bluuebunny/crossref_metadata_2025_split huggingface dataset:
Causal and observational evidence on the role of early menopause in hypertension
Authors: Roa Diaz Z M , Asllanaj E , Amin H A , Rojas L Z , Nano J , Ikram M A , Drenos F , Franco O H , Pazoki R , Marques-Vidal P , Voortman T , Muka T 
Published: October 2021

Abstract

Introduction
Blood pressure has been suggested as potential factor contributing to the increased risk of cardiovascular disease observed in women experiencing early menopause (&lt;45 years). However, whether the association between early menopause and hypertension is causal remains unclear (1,2).

Purpose
To evaluate the observational and causal association between age at natural menopause (ANM) and blood pressure (BP) traits in Caucasian women.

Methods
Cross-sectional and one-sample Mendelian randomization (MR) study was conducted in 4451 postmenopausal women from two different cohort studies. Hypertension was defined as a systolic BP (SBP) ≥140 mmHg, and/or diastolic BP (DBP) ≥90 mmHg, and/or the use of antihypertensive medication. Multivariable linear and logistic regressions were implemented in the observational analysis. We calculated a weighted genetic risk score with 54 variants associated with ANM (GRS-ANM) (3). The genetic variants were previously identified in a genome wide association study (4), after that we implemented two-stage least squares in the one-sample MR. Estimates from all cohorts were pooled through meta-analysis

Results
The pooled analysis across cohorts showed early menopause, compared to menopause between 50–54 years, to be associated with lower DBP (β=−1.31 mmHg, 95% CI: −2.43; −0.18), while no association was found between other ANM categories and DBP. Similarly, the pooled analysis of both cohorts did not show an association of ANM with SBP, neither as a continuous variable nor by category. One year of later onset of menopause was associated with higher odds of developing hypertension (Odds ratio (OR): 1.02, 95% CI: 1:00; 1.04) while no association was found for the ANM categories and hypertension (Table 1). Results of the evaluation of MR assumption, supported their compliance, the GRS-ANM was associated with observed ANM and explained between 1.4% and 3.4% of the ANM variance in the included cohorts, F statistic values were among 11.15 and 40.63 (Figure 1). We found no association between GRS-ANM and SBP, DBP or hypertension (Table 1).

Conclusion
The present study does not support the hypothesis that early onset of menopause is associated with higher BP.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): The CoLaus study was and is supported by research grants from GlaxoSmithKline, the Faculty of Biology and Medicine of Lausanne, and the Swiss National Science Foundation (grants 33CSCO-122661, 33CS30-139468 and 33CS30-148401).Zayne M. Roa-Díaz has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 801076, through the SSPH+ Global PhD Fellowship Programme in Public Health Sciences (GlobalP3HS) of the Swiss School of Public Health.
Blood pressure control in the general and high risk populations, longitudinal trends
Authors: Bruthans J , Mayer O , Cifkova R 
Published: October 2021

Abstract

Introduction
Despite better control of high blood pressure (BP) in the general as well as high cardiovascular (CV) risk populations as a factor contributing to the decrease in CV mortality since 1990, the targets set by the guidelines may not have been reached.

Purpose
We analysed longitudinal trends in BP control in the general and high risk populations, to assess implementation of guidelines and to identify subpopulations with still unsatisfactory BP control.

Methods
Analysis of seven independent surveys of the general population (Czech MONICA and post-MONICA studies, 1985–2017) and five independent surveys of patients with stable manifest coronary heart disease (CHD) 1995–2017 (Czech samples of the EUROASPIRE I-V surveys).

Results
A total of 15 000 persons (Czech MONICA) and 2 098 patients (Czech EUROASPIRE) were investigated. In the 1985–2017 period, mean systolic BP decreased in the general population (MONICA) from 134 to 128 mmHg (p&lt;0.001) and diastolic BP from 84 to 82.5 mmHg (p&lt;0.01), hypertensive levels of BP (&gt;140/90mmHg) were found in 45% in 1995 but only in 27.5% in 2017, and the prevalence of uncontrolled severe hypertension (BP&gt;180/110 mmHg) decreased from 3 to 1%. The proportion of properly controlled hypertension increased from 13.2 to 53% (p&lt;0.0001). In the 1995–2017 surveys of the high-risk population (EUROASPIRE) systolic BP decreased from 144.1 to 135.5 mmHg (p&lt;0.001), diastolic BP from 87.5to 83.5mmHg (p&lt;0.01), higher than recommended BP (&gt;140/90mmHg, &gt;140/85mmHg in diabetics) was found in 66.2% in 1995, still present as much as in 54.4% in 2017. Proportion of patients with very high BP (BP&gt;180/110 mmHg) decreased from 18.4 to 1% only. Drugs with a potentially antihypertensive effect were used in 79.9 and 95.3% of patients in 1995 and 2017, respectively (p&lt;0.0001). Population BP levels ceased to decline since 2000/01 survey, in the CHD population since the 2012/13 survey. This is obviously due to considerable increase in prevalence of obesity, and an increasing prevalence of diabetes, both in the general and high-risk populations. The more intensive medical high BP treatment seems to have a beneficial effect on hypertension control, even more in the general than in the high risk population.

Conclusions
The recent trend in BP levels, both in the general and high-risk populations, are far from satisfactory, with the main causative factor suggested to be the increasing prevalence of obesity and diabetes. While there has been progress in hypertension control, more in the general nad limited in high-risk population, truly effective BP control may be illusory without comprehensive CV risk factor control.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Agency for Medical Research, Ministry of Health of the Czech Republic
Renal denervation in truly resistant hypertensive patients: six-year follow-up results of a single-center study
Authors: Ionov M , Emelyanov I V , Yudina Y S , Panarina S A , Zverev D A , Avdonina N G , Zvartau N E , Konradi A O 
Published: October 2021

Abstract

Background
Renal sympathetic denervation (RDN) is one of the invasive treatment options for the patients with hypertension (HTN) who are resistant to antihypertensive therapy (AHT). The short-term efficacy of RDN has been proven in a number of randomized clinical trials, but remains controversial, the data on its long-term efficacy are limited.

Purpose
To evaluate the natural course of HTN, to assess long-term major adverse cardiovascular events (MACEs) and other clinically significant outcomes, as well as AHT efficacy and its features in patients with truly resistant HTN after bilateral RDN during extended prospective follow-up.

Methods
We included 22 patients with truly resistant HTN (median 57 y.o., 9 males), in whom RDN was performed during 2012–2015 in the clinical center of excellence. We assessed initial and further (after 1 year and after ≥5 years) office and 24-hour BP values, as well as AHT history in detail. Long-term MACEs and other cancer-related outcomes were recorded. The baseline quality of life (QoL) and its dynamics were assessed with the use of EQ-5D-5L questionnaire at all timepoints. Multiple linear regression was used to find possible predictors of the efficacy of RDN.

Results
The median follow-up after the RDN was 6 (from 5 to 8) years. A significant decrease in office and 24-hour systolic (S) and diastolic BPs was observed at 12 months after RDN compared to initial values (Δ −24 and −12 mm Hg, p&lt;0.005; Δ −10 and −7 mm Hg, p&lt;0.05, respectively). There were 7 patients with office SBP on-target (&lt;140 mm Hg), and 12 patients were considered responders (SBP decrease more than 10 mm Hg from the baseline). These numbers increased to 10 and 14 patients after 6 years after RDN, respectively. A causal relationship between changes in office SBP was found only for SBP baseline values (β −0.6, p=0.02). No differences in the number of medications were noted during follow-up (4.4 versus 4.1 versus 4.1 drugs, p=0.41). We have recorded 10 MACEs and 5 cancer cases with various types with no fatal outcomes. The QoL significantly improved at 12 months after RDN (+9.7 points, p=0.01), however a negative trend was observed in the next 6 years (−13,8 points, p=0,02) with return to the reference. No association was observed between BP and QoL changes in two timepoints (p=0,65).

Conclusions
The RDN shows a pronounced clinical effect in patients with resistant HTN up to 6 years, and is not accompanied by an AHT intensification, and also is not associated with QoL changes. The initial positive trend for QoL completely harked back after 5 years which may be associated with the development of MACEs. The only predictor of RDN positive effect seems to be baseline office SBP levels.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Russian Science Foundation Study flow-chartChanges in BPs during follow-up
Is the minimal mitral regurgitation a marker of high blood pressure, and can predispose to the appearance of atrial fibrillation?
Authors: Paterno Marchioli C A 
Published: October 2021

Abstract

Background
Leonardo da Vinci intuited that the cardiac valves were the key to the functioning of the heart. Minimal mitral regurgitation (MMR) in young's is often interpreted as haemodynamically insignificant, it is attributed that it starts from birth or named para-physiologic effect. Pathophysiological changes in the arterial wall can lead to mitral regurgitation, left atrial enlargement, and atrial fibrillation (AF).

Purpose
The aim of this study is to know if the presence of MMR is a consequence of the High Blood Pressure (BP), and whether in the own evolution can contribute to the appearance of the AF.

Methods
For this cross-sectional retrospective study, data were collected from 436 patients. Female-Male: 249–187 from the 20 to the 89 years old, mean age (±SD) 59.6 (16.5) – 59.7 (16.1), divided and analyzed in each one of them all 7 decades. All patients had MMR. Some patients were unaware of having hypertension, others with and without antihypertensive therapy. The measures of BP were registered in mmHg. The finding of AF was confirmed with the presence of brief phases in the 24hs-Holter monitoring. The Central Haemodynamic Parameters (CHP) were measured with a SphygmoCor System PVX (AtCor-Medical Australia), a validated device employing the high-fidelity technique of applanation tonometry according to established protocols. Also, the difference of Augmentation Index (between the normal levels and the observed values) was assessed according to the normal range by age.

Results
In all patients female - male, the mean (±SD) of SBP/DBP 142.7 (24.5)/83.7 (13.6) – 137.7 (20.2)/82.4 (11.3) was higher than normal levels of BP accepted by ESC/ESH. All measures of CHP and SBP/DBP increased with age in each decade, in female from the 20s 120.3 (18.9)/76.7 (14.1) to the 80s 160.4 (21.1)/86.0 (25), and in male from the 20s 133.7 (16.7)/78.9 (6.4) to the 70s 142.8 (23.5)/78.8 (12.4), but slightly decreased in the 80s 138.4 (20.4)/76.6 (8.0). The difference of Augmentation index (surrogate value of arterial stiffness) in all decades was higher too, for both genders. In the adult total sample, in female - male the AF reached 26.5% - 27.8%, beginning after 33 years old, and strongly increased its prevalence after the 60s to a top of 50.0% - 43.8% at 80s.

Conclusions
MMR can be an early marker of high BP levels, the prevalence increasing with age, and it would be a predisposing condition to evolving to AF. The appearance of MMR principally among younger can indicate that the brachial BP found is higher than “normal”, needing any time to modify the original ventricular geometry toward myocardial remodelling, Therefore, it should be reassessed the optimal levels of BP to avoid its complication.

Funding Acknowledgement
Type of funding sources: None.
Sex-specific associations of evening blood pressure burden and cardiac load with nocturia severity in the Japanese at high-risk of cardiovascular disease
Authors: Nagai M , Hoshide S , Kario K 
Published: October 2021

Abstract

Background
Earlier epidemiologic studies have reported a significant relationship between hypertension and nocturia. However, the underlying pathophysiology has not been established. We hypothesized that blood pressure (BP) burden, the classes of antihypertensive agents and cardiac load were associated with severity of nocturia, and that these associations might be moderated by gender.

Purpose
To investigate the relationships of home BP (HBP) level, the class of antihypertensive agent, brain natriuretic peptide (BNP) with nocturia severity, and to investigate these associations stratified by gender in the Japanese at high-risk of cardiovascular disease.

Methods
In the Japan Morning Surge-Home Blood Pressure Study, measurements of HBP at evening (mean 11.2 days) as well as BNP were performed in the 4310 patients with one or more cardiovascular risks (64.9 years old, male 47%). A self-administered questionnaire included items on nocturia was used.

Results
According to the number of nocturia (no void: n=2382; one void: n=847; &gt;2 voids per night: n=1082), significant associations of systolic BP (SBP) at evening (130 vs 130 vs 132 mmHg, p&lt;0.0001) and logBNP (1.20 vs 1.30 vs 1.42, p&lt;0.0001) were observed with nocturia severity. In the multinomial logistic regression analysis adjustment for confounders including age, smoking, total cholesterol, fasting blood glucose, HbA1c and clinic SBP, the use of diuretics (OR: 1.26, 95% CI: 1.06–1.52, p&lt;0.05) was significantly associated with one nocturnal void, while evening SBP (OR: 1.009, 95% CI: 1.003–1.014, p&lt;0.01) and logBNP (1.43, 95% CI: 1.19–1.73, p&lt;0.001) were significantly associated with multiple nocturnal voids. While no significant interaction was found between evening SBP and logBNP for multiple nocturnal voids in the total population, a significant interaction was found between evening SBP and logBNP for multiple nocturnal voids in females (p&lt;0.05).

Conclusions
In this study, the use of diuretics was a significant indicator of single nocturnal void, while evening SBP and BNP were those of multiple nocturnal voids in the high-risk Japanese population. Specifically, in the females, treatment to reduce BP burden as well as cardiac overload might be important to improve sleep disturbance caused by nocturia.

Funding Acknowledgement
Type of funding sources: None.
Myocardial work in overweight and obesity: impact of sex and central haemodynamics
Authors: Lindseth K T , Gerdts E , Midtboe H , Pristaj N , Cramariuc D , Einarsen E 
Published: October 2021

Abstract

Background
Women with increased body mass index (BMI) have better left ventricular (LV) global longitudinal strain (GLS) than men. LV global myocardial work index (GWI) is a novel measure of myocardial function that adjusts for afterload and offers the opportunity to differentiate between early systolic dysfunction and elevated myocardial workload.

Purpose
To investigate sex differences in myocardial work in women and men with increased BMI.

Methods
Clinical and echocardiographic data from 467 participants (61% women, average age 47±9 years) with a BMI above 27 kg/m2 and without cardiac disease was analysed. Central pulse wave analysis was assessed by applanation tonometry. GWI was calculated by GLS and post-echocardiography blood pressure (BP). Covariables of GWI were identified by linear regression analysis with collinearity tools.

Results
Women had higher BMI (31.4 vs. 31.0 kg/m2) and higher aortic augmentation pressure (12±7 vs. 8±6 mmHg), but lower clinic systolic BP (127±17 vs. 134±14 mmHg) compared to men (all P&lt;0.05). Women also had higher LV GLS (20.0±2.8 vs. 18.8±2.8%) and GWI (2126±385 vs. 2047±389 mmHg%) (both P&lt;0.05). In univariable regression analyses, higher GWI was significantly associated with higher age, clinic systolic BP, wall stress, ejection fraction, aortic augmentation pressure, left atrial size, and LV ejection time, and with lower waist circumference (all P&lt;0.05), but not with BMI. In multivariable linear regression analyses, adjusting for these correlates, female sex was independently associated with higher GWI (Table 1, model 1). After additional adjustment for aortic augmentation pressure, the association between GWI and sex became non-significant (Table 1, model 2).

Conclusions
Women with increased BMI have higher GWI compared to men, despite lower BP. Higher GWI in women is mainly explained by elevated workload due to higher central aortic stiffness.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Western Norwegian Regional Health Authorities
Parameters of treadmill exercise test and sympathetic activation are linked to the development of hypertension in subjects with high normal blood pressure
Authors: Kalos T , Dimitriadis K , Konstantinidis D , Tatakis F , Drogkaris S , Manta E , Dri E , Thomopoulos C , Tousoulis D , Tsioufis K 
Published: October 2021

Abstract

Background/Introduction
The clinical importance of a hypertensive response to exercise (HRE) in subjects with high normal blood pressure (BP) is not fully elucidated, while sympathetic overactivity followed by arterial stiffening are linked with development of hypertension.

Purpose
The aim of this study was to assess parameters related to the development of hypertension in a 3 year follow in subjects with high normal BP.

Methods
One hundred consecutive subjects with high normal office BP (54±8 years, 42 males, baseline office BP: 132/82 mmHg, 24-hour BP: 122/76 mmHg) at baseline underwent a negative for ischemia treadmill exercise test. Arterial stiffness was evaluated on the basis of carotid to femoral pulse wave velocity (PWV) values and sympathetic drive was assessed by muscle sympathetic nerve activity (MSNA) based on established methodology. SBP/MET-slope defined as: peak systolic BP–resting SBP)/(peak MET-1) was assessed. Follow up was scheduled every 6 months for 3 consecutive years, where BP was measured both in the office and with ambulatory blood pressure monitoring. End point was the development of hypertension diagnosed from office blood pressure measurements and confirmed from ambulatory blood pressure monitoring.

Results
Patients who developed hypertension (n=35) compared to those who remained normotensives (n=65) had at baseline higher prevalence of HRE (75% vs. 13%, p=0.026), higher levels of carotid to femoral PWV (8.35 vs. 7.5 m/sec, p=0.043) and MSNA (37 vs. 31 bursts per minute, p=0.04), while their metabolic profile did not differ at the follow up (p=NS for all). In those who developed hypertension, SBP/MET-slope was higher in all Bruce protocol stages till peak exercise (stage 1: 6.25 vs. 4.25, stage 2: 7.6 vs. 5.3, peak exercise: 7.22 vs. 5.1; p&lt;0.05 for all). Additionally, those who remained normotensives compared to those who developed hypertension exhibited a higher exercise capacity (10 vs. 11.5 METs, p&lt;0.05) and maximal heart rate at peak exercise (154 vs. 164, p=0.001).

Conclusion
In subjects with high normal BP, those who develop hypertension during follow-up are characterized by more frequent HRE accompanied with lower exercise capacity, arterial stiffening and sympathetic overactivation. These results suggest that exercise BP response, along with PWV and MSNA estimation could contribute to identify high normal BP subjects who are more prone to become hypertensives.

Funding Acknowledgement
Type of funding sources: None.
Daily calorie intake and efficacy of 24-hours blood pressure control in hypertensive patients with obesity on stable antihypertensive therapy
Authors: Isayeva A , Matyashova L 
Published: October 2021

Abstract

Although it has been established that excessive daily calorie intake contributes to the development of hypertension, the relation between daily energy consumption and blood pressure in patients on stable antihypertensive therapy is not yet known.
The aim of the study was to evaluate the relation between daily calorie intake and 24 hours blood pressure control in patients on stable antihypertensive therapy.

Materials and methods
Cross-sectional study included 141 hypertensive patients with age median 56.5 (45.00 ÷ 63.70) years old. All hypertensive patients had been on the stable antihypertensive therapy during three months and had target office blood pressure at the moment of inclusion to the study. Ambulatory blood pressure monitoring (ABPM) was done to all patients with Heaco ABPM50 monitoring. Physical activity was assessed using International Physical Activity Questionnaire (kcal/week). Patients full in daily dietary diaries and mean daily calorie intake for three days was calculated with standardized soft “Test of Rational Nutrition” (TRP-D02, Ukraine). Fasting glucose, HbA1c, blood lipids, uric acids, creatinine, C-reactive protein were assessed in all patients. Data were analyzed with SPSS IBM 19.0.

Results
Mean office systolic blood pressure (SBP) was 128.5±11.3 mmHg and diastolic blood pressure (DBP) was 78.5±9.1 mmHg; mean body mass index (BMI) was 34.7±6.2 kg/m2. All patients were divided into three groups according to daily calorie intake: in the 1st group (n=21) patients daily intook less than 1372.2 kcal per day, in the 2nd group (n=58) daily calorie intake was between 1373.2 and 2976.3 kcal per day and in the 3rd (n=62) group subjects intook more than 2977.5 kcal per day. Body mass index in groups 1, 2 and 3 corresponds to 30.34±5.1, 35.1±8.9 and 34.3±6.9 kg/m2, ANOVA test F=2.3, p=0.10. The physical activity level was low in all three groups and did not differs significantly between groups. Results of ambulatory blood pressure monitoring are presented in the table 1. It was observed that high daily calorie intake contributes to non-satisfactory blood pressure control according to ABPM. The odd ratio of day SBP higher than target level in the 2nd group was 1.21 (95% CI, 0.42–4.51) and in the 3rd group 2.67 (95% CI, 0.67–11.70). The odd ratio of day DBP higher than target level was in the 2nd group was 1.19 (95% CI, 0.33–3.50) and in the 3rd group 2.12 (95% CI, 0.61–7.79). The odd ratio of night SBP higher than target level was 2.81 (95% CI, 0.33–10.51) and for DBP 2.88 (95% CI, 0.37–9.43).

Conclusion
In hypertensive patients with obesity on stable antihypertensive therapy with target office blood pressure high calorie intake contributes to non-satisfactory day and night blood pressure control.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Academy of Medical Science of Ukraine