bluuebunny/crossref_metadata_2025_split huggingface dataset:
SURVEY OF ACCESSIBILITY, AVAILABILITY, PRICE AND AFFORDABILITY OF ESSENTIAL MEDICINES AND DIAGNOSTIC TECHNOLOGIES FOR THE CLINICAL MEASURE AND TREATMENT OF HYPERTENSION ON PRIMARY
Authors: Yirga Zelalem , Fang Jing , Sugerman Davi , Asrat Anemaw 
Published: April 2021

Objective:
To assess the accessibility, availability and affordability of essential drugs and diagnostic technologies for the clinical measure and treatment of hypertension on primary health care unit of West Gojjam, Ethiopia 2020

Design and method:
Facility-based cross-sectional survey was conducted from march16/2020-march30/2020 at 40 primary health care unit drug outlets of west Gojjam. Data was collected with an interviewer administered structured data collection tool and analyzed using SPSS version 23 ad Microsoft excel 2016. Medicines prices was compared with facilities and sectors. The daily wage of the lowest paid government worker was used to measure affordability.

Results:
The mean availability of essential drugs and diagnostic technologies at the primary health care units of west Gojjam was 62.5% and 67.5% respectively. The number of days wage needed for getting essential antihypertensive medications was two or more working days. All the available essential antihypertensive medications was in generic brands and not affordable for one month course of treatment.

Conclusions:
Essential anti-hypertensive medications and diagnostic medical technologies for the clinical measure and treatment of hypertension are available at fairly high, but unaffordable for the wage of unskilled government worker, and for money peoples living udder the poverty line of the country. The national NCD program should give an emphasis on improvement of access to affordable essential anti-hypertensive medications and diagnostic technologies for the diagnosis and treatment of hypertension at primary health care units.
THE PROTECTIVE EFFECT AND MECHANISM OF HSP47 IN HYPERTENSIVE INTRACEREBRAL HEMORRHAGE
Authors: Wen Hongyan 
Published: April 2021

Objective:
Hypertensive intracerebral hemorrhage (ICH) has a high mortality rate, but there is no effective treatment,so how to prevent it has become a top priority. Heat shock protein 47 (HSP47) is a molecular chaperone for collagen synthesis and is responsible for transporting procollagen from the endoplasmic reticulum to the golgi lumen, effectively maintaining the three-dimensional structure of collagen. Absence of HSP47 may affect collagen synthesis and the stability of extracellular matrix (ECM), further damaging the stability of blood vessels. Therefore, we aimed to explore the role of HSP47 in ICH.

Design and method:
Spontaneous hypertensive ICH of mice were induced by angiotensin II and L-NAME We found that the level of HSP47 gradually decreased with the increase of modelling days. The adeno-associated virus was delivered into brain by stereotactic injection to overexpress HSP47.

Results:
The incidence of ICH were decreased significantly in mice by HSP47 overexpression. At the same time, the number and size of ICH in mice were significantly reduced. Experimental results show that HSP47 overexpression was sufficient to enhance ECM integrity and reduce VSMC apoptosis before ICH.

Conclusions:
These results suggest that HSP47 may have a protective effect on hypertensive ICH. Therefore, we emphasize that overexpression of HSP47 may be a new strategy for clinical treatment of hypertensive ICH.
BLOOD PRESSURE MEASUREMENT AND MONITORING BY INTERNAL MEDICINE SPECIALISTS IN GERMANY IN VIEW OF THE SPRINT TRIAL
Authors: Unger Leonie , Mengden Thomas 
Published: April 2021

Objective:
There are continuous discussions about the optimal target blood pressure values, not least due to the publication of the SPRINT study, where unattended ambulatory office blood pressure (AOBP) was used for blood pressure (BP) measurement. The aim of the following online survey was to examine how BP measurement and the management of hypertensive patients are handled in everyday practice by internal medicine specialists in Germany and to compare it with the current guidelines.

Design and method:
An online questionnaire with ten questions concerning methods of BP measurement was sent to 15,884 internal medicine specialists as an email via the mailing list of the German Society of Internal Medicine (DGIM). Of these, 731 took part in the survey, which corresponds to a response rate of 4 %. The statistical evaluation was carried out with MS Excel.

Results:
The standard auscultatory measurement with an aneroid manometer is the leading method used by 44 % and in 95 % of the cases, it is measured in the presence of medical staff, i.e., attended. With 53 %, more than half of the respondents only take one measurement. A group of 36 % take two or more measurements. Of these, the largest percentage with 28 % takes the last value, closely followed by 26 %, who use the average value. The first or lowest value is each used by 17 %, while a minority of 12 % use the highest value. A majority of two-thirds measures without any time reference to taking medication (66 %). Ambulatory and Home BP are used by the majority for therapy control, according to the survey (fig.)

Conclusions:
The guidelines are not implemented correctly in many places and the approach to managing hypertension patients varies considerably. Possible reasons for this might be a lack of time in everyday practice and not always specifically formulated specifications in the recommendations of the professional associations, which leads to ambiguities. Measurement using unattended AOBP is rarely used in Germany. To be able to transfer the results from SPRINT, this measurement method would first have to be established.
HOSPITAL PHARMACISTS’ KNOWLEDGE ABOUT CARDIOVASCULAR DISEASE RISK FACTORS
Authors: Ukoha-Kalu Blessing Onyiny , Adibe Maxwell Ogochukw , Ukwe Chinwe Victoria , Anosike Chibueze , Isah Abdulmuminu 
Published: April 2021

Objective:
This study aimed to assess hospital pharmacists knowledge of cardiovascular disease (CVD) risk factors and their practice of primary prevention of CVD.

Design and method:
This was a prospective cross sectional survey of all the Hospital pharmacists in Federal Medical Centre Lokoja (FMCL), and Kogi State Specialist Hospital (KSSH) both in Lokoja L.G.A of Kogi State Nigeria. A Questionnaire on diagnostic cut-off for common cardiovascular diseases (CVD) and practice of primary prevention of CVD was used for the study. The Statistical Package for Social Sciences (SPSS for windows, Version 16.0. SPSS Inc. 2007.Chicago, USA) software was used for data analysis. Continuous data were presented as mean ± standard deviation while categorical data were presented as percentages and frequencies.

Results:
About half, 20(46.5) of the hospital pharmacist were less than 40 years with a mean age of 43.44 years. The hospital pharmacist had poor knowledge of diagnostic cut-off for common cardiovascular disease risk factors. Also, the hospital pharmacists had poor practice of primary prevention of cardiovascular diseases. Age, gender and years of practice were associated with knowledge of CVD risk factors while age alone was associated with practice of primary prevention of CVD.

Conclusions:
Hospital pharmacists have a poor knowledge of CVD risk factors and also a poor practice of primary prevention of CVD.
PREVALENCE OF HYPERTENSION SELF CARE ACTIVITIES AMONG HYPERTENSIVE PATIENTS RECEIVING CARE IN A SECONDARY HEALTH CARE FACILITY IN KOGI STATE NIGERIA
Authors: Ukoha-Kalu Blessing Onyiny , Adibe Maxwell Ogochukw , Isah Abdulmuminu , Ukwe Chinwe Victoria 
Published: April 2021

Objective:
This study aimed to access the Hypertension self care activities of hypertensive patients receiving care in a Secondary health care facility in Kogi state Nigeria.

Design and method:
This was a prospective cross sectional study conducted among Hypertensive patients receiving care in the Kogi State Specialist Hospital in Lokoja, Kogi state. All hypertensive patients visiting the Kogi State Specialist Hospital during the period of study and have given consent were allowed to participate in the study. A profoma was designed to collect the socio-demographic and clinical characteristics like the blood pressure, weight (in Kilograms) and height (in meters) while the hypertension self-care activity levels effect (H-SCALE) questionnaire was used to collect information on self care activities. The data cleaning was conducted in Microsoft excel after which information were exported and analysed using the Statistical Package for Social Sciences (SPSS for windows, Version 16.0. SPSS Inc. 2007.Chicago, USA) software.

Results:
More than half of the patients under study 183 (61.4%) were adherent to their medication. However, almost all the patients 305 (99.1%) and 308 (100%) did not adhere to low salt diets and physical activity respectively. A majority of the patients 266 (87.0%) admitted not to be smoking while more than half of the patients 221 (63.1) did not follow good weight management practices. About three-fourth of these patients did not abstain from drinking alcohol. Although more of the males (31.5%) adhered to their medications more than the females (27.9%), this was not statistically significant. More of those who adhered to their medications, had a low salt diet, engaged in physical activity and weight management practices had a source of income. Patients who had obtained a formal education had a better medication adherence, adhered to low salt diets, engaged in weight management practices and smoked less when compared to those who had no formal education. It was observed that patients who have had hypertension for a longer time adhered more to their medications.

Conclusions:
In conclusion, adherence to hypertension self care activities was low. This could lead to an increased risk of hypertension related complications.
PREDICTION OF MAJOR CARDIOVASCULAR AND CEREBROVASCULAR OUTCOMES FOR OLDER PEOPLE WITH HYPERTENSION AND FRAILTY: LINKED PRIMARY CARE ELECTRONIC HEALTH RECORDS COHORT STUDY
Authors: Todd Oliver , Wilkinson Chris , Hollinghurst Joe , Akbari Ashley , Sheppard James , McManus Richard J. , Rockwood Kenneth , Lyons Ronan , Gale Chris P. , Hall Marlous , Clegg Andrew 
Published: April 2021

Objective:
For older people, the association of blood pressure (BP) with cardiovascular outcomes may vary according to the degree of frailty. We investigated whether frailty improved the prediction of major adverse cardiovascular or cerebrovascular events (MACCE) among older people with hypertension treated for primary prevention.

Design and method:
Retrospective cohort study using population-scale electronic health record data from the Welsh Secure Anonymised Information Linkage (SAIL) databank, linked to hospital outcomes from Patient Episode Database for Wales (PEDW), and death outcomes from Office for National Statistics. Inclusion criteria were age > 65 years, BP recorded in primary care in 2007, and diagnosis of hypertension. Exclusion criteria were established cardiovascular disease (stroke, myocardial infarction or heart failure). We extracted the minimum BP measurement on the day the patient first attended primary care in 2007, and BP-lowering treatment over one year prior. Cardiovascular risk was measured using QRISK-3, and frailty using the electronic frailty index (eFI). Time-to-event analysis measured first ever MACCE (stroke, myocardial infarction, heart failure or cardiovascular death) through 10-years follow-up.

Results:
The analytic cohort comprised 145,598 patients, registered in 502 general practices. The mean age was 75-years (SD 7); 62% were female; 17% were in the most deprived Townsend quintile. Using the QRISK-3 cardiovascular risk score, 29% (IQR 21 – 39) were predicted to suffer coronary heart disease or stroke over 10-years. The unadjusted risks for MACCE were all increased with increasing severity of frailty (Figure).
Compared with robust participants, living with frailty was associated with significantly higher MACCE events despite adjustment for known cardiovascular risk factors (increased risk of 38% in mild frailty, 84% in moderate frailty and 117% in severe frailty). The addition of frailty to a model that was already adjusted for cardiovascular risk factors and BP-lowering treatment improved measures of model fit (AIC reduced from 248,829 to 247,409; BIC reduced from 249,023 to 247,579).

Conclusions:
Our study provides population-based evidence that the degree of frailty is a useful prognostic factor in older people who are at high risk of cardiovascular outcomes in the management of hypertension.
ARTERIAL HYPERTENSION IN A PATIENT OPERATED FOR CONN ADENOMA: ABOUT A CASE
Authors: Thabet Maissa , Romdhane Wiem , Anoun Jihed , Hassine Imen Ben , Karmeni Monia , Fredj Fatma Ben , Anis Mzabi , Laouani Chadia 
Published: April 2021

Objective:
Conn's adenoma is a rare cause of high blood pressurr. It is the second surgically curable cause of hypertension after renal artery stenosis. Its recurrence after surgery remains rare.

Design and method:
We report a case.

Results:
Mr B.M, 60 years old, with a history of diabetes, hypertensive and right adrenalectomy for Conn's adenoma, admitted for investigation of dysphagia and high blood pressure. On examination, the blood pressure was 17/10, the pulses are present and symmetrical. Skin examination revealed sclerodactyly, subcutaneous calcinosis and raynaud's syndrome. The blood ionogram showed hypokalaemia while the renal workup noted chronic renal failure. Urinary cortisol and plasma cortisol were normal. The adrenal CT scan showed a left adrenal nodule. A contralateral recurrence of Conn's adenoma associated with CREST syndrome was strongly suspected. The decision was to intensify the antihypertensive treatment.

Conclusions:
Hypertension can be multifactorial: metabolic syndrome, Conn's adenoma and systemic disorder. A recurrence of an operated Conn's adenoma should be systematically sought in the presence of persistent elevated blood pressure levels.
ARTERIAL HYPERTENSION REVEALING A TIGHT AORTIC COARCTATION IN A YOUNG PATIENT: ABOUT A CASE
Authors: Thabet Maissa , Romdhane Wiem , Hassine Imen Ben , Fakhfakh Rym , Anoun Jihed , Karmeni Monia , Fredj Fatma Ben , Mzabi Anis , Laouani Chadia 
Published: April 2021

Objective:
Coarctation of the aorta is an obstructive lesion responsible for high blood pressure (hypertension). The diagnosis of coarctation is usually made during the first months of life but can be mentioned much later, especially when there is no other associated heart disease.

Design and method:
we report a case of a tight aortic coarctation in a young person revealed by arterial hypertension.

Results:
Mr K.H, 24 years old, with no notable pathological history, admitted for fever, cough and purulent sputum. At the examination the patient was polypneic, BP was 16/7, cardiac auscultation revealed a diastolic murmur to the aortic focus and reduced femoral pulses.
Infectious endocarditis was suspected. Transesophageal ultrasound showed grade IV aortic insufficiency, aortic bicuspid, aneurysmal dilatation of the ascending aorta, and absence of endocardial adenoids. The thoracic angio scanner noted a short and tight stenosis of the aortic isthmus, a funnel dilation of the arch of the aorta with a significant aneurysmal dilation of the ascending aorta without signs of dissection, a focus of right lower lobar pneumonia. The diagnosis of hypertension secondary to coartation of the aorta was then retained. The patient was put on antibiotic therapy for his infectious lung disease, on antihypertensive treatment.

Conclusions:
This clinical fact underscores the importance of measuring blood pressure during any examination of a patient. Indeed, an isthmic coarctation can be easily ignored because, apart from hypertension, the damping of the femoral pulses is often the only clinical sign.
EARLY EVIDENCE FOR THE EFFECTIVENESS OF SOUTH AFRICA'S LEGISLATION ON SALT RESTRICTION IN FOODS: THE AFRICAN-PREDICT STUDY
Authors: Strauss-Kruger Michel , Wentzel-Viljoen Edelweiss , Ware Lisa J. , Van Zyl Tertia , Charlton Karen , Schutte Aletta E. 
Published: April 2021

Objective:
South Africa was one of the first countries to adopt mandatory regulation in 2016 to lower the salt content of a wide range of processed foods. To assess the effectiveness of this regulation, we determined the change in salt intake of young adults over a mean follow-up time of 4.56-years spanning the implementation of the regulation. Since young populations have a higher salt intake, salt reduction may have a greater long-term impact as a preventative strategy in this age group.

Design and method:
This study included baseline (N = 668; aged 24.9 ± 3 years; 47.8% black; 40.7% men) and follow-up data for the first 311 participants (aged 29.9 ± 3.09 years; 51.1% black; 43.4% men) tracked over time as part of the African-PREDICT study. Participants had baseline data before 30th June 2016, and follow-up from 2018 - 2020. Estimated salt intake at baseline and follow-up was calculated from 24-hour urinary sodium excretion.

Results:
The median salt intake of the population (N = 668) at baseline was 7.88 g/day (IQR: 5.67). In those followed (N = 311), salt intake reduced from baseline [median (IQR): 7.91 g/day (5.83)] to follow-up [median (IQR): 7.26 g/day (5.30)] in the total group [median difference (IQR): -0.82 g/day (7.02); p = 0.007], with a greater reduction observed in black adults [N = 159, median difference (IQR): -1.35 g/day (7.91); p = 0.003]. Reduced salt intake was more pronounced in black adults from a low (p = 0.007) and middle socio-economic status (p = 0.009), compared to a high socio-economic status (p = 0.27).

Conclusions:
Our preliminary findings suggest that South Africa's mandatory salt reduction regulation for processed foods has been effective in lowering salt intake in young adults by a magnitude of ∼0.82 g salt/day. Our study supports the effectiveness of “upstream” sodium reduction interventions at population level that may impact on the health and economic burden of countries.
IN MILD HYPERTENSIVE PATIENTS 24-HOUR AVERAGE HEART RATE IS ASSOCIATED WITH EARLY CARDIAC DAMAGE AND ENDOTHELIAL DYSFUNCTION
Authors: Rus Horatiu , Poinareanu Ionut , Bobescu Elena 
Published: April 2021

Objective:
To investigate the correlation of 24-hour average heart rate (HR) in untreated and recently diagnosed mild hypertensives, and evaluate their association with subclinical initial signs of cardiac target organ damage (TOD), and endothelial dysfunction.

Design and method:
A total of 400 outpatients with initial diagnosis of mild hypertension were recruited between December 2017 and November 2019. Ambulatory electrocardiogram and blood pressure (BP) were monitored in all patients. According to the 24-hour average HR, patients were divided into fast HR group (24-hour average HR > 75 beats/minute, n = 220) and non-fast HR group (24-hour average HR less or equal to 75 beats/minute, n = 180) We evaluate endothelial dysfunction by flow mediated vasodilatation (FMD) at the level of brachial artery. We use echocardiography to determine the presence of initial signs of (TOD), (presence of signs of left ventricular hypertrophy left ventricular mass indexed for height (LVMi) > 48 g/m2 for men and > 44 g/m2 for women and/or increased left atrial volume 4-chamber indexed for body surface area (LAVi) > 34 ml/m2).

Results:
Endothelial dysfunction, LVMi and LAVi, 24-hour average HR, night and day average HR, diastolic BP, and daytime systolic BP were higher, while nocturnal BP drop rate was lower in patients with fast HR group than those in non-fast HR group (all P < 0.04). Twenty-four-hour HR, the degree of endothelial dysfunction and TOD increased significantly with increases of office BP (P < 0.04). The 24-hour average HR and resting HR were correlated positively with the presence of TOD (r = 0.159, 0.262, respectively, both P < 0.01), and degree of endothelial dysfunction (r = 0.155, 0.260, respectively, both P < 0.01). Multivariate linear regression analysis showed that the level of BP (B = 17.420, 16.540), nocturnal BP drop rate (B = 1.652, 1,586), and 24-hour average HR (B = 0.558, 0.5442) were correlated with the presence of TOD and FMD cuantified endothelial dysfunction.

Conclusions:
In patients with initial diagnosis of mild hypertension, 24-hour average heart rate is associated with the early cardiac damage and endothelial dysfunction, confirming the participation of increased heart rate in initial cardiac and vascular changes in human hypertension.
BODY-MASS INDEX AND BLOOD PRESSURE AS DISEASE MODIFIERS IN DYSTROPHINIC CARDIOMYOPATHY
Authors: Rodoman Iulia , Palii Ina , Sacara Victoria , Pirtu Lucia 
Published: April 2021

Objective:
Introduction: Duchenne muscular dystrophy (DMD) is one of many neuromuscular diseases, that commonly creates severe disability and early death. Cardiomyopathy associated with DMD is an increasingly acknowledged presentation of this neuromuscular disorder, significantly increasing morbidity and mortality, as well as the requirement for cardiological treatment.

Design and method:
Purpose: is to review literature data relatively the presence of elevated blood pressure values and body mass index in children with DMD and their impact on the development of heart disease.

Results:
Several studies have published cross-sectional data about the prevalence of hypertension and increased BMI in children with DMD. Wong et al., 2017 reported that 25.5% of patients on daily steroids aged 10–13 years had systolic hypertension. In patients aged 13–16 years, they reported systolic hypertension in 10.3% of patients. Corticosteroid treatment is thus an essential part of the standards of care in DMD and is recommended from the age of 4 to 5 years onward. Ricotti et al., 2013 observed hypertension in 5% of the patients aged 3–15 years on intermittent steroids while in a study by Braat et al., 2015, 45% of the patients had hypertension. In N.M. van de Velde et al., 2019, study increased BMI, but not systolic blood pressure, was related to early myocardial deformation defined by peak systolic GLS in young DMD patients < 11 years of age. Prevalence of obesity has been described up to 73% in steroid-native DMD patients < 13 years and higher BMI was associated with longer duration and higher cumulative dose in ambulant DMD patients using prednisone (Lamb et al., 2016). In Barber et al. study, 2013 use of corticosteroids has managed to prolongation of the ambulant stage in DMD by almost 3 years. It has also been correlated with a delayed onset of dystrophinic cardiomyopathy in Markham et al., 2008 and Davidson et al., 2014 studies.

Conclusions:
The results of this review suggest that factors influencing afterload, such as increased blood pressure and BMI, may play a role in the deterioration of cardiac function in DMD.