bluuebunny/crossref_metadata_2025_split huggingface dataset:
CLINICAL FACTORS AND HYPERTENSION ASSOCIATED WITH HOSPITAL READMISSION IN HEART FAILURE PATIENTS
Authors: Tun Han Naung , Raza Syed Haseeb 
Published: April 2021

Objective:
To systematically investigate the patients’ perspectives about the reasons for their hospital readmission related to hypertension after discharged of stabalized HF patients and to study how to improve our heart failure care system to reduce the number of readmission in cost effective way.

Design and method:
Patients were recruited for this study was admitted to national institute of cardiovascular diseases, through emergency department. Patients discharged with a primary discharge diagnosis for HF who were then readmitted for any cause in the subsequent 6 month were eligible for the study. We recruited patients over the period of 3 month form June 2019 till August 2019. Eligible patients were approached, consented, and interviewed within the next 24 hours while they were still in hospital.

Results:
For the readmission, median length of stay was 6 days. Total 500 patient included, out of which 375 (75%) were male and most important cause of heart failure is ischaemic cardiomyopathy 400 (80%). No death recorded. Common reasons for readmission are lack of counselling 200(40%), under dose 75(15%), non-compliance 60(12%), volume over load 50(10%), hypertension 50(10%), secondary infection 35(7%). Only 50 out of 500 patients which is 10 % of the study participants were associated with hypertension in hospital readmission. Out of 500 patients, 80% had ischemic cardiomyopathy which is directly proportional to HF.

Conclusions:
We concluded that hypertension is not largely associated with heart failure hospitalization in our single center study. But patient compliance of medication, appropriate fluid intake, self-care and life style modification are the important elements in hospital readmission of heart failure.
OUTCOMES OF A QUALITY ASSESMENT PROGRAM FOR HYPERTENSION MANAGEMENT IN A UNIVERSITY HOSPITAL
Authors: Lemo Tatiana , Kotliar Carol , Princz Magdalena , Obregon Sebastian 
Published: April 2021

Objective:
We developed an institutional Clinical Practice Guidelines for hypertension (HT) management in a large university hospital, and after one year of its approval and communication we follow up its rate of implementation by physicians.

Aims:
Four outcomes (metrics) were defined and established as objectives; 1) rate of office BP measurement registered in electronic clinical record first 6 months of the year, 2) rate of reaching BP goals in hypertensives (office BP < 140/90 mm Hg), 3) rate of ambulatory (out of office) BP measurement in (ABPM/HBPM) outpatients diagnosed with HT in the last year, and 4) rate of evaluation of hypertension-mediated organ damage through transthoracic echocardiogram (TTE) in outpatients with diagnosis of HT, in the last year.

Design and method:
A random sample of 500 cases (Excel™ randomization function, incremental order) was analyzed, from a total population of 72393 clinical visits from January to July 2019 attending to General Medicine, Cardiology, Hypertension Unit, Diabetes and Nephrology. All subjects were 18 years or older, both genders.
Each visit was evaluated, and only those corresponding to clinical evaluations were included, excluding those visits related to evaluation of medical studies results or administrative. This sample was randomly follow-up until 50 subjects diagnosed with HT were identified.

Results:
A final random selected sample of 206 consultations was included, and after exclusion of not valid data (n:72), we analyzed 134 valid cases. Diagnosis of HT was reported in 50 (37.3%) and rate of BP properly registered in clinical record from the whole population was 63.43% (123 / 74.7 mm Hg). Among those with HT, BP registration rate was 72% (128.83 / 76.5 mm Hg), and 61.1% at therapeutic goals. The utilization rate of ABPM/HBPM was 22.2%., and 64% for TTE in the last year.

Conclusions:
BP registration and use of ABPM/HBPM were suboptimal, but BP control in HT subjects was largely better than reported in epidemiological studies in Argentina. A significative HMOG evaluation was observed. Monitoring clinical performing lead to improvement in management of HT.
VERIFY AND EVALUATE FOUR SPOT URINARY METHODS FOR ESTIMATING 24-HOUR URINARY SODIUM EXCRETION RATE IN TIBETAN POPULATION
Authors: Zhang Xin , Chen Xiaoping 
Published: April 2021

Objective:
To verify and evaluate four spot urinary methods for estimating 24-hour urinary sodium excretion rate in Tibetan population (Kawasaki method, Tanaka method, INTERSALT method and SH2 method).

Design and method:
323 subjects were selected from the Ganzi Tibetan Autonomous Prefecture of Sichuan Province, China. The morning second urine samples and 24 hours urine samples were collected. The concentrations of creatinine, sodium and potassium in the morning second urine samples and 24 hours urine samples were measured. To compare the mean deviation, correlation, and consistency between the measured values and estimated 24-hour urinary sodium excretion by Kawasaki method, Tanaka method, INTERSALT method and SH2 method.

Results:
The average differences between the estimated values and measured values by Kawasaki method, Tanaka method, INTERSALT method and SH2 method were 124.86 mg/days, -937.58 mg/days, -1314.15 mg/days and -1747.436 mg/days, respectively. The correlation coefficient with the measured values was 0.434, 0.38, 0.273 and 0.348, respectively. The intraclass correlation coefficient was higher for Kawasaki method (0.473) than for Tanaka method (0.397), INTERSALT method (0.269) and SH2 method (0.348). The Bland Altman analysis showed 3.4%, 6.2%, 5.9% and 5.6% of the subjects’ estimated values exceeded the consistent boundary of ± 1.96 for Kawasaki method, Tanaka method, INTERSALT method and SH2 method. When four spot urinary sodium methods used for evaluating the individual salt intake, the misclassification rate was more than 45%. Compared with the other three methods, the misclassification probability of Kawasaki method was 48.2%, while the misclassification probability of Tanaka, INTERSALT and SH2 methods was 72.1%, 75.5% and 74.6%, respectively. However, when individual's salt intake was higher than 12.8 g/days, the probability of misclassification of Kawasaki method, Tanaka method, INTERSALT method and SH2 method was 20%, 90%, 97.5% and 97.5%, respectively.

Conclusions:
When the Kawasaki method is used to evaluate the salt intake of Tibetan population, the deviation, consistency and reproducibility were better than Tanaka method, INTERSALT method and SH2 method. It was especially suitable for the evaluation of 24-hour urinary sodium excretion rate of people with high salt intake. It can be used to investigate the salt intake of Tibetan population in a large-scale epidemiological study.
ADHERENCE AND ASSOCIATED FACTORS OF ANTIHYPERTENSIVE DRUGS AMONG ADULT HYPERTENSIVE PATIENTS AT CHRONIC FOLLOW UP CLINICS OF WEST GOJJAM ZONE, NORTH-WEST ETHIOPIA 2020
Authors: Yirga Zelalem , Elfu Birhanu , Mehari Zelalem , Abiye Melkam 
Published: April 2021

Objective:
To assess the adherence and associated factors of anti hypertensive medications among adult hypertensive patients at chronic follow up clinics of West Gojjam, North West Ethiopia.

Design and method:
Institutional based cross-sectional study was conducted in chronic follow up clinics of randomly selected hospitals from June 1/2020-June15/2020. Systematic Random sampling technique used to select participants and pretested structured questioner with observation of medical charts, and the MMAS-8 tool was used to assess the adherence status. Data entered to Epi-Info version-7.3 and analyzed by SPSS version-25. Variables with P-value < 0.25 in bi-variate logistic regression analysis entered to multivariate logistic regression. P-value < 0.05 used to determine the statistical association.

Results:
Among five hundred forty one participated hypertensive patients, 60.6% participants were male and the mean age of the participants was 54.39 and SD of ± 11.4. The adherence level of the participants was 61.4%(95%CI = 0.573–0.655). Factors like, abused by alcohol (AOR = 0.213,95%CI = 0.072–0.632), rural residency (AOR = 0.423, 95% CI = (0.224–0.798), forgetful of taking the medication (AOR = 0.116–95%CI = 0.063–0.213), poor knowledge about treatment and control of hypertension (AOR = 0.191, 95%CI = 0.085–0.43), and thinking AHD as non-useful (AOR = 0.537, 95%CI = 0.309–0.936) were inversely associated with adherence.

Conclusions:
Only 61.4% of the participants found adherent, which is below the WHO standards. Adherence to anti hypertensive medications affected by the residency, knowledge status, forgetfulness, attitude towards the medications, and alcohol abuse. Adherence counseling and patient education about hypertension and its treatment is important to improve adherence status of patients.
SHIFT WORK IN NURSES AND 7-DAY/24H AMBULATORY BLOOD PRESSURE MONITORING
Authors: Siegelova Jarmila , Havelkova Alena , Krabkova Marie , Dusek Jiri , Dunklerova Leona , Pohanka Michal , Dobsak Petr , Cornelissen Germaine 
Published: April 2021

Objective:
The aim of the study is to evaluate seven day/24 h ambulatory blood pressure monitoring (ABPM) during shift work in nurses and compared then with 170 healthy subjects from our database of 7 day/24 h ABPM.

Design and method:
297 healthy subjects and ten shift workers in hospital were monitored during shift work. The seven day working process was composed from the day with day work shift, night work shift systolic and diastolic blood pressure and weekly mean blood pressure values from the seven-day/24-h ambulatory blood pressure monitoring T 2431 (A and D, Japan).

Results:
In healthy subjects with aerobic training, seven days of systolic blood pressure was 115 ± 1.1 mmHg, diastolic 69 ± 1.4 mmHg, in days with exercise (0–24 h) systolic blood pressure was 115 ± 2.8 mmHg, diastolic 69 ± 1, 7 mmHg, in days without exercise (25–48 h) systolic blood pressure was 116 ± 3.4 mmHg, diastolic 69 ± 2.2 mmHg.
In healthy subjects with combined training seven days of systolic blood pressure blood pressure was 113 ± 1.8 mmHg, diastolic 68 ± 1.4 mmHg, days with exercise (0–24 h) systolic blood pressure were 112 ± 1.9 mmHg, diastolic 69 ± 1, 5 mmHg, in days without exercise (25–48 h) systolic blood pressure was 113 ± 1.8 mmHg, diastolic 68 ± 1.4 mmHg.
In patients with myocardial infarction, seventy-day mean systolic blood pressure was 122 ± 4 mmHg, diastolic 74 ± 3 mmHg, in days with exercise (0–24 h) systolic blood pressure was 121 ± 3 mmHg, diastolic 74 ± 2 mmHg, in days without exercise systolic blood pressure 121 ± 3 mmHg, diastolic 73 ± 3 mmHg.

Conclusions:
Our results showed that 1 hour of aerobic training, combined training did not change the 24-hour mean blood systolic and diastolic blood pressure profile assessed from a seven-day ambulatory blood pressure monitoring (7 days / 24 hours) in healthy subject and in patients, if the timing of exercise is during the day hours (6:00–22:00).
CHARACTERISING A NOVEL MODEL OF SUPER-IMPOSED PRE-ECLAMPSIA
Authors: Scott Kayley , Morgan Hannah , Graham Delyth , Delles Christian 
Published: April 2021

Objective:
The stroke-prone spontaneously hypertensive (SHRSP) rat is a model of chronic hypertension and defective vascular remodelling during pregnancy that can be stressed by administration of angiotensin II (ANGII) to mimic super-imposed pre-eclampsia. This novel model has been tested with doses of 500 ng/kg/min and 1000 ng/kg/min ANGII.
The aim of this study was to characterise the pathology of this model with a dose of 750 ng/kg/min to enhance reproducibility and refine the model.

Design and method:
SHRSP and normotensive Wistar Kyoto (WKY) females were time mated with males of the relevant strain. On gestational day (GD) 10.5 mini osmotic pumps were implanted administering either 0.9% saline or 750 ng/kg/min of ANGII. SHRSPs were split into either SHAM (saline) or ANGII groups. WKY received saline only. At pre-pregnancy (PP), GD 6.5, 14.5 and 18.5 blood pressure, cardiac function and uteroplacental blood flow were measured by tail cuff plethysmography and ultrasound. Urine was collected by metabolic cage at PP, GD6.5 & 18.5 to assess proteinuria.

Results:
ANGII showed reduced pregnancy-related weight gain vs WKY and SHAM (168.3 ± 3.7 g vs 231.2 ± 3.0 g vs 183.3 ± 5.9 g, p < 0.001). ANGII showed an increased BP when compared to SHAM and WKY (180.9 ± 9.7mmHg vs 127.5 ± 6.5mmHg vs 139.8 ± 7.1 mmHg p < 0.001 GD18.5). ANGII dams showed signs of left ventricular cardiac dysfunction with an elevated relative wall thickness and reduced stroke volume and cardiac output vs WKY (p < 0.05). ANGII and SHAM exhibited impaired uteroplacental blood flow vs WKY at GD18.5 (0.57 ± 0.03au vs 0.62 ± 0.05au vs 0.38 ± 0.02au, p < 0.01). Infusion of ANGII successfully induced proteinuria, measured as urinary albumin:creatinine compared to SHAM and WKY (12.2 ± 8.28 μg/μmol/L vs 0.16 ± 0.01 μg/μmol/L vs 3.9 ± 0.40 μg/μmol/L, p < 0.001).

Conclusions:
The results presented here show this model has effectively captured the overall disease picture of pre-eclampsia with consistent disease characteristics such as proteinuria, hypertension, maternal cardiovascular impairment and dysregulated uterine artery remodelling. It may serve as a useful tool in the study of pre-eclampsia.
CARDIORENAL CONSEQUENCE IN A CHILD WITH LATENT HEPATITIS B
Authors: Rodoman Iulia , Ina Palii , Eva Gudumac , Tatiana Raba , Angela Ciuntu , Lucia Pirtu , Adrian Chiriac , Ilona Cucu , Diana Bujor 
Published: April 2021

Objective:
Approximately 20% of patients with HBV infection have a wide range of extrahepatic damages that include renal and cardiovascular abnormalities. The purpose: is to highlight the cause of hypertension in a child with viral hepatitis B and multiorgan damage.

Design and method:
Describing a clinical case of a child with occult hepatitits.

Results:
A 1-year-old girl with toxic syndromes was hospitalized in Pediatric Department. Anamnestic data: the mother was diagnosed with HBsAg positive 4 years ago. The child was vaccinated with all 4 scheduled doses of anti-HBV vaccine. At first examination - increased BP values (160–220/100–120 mm/Hg), tachycardia, hepatomegaly. Laboratory tests: anemia gr. II, hypoproteinemia, hypoalbuminemia, hypocalcemia, slightly elevated transaminases. Ecocardiography - cardiac remodeling with dilated lef ventricle (LV); hypokinesia, and mild hypertrophy of interventricular septum; LV ejection fraction - 47%.
The secondary causes of arterial hypertension have been investigated: concentration of fractionated urinary and plasma metanephrines - N, direct plasma renin - > 5000 UI/mL, and serum aldosterone - 128 ng / dL. The aldosterone/renin ratio was 0.025 - suggestion of renal ischemia with secondary hyperaldosteronism. Cardiac and abdominal angioCT - severe hypoplasia of the common hepatic artery, moderate diffuse stenosis of the abdominal aorta at the renal and infrarenal levels, moderate diffuse stenosis of the bilateral renal arteries, more pronounced on the right, bilateral renal atrophy changes; cateterism cardiac - the aorta is permeable throughout, stenosis on the renal arteries, celiac trunk, and mesenteric artery was not determined, data that allowed the exclusion of the renovascular cause of hypertension. Abdominal MRI - focal areas 7x8 mm of diffusion restriction in the bilateral renal parenchymal.
The patient was suspected of an HBV infection with a risk of perinatal transmission, after in dynamics, there was identified hepatomegaly (+3.0 cm) and elevated ALAT and ASAT. Quantitative plasma HBV DNA -1 418 771 300 copies/ml or 834 571 352 IU/ml, which confirmed the diagnosis - Occult viral hepatitis B, gr. III of activity, seropositive form, with extrahepatic cardiorenal impairment.

Conclusions:
Cardiorenal impairment should be suspected in patients with HBV infection, especially in presence of clinical signs.
ENHANCED PRODUCTIONS OF INTRARENAL NLRP-3 INFLAMMASOME AND ANGIOTENSINOGEN IN ANGIOTENSIN II-DEPENDENT HYPERTENSION ARE PREVENTED BY IMMUNOSUPPRESSANT TREATMENT
Authors: Navar Luis Gabriel , Franco Martha , Katsurada Akemi , Dugas Courtney , Satou Ryousuke 
Published: April 2021

Objective:
Activated inflammasomes enhance maturation of pro-inflammatory cytokines, which facilitates the development of kidney injury. NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3), one of major subunits in the inflammasome complex, plays a crucial role in innate immunity and inflammation. NLRP3 inflammasome is activated by ATP-P2X7 axis and reactive oxygen species. Expression of pro-NLRP3 is promoted by activated NF-κB by cytokines or PAMPs/DAMPs. In angiotensin II (Ang II)-dependent hypertension, there is augmentation of renal immune cells leading to enhanced production of cytokines and consequent activation of NF-κB. Therefore, we hypothesized that intrarenal NLRP3 levels are increased in Ang II-dependent hypertension in association with the kidney injury, and treatment with mycophenolate mofetil (MMF), an immunosuppressant, prevents the augmentation of NLRP3 and attenuates the consequent progression of kidney injury.

Design and method:
Ang II (80 ng/min) was infused with/without daily MMF administration (50 ng/kg) to male rats for 2 weeks. mRNA levels of intrarenal NLRP3 and AIM2, which forms another type of inflammasome complex by viral or bacterial infections, were measured by droplet digital PCR. Furthermore, levels of intrarenal angiotensinogen (AGT), a critical contributor to activation of intrarenal renin-angiotensin system leading to the development of hypertension and associated kidney injury, were evaluated. Histological analyses of kidney injury were also performed.

Results:
MMF prevented increases in intrarenal macrophage/monocyte and IL-6 levels induced by Ang II infusion, confirming immunosuppression by the drug. Ang II infusion significantly increased intrarenal NLRP3 levels (control group: 4.12 ± 1.1 copies/ng RNA vs. Ang II-infused group: 9.96 ± 1.8 copies). The elevated NLRP3 expression was attenuated by MMF (6.24 ± 1.4 copies). In contrast, intrarenal AIM2 levels were not altered by Ang II infusion or MMF. Urinary protein and AGT levels were elevated in Ang II-infused rats, which were prevented by MMF. Histological analyses showed mesangial expansion and tubulointerstitial fibrosis observed in Ang II-infused group, but these injury markers were in normal ranges in the group receiving Ang II + MMF.

Conclusions:
These results demonstrate activation of the NLRP3 inflammasome in Ang II dependent hypertension and indicate that immunosuppression by MMF mitigates the inflammasome activation, which contributes to attenuation of the kidney injury.
CHANGE IN HEMODYNAMIC PARAMETERS AND CAROTID STIFFNESS INDICES AFTER VITAMIN K2 SUPPLEMENTATION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
Authors: Marinova Elena , Dimova-Mileva Maria , Kanazirev Branimir 
Published: April 2021

Objective:
Vitamin K2 is a cofactor of gamma-carboxylase activating group of vitamin K-dependent proteins involved in vascular calcification and arterial stiffness. Data on the protective effects of vitamin K2 supplementation in the progression of vascular damage in patients with type 2 diabetes mellitus (T2DM) are scarce.

Aim:
to investigate the change in systolic (SAP), diastolic (DAP), pulse (PP), mean (MAP) blood pressure, central systolic aortic pressure (CASP), pulse wave velocity (PWV) and beta-stiffness index (BSI) in patients with T2DM after vitamin K2 supplementation.

Design and method:
We included 18 patients with T2DM (mean age 59.09 ± 8.5 men 38.8%) who received Vitamin K2 (Menaquinone-7) 75 μg once daily for a period of 4 weeks. Patients with overt cardio-vascular diseases, uncontrolled blood pressure and vitamin K-antagonists intake were excluded from the study. Hemodynamic parameters were measured using an A-pulse CASP-AL device. Carotid stiffness indices were measured by one-point echo-tracking method with Aloka Hitachi Prosound on the both common carotid arteries (CA).

Results:
All hemodynamic parameters showed increased values compared to the baseline: SAP (+5 mmHg) (p = 0.1), DAP (+2.9mmHg) (p = 0.19), PP (+1.4mmHg) (p = 1.4), MAP (+3.4 mmHg) (p = 0.08). CASP increased from 119.8 ± 12.1mmHg to 126.8 ± 11.4 mmHg (+5 mmHg), and this change was significant (p = 0.02). PWV on the right CA did not change significantly before (7.0 ± 1.48 m/s) and after (7.19 ± 1.28 m/s) supplementation (p = 0.47), similar to BSI 10.08 ± 3.41 and respectively 10.51 ± 3.99 (p = 0.61). PWV on the left CA before supplementation is 7.01 ± 1.22 m/c, respectively after 7.19 ± 1.56 m/c (p = 0.49). BSI on the left CA is 9.97 ± 2.79, resp. 10.69 ± 5.07 (p = 0.43).

Conclusions:
Vitamin K2 supplementation for four weeks showed significant increase in CASP in our cohort of patients with T2DM. The other hemodynamic parameters as well as the indicators of carotid stiffness do not change significantly. A limitation of our study is the small number of patients included and the short period of intake of vitamin K2, which may not lead to morphological changes in the vessel wall. More extensive research is needed in the field.
HYPERTENSION PHENOTYPES, TARGET ORGAN DAMAGE AND STIFF ARTERIES AND SEVERITY OF COVID-19
Authors: Mahmud Azra , Alhabdan Nawaf Abdulaziz , Alkhdiri Mohammad Hamad , Alahaideb Ruba , Rajendrum Rajkumar 
Published: April 2021

Objective:
Since the Coronavirus Disease 2019 (COVID-19) pandemic began, conflicting reports have emerged regarding its association with hypertension (HTN) in various populations worldwide. However, there is paucity of data regarding the association between the severity of COVID-19 and HTN phenotypes and HTN mediated organ damage (HMOD).

Design and method:
In a cohort of patients (n = 501, mean age 53.5 ± 14.6) attending a specialist hypertension clinic at King Abdulaziz Cardiac Center, Riyadh, Saudi Arabia, we identified patients diagnosed with COVID-19 between January and November, 2020. We compared HTN phenotypes and HMOD in patients admitted with severe COVID-19 infection to those with mild disease and without disease. Data were analysed using JMP version 13 Pro (SAS for Windows).

Results:
Twenty-seven patients developed COVID-19 (5.38%), 8 of whom were admitted (29.6%), with one fatality (3.8%). Patients admitted with COVID-19 were more likely to have refractory HTN (43% vs. 15% vs. 8.9%, p < 0.01), body mass index > 30 (85.7% vs. 46% vs. 47%, p < 0.05), left ventricular hypertrophy (28.6% vs. 7.7% vs. 6.5%, p < 0.01), high hs-CRP (7.8 ± 1.1 vs. 2.1 ± 2 vs. 5 ± 1.5, p < 0.01) and greater central systolic pressure (132 ± 5 vs. 122 ± 7 vs. 110 ± 13, p < 0.01) with no difference in age and gender.

Conclusions:
In hypertensive patients, severe COVID-19 is associated with severe uncontrolled hypertension with HMOD and stiff arteries. While this is a small single center study, it does highlight aspects of COVID-19 in hypertensive patients which warrant further investigation.