bluuebunny/crossref_metadata_2025_split huggingface dataset:
SHORT-TERM SAFETY OF ANTIHYPERTENSIVE MEDICATION REDUCTION IN MULTI-MORBID PATIENTS WITH MILD HYPERTENSION: THE OPTIMISE RANDOMISED CONTROLLED NON-INFERIORITY TRIAL
Authors: Sheppard James , Burt Jenni , Lown Mark , Temple Eleanor , Lowe Rebecca , Fraser Rosalyn , Allen Julie , Ford Gary , Heneghan Carl , Hobbs Richard , Jowett Sue , Kodabuckus Shahela , Little Paul , Mant Jonathan , Mollison Jill , Payne Rupert , Williams Marney , Yu Ly-Mee , McManus Richard 
Published: April 2021

Objective:
Deprescribing of antihypertensive medications is recommended in some elderly patients with polypharmacy and multi-morbidity. However, the evidence base for this strategy is limited. We aimed to establish whether antihypertensive medication reduction is possible without significant hazard or changes in systolic blood pressure (SBP) control at 12-week follow-up.

Design and method:
This study used a randomised, controlled, open label, non-inferiority trial design. Participants aged at least 80 years with SBP < 150 mmHg and receiving 2 or more antihypertensive medications, whose GP considered appropriate for medication reduction were recruited from 69 general practices across England. Those enrolled were randomised (1:1 ratio) to antihypertensive medication reduction (intervention) or usual care (control). The primary outcome was difference (<10%) in proportion of participants with clinically acceptable SBP (<150 mmHg) at 12-week follow-up. Secondary outcomes included difference in SBP and adverse events. Trial registration EudraCT (2016-004236-38), ISRCTN (97503221).

Results:
Of 569 participants who were randomised, 35 (6%) were lost to follow-up. Overall, 229 (86.4%) patients in the intervention group and 236 (87.7%) patients in the control group had clinically acceptable systolic blood pressure at follow-up (Adjusted RR 0.98, 95% CI 0.92 to 1.04). Since the lower 95% confidence interval was greater than 0.9, medication reduction was assumed to be non-inferior to usual care. Medication reduction was sustained in 187 (66.3%) participants in the intervention group who were taking 0.63 (95% CI 0.56 to 0.71) fewer antihypertensive medications than the control group at 12 weeks. Systolic blood pressure corrected for baseline was 3.5 mmHg higher (95% CI 1.1 to 5.9 mmHg) in the intervention group. Adverse events were higher in the intervention group but there was no significant difference in rates of serious adverse events.

Conclusions:
Antihypertensive medication reduction can be achieved in two thirds of older multi-morbid patients with systolic blood pressure remaining within clinically acceptable limits. However, potential benefits must be balanced against the possible harms from increased systolic blood pressure (and therefore cardiovascular risk) plus increased adverse events (although most were apparently unrelated).
COLLATERAL BENEFITS OF PARTICIPATION IN CLINICAL RESEARCH: INSIGHTS FROM A RESISTANT HYPERTENSION TRIAL SCREEN OUT POPULATION
Authors: Saxena Manish , Kermali Muhammed , Balawon Armida , Pheby Jane , Benu Elena , Piniera Brian , Low Deborah , Mathur Anthony , Lobo Melvin D. 
Published: April 2021

Objective:
Patients with resistant hypertension (HTN) were invited to take part in an ongoing randomised, double-blind, sham-controlled, multi-centre, multi-national renal denervation trial. We evaluated the benefits for patients coming into research at our centre.

Design and method:
Male or female patients 18–75 years old with resistant HTN were invited to participate. Post consent, clinic blood pressure (CBP) measurements were recorded. Patients also had 24-hour ambulatory BP (ABP) to exclude pseudo-resistant HTN. All patients underwent screening for secondary causes of HTN. Antihypertensive medications were changed to a fixed dose combination pill (Sevikar/HCT). Ineligible patients had medication changes as per clinical judgement to improve BP control. Repeat CBP and ABP assessments were done at 4 weeks.

Results:
170 patients were assessed. The mean age was 59.6 ± 9.6 years, males (78%) and Caucasians (66%). The average number of anti-hypertensive medications was 4.1 ± 1.2. The mean CBP was 154/91mmHg, mean daytime ABP was 150/85mmHg. Following adjustments in medication after 4 weeks, the reduction in Clinic SBP was 14 ± 10 mmHg and DBP was 6.3 ± 6.2 mmHg (n = 145; p < 0.001 for both). The reduction in mean systolic daytime ABP was 8 ± 8.2 mmHg and DBP was 6 ± 7 mmHg (n = 91, p < 0.001 for both). The average number of anti-hypertensive medications reduced to 3.2 ± 1.3. Screening generated 74 new diagnoses and 34 newly detected cases of secondary hypertension (summarised below).

Conclusions:
High screen failure rate in studies could be considered a waste of time and resources. However, our findings demonstrate considerable collateral benefits for patients:
1. Accessing specialist care as part of the study.
2. Frequent new diagnoses and newly detected secondary HTN.
3. Medication optimisation resulting in clinically meaningful BP reduction and reduced medication burden.
EFFECTS OF BENZODIAZEPINES ON ORTHOSTATIC BLOOD PRESSURE IN OLDER PEOPLE
Authors: Rivasi Giulia , Kenny Rose Anne , Ungar Andrea , Romero-Ortuno Roman 
Published: April 2021

Objective:
Older people taking benzodiazepines (BDZs) have higher risk of falling, which is mainly attributed to unfavorable drug-related effects on cognition and psychomotor functioning. BDZs may also have hypotensive effects, but evidence concerning their consequences on orthostatic blood pressure (BP) behaviour is scarce. We investigated the association between BDZs and BP response to an active stand test in older people.

Design and method:
We performed a retrospective analysis of data from an outpatient research clinic in an Irish university hospital, where people aged 60 or older underwent a comprehensive geriatric assessment between August 2007 and May 2009. Non-invasive beat-to-beat orthostatic BP was measured during an active stand, with systolic BP assessed at each 10-second interval. Information on regular BDZs use was collected. Factors independently associated with orthostatic systolic BP were investigated using multiple linear regression.

Results:
Of 538 participants (67.7% female, mean age 72.7 ± 7.2), 33 (6.1%) reported regular use of BDZs. During active stand, participants taking BDZs showed a significantly greater systolic BP drop 10 seconds after the posture change (“immediate” BP drop), while no significant differences were detected in orthostatic systolic BP in the latter phases of standing. After adjusting for possible confounders, BDZs use was independently associated with a mean immediate systolic BP drop of 12 mmHg after standing.

Conclusions:
Older people taking BDZs may have higher risk of an immediate systolic BP drop after standing, adding to other BZD-related falls risks. BDZs should be avoided in older people at risk of falling.
AEROBIC EXERCISE TRAINING REDUCES 24‐HOUR AMBULATORY BLOOD PRESSURE IN PATIENTS WITH RESISTANT HYPERTENSION: A RANDOMIZED CONTROLLED TRIAL (ENRICH TRIAL)
Authors: Lopes Susana , Mesquita-Bastos José , Garcia Catarina , Leitão Cátia , Ribau Verónica , Figueiredo Daniela , Bertoquini Susana , Oliveita José , Polónia Jorge , Alves Alberto J. , Ribeiro Fernando 
Published: April 2021

Objective:
To assess the effect of aerobic exercise training in 24-hour ambulatory blood pressure (ABPM) in patients with resistant hypertension.

Design and method:
In this randomized-control trial (ClinicalTrials.gov: NCT03090529), 48 patients with resistant hypertension were allocated to either the exercise (EG, n = 26) or control group (CG, n = 22). Exercise training consisted of 40 min aerobic exercise at 50–70% of VO2peak, 3 sessions per week for 12 weeks. Ambulatory blood pressure (ABPM) was recorded at the same weekday at baseline and 48 hours after the last exercise session. The main outcome was the change in mean 24-hour ABPM.

Results:
Both groups were similar at baseline for: number of antihypertensive drugs (EG: 4.58 ± 0.86 vs.CG: 4.65 ± 0.56, p = 0.626), age (EG: 59.3 ± 8.3 vs CG: 59.6 ± 9.0 yrs, p = 0.897), body mass index (EG: 30.1 ± 4.9 vs CG:30.0 ± 4.9 kg/m2, p = 0.954), and VO2peak (EG: 34.5 ± 5.7 vs CG: 31.8 ± 6.6 mlO2.Kg-1.min-1, p = 0.138). No differences in ABPM were found between groups at baseline. The EG improved ABPM; there was a significant group∗time interaction in 24-hour mean systolic ABPM (EG: 127.4 ± 12.2 to 121.1 ± 12.6 mmHg vs. CG: 122.7 ± 14.4 to 124.0 ± 14.3 mmHg, p = 0.011), 24-hour mean diastolic ABPM (EG: 75.6 ± 7.8 to 71.4 ± 7.6 mmHg vs. CG: 73.1 ± 9.3 to 72.9 ± 8.6 mmHg, p = 0.015), daytime mean systolic ABPM (EG: 133.0 ± 12.3 to 125.8 ± 13.3 mmHg vs. CG: 128.2 ± 14.5 to 129.2 ± 13.2 mmHg, p = 0.010) and daytime mean diastolic ABPM (EG: 79.4 ± 8.1 to 74.8 ± 8.6 mmHg vs. CG: 77.1 ± 9.8 to 77.0 ± 8.5 mmHg, p = 0.019). No differences between groups were observed for night-time mean systolic (EG: 115.0 ± 15.0 to 111.1 ± 11.2 mmHg vs. CG: 112.0 ± 15.2 to 113.9 ± 17.7 mmHg, p = 0.131) and mean diastolic ABPM (EG: 67.3 ± 9.4 to 64.2 ± 5.6 vs. CG: 65.7 ± 8.6 to 65.4 ± 9.7 mmHg, p = 0.180).

Conclusions:
Aerobic exercise training decreases 24 h and daytime ABPM in patients with resistant hypertension. This decrease in 24-hour ABP is of the same magnitude as reported for individuals with non-resistant hypertension, suggesting that in patients with resistant hypertension aerobic exercise training may have the same positive effects as in patients with non-resistant hypertension.
SURVEY OF AWARENESS AND ATTITUDES TO CLINICAL RESEARCH AND CARDIOVASCULAR HEALTH AMONG ETHNIC MINORITIES IN GLASGOW
Authors: Lip Stefanie , Jain Sahil , McCallum Linsay , Brooksbank Katriona , Padmanabhan Sandosh 
Published: April 2021

Objective:
Despite efforts to increase diversity in clinical trials, racial/ethnic minority groups generally remain underrepresented, limiting researchers’ ability to test the efficacy and safety of new interventions across diverse populations. Previous research identified minority patient barriers to participation in clinical trials such as mistrust in medical researchers, fear of experimentation, and other logistical issues (language, transportation and financial barriers). Our aim is to design an observational survey to help understand the barriers or enablers that affect our local ethnic minority population in Glasgow when it comes to their own health and involvement in clinical research.

Design and method:
Surveys were conducted at two events in Glasgow – one South Asian (SA) and the other African (AF) where blood pressure screening was offered along with cardiovascular health advice. Participants completed a survey designed to examine awareness of cardiovascular health and attitudes to health and clinical research. Chi-square test was used to examine the association between races.

Results:
65 SA and 31 AF individuals completed the survey. There were significant differences between the demographics of the groups. The AF participants were younger with 87% between 25 and 54 years of age, while the SA participants were represented across all age groups. The questions which showed significant differences between groups are as follows: “Do you think that the current treatment guidelines for cardiovascular diseases are tailored for different ethnicities?”(Yes-SA: 32%; AF: 16%); “Do you believe treatment of conditions for your ethnic group is likely to be different compared to other ethnic groups?”(Yes-SA: 39%, Yes-AF: 52%); “Friends/family as source of health information” (No-SA: 88%, No-AF: 68%); “I do not know anything about clinical trials – I am not interested in knowing more” (No-SA: 66%, No - AF: 84%); I know what clinical trials are and I am keen to participate (No-SA: 88%, No-AF: 65%); Willingness to take part in clinical trials in the future (Yes -SA: 49%, Yes-AF: 74%); Trials will advance science and help treatment of their condition (No-SA: 83%, No-AF: 61%)

Conclusions:
There are differences in understanding and attitudes to clinical research between the SA and AF individuals. A tailored approach is necessary to overcome the lack of understanding of both health and clinical research in these two groups.
ANTIHYPERTENSIVE EFFECTIVENESS AND TOLERABILITY OF PERINDOPRIL/INDAPAMIDE/AMLODIPINE TRIPLE SINGLE‐PILL COMBINATION IN THE TREATMENT OF PATIENTS WITH ARTERIAL HYPERTENSION (TRICOLOR)
Authors: Logunova Natalya , Khomitskaya Yunona , Karpov Yuriy , Gorbunov Vladimir 
Published: April 2021

Objective:
To assess the antihypertensive effectiveness and tolerability of perindopril/indapamide/amlodipine triple single-pill combination (SPC) in hypertensive patients in real-life clinical practice.

Design and method:
TRICOLOR (NCT03722524) was a multicenter, open-label, uncontrolled, 3-month observational Russian study in 1,247 patients (Full analysis set) with uncontrolled hypertension (HTN). The changes in office systolic (SBP) and diastolic blood pressure (DBP) were assessed from baseline visit (V1), at 2 weeks (V2), 1 month (V3) and 3 months (V4) after inclusion in the study and on treatment with SPC.

Results:
At V4, perindopril/indapamide/amlodipine SPC significantly decreased the mean office SBP and DBP compared with baseline (V1), by 34.8/15.2 mm Hg, respectively (P < 0.0001). Mean office SBP and DBP values were significantly reduced at each subsequent visit versus the previous one, with the degree of these differences being reduced by V4: by 19.9/8.9 mm Hg (P < 0.0001) between visits V1 and V2; by 9.1/3.9 mm Hg (P < 0.0001) between visits V2 and V3; by 5.8/2.4 mm Hg (P < 0.0001) between visits V3 and V4. The target office BP (<140/90 mm Hg) was achieved in 39.9% (n = 497) of patients after 2 weeks of treatment with SPC, in 74.6% (n = 921) after 1 month and in 93.3% (n = 1,150) after 3 months. During the study 14 adverse events were registered, including 7 drug-related adverse events (cough – 5, hypotension – 1, worsening of HTN – 1) and 1 case of lack of efficacy.

Conclusions:
The triple SPC of perindopril/indapamide/amlodipine showed antihypertensive effectiveness and good tolerability in patients with uncontrolled HTN during a 3-month treatment.
TREATMENT OF MASKED HYPERTENSION WITH A CHINESE HERBAL FORMULA: A RANDOMIZED, PLACEBO‐CONTROLLED, SINGLE‐BLIND TRIAL
Authors: Zhang Dongyan , Cheng Yibang , Guo Qianhui , Shan Xiaoli , Wei Fangfei , Lu Feng , Sheng Changsheng , Huang Qifang , Yang Chuanhua , Li Yan , Wang Jiguang 
Published: April 2021

Objective:
Masked hypertension is associated with adverse cardiovascular outcomes. Nonetheless, no randomized controlled trials exist in the treatment of masked hypertension. The aim of this randomized, placebo-controlled trial was to investigate the efficacy and safety of blood pressure (BP) lowering treatment with a Chinese herbal formula, gastrodia-uncaria granules (GUG), in patients with masked hypertension.

Design and method:
Patients with an office BP of < 140/90 mmHg and daytime ambulatory BP of 135–150 mmHg systolic and/or 85–95 mmHg diastolic were randomized 1:1 to the treatment of GUG or placebo 5–10 grams twice daily for 4 weeks. The primary efficacy variable was the change in daytime ambulatory BP.

Results:
At baseline, office and daytime BP of the 251 participants (mean age 50.4 years, 53.4% men, mean body mass index 24.5 kg/m2, and 2.8%, 1.6%, and 30.7% with cardiovascular disease, diabetes mellitus, and smoking, respectively) averaged 129/82 and 135/89 mmHg, respectively. In the intention-to-treat analysis, daytime systolic/diastolic BP was reduced by 5.44 /3.39 and 2.91/1.60 mmHg in the GUG and placebo groups, respectively. The between-group difference in BP reductions was significant for the daytime (2.52/1.79 mmHg, P?0.025) and 24-h BP (2.33/1.49 mmHg, P?0.012), but not for the clinic and nighttime BPs (P?0.162). The per-protocol analysis in 229 patients produced similar results. Only one adverse event (sleepiness during the day) was reported and no serious adverse event occurred.

Conclusions:
BP lowering treatment with Chinese traditional medicine GUG is efficacious for patients with masked hypertension.
EFFECT OF MINERALOCORTICOID RECEPTOR BLOCKER, ESAXERENONE, ON NOCTURNAL HYPERTENSION: A POST HOC ANALYSIS OF ESAX-HTN STUDY
Authors: Kario Kazuomi , Ito Sadayoshi , Itoh Hiroshi , Rakugi Hiromi , Okuda Yasuyuki , Yamakawa Satoru 
Published: April 2021

Objective:
Nocturnal hypertension is an important phenotype of abnormal diurnal blood pressure variability and a known risk marker for target organ damage and cardiovascular events. Esaxerenone is a novel, first non-steroidal mineralocorticoid receptor blocker (MRB) with a dose-dependent antihypertensive effect. We investigated the efficacy of esaxerenone on nocturnal hypertension in Japanese hypertensive patients.

Design and method:
The ‘Esaxerenone compared to Eplerenone in Patients with Essential Hypertension (ESAX-HTN)’ study was a phase 3, multicenter, randomized, controlled, double-blind, and parallel-group clinical study conducted in Japan. Patients were eligible for enrolment in the study if they had trough systolic BP (SBP) > = 140 and < 180 mmHg, trough diastolic BP (DBP) > = 90 and < 110 mmHg, 24-hour mean BP (ABPM) > = 130/80 mmHg. This post hoc analysis used ABPM data to evaluate the effects of esaxerenone and eplerenone on nocturnal blood pressure in patients with essential hypertension.

Results:
Patients (n = 1001) were randomized to esaxerenone 2.5 mg/day (n = 331) or 5 mg/day (n = 338), or eplerenone 50 mg/day (n = 332). Esaxerenone significantly lowered blood pressure from baseline throughout the 24-hour dosing interval; reductions in nighttime systolic blood pressure (95% confidence interval [CI]) were significantly greater with 2.5 and 5 mg/day esaxerenone versus eplerenone (-2.6 mmHg [-5.0, -0.2] and -6.4 mmHg [-8.8, -4.0], respectively). Esaxerenone 2.5 and 5 mg/day significantly reduced nighttime blood pressure from baseline compared with eplerenone in non-dipper patients (-4.4 mmHg [-8.6, -0.2] and -10.8 mmHg [-15.0, -6.7], respectively). In addition, esaxerenone did not markedly alter nighttime blood pressure in extreme dipper patients. In the esaxerenone 5 mg/day group, esaxerenone-induced decreases in nighttime blood pressure were greater than eplerenone-induced decreases in older patients.

Conclusions:
Esaxerenone may be an effective treatment option for nocturnal hypertension, especially in older patients and those with non-dipping patterns of nocturnal blood pressure.
A CROSS SECTIONAL OBSERVATIONAL STUDY EVALATING PERSPECTIVES AND THERAPEUTIC OPTIONS AMONGST CLINICIANS IN YOUNG INDIAN HYPERTENSIVES
Authors: Jadhav Uday , Khan Aziz , Kalmath Bc , Ponde Ck , Sawhney Jps , Tripathy Mp , Hazra Pk , Sahoo Pk , Routray Sn , Chandra Sharad , Alexander Thomas , Chopra Vk , Abhyankar Mahesh , Revankar Santosh 
Published: April 2021

Objective:
Hypertension has been reported in 12.1% of young adults in a recent population-based study in India and is a growing concern. There is a paucity in guidelines on the definite therapeutic approach in young hypertensives. This study aimed to understand the clinician's perspective on approach to management of hypertension in young adults in India.

Design and method:
Cross-sectional observational survey conducted between February 6, 2020 and 22 February 22, 2020 using a structured 14-item questionnaire. Total of 2287 clinicians (cardiologists, diabetologists, consultant physicians, and family physicians) across India participated in this survey. Descriptive statistics were first computed. Inferential statistics, namely chi-square test was then run to test the associations among knowledge, awareness and practice among the respondents across India.

Results:
Prevalence of hypertension in young adults was observed in 10–30% by 64.8% participant clinicians. Smoking, mental stress and obesity were considered as the most common risk factors for hypertension in young adults. Parameters of sympathetic overactivity in young hypertensive patients were considered as only increased systolic blood pressure, only increased heart rate and both increased heart rate and increased systolic blood pressure by 15.1%, 24.2% and 57.4% of respondents respectively. Angiotensin II receptor blockers (ARBs) were considered the most appropriate class of drugs to treat hypertension in young by 61.6% respondents. Beta-blockers were preferred by 15.8%, followed by calcium channel blockers, diuretics and ACEI by 10.4%, 7.6% and 4.6% respondents respectively. Beta-blockers were selected as antihypertensive class in young hypertensive adults based on their perception of sympathetic overactivity by 74.5% respondents. Metoprolol was the preferred beta-blocker by 63.1% respondents. Combination therapy of telmisartan & metoprolol was preferred by 15.5%, 40.9%, 43.6% clinicians in young hypertension, uncontrolled hypertension, both young and uncontrolled hypertension patients respectively.

Conclusions:
This study adds to the real-world data in management strategies of young Indian hypertensives. Amongst the current class of anti-hypertensive drugs, ARBs and beta -blockers were preferred by the clinicians who participated in the study. Monotherapy and combination therapy with telmisaratan and metoprolol as a prototype of the respective anti-hypertensive class were preferred in the study.
TARGET ACHIEVEMENT IN VERY HIGH RISK PATIENTS IN LIGHT OF THE NEW DYSLIPIDEMIA GUIDELINES
Authors: Vintila Ana Maria , Horumba Mihaela , Cimpu Cristiana , Dumitrescu Diana , Miron Paul , Alucai Andreea , Cristea George , Tudorica Cezar Cornel , Vintila Vlad Damian 
Published: April 2021

Objective:
The 2016 ESC Dyslipidemia guidelines established LDL-cholesterol and HbA1c targets at 70 mg/dl and 7% for patients at very-high cardiovascular risk. The 2019 Dyslipidemia guidelines set LDL-cholesterol targets as low as 55 mg/dl for patients with diabetes, hypertension and atherosclerotic cardiovascular disease (ASCVD) or severe chronic kidney disease (CKD), while maintaining 70 mg/dl targets for patients at high cardiovascular risk. The purpose of our study was to establish a baseline of LDL-cholesterol target achievement based on past years’ experience.

Design and method:
We performed a retrospective study on patients admitted to our Internal Medicine and Cardiology Department, from January 2014 to December 2018. All patients had arterial hypertension (HTN) and type 2 diabetes mellitus (T2DM). Data regarding patient demographics, comorbidities and laboratory assay results (including glycemia, glycated hemoglobin and a complete lipid profile) were recorded. Data analysis was performed using SPSS version 20.

Results:
A total of 1239 patients were enrolled with a mean age of 71.3 ± 10.1 years and a slight female predominance (59.4% female). All patients were at very-high risk according to 2016 guidelines, but only 56.3% based on 2019 guidelines: 54.3% had ASCVD and 4.2% had severe CKD. LDL-cholesterol target achievement was 28.6% and 12.4% according to 2016 and 2019 ESC recommendations. The overall mean LDL-cholesterol value was 97.1 ± 39.4 mg/dl, but LDL-cholesterol values were lower after 2016 (93.4 vs. 100.7, p = 0.030) supposedly owing to the publication of the guideline. In terms of HbA1c targets achievement, overall HbA1c was 7.2 ± 1.5% and there was no difference in target achievement before and after 2016: 60.1% vs. 53.8%, p = 0.105.

Conclusions:
Our study shows that very few patients reach the desired treatment goals but lower targets equal better control of risk factors. We also believe that the timing of guideline publication may have an effect on risk factor correction: yearly publications from the American Diabetes Association may help as a reminder about target HbA1c levels, leading to tighter control.