bluuebunny/crossref_metadata_2025_split huggingface dataset:
MAY MEASUREMENT MONTH: DATA FROM A NATIONAL SCREENING PROGRAMME IN OMAN IN 2017 AND 2018
Authors: Al-Riyami Hassan , Nadar Sunil , Al-Riyami Adil , Panakkal Benny , Mohammed Shafeeq , Gb Nagaraju , Sharma Sn , Beaney Thomas , Ster Anca , Poulter Neil 
Published: April 2021

Objective:
Hypertension is a major cardiovascular risk factor yet many patients remain undiagnosed. The aim of the May Measurement Month (MMM) screening programme was to identify individuals with undiagnosed hypertension.

Design and method:
This study was part of a global screening programme with screening centers set up in various hospitals and public areas in Muscat, Oman during the months of May 2017 and 2018. Screening was done according to the MMM protocol with three blood pressure (BP) readings taken along with a questionnaire of demographic, lifestyle and other risk factors. Hypertension was defined according to the European Society of Hypertension 2018 guidelines,(systolic BP(SBP) greater than140mmHg and/or diastolic BP(DBP) greater than 90mmHg)

Results:
A total of 13,621 individuals (age 40.8 + 12.6 years, 30.1 % male, 88.4% arab ethincity) were screened over the two month period. The mean of the first BP was 132.1 + 19.1/ 81.1 + 12.2 mmHg. The average of the second and third readings, where available (n = 5,934, age 41.5 + 14.3 years, 64.4% male) was 128.5 + 17.7/79.1 + 11.1 mmHg. This was significantly lower than the first BP reading alone (p < 0.001 for both SBP and DBP). Women were more likely to have only one reading. Further analysis was done only where three BP readings were available. In those with 3 BP readings, 1438 individuals (of which 471 were on antihypertensive medication) had BP in the hypertensive range. This works out to 47.7% of patients on medications(n = 988) having uncontrolled BP. The remaining 967 were newly diagnosed hypertensive. The number of hypertensives in our sample therefore was 1,955, giving a proportion of 32.9% of hypertensive individuals (of those with three BP readings) in our sample. Pregnant women had significantly lower BP than non pregnant women. By binary logistic regression, the factors predicting BP in the hypertensive range were age, sex, previous stroke, but not diabetes, previous MI or ethnicity

Conclusions:
In Oman, the proportion of individuals having hypertension is comparable to previous estimates and surveys. A high proportion of individuals on treatment still have uncontrolled BP. More needs to be done to educate the public regarding the need for better BP control.
BLOOD PRESSURE RESPONSE TO AN ISOMETRIC CONTRACTION AND 3 MINUTE OF TREADMILL TEST PREDICTS LEFT VENTRICULAR HYPERTROPHY IN NORMOTENSIVES
Authors: Pittaras Andreas , Faselis Charles , Grassos Haralampos , Poulimenos Leonidas , Doumas Michel , Stavropoulos Konstantinos , Kyfnidis Konstantinos , Samuel Immanuel , Pyriovoli Georgia , Kallistratos Manolis , Imprialos Konstantinos , Manolis Athanasios , Kokkinos Peter 
Published: April 2021

Objective:
Left ventricular hypertrophy (LVH) is associated with a significant increase in major CV event. Recent evidence supports the presence of LVH independent of BP and other confounders.
The presence of LVH, especially in those with normal resting BP, is likely to remain undetected in this cohort for two main reasons: 1) The misconception that LVH only occurs when hypertension is present and, 2) The non-invasive methods to screen for LVH either have poor sensitivity (EKG) or are relatively costly and labor intensive (Echo, MRI). We hypothesized that BP response in isometric contraction, and exercise treadmill test, will be significantly associated with cardiac structure and function, providing an inexpensive and practical screening method to identify pts at high risk of LVH.

Design and method:
In 344 men and 46 women, normotensives with no ECG-LVH, we assessed BP response: 1) during an isometric contraction (HGR) using 50% of the maximum force generated (1-RM) and 2) at 3 min of exercise treadmill test (ETT). Cardiac structure was assessed via echocardiogram. We used a logistic regression to determine the relationship between HGR-BP, ETT-BP and LVH, with LVH as the dependent variable. The model was adjusted for age and resting BP.

Results:
Both HGR-SBP/DBP, and ETT-3min-SBP/DBP were significant predictors of LVH (p < 0.05).
Inflection point analysis identified a HGR-SBP/DBP threshold of 146/84mmHg and ETT-SBP/DBP threshold 141/78 mmHg.
Beyond these thresholds, the probability of LVH increased by 3% for every 1 mmHg change in SBP and 6% in DBP for HGR, and 2% & 4% for ETT-SBP/DBP respectively.
The sensitivity and specificity of HG-SBP test was 90% and 79%
The sensitivity and specificity of ETT-SBP-3 min test was 90% and 82%

Conclusions:
Both HGR-SBP/DBP and ETT-3min-SBP/DBP were strong predictors of LVH in normotensive subjects with no evidence of ECG-LVH, having clinically significant sensitivity and specificity.
NONINVASIVE MEASUREMENTS OF NORMAL VALUES OF STROKE VOLUME AND TOTAL PERIPHERAL RESISTANCE IN AN ELDERLY POPULATION ACCOUNTING FOR AGE AND SEX DIFFERENCES
Authors: Woodford Stephen , Avolio Alberto , Butlin Mark 
Published: April 2021

Objective:
Clinical management guidelines generally provide ideal ranges for stroke volume (SV) and total peripheral resistance (TPR) [1] and rarely provide detailed normal values addressing age and sex, particularly in the elderly population. This has likely impact on anaesthesia management in surgery and critical care and may impact other clinical fields. This study quantifies SV and TPR in older age.

Design and method:
1051 (579 female) participants 50–100 years old presenting for a range of surgeries were studied at rest pre-surgery. SV was determined noninvasively using either the Vigileo Flotrac (Edwards Life Sciences) or Uscom 1A (USCOM) device. Coupled with blood pressure measurement, SV and TPR were calculated and cross-sectional differences were quantified in relation age, sex, and body mass and surface area.

Results:
At any age, SV and TPR differed in males and females and correlated with body mass index and body surface area. In both sexes, SV decreased and TPR rose for each decade. In females between the 6th and 10th decades, mean resting SV fell from 84 ± 14 mL to 40 ± 6 mL (outside “normal” range of 60–100 ml [1]), and TPR rose from 1200 ± 240 dynes.sec/cm5 to 2720 ± 480 dynes.sec/cm5 (above “normal” range of 1000–1500 dynes.sec/cm5 [1]). In males, mean resting SV fell from 111 ± 23 mL to 64 ± 10) mL (within “normal” range) and TPR rose from 1040 ± 160 dynes.sec/cm5 to 1600 ± 240 dynes.sec/cm5 (marginally above “normal” range) [1].

Conclusions:
SV and TPR as reported by the Vigileo Flotrac and Uscom 1A devices move outside the generally accepted “normal” range for older individuals. This may either be due to the algorithms used for noninvasive calculation of SV and TPR, or may mean that “normal” values need to be revisited for older individuals, which will require confirmatory evidence by direct or invasive methods.
[1] Parrillo, J.E. & Dellinger, R.P., 2008. Principles of Diagnosis and Management in the Adult, Philadelphia: Mosby Elsevier.
QUANTITATIVE METHODS FOR ASSESSING CONTRACTILE RESERVE IN PATIENTS WITH HYPERTENSION AND DIASTOLIC HEART FAILURE
Authors: Hristova-Tselova Krasimira , Tselov Nikolay , Tsonev Svetlin , Marinov Rumen 
Published: April 2021

Objective:
We assessed the effect of several hemodynamic parameters and it changes during handgrip maneuvers in patients with different stages of diastolic heart failure during chemotherapy and their improvements after 4 months follow up (4mFU) treatment with single pill combination of ACE inhibitor ACE) and beta –blocker (BB).

Design and method:
The study population included 65 patients- female / mean age of 45 ± 12 years/ 55 with breast cancer and undergoing chemotherapy / 30 pts with HFpEF and 25 pts with HFmrEF / and 10 pts with HFnEF and without chemotherapy. Following maximal squeeze by 100%, during the next 3 minutes patients were instructed to apply pressure at 50%. The global longitudinal strain and MAP and HR were performed at basal level, 1st, 2nd and 3rd minutes during handgrip stress test. The contractility /force/ of LV were also calculate as ratio SBP / ESV.

Results:
Heart rate (HR) and mean arterial pressure (MAP) increased significantly after handgrip maneuver / from 75 ± 6 beats /min to 101 ± 12 beats/ min, 109 ± 15 mmHg to 118 ± 19 mmHg, p < 0,05 /. Pulmonary artery systolic(s) and diastolic (d) pressure (PAP),pulmonary capillary wedge pressure (PCWP), cardiac index (CI), LVEF did not change significantly (p > 0,5) after handgrip maneuvers. On the other hand, LV force (SBP/ ESV ratio), MAP and HR decreases significantly (p < 0,01) in group with HFmrEF. In same group were found significantly decreased GLVLS at 2nd and 3rd minutes during stress- test comparable with other 2 groups with HFpEF and HFnEF. After 4mFU and treatment with 5/5 mg doses combination of ACE / BB were found improvement in parameters: HR /p < 0,001/, MAP /p < 0.01/ and contractile reserve as well as LV force /p < 0, 01/ and GLVLS /p < 0,001/.

Conclusions:
Patients with good LV reserve had a rise in stroke –work with little or no change in LVEDP. Patients with poor contractile reserve had a fall in stroke- work reserve together with a substantial rise in LVEDP. The treatment with combination with small doses ACE/BB is a big challenge in patients with HFmrEF and HFpEF to improve the contractile reserve.
AORTIC STIFFNESS AND LEFT VENTRICULAR MASS ASSESSED BY CARDIOVASCULAR MAGNETIC RESONANCE IN ADOLESCENTS WITH WHITE COAT HYPERTENSION, SPURIOUS HYPERTENSION AND TRUE HYPERTENSION
Authors: Sarnecki Jedrzej , Obrycki Lukasz , Feber Janusz , Litwin Mieczyslaw 
Published: April 2021

Objective:
Cardiovascular magnetic resonance (CMR) is the gold standard for the noninvasive assessment of left ventricular mass (LVM) and it permits the evaluation of aortic stiffness (AS).
Our aim was to assess LVM and AS in adolescents with suspected arterial hypertension (AH), who were divided into the following groups: white coat hypertension (WCHT), spurious hypertension (sHT) and true hypertension (tHT).

Design and method:
LVM, pulse wave velocity in the proximal (proxPWV) and whole thoracic aorta (thPWV) were assessed by CMR imaging in 72 patients with suspected AH (15 girls, mean age 16.4 ± 1.5years).
Based on the results of 24-hour ambulatory blood pressure monitoring AH or WCHT was diagnosed. AH group was further subdivided into sHT, defined as isolated systolic hypertension with normal central blood pressure (cBP), and tHT defined as elevated cBP.

Results:
WCHT was diagnosed in 42 and AH in 30 patients (12 sHT; 18 tHT).
Comparison of WCHT with AH revealed significantly higher LVM index (LVMI, 63.8 ± 11.3 vs 72.6 ± 8.8 g/m2), LVMI z-score (0.4 ± 0.8 vs 1.0 ± 0.7), proxPWV (3.9 ± 0.8 vs 4.5 ± 1.4m/s), proxPWV z-score (0.3 ± 1.1 vs 1.0 ± 1.6) and thPWV (3.7 ± 0.7 vs 4.2 ± 0.8m/s) in AH group (p < 0.05 for all comparisons).
LVMI/LVMI z-scores were significantly higher in both sHT (72.8 ± 10.8 g/m2 / 0.96 ± 0.79) and tHT (72.5 ± 7.5 g/m2 / 0.99 ± 0.64) as compared to WCHT (63.6 ± 11.3 g/m2 / 0.34 ± 0.82). Patients with sHT also had significantly higher thPWV (4.4 ± 0.8m/s) compared to WCHT (3.7 ± 0.7m/s) and tHT (4.0 ± 0.8m/s).

Conclusions:
Both tHT and sHT are associated with greater LVM and AS than WCHT. This supports the argument that sHT is not a benign phenomenon.
ARTERIAL STIFFNESS IN CHRONIC AUTOIMMUNE LIVER DISEASES. A PILOT STUDY
Authors: Premuzic Vedran , Knezevic-Stromar Ivana , Sesa Vibor , Premuzic Marina , Ostojic Rajko , Jelakovic Bojan 
Published: April 2021

Objective:
Chronic inflammatory disease increase arterial stiffness and are associated with accelerated atherosclerosis. Our aim was to determine augmentation index (AIx) and pulse wave velocity (PWV) in patients with chronic autoimmune liver disease.

Design and method:
We have enrolled 38 patients (3m 35w; age 58.7 ± 9.6) with chronic autoimmune liver disease (autoimmune hepatitis 4, primary biliary cholangitis 24, primary sclerosing cholangitis 10). Office blood pressure (BP) was using Omron M6; PWV and AIx by Arteriograph. The assessment of liver cirrhosis was determined with FibroScan. Fasting blood and 24-hour urine samples were collected. Hypertension was diagnosed in 42.1% patients (18.7% were treated) and diabetes in 8.4%.

Results:
PWV was 9.7 m/s while AIx was also increased (32.8%). PWV was positively correlated with age, sedimentation rate, CRP and central systolic BP and negatively with eGFR. AIx was positively correlated with heart rate and central systolic BP. Linear regression analysis showed positive association of Aix with duration of disease, sedimentation rate, total cholesterol,triglycerides and FibroScan stiffness. PWV was positively associated with age, duration of disease, sedimentation rate, total cholesterol and triglycerides. We found that patients with PWV > 9 m/s were significantly older, had higer sedimentation rates, lower GFR, higher total cholesterol, LDL cholesterol, systolic/diastolic BPr and central systolic BP values.

Conclusions:
Patients with chronic autoimmune liver diseases have increased arterial stiffness than general population which confirmed our hypothesis on impact of chronic inflammation on increased arterial stiffness. However, this should be confirmed on larger number of patients.
WHITE-COAT HYPERTENSION AND ARTERIAL STIFFNESS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE
Authors: Premuzic Vedran , Jelakovic Mislav , Prijic Radovan , Jelakovic Ana , Cukovic-Cavka Silvija , Krznaric Zeljko , Jelakovic Bojan 
Published: April 2021

Objective:
Our aim was to analyze cardiovascular (CV) risk factors, target-organ damage, arterial stiffness and ABPM in patients with inflammatory bowel disease (IBD).

Design and method:
A total of 120 IBD patients (77 Crohn; 43 ulcerative colitis; age 37.1 ± 4.2; men 58.3%) were enrolled. Office blood pressure (BP) (Omron M6), pulse wave velocity (PWV) and aortic augmentation index (AIx) (Arteriograph) and ABPM (SpaceLab 90207) were measured in all patients. Hypertension was defined as BP > 140/90 mmHg. None of patients used antihypertensive drugs. Chronic kidney disease (CKD) = eGFR < 60 ml/min/1.73m2 (CKD Epi); microalbuminuria (MA) = 24-h albuminuria > 30 mg/dU.

Results:
Dyslipidemia, left ventricular hypertrophy, CKD and MA were found in 10%, 0.83%,1.67% and 15% of patients, respectively. PWV > 8m/s was found in 45% of patients. In the linear regression model age and duration of IBD were only positive predictors of higher PWV. On logistic regression older patients and patients with longer duration of IBD had OŔs for PWV > 8 m/s of 0.94 [CI 0.89, 0.99] and 0.99 [CI 0.98, 1.00]. In the whole group of patients older age and longer duration of IBD had OŔs for TOD (0.93 [CI 0.89, 0.96]; 0.99 [CI 0.98, 1.00]). White coat hypertension (WCH) was found in 38 subjects (31.7%), while 1 patient had masked hypertension. There were 41.7% non-dippers. We failed to find differences in traditional CV risk factors between WCH and normotensives. However, patients with WCH had significantly higher values of central systolic BP, AIx and PWV. PWV and non-dipping pattern were associated with WCH (OR 0.69 [CI 0.52, 0.92] and 2.50 [CI 1.08, 5.77].

Conclusions:
The most important finding of our study is high prevalence of WCH which was associated with PWV, Aix and higher central systolic BP. The second important result is higher prevalence of patients with PWV above the cut off value which was associated with age and the duration of IBD but not with other traditional risk factors. We confirmed that traditional CV risk factors are not frequently present in IBD patients indicating that inflammation is important determinant of arterial stiffness in IBD.
VASCULAR IMAGING IN TAKAYASU DISEASE
Authors: Abid Dhia El Hak , Thabet Maissa , Jihed Anoun , Monia Karmeni , Fatma Ben Frej , Amel Rezgui , Chedia Laouani 
Published: April 2021

Objective:
Assessment of the radiological characteristics in a series of Tunisian patients with Takayasu disease.

Design and method:
Retrospective study of records of patients with Takayasu arteritis who were admitted in our department between 1997 and 2017. The diagnosis was established according to the criteria of the American College of Rheumatology (1990).

Results:
We have included 26 patients (5 men and 21 women). The average age at the time of diagnosis was 34.27 years (extremes: 16 - 46 years). The occlusive phase lesions were assessed with Doppler ultrasound (n = 21), Computed Tomography Angiography or CTA (n = 19) and Magnetic Resonance Angiography or MRA (n = 7). The main observed abnormalities were: parietal thickening (n = 19), stenosis (n = 19) and aneurysmal dilation (n = 5). Arterial damage predominated in the left subclavian artery (n = 22), the right subclavian artery (n = 19) and the left common carotid artery (n = 11). The aorta was affected in its ascending portion (n = 9), its arch (n = 9), its descending thoracic portion (n = 8) and its abdominal portion (n = 5). The right and left axillary arteries were affected in seven and eight cases respectively. Lesions of the humeral artery were noted on the right and left sides, in four cases each. The left renal artery was more frequently affected (ten cases on the left side versus eight cases on the right side). Digestive vascular impairment concerned three patients. A pulmonary arteritis was noted in one case. The lesions were angiographically classified: type 1 (n = 6), type 2A (n = 1), type 2B (n = 1) and type 5 (n = 18).

Conclusions:
The results obtained in our series are in line with the literature data. Doppler ultrasound and CTA were the most commonly used radiological modalities. The access to other types of imaging, particularly the MRA and the Positron Emission Tomography or PET-Scan, remains limited in our context due to problems of cost and availability.
EFFECT OF RENAL DENERVATION ON RENAL FUNCTION OF PATIENTS WITH UNCONTROLLED HYPERTENSION: INSIGHTS FROM A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED, SHAM-CONTROLLED TRIALS
Authors: Stavropoulos Konstantinos , Katsimardou Alexandra , Patoulias Dimitrios , Imprialos Konstantinos , Bouloukou Sofia , Tegou Zoi , Bakaloudi Dimitra , Kerpiniotis Georgios , Dimitriadis Kyriakos , Papademetriou Vassilios , Tsioufis Konstantinos , Doumas Michael 
Published: April 2021

Objective:
Renal denervation (RDN) has been studied extensively during the last decade. Its role in the management of resistant hypertension has been placed at the epicenter. Its effect on renal function however represents a major safety issue.

Design and method:
PubMed and CENTRAL, along with grey literature sources, were searched from their inception to May 2019 for randomized, sham-controlled trials primarily evaluating the efficacy and safety of RDN on the management of hypertension, irrespective of study blinding, setting and sample size. We extracted those data concerning the effect of RDN on renal function of enrolled participants.

Results:
Six randomized, sham-controlled trials were identified and included in the meta-analysis. In total, 981 patients with hypertension were randomized in all 6 trials to undergo either RDN (n = 585) or sham-procedure (n = 396). RDN was associated with a non-significant decrease in estimated glomerular filtration rate by 0.24 ml/min/1.73 m2 (95% CI: -1.95 to 1.47; I2 = 0%), compared to sham procedure. It was also observed that restriction of the analysis on second-generation trials did not alter significantly the observed effect estimate (mean difference = -0.02; 95% CI: -2.64 to 2.62; I^2 = 0%). Finally, no difference was detected in serum creatinine levels, when RDN was compared to sham (mean difference = 0.00; 95% CI: -0.02 to 0.02; I^2 = 0%).

Conclusions:
RDN constitutes a safe procedure, as far as renal function is concerned. It has to be admitted however, that all trials were relatively short-term (up to 1 year); thus, data from long-term studies are needed to confirm the renal safety of RDN.
NONINVASIVE 24-HOUR HEMODYNAMICS PREDICT BLOOD PRESSURE RESPONSE TO RENAL DENERVATION IN THE SPYRAL HTN-OFF MED PILOT AND PIVOTAL TRIALS
Authors: Weber Thomas , Wassertheurer Siegfried , Mayer Christopher C. , Hametner Bernhard , Townsend Raymond R. , Mahfoud Felix , Kario Kazuomi , Fahy Martin , Debruin Vanessa , Peterson Nicole , Negoita Manuela , Weber Michael A. , Boehm Michael 
Published: April 2021

Objective:
To investigate whether hemodynamic measures obtained during regular 24-hour blood pressure (BP) monitoring may predict BP response to renal denervation (RDN) using the SYMPLICITY SPYRAL renal denervation system.

Design and method:
This was a post-hoc analysis from the SPYRAL HTN-OFF MED pilot and pivotal trials. We used the raw BP waveforms, obtained at baseline and 3 months during 24-hour BP monitoring with an oscillometric sphygmomanometer. Waveforms were acquired at diastolic BP level, underwent in-device and post-hoc quality control, and were processed with validated ARCSolver algorithms to derive parameters of pulsatile hemodynamics (Augmentation Index – AIx). AIx quantifies the impact of wave reflection on the central aortic waveform. Its main hemodynamic determinants are aortic stiffness, peripheral resistance, heart rate and left ventricular function. We investigated the relationship between 24-hour AIx at baseline and the change in 24-hour systolic and diastolic BP (SBP/DBP) at 3 months in the combined RDN groups from both trials. Data were adjusted for observed trends in the sham group. We defined a favorable response as a drop in 24-hour systolic BP of at least 5 mm Hg.

Results:
Raw pressure waveforms were available for analysis in 103 patients undergoing RDN and 104 sham controls. Baseline characteristics and 24-hour BP changes at follow-up were comparable to the original trials. The relationship between baseline AIx and change in 24-hour SBP/DBP in the RDN group was: -8.2/-6.6 mm Hg for AIx < = 50. percentile and -0.8/-0.8 mm Hg for AIx > 50. percentile (p < 0.001). In addition, a higher heart rate at baseline was associated with a larger BP drop at 3 months. Taking AIx and heart rate into account, a favorable BP response following RDN could be predicted with an area under the curve of 0.70. Interestingly, baseline BP was no longer associated with BP response to RDN after adjustments for the BP changes in the sham group.

Conclusions:
Our hypothesis-generating results for the first time suggest that hemodynamic measures, obtained during regular 24-hour BP monitoring in the workup before RDN, may predict BP response. Due to sample size, further investigation is needed.