bluuebunny/crossref_metadata_2025_split huggingface dataset:
FACTOR ANALYSIS OF UNTREATED HYPERTENSION FROM TARUMIZU STUDY
Authors: Sakoda Takashi , Akasaki Yuichi , Kubozono Takuro , Iked Yoshiyuki , Ohishi Mitsuru 
Published: April 2021

Objective:
The percentage of hypertensive patients taking antihypertensive drugs has continued to rise in Japan, it is over 50% in 60 s age group and over 60% in 70 s age group. However, the reason for not receiving treatment for hypertension is not clear. We tried to analyze the factors of untreated hypertension.

Design and method:
We conducted a cross-sectional study of 864 people who participated in health check-up in Tarumizu study in 2018. Untreated hypertension group was defined as participants’ blood pressure was 140 / 90mmHg or higher and not taking antihypertensive medications, and also treated hypertension group was defined as participants were taking antihypertensive drugs regardless of blood pressure control status. Among 864, 221 was in normal blood pressure group (26%; male / female ratio = 75/146, average 73.4 years old), 207 was in untreated hypertension group (24%; male / female ratio = 71/136, average 73.8 years old) and 436 were in treated hypertension group (50%; gender ratio = 170/260, average 76.4 years old).

Results:
Patients with or without antihypertensive therapy were compared by univariate analysis. We selected advanced age (P < 0.0001), living with children (P = 0.0115), angina (p = 0.024), past stroke (p = 0.0004), diabetes mellitus (p < 0.0001), dyslipidemia (p < 0.0001), family history of hypertension (p < 0.0001), family history of no cancer (p = 0.0314), poor health awareness (p = 0.0072), fear of falling (p = 0.0375), awareness of decline in memory (p = 0.0322), interruption of interest (p = 0.0348), lack of vitality (p = 0.0353), decline in motor function (p = 0.0045), brushing after breakfast or lunch (p = 0.0212 / 0.008), lack of exercise (p = 0.0242), few remaining teeth (p = 0.0157), normal walking slowly (p = 0.010), forced walking slowly (p = 0.0002) as related factors for receiving antihypertensive therapy.

Conclusions:
The reasons for not visiting a medical institution include young, energetic and confident in health, not having a major illness such as angina or stroke. If patients had a family history of hypertension, other lifestyle related diseases or lived with their children, the probability of receiving antihypertensive therapy increases.
ANTIHYPERTENSIVE DRUG THERAPY IN NEPAL: FINDINGS FROM MAY MEASUREMENT MONTHS 2019
Authors: Neupane Dinesh , Dhungana Raja Ram , Bhattarai Harikrishna , Adhikari Tara Ballav , Koirala Sweta , Khanal Pratik , Khatiwoda Shiva Ram , Kallestrup Per , Koirala Bhagawan , Matsushita Kunihiro , Olsen Michael Hecht , Poulter Neil , Appel Lawrence J. 
Published: April 2021

Objective:
To explore the pattern of the antihypertensive medication use among Nepali patients.

Design and method:
This cross-sectional study in Nepal analysed data from the May Measurement Month 2019 (MMM19). We converted all trade names to generic names and further categorized according to class of medication. Participants who provided the information about the name of their antihypertensive medication at the time of interview were included. Blood pressure (BP) control was defined as a systolic BP < 140 mmHg and diastolic BP < 90.

Results:
Out of 72,320 who participated in the MMM19, three BP readings were available for 66,955 (93%). Among them, 15,872 (24%) had hypertension and 7,507 (47%) were taking antihypertensive medication. Out of them, 1,434 (19%) provided the information about the antihypertensive medication. The mean (SD) of systolic and diastolic blood pressure were 135 mmHg (17 mmHg) and 86 mmHg (11 mmHg). Among those treated for BP, 85%,14% and 1% used 1, 2 and > 2 drugs respectively and 63% were controlled. The proportion of patient taking calcium channel blockers (CCB), angiotensin II receptor blockers (ARBs), and CCB plus ARB were 56%, 24% and 10%, respectively. Amlodipine was the most widely used medicine (55 %) followed by losartan (15%). Blood pressure control rate among participants using telmisartan, losartan plus hydrochlorothiazide, amlodipine plus losartan, losartan and amlodipine were 75%, 68%, 64%, 62% and 62%, respectively.

Conclusions:
Among individuals taking antihypertensive medications in Nepal, 85% of patients were taking monotherapy, mostly amlodipine. Improvements in BP control will likely require intensification of therapy, potentially through greater use of fixed dose combination therapy.
STATIN ADHERENCE IN REAL CLINICAL PRACTICE
Authors: Grintsevich Julia , Vasilyeva Lyubov , Bragina Anna , Podzolkov Valeriy 
Published: April 2021

Objective:
To study statin adherence and factors associated with in real clinical practice.

Design and method:
53 statin taking patients with multimorbidity during their hospitalization were included. Mean age was 68,1 ± 10,2 years. All participants completed general questionnaires containing questions about their comorbidity and knowledge about statins, HADS (Hospital Anxiety and Depression Scale) and MoCa (The Montreal Cognitive Assessment) scale. Adherence was assessed by original questionare. Statistica 10.0 software was used for data management and statistical analysis.

Results:
50,9% of patients were non-adherent, 22,6% were adherent, and 26,4% had insufficient adherence. 67,9% of respondents had some knowledge about statins, 32% had lack of information. Among informed patients answers of 91,7%, were correct, 8,3% had wrong information. 34,0% of patients took prescribed therapy for less than a year, 9,4% - from 1 year to two years, 22,6% - from 2 to 5 years, 17,0% - more than 5 years, the longest period of statin intake was 13 years. Long-standing course of statin administration (r = -0,30), level of total cholesterol (r = -0,30) and body mass index (BMI) (r = 0,28) were correlated with the score of adherence questionare. Patient awareness about statins were associated with gender (r = -0,33), smoking (r = -0,35), family history of cardiovascular diseases (r = 0,43), anxiety (r = 0,35), comorbidity (r = 0,41), initial insomnia (r = 0,38), sleeping quality disorder (r = 0,33), grade of hypertension (r = 0,39). There was correlation between correct patient knowledge and scores on the Moca scale (r = 0,46).

Conclusions:
About a half of all respondents were non-adherent to statin therapy and adherence of one-third was insufficient. Adherence to therapy was associated with the duration of taking statins, levels of total cholesterol and BMI. Due to the received correlations it was possible to identify male gender and smoking as markers of low awareness. Presence of family history of cardiovascular diseases, anxiety, comorbidity, initial insomnia and sleeping quality disorder, grade of hypertension were positively correlated with awareness about statins. Correct information about statins were also associated with the cognitive functions level.
STATIN TREATMENT REDUCES THE RISK OF DEATH AMONG ELDERLY FRAIL PATIENTS. EVIDENCE FROM A LARGE POPULATION-BASED COHORT
Authors: Rea Federico , Corrao Giovanni , Mancia Giuseppe 
Published: April 2021

Objective:
Randomized controlled trials show that statin treatment is associated with a reduction of cardiovascular outcomes and mortality. Evidence is limited, however, on whether these drugs are protective in frail patients. Aim of our study was to assess the protective effect of these drugs in a large and unselected cohort of frail elderly subjects. Protection was inferred from the reduction of mortality associated with adherence to treatment because of the evidence that adherence to statin is closely related with outcomes.

Design and method:
The target population included Lombardy residents (Italy), aged 65 years or older, who received at least three consecutive prescriptions of a statin during 2011–2012. A case-control study was performed, the cases being the cohort members who died until 2018. Logistic regression was used to model the outcome risk associated with statin adherence. Adherence was measured by the proportion of the follow-up covered by prescriptions. The analysis was stratified according to four clinical categories (good, medium, poor, and very poor clinical status), based on different life expectancies, as assessed by a prognostic score (i.e., the Multisource Comorbidity Score) which had been found to sensitively predict the risk of death. From the good to the very poor clinical status, the 7-year death probability increased from 11% to 52%.

Results:
In each clinical status, there was a significant reduction of all-cause mortality as adherence to statin treatment increased. The reduction in the adjusted risk of mortality from the lowest to the highest adherence level was greatest among patients with a good clinical status (-56%) and less among other cohort members (i.e., -48%, -44% and -47% in medium, poor and very poor groups, respectively). Similar findings were obtained for the risk of cardiovascular mortality.

Conclusions:
In a real-life setting, adherence to statin treatment reduced the risk of death in elderly patients regardless their clinical conditions. The reduction extended to patients with a high risk of mortality, suggesting that also frail patients are protected by lipid-lowering treatment. However, in these patients the benefit from the treatment seems lower than those in good clinical conditions.
POTENTIAL ADHERENCE TO TREATMENT OF PATIENTS, HOSPITALIZED WITH THE HYPERTENSIVE CRISIS
Authors: Pereverzeva Kristina , Iakushin Sergey 
Published: April 2021

Objective:
To analyze potential adherence to treatment of patients, hospitalized with the hypertensive crisis using the quantitative questionnaire of adherence. The level of potential adherence (PA) in the interval to 50% is interpreted as “low”, within the range of 51% to 75% is interpreted as “medium” and in the interval of more than 75% as “high”.

Design and method:
112 patients took part in this research, 71.4 % of them were women. The median age is 58 [49;70] years old.

Results:
The median of overall PA to treatment of patients was 47.2% [42.6; 60.1]. The median of PA to lifestyle modification was 48.7% [32.4; 54.8] to medical support - 40.6% [30.9; 57.8] and to therapy with drugs – 41.4% [36.4; 63.2].
The duration of the anamnesis of hypertensive disease was 3 [2; 10] years in a group with a medium level of PA to lifestyle modifications and was less durable than the duration of the disease in groups of patients with lower levels of adherence 8 [4; 12] years, p < 0.05. Big number of patients, who had a disease duration of more than 5 years had a low level of PA to lifestyle modification (78.3% against 62.2%, p < 0.05), alone patients had a low level of PA to medical support (80.4% against 40.7%, p < 0.05), male patients had a low level of PA to therapy with drugs (71.8% against 42.4%, p < 0.05). Patients, hospitalized more than once during this year had a low level of potential adherence to treatment more frequently (83.6% against 60.2%, p < 0.05).

Conclusions:
1. Among the indexes of PA the highest quantity had the adherence to lifestyle modification – 48.7% [32.4; 54.8] and the lowest quantity had the adherence to medical support – 40.6% [30.9; 57.8] (p > 0.05). 2. Statistically significant factors that affect patients’ potential adherence were gender differences, the duration of a disease, presence or absence of family and number of hospitalizations during the year.
PHONE CALLS FOR IMPROVING BLOOD PRESSURE CONTROL AMONG HYPERTENSIVE PATIENTS ATTENDING PRIVATE MEDICAL PRACTITIONERS IN INDIA: FINDINGS FROM MUMBAI HYPERTENSION PROJECT
Authors: Kannure Mandar , Sharma Bhawna , Pathni Anupam Khungar , Negi Sagri , Vijayan Shibu , Hegde Asha , Gandhi Ravdeep , Scuteri Angelo , Hering Dagmara 
Published: April 2021

Objective:
Despite the availability of effective medication, blood pressure control rate is low, particularly in low- and middle-income countries. Adherence to medication and follow-up visits are important factors in blood pressure control. This study assessed the effectiveness of reminder telephone calls on follow-up visits and blood pressure control among hypertensive patients as part of the Mumbai Hypertension Project. This project was initiated by PATH with the support from Resolve to Save Lives (RTSL) from January 2019 to February 2020. The study included hypertensive patients attending 164 private practitioners in Mumbai, India; practitioners screened all adults visiting clinic during the project period. Among 13184 hypertensive patients registered, the mean age was 53 years (SD = 12.38), 52% were female and 96% provided phone number. 9528 (72%) patients responded to a telephone call at least once during the study period. 82% of patients visited the clinic for follow-up visit within one month after receiving the phone call. The blood pressure control rate among those who answered phone calls and who did not answer phone calls increased from 21.0% to 44.3% (P < 0.001) and 22.8% to 48.8% (P < 0.001), respectively. The blood pressure control rate at follow-up was significantly associated with phone calls (OR: 1.51, 95% CI: 1.34 - 1.71). The study demonstrates that follow up visits and telephone call intervention can improve patient retention in care and subsequently, blood pressure control among hypertensive patients attending urban private-sector clinics in India.
SERUM CONC. OF ANTIHYPERTENSIVE DRUGS MAY REVEAL NON-ADHERENCE IN PATIENTS CONSIDERED TO HAVE TRUE TREATMENT RESISTANT HYPERTENSION ASSESSED BY DIRECTLY OBSERVED THERAPY
Authors: Halvorsen Lene Vernås , Bergland Ola Undrum , Søraas Camilla Lund , Larstorp Anne Cecilie Kje , Hjørnholm Ulla , Kjær Vibeke Norheim , Mula Fadl El Mula Fadl El , Opdal Mimmi Stokke , Høieggen Aud 
Published: April 2021

Objective:
Detecting non-adherence is challenging. Both directly observed intake of antihypertensive medication (DOT) followed by 24 hour-ambulatory blood pressure monitoring and serum conc. measurements of antihypertensive drugs are objective methods considered reliable in revealing drug non-adherence. We aimed to investigate whether serum conc. offers additional information regarding drug adherence compared to DOT in patients with assumed true treatment resistant hypertension.

Design and method:
Patients referred for renal denervation (RDN) were thoroughly investigated and tested for adherence. 19 patients were defined as true treatment resistant when their daytime systolic BP remained high (> 135 mmHg) after DOT. Blood samples were collected at baseline, 6 months and 3 years after RDN and analyzed using ultra high pressure liquid chromatography-tandem mass spectrometry. Partial non-adherence was defined as at least one undetectable drug (but not all)and non-adherence as no detectable drugs in serum.

Results:
Ten out of 56 blood samples (17.9%) showed too low levels of one or more drug to be compatible with drug adherence. Six patients were redefined as either non-adherent or partially non-adherent based on their serum conc. results. Their systolic BPs are shown in the Figure.
Three of these six patients went through a renal denervation procedure, while the remaining three were randomized to control. One of two patients considered to be RDN responders, became adherent to medication after six months which may have contributed to the fall in BP. At the 3 years visit none of the five antihypertensive agents prescribed were detected, and the patient́s BP was again elevated.

Conclusions:
Non-adherence was revealed in more patients when serum conc. measurements of antihypertensive drugs were added to directly observed therapy. Serum conc. measurement is objective and quantitative, and since some antihypertensive drugs require regular intake over a certain period of time to have maximal effect, they may offer important additional information.
DEVELOPMENT OF A MOBILE HEALTH APP FOR THE MANAGEMENT OF HYPERTENSION, INCLUDING TREATMENT ADHERENCE ASSESSMENT, USING IMAGE DETECTION TECHNOLOGY – INSPIRERS-HTN
Authors: Nogueira-Silva Luis , Vieira-Marques Pedro , Valente José , Holtkötter Jannis , Amaral Rita , Jácome Cristina , Ferreira Ana , Almeida Rute , Fonseca João Almeida 
Published: April 2021

Objective:
We aim to develop a mHealth smartphone app with a novel strategy to support the management of hypertension, including the measurement of adherence to treatment, taking advantage of the widespread use of smartphones and using only their embedded sensors.

Design and method:
We have designed and developed a cross-platform, multi-language app which allows to register a pharmacological treatment and to customize alerts for the patient to take his/her medication and to measure his/her blood pressure (BP). Moreover, the app will be able to identify the number of pills in a blister and to capture the BP values from the screen of BP measuring devices, using the smartphone's camera. Thus, the app will quantify adherence to therapy and generate automatic BP reports.
Blister photos and BP values collected by the users are enhanced using standard image processing methods for contrast increase, gap filling and relevant elements location. Classification strategies allow to count the pills present in the blisters, while the Google MLKit text mining API is employed for BP values recognition. Health Level Seven International (HL7) Fast Health Interoperability Resources (FHIR) standard is used for health care data modeling and exchange, promoting interoperability while guaranteeing data quality and security.
Evaluation of the app's performance by real users will be presented, regarding its usability and the offline validity of the data acquisition.

Results:
The user interface concept of the app has been defined and the mockups have been produced.
Regarding pill counting, blisters with diverse materials and textures were considered. Different processing strategies are used depending on blisters’ characteristics, which has allowed an accuracy above 95% for most of the tested blisters. Extracting the BP measures from smartphone acquired images using the MLKIT app seems to be feasible. Further improvements and evaluations are ongoing. We will show preliminary results regarding usability and offline validity.

Conclusions:
We propose a new smartphone app that will support the management of hypertension, including an innovative image detection tool that will allow to objectively measure adherence to therapy and will facilitate the capture of BP values.
TARGET DIASTOLIC BLOOD PRESSURE RANGE ACCORDING TO THE AGE CATEGORY AND PRESENCE OF PRIOR CARDIOVASCULAR DISEASE DURING ANTIHYPERTENSIVE TREATMENT
Authors: Sobieraj Piotr , Sinski Maciej , Lewandowski Jacek 
Published: April 2021

Objective:
The evidence supporting European Society of Cardiology (ESC) recommended target diastolic blood pressure (DBP) in range 70–79 mm Hg is scarce. The study was aimed to evaluate optimal DBP according to age category (< 65 years, 65–80 years, > 80 years) and presence of cardiovascular disease (CVD).

Design and method:
Analysis was performed using Systolic Blood Pressure Intervention Trial (SPRINT) data shared by National Heart, Lung and Blood Institute. On-treatment DBP was computed as a mean of DBP measurements made in period from 6th month of participation to the end of the study, when BP was stable. Composite outcome event (CE) included myocardial infarction and other acute coronary syndrome, stroke, heart failure decompensation and cardiovascular death. Adjusted Cox proportional models were used to establish association between DBP and hazard ratio according to age category and presence of CVD.

Results:
Data of 8890 SPRINT participants (aged 67.8 ± 9.4 years) with available data were analysed. 3139 (35.3%) were female and 1773 (19.9%) were diagnosed with prior CVD. There was 3049 (42.8%) participants younger than 65 years, 3288 (46.2%) in age 65–80 years and 780 (11%) older than 80 years in group without prior CVD. There was 583 (32.9%) participants younger than 65 years, 891 (50.3%) in age 65–80 years and 299 (16.9%) older than 80 years in group with prior CVD. There was 293 (4.1%) CE events in group without prior CVD and 168 (9.5%) CE events in participants with prior CVD.
Figure 1 presents the relationship between DBP and hazard ratio according to age category and presence of CVD.

Conclusions:
Optimal DBP range for patients with hypertension and CVD younger than 80 years is similar to the recommended interval 70–79 mm Hg. Similar DBP target should be recommended for younger than 65 years adults with hypertension but without prior CVD. DBP range 70–79 mm Hg should be reconsidered as a treatment target in subjects without prior CVD older than 65 years and in subjects with prior CVD older than 80 years.
INFLUENCE OF RESTING HEART RATE ON BLOOD PRESSURE LOWERING EFFECT
Authors: Sobieraj Piotr , Lewandowski Jacek , Sinski Maciej 
Published: April 2021

Objective:
Elevated resting heart rate (RHR) identifies hypertensive subjects at higher cardiovascular risk. The study was aimed to compare benefit of intensive blood pressure (BP) lowering in subjects with higher and lower RHR.

Design and method:
The analysis was performed using Systolic Blood Pressure Intervention Trial (SPRINT) data shared by National Heart, Lung and Blood Institute. SPRINT trial assessed intensive lowering of systolic BP to a target < 120 mm Hg in comparison to standard goal (< 140 mm Hg).
Baseline RHR was estimated as a pulse rate obtained during automated office BP measurements at first study visit.
RHR higher than 80 b.p.m. was defined as increased according to current European Society of Cardiology guidelines.
Composite outcome event (CE) included myocardial infarction and other acute coronary syndrome, stroke, heart failure decompensation and cardiovascular death.
Cox proportional model was used to assess impact of BP lowering in subjects with RHR higher and lower than 80 bpm. P-value for interaction between study BP intervention and baseline RHR.

Results:
Data of 9361 SPRINT participants, aged 67.9 ± 9.4 years, were analyzed. 3332 (35.6%) were female an 1877 (20.1%) were diagnosed with prior cardiovascular disease.
Mean baseline RHR was 66.3 ± 11.6 b.p.m. Baseline HR in both treatment arms was similar (standard arm 66.3 ± 11.7 b.p.m. vs intensive arm 66.2 ± 11.5 b.p.m., p = 0.762)
1198 (12.8%) participants had baseline RHR higher than 80 b.p.m. and experienced 78 (6.8%) CE events. There were 484 (5.9%) events among subjects with RHR lower than 80 b.p.m.
Intensive lowering of systolic BP was beneficial both in subjects with elevated RHR (hazard ratio 0.79 with 95% confidence interval 0.51–1.24, p = 0.311) and non-elevated RHR (hazard ratio 0.75 with 95% CI 0.62–0.89, p = 0.002). The intervention between study BP intervention and baseline RHR was not significant (p for interaction 0.819).

Conclusions:
Elevated RHR does not influence effect of BP reduction on cardiovascular events risk.