bluuebunny/crossref_metadata_2025_split huggingface dataset:
HOW MANY BLOOD PRESSURE VALUES WE SHOULD USE TO PREDICT OUT-OF-OFFICE BLOOD PRESSURE ON PROOF-BP ALGORITHM. IS THE MORE BETTER THAN THE LESS ?
Authors: Silva Marco Antonio Vieira Da , Resende Luiz Antonio Pertili R. De , Resende Elizabeth Mantovani R. De , Filho Dalmo Correia , Neto Otavio Barbosa , Silva Luiz Otavio Da , Jajah Camila Blanco Ferreira , Vieira Mateus Marchiori , Ferreira Pedro Paulo G. Dos Reis , Achkar João Lucas Carvalho , Vieira Livia Marchiori , Rambourg Nicole Cristine , Moreira Guilherme Marchiori , Resende Ana Luísa Mantovani , Ganem Fernando 
Published: April 2021

Objective:
Compare the performance of 3 or 6 sequential blood pressure (BP) measurements to predict awake BP (ABP) values by Predicting Out of Office Blood Pressure in the clinic (PROOF BP).

Design and method:
This study is a secondary analysis of published research. A nursey collected clinical characteristics, in all participants, taking six sequential observed BP measurements, with a 1-minute interval (Microlife-BP3BTOA). Also, it was recorded ABPM (DynaMAPA). We selected 426 suspected people having hypertension. We estimated out-of-office BP on an algorithm from first to third BP (PROOF BP 1–3) and fourth to sixth (PROOF BP 4–6). We classified the patients in four BP categories, such as true hypertension (HT), true normotension (NT), masked hypertension (MH), and white coat hypertension (WCT). The office standard average considered the first three measurements as office BP (cut off – 140/90) and ABP as a reference standard, and for ABP and tested BP, the cut off was 135/85. We correctly compared the proportion of classified patients, coefficient of correlation (r), receiver operating characteristic curve (AUC), and Bland–Altman plot. The differences of proportions were evaluated using the chi-square test for media analysis of covariance.

Results:
Among 446 patients, 40.1% were classified as HT, 17.4% (MH), 11.7% (WCH) and 30.8% (NT), age 43.3 ± 13.3, women (44.6%), white people (67.8%), diabetes (2.6%), dyslipidemia (19.2%), obese (39.9%), body mass index 28. 9 ± 5.3, smokers (8.6%). The algorithm recommended AMBP in 41.07%. The proportion of HT was 40.1% MH 17.4%, WCH 11.7%, and NT 30.8%. The main clinical characteristics were age 43.3 ± 13.3, women (44.6%), white people (67.8%), diabetic (2.6%), dyslipidemia (19.2%), obese (39.9%), body mass index 28. 9 ± 5.3, smokers (8.6%). The mains results are in Table 1. Figure 1 shows a Bland and Altman plot of PROOF BP 1–3 and 4–6 against ABP.

Conclusions:
In conclusion, this secondary analysis data reinforce that the algorithm correctly classifies the vast majority of hypertensive patients and recommends ABPM in less than half of patients. It also adds that six sequential measurements no longer add accuracy to the ambulatory BP prediction tool.
24-HR AMBULATORY BLOOD PRESSURE MONITORING & ACTIGRAPHY-MEASURED SLEEP DISTURBANCES
Authors: Veerabhadrappa Praveen , Mcdonnell Evan , Rhudy Matthew , Schade Serena , Phillips Jenna 
Published: April 2021

Objective:
Non-dippers tend to have a high risk for cardiovascular disease. Actigraphy has been validated for objective measures of sleep in clinical-based and population-based studies. PURPOSE: The purpose of this study was to assess Actigraphy measured sleep disturbances among dippers and non-dippers.

Design and method:
Thirteen (6F/7 M) relatively healthy and clinically free of any sleep-related disorder were recruited. 24-hr Ambulatory blood pressure (BP) monitor applied to the non-dominant arm was used to profile dipping and nondipping status (awake value - sleep value)/awake value < 0.1. 24-hr wrist (dominant arm) Actigraphy data were collected in 1 min epochs, and the ‘Cole-Kripke’ sleep algorithm for adults was used to assess sleep. Sleep disturbance metrics including sleep efficiency, total min in bed, total sleep time, number of awakenings, long wake after sleep onset (WASO: number of min awake between sleep onset and time of final waking) were assessed.

Results:
Awake SBP (Mean ± SD) for non-dippers (N = 7) 120.2 ± 8.1 vs. dippers 129.1 ± 8.1mmHg; sleep SBP for non-dippers 117.2 ± 8.4 vs. dippers 114.3 ± 5.5mmHg. Non-dippers vs. dippers sleep efficiency (85 vs. 89%); total min in bed (408 vs. 450 min); total sleep time (352 vs. 398 min); number of awakenings (21.1 ± 10.2 vs. 21.1 ± 3.1) were not statistically different. WASO for non-dippers 55.5 ± 32.5 vs. dippers 49.5 ± 18.2 min (p < 0.05).

Conclusions:
In our preliminary study with a very small N, WASO was 10% higher in non-dippers compared to dippers despite having similar number of awakenings. This indicates that participants with a non-dipper blood pressure profile have disturbed sleep with being awake for a greater amount of time between sleep onset and time of final waking when compared to dippers. Thus, sleep assessment among non-dippers might be reasonable.
GEOGRAPHIC VARIATION IN VASCULAR STIFFNESS VALUES IN CROATIAN AND INDIAN PATIENTS WITH HYPERTENSIVE URGENCY
Authors: Varahabhatla Sai Krishna Ragh , Achappa Basavaprabhu , Kamath Padmanabh , Prkacin Ingrid 
Published: April 2021

Objective:
The food habits, life style and genetic constitution are different for every country and contribute to a significant raise in blood pressure. Objective was to estimate the values of pulse wave velocity (PWV) and central blood pressure (CBP) in hypertensive urgency (raise in systolic and diastolic blood pressure with no end target organ damage) in patients from two different geographical areas Croatia (C) and India (I) for the first time non-invasively.

Design and method:
We identified 17 patients from Croatia and 20 patients from India with a clinical diagnosis of hypertensive crisis with no end target organ damage, who entered the emergency outpatient clinics in respective countries. The PWV, pulse pressure (PP), CBP, brachial pressure (BP) were evaluated using the noninvasive Agedio B900 device (Germany). Statistical data was processed in SPSS software, significant differences were considered at p < 0,05.

Results:
Average age of patients in C (64,18 ± 10,87 years, 58,82% were females and 41,18% were males); I (63.35 ± 9.74 years, 30% were females and 70% males). Average brachial systolic BP in C and I was found to be 191,17 ± 10,98 mmHg and 191,42 ± 9,88 mmHg respectively. Average central systolic blood pressure in C and I was 149.23 ± 18.93 mmHg, 178.35 ± 28.61 and average central diastolic blood pressure was 99.23 ± 17.22 mmHg; 115.64 ± 8.01 respectively. PWV for each patient was higher than the reference range for age with average values of 10,5 ± 2,01 m/s in C and 11.74 ± 1.74 in I population. Student's t-test showed statistically significant difference between PWV measured in patients from Croatia and India (C- 10.54 ± 2.15, I- 11.17 ± 1.74; p = 0.008). Values of PWV showed a positive correlation with age in both patient groups C (r = 0.9471, p < 0.00001); I (r = 0.838, p < 0.00001). Central systolic blood pressure shows a weak positive correlation with PWV, C (r = 0.5225, p = 0.03);I (r = 0.1294, p = 0.05).

Conclusions:
It is clear from the results that the PWV, CBP and vascular age were higher in Indian population than the Croatian data. This is explained by the irregular lifestyle, high risk of diabetes, obesity and high salt diet corresponds to increased vascular stiffness.
PRESCRIPTION PATTERN AND FACTORS ASSOCIATED WITH THE CONTROL OF BLOOD PRESSURE AMONG HYPERTENSIVE PATIENTS RECEIVING CARE IN A NIGERIAN TERTIARY HOSPITAL
Authors: Ukoha-Kalu Blessing Onyinye , Adibe Maxwell , Ukwe Chinwe 
Published: April 2021

Objective:
Despite the numerous Pharmacological and non-Pharmacological modalities available for the management of Hypertension, majority of the patients. The study aimed to identify the factors associated with the control of blood pressure among hypertensive patients receiving care in a Nigerian Tertiary Hospital.

Design and method:
The study was a retrospective cross sectional study carried out at the University of Nigeria Teaching Hospital Ituku/Ozalla, Enugu State Nigeria. A well Structured Pro-forma was used to extract variables from patient folders. These variables include Age, gender, marital status, religion, state of origin, educational level, occupation, age at first dose of antihypertensive, co-morbidities (diabetes, CKD), antihypertensive(s) used, duration of therapy, reasons for stopping (if stopped). Quantitative data was managed using Microsoft office excel and statistical product and services solution (SPSS) for windows.
Continuous variables were expressed as mean ± SD and categorical variables as percentages with 95% confidence intervals. The students’t-test and the paired sample t-test were used to compare continuous variables while the pearson chi square test and fishers exact test will be used to compare categorical variables. All statistical test will be considered significant when the 2- sided p-value is <0.05.

Results:
Three hundred and Ninety patient Folders were used for the study. About 174 (42.4%) of the patients were male while 216 (52.7%) were female with a mean age of 62 years. Amlodipine with a frequency of 182 (64%) was the most prescribed antihypertensive in this study followed by losartan 182 (46.43%) and the least being atenolol and nebivolol with frequency of 4 (1.03%) each. 302 (94.4%) patients had hypertension and an existing comorbidity while 88(22.6%) had no comorbidities. The most common comorbidities were diabetes mellitus and chronic kidney disease.
About 197 (50.3%) of the patients had their blood pressure under control while 193(49.7%) had uncontrolled blood pressure. Age, Monthly income, educational status and presence of comorbidity were the major predictors of uncontrolled blood pressure.

Conclusions:
Amlodipine was the most frequently prescribed antihypertensive. About half of the patient had their blood pressure uncontrolled. Age and monthly income were associated with uncontrolled blood pressure.
COMPARISON OF THE EUROPEAN SOCIETY OF HYPERTENSION STRATIFICATION AND EUROPEAN SOCIETY OF CARDIOLOGY HEARTSCORE FOR PREDICTION OF CORONARY ARTERY DISEASE AND STROKE IN ESSENTIAL HYPERTENSION
Authors: Leontsinis I. , Tsioufis K. , Dimitriadis K. , Kasiakogias A. , Liatakis I. , Koutra E. , Konstantinidis D. , Laina A. , Kouremeti M. , Andrikou I. , Iliakis P. , Tsioufis P. , Thomopoulos K. , Tzorovili E. , Tousoulis D. 
Published: April 2021

Objective:
For estimation of overall cardiovascular risk ESH proposes stratification according to BP, prevalence of risk factors, asymptomatic TOD, diabetes, kidney and symptomatic cardiovascular disease, while the ESC HeartScore constitutes another potent predictive tool of adverse outcome. The purpose is to compare the predictive role of ESH stratification and ESC HeartScore for the incidence of the composite end-point of coronary artery disease (CAD) and stroke in a cohort of essential hypertensive patients.

Design and method:
We followed up 2150 essential hypertensives (mean age 55.7 years, 1085 males, office BP = 145/91 mmHg) for a mean period of 8 years. All subjects had at least one annual visit. CAD was defined as the history of myocardial infarction or significant coronary artery stenosis revealed by angiography or coronary revascularization procedure. Stroke was defined as rapid onset of a new neurological deficit persisting at least 24 hours unless death supervened confirmed by imaging findings.

Results:
The incidence of CAD, stroke and their composite over the follow-up period were 2.8% 1.11% and 3.9% respectively. By using the ESH stratification, 15.3% was of low and moderate risk, 54.4% was of moderate to high and high risk and 30.3% was high to very high and very high risk. According to the ESC HeartScore 89.2% was of low to moderate risk, 10% of high risk and 0.8% of very high risk. Cox-regression analyses revealed that high to very high and very high ESH risk category was related to increased risk for the composite end-point of CAD and stroke (hazard ratio = 4.5, p < 0.0001), while focusing on the ESC Heart Score the composite end-point was predicted by the high risk category (hazard ratio = 3.43, p < 0.0001). The ESH risk model had better fit than the ESC HeartScore due to the lowest Akaike's values (1442.66 vs 1498.31, respectively).

Conclusions:
The ESH risk stratification constitutes a better prediction model for CAD and stroke than the ESC HeartScore in essential hypertension and its estimation is essential in order to improve overall risk assessment in this setting.
ASSOCIATION OF SLEEP-DISORDERED BREATHING AND SLEEP-RELATED FACTORS WITH DIFFERENT TYPES OF NOCTURNAL–MORNING HYPERTENSION AND OFFICE HYPERTENSION: THE NAGAHAMA STUDY
Authors: Tabara Yasuharu 
Published: April 2021

Objective:
High morning blood pressure and an increase in the nocturnal blood pressure are well-documented risk factors for poor cardiovascular outcomes. A possible shared risk factor for the morning and nocturnal hypertension (HT) is sleep-disordered breathing (SDB). This study aimed to clarify the association of SDB with nocturnal and morning HT, as well as office HT, to better understand the pathophysiological significance of SDB in HT.

Design and method:
Study participants in this cross-sectional study were 5,866 general population (mean age: 57.9 years). Sleep characteristics including sleep duration and sleep efficiency were evaluated using a wrist activity monitor for one week. SDB was assessed using the 3% oxygen desaturation index corrected for actigraphy-determined sleep duration. A timer-equipped cuff-oscillometric device was used for home and sleep blood pressure monitoring. The BP monitor was programmed to automatically measure the BP at 0.00, 2.00, and 4.00 a.m. Sleep BP was determined using actigraphy and BP values measured within 1 h after waking up and within 1 h before sleeping were considered as morning and evening BPs, respectively.

Results:
Isolated nocturnal, isolated morning, and sustained nocturnal-to-morning HT occurred in 13.5%, 9.1%, and 25.9% of participants, respectively. Participants with HT generally were older, more frequently were men, and obese compared with normotensive individuals (all P < 0.001). Other clinical factors that were significantly different depending on the HT types were carotid hypertrophy, nocturnal voiding frequency, sleep efficiency, and SDB (all P < 0.001). Multinomial logistic regression analysis identified SDB as a significant determinant for sustained HT (coefficient = 0.026, P < 0.001) and morning HT (coefficient = 0.024, P < 0.001) but not isolated nocturnal HT (P = 0.907). SDB was also associated with office HT (Coefficient = 0.027, P < 0.001). In contrast, low sleep efficiency was associated with isolated nocturnal HT, while the frequency of nocturnal urination showed a positive association with isolated nocturnal HT and sustained HT.

Conclusions:
SDB had a stronger influence on morning than nocturnal BP, while low sleep efficiency and nocturnal urination had greater influences on sleep BP
UNATTENDED VERSUS ATTENDED BP MEASUREMENT: RELATIONSHIP WITH 24 HOURS BLOOD PRESSURE VALUES
Authors: Salvetti Massimo , Paini Anna , Bertacchini Fabio , Aggiusti Carlo , Stassaldi Debora , Capellini Sara , Saccà Giovanni , Arnoldi Chiara , De Ciuceis Carolina , Rizzoni Damiano , Bertini M. , Gatta Roberto , Muiesan Maria Lorenza 
Published: April 2021

Objective:
It has been suggested that measurement of “unattended” or “automated oscillatory” blood pressure(BP) values (AOBP) may provide advantages over conventional BP measurement. More data are needed on the relationship between BP values measured by the conventional approach, by AOBP and values obtained by 24 hours BP monitoring (ABPM).

Design and method:
In 607 consecutive patients attending the outpatient clinic at an ESH Excellence Centre, BP values were measured by the physician with an automated oscillometric device (Omron HEM 9000Ai, mean of 3 measurements), after 5 minutes of rest. After the measurement of BP by the physician, the patient was left alone in the room, and the device was programmed to automatically perform 3 BP measurements after 5 minutes. ABPM was performed in all subjects.

Results:
Mean age was 60 ± 13 yrs, 53% females, BMI 26 ± 4, 77 % with a previous diagnosis of hypertension (58 % treated). Unattended systolic BP (SBP) (126.4 ± 14.5) was lower as compared to attended SBP (132.7 ± 15.9mmHg) and to 24 hours daytime BP (129.4 ± 14.5 mmHg). Attended and unattended SBP were similarly correlated to daytime BP (r = 0.649, R = 0.669, P < 0.000, p for the comparison between r ns). The differences (d) between SBP values obtained using the three techniques were 6.3 ± 7.7 mmHg (attended-unattended), 3.5 ± 12.2 mmHg (attended-daytime BP) and – 2.8 ± 11.0 (unattended-daytime).

Conclusions:
Our findings indicate that “unattended BP” measurement provides values significantly lower as compared to measurements obtained in the presence of the physician and also to 24 hours daytime BP. In our population BP values obtained by the unattended approach are similar to 24 hours daytime BP values. However 24 hours daytime BP was similarly correlated to both attended and unattended BP
DISTRIBUTION OF SPOT URINARY ELECTROLYTES AND THEIR PREDICTED 24 HOUR LEVELS BY ETHNICITY ASSOCIATIONS WITH MORTALITY IN A LONGITUDNAL COHORT
Authors: Saluja Sushant , Powell Leo -Paul , Jiang Xiao , Heald Adrian , Cruickshank Kennedy , Anderson Simon 
Published: April 2021

Objective:
Hypertension is a modifiable risk factor for development of cardiovascular disease. Increased urinary sodium excretion, representing high dietary sodium intake is associated with hypertension. Observational cohort studies consistently demonstrate a low sodium intake is also associated with increased mortality. It is not known what the optimal amount of salt intake is good for cardiovascular health. Hypertension is a modifiable risk factor for development of cardiovascular disease. Increased urinary sodium excretion, representing high dietary sodium intake is associated with hypertension. Observational cohort studies consistently demonstrate a low sodium intake is also associated with increased mortality. It is not known what the optimal amount of salt intake is good for cardiovascular health.

Design and method:
Urine samples were obtained from 331 people [100 Afro-Caribbean (AC), 118 European and 113 Gujarati Indians] to estimate 24-hour sodium and potassium excretion. Association between estimated urinary sodium, potassium and creatinine excretion to composite outcome of major cardiovascular event and death were examined. We also aimed to study if ethnicity influenced this relationship.

Results:
We noted heterogeneity in association between sodium, potassium, creatinine excretion and mortality. Significantly higher, age-sex adjusted, spot urinary sodium (OR- 2.7; CI – 1.9–3.2) and creatinine (OR- 1.7; CI – 1.2–2.2) levels were seen in AC men who also had higher mean diastolic blood pressure (84 ± 5.5 vs 78 ± 3.3; p < 0.05). Overall, 42.9% (n = 142) of the cohort were hypertensive. Of the 331 eligible participants at baseline, a total 69 cardiovascular deaths were recorded. Spot sodium levels were higher in those who died from cardiovascular causes [(125.3; CI- 116.9, 133.7) mmol/l] vs [(108.7; CI - 99.4 – 118.0); p = 0.02]. Survival was associated with a urinary sodium below and urinary potassium above the median. There was no survival advantage associated with differences in creatinine output.

Conclusions:
This study estimates a sodium intake of between 2.0 g/day and 2.5 g/day as being associated with a lower risk of death and cardiovascular events. A higher potassium excretion was associated with a lower risk of death and cardiovascular events. Creatinine output made no difference to survival advantage.
ASSESSING THE USEFULNESS OF SELF-MEASUREMENT OF BLOOD PRESSURE IN PATIENTS IN CONTROLLING BLOOD PRESSURE IN HYPERTENSIVES
Authors: Patil Vishal , Patil Mansi 
Published: April 2021

Objective:
To evaluate the efficiency of self-measurement of blood pressure (SMBP) in controlling blood pressure levels in known hypertensives

Design and method:
The study was conducted on 1700 known adult hypertensives attending the outpatient department of a charitable hospital. The patients were on anti-hypertensive treatment but had poorly controlled hypertension (Systolic Blood pressure more than equal to 140 mmHg, Diastolic Blood Pressure more than equal to 90 mmHg). The patients were divided into Group 1(Non-Intervention group) and Group 2 (Intervention group). The patients were given an Omronâ HEM-7200-AP3 automatic blood pressure monitor to record their blood pressure daily at home. Blood pressure was recorded at each visit to the clinic. There were 820 participants in the intervention group, 880 in the control group. Baseline characteristics were similar in both groups. Training was given to the participants to measure their blood pressure. The patients recorded 3 blood pressure readings at home daily in the morning at an interval of 1 minute between each reading.

Results:
Blood pressure was measured after 6 weeks of the self-monitoring of blood pressure and the proportion of patients whose blood pressure was well controlled was 13.4% higher in the intervention group than in the control group (P = .01). After 12 weeks of SMBP the difference between groups was 14.1% (P = .02).
Most participants(n = 1340/1700, 78.8%) did not take 5 minutes rest before recording their first blood pressure and 91.7% participants (n = 1560/1700) did not wait for 1 minute between two blood pressure readings.

Conclusions:
Self-measurement of blood pressure was effective in controlling blood pressure in the short term, but its effects need to be studied over a long term.
The patients did not wait for 1 minute between each blood pressure reading or took complete 5 minutes rest before the first reading.
Regular training and guidance for the patients is needed for protocols to be followed.