bluuebunny/crossref_metadata_2025_split huggingface dataset:
HYPERTENSIVE URGENCY, EMERGENCY AND KIDNEY FUNCTION
Authors: Jug Juraj , Prkacin Ingrid , Eder Gregor , Prkacin Ingrid 
Published: April 2021

Objective:
The aim of this study was to determine risk factors for hypertensive crisis development just as an impact of the kidney function on it.

Design and method:
From January to October 2019, 237 patients (109 males, 128 females) with hypertensive crisis were analyzed at the Emergency department in Clinical Hospital Merkur, Zagreb. We defined the hypertensive crisis as a rapid increase in blood pressure above 180/120mmHg (SBP range 182–260mmHg). Hypertensive crises were divided into two subgroups due to the evidence of end-organ damage. Elementary lab results and pulse wave velocity were checked in all patients.

Results:
Hypertensive urgency was found in 184 patients (77.64%), emergency in 53 (22.36%). Comparison of these two subgroups showed that patients with an emergency were significantly older (70.51 vs. 64.44 years, p < 0.01), had significantly elevated serum glucose levels (10.04 vs. 6.94mmol/L, p < 0.0001), decreased glomerular filtration rate (CKD-EPI formula 75.96 vs. 59.15 mL/min/1.73m2, p < 0.0001) and high heart rate (mean 96.32 vs. 77.17bpm, p < 0.0001) which showed as the most significant risk factor. Body mass index didn’t show any relevance in the hypertensive crisis development (31.26 vs. 30.58 kg/m2, p = 0.18). Hypertensive emergency incidence increased with a decline in kidney function. Such events developed in 16.94% patients with CKD stage 1, 14.42% in stage 2, 34.61% in stage 3a, 50.00% in stage 3b, 60.00% in stage 4 and 50.00% in stage 5. Within main groups, patients were divided into two groups whether they used antihypertensive medication. A group of 53 patients was without medication (22.36%) of which 13 met criteria for a hypertensive emergency. Pulse wave velocity was much higher in patients with CKD-EPI < 45 ml/min/1.73m2 (13.01 vs. 10.74m/s, p = 0.01). Even though female patients were significantly older (69.02 vs. 62.02years, p < 0.0001), no other differences between genders were found.

Conclusions:
Age, elevated plasma glucose and a decline in glomerular filtration rate combined with high heart rate values, but gender and body mass index independently are the main factors which are linked to the development of hypertensive emergency.
DIFFERENCE IN THE EFFECT OF RENAL DENERVATION ON HEART RATE VARIABILITY IN RESISTANT HYPERTENSION WITH AND WITHOUT DISTURBANCE OF GLUCOSE METABOLISM AFTER 12 MONTH FOLLOW-UP
Authors: Manukyan Musheg , Shelemekhov Aleksey , Falkovskaya Alla , Mordovin Victor , Pekarskiy Stanislav , Zyubanova Irina , Lichikaki Valeriya , Kurlov Igor , Baev Andrey 
Published: April 2021

Objective:
To investigate the effects of renal denervation (RDN) on heart rate variability (HRV) in resistant hypertension (RHTN) with and without disturbance of glucose metabolism.

Design and method:
In a single-arm prospective interventional study with renal denervation (NCT02667912 and NCT01499810 on ClinicalTrial.gov) were included 87 patients with RHTN: 39 patients without disturbance of glucose metabolism (RHTN group) (mean age 51.2 ± 8.5years, 20 (51%) men, 24-hour (24 h) blood pressure (BP) (systolic/diastolic) 162.3 ± 19.4/99.6 ± 13.5 mmHg); 34 patients with type 2 diabetes mellitus (RHTN + DM group) (mean age 59.2 ± 7.8 years, 11 (32%) men, 24 h BP 157.8 ± 17.4/80.1 ± 12.4 mmHg, mean HbA1c 6.9 ± 1.4%) and 14 patients with impaired glucose tolerance (RHTN + IGT group) (mean age 54.0 ± 10.0 years, 3 (27%) men, 24 h BP 156.6 ± 14.3/89.5 ± 15.6 mmHg). All patients were underwent ABPM and 24-h Holter monitoring with analysis of time and frequency domain-based HRV. Follow-up after 12 months was completed by 38 patients of RHTN group, 22 patients of RHTN + DM group and 9 patients of RHTN + IGT group.

Results:
There was a significant decrease in 24 h BP in all groups at 12 months after RDN (p < 0,001). In the RHTN group, there were no significant changes in both high frequency (HF) and low frequency (LF) (for HF from 14.8 (8.6; 24) to 29.5 (19.0; 40), p > 0.05, and for LF (from 23.1 (15, 0; 61) to 61.0 (40.5; 70), p > 0.05). There were also no significant changes in both LF and HF in the RHTN + IGT group (for LF from 52 (38; 61) to 50 (42; 61), p > 0.05, for HF from 37 (30; 50) to 44 (29; 47), p > 0.05). On the contrary, in the RHTN + DM group, there was a significant decrease in LF (from 55 (39; 63) to 50 (42; 61), p = 0.004), which occurred independently from BP effects, and a non-significant increase in HF. Other measured HRV parameters (mean NN, SDNN, SDNN-I, SDANN-I, r-MSSD, pNN50) were unchanged in all groups (p > 0.05).

Conclusions:
RDN was associated with a reduction of LF, HRV parameters that mainly reflect sympathetic overactivity, only in patients with resistant hypertension and diabetes mellitus.
RENAL SODIUM HANDLING ABNORMALITY IN OBSTRUCTIVE SLEEP APNEA-RELATED HYPERTENSION
Authors: Shiina Kazuki , Tomiyama Hirofumi , Fujii Masatsune , Nakano Hiroki , Chikamori Taishiro 
Published: April 2021

Objective:
Obstructive sleep apnea (OSA) has been much focused as one of underlying factors of resistant hypertension. A substantial number of mechanisms (sympathetic nerve activation, oxidative stress, renin-angiotensin-aldosterone system, systemic inflammation and fluid retention) contributed to OSA-related hypertension, and these factors can lead to resistant hypertension. However, renal sodium handling abnormality in OSA patients with hypertension has not been fully clarified.

Design and method:
We evaluated the urine sodium excretion before and after continuous positive airway pressure (CPAP) therapy in OSA. 24-h urinary sodium excretion was estimated at baseline and after 6 months of CPAP using the Kawasaki formula, and fractional urinary sodium excretion (FENa) was also calculated in 23 OSA patients with hypertension.

Results:
In patients with severe OSA, 24 h Na excretion had no significant correlation with AHI, abdominal circumference and plasma aldosterone. After CPAP therapy, systolic blood pressure significantly decreased (P < 0.05), and estimated sodium excretion significantly increased compared to baseline (P < 0.05). The increase in Na excretion was significantly associated with BP reduction by CPAP therapy.

Conclusions:
These results suggested that urine sodium excretion abnormality contribute to the blood pressure elevation in patients with OSA.
Therefore, urine sodium excretion may be a key mechanism in managing OSA-related hypertension.
THE ASSOCIATION BETWEEN BLOOD PRESSURE AND PHYSICAL ACTIVITY DURING CLIMBING MT. FUJI -THE COMPARISON STUDY WITH DAILY LIVING-
Authors: Komori Takahiro , Hoshide Satoshi , Kario Kazuomi 
Published: April 2021

Objective:
Hiking and mountaineering are one of the aerobic exercises, and blood pressure (BP) changes greatly. In high altitude, cardiovascular response is differed from daily living. However, BP change during mountaineering in high altitude was not clear at high altitude. The hypothesis of this study is to investigate BP change and physiological response during mountaineering at high altitude.

Design and method:
We enrolled cumulative 14 healthy people. Multi-sensor ambulatory blood pressure monitoring which has barometer, thermometer, and accelerometer was performed during climbing Mt. Fuji. Climbing was started from 5th station of Mt. Fuji, and study participants stayed overnight at summit of Mt. Fuji research station. Pulseoxymetry was performed during sleep. Ambulatory blood pressure monitoring during daily living was performed in another day.

Results:
Blood pressure parameters were significantly higher during climbing than daily living (24-hr SBP: 119 ± 6 mmHg vs. 113 ± 5, p < 0.01, Awake SBP: 125 ± 9 mmHg vs. 118 ± 6 mmHg, p = 0.01, Sleep SBP: 106 ± 8 mmHg vs. 100 ± 5 mmHg, p < 0.01). Atmosphere, temperature, and activity were significantly associated with BP parameters during mountaineering. Compared to daily living, BPs during mountaineering was strongly correlated with activity. (figure)

Conclusions:
BP change during mountaineering was significantly associated with activity. BP response to the activity was different between high altitude and daily living.
RECLASSIFICATION OF CARDIOVASCULAR RISK IN PATIENTS WITH UNCOMPLICATED ARTERIAL HYPERTENSION WHO SAW PRIMARY CARE PHYSICIANS FOR THE FIRST TIME
Authors: Nebieridze David , Kamyshova Tatiana , Safarian Anush , Sarycheva Anna , Sargsyan Vardui 
Published: April 2021

Objective:
Assessment of changes in the structure of cardiovascular risk (CVR) determined by the SCORE scale (Systematic Coronary Risk Evaluation) in patients with arterial hypertension, who first contacted with primary care setting, taking into account the target organ damages (TOD) identified during additional examination.

Design and method:
300 men and women (aged 40–65) with newly diagnosed uncomplicated hypertension were included in the study. All patients underwent medical examination, history taking to identify risk factors, blood pressure measurement, biochemical blood, blood lipids assessment. Based on the specified parameters, the risk was determined by SCORE scale. After that additional examination was done aimed at revealing TOD: echocardiography, duplex ultrasonography of the brachiocephalic arteries and determination of microalbuminuria. Based on the results obtained, the CVR was reclassified taking into account the presence of TOD

Results:
The study showed frequent prevalence of TOD in patients with different CVR assessed by the SCORE scale. In the high and very high risk groups the prevalence of TOD was 96.5% and 98.1%, respectively. Attention was drawn to the high prevalence of TOD in the moderate risk group – 73.1%. The obtained data significantly changed the structure of CVR. The main changes affected patients with moderate and high CVR: the number of moderate risk patients decreased by 31.7%, while the number of patients with high risk increased by 36.7%. As a result, if initially high CVR had 28,7% pts (86 pts) assessed by SCORE scale after taking into account the presence of TOD 62.3% pts (186pts) were classified as high risk ones (p < 0,001). So there was an impressive changes in the structure of CVR towards to increase of high-risk patients.

Conclusions:
The results of the study indicate that TOD determination should be an inseparable part of the screening of hypertensive pts who see primary care physicians first time. It would provide correct estimation of the CVR and the development of adequate strategy of patient treatment aimed at effective decrease of cardiovascular mortality.
EFFECTIVENESS AND SAFETY OF NUTRACEUTICAL COMPOUNDS ADDED TO EZETIMIBE TREATMENT IN HYPERTENSIVE AND HYPER–CHOLESTEROLEMIC SUBJECTS WITH STATIN–INTOLERANCE
Authors: Mazza Alberto , Nicoletti Mariaceleste , Lenti Salvatore , Torin Gioia , Rigatelli Gianluca , Fratter Andrea , Pellizzato Marzia 
Published: April 2021

Objective:
The effectiveness of statins in the primary and secondary prevention of cardiovascular (CV) diseases has been widely proven. However, the onset of adverse events associated with their use, prevents to achieve the therapeutic targets recommended by the guidelines (GL) for the management of dyslipidaemia. In the event of statin intolerance, is recommend to use bile acid sequestrants, fibrates and ezetimibe in monotherapy, but their benefits in improving lipid pattern are quite modest. This study aims at evaluating the effectiveness and safety of a nutraceutical compound (NC) associated with ezetimibe (E) on the lipid profile in statin-intolerant patients with moderate-to-high CV risk

Design and method:
Ninety-six statin-intolerant hypertensive and hyper-cholesterolemic subjects treated with E 10 mg daily, were randomised in open label (n = 48) to take for 3 months a NC containing Monacolin K (MK) 5 mg, Berberine Hydrochloride, t-Resveratrol, Quercetin, and Chromium, in the form of a gastro-resistant tablet that improves enteric bio-accessibility and bio-availability of these substances. The control group (n = 48), took only E in monotherapy at the same dosage; both groups followed a standardised lipid-lowering diet. The total serum cholesterol (TC), low density lipoprotein cholesterol (LDLC), high density lipoprotein cholesterol (HDLC), triglycerides (TG), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and creatinine phosphokinase (CPK) levels were compared at the follow-up in both groups using Student's t-test.

Results:
TC and LDL levels reduced in both groups, but there lower in the group treated with E+ NC vs E alone (-25.9 vs -15%, p < 0.05 and -38.7 vs. -21.0%, p < 0.05, respectively). No changes were observed in either group regarding to a decrease in TG (-9.4 vs. -11.7%, NS) and an increase in HDLC (+ 4.2 vs. +1.1%, NS). The AST, ALT and CPK levels increased in the E + NC compared to the control group, but were still within the acceptable range. There was no difference for the lipid-lowering treatment between gender, and no patient withdrawn the study.

Conclusions:
In hypertensive and hyper-cholesterolemic subjects with statin-intolerance, the E + NC combination therapy is well-tolerated and effective in the short term in improving TC and LDLC levels.
EFFECTS OF EXERCISE TRAINING ON ARTERIAL STIFFNESS IN PATIENTS WITH HYPERTENSION: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Lopes Susana , Afreixo Vera , Teixeira Manuel , Garcia Catarina , Leitão Cátia , Gouveia Marisol , Alves Alberto J. , Oliveira José , Mesquita-Bastos José , Ribeiro Fernando 
Published: April 2021

Objective:
This review aims to determine the effects of exercise training on arterial stiffness, namely Pulse Wave Velocity (PWV), in patients with hypertension. The identification of possible moderator variables of the effect of exercise on PWV was defined as a secondary objective.

Design and Methods:
For this systematic review and meta-analysis (PROSPERO CRD42019138658), MEDLINE, Scopus, Cochrane and Web of Science were searched up until July 2019. Randomized controlled trials assessing the effect of exercise interventions lasting 4 or more weeks on PWV in (pre)hypertensive subjects were included. The standardized mean difference between the pre-post of the intervention group versus the control group was calculated for PWV using the Cohen's d index as the effect size statistic. The type of exercise, PWV assessment site, use of medication, baseline PWV and study quality assessment score were used to perform subgroup analysis.

Design and method:
Fourteen trials, involving 15 exercise groups (5 aerobic, 2 dynamic resistance, 6 combined, and 2 isometric resistance groups), totaling 694 subjects with pre- and hypertension (374 exercise). Exercise program duration ranged from 4 to 26 weeks, with a mean duration of 13.1 ± 6.1 weeks. The overall effect size showed statistically significant differences in PWV [(d (95% CI) = 1.35 (0.72, 1.98)] in favor of the exercise group. Aerobic exercise [d (95% CI) = 1.93 (0.31, 3.55)], combined exercise [d (95% CI) = 0.79 (0.09, 1.49)] and isometric resistance exercise [d (95% CI) = 2.23 (1.66, 2.81)] reduced PWV for the exercise group when compared to the control group. There was no significant reduction in PWV in subjects undertaking dynamic resistance training [d (95% CI) = 0.69 (-2.32, 3.69)]. Subgroup analysis demonstrated that the positive effects of exercise training on PWV are independent of medication use, PWV assessment site, study quality assessment score and baseline PWV, although higher baseline PWV values presented a more significant reduction with exercise.

Results:
Aerobic, combined and isometric resistance exercise significantly decreased PWV in (pre)hypertensive patients. Despite the small number of studies, data from the isometric resistance exercise has the potential for the largest reductions in PWV.
THERAPEUTIC EFFECTS OF MINERAL CORTICOID RECEPTOR BLOCKER IN THE COMBINATION ANTIHYPERTENSIVE DRUG THERAPY IN HYPERTENSIVE PATIENTS
Authors: Murayama Yoshiki , Yokoyama Shohei , Abe Makoto , Nagase Akihiko , Ohira Takehiro , Iwashima Yoshio , Tojo Akihiro , Ishimitsu Toshihiko 
Published: April 2021

Objective:
Among the components of renin-angiotensin-aldosterone system, aldosterone is supposed to facilitate the progression of cardiovascular organ injuries not only by promoting renal tubular Na reabsorption but also by causing oxidative stress, inflammation and cardiovascular tissue hypertrophy and fibrosis. Therefore, mineral corticoid receptor blockers (MRB) are expected to exhibit protective effects against cardiovascular organ injuries in hypertensive patients. In the present study, the therapeutic effects of MRB in the combination antihypertensive treatment were examined in hypertensive patients.

Design and method:
Fifty mg eplerenone (EPL) was added to 24 hypertensive patients under antihypertensive drug therapy who were not achieved the target blood pressure levels. The combination was continued for 3 to 4 months and the effects on blood pressure (BP) and laboratory data including renal function and cardiovascular endocrine system were evaluated.

Results:
After 3–4 months, office BP was lowered from 148/91 to 135/86 mmHg (p < 0.001/p = 0.002) as well as the home BP (morning 150/86 to 134/81, p = 0.001/p = 0.033; evening 139/80 to 127/74, p = 0.005/p = 0.030). Serum K (4.2 to 4.3mEq/L, p = 0.014) and creatinine (0.82 to 0.87 mg/dL, P < 0.001) were slightly but significantly increased. Serum uric acid was significantly also increased from 5.8 to 6.4 mg/dL (p = 0.015). However, the indices of glucose metabolism and serum lipids were not affected. In addition to the natural increases in plasma renin and aldosterone, plasma B-type natriuretic peptide (BNP: 23 to 17 pg/mL, p = 0.028) and urinary albumin excretion (111 to 70 mg/gCr, p = 0.009) were significantly decreased.

Conclusions:
In the combination antihypertensive drug therapy, MRB is expected to cardiac and renal injuries and the influences on glucose and lipid metabolisms seem negligible, however, care should be taken for the development of hyperuricemia and renal dysfunction in addition to hyperkalemia.
ADHERENCE DECREASES WITH HIGHER NUMBER OF MEDICATIONS IN CONTROLLED HYPERTENSIVE PATIENTS, CONTROLLED RESISTANT PATIENTS HAVE LOWER ADHERENCE THAN CONTROLLED NON-RESISTANT PATIENTS
Authors: Siddiqui Mohammed , Gupta Pankaj , Tomazewski Maceij , Patel Prashanth , Oparil Suzanne , Calhoun David 
Published: April 2021

Objective:
Controlled hypertension in treated hypertensive patients is defined as controlled blood pressure (BP) in clinic (automated office BP [AOBP] < 130/80 mmHg) and out-of-clinic by 24-hr ambulatory blood pressure monitoring (ABPM < 125/75 mmHg). Uncontrolled resistant hypertension (RHTN) is defined as uncontrolled blood pressure (BP) on 3 or more medications, including a diuretic; BP controlled on 4 or more medications is defined as controlled RHTN. Controlled non-RHTN is BP controlled on 3 or less medications. Antihypertensive medication adherence is known to decrease with increase in number of antihypertensive medications, as well as medication adherence is lower in patients with uncontrolled RHTN. Unknown is the relative medication adherence in patients with controlled hypertension with number of antihypertensive medications and medication adherence in controlled RHTN versus controlled non-RHTN.

Design and method:
In this prospective evaluation patients were recruited from the Hypertension Clinic after having controlled BP readings at 3 or more clinic visits. All the patients were evaluated by in-clinic AOBP with use of the BpTRU device, out-of-clinic 24-hr ABPM monitoring and 24-hr urine collection to determine antihypertensive medication adherence by high-performance liquid chromatography-tandem mass spectrometry. After excluding patients with masked uncontrolled hypertension, 82 patients were controlled by AOBP and 24-hr ABPM. Of these, 40 patients had controlled RHTN and 42 patients had controlled non-RHTN.

Results:
Higher number of prescribed antihypertensive medications was associated with lower levels of medication adherence in patients with controlled hypertension. In addition, patients with controlled RHTN (72.7%) had significantly lower medication adherence than controlled non-RHTN (90.9%).

Conclusions:
Similar to uncontrolled hypertension, patients with controlled hypertension have less medication adherence with use of higher numbers of antihypertensive medications. In addition, similar to uncontrolled RHTN, patients with controlled RHTN have lower medication adherence than patients with controlled non-RHTN.
A PRACTICAL APPROACH TO SWITCH FROM A MULTIPLE PILL THERAPEUTIC STRATEGY TO A POLYPILL-BASED STRATEGY FOR SECONDARY PREVENTION IN PATIENTS WITH HYPERTENSION
Authors: Coca Antonio , Kreutz Reinhold , Manolis Athanasios , Mancia Giuseppe 
Published: April 2021

Objective:
The recommendation in hypertension is to initiate treatment with a combination of two blood pressure-lowering drugs in a single pill regardless of the cardiovascular (CV) risk, to add a statin in patients with established CV disease (CVD) or at moderate or high risk, and to add as well an antiplatelet agent only among those with established CVD.
Some clinical guidelines nowadays endorse the polypill approach to increase the efficiency of the pharmacological treatment and decrease CV morbidity and mortality. The CNIC polypill is the only CV polypill marketed in Europe and the only approved by the EMEA for the secondary prevention of CVD. This polypill contains aspirin, ramipril, and atorvastatin. We aimed at helping clinicians to start treatment with the CNIC polypill switching from any other statin to atorvastatin, and from any angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) to ramipril.

Design and method:
We looked for available data and recommendations to build tables of equivalent effective daily doses of two of the polypill components (ramipril and atorvastatin), and we developed a treatment algorithm based on expert opinion.

Results:
We provide the approximate equivalent effective daily doses of other ACEIs and ARBs with ramipril and of other statins according to atorvastatin's potency. Moreover, to guide clinicians in the management of patients for secondary prevention of CVD, we provide a treatment algorithm and detail the indications and different available preparations to start treatment with the CV polypill in patients with high BP and prior CVD, and how to associate other BP-lowering drugs or lipid-lowering drugs if need be. Finally, we give advice on how to switch and adapt the treatment of patients already on fixed-dose combinations of antihypertensive medications to initiate the CV polypill regimen.

Conclusions:
The multiple doses of the individual components of the CNIC polypill versions allow for increased flexibility in prescribing and use it to start treatment in patients with high BP and prior CVD, and probably also in the particular scenario of hypertensive patients at high CVD risk without previous CV event and no significant risk of major bleeding.