bluuebunny/crossref_metadata_2025_split huggingface dataset:
WHITE-COAT HYPERTENSION AND MASKED HYPERTENSION IN HYPERTENSIVE KIDNEY TRANSPLANT RECIPIENTS
Authors: Loutradis Charalampos , Korogiannou Maria , Xagas Efstathios , Marinaki Smaragdi , Argyris Antonios , Protogerou Athanasios , Sarafidis Pantelis , Boletis John 
Published: April 2021

Objective:
Patients suffering from chronic kidney disease (CKD) have inadequate control of blood pressure (BP) ranging between 30 to 40%. In addition 35% of them have white-coat hypertension or masked hypertension. Recent epidemiologic data in the general population associate both of the aforementioned BP patterns with poor outcomes. The objective of this study is to examine the prevalence of these hypertension phenotypes in hypertensive kidney transplant recipients.

Design and method:
150 kidney transplant recipients were included in this study. They underwent 24-hour ABPM with the Mobil-O-Graph NG device. Hypertension was defined as: (1) office BP (oBP) > or = 140/90 mmHg or use of antihypertensive agents, (2) ambulatory BP > or = 130/80 mmHg or use of antihypertensive agents. Patterns of BP control were defined as follows: (1) truly controlled BP (oBP < 140/90 and 24-hr BP < 130/80mmHg), (2) uncontrolled hypertension (oBP > or = 140/90 and 24-hr BP > or = 130/80mmHg), (3) white-coat hypertension (oBP > or = 140/90 and 24-hr BP < 130/80mmHg), (4) masked hypertension (oBP < 140/90 and 24-hr BP > or = 130/80mmHg).

Results:
The prevalence of hypertension was 88.0% according to office BP readings and 93.3% according to ABPM (p = 0,112). 125 individuals (89,3% of the total) were hypertensives receiving antihypertensive agents. Among them, according to office BP readings and 24-hr ABPM, 44 (31,0%) hypertensive patients had BP control and 30 (21,1%) had uncontrolled hypertension. Moreover, among the hypertensive patients, 10 (7,0 %) had the white-coat hypertension phenotype and 58 (40,8%) had masked hypertension (Fig 1).

Conclusions:
The use of ABPM in kidney transplant recipients reveals low control of BP, low prevalence of white-coat hypertension and markedly high prevalence of masked hypertension. The last finding is particularly important, considering the established association between masked hypertension and increased cardiovascular risk.
MEDICATION, COMORBIDITY AND POLYPHARMACY BURDEN IN ROMANIAN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Gaman Mihnea-Alexandr , Cozma Matei Alexandru , Dobrica Elena Codruta , Diaconu Camelia Cristina 
Published: April 2021

Objective:
Polypharmacy (prescription of minimum 5 drugs/day) is often encountered in chronic kidney disease (CKD) patients due to their high number of comorbidities. Thus, a vicious cycle is born: the prescription of more drugs can lead to drug-drug (DDI) or food-drug interactions (FDI) and adverse effects mistakenly considered new comorbidities and treated with new medications. We evaluated polypharmacy use and the potential risk of DDI/FDI in Romanian CKD patients.

Design and method:
Retrospective, observational study in an internal medicine clinic. Data were extracted from medical records of patients attending the clinic in a two-month period in 2018. Patients were divided into CKD patients and controls (patients diagnosed with a different disease other than CKD). DDI/FDI were checked via the Drug Interactions Checker. The hospital's ethics council approved the study (approval 4263/13.05.2019). Written informed consent was collected from all patients. Regulations imposed by the national law/Declaration of Helsinki [1975&2008(5) revised] were respected. We presented categorical variables as frequencies/percentages and continuous variables as mean±standard deviation. Continuous variables were compared via independent samples t-tests. Categorical variables were compared using Fisher's exact test. The level of significance was set at 5% and presented as p-values. The analysis was performed using GraphPadQuickCalcs.

Results:
Study group: 22 CKD patients, 72.72 ± 10.37 years, range 54–93 years, 54.55% males. Controls: 144 patients, 67.90 ± 13.31 years, range 22–92 years, 52.77% females. CKD patients had more comorbidities (P = 0.0001) and drug prescriptions at discharge (P = 0.005) versus controls. Polypharmacy was noted in 95.45% (N = 21) of CKD patients versus 74.30% (N = 107) of controls (P = 0.02). CKD patients were at a higher risk of DDI (P = 0.01) and especially major and moderate DDI (P = 0.005 and P = 0.02, respectively) versus controls. CKD patients had a similar risk of potential FDI and DDI to controls (Table 1). The most frequent potential DDI and FDI interactions in CKD patients are depicted in Table 2.

Conclusions:
Polypharmacy is a serious reason for concern in CKD patients. Their management should be targeted at reducing medication burden and revised to include only drugs with low DDI/FDI risks. Patients should be carefully monitored and informed regarding the risks posed by polypharmacy.
ARTERIAL STIFFNESS CIRCADIAN PATTERN AND CARDIOVASCULAR MORTALITY IN HEMODIALYZED PATIENTS
Authors: Premuzic Vedran , Katalinic Lea , Barisic Ivan , Mesar Ines , Jelakovic Bojan 
Published: April 2021

Objective:
Our aim was to analyze association of circadian pattern of 48-hours pulse wave velocity (PWV) and augmentation index (AIx) with cardiovascular (CV) mortality in patients undergoing chronic hemodialysis (HD).

Design and method:
85 patients (mean age, 48m; 37w) were followed-up until for 36-months or till the time of death. Blood pressure (BP) (Omron M6), 48-h PWV and AIx (Arteriograph) and 24-h ABPM (SpaceLab 90207)-both after mid-week dialysis session were measured in all patients. PWV dippers = night-time PWV drop > 0.5 m/s; PWV risers = night-time PWV rise > 0.5 m/s compared to the day-time period. Aix dippers= night-time Aix drop > 10%; Aix risers= night-time Aix rise > 10% compared to day-time period.

Results:
After 36 months of follow-up, CV mortality was 49.4% (men 57.1%, women 42.9%). Deceased patients were older when enrolled and when had started with dialysis (both p < 0.001). There were no differences in prevalence of hypertension (100% vs. 95.3%), diabetes (23.8% vs. 11.6%) and number of hypertensive drugs (3.51 vs. 3.23) between two groups (all p > 0.05). Deceased patients had significantly longer duration of hypertension (p < 0.01) as well as significantly higher proportion of AIx and PWV risers and higher nocturnal AIx levels than survived patients. On the non-dialysis day both nocturnal AIx and PWV levels were higher in deceased group with significantly more AIx and PWV dippers when compared to survivors. PWV risers were significantly older when enrolled and when started with dialysis and had significantly higher ultrafiltration rates than PWV non-risers and survived significantly shorter. In the linear regression model survival was negatively associated with age, duration of hypertension, ultrafiltration but the strongest association was with AIx and PWV risers on the non-dialysis day. On logistic regression only PWV rising pattern on non-dialysis day had increased HR of 1.78 [CI 1.60, 1.96] for CV mortality.

Conclusions:
Non-rising patterns of PWV and AIx on non-dialysis days were significantly associated with CV mortality in patients undergoing chronic HD. Our data confirmed importance of 48-hour measurements of PWV and Aix in prediction of CV mortality.
RELATIONSHIP AMONG ARTERIAL STIFFNESS PARAMETERS AND TARGET ORGAN DAMAGE
Authors: García Fernando Martínez , De Gracia Ana , Calaforra Oscar , Solaz Elena , Vicente Antonio , Pichler Gernot , Redon Josep 
Published: April 2021

Objective:
Carotid-femoral (cf) PWV is considered the gold standard for arterial stiffness (AS) but other different parameters can add information about systemic or local AS. Whether that information is clinically redundant or complementary is currently unknown. We analyzed the relationship among different AS parameters to each other and with a target organ damage (TOD) score.

Design and method:
AS data were retrospectively evaluated in a sample of 1031 hypertensive patients. Cf-PWV and Augmentation index (Aix) by peripheral applanation tonometry (PAT) were determined with an SphygmoCor® device. Local PWV, local Aix, Ep module, Beta parameter and arterial compliance were determined by echo-tracking at the carotid level with an Aloka ultrasound (US) device. Left ventricular mass (LVM) was assessed by echocardiography, intima-media thickness (IMT) and plaques by carotid US and albumin-creatinine ratio (ACR) by immunonephelometry. A 24 points subclinical target organ damage (TOD) score was created using not only qualitative (presence or absence) but also quantitative information (magnitude of damage). The relationship among parameters of AS to each other and with the score of TOD were established by Pearson or Spearman correlation coefficients.

Results:
There was a significant relationship between cfPWV and the score of subclinical TOD, the higher the score, the higher the PWV (r = 0.19, p-value < 0.05).
All echo-tracking parameters, particularly the Ep module were also significantly related to the score but not the Aix by PAT. There were significant correlations among the different measures of AS to each other. The highest correlation was found between the Aix determined by tonometry and local Aix determined by carotid echo-tracking (r = 0.71, p-value < 0.05). By contrast the correlation between the cfPWV and local carotid PWV was very low (r = 0.28, p-value < 0.05).

Conclusions:
There was a significant correlation among different AS parameters and probably these parameters may add extra information to the gold standard (cfPWV). The presence of an increase in AS parameters is linearly related with the presence of subclinical TOD at other levels. Further studies are needed to determine the clinical prognostic values of combined AS parameters.
RELATIONS OF THE AORTIC STIFFNESS AND CENTRAL BLOOD PRESSURE WITH FEATURES OF THE LEFT VENTRICLE IN ASCENDING AORTIC ANEURYSM
Authors: Gurevich Alexandra , Zherdev Nicolay , Emelyanov Igor , Chernyavskiy Mikhail , Uspenskiy Vladimir , Konradi Alexandra 
Published: April 2021

Objective:
To reveal relations of the arterial stiffness, central blood pressure (BP) with left ventricular (LV) structure and function in patients with ascending aortic aneurysms (AAA).

Design and method:
We examined 44 patients with AAA (30 (68%) males; 55 ± 13 years old) before AAA surgical repair. Office brachial BP (BBP) was measured by OMRON (Japan). Arterial stiffness was evaluated by carotid-femoral pulse wave velocity (PWV). Central BP (CBP) and PWV were measured with the SphygmoCor (Australia). Ambulatory BP monitoring was performed with the BPLab (Russia) with 24-hour measuring of BBP and CBP. A transthoracic echocardiographic examination was performed with a Vivid 7 GE (USA).

Results:
Hypertension was observed in 40 (91%) patients. LV hypertrophy (LVH) was found in 41 (94%) patients (mean LV mass index (LVMI) 163 ± 48 g/m2). Diastolic dysfunction presented in 39 (89%) patients. PWV was inversely related to the AAA diameter (r = - 0.389, P = 0.03): PWV decreased with an increase of the aortic diameter at the level of the aortic root. A decrease of PWV correlated with a decline of relative wall thickness (RWT) (r = 0.365, P = 0.040), but eccentric LVH occurred only in 17 (38%) patients with AAA. PWV correlated directly with LV ejection fraction (r = 0.464, P = 0.048), but PWV was inversely related to LV end-diastolic size (LVED) (r = -0.533, P = 0.003). Rigid type diastolic disturbances (E/A ratio>2) were negatively correlated with PWV (r = -0.652, P = 0.041). Office pulse BBP and CBP correlated with the LVMI (r = 0.428, P = 0.019 and r = 0.508, P = 0.002, respectively). 24-hour pulse BBP and CBP were correlated with LVMI (r = 0.660, P = 0.018 and r = 0.721, P = 0.008, respectively). The increase of LVED had a closer association with office pulse CBP (r = 0.459, P = 0.007) than with office pulse BBP (r = 0.410, P = 0.017).

Conclusions:
Eccentric LV hypertrophy was accompanied by a significant reduction of PWV in patients with AAA. The severity of the diastolic dysfunction increased with a decline of PWV. PWV is probably not suitable for accurate assessment of the arterial stiffness in AAA due to the apparent confounding effect of aortic diameter. In AAA central pulse BP had a closer association with LVMI and LVED than brachial pulse BP.
TOWARDS NOVEL CIRCULATING MARKERS FOR ABDOMINAL AORTIC ANEURYSM PROGNOSIS
Authors: Galán María , Sánchez-Infantes David , Nus Meritxell , Navas-Madroñal Miquel , Pérez Belén , Camacho Mercedes , Martínez-González José , Rodriguez Cristina , Mallat Ziad 
Published: April 2021

Objective:
Abdominal aortic aneurysm (AAA) is increasing due to aging of the population and is a major cause of death among the elderly. Ultrasound screening programs are useful in early diagnosis but aneurysm size is not always a good predictor of rupture. Thus, there is an urgent need to find new potential prognostic factors. Our aim is to determine whether a battery of immune, inflammatory and oxidative stress markers, previously described to be involved in other cardiovascular diseases, may be used as potential biomarkers to provide personalized prediction of AAA progression for the clinical practice.

Design and method:
To address this, human abdominal aneurysmatic aortas (N = 80) and blood samples (N = 94) were obtained from patients undergoing open repair or endovascular surgery repair for AAA, whereas healthy aortas (n = 15) and blood samples (n = 46) were obtained from healthy donors.
We studied the immune infiltrate in paraffin sections of human aneurysmatic tissue and quantified IgM and IgG circulating levels in our AAA patient cohort. Circulating levels of ROS, CD38, CD36, GDF15 and S100A4 were measured by ELISA and their tissue expression was studied by real Time PCR and by immunostaining. Potential correlations with the aneurysm diameter or with peak wall stress, determined by finite element analysis, were measured by the Pearson product-moment correlation.

Results:
Our study shows for the first time the alteration of IgM, IgG, ROS, CD38, GDF15 and S100A4 levels in plasma and in aneurysmatic tissue of AAA patients in comparison with controls. After performing the corresponding statistical analysis we could exclude age and sex as confounding factors of our current observations. Circulating levels of IgG, CD38 and GDF15 were positively correlated with abdominal aortic diameter and peak wall stress.

Conclusions:
Our data indicate that IgG, CD38 and GDF15 may have potential to aid AAA prognosis as indicators of the progression of the aneurysm growth.
LACK OF CHANGES IN FOOD BEHAVIOUR OF FIRST-GENERATION CHINESE MIGRANTS THROUGH THE YEARS OF RESIDENCE IN ITALY
Authors: Modesti Pietro Amedeo , Marzotti Ilaria , Pellegrino Alessio , Ermini Elena , Bartoletti Alessio , Mascherini Gabriele , Galanti Giorgio 
Published: April 2021

Objective:
The length of residence in the host country is frequently associated with progressive modifications in lifestyle and diet, adapting to the host country habits with implications on CV risk. Information on diet changes in first-generation Chinese migrants to Europe is lacking.
To explore the associations between the length of residence in Italy with modifications in food behavior and physical activity of first-generation Chinese migrants living in Prato, Italy.

Design and method:
Chinese first-generation migrants aged 14 80 were enrolled in a cross-sectional survey starting from 2014. Participants underwent administration of validated questionnaire to evaluate dietary habits (food frequency) and physical activity (sedentary, light, moderate, vigorous).
The relationship of quartiles of years lived in Italy with main foods consumption, physical activity was investigated using a univariate and multivariate regression analysis (adjusted for age, gender, education, work category).

Results:
On average participants had lived in Italy 12 ± 6 years (range 1–32). Results of linear regression analyses are reported in the following Table. Although a trend to increase physical activity was observed, a huge number of subjects reported sedentary habit (642 out of 718).

Conclusions:
First generation Chinese migrants do not change their dietary habit, alcohol use or smoking through the years of residence in Italy. A large part of investigated subjects self-reported sedentary habit.
TRENDS IN THE DIETARY HABITS OF THE BULGARIAN POPULATION DURING A NINE YEARS PERIOD-2010-2018
Authors: Gruev Ivan , Tsanova-Savova Silvia 
Published: April 2021

Objective:
Bulgaria is one of the European countries with highest rate of cardiovascular morbidity and -mortality.
In attempt to find out the reasons for this negative fact, we tried to analyze the changes in the typical Bulgarian diet during the last decade.

Design and method:
We used the household consumption data from National Statistical Institute of Bulgaria for the mean consumption of the main food products per person per year. The available information included period of 9 years-2010-2018.

Results:
There is a decrease of the consumption of sugar from 8.5 kg/person/year to 6.9 kg/person/year, but there is increase of the consumption of sugary (from 1.4 to 1.7 kg/person/year) and chocolate products (from 1.1 to 1.5 kg/person/year). There is also significant increase of the intake of soft drinks (known to be the most powerful source of hidden sugar) - from 50.9 to 66.5 l/person/year.
The salt consumption slightly decreased (2.0 to 1.8 kg/person/year) but the intake of dried and processed (and very salty) meat products increased from 3.2 to 4.0 kg/person/year.
The intake of the traditional Bulgarian sunflower oil decreased from 14.1 to 12 l/person/year, but the consumption of butter increased from 0.2 to 1.0 kg/person/year.
The consumption of red meat increased and that was mainly due to increased intake of pork-from 6.9 to 10.5 kg/person/year. On the opposite- the trend of increased consumption of fish until year 2013 was negatively reversed in the following years, reaching the lowest point of 5.2 kg/person/year in 2018.
The consumption of fruits and vegetables remained relatively stable, but there is a negative trend of decreased intake of local products (rich of antioxidants) such as apples, pepper and cabbage.
Alcohol consumption increased significantly (23.6–31 l/person/year), mainly due to increased beer intake.
And finally, despite of law restrictions- the intake of cigarettes increased from 591 to 674 person/year.

Conclusions:
Our conclusion is that the trends in the dietary habits of the Bulgarian population during a nine years period-2010–2018 are generally negative. We must improve the level of dietary education from early age and involve the whole society in this process.
SKIN NA+ EXCESS IN HYPERTENSIVE PATIENTS: ISOTONIC NATURE AND CLINICAL CORRELATES
Authors: Rossitto Giacomo , Chen Jun Yu , Mary Sheon , Chew Khai Syuen , Montezano Augusto , Welsh Paul , Petrie Mark C. , Touyz Rhian M. , Delles Christian 
Published: April 2021

Objective:
Our traditionally nephrocentric view of Na+ homeostasis has recently been challenged by the concept of Na+ accumulation in tissues, predominantly skin, observed in hypertension. Its proposed water-independent (hypertonic) nature, carrying pathogenic potential, lacks firm demonstration. This study investigates the nature and clinical correlates of skin Na+ accumulation in hypertensive patients.

Design and method:
Responses to a validated salt intake questionnaire, measures of transepidermal water loss (TEWL), blood samples and a skin punch biopsy were collected from adult, non-pregnant and consenting hypertensive patients at the Glasgow Blood Pressure Clinic. Histochemical analysis was conducted by splitting the skin into epidermis/superficial dermis (ESD) and deep dermis (DD) layers. Water was measured by gravimetric approach (wet weight – dry weight), and Na+ and K+ by flame photometry.

Results:
Seventy-six patients consented to skin biopsy (age: 58 ± 15, range 22–86 years; females = 47.4%; BMI: 30.3, IQR 27.5–36.3). Na+ concentration ([Na+]) and K+ concentration ([K+]) was lower and higher in ESD (richer in cellularity) compared to DD, respectively (112.6 ± 8.57 and 30.17 ± 4.88 vs 119.0 ± 11.81 and 17.28 ± 3.62 mmol/l), respectively (p < 0.001 for both). Virtually none of the patients had [Na++K+] exceeding normal physiological levels in either layer, thus excluding hypertonic extracellular Na+ accumulation. Water content was positively and negatively correlated with Na+ and K+, respectively. Female DD, which is richer in fat content, contained less water, Na+ and K+ than male dermis (p < 0.01 for all), with no difference in concentrations or in ESD. Age was associated with an increase in ESD water and [Na+], and a decrease in [K+] in both layers, suggestive of oedema accumulation and independent of sex, BMI and estimated Na intake (padj < 0.005). The latter independently predicted epidermal water content (padj = 0.017). Patients with uncontrolled BP had higher ESD [Na+] (padj = 0.02). NT-proBNP levels mirrored all measures of skin oedema accumulation, while no significant interaction with medications or TEWL was observed.

Conclusions:
Skin Na+ accumulation in hypertensive patients is isotonic, prevalent and reflects subclinical oedema. Tissue architecture considerably impacts on Na+ content and concentration, whereas TEWL has minimal effect. These results have mechanistic, diagnostic and therapeutic implications.
ELEVATED TRIGLYCERIDE TO HIGH-DENSITY LIPOPROTEIN CHOLESTEROL RATIO INCREASED RISK OF HYPERURICEMIA IN CHINESE ADULTS: A 4-YEAR COHORT STUDY
Authors: Chen Jingyuan , Liu Xingyao , Lu Yao , Yuan Hong 
Published: April 2021

Objective:
Previous studies showed that high serum uric acid (SUA) levels associated with elevated triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio. However, evidence is lacking regarding whether TG/HDL-C is an independent risk factor. Our aim was to investigate the association between TG/HDL-C and the risk of hyperuricemia in Chinese population after adjusting for relevant risk factors.

Design and method:
This retrospective cohort study included 15,198 participants with an average age of 43 years who did not have hyperuricemia at baseline. The association between TG / HDL-C and the risk of hyperuricemia in the total sample was examined by multiple logistic regression analysis. To completely rule out the impact of metabolic syndrome on the relationship between TG/HDL-C and hyperuricemia, we reevaluate the relationship between TG/HDL-C and hyperuricemia in participants without metabolic syndrome (N = 12,813).

Results:
During a 4-year follow-up, 2,365 (15.6%) participants developed hyperuricemia. With the increase of the TG/HDL-C quartile, the cumulative incidence of hyperuricemia increased significantly (5.9,10.8, 18.4, and 27.5%, respectively). After multivariate adjustment, the odds ratio (OR) for hyperuricemia in the highest compared with the lowest quartile of TG/HDL-C was 1.80 (95% confidence interval [CI] 1.49, 2.18), and each SD increment of TG/HDL-C ratio caused a 10% additional risk for hyperuricemia. The cumulative incidence of hyperuricemia was also significantly elevated with increasing TG/HDL-C quartiles (5.6, 9.4, 15.5, and 24.0%, respectively) in participants without metabolic syndrome. The OR for hyperuricemia in the highest compared with the lowest quartile of TG/HDL-C was 1.70 (95% CI 1.38–2.10), and each SD increment of TG/HDL-C ratio caused a 18% additional risk for hyperuricemia in people without metabolic syndrome after adjusting for all confounders.

Conclusions:
Elevated TG/HDL-C ratio increased future risk of hyperuricemia in Chinese population. This association suggested the potential of TG/HDL-C ratio to serve as an independent risk indicator in the prevention of hyperuricemia.