bluuebunny/crossref_metadata_2025_split huggingface dataset:
AMBULATORY ARTERIAL STIFFNESS INDEX PREDICTS CARDIOVASCULAR EVENTS IN PATIENTS WITH NON-ST ELEVATION MYOCARDIAL INFARCTION: ONE-YEAR FOLLOW-UP STUDY
Authors: Koumelli A. , Tsioufis K. , Kouremeti M. , Mantzouranis M. , Konstantinou K. , Vogiatzakis N. , Tolis P. , Tolis E. , Leontsinis I. , Tousoulis D. 
Published: April 2021

Abstract

Objective:
Ambulatory arterial stiffness index (AASI) has been shown to predict cardiovascular morbidity and mortality in hypertensive patients. However, there are limited data with respect to its prognostic significance among patients with acute myocardial infarction (AMI). Weevaluated the relationship between AASI and long-term cardiovascular outcomes in patients withAMI.

Design and method:
We followed up 254patients (82.7% male; mean age 63.7 years; 71.7% hypertensives; 29.9% with diabetes mellitus) who were hospitalized because of ST-elevation MI (STEMI, 48.8%) and Non-ST–elevation MI (NSTEMI), for a period of 12 months. All patients underwent baseline estimation of clinical and laboratory parameters during their hospitalization. Patients underwent 24-hour ambulatory blood pressuremonitoring (ABPM) during the third day of hospital stay. The AASI was calculated as 1- (slope of diastolic on systolic blood pressureduring ABPM). Endpoints of interest where total and cardiovascular mortalityand cardiovascular morbidity set as hospitalization for congestive heart failure, acute coronary syndrome, stroke, ventricular tachycardia, atrial fibrillation and acute renal failure.

Results:
The AASI failed to predict mortality orthe composite endpoint of cardiovascular morbidity and mortality during the follow-up period either in the entire population or separately for each AMI type. However, AASI demonstrated a significant prognostic role for hospitalization for cardiovascular events in the NSTEMI population in univariate regression analysis (HR = 0.102; 95% CI: 0.048–0.155; p < 0.001). In a model of multivariate regression analysis in the same AMI group, this association was maintained (HR = 0.067; 95% CI: 0.020–0.115; p = 0.006) after adjusting for traditional risk factors and severity of coronary artery disease assessed by the number of affected main vessels.

Conclusions:
AASI emerges as an independent predictor of one-year cardiovascular morbidity in patients with NSTEMI. More data are required to determine the usefulness of this non-invasive tool in risk stratification and management of these patients.
URIC ACID IN ACUTE CORONARY SYNDROME: CORRELATIONS WITH IN-HOSPITAL MORTALITY AND COMPLICATIONS
Authors: Maloberti Alessandro , Rebora Paola , Morici Nuccia , Sacco Alica , Viola Giovanna , Lattuada Francesca , Molinari Valentina , Occhi Lucia , Bassi Ilaria , Portoghese Alessandro , Fortina Matteo , Oliva Fabrizio , Giannattasio Cristina 
Published: April 2021

Abstract

Objective:
Uric acid (UA) has been related to in-hospital mortality in ACS patients. Furthermore, it has been related to early relapse of non-fatal cardiovascular events and to intermediate outcome such as use of intra-aortic balloon pump, noninvasive ventilation, longer inward stay, bleeding but also clinical presentation with AF or Heart Failure (HF). Aim of the study was to evaluate the role of UA as a possible determinants of primary (in-hospital mortality) and secondary outcomes considered as variables indicative of in-hospitale complications (myocardial re-infarction, in-stent thrombosys, bleeding, stroke), worst clinical presentation (presentation with HF or AF, admission EF, three vessels coronaric involvement at the coronary angiogram), in-hospital complication (inotropes, intra-aortic balloon pump and non-invasive ventilation uses during hospital stay) and worst recovery (discharge EF).

Design and method:
retro-prospective cohort study of 563 patients admitted for ACS at the Cardiological Intensive Care Unit of the Niguarda Ca’ Granda Hospital. Cox regression analysis was performed to evaluate the association between UA and primary and seconday outcome adjusted for the following covariates: age, gender, previous myocardial infarction, arterial hypertension, Charlson Comorbidity Index and creatinine.

Results:
mean age was 66.5 ± 12.3 years, 79.2% of the patients were males and 49.9% of the ACS were STEMI. Hyperuricemic subjects were older, with more prominent cardiovascular risk factor and previous myocardial infarction. Furthermore, they more frequently died during hospital stay, they present more frequently heart failure and AF as clinical presentation, have more commonly three vessels disease and use more frequently intra-aortic balloon pump and non-invasive ventilation. Finally, also EF at admission and discharge were lower in hyperuricemic patients. At multivariate analysis UA was a significant determinants of primary and secondary outcomes (except for three vessels coronaric disease, bleeding, stroke, re-infaction and in-stent thrombosys).

Conclusions:
in conclusion UA is an independent determinants of in-hospital mortality and a variables suggestive of worst clinical presentation, in-hospital complications and worst recovery.
COMPARISON OF BLOOD PRESSURE VARIABILITY BETWEEN 24H AMBULATORY MONITORING AND OFFICE BLOOD PRESSURE IN DIABETICS AND NON-DIABETIC PATIENTS A CROSS-SECTIONAL STUDY
Authors: Rouxinol-Dias Ana Lídia , Gonçalves Marta Lisandra , Silva José , Ramalho Diogo , Barbosa Loide , Polónia Jorge 
Published: April 2021

Objective:
To examine the relationship of different measurements of Blood Pressure Variability (BPV) both based on 24 h Ambulatory BP Monitoring (ABPM) and on visit-to-visit in office BP (OBP) evaluation in a large set of diabetic (D) and non-diabetic (ND) patients.

Design and method:
A total of 1123 patients with ABPM and OBP measurements were included in a single-center cross-sectional study: 272 (24%) D, 43% male, 41% dyslipidemia, ageing 52 years (range 38- 64), BMI 27.9 kg/m2 (range 24.7–31.3). Comparison of BPV between D and ND used Mann-Whitney U test and a generalized linear model (GLM) including D as only predictor and age <65 years, BMI, gender, dyslipidemia, family history of D, of hypertension, urinary sodium and eGFR as covariates.

Results:
Mean systolic BP (SBP) was significantly higher in D vs ND (p < 0.001), for all 24 h, daytime and nighttime periods of ABPM and for OBP. BPV in daytime ABPM was higher in D vs ND, in unadjusted analysis: coefficient of variation of SBP (CVS) for D: 9.5 (range 8.0–10.9 vs ND: 8.8 (range 7.4–10.7), p < 0.001 but no measure of OBPV showed significant differences between groups. OBPV did not correlate with 24-h BP variability. Morning rise of SBP was higher in ND group (10.9 ± 0.3 vs 9.7 ± 0.6 mm Hg (p = 0.014). GLM analysis confirmed higher ambulatory SBP variability in D vs ND. CVS (24H and daytime BP p < 0.001) was higher in D (vs ND) independently of other covariates. Arterial stiffness index (ASI) was higher (p < 0.001) in D = 0.44 (0.35 -0.56) vs ND = 0.32 (0.20 -0.44) but weakly related with BP variability.

Conclusions:
BP variability on ABPM was higher in diabetic vs ND. BP variability in long-term visit-to-visit in OBP was weakly correlated to short-term ABPM variability. In diabetics the lower morning rise of BP and the higher BPV in ABPM values may indicate different spectra of adjusted vs inadequate autonomic response in D. ABPM BPV may be a relevant component of pathophysiologic path involved in higher incidence of adverse events in diabetic population.
THERAPEUTIC EFFECTS OF A SODIUM GLUCOSE COTRANSPORTER 2 INHIBITOR IN DIABETIC PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Hirao Jun , Onoda Shou , Murayama Yoshiki , Uematsu Mayu , Ishimitsu Akira , Kaiga Akiko , Satonaka Hiroshi , Ishimitsu Toshihiko 
Published: April 2021

Objective:
Multiple large-scale clinical trials have indicated that sodium glucose cotransporter 2 (SGLT2) inhibitors reduce the incidence of cardiovascular events, the deterioration of renal function and mortality. However, the therapeutic effects of SGLT2 inhibitors are supposed to be limited in patients with reduced renal function considering the mechanism of their action.

Design and method:
In this study, a SGLT2 inhibitor, ipragliflozin was given to 30 type 2 diabetic patients with nephropathy whose estimated glomerular filtration rate (eGFR) was not lower than 30 mL/min/1.73m2. The treatment was continued for 3 to 4 months and the effects on body weight, blood pressure (BP) and laboratory data including renal function, albuminuria and plasma B-type natriuretic peptide (BNP) were evaluated.

Results:
After 3 to 4 months, hemoglobin A1c was decreased by 0.6 % (p < 0.001), body weight was reduced by 1.8 kg (p < 0.01) and blood pressure was lowered by -10/-6 mmHg (p < 0.001/p < 0.001). This was accompanied by reductions in serum uric acid (-0.7 mg/dL, p < 0.001), triglycerides (-25 mg/dL, p = 0.028) and gamma-glutamyl transferase (-8 U/L, p = 0.001). On the other hand, plasma BNP was also decreased by 12 % (p = 0.020) and urinary albumin excretion was reduced by 23 % (p = 0.018) although the eGFR was not significantly changed. It is concluded that ipragliflozin is effective in lowering blood glucose even in patients with diabetic kidney disease and is beneficial in improving accompanying obesity and hypertension. In addition, ipragliflozin is thought to have favorable influences on the metabolisms of uric acid and lipids.

Conclusions:
These properties of ipragliflozin is expected to bring about protective effects against the progression of nephropathy and the development of cardiovascular disease resulting in the improvement of prognosis in diabetic patients with mild to moderate chronic kidney disease.
PREHYPERTENSION AND RISK FOR ALL-CAUSE AND CARDIOVASCULAR MORTALITY BY DIABETES STATUS: RESULTS FROM THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEYS
Authors: Huang Jiayi , Yu Yuling , Lin Lin , Chen Chaolei , Shen Geng , Huang Yuqing , Lo Kennth , Feng Yingqing 
Published: April 2021

Objective:
The objective of this study was to investigate whether the association between prehypertension and all-cause and cardiovascular mortality was related to diabetes status.

Design and method:
Totally 26070 participants aged >= 18 years were all from the 1999–2014 National Health and Nutrition Examination Surveys (NHANES). Prehypertension was defined as systolic/diastolic blood pressure: 120–139/80-89 mmHg. Participants were followed up for all-cause and cardiovascular mortality until 31 December 2015. Cox proportional hazards models, sensitivity analyses and Kaplan-Meier survival curves were conducted.

Results:
Overall, 15295 (58.67%) of participants did not have diabetes and prehypertension, 8870 (34.02%) had prehypertension alone, 835 (3.20%) had diabetes alone, and 1070 (4.11%) had both diabetes and prehypertension. Compared with participants without either diabetes or prehypertension, the multivariable adjusted hazard ratios for all-cause mortality among participants with prehypertension alone, diabetes alone, and both diabetes and prehypertension were 1.08 (95% CI: 0.95,1.23), 1.26 (0.98,1.62), and 1.67 (1.38,2.03)(P for trend<0.001),as well as for cardiovascular mortality were 1.40 (95% CI: 0.92,2.14), 2.21 (1.12,4.38), and 2.87 (1.65,4.99)(P for trend<0.001), respectively. The associations were robust in the subgroup analysis.

Conclusions:
Our findings suggested that prehypertension with an increased risk for cardiovascular and all-cause mortality based on diabetes status.
BLOOD PRESSURE TELEMONITORING AND REMOTE COUNSELING IN PATIENTS WITH UNCONTROLLED HYPERTENSION: A COST-UTILITY ANALYSIS
Authors: Ionov Mikhail , Zhukova Olga , Zvartau Nadezhda , Konradi Alexandra 
Published: April 2021

Objective:
Telehealth is a useful adjunct in hypertension (HTN) management. Despite obvious short-term clinical benefit, long-term social impact and cost-effectiveness have not been fully investigated.
The aim of the study was to perform predictive modeling of long-term clinical and social outcomes and to conduct a cost-utility analysis of blood pressure (BP) telemonitoring and remote counseling (BPTM) in patients with HTN.

Design and method:
A Markov cohort-based (n = 2000 patients) model was developed and adopted a 10-year time horizon with 12-month time cycles. Cost and outcome data collected from the three-month study of 240 patients (160 in BPTM group and 80 controls, 48 y.o.). All patients started at non-complicated HTN state then moving to disease complications with a certain transition probabilities over a discrete time period (1 Markov cycle).
BPTM was compared with usual care in terms of lifetime costs, quality adjusted life years using a Ministry of Health of Russian Federation perspective.

Results:
At the end of a clinical part of the study there was a decrease in office systolic BP by -16,8 ± 2,9 mm Hg -7,9 ± 3,9 mm Hg in BPTM and usual care groups respectively. By the way, there was an improvement in health-related quality of life (measured with MOS SF-36) +16% and +4% in respective groups.
In the long-term run when compared with usual care BPTM was more effective in terms mortality (67 versus 91 patients lost and 9,6 versus 9,71 life years gained) and costs (cost of illness 102 508 000 RUR versus 145 237 700 RUR). Taking quality of life measures into account, the effect of BPTM was also more pronounced (8,31 versus 7,82 QALYs). The resultant incremental cost-utility ratio for BPTM was 275 178,98 RUR/1 QALY gained/1 patient (134837,70 RUR/0,49 QALY/1 patient).

Conclusions:
According to the results of predictive modeling BPTM in clinical practice is likely to lead to reduced cardiovascular morbidity and mortality being also a cost-effective use of healthcare resources. Larger randomized clinical trials will give more information on BPTM cost-effectiveness in other middle-income countries.
AN EFFECTIVE LIFESTYLE DIGITAL THERAPEUTIC FOR HYPERTENSION AND METABOLIC RISK FACTORS
Authors: Colwell Niall , Wienecke Gitte , Egan Jack , O’croinin Micheal , Shepherd Andrew 
Published: April 2021

Objective:
Lifestyle modification is a class one indication for control of hypertension, diabetes, metabolic syndrome and other chronic diseases. The success of lifestyle change is fraught, as evidenced by the ballooning syndemic of diabesity. We examined the effect of a prescribed digital lifestyle therapeutic in subjects with prehypertension and hypertension; prediabetes and type II diabetes.

Design and method:
We analysed two cohorts: Cohort 1 consisted of 50 subjects with type II diabetes mellitus who were enrolled by Diabetes Ireland, 39 of the subjects completed the programme. Cohort 2 consisted of 43 patients who were recruited from a primary care setting. These subjects had a mixture of metabolic syndrome (n = 6), prediabetic (n = 14), and Type II diabetic subjects (n = 7); stage 1 hypertensive (n = 11) and Prehypertensive (n = 9).
All subjects were prescribed a digital therapeutic called “RediCare Control” for its effect on blood pressure, HbA1c and other metabolic syndrome parameters over 8–12 weeks. RediCare Control has 5 components, (1) Chronic condition patient education, delivered via algorithm based on patient needs. (2) Resources such as recipes, cooking videos, meal plans and food guides (3) Unlimited access to 1-1 online health coach consultations. (4) A moderated peer support forum. (5) An evidence based whole food dietary protocol. Results were analysed by the student two-tailed t-test.

Results:
Results demonstrate a significant reduction in systolic and diastolic blood pressure, pulse pressure, HbA1c, BMI and triglycerides as shown: (Table 1).

Conclusions:
A prescribed digital therapeutic for lifestyle change in hypertension and type II diabetes has a potent positive effect on blood pressure and metabolic syndrome parameters and can be delivered in a cost-effective manner (60 euros), in primary care and in community settings. This digital therapeutic is malleable, scalable, and compliments the conventional medication approach to treatment.
AN INTEGRATIVE MULTIDISCIPLINARY APP DEVICE FOR HEALTHCARE MONITORING OF PATIENTS WITH UNCONTROLLED HYPERTENSION
Authors: Bortolotto Luiz , Sanchez Renata , Rodrigues Dayane , Rodrigues Sara , Duenas Ana , Pereira Jaqueline , Monteiro Rosangela , Sahota Jaspal , Wilkinson Michael , Teulon Aymeric , Vujasinovic Marko , Ferreira Norberto , Manucci Anderson , Rabello Guilherme 
Published: April 2021

Objective:
The most important cause of uncontrolled blood pressure (BP) is a poor adherence to healthy lifestyle and drug treatment. New technologies have provided tools for a better monitoring of the patient and an improvement of treatment adherence by educational and motivational issues.
We aim to present a new approach for patient monitoring at home by a software application (APP) designed to run on a mobile device developed to improve BP control, healthy life style and medication adherence, and quality of life of patients with uncontrolled BP

Design and method:
The APP was developed by an interdisciplinary team including members of a company of artificial intelligence, doctors and other health professional (nutritionist, physical educator, and nurse) and the innovation department of the Hospital.

Results:
The APP (see figure) allows the insertion of BP values measured at home and the list of medications that the patient routinely uses, that can be done manually or by voice system, which is recognized when the patient verbally informs BP values or drugs on use. Also, the patient can interact with the system by answering questions automatically issued regarding physical activity and sodium intake. The APP has warning systems where, from certain information provided by the patient regarding BP values or symptoms, the nursing and/or medical team will contact the patient to provide the adequate management. The APP will be introduced in the outpatient clinic of the hospital and will be offered for the patients with uncontrolled BP despite drug treatment).

Conclusions:
The use of new technologies by APP can be introduced in the clinical practice to improve BP control and adherence to antihypertensive medications and healthy lifestyle providing a strong interaction between patients and healthcare team by distance monitoring. This approach could be extremely useful for underserved patients or during pandemic conditions
WHAT IS IN THE SHADOW – A CASE OF SECONDARY HYPERTENSION
Authors: Mihailescu Anamaria , Balahura Ana Maria , Weiss Emma , Mehic Florentina , Bartos Daniela , Badila Elisabeta 
Published: April 2021

Objective:
To present a case of secondary hypertension, to rule the importance of having evidence based recommendations.

Design and method:
We describe the case of a diabetic, dyslipidemic 63 years old man, with coronary artery disease-percutaneous coronary intervention (PCI) of right coronary artery (RCA) and of circumflex coronary artery(CCA) in 2016, hypertensive (ambulatory treatment: angiotensin-enzyme inhibitor, a calcium channel blocker, beta blocker and alpha2 central receptors) admitted in internal medicine ward with fronto-occipital headache, dizziness, hypertension (with a blood pressure value of 170/110 mmHg), hypokalemia (K 1.76 mmol/l). Taking into consideration the characteristics of the particularly case presented above, the patient is considered to meet the admission criteria. The abdominal CT scan revealed adrenal gland adenoma (1.8/1.4 cm). The diagnose of primary hiperaldosteronism is confirmed by the value of aldosteron/renine ratio (ARR 17). The patient's blood pressure and hypokalemia was influenced by the dose adjustment to the patient's ambulatory treatment and the administration of antimineralocorticoid and potassium supplement.

Results:
The new regimen reduced the blood pressure values, normalized the blood pressure and partially increased the potassium level (K 2.82 mmol/l).

Conclusions:
Although the prevalence of secondary hypertension is approximately 10 % the risks associated with are significantly higher. We reported a case of secondary hypertension with a good outcome despite it's severity.
EVALUATION OF A NEW DIAGNOSTIC TEST FOR PRIMARY ALDOSTERONISM
Authors: Rusev Rosen , Matrozova Joanna , Vasilev Vladimir , Elenkova Atanaska , Kalinov Krasimir , Zacharieva Sabina 
Published: April 2021

Objective:
Primary aldosteronism (PA) is the most common form of endocrine hypertension. Currently, diagnosis comprises a screening test based on the aldosterone –to-renin ratio (ARR), followed by a confirmatory test to verify autonomous aldosterone secretion. However, available confirmatory tests (fludrocortisone, saline infusion) are laborious or relatively expensive. For this reason, the non-invasive Captopril test has been widely used despite its lower specificity. Recently, a new overnight screening test (DCVT) has been proposed, using oral administration of combined blockers of RAAS (renin–angiotensin–aldosterone system). The aim of the study was to assess the performance of DCTV in the diagnosis of PA in patients in whom the diagnosis was confirmed by the established Captopril test.

Design and method:
A total of 94 subjects with hypertension were investigated over a 2-year period. To confirm PA diagnosis all the patients underwent the Captoptil challenge test, as previously described. In addition, in all participants the DCVT was performed (patients received 2 mg Dexamethasone, 50 mg Captopril and 320 mg Valsartan at midnight and an extra dose of 50 mg Captopril 1 h before blood sampling in the next morning).

Results:
In the whole group of patients, 37 were diagnosed with PA on the basis of Captopril test cut-offs. The remaining 57 patients were considered to have essential hypertension. There was no significant difference in the main characteristics (age, sex, BMI, blood pressure, fasting blood glucose, lipids) between the two groups, except for potassium which was lower in patients with PA (p < 0.001). The areas under the receiver–operator characteristics curves for the post DCTV-aldosterone and post-DCVT ARR were 0.88 and 0.82, respectively. The optimal cutoff value for post DCTV- aldosterone was 262 pmol/l, which yielded a sensitivity and specificity of 83% and 75% respectively.

Conclusions:
In conclusion, DCVT is an reasonable alternative to the more complex invasive confirmatory tests in the PA diagnosis. Similarly to Captopril test, DCVT is safe and much easier to perform, so it may serve as a feasible alternative, despite slightly lower performance indices. When interpreting the results of DCVT, post- DCTVT aldosterone is recommended compared to post-DCVT ARR.