bluuebunny/crossref_metadata_2025_split huggingface dataset:
SECONDARY CAUSES OF HYPERTENSION IN PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION
Authors: Kvapil Tomas , Václavík Jan , Benesova Klara , Jarkovsky Jiri , Kocianova Eva , Kamasova Monika , Jelinek Libor 
Published: April 2021

Objective:
Resistant hypertension is defined as blood pressure that remains above therapeutic goal despite concurrent use of three antihypertensive agents (at full or maximum tolerated doses) of different classes, one of which is a diuretic. The prevalence of secondary causes of hypertension among patients with resistant hypertension is not exactly known.

Design and method:
We retrospectively analysed the hospital records of patients with resistant arterial hypertension, who underwent complete laboratory and imaging examinations to exclude the secondary etiology of arterial hypertension. Standard descriptive statistics were used for statistical evaluation.

Results:
Among the 600 patients with resistant hypertension, secondary etiology of hypertension was found in 160 (27,5%). The most frequent cause was primary aldosteronism in 93 cases (58% relatively), followed by renovascular hypertension (30 cases, 18.8%), renal parenchymal hypertension (25 cases, 15,6%). Less common causes were pheochromocytoma (3,1%), hyperreninism (3.1%), hypercortisolism (0,6%). Obstructive sleep apnoea has been found in 75 (12.5%) patients.

Conclusion:
Secondary etiology was much more frequent (27,5%) in our group of patients with resistant hypertension than in non-selected hypertensive population (5–15%).

Conclusions:
This work was supported by IGA_LF_2019_036, IGA_LF_2020_039
HYPERTENSION ASSOCIATED RISKS DURING THE COVID-19 PANDEMIC: THE PATIENTS’ PERCEPTION
Authors: Ioannidis Antonios , Fragkiskou Afroditi , Paraskelidou Maria , Pechlevanis Apostolos 
Published: April 2021

Objective:
Soon after the outbreak of the pandemic, uncontrolled hypertension was recognized as a risk factor for severe COVID-19 while concerns were raised that RAAS-i may increase the susceptibility and the severity of disease. The study aims to assess patients’ perception on risks associated with hypertension.

Design and method:
Hypertension patients visiting the emergency (non-COVID) department or the outpatient clinics of a tertiary hospital in Northern Greece were invited to participate by completing a short questionnaire. This observational study was conducted during the first and the much more forceful ongoing second wave. The Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) were used to measure the frequency and severity of depression and anxiety.

Results:
373 hypertensive patients (205 women, 55.0%) participated (mean age 63.6 ± 9.4 years), with 341 (91.4%) taking RAAS-i. About half (191, 51.2%) were taking RAAS-i for hypertension, while the rest for other indications. The vast majority (364, 97.6%) were alert that hypertension was a risk factor for COVID-19, although only 1 in 8 were informed that it mainly implied uncontrolled/untreated hypertension. Most of the patients (347, 93.0%) had heard that antihypertensive drugs might be harmful (mainly from TV reports), though only 199 (58.4%) of the patients taking RAAS-i knew they were taking such drugs. Moreover, 176 patients (47.2%), mostly during second wave, conducted their doctor and eventually 17 altered therapy. Participants during second wave reported higher chances of getting COVID-19, with the majority believing they are more susceptible and expecting more severe disease. The mean Beck's anxiety and depression score was 10.7 ± 7.1 and 12.2 ± 9.3 respectively, with the prevalence of significant anxiety (BAI> = 10) or depression (BDI> = 17) reaching 11% (41 patients) and 6.2% (23 patients), with as expected, higher scores for second wave patients. Disturbingly, only 20 patients (5.4%) had been informed of the position of major scientific.

Conclusions:
Greek patients are concerned of hypertension association with COVID-19 although not properly informed that it implies mainly uncontrolled/untreated hypertension. Hypertensive patients seem worried about the pandemic which is mirrored into anxiety and depression scores. Nevertheless they lack information from scientific societies.
THE PREVALENCE OF ARTERIAL HYPERTENSION AMONG PATIENTS HOSPITALIZED WITH COVID-19
Authors: Eruslanova Kseniia , Akapyan Anna , Malaya Irina , Strojesko Irina , Leonov Nikolay , Kotovskaya Julia , Runikhina Nadejda , Tkacheva Olga 
Published: April 2021

Objective:
To estimate the prevalence of arterial hypertension (AH) among patients admitted to the hospital with COVID-19 pneumonia and to discover the relationship between AH and the risk to be placed in ICU and mortality.

Design and method:
The study included 542 patients aged 18 to 98 years old with verified COVID-19 pneumonia by CT of the chest and PCR diagnosis of COIVD-19. Arterial hypertension was diagnosed by past medical history.

Results:
The patients’ age was 58 ± 15 years (n = 542), 53,9 (n = 292) of them were women. There were 49,3% (n = 267) patients with AH. The prevalence of AH was higher among women (63% (n = 169) compare to 37% (n = 98) of men) and older adults. The average age of patients with AH was 65,3 ± 14,5 years old compared to 50,1 ± 14,5 years old among patients without hypertension (p < 0,01). There was no statistical difference in NEWS scores between patients with and without arterial hypertension (p > 0,05). 16% of patients with AH were transferred to ICU, while only 10% without AH needed to be placed in ICU (p < 0,05). However, the mortality was higher in patients with arterial hypertension (8,6% compared to 0,7%, p < 0,05%).

Conclusions:
Arterial hypertension is relatively common among patients with COVID-19 pneumonia and is associated with higher mortality. However, arterial hypertension is more prevalent among older adults, and more detailed analysis should be performed to exclude confounding bias.
DEPRESCRIBING AND PROGNOSIS IN OLDER PATIENTS WITH ARTERIAL HYPERTENSION AND CHRONIC HEART FAILURE
Authors: Efremova Elena , Shutov Alexander , Antonova Elena , Bykova Alina , Samsonova Natal’ja , Hramova Anna , Cheremnyh Anastasija 
Published: April 2021

Objective:
Treatment of older patients with arterial hypertension is complicated by comorbidity and frailty syndrome. Deprescribing is a possible option for comorbid patients. The aim of this study was to investigate deprescribing and prognosis in older hypertensive patients with chronic heart failure (CHF).

Design and method:
119 older hypertensive patients with CHF (89 males, mean age was 68.9 ± 6.7 years) were studied. Arterial hypertension was defined according to ESC Guidelines for the diagnosis and treatment of arterial hypertension, 2018. Charlson comorbidity index (CCI) was estimated. Comorbidity was regarded as high at index more or equal 6 scores. Quality of life, frailty syndrome, personal characteristics were evaluated. GerontoNet ADR Risk Score was used for predicting ADRs. Follow-up period was 1 year, primary endpoint - all-cause mortality.

Results:
The CCI was 5.9 ± 1.9 scores. 67 (56.3%) older hypertensive patients with CHF had high comorbidity, 19 (10%) - frailty syndrome. The total number of drugs was 5 [4;7]. According to GerontoNet ADR Risk Score patients had 3 [2;4] scores. Most of patients (92;77.3%) had more than 5 scores (high risk of ADRs). Only 30 (25%) patients had high adherence to drug therapy. Patients with high comorbidity had more scores according to GerontoNet ADR Risk Score, than patients with low comorbidity (4 [3;6]. and 2 [1;4] resp., p = 0.0003). During the follow-up 13 patients died. The deceased patients compared to the surviving patients had a higher level of comorbidity (7.5 ± 1.9 and 5.8 ± 1.9 resp., p = 0.001)) and higher scores according to GerontoNet ADR Risk Score (4 [3;7]. and 3 [2;4] resp., p = 0.0006)). Relative risk of death within 12 months in older hypertension patients with CHF and high risk of adverse drug reactions (more or equal 6 scores according to GerontoNet ADR Risk Score) was 3.85 times (95% CI 1.42 - 10.48) higher risk of death in patients with low risk of ADRs.

Conclusions:
Older patients with arterial hypertension and CHF are characterized by high comorbidity, polypharmacy and low adherence to treatment. GerontoNet ADR Risk Score may be recommended for assessing prognosis in older hypertensive patients with CHF.
IN MIXED MARTIAL ARTS (MMA) WEIGHT LOSS BY DEHYDRATION RESULTS IN ACUTE EFFECTS ON KIDNEY FUNCTION
Authors: Pereira Antonio André Jarsen , Casarini Dulce Elena 
Published: April 2021

Objective:
Currently there is a significant growth in the world in the number of professional fighters and practitioners of Mixed Martial Arts (MMA). To promote greater preservation of athletes physical integrity, weight categories were created, however some fighters in the attempt of insertion into inferior categories, use the dehydration for their drastic weight reduction. The method used may trigger some damage to the body, such as a decrease in the volume of renal blood flow. We aimed to identify the acute effects of weight loss by dehydration on kidney function in a MMA fighter.

Design and method:
The volunteer is MLC, 34 years old, male, black, single, resident in Maceió-AL-Brazil, without metabolic diseases, with a family history of arterial hypertension. It does not use drugs or dietary supplementation. The athlete has participated in the fights in the last 3 years, losing 7 kg per dehydration for a month before the fight. The signature of the Free and Informed Consent Term was collected. Three collections were carried out: one month before the fight, in the official weighing day and the day of the event.

Results:
In this study in response to reduction of body weight by dehydration of around 7 kg, it was observed that the athlete presented some abnormalities during the body weight loss/gain cycle as glycosuria, non-reversible positive leukocyturia and proteinuria within 24 hours, elevated serum creatinine (1.3 mg/dL) and urea (42 mg/dL) during the peak of dehydration (day of weighing and fighting). Blood ureic nitrogen/creatinine ratio (15.8) and creatinine clearance (126.1 mL/min) were elevated during the three moments of observation, namely 30 days pre-fight, day of weighing and fighting.

Conclusions:
Elevated creatinine clearance suggests renal damage with increased filtration rate with possible renal damage from dehydration. We are completing the analysis of 10 athletes. Our data suggest that athletes need to be instructed so that the training method is less detrimental to their physical integrity.
Supported by CAPES
PRECIOUS TRIAL CONFIRMS SAFETY AND EFFICACY OF GUIDELINE'S SINGLE-PILL COMBINATION STRATEGY
Authors: Brguljan Jana , Chazova Irina E. , Gaciong Zbignew , Simic Dragan , Vajer Peter , Zelveian Parounak , Jelakovic Bojan 
Published: April 2021

Objective:
To assess the efficacy and safety of guideline's SPC strategy with perindopril/amlodipine (dual SPC arm) and perindopril/amlodipine/indapamide (triple SPC arm) with the goal of reaching blood pressure (BP) control in newly diagnosed and uncontrolled hypertensive patients.

Design and method:
450 adults with essential hypertension were assessed in the interventional, open-label, prospective, international, multicentre PRECIOUS trial. Treatment duration was 16 weeks, divided into four treatment periods. Office BP was measured with a validated automated BP-measuring device by a qualified health professional following guidelines protocol. At the inclusion naïve or patients uncontrolled on previous mono or dual therapy (other than perindopril/amlodipine (P/A)) were assigned to dual SPC arm with initial dose of 4/5 mg P/A. Those uncontrolled on previous dual or triple therapy were assigned to triple SPC arm with initial dose of 4/5/1.25 mg perindopril/amlodipine/indapamide (P/A/I). If BP control was not reached, the initial dose was up-titrated in 4-week intervals to 8/5 mg, 8/10 mg P/A or 8/10/2.5 mg P/A/I in dual SPC arm and to 8/5/2.5 mg, or 8/10/2.5 mg P/A/I in triple SPC arm.

Results:
After 4 months of treatment mean office BP lowered from 159.5 ± 11.6/ 99.6 ± 8.6 mmHg to 128.6 ± 9.4/81.7 ± 7.2 mmHg and from 162.4 ± 14.3/ 99.5 ± 9,6 mmHg to 127.8 ± 11.3/80.2 ± 7.5 mmHg in dual and triple SPC arm (all p < 0.001), respectively. Significant decrease by -17.1/-10.9 mmHg in dual and -14.4/-9.0 mmHg in triple SPC arm was achieved after one month of treatment (both p < 0.001). Target BP of <140/90 mmHg was achieved in 77.7% of patients in dual and in 83.0% of patients in triple SPC arm. The majority of the effect was observed within 3 months. Approximately 1/3 of patients remained on initial dose, and 1/3 needed one up-titration of the therapy. 85% of patients experienced no adverse events, recorded ones were clinically irrelevant.

Conclusions:
Guideline's SPC strategy with perindopril/amlodipine and perindopril/amlodipine/indapamide resulted in fast achievement of guideline's recommended target BP with no or just 1 up-titration therapy step in approximately 2/3 of patients, accompanied by good tolerability.
NOCTURNAL NON-DIPPING STATUS AND LEFT VENTRICULAR HYPERTROPHY IN HYPERTENSIVE PATIENTS
Authors: Amaral Teresa , Castro Daniel Pereira de , Rua Inês , Ruivo Pedro 
Published: April 2021

Objective:
Ambulatory Blood Pressure Monitoring (ABPM) is used to assess the dipping status in hypertensive patients according to the nocturnal blood pressure (NBP) decline: extreme dippers, dippers, non-dippers and inverted dippers.
Increased NBP is currently regarded as a risk factor for cardiovascular (CV) events and hypertension-mediated organ damage (HMOD).
One of the most common HMOD include left ventricular (LV) remodelling as chronic BP elevation may progressively increase LV thickness.
The aim of this study is to determine if there is a higher prevalence of LVH in echocardiographic (ECHO) parameters in patients with increased NBP.

Design and method:
Prospective observational study.
Inclusion criteria: subjects with treated hypertension undergoing ABPM performed in our Primary Health Care Unit and with ECHO in the last 3 years.
Fisher's exact test was used whenever appropriate to assess independence and statistical significance of reported factors. Logistic regression analysis was performed to assess the effects and its statistical significance between established parameters. Statistical differences were indicated as p < 0.05 and p < 0.01. Statistical analysis was performed using R version 4.0.3.

Results:
For this study, 67 patients were screened, from which 44 were male and 23 females, average age of 55 years old.
We obtained a distinct distribution of dipper and non-dipper profiles in a LVH dependent manner. The non-dipper presented higher significant effect with LVH (p < 0.01) and the results obtained from the fisher test showcase a statistically significant relation between non-dippers and LVH (annex 1)

Conclusions:
The limitations of this study included the small sample size and the usage of a questionable diagnose of dipping status in a 24 h period since it is often highly variable. Based on the results, there seems to be an impact of NBP on LV structure since there is a statistically significant relation between non-dipper status and LVH.
Hypertensive patients should be submitted to ECHO and other forms of HMOD screening, especially non-dippers, considering their increased CV risk, in order to improve CV risk stratification therapeutic strategies.
ActiGraph and Short-term Heart Rate Variability Study Protocol
Authors: Luong Anna , Goodyke Madison , Dunn Susan L. , Baynard Tracy , Bronas Ulf 
Published: April 2021

Background
ActiGraph accelerometry is widely used in nursing research to estimate daily physical activity. Heart rate variability (HRV), a measure of autonomic modulation, can be assessed in conjunction with the ActiGraph using a Polar H7 Bluetooth heart rate monitor. There is a paucity of nursing literature to guide nurse researchers' protocol development when using the ActiGraph to assess both physical activity and short-term HRV via its Bluetooth capabilities.

Objectives
The aim of this study was to describe a standardized research ActiGraph and HRV (ActiGraph HRV) protocol for an ongoing randomized controlled trial to measure physical activity and short-term HRV in patients with ischemic heart disease who report hopelessness.

Methods
We outline the study protocol for the standardization of reliable and rigorous physical activity and HRV data collection using the ActiGraph wGT3X-BT and Polar H7 Bluetooth heart rate monitor, and data analysis using ActiLife and Kubios software programs.

Results
Sixty-four participants enrolled in the randomized controlled trial to date, and 45 (70.3%) have completed or are actively participating in the study. Heart rate variability data have been collected on 43 of the 45 participants (96%) to date. During the first data collection time point, 42 of 44 participants (95.5%) wore the ActiGraph for a minimum of 5 valid days, followed by 28 of 31 participants (90.3%) and 25 of 26 participants (96.2%) at subsequent data collection time points. The intraclass correlation for physical activity in this study is 0.95 and 0.98 for HRV.

Discussion
Revisions to the protocol were successfully implemented at the onset of the COVID-19 pandemic for data collection using social distancing. The protocol was additionally amended in response to an unanticipated problem with ActiGraph battery life using Bluetooth technology. Use of the ActiGraph HRV protocol has led to a reliable and rigorous measurement of physical activity and HRV for patients with ischemic heart disease who report hopelessness in this randomized controlled trial.

Conclusion
We provide an ActiGraph HRV protocol that can be adapted as a model in the development of ActiGraph HRV protocols for future nursing research in community and home-based settings while maximizing social distancing in the current and future pandemics.
A Quality Improvement Initiative Is Associated With Reduced Time to Administer Biologics and Small Molecules and Emergency Room Visits in Inflammatory Bowel Disease
Authors: Battat Robert , Galati Jonathan S. , Lukin Dana , Chabouni Fatiha , Sockolow Robbyn , Carter Jeff , Fajardo Kristina , Yang Stevie , Reich Jenna , Jacobs Vinita , Abramowitz Meira , Kumar Anand , Christos Paul , Longman Randy S. , Burakoff Robert , Simone Laura , Sapir Tamar , Crawford Carl V. , Scherl Ellen J. 
Published: April 2021

Background:
Delays in biologic or small molecule medication administration are associated with increased adverse events, hospitalization, and surgery in inflammatory bowel disease (IBD). We evaluated the impact of a quality improvement (QI) intervention on the time to administration of biologics or small molecules (TABS) in IBD.

Methods:
Data were retrospectively extracted for IBD patients prescribed biologics or small molecules from a convenience sample of providers participating in an accredited QI educational intervention (baseline cohort). Subsequent to the intervention, data were prospectively collected from patients prescribed these medications (postintervention cohort). Dates related to steps between a treatment decision to medication administration were collected. The primary outcome compared TABS in baseline and postintervention cohorts.

Results:
Eighteen physicians provided survey and patient data for 200 patients in each cohort (n=400). The median time to medication administration (TABS) decreased from baseline to postintervention cohorts (30 vs. 26 d, P=0.04). Emergency room visits before medication administration also decreased (25.5% vs. 12.5%, P=0.001). Similar numerical TABS reductions were observed in subgroups limited to physicians providing patients to both cohorts and for individual medications prescribed. Primary contributors to delays included filling prescriptions subsequent to insurance approval and dispensation subsequent to this.

Conclusions:
A QI intervention successfully reduced medication administration times (TABS) by accelerating provider-dependent steps. This intervention was associated with reduced emergency room visits. We propose TABS as a quality metric to assess the effective delivery of therapies in IBD. Further evaluation of QI interventions, patient education on prescription drug insurance, and quality metrics are warranted.
Association of sex with the clinical course and outcome of internal emergency department patients: a secondary data analysis
Authors: Thomas Clara , Möckel Martin , Searle Julia , Vollert Jörn Ole , Somasundaram Rajan , Slagman Anna 
Published: April 2021

Background and importance
Differences between men and women visiting the emergency department (ED) with nonsurgical complaints have mostly been investigated in small, diagnosis-based subpopulations.

Objective
This study investigated sex-differences in an unselected cohort of nonsurgical ED patients.

Design
Secondary data of all patients attending two EDs of the Charité, Universitätsmedizin Berlin collected in the framework of their medical evaluation was reviewed.

Settings and participants
Within a 1-year-period all 34 333 adult internal patients presenting to one of the two EDs were included and analysed.

Outcomes measure and analyses
Sex-stratified descriptive analysis of the in-hospital course and outcome of the ED patients was performed as primary endpoint. Admission data, ED processes and diagnoses were analyzed as secondary endpoints.

Main results
A total of 51.2% of all patients were women. Women were slightly younger (median 56 years vs. men 58 years; P < 0.001) and presented more frequently with abdominal pain and headache. Men rather showed chest pain and dyspnea. Accordingly, women had more gastroenterological diseases; men were more often diagnosed with cardiological and pneumological diseases. Women were less frequently admitted for inpatient treatment [35.3 vs. men 43.7%; difference 8.4 percentage points (95% confidence interval (CI), 7.3–9.4)] and intensive care treatment [5.8 vs. men 9.0%; difference 3.2 percentage points (95% CI, 2.7–3.8)]. Inpatient-mortality did not show significant sex differences [4.6 women vs. 4.8% men; difference 0.2 percentage points (95% CI, −0.6 to 0.8)].

Conclusions
There are significant differences in characteristics, symptoms, diagnoses and clinical course between men and women. Further investigations could identify causes and measures like sex-specific algorithms for ED-work processes.
The Work of Oskar Herzberg—Did Psychosis or the Residence in a Psychiatric Institution Serve as a Catalyst for Creativity?
Authors: Strube Sebastian , Steinberg Holger 
Published: April 2021

Abstract
In the 1920s, the Heidelberg psychiatrist and art historian Hans Prinzhorn collected pictorial works by “mentally ill people”—today’s Prinzhorn Collection.
His colleague Paul Schilder sent him works by Oskar Herzberg thereto, which Prinzhorn included as “Case 355” in his famous work Bildnerei der Geisteskranken.
Using Herzberg as an example, we approached the general issue of the relationship between mental illness, creativity, and art from a historical psychiatric perspective.
It was not before his admission to the Leipzig clinic due to his schizophrenic illness that Herzberg began to paint. Prinzhorn and his doctor Ernst Jolowicz considered this late start of artistic activities to be the expression of an immanent creative urge caused by exceptional psychotic experiences. Our study intends to view such artworks outside a rather pathological context. Therefore, we discuss being secluded in psychiatry, supplied painting utensils, and released from his daily constrains as other possible triggering factors for Herzberg’s artistic development.