bluuebunny/crossref_metadata_2025_split huggingface dataset:
FIRST RESULTS OF THE NEW HUNGARIAN HYPERTENSION REGISTRY: SEASONAL CHANGES OF BLOOD PRESSURE VALUES
Authors: Páll Dénes , Nemcsik János , Habony Norbert , Farsang Csaba , Ábrahám György , Simon Attila , Benczúr Béla , Járai Zoltán 
Published: April 2021

Objective:
It is well known that blood pressure (BP) changes continuously and there is a seasonal change of BP. Our aim was to examine how these changes are present among the Hungarian population.

Design and method:
Omron M3 IT devices were placed to physicians between October 2018 and November 2019. All of the measured BP values were transmitted online to an evaluating center using the Medistance system of Omron. 1.691 general practitioners and 235 internists have been involved in the study. Based on this database, we analyzed the seasonal changes of BP in our population.

Results:
At this moment we have more than a million (1.008.398) BP data in our new Hungarian Hypertension Registry. Separating these BP data by month, we found the highest systolic BP average in winter (in December 141.84 mmHg, January 142.00 mmHg, February 141.47 mmHg). On the other hand, the lowest systolic BP data were measured in summer (in June 136.74 mmHg, July 137.10 mmHg, August 135.86 mmHg). We observed the same trend comparing diastolic BP. The highest average values were in January (85.48 mmHg), December (85.02 mmHg), February (84.93 mmHg) and the lowest were measured in August (82.13 mmHg), June (82.82 mmHg), July (83.11 mmHg). During spring and autumn, the BP values were between our winter and summer data. The mean difference between the average of the highest and lowest month (January vs August) is 6.34 mmHg for systolic, and 3.35 mmHg for diastolic BP. In summer (June, July, August) the ratio of the well-controlled hypertensives was 51.37%, 51.05% and 53.51%, respectively, while it was only 42.1%, 41.76% and 42.53% in December, January and February. We observed grade III. hypertension in 5.09%, 6.11% and 5.75% in summer, while it was much higher in winter (7.44%, 7.79%, 7.3%).

Conclusions:
There is an important difference in the average values of our winter and summer BP data, and the ratio of the well-controlled as well as the severe hypertensives. Based on these data there can be need for seasonal change in the quantity of their antihypertensive drugs to reach the optimal BP values.
A NOVEL DEFINITION, EARLY EVENING ELEVATED BLOOD PRESSURE, HAS A HIGH PREVALENCE RATE ACCORDING TO AMBULATORY BLOOD PRESSURE MONITORING
Authors: Ma Zhiyi , Zhao Yixin , Lu Xining , Yang Fan , Chen Yuanyuan , Sun Ningling 
Published: April 2021

Objective:
Early evening (from 6pm to 10pm) involves with many daily life activities and is just before sleep. A novel definition, Early Evening Elevated blood pressure (EEE), was made in this study. We investigated its prevalence rate based on ambulatory blood pressure monitoring (ABPM).

Design and method:
The ABPM data was collected in our hospital from October to December in 2018. The age of each subject should be at least 18 years old. The percentage of successful measurements for each subject should not be lower than 70%. Only the first ABPM of one subject during these three months was included. The ABPM devices were US Space Lab 90217 Dynamic Blood Pressure Monitors. The EEE was defined as high average blood pressure from 6pm to 10pm (detailed definition and classification seen in Table 1). The high blood pressure and morning blood pressure surge were diagnosed based on 2018 ESC/ESH Guidelines for the management of arterial hypertension.

Results:
1. The ABPM data of total 697 subjects were valid data. Among them, there were 438 subjects with high blood pressure according to their ABPM. There were 324 subjects with morning blood pressure surge according to their ABPM. 2. The prevalence rate of EEE (Definition A) was 43.62% among all valid data and the prevalence rates of definition B, C and X were higher than that of A, 51.65%, 62.41% and 81.35% respectively. 3. The prevalence rate of EEE (Definition A) was 65.98% among those diagnosed with high blood pressure and was 71.60% among those diagnosed with morning blood pressure surge. (Details seen in Table 2)

Conclusions:
In this study, there was a high prevalence rate of early evening elevated blood pressure at least among the subjects undergoing ABPM. This EEE phenomenon might influence medication, including multi-kinds, overlap-add, high dosage and so on. Further investigation is needed to find out its possible reasons and better corresponding solutions.
SODIUM CONSUMPTION QUESTIONNAIRE WITH PHOTOGRAPHIC MANUAL: DEVELOPMENT OF A NEW TOOL FOR EVALUATION OF HYPERTENSIVE OUTPATIENTS
Authors: Bortolotto Luiz , Cardoso Bruna , Duenhas Ana 
Published: April 2021

Objective:
To develop and evaluate the reliability of the Sodium Consumption Questionnaire with Photographic Manual for routine use in outpatient clinical care of hypertensive patients in a tertiary hospital, using the gold standard 24-hour sodium urinary test as reference.

Design and method:
Prospective cohort study with 50 patients, for development of the Sodium Consumption Questionnaire with Photographic Manual from the consumption frequency of rich sodium foods, intake of addition and per capita sodium compared to 24-hour sodium urinary test performed at the same day of application of the questionnaire. After patients signed informed consent it were excluded those who were unable to answer the questions, whose urine collection procedure was performed improperly and/or had a glomerular filtration rate < 45 mL/min/1.73m2. The reliability of the rich sodium foods list was done with pre-established portions, which were assessed by Cronbach's Alpha, as well as Pearson's correlation coefficient to rich sodium foods frequency and sodium intake per capita from 24-hour sodium urinary. The photographs for the manual were obtained from a horizontal surface and 45 ° angles in a portable studio with illumination and infinite background for better accuracy.

Results:
The mean age was 54 ± 13 years and 62,0% female, with a mean BP 165 ± 28/90 ± 25 mmHg and a mean body mass index of 31 (27,85 – 36,99) kg/m2. The mean 24-h Urinary sodium was 177 mEq (equivalent 4,07 grs of sodium).
The value for Cronbach's Alpha was 0.542, assuming this result as satisfactory for the questionnaire. The consumption frequency by rich sodium foods list and sodium added per capita showed significant correlation with 24-hour sodium urine (r = 0.892; p < 0.01 and r = 0.501; p < 0.01, respectively). Thus, the development of the Sodium Consumption Questionnaire with Photographic Manual was done with consumption frequency and 34 pre-established standard photographs.

Conclusions:
The Sodium Consumption Questionnaire with Photographic Manual was developed with reliability and significant correlation with 24-hour urine sodium, allowing applicability in outpatient routine.
ASSESSING THE EFFICACY OF A 90 DAY GLUTEN-FREE DIET ON CHANGE IN WEIGHT AND ANTHROPOMETRY IN HYPERTENSIVE MALES
Authors: Patil Mansi , Patil Vishal 
Published: April 2021

Objective:
To assess the efficacy of a gluten-free diet on change in weight, blood pressure and anthropometry [waist circumference (WC), Waist to hip ratio (WHR), Body mass Index (BMI)] after 90 days in hypertensive males.

Design and method:
A cross-sectional study on 200 male patients with uncontrolled hypertension was carried out to assess the effect of a 90 day gluten-free diet on blood pressure, weight and anthropometry. Patients (n = 200) were advised a 1800 kcals diet with 60% carbohydrates, 20% proteins and 20% fats. Patients (n = 100) were provided gluten-free dietary advice and 100 patients (control group) were advised to continue a gluten containing diet. Diet diary was maintained by patients and monitored weekly. Clinic blood pressure, height, Weight, Waist circumference and hip circumference measured using the NHANES standard procedures were obtained. BMI and WHR were calculated.

Results:
At the commencement of the trial 90% (180/200) of the patients had weight greater than their Ideal body weight, with 68% (136/200) being obese and 22% (44/200) overweight. Significant weight loss was observed in both gluten free diet (p < 0.0001) and control group (p < 0.05). Mean weight loss in control group was 7.66 ± 1.24 kgs and in gluten free group was 13.03 ± 2.42 kgs. The gluten-free diet was associated with significant weight loss and reduction in WC, WHR (p < 0.001) and both SBP and DBP (p < 0.0001). Significant reduction in SBP in gluten free group with reduction in WC and BMI (p < 0.001). Significant reduction in DBP associated with reduction in WHR, WC and BMI (p < 0.001) after 90 days.

Conclusions:
Gluten-free diet was found to be effective in weight loss and reduction of systolic and diastolic blood pressure in patients with uncontrolled hypertension when consistently followed. Weight loss, reduced WC and WHR on gluten free diet was positively correlated with a reduction in SBP and DBP.
REDUCTION OF ALCOHOL CONSUMPTION CAN DECREASE HOME MORNING BLOOD PRESSURE IN MALE HYPERTENSIVE PATIENTS-OSAKE STUDY
Authors: Akagi Yuya , Kabayama Mai , Tamatani Michio , Tomita Jun , Takiuchi Shin , Yamamoto Koichi , Sugimoto Ken , Rakugi Hiromi , Kamide Kei 
Published: April 2021

Objective:
Excess alcohol consumption is supposed to be a strong risk of blood pressure (BP) elevation, therefore the reduction of number of heavy drinkers is an important issue for health promotion. In previous studies, few studies have examined the effectiveness of reduced alcohol intake on BP by improving drinking habits. The aim of this study is to investigate the association between reduced alcohol consumption and changes in home morning BP in male hypertensive patients.

Design and method:
This research was conducted as part of OSAKE Study. The OSAKE study (a randomized controlled trial of saving alcohol amount program for keeping optimal blood pressure control in patients with hypertension) provides outpatient health guidance intervention and verifies its effectiveness on BP reduction. The subjects were 51 men who completed a six-month health guidance intervention or control period. Detailed alcohol consumption per week was inquired and converted to pure alcohol (g). A home BP auto measuring apparatus with auto data communicating system by internet was distributed to patients. To investigate the relationship between changes in alcohol consumption and BP reduction (δSBP, δDBP), multiple regression analysis adjusted for changes in room temperature (δT), the correlation of baseline BP with alcohol consumption was performed.δ

Results:
Mean age in study participants was 64 ± 7.6 years old. After 6 months from baseline, the weekly alcohol consumption decreased significantly from 423.2 ± 288.8 g to 330.2 ± 243.9 g (p < 0.01). Regarding weekly and monthly BP average both systolic BP (SBP) and diastolic BP (DBP) significantly decreased (1week SBP: 142 ± 10.3 to 138.9 ± 13, DBP: 88.1 ± 8.3 to 85.1 ± 9.8, 1 month SBP: 141.3 ± 10.1 to 138.2 ± 12.2, DBP: 87.9 ± 8.4 to 84.8 ± 9.4, respectively p < 0.05). As a result of multiple regression analysis, δalcohol consumption was significantly associated with both δSBP and δDBP for one week and one month (p < 0.05). For covariates, δT and δγGTP were also significantly associated with BP reduction.

Conclusions:
It may be effective for lowering home morning BP to improve drinking habits in male hypertensive patients.
BLOOD PRESSURE LOWERING TREATMENT FOR PREVENTION OF CARDIOVASCULAR EVENTS IN PATIENTS WITH ATRIAL FIBRILLATION: AN INDIVIDUAL-PARTICIPANT DATA META-ANALYSIS
Authors: Pinho-Gomes Ana Catarina Pin , Azevedo Luis , Copland Emma , Canoy Dexter , Nazarzadeh Milad , Ramakrishnan Rema , Berge Eivind , Sundstrom Johan , Kotecha Dipak , Woodward Mark , Rahimi Kazem 
Published: April 2021

Objective:
Randomised evidence showing that pharmacological blood pressure (BP) lowering can reduce cardiovascular risk in patients with atrial fibrillation (AF) is limited. Therefore, this study aimed to compare the effect of BP-lowering treatment on fatal and non-fatal cardiovascular outcomes in patients with and without AF.

Design and method:
We extracted individual participant data from all trials with over 1,000 person-years of follow-up that had randomly assigned patients to different classes of BP-lowering drugs, BP-lowering drugs vs placebo, or to more vs less intensive BP-lowering regimens. We investigated the effects of BP-lowering treatment on a composite endpoint of major cardiovascular events (stroke, ischaemic heart disease or heart failure) according to AF status at baseline using fixed-effect one-stage individual participant data meta-analyses based on Cox proportional hazards models stratified by trial.

Results:
Twenty-two trials were included with 188,570 patients, of whom 13,266 (7%) had AF at baseline. Patients with AF had lower BP at baseline than patients without AF (143/84 mmHg, SD 21/12mmHg) versus 155/88 mmHg, SD 21/13 mmHg, respectively). Meta-regression showed that relative risk reductions were proportional to trial-level intensity of BP lowering, both in patients with and without AF. The hazard ratio for major cardiovascular events was 0.91 in patients with AF (95% confidence interval [0.83 – 1.00]) and 0.91 without AF (95% confidence interval [0.88 – 0.93]) for each 5-mmHg reduction in systolic BP, with no difference between subgroups (p = 0.91) (Figure). Similar patterns were observed for individual components of the composite primary outcome. In patients with AF, there was no evidence that treatment effects varied according to baseline systolic BP or use of specific drug classes.

Conclusions:
BP-lowering treatment reduces the risk of major cardiovascular events in patients with AF to a similar extent to that of patients without AF, even when baseline BP is below recommended treatment thresholds. Owing to their higher absolute cardiovascular risk, treatment in patients with AF is likely to result in greater absolute risk reduction than in patients without AF. Guidelines should be updated to clearly recommend pharmacological BP lowering for prevention of cardiovascular events in patients with AF.
ASSESSMENT OF CARDIOVASCULAR EVENTS IN HYPERTENSIVE PATIENTS AT RISK FOR HEART FAILURE USING GERIATRIC NUTRITIONAL RISK INDEX
Authors: Hashizume Toshikazu , Arita Mikio 
Published: April 2021

Objective:
The management of hypertension in heart failure (HF) stage classification A/B is important to prevent the development of symptomatic HF. In addition, malnutrition is commonly prevalent in patients with HF. On the other hand, the relationship between malnutrition and cardiovascular prognosis in hypertensive patients at risk for HF stage A / B has not yet been fully validated. This study aimed to evaluate the association between the Geriatric Nutritional Risk Index (GNRI), one of the most commonly used nutritional indicators, and long-term outcomes in hypertensive patients at risk for HF stage A/B.

Design and method:
We retrospectively investigated 418 hypertensive patients at risk of HF stage A/B. GNRI was calculated at baseline as follows: GNRI = [14.89 × serum albumin (g/dl) + [41.7 × (body weight/body weight at body mass index of 22)]]. Patients were then stratified into tertiles based on GNRI. The study endpoint was a composite of cardiovascular (CV) event, including CV death, non-fatal myocardial infarction, and non-fatal stroke.

Results:
Over a 6.0-year median follow-up, 49 CV events occurred. Using Kaplan-Meier analysis, patients with lower GNRI group (<103.2, n = 139) showed worse prognosis compared with those with middle GNRI group (103.2 to < 111.1, n = 139) and higher GNRI group (>111.1, n = 140) (Chi-square value 10.8; p = 0.005, log-rank test). In the multivariate Cox proportional hazards analysis, lower GNRI group was significantly associated with the incidence of CV events (hazard ratio 2.23, 95% confidence incidence interval 1.14–4.39, p = 0.02) compared with higher GNRI group after adjusting for confounding factors.

Conclusions:
GNRI was significantly associated with CV events in hypertensive patients at risk for heart failure stage A/B. The assessment of GNRI might be a useful index to predict CV events in hypertensive patients at risk for HF stage A/B.
CLINICAL CHARACTERISTICS AND BLOOD PRESSURE TIME-COURSE IN THE YOUNG ACCORDING TO HYPERTENSION SUBTYPE
Authors: Saladini Francesca , Mos Lucio , Vriz Olga , Mazzer Andrea , Fania Claudio , Rattazzi Marcello , Palatini Paolo 
Published: April 2021

Objective:
The prognostic significance of different hypertension subtypes in youth is still debated. The aim of the study was to investigate baseline clinical and haemodynamic characteristics and blood pressure (BP) time-course in young subjects with systolic hypertension compared to other hypertension subtypes.

Design and method:
We investigated 1206, 18-to-45-year old subjects from the HARVEST: 81 normotensives (NT), 146 isolated systolic hypertensives (ISH), 281 isolated diastolic hypertensives (IDH) and 698 systolic-diastolic hypertensives (SDH). Baseline haemodynamic and metabolic characteristics, BP and heart rate (HR) changes during a 7-year follow-up were measured. Age-and-sex-adjusted ANCOVA analysis was used for group comparisons.

Results:
ISH were younger and more frequently males compared to others (25.6 ± 6.6 years, p < 0.001), were thinner compared to SDH (24.6 ± 2.6 vs 25.8 ± 3.6 kg/m2, p = 0.028). HR was higher among ISH (75.7 ± 9.4 bpm) and SDH (75.8 ± 9.7) compared to other categories (p < 0.001). ISH were more active in sports (55.5%) compared to others (p < 0.001). Metabolic characteristics were not significantly different among groups. Systolic white-coat effect was higher among ISH (17.6 ± 12.4 mmHg) compared to others (p < 0.001). Cardiac output was significantly higher among ISH (6.3 ± 1.2 ml/min) compared to NT and IDH (p < 0.001); ISH had similar peripheral resistances to NT and lower than IDH and SDH (p < 0.001). Small and large artery compliance was greater and central systolic BP and augmentation index were lower among NT and ISH than IDH and SDH, but differences were not statistically significant (N = 360). During follow-up systolic BP decreased (-7.6 ± 14.4 mmHg) among ISH, while it increased among NT and IDH (p < 0.001). HR decreased in all categories but to a higher extent among ISH (-3.8 ± 10.9 bpm) and SDH (-3.4 ± 10.8 bpm, p = 0.002 versus NT). The percent of patients who started pharmacological treatment during follow-up was: 70.6% among SDH, 54.1% among IDH, 41.1% among ISH, and 39.5% among NT (p < 0.001).

Conclusions:
Young ISH had greater white coat effect, hyperkinetic circulation and lower peripheral resistances compared to other hypertension categories, while arterial distensibility parameters did not differ significantly among groups. Subjects with ISH showed a favourable time-course of BP and HR with a lower percent of subjects needing antihypertensive treatment, suggesting a lower risk profile.
EPIDEMIOLOGICAL PREVALENCE ESTIMATES OF HYPERTENSION OF 856,878 ADULTS IN GLASGOW
Authors: Lip Stefanie , Mccallum Linsay , Strachan Kylie , Mckinstry Brian , Webb David , Padmanabhan Sandosh 
Published: April 2021

Objective:
Systematic reviews estimate the prevalence of hypertension in high income countries to be 28.5%, with 55.6% of hypertensives on treatment and 28.4% of those on treatment having controlled hypertension. We used these estimates to determine the proportion of untreated hypertensives in the Greater Glasgow and Clyde population and to evaluate if the estimated proportion of untreated hypertension translated into increased CV mortality.

Design and method:
Dispensed prescription and mortality data were obtained on 856,878 adults who attended either primary care or secondary care in the NHS Greater Glasgow and Clyde area between 2010 and 2016. Age-specific hypertension prevalence were obtained from the Scottish Public Health Observatory (2018) and for high income countries from Mills et al (Circulation 2016). Individuals were considered to be on hypertension treatment if they had at least 6 months of 2011 covered by their antihypertensive prescriptions. Cardiovascular deaths from 2012–2016 were obtained from mortality records through record linkage. Generalised estimating equations (GEE) were used to assess the relationship between proportion of untreated hypertension and CV mortality.

Results:
The estimated number of hypertensives was 308,208 (35.9%) and the numbers treated and untreated were 181,662 (58.9%) and 126,546 (41.1%) respectively. Age-stratified analyses showed the highest proportion of untreated hypertensives was in the 30–40-year (72%) and 40–50 year (58%) age groups while the lowest proportion was the 70–80 year group (28%).
Stratification by SIMD showed SIMD 1 (least deprived group) had the lowest proportion of untreated hypertensives (34%) while the most deprived groups 4 and 5 had 49% and 43% respectively. Cardiovascular mortality rates increased with each decade of life -0.95/1000 among 30–40 years old group and rising to 233/1000 in the 80+ age group. These results were maintained even after adjusting for age and SIMD using GEE.

Conclusions:
Estimating prevalence of untreated hypertension in the Greater Glasgow and Clyde region do not show correlation with five-year cardiovascular mortality. This discrepancy indicates more accurate estimation of hypertension prevalence and treatment using home BP is required for formulating effective health policies on hypertension.
CLINICAL CHARACTERISTICS IN THE PATIENTS WITH MASKED UNCONTROLLED NOCTURNAL HYPERTENSION MEASURED BY NIGHTTIME HOME BLOOD PRESSURE MONITORING: THE J-HOP NOCTURNAL BLOOD PRESSURE ST
Authors: Narita Keisuke , Hoshide Satoshi , Kario Kazuomi 
Published: April 2021

Objective:
Various international guidelines on the management of hypertension recommend nighttime blood pressure (BP) measurements in specific conditions such as sleep apnea, secondary hypertension, etc. However, we physicians sometimes miss nocturnal hypertension in patients with controlled daytime (morning and evening) home BP (HBP), i.e. “masked uncontrolled nocturnal hypertension”. Risk factors of masked uncontrolled nocturnal hypertension remain unclear in clinical practice and we thus assessed that using a dataset of the Japan Morning Home-Surge BP (J-HOP) Nocturnal BP study.

Design and method:
This is a cross-sectional, post-hoc analysis using the dataset of the J-HOP Nocturnal BP study, which recruited patients with risk factors of CVD. Participants underwent consecutive 14-day HBP measurements (morning and evening) and nighttime HBP measurements (a.m. 2, 3, and 4). In the present study, masked uncontrolled nocturnal hypertension was defined as controlled daytime HBP (mean of morning and evening home systolic BP [SBP] < 135 mmHg and diastolic BP [DBP] < 85 mmHg) and uncontrolled nighttime HBP (mean nighttime home SBP > = 120 or DBP > = 70 mmHg). To detect the risk factors of masked uncontrolled nocturnal hypertension, we used traditional host factors, using each type of antihypertensive medications, and markers of target organ damage (urine-albumin creatinine ratio [UACR] and b-type Natriuretic peptide) as covariant in stepwise logistic regression models.

Results:
Among 1490 participants with controlled daytime HBP levels (age, 62.5 ± 9.7yrs; 49% of male; antihypertensive medication use, 82.2%), male, diabetes, elevated office BP, and log-UACR were significant risk factors for masked uncontrolled nocturnal hypertension in multivariate logistic regression models (OR [95%CI]: male, 1.42 [1.11–1.82]; diabetes, 1.41 [1.09–1.83]; elevated office BP, 1.72 [1.38–2.14]; log-UACR, 1.35 [1.06–1.71]) (Table). Whereas, combination therapy of more than three antihypertensives including diuretics showed a lower odds ratio (0.56 [0.40–0.78]).

Conclusions:
In the present study, we revealed that male, diabetes, elevated office BP, and highly log-UACR were suggested to be risks for masked uncontrolled nocturnal hypertension. A nighttime HBP monitoring might be recommended for patients who have these risks even if they are controlled daytime HBP levels.