP levels and reduce PWV levels in type-2 diabetics. Improvement in these parameters may substantially contribute to the cardiovascular benefits of SGLT-2 inhibitors.
PREVALENCE OF CHRONIC HYPERTENSION IN PREGNANT WOMEN FOLLOWING THE 2017 ACC/AHA GUIDELINE CHANGE IN DIAGNOSTIC CRITERIA FOR HYPERTENSION
Authors: Reynolds Kristi , Zhou Hui , Bider-Canfield Zoe , Cheetham T. Craig , Portugal Cecilia , Bello Natalie A. 
Published: April 2021

Objective:
To examine the effect of the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline for high blood pressure (BP) on the prevalence of chronic hypertension in pregnant women.

Design and method:
We conducted a cross-sectional study among women aged 15–49 years who had a live or stillbirth between 2009 and 2014 within an integrated US healthcare system. We compared the prevalence of chronic hypertension by the 2017 ACC/AHA guideline (defined as BP > = 130/80 mmHg) and the American College of Obstetricians and Gynecologists (ACOG) guideline (defined as BP > = 140/90 mmHg) overall and stratified by maternal age at delivery and race/ethnicity. Chronic hypertension was defined as > = 2 high BPs from outpatient encounters on different days within 30 days and taken < = 20 weeks gestation. The lowest BP value was used when there were multiple measurements from a single encounter. Women dispensed antihypertensive medication and who had a diagnosis of hypertension were classified as having hypertension by both guidelines regardless of BP value.

Results:
A total of 143,191 unique pregnancies were included (mean age was 30.1 years; 51% Hispanic, 26% non-Hispanic White, 8% non-Hispanic Black, 13% Asian). The prevalence of hypertension by ACOG and AHA/ACC was 2.3% and 9.7%, respectively. Using the 2017 ACC/AHA guideline, we identified 108,512 (75.8%) women with normal BP (<120/80 mmHg), 20,808 (14.5%) women with elevated BP (120–129/< 80 mmHg), 12,658 (8.8%) with hypertension stage 1 (130–139/80–89 mmHg), and 1,213 (0.9%) with hypertension stage 2 (> = 140/90 mmHg). Using ACOG criteria, 139,937 (97.7%) women had BP < 140/90 mmHg (31,425 of these women (22.5%) had BP 120–139/80–89 mmHg) and 3,254 (2.3%) women had hypertension (27 of these women (0.8%) had severe hypertension defined as BP> = 160/110 mmHg). Younger women and non-Hispanic whites and Hispanics experienced larger increases in the prevalence of hypertension by the 2017 ACC/AHA guideline (Figure).

Conclusions:
Adoption of the 2017 ACC/AHA guideline to define hypertension increased the prevalence of chronic hypertension in pregnancy over 300%. Further research is needed to examine whether this lower threshold for defining hypertension in pregnancy is associated with increased maternal and neonatal complications.
PARAMETERS OF CHANGING COAGULATION SYSTEM IN PREGNANT WOMEN WITH PREECLAMPSIA
Authors: Kurbanov Bakhodir 
Published: April 2021

Objective:
The reasons for the development of preeclampsia are multifactorial, complex and not fully understood. However, according to modern concepts, the leading role belongs to endothelial damage, changes in platelet function, as well as immunological and genetic factors. Purpose of our study: to investigate changes of hemostasiological indicators in women with preeclampsia.

Design and method:
We conducted a study of the blood coagulation system in 68 pregnant women in the third trimester, of which 34 were pregnant with a physiological course of the gestational period (control group) and 38 pregnant women with preeclampsia (main group). The age of the women surveyed ranged from 20 to 42 years. The average age of women in the main group was 28.13 ± 0.83, and in the control group, 29.27 ± 0.70 years.

Results:
A significant decrease in the average platelet count in women with severe preeclampsia relative to healthy pregnant women in the third trimester of pregnancy (161.2 ± 9.6 × 109 / l and 193.5 ± 8.7 × 109 / l) (P < 0.05) When studying platelet aggregation activity, we found that platelet aggregation activity was significantly higher in the main group –112.7 ± 3.5 compared with the control group — 99.8 ± 3.3 (P < 0.05).
The concentration of fibrinogen, the main substrate of blood coagulation, was slightly higher in pregnant women with preeclampsia - 4.0 ± 0.2 g / l than in women with physiological pregnancy - 3.5 ± 0.17 g / l. In pregnant women with preeclampsia in the III trimester, a statistically significant shortening of ABP was established - 43.9 ± 0.9 seconds compared with the control - 51.2 ± 0.2 seconds (P < 0.001).

Conclusions:
Women with preeclampsia have signs of a subacute form of disseminated intravascular coagulation and signs of thrombocytopathy and consumption coagulopathy in combination with a decrease in blood anticoagulant and fibrinolytic potential.
ATTENUATION OF PLACENTAL LIPID DEPOSITION BY GLUTAMINE SUPPLEMENTATION IMPROVES FETAL OUTCOME IN INSULIN-RESISTANT PREGNANT RATS
Authors: Olaniyi Kehinde , Olatunji Lawrence 
Published: April 2021

Objective:
Maternal metabolic adaptation is critical for placental and fetal development, growth and survival. However, evidence exists that indiscriminate consumption of fructose-enrich drink (FRD) during pregnancy disrupts maternal-fetal metabolic tolerance and/or glucose homeostasis with consequent adverse pregnancy outcomes. Glutamine supplementation (GLN) has been shown to exert a modulatory effect in metabolic pathologies. Nevertheless, the effects of GLN on FRD-induced placental lipotoxicity during pregnancy are unknown. The present study was conducted to investigate the protective effects of GLN on pregnancy outcomes of female rats exposed to gestational FRD.

Design and method:
Pregnant Wistar rats weighing 160–180 g were randomly allotted into control, GLN, FRD and FRD+GLU groups (6 rats per group). The groups received vehicle (p.o.), glutamine (1 g/kg), fructose (10%; w/v) and fructose plus glutamine respectively throughout the period of gestation. Insulin resistance (IR) and insulin sensitivity were estimated by homeostatic model of assessment (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI) respectively. Plasma and tissue biochemical analysis were determined using enzyme-linked immunosorbent assay kits or fluorescence assay as appropriate.

Results:
Data showed that FRD increased placental weight and decreased fetal length and weight. It also caused maternal insulin resistance with correspondent increase in blood glucose, plasma insulin and decreased insulin sensitivity. In addition, FRD increased placental triglyceride, total cholesterol, low density lipoprotein-cholesterol, free fatty acid, atherogenic lipid, lipid peroxidation (malondialdehyde), lactate and uric acid synthesis, and decreased nitric oxide, adenosine and glucose-6-phosphate dehydrogenase-dependent antioxidant defense.

Conclusions:
The present study demonstrates that high FRD consumption during pregnancy causes placental lipotoxicity-driven defects with consequent fetal growth restriction. The findings also suggest that glutamine supplementation improves fetal outcome by ameliorating placental defects through suppression of uric acid synthesis and lipid peroxidation, as well as enhancement of NO-dependent endothelial function and antioxidant defense (Figure 1). Similarly, the study also suggests that glutamine supplementation in pregnancy could be useful as a reprogramming intervention to prevent impaired placental-fetal development and subsequent newborn and adulthood metabolic-related syndromes (Figure 1).
MISMATCH BETWEEN AVAILABLE CAPACITY AND ESTIMATED NUMBER OF PHYSICIAN VISITS NEEDED FOR HYPERTENSION CARE: AN ANALYSIS OF WORLDWIDE DATA
Authors: Neupane Dinesh , Gao Yumin , Feng Yijing , Matsushita Kunihiro , Appel Lawrence J. 
Published: April 2021

Objective:
In most countries, only physicians are allowed to prescribe antihypertensive medication. Thus physician capacity (number of clinic visits physicians can allocate for hypertension care) is a key determinant of hypertension control. The objective of this study is to estimate the gap in clinic visits between available visit capacity and number of visits needed for hypertension care worldwide.

Design and method:
Data from the Global Health Observatory of World Health Organization and the World Bank were used to calculate the total number of hypertensive patients in each country. We assumed that the average physician would have 5,000 clinic visits/year and patients with hypertension require at least three visits a year. The gap in clinic visits between available capacity and patient need was calculated for each country. The analysis was further stratified based on income group according to the World Bank classification.

Results:
We estimated that 67 countries do not have the capacity to provide at least three visits to each hypertensive patient (countries in light to dark orange/red in Figure). Most of those countries are in Sub-Sharan Africa (63%), East Asia and Pacific (16%) and South Asia (9%), and all are in lower middle income or low-income countries. Of these countries, 38 countries cannot provide even a single visit to a hypertensive patient. On the other hand, 98% of high-income countries and 77% of upper-middle-income countries have the capacity to provide at least three visits per patient per year. The largest gap is seen in India followed by Indonesia, Ethiopia and Bangladesh.

Conclusions:
There is a huge gap in clinic visits between available capacity and the estimated need for hypertension care in low and middle income countries. To fill this gap, countries will need additional physicians or more likely implement a system of task sharing with allied health workers, such as nurses and community health workers.
THE ASSOCIATIONS BETWEEN HYPERTENSION AND STROKE FROM MAY MEASUREMENT MONTH AND BETWEEN NATIONAL HYPERTENSION PARAMETERS WITH STROKE MORTALITY FROM THE GLOBAL BURDEN OF DISEASE
Authors: Lin Queran , Ye Tingxi , Beaney Thomas , Poulter Neil R. 
Published: April 2021

Objective:
To characterise the association between stroke history and hypertension from the 2017 and 2018 May Measurement Month (MMM) blood pressure (BP) screening campaigns.
To identify whether national-level MMM hypertension parameters are associated with national stroke mortality statistics.

Design and method:
Three BP readings and self-reported demographic, lifestyle and cardiovascular risk factors were collected from 2,515,578 participants in 95 countries. National stroke mortality statistics and Socio-Demographic Index (SDI) were extracted from the Global Burden of Disease (GBD) study 2017. Hypertension was defined as a raised BP (systolic BP > = 140 mmHg or diastolic BP > = 90 mmHg based on the mean of the second and third readings), or on antihypertensive medication.
Multiple imputation using chained equations was performed to estimate mean BP readings where missing. Logistic and linear regression were applied, respectively, to the association between hypertension and stroke and between national-level GBD stroke mortality with MMM proportions with raised, treated and uncontrolled BP.

Results:
Low-middle-SDI countries in MMM had the highest age-sex standardised proportion of participants with a previous stroke (4.9%), compared with high-middle-SDI countries (1.4%). Globally, individuals with a history of stroke had a significantly higher mean BP than those without (6.6/1.7 mmHg higher, p < 0.001). Amongst post-stroke participants, antihypertensive medication appeared to mitigate the impact of lifestyle factors on the odds of hypertension.
Stroke mortality increased, on average, by 34 per 100,000 per 1% increase in the proportion of untreated individuals with raised BP (p = 0.006) and by 22 per 100,000 per 1% increase in proportion with treated but uncontrolled BP (p = 0.003). Stroke mortality decreased, on average, by 14 per 100,000 per 1% increase in the proportion of hypertensives treated (p = 0.01).

Conclusions:
Our study found suboptimal BP control among participants with a previous stroke globally, especially in low SDI countries. There was a significant association between national stroke mortality from GBD and the proportions of participants with raised or uncontrolled BP and of hypertensives treated in MMM. This suggests that despite lacking a population-based design, estimates from MMM broadly reflect rates of downstream mortality and that opportunistic screening can be an effective means of screening for hypertension.
FEASIBILITY AND ACCEPTABILITY OF A NOVEL INTEGRATION OF ABSOLUTE CARDIOVASCULAR DISEASE RISK ASSESSMENT INTO ROUTINE BLOOD CHOLESTEROL TESTING
Authors: Chapman Niamh , Fonseca Ricardo , Murfett Leigh , Beazley Kevin , Mcwhirter Rebekah , Schultz Martin , Nelson Mark , Sharman James 
Published: April 2021

Objective:
Absolute cardiovascular disease (CVD) risk assessment is recommended for primary prevention of CVD, yet uptake in general practice is limited. Lipid profile requests at pathology services provides an opportunity to improve uptake by integrating absolute CVD risk assessment with this service. This study aimed to assess the feasibility of such an additional service.

Design and method:
299 participants (aged 45–74 years) referred to pathology services for blood cholesterol had variables required to determine absolute CVD risk measured (blood pressure, age, sex, smoking and diabetes status). Data were recorded via self-report on a computer-based application with minimal direction from staff. The absolute risk score was communicated via the report sent to the referring medical practitioner as per usual practice. Evaluation questionnaires were completed immediately post visit and at 1-, 3- and 6-month follow-up via telephone (n = 262).

Results:
Absolute CVD risk reports were issued for 90% of participants. Most participants (95%) reported that the length of time for the pathology service assessment was acceptable, and 91% that the self-directed computer-based application was easy to use. 78% reported a preference for pathology services to conduct absolute CVD risk assessment. Only 2% preferred a medical practitioner. Of follow-up participants, 202 (75%) had a consultation with a medical practitioner, during which, aspects of CVD risk prevention were discussed (cholesterol and blood pressure 74% and 69% of the time, respectively).

Conclusions:
Measurement of absolute CVD risk in pathology services is feasible, highly acceptable among middle to older adults and may increase uptake of guideline-directed care in general practice.
STUDY ON REDUCTION OF MICROALBUMINURIA AMONGST HYPERTENSIVE PATIENTS WITH USE OF TRIPLE COMBINATION THERAPY (TRIPLIXAM)
Authors: Arun Abhishek 
Published: April 2021

Objective:
Persistent microalbuminuria is earliest indicator of Chronic Kidney Disease amongst hypertensive patients and is also associated with target organ damage resulting in stroke, retinopathy and adverse cardiovascular outcomes.
The present study was aimed to evaluate the reduction in microalbuminuria amongst uncontrolled essential hypertensive patients with use of triple combination therapy.

Design and method:
It was a hospital based cross sectional prospective study done on 50 essential hypertension patients having uncontrolled blood pressure and presence of microalbuminuria in urine. Total duration of therapy was 3 months and triple combination therapy used in study as antihypertensive was Triplixam (Perindopril 4 mg, Amlodipine 5 mg and Indapamide 1.25 mg). Patients having Diabetes and other co morbidities were excluded from the study. Patients were evaluated at baseline and end of study visit for SBP,DBP, Urine for albumin excretion. Ethical clearance was taken prior to inclusion of patients.

Results:
There was significant reduction in both SBP (18 mm Hg) and DBP (10 mm Hg) with use of triple combination therapy (Triplixam). Microalbuminuria turned to normal albumin excretion in urine that was statistically significant (p < 0.01) was most significant and convincing finding.

Conclusions:
Triplixam is an excellent triple agent that can reduce blood pressure promptly and bring about reduction in urine albumin excretion thereby decreasing risk of end target organ damage. Early detection of renal dysfunction through microalbuminuria and prompt treatment can confer future protection from end stage renal disease.