bluuebunny/crossref_metadata_2025_split huggingface dataset:
A RANDOMIZED CONTROLLED TRIAL OF LIFE-MODIFICATION INTERVENTION FOCUSED ON REDUCING ALCOHOL INTAKE TO CONTROL THE HYPERTENSION IN MALE PATIENTS DURING OUTPATIENT VISIT: OSAKE STUDY
Authors: Kabayama Mai , Akagi Yuya , Tamatani Michio , Tomita Jun , Takiuchi Shin , Yamamoto Koichi , Sugimoto Ken , Rakugi Hiromi , Kamide Kei 
Published: April 2021

Objective:
To verify the effectiveness of the nurse-led life-modification intervention focused on reducing alcohol in male patients with hypertension during outpatient visit.

Design and method:
We enrolled 53 male patients (20–74years old) with morning home blood pressure (HBP) of 135/85 mmHg or more with excessive drinking (alcohol > = 210 g/week or > = 60 g/day habitually) from outpatient visit (at University hospital, General hospital, and Clinic setting) in a randomized controlled trial. Patients were assigned to a nurse-led intervention (in which patients were encouraged to modifying the alcohol consumption to optimal level in addition to the usual treatment every 2 month) or to the control (in which patients were followed see by their doctor as usual). The primary outcome were mean morning HBP of 5 consecutive days at 6 months and the amount of alcohol consumption. The HBP was measured by OMRON EM7251G and recorded on the Medical link Website.

Results:
The number of patients randomized to intervention were 28 and control were 25 (mean age; 62.7 ± 8.8years old, 64.5 ± 5.9 respectively), and 1 patient drooped-out in each group. At baseline, the mean HBP was 143/90 mmHg in the intervention group and 144/88 mmHg in the control (n.s.). At 6 months, the mean HBP was 131/82 mmHg in the intervention group and 145/87 mm Hg in the control (SBP < 0.001, DBP = 0.09). HBP level of less than 135/85 mmHg was achieved among 55.6% of the participants in the intervention group versus 16.7% in the control (P = 0.004). At baseline, the weekly alcohol consumption was 479 ± 353 g in the intervention group and 360 ± 182 g in the control (n.s.). At 6 months, it was 256 ± 206 g in the intervention group and 413 ± 260 g in the control (p = 0.020).

Conclusions:
We confirmed the effectiveness of the nurse-led life-modification intervention focused on reducing alcohol intake to control the morning HBP in male patients with hypertension as a method of non-pharmacological treatment during outpatient visit.
CLINICAL AND ECHOCARDIOGRAPHIC FEATURES OF PATIENTS WITH HEART FAILURE WITH MID-RANGE EJECTION FRACTION COMPARED TO REDUCED AND PRESERVED
Authors: Biolcati Marco , Maloberti Alessandro , Bianchi Sofia , Giani Valentina , Pellegrinelli Claudia , Ceratti Umberto , Belli Oriana , Casadei Francesca , Musca Francesco , Sormani Paola , Santambrogio Gloria , Spano’ Francesca , De Chiara Benedetta , Giannattasio Cristina , Moreo Antonella 
Published: April 2021

Objective:
The 2016 ESC guidelines classify Heart Failure (HF) according to levels of Ejection Fraction (EF) in HF with reduced EF (HFrEF, EF < 40%), HF with preserved EF (HFpEF, EF > = 50%) and the newborn HF with mid-range EF (HFmrEF, EF 40–49%). The aim of our work is to analyse clinical and echocardiographic features of patients admitted for HF when divided accordingly to their admission EF, focusing on HFmrEF.

Design and method:
We enrolled 192 patients hospitalized in the Internal Medicine of our hospital between January and September 2017. We collected data on clinical history, physical examination, laboratory tests, pharmacological treatment and echocardiographic examination; follow-up for subsequent fatal and non-fatal events ended in May 2018.

Results:
Prevalence of HFpEF (55.21%) is higher than HFrEF (23,60%) and HFmrEF (17,19%). Mean age is 80.9 ± 8.3 years, and does not differ among groups. HFpEF are more commonly female, show higher SBP at the presentation (p < 0,001), and have more non-cardiac comorbidities, such as renal dysfunction (p < 0,001), anemia (p = 0,05), chronic obstructive pulmonary disease (p = 0,036) and also atrial fibrillation (p = 0,04); in this group hypertensive aetiology is significantly prevailing (p = 0,002). On the contrary previous myocardial ischaemia and higher NT-proBNP levels on the admission (p = 0,038) are typical in HFrEF. Diastolic and systolic dysfunctions co-exist in patients and many candidates show marks of inverse remodelling. HFmrEF carry intermediate attributes (prevalence of CAD and systemic multimorbidities) and exhibit a ‘hybrid’ US hypertrophy pattern (high RWT, medium LVMi); compared to the other groups, they include the lowest trend on NYHA classification (classes I-II, p = 0,027), a less aggressive treatment with the shortest number of drugs and the shortest dosages (p = 0,04) and show decreased mortality and rehospitalization rates. During the follow-up, patients with HFmrEF experience more longitudinal transition among groups (33% becomes HFpEF and 23% HFrEF).

Conclusions:
HFmrEF share features of both HFrEF and HFpEF, with a high prevalence of hypertension and a large longitudinal transition to the other two classes.
BLOOD PRESSURE AT ADMISSION PREDICTS 1-YEAR OUTCOMES OF PATIENTS HOSPITALIZED FOR HEART FAILURE
Authors: Huang Xinghe , Liu Jiamin , Hu Shuang , Li Jing 
Published: April 2021

Objective:
This study aimed to evaluate the association between admission blood pressure (BP) and 1-year clinical outcomes in patients hospitalized for heart failure (HF) stratified by left ventricular ejection fraction (LVEF).

Design and method:
In the China PEACE Prospective Heart Failure Study, 4,930 patients hospitalized primarily for HF in 52 hospitals from 20 provinces in China have been enrolled. We included 4,611 patients with available LVEF and admission BP into analysis. Heart failure with reduced ejection fraction (HFrEF), heart failure with mid-range ejection fraction (HFmrEF), and heart failure with preserved ejection fraction (HFpEF) were defined as LVEF < 40%, LVEF of 40–49%, and LVEF > = 50%, respectively. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) at admission were categorized by 10 mmHg increments. The primary outcome was the composite of all-cause death or HF readmission within 1 year after admission. The association between BP and the outcome was estimated with Cox proportional hazard models. A generalized additive model with restricted cubic splines was used to explore the possible non-linear relationship between BP and the outcome.

Results:
In our study, there were 1,850 (40.1%), 1035 (22.4%) and 1,726 (37.4%) patients with HFrEF, HFmrEF and HFpEF, respectively. In the multivariable analysis, compared to SBP of 120–129 mmHg, SBP > = 150 mmHg was significantly associated with a lower risk in HFrEF and SBP < 110 mmHg was significantly associated with a higher risk in HFmrEF and HFpEF (Table 1). For DBP, a significant decrease in the risk was observed for DBP > = 100 mmHg and DBP of 90–99 mmHg compared with DBP of 70–79 mmHg in HFrEF and HFpEF, respectively (Table 1). SBP and DBP were inversely and linearly associated with the primary outcome in HFrEF and HFpEF. Conversely, in HFmrEF, the association between SBP or DBP with the primary outcome was nonlinear.

Conclusions:
In patients hospitalized for HF, different prognostic effects of admission BP on clinical outcomes have been found by LVEF status. In HFrEF and HFpEF, the risk of clinical outcomes increased significantly only at lower BP, however, in HFmrEF, there is a nonlinear trend between BP and clinical outcomes.
HOW MANY ADDITIONAL PHYSICIANS ARE NEEDED FOR HYPERTENSION TREATMENT IN INDIA?
Authors: Marklund Matti , Marklund Matti , Neupane Dinesh , Wu Jason Hy , Neal Bruce , Matsushita Kunihiro , Appel Lawrence J. 
Published: April 2021

Objective:
To estimate the number of additional physicians needed to treat all individuals with hypertension in India.

Design and method:
We incorporated existing data and corresponding uncertainties from the Global Burden of Disease Study and two national-representative surveys (including > 1.3 adults) to estimate the number of adults (18+ years) with hypertension in India. To estimate the number of additional physicians needed to treat all adults with hypertension, we used Monte Carlo simulations and derived central estimates and 95% uncertainty intervals from the 50th, 2.5th, and 97.5th percentiles of 1,000 simulations. We varied the proportion of visits for new physicians to spend on treating hypertensive patients from 10% to 100% of all visits (i.e., full dedication to hypertension treatment), and the number of visits per patient per year from 3 to 12, the latter being the current practice to allow monthly prescription renewals. The estimated capacity of currently available physicians (n = 835,910) was 418 million visits per year, assuming 10% of visits devoted to treating hypertensive patients.

Results:
In 2014, 195 million (95% uncertainty interval: 193–197) adults in India were estimated to have hypertension. This would require over 2.3 billion visits per year assuming monthly visits (i.e., current practice), and nearly 600 million visits per year assuming 3 visits per patient per year. With the current practice of monthly visits, 3.8 million new physicians would be required if they would have the same proportion of hypertensive patients as the available physicians (e.g., 10%), or 384,921 new physicians if they only were to see hypertensive patients (Table). These numbers were considerably reduced assuming 3 visits annually per patient, yet 33,529 new physicians would be required even if they only were to see hypertensive patients.

Conclusions:
Adequate monitoring and treatment of individuals with hypertension in India will require a substantial number of new physicians. Even in the most optimistic scenario (3 visits per patient per year and full (100%) dedication of additional physician time to hypertension treatment), around 30,000 new physicians will be required. These findings indicate that another approach, e.g. task-sharing, will be required to achieve nationwide hypertension control.
24-H-AMBULATORY BLOOD PRESSURE IN SUB-SAHARAN AFRICA: PREVALENCE OF WHITE COAT OR MASKED HYPERTENSION AND DISRUPTED DIPPING PATTERNS IN HIV+ PATIENTS ON ANTIRETROVIRAL THERAPY
Authors: Kasper Philipp , Phiri Sam , Chaweza Tom , Tweya Hannock , Mwagomba Beatrice , Muula Adam , Nhlema Angellina , Chiwoko Jane , Neuhann Florian , Steffen Hans-Michael 
Published: April 2021

Objective:
Background: Cardiovascular disease and especially hypertension are a growing problem among people living with HIV (PLHIV) on antiretroviral therapy (ART) in sub-Saharan Africa. As robust data on hypertension phenotypes associated with distinct cardiovascular risks among PLHIV are limited, we aimed to assess the frequency of white-coat (WCH) or masked (MH) hypertension and blood pressure dipping-patterns in a group of Malawian PLHIV.

Methods:
As part of the prospective Lighthouse-Tenofovir-Cohort-Study, we analyzed clinical, laboratory and 24-h-ambulatory blood pressure monitoring (ABPM) data of PLHIV from urban Lilongwe with known treated or untreated hypertension or raised office blood pressure (OBP) during routine study-visits (hypertension unknown and untreated).

Design and method:
118 PLHIV were included and data of 117 participants could be analyzed. 24-h ABPM-normotension was found in 14/37 PLHIV with known treated hypertension (37.8%), 19/24 with known untreated hypertension (79.2%) and 40/56 with raised OBP (unknown/untreated hypertension; 71.4%). Using the strict definition of controlled hypertension or true normotension, i.e. normal OBP plus normal mean BP for all periods of ABPM the corresponding rates were 10.8%, 41.7%, and 39.3%. WCH with normal BP during all periods of 24-h-ABPM was identified in 12/64 OBP-hypertensive PLHIV (18.8%), primarily in patients with grade 1 hypertension (11/41 patients; 26.8%). MH was found in 17/53 PLHIV with OBP-normotension (32.1%), predominantly in patients with high normal BP (11/20 patients; 55%). The estimated glomerular filtration rate was significantly lower in MH compared to strictly defined normotensive PLHIV (92.0 ± 20.4 vs. 104.8 ± 15.7 ml/min/m2, p = 0.031). 64.1% of PLHIV (59.5% with 24-h hypertension and 66.7% with 24-h normotension) had abnormal systolic dipping.

Conclusion:
The high prevalence of WCH and MH with early signs of renal end-organ damage and an abnormal dipping in approximately 2/3 of PLHIV warrants further confirmation as these factors may contribute to the increased cardiovascular risk of PLHIV in resource-limited settings like Malawi.
STRIDE BP REVIEW OF PUBLISHED EVIDENCE ON ACCURATE BLOOD PRESSURE MEASURING DEVICES
Authors: Stergiou George S. , O’Brien Eoin , Myers Martin , Palatini Paolo , Menti Ariadni , Kollias Anastasios , Parati Gianfranco 
Published: April 2021

Objective:
STRIDE BP has systematically reviewed PubMed publications reporting validation data of BP measuring devices using an established protocol. Lists of accurate devices for clinical use are available on the STRIDE BP website (www.stridebp.org) and are circulated to hypertension societies. This report presents the results of the STRIDE BP review.

Design and method:
The STRIDE BP Advisory Board reviewed 446 validation studies of 287 BP measuring devices reported in 294 PubMed publications up to Nov. 2019. Using an online review system each study is evaluated independently by 2 reviewers experienced in validation studies using a structured checklist which is specific for each protocol and a final internal review is developed. This is reviewed by 2 members of the STRIDE BP Advisory Board and a final decision is taken to approve or reject the study.

Results:
220 devices were approved (77%) and 115 (52%) were ‘Preferred’ according to predefined criteria (specific device features depending on its use; recent validation study). The numbers of approved office, home and ambulatory BP monitors for general population, children and pregnancy/preeclampsia are shown in the Table. Of 446 validations 390 (87%) were published as device ‘Pass’ and 56 (13%) ‘Fail’. Of 390 validations published as ‘Pass’, 95 (24%) were rejected in the STRIDE BP review process. The latter studies were rejected because of major protocol violation (single observer 22%, inadequate sample size 13%, BP measurement protocol violation 36%, inappropriate data analysis 31%, validation criteria not reported 32%).

Conclusions:
Using a standardised review process STRIDE BP provides independent evaluation of the accuracy of BP measuring devices that are available in various countries. The STRIDE BP review process by international experts, which examines validation studies using a structured and detailed process, is more critical than the classic review process of PubMed journals, which often miss important methodological issues in the validation studies. By widely circulating this information, STRIDE BP encourages health care professionals and the public to use only accurate devices for the evaluation of BP.
ARTERIAL HYPERTENSION RISK PREDICTION IN CONDITIONS OF ROTATIONAL SHIFTWORK IN THE ARCTIC
Authors: Shurkevich Nina , Vetoshkin Aleksandr , Gapon Lyudmila , Simonyan Ani 
Published: April 2021

Objective:
To study features and dynamics of chronostructure of circadian blood pressure (BP) rhythm in normotensive patients and define their prognostic value with respect to arterial hypertension (AH) within prospective observation in conditions of Arctic rotational shiftwork.

Design and method:
During the prospective one-year study, in conditions of rotational shiftwork in the Arctic, 173 men with normal BP and with negative history of AH (mean age 40.2 ± 4.1 years) were examined. Work experience in the Arctic was 16.5 ± 6.8 years; work experience in rotational shifts was 11.2 ± 3.8 years and office BP was 123.4 ± 7.5/80.5 ± 5.5. All patients underwent ambulatory blood pressure monitoring (ABPM) 1 time in 3 months; individual cosinor-data analysis was carried out to determine circadian rhythm chronotypes.

Results:
According to the classification of P. Cugini, true normotension (50%) and atypical chronotypes: allonormotension (22%) and isonormotonia (28%) were revealed in individuals with normal BP. The prognostic value of circadian BP rhythm disturbances was explained by high frequency of atypical normotensive chronotype transformation into hypertensive ones. During the year of observation, AH developed in 26% of normotonics with atypical chronotypes.
Based on results of the study of chronobiological parameters in individuals with normal BP, the role of autonomic nervous system in the formation of chronotypes of circadian BP rhythm in normotensive patients was assessed. Moreover, atypical chronotypes of BP highlighted as main disturbances of circadian rhythm in the conditions of the Arctic region. Atypical normotensive chronotypes were characterized by more evident structural changes of the heart and vessels. In conditions of the Arctic, chronobiological approach in comparison with standard analysis of ABPM indicated higher diagnostic sensitivity, specificity and efficiency. Logistic regression revealed prognostic significance of normotensive atypical chronotypes compared to main risk factors (smoking, low physical activity, body mass index, dyslipidemia, age, duration of work in the Arctic and rotational shiftwork experience, the mode and type of rotational shiftwork).

Conclusions:
Using multivariant analysis, there was received the model for determining a diagnostic indicator showing risk for AH development during one-year observation in normotensive individuals in condition of rotational shiftwork in the Arctic.
DIRECT COMPARISON OF HOME VERSUS AMBULATORY DEFINED NOCTURNAL HYPERTENSION FOR PREDICTING CARDIOVASCULAR EVENTS: THE J-HOP STUDY
Authors: Mokwatsi Gontse , Hoshide Satoshi , Fujiwara Takeshi , Negishi Keita , Schutte Alta , Kario Kazuomi 
Published: April 2021

Objective:
The home blood pressure monitoring (HBPM) method that measures blood pressure during sleep hours was reported to be comparable to ambulatory blood pressure monitoring (ABPM) in measuring night-time blood pressure and detecting nocturnal hypertension. The aim of this study was to directly compare the prognostic power of nocturnal hypertension detected by HBPM versus ABPM for predicting future cardiovascular events.

Design and method:
We analyzed night-time blood pressure (measured by HBPM and ABPM) data of 1005 participants who were included in the Japan Morning Surge-Home Blood Pressure (J-HOP) study.

Results:
During a follow-up period of 7.6 ± 3.4 years, 80 cardiovascular disease events occurred. The majority (91.8%) of our study population were hypertensive and 80.7% participants were using antihypertensive medication. Night-time home systolic blood pressure (SBP) was higher compared to night-time ambulatory SBP (123.0 ± 14.6 versus 120.3 ± 14.4, p < 0.001). Nocturnal hypertension was defined as night-time home or ambulatory SBP of 120 mmHg or more. The number of participants with nocturnal hypertension defined by HBPM and ABPM was 564 (56.1%) and 469 (46.7%), respectively. Nocturnal hypertension defined by HBPM was associated with increased risk of future cardiovascular events; total cardiovascular events (coronary artery disease and stroke events) [1.83 (1.00; 3.37)] and stroke [2.87 (1.17; 7.03)], independent of office SBP and night-time ambulatory SBP. These results were absent with nocturnal hypertension defined by ABPM.

Conclusions:
This is the first comparison prospective study illustrating that uncontrolled nocturnal hypertension defined by HBPM (independent of office SBP and night-time ambulatory SBP) is a predictor of future cardiovascular events.
ASSOCIATION OF FATAL AND NONFATAL CARDIOVASCULAR OUTCOMES WITH 24 HOUR MEAN ARTERIAL PRESSURE
Authors: Melgarejo Jesus , Yang Wen-Yi , Thijs Lutgarde , Li Yan , Asayama Kei , Hansen Tine , Kikuya Masahiro , Ohkubo Takayoshi , Dolan Eamon , Stolarz-Skrzypek Katarzyna , Huang Qi-Fang , Tikhonoff Valérie , Malyutina Sofia , Casiglia Edoardo , Lind Lars , Sandoya Edgardo , Filipovský Jan , Gilis-Malinowska Natasza , Narkiewicz Krzysztof , Kawecka-Jaszcz Kalina , Boggia José , Wang Ji-Guang , Imai Yutaka , Vanassche Thomas , Verhamme Peter , Janssens Stefan , Brien Eoin O. , Maestre Gladys E. , Staessen Jan A. , Zhang Zhen-Yu 
Published: April 2021

Objective:
Automated oscillometric devices are increasingly replacing auscultation for assessment of systolic (SBP) and diastolic (DBP) blood pressure, but determine mean pressure (MAP) and extrapolate SBP and DBP. Major adverse cardiovascular events (MACE) are closest associated with 24 H blood pressure levels. We determined outcome-driven 24 H MAP thresholds and assessed association of MAP, SBP and DBP with MACE.

Design and method:
In a population-based cohort (n = 11,596), blood pressure and risk factors were measured at baseline. Office MAP, computed from SBP and DBP, was categorized according to the 2017 American guideline. 24 H MAP was recorded oscillometrically. Statistics included multivariable Cox regression and the log-likelihood ratio test.

Results:
Baseline office and 24 H MAP averaged 97.4 and 90.1 mm Hg. Over 13.6 years (median), 2034 MACE occurred. 24 H MAP levels of < 90, 90–92, 93–96 and = > 96 mm Hg yielded equivalent 10 year MACE risks as the office MAP standard and delineated normotension (n = 6304), elevated 24 H MAP (n = 1074), and hypertension stages 1 (n = 1732) and 2 (n = 2484). MACE rates per 1000 person-years increased (P < 0.001) with higher 24 H MAP category from 11.9 (95% CI, 11.1–13.2) to 12.5 (10.7–14.7), 16.2 (14.6–18.1) and 22.0 (20.4–24.1). Compared with 24 H MAP normotension, the corresponding hazard ratios were 1.06 (0.88–1.25), 1.43 (1.26–1.63) and 1.78 (1.59–2.00). Adding 24 H MAP to covariables, SBP and DBP improved the model fit (P < 0.001). On top of MAP, higher SBP increased, whereas higher DBP attenuated risk (P < 0.001).

Conclusions:
The oscillometrically determined 24 H MAP used in conjunction with SBP and DBP substantially refined estimates of MACE risk.