bluuebunny/crossref_metadata_2025_split huggingface dataset:
ADHERENCE TO THERAPY IN UNCONTROLLED MIDDLE-OLD HYPERTENSIVES – A PROBLEM TO SOLVE
Authors: Livia Popescu , Horia Balan 
Published: April 2021

Objective:
Hypertension is worldwide spread, affects 40.41% of Romanians, and represents the leading cause of death. Epidemiological evidence suggests increasing proportion of elderly people. One half/two thirds of them have hypertension. Suboptimal adherence to treatment is considered to be the main impediment in controlling chronic diseases and the most common precipitating factors for hospitalization. Among the new concepts in 2018 ESC/ESH Guidelines for the Management of Arterial Hypertension is a strong emphasis on evaluating treatment adherence as a major cause of poor BP control.
The aim of our study was to assess adherence to therapy in uncontrolled middle-old hypertensives admitted in an Internal Medicine Department

Design and method:
We enrolled 192 consecutive treated but uncontrolled patients with hypertension (BP>140/90mmHg) and age between 75 and 85 years old. All patients completed the Morisky questionnaire for adherence to treatment.

Results:
90 patients (53.57%) were females, and 78 (46.43%) males. Morisky score 0 (maximum adherence to therapy) was recorded in only 15.47% of the patients, 36.92 % had intermediate adherence (Morisky score 1–2) and 47.61% low adherence (Morisky score 3–4). Adherence to treatment was low in both sexes. Men had a sleight better maximum adherence than women (17.94% vs 13.33%). Women had a sleight lower low adherence to therapy than men (46.66% vs 50%).

Conclusions:
In-hospital middle-old uncontrolled patients with hypertension have a very poor adherence to therapy. Low adherence is present in both sexes. Since adherence to therapy is crucial in controlling chronic diseases, effective strategies to increase adherence to therapy are mandatory in uncontrolled middle-old hypertensives.
ASSOCIATION OF ARTERIAL HYPERTENSION AND BLOOD PRESSURE WITH MORTALITY AMONG POPULATION AGED 55 YEARS AND OLDER, ACCORDING TO ANTIHYPERTENSIVE TREATMENT
Authors: Imaeva Asiia , Shalnova Svetlana , Balanova Yulia , Kapustina Anna , Shkolnikov Vladimir 
Published: April 2021

Objective:
Objective: to evaluate relationship of arterial hypertension (AH), elevated blood pressure (BP) and all-cause and cardiovascular disease (CVD) mortality among Muscovites aged 55 years and older according to antihypertensive therapy.

Design and method:
Methods: data of 1876 Muscovites 55 years and older (47.9% males) from the prospective population-based cohort study named the Stress, Aging and Health in Russia (SAHR) was used. The elevated BP was defined as BP > = 140/90 mmHg. AH was diagnosed according to European Society of Cardiology Guidelines. The treatment of hypertension was defined as the current use of a prescribed medication intended to lower BP, the effective treatment – as the presence of SBP < 140 mmHg and DBP <90 mmHg among treated participants. During the follow-up period (mean – 8,5 years) 547 deaths, including 330 from CVD, were identified. Hazard proportional risk model (Cox) was applied for hazard risks (HR) evaluation with 95%CI.

Results:
Results: the prevalence of AH and elevated blood pressure was 73,9% and 53,4%, respectively. After adjusting for age and sex AH had no significant associations with all-cause and CVD mortality (HR = 1,2; 95% CI: 0,98–1,5; p = 0,07; HR = 1,24; 95% CI: 0,94–1,64; p = 0,1). Whereas elevated BP was significantly associated with all-cause and CVD mortality (HR = 1,31; 95% CI: 1,10–1,55; p = 0,003, HR = 1,40; 95% CI: 1,12–1,75; p = 0,004). Moreover there was the strong contribution of elevated BP to all-cause mortality (HR = 1,39; 95% CI: 1,10–1,77; p = 0,006) and CVD mortality (HR = 1,55; 95% CI: 1,14–2,10; p = 0,005) among those who received antihypertensive therapy after adjustment to sex and age. Receiving antihypertensive therapy had no associations with all-cause and CVD mortality (p > 0,05). At the same time, the effective antihypertensive therapy reduced risk of all-cause and CVD mortality by 28% and 35%, respectively (HR = 0,72; 95% CI: 0,57–0,91; p = 0,006; HR = 0,65; 95% CI: 0,48–0,88; p = 0,005).

Conclusions:
Although AH is an important risk factor of CVD, among population aged 55 years and older only the elevated levels of BP and antihypertensive therapy efficacy were associated with all-cause and CVD mortality.
ANTIHYPERTENSIVE DRUG THERAPY BETWEEN ELDERLY PATIENTS IN A RURAL AREA OF PORTUGAL
Authors: Iashchuk Mykhailo , Galvez Juan Manuel Urbano , Real Lorena Lozano , Araujo Paula Sofia 
Published: April 2021

Objective:
The aim of this study is to evaluate the antihypertensive therapy among > 65 years old in a rural area of Portugal.

Design and method:
The study includes 400 patients 65–93 years old. Average age was 76.2 ± 6.8 years old (76.4% women). The 40.3% of individual have complete basic education and 4% still continued to work. Study was conducted in several internal medicine external offices of a Hospital in a rural area of Portugal from October 2017 to May 2019. The presence of High Blood Pressure (HBP), cardiovascular diseases (CVD) and antihypertensive therapy was evaluated in 2 groups of patients: 65–79 years old (n = 336) and > 80 years old (n = 64).

Results:
Antihypertensive therapy was reported by 93% (n = 372) patients. The 45,46% of the patients (n = 171) received monotherapy. Combination of two-drugs were taken by 31.98% (n = 119) of the patients. Three and four drugs combination were taken by 16,12 % (n = 60) and 5,91% (n = 22) of the patients, respectively. The study revealed ACE inhibitors and like thiazides diuretics as most frequent drugs (52.8% and 49.6% of patients, respectively). The distribution of another groups of antihypertensive pills is following: calcium channel blocker - 39.6%, angiotensin receptor blocker - 24.7%, beta blocker - 14% patients and central action blockers 6,5 %. In patients taking 2 anti-hypertensive drugs, the most frequent association was ACE inhibitors and like thiazides diuretics (42,3 %) followed by ACE inhibitor plus calcium channel blocker (28,5 %). In patients taking 3 drugs, the most frequent association was ACE inhibitor plus like thiazide diuretic plus calcium channel blocker.

Conclusions:
Most hypertensive patients > 65 years old receive combination antihypertensive therapy. Combinations of ACE inhibitors + like thiazides diuretics or ACE inhibitors + calcium channel blocker are among the most common.
THE IMPACT OF ADIPOKINES IN THE ONSET OF ATRIAL FIBRILLATION
Authors: Papadopoulos Dimitrios , Sanidas Elias , Velliou Maria , Tsakalis Konstantinos , Zerva Kanella , Kyrana Panagiota , Iliopoulos Dimitrios , Mantzourani Marina , Toutouzas Konstantinos , Barbetseas John 
Published: April 2021

Objective:
Several adipose tissue bioactive factors (adipokines) have been linked to cardiovascular (CV) diseases. Apelin and omentin-1 have cardioprotective effects whereas visfatin and chemerin have negative effects on CV function. The aim of this study was to calculate apelin, omentin-1, visfatin and chemerin plasma levels in patients with a first episode of atrial fibrillation (AF) investigating any potential association of these factors with the presence of the arrhythmia.

Design and method:
Overall, 60 patients without a previous history of AF were studied. Of them, 30 had a first documented episode of AF on ECG or 24-hour Holter monitoring during the last month and 30 did not. Apelin, omentin-1, visfatin and chemerin plasma levels were measured by the Elisa method.

Results:
Compared to non-AF patients, visfatin and chemerin levels were higher in patients with a first episode of AF while apelin and omentin-1 levels were lower. However, statistically significant differences were observed only for apelin and visfatin. No statistically significant differences in demographic characteristics and CV risk factors were noted between the two groups (Table).

Conclusions:
Visfatin as a non-cardioprotective adipokine was increased in patients having AF for the first time while apelin as a cardioprotective adipokine was decreased indicating a potential correlation of these hormones with the presence of the arrhythmia.
THE RELATIONSHIP BETWEEN ATRIAL FIBRILLATION AND RENAL DYSFUNCTION
Authors: Tatar Maria Cristina , Husariu Madalina , German-Sallo Marta , Tilea Ioan 
Published: April 2021

Objective:
Lately, interrelation between atrial fibrillation (AF) and chronic kidney disease (CKD) has received increasing attention, owing to the collective risk factors. The aim of this study, was to appreciate the severity of the renal dysfunction depending on the temporal pattern of atrial fibrillation in patients presenting both conditions.

Design and method:
We retrospectively analyzed 258 atrial fibrillation patients, mean age 73.48 yr (SD= 10.4), 51.6% females, presenting different stages of chronic kidney disease. The study population was divided in three groups based on the presentation and duration of AF: paroxysmal, persistent and permanent. In order to quantify the severeness of the CKD, we estimated the glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) equation.

Results:
Related to the type of atrial fibrillation, 38% of patients had paroxysmal AF, 3.9% persistent AF, respectively 58.1% had permanent AF. Regarding the mean value of the eGFR, in the paroxysmal AF group we obtained a mean value of 69.06 ml/min/1.73 (median= 67.5, SD= 33.54) while in the persistent AF group the mean eGFR value was 70.9 ml/min/1.73 (median= 67.5, SD= 31.2) and in the group of permanent AF, the mean value was 61.2 ml/min/1.73 (median= 55.5, SD= 30.26). Therefore, no statistically significant difference (p = 0.6262) was obtained in terms of the severity of renal dysfunction compared to the type of atrial fibrillation.

Conclusions:
Our findings demonstrate that neither type of AF is predisposing to more severe outcome of chronic kidney disease. On the other hand, independent of atrial fibrillation type, the eGFR is an important monitoring tool of CKD progression in atrial fibrillation patients. Overall, due to increasingly occurrence of atrial fibrillation with chronic kidney disease, further studies are required in order to streamline their management, taking into account renal function in determining cardioembolic risk as well.
ESTIMATED PULSE WAVE VELOCITY (EPWV) DISTRIBUTION IN A COHORT STUDY – EH-UH STUDY (CROATIAN SCIENTIFIC FOUNDATION)
Authors: Bosnjak Vito , Blagus Luka , Frkanec Stjepan , Katic Luka , Domislovic Viktor , Matasin Marija , Glavic Mihaela Marinovic , Kos Jelena , Vrkic Tajana Zeljkovic , Pecin Ivan , Jelakovic Ana , Premuzic Vedran , Dika Zivka , Karanovic Sandra , Jelakovic Bojan 
Published: April 2021

Objective:
Carotid-femoral pulse wave velocity (cfPWV) was recommended by guidelines as a biomarker of arterial stiffness and an independent predictor of future cardiovascular (CV) events. However, due to practical and logistic reasons it was not become a routine in clinical work. Recently, it was shown that estimated PWV (ePWV) which is much more convenient for everyday work correlates excellent with cfPWV and had predictive role in hypertensive patients with various degrees of CV risk. Our aim was to determine the distribution of ePWV values in general Croatian population.

Design and method:
In a stratified random sample of 1087 subjects from the general Croatian adult population which was enrolled in a nationwide survey (EH-UH 1) from 2000–2005 analyses on ePWV were done and subjects were followed-up for 17 years. ePWV was calculated from age and mean BP (MBP): ePWV = 9.587 - 0.402 × age + 4.560 × 10-3 × age2 - 2.621 × 10-5 × age2 × MBP + 3.176 × 10-3 × age × MBP - 1.832 × 10-2 × MBP. MBP = diastolic BP (DBP) + 0.4(SBP - DBP).

Results:
Mean values of ePWV according to the age and BP categories are shown in Figure 1. Distribution of PWV according to the age category in the normal values European population (European Heart Journal 2010; 31: 2338) and ePWV in general Croatian population are presented in Table 1. Concordance between cfPWV and ePWV was found in younger subjects with less stiffed arteries. Discrepancies between cfPWV and ePWV increased with levels of cfPWV

Conclusions:
According to our knowledge this is the first study presenting the distribution of ePWV by age category in a population-based survey. Observed differences between cfPWV and ePWV in older subjects could be explained with differences between groups (normal population vs. general population) but also by the fact that our participants were not classified according to levels of BP what is in line with the results of other authors (J of Hypertension 2016, 34:1279)
URINARY UROMODULIN IS POSITIVELY ASSOCIATED WITH TOTAL CARDIOVASCULAR RISK IN MIDDLE-AGED NON-TREATED SUBJECTS WITH HIGH-NORMAL BLOOD PRESSURE
Authors: Josipovic Josipa , Simicevic Livija , Milicic Borna , Domislovic Viktor , Jelakovic Bojan 
Published: April 2021

Objective:
Recent studies found bidirectional association of urinary uromodulin (UM) with total cardiovascular (CV) risk. Our aim was to analyse association of urinary UM with total CV risk in a group of middle-aged non-treated subjects with high-normal blood pressure (BP).

Design and method:
We included 326 apparently healthy subjects (mean age 37). Fasting blood and urine samples were obtained and office and ambulatory BP were measured in all subjects. UM (morning spot urine sample) was determined by ELISA (Cobas Roche).

Results:
According to the JNC-7 classification, optimal BP (OBP), prehypertension (PHT) and hypertension (HT) were diagnosed in 103 subjects (72% m), 143 subjects (43% m), and 80 subjects (38% m), respectively. Based on the general cardiovascular risk algorithm 257 (78.8 %), 42 (12.9 %) and 19 (5.8%) participants were classified into the low/medium risk, high risk and very high risk groups, respectively. There were 12.9% high risk and 5% very high risk subjects in PHT, and 21% high and 16% very high risk participants in HT groups, while there weren’t high/very high risk subjects in OBP group. Nonindexed UM (nUM) was significantly lower in low/medium vs. high/very high risk groups (48.2 vs. 69/73; P = 0.003). Nonsignificant trend to the higher nUM values (mg/ml) were found in HT/PHT compared to OBP (52/56.1 vs 49.8 mg/ml). Opposite trend (43/42.9 vs. 40.6 mg/g creatinine) was observed for indexed UM (iUM). In PHT group, there were significant difference in nUM between low/medium and high/very high risk groups (50 vs. 75/77; P = 0.006). In the whole group, nUM correlated positively with total CV risk (Rho = 0.169; P = 0.003). In the PHT group, both nUM (Rho 0.32; P < 0.001) and iUM (Rho 0.236; P = 0.007) correlated positively with total CV risk.

Conclusions:
Urinary uromodulin is positively associated with total cardiovascular risk in middle-aged non-treated prehypertensives.
NOVEL PATHOPHYSIOLOGICAL ROLES OF ALPHA-SYNUCLEIN (SNCA) IN AGE-RELATED VASCULAR ENDOTHELIAL DYSFUNCTION
Authors: Takami Yoichi , Nakagami Hironori , Yamamoto Koichi , Takeya Yasushi , Morishita Ryuichi , Takeda Shuko , Kaneda Yasufumi , Rakugi Hiromi 
Published: April 2021

Objective:
Although SNCA is one of the well-known pathological molecule of synucleinopathy in neurons, its physiological roles remain to be identified. In the present study, we sought to elucidate the novel functions of SNCA in endothelium.

Design and method:
Analysis for human samples, in vitro experiments using endothelial cells (ECs), and in vivo investigation using SNCA knockout or SNCA/ApoE double knockout mice were performed.

Results:
We found SNCA was expressed in and secreted from ECs by functional screening for anti-inflammatory molecules and detectable in circulating blood. Intriguingly, the human population study revealed serum SNCA levels decreased with aging and displayed inverse correlation with blood pressure and insulin sensitivity, which indicated protective properties of circulating SNCA on vascular endothelial function. Furthermore, we also found SNCA knockout mice displayed phenotypes of metabolic syndrome such as hypertension, impaired glucose metabolism, and dyslipidemia. Based on these preliminary data, we sought to elucidate the physiological functions of endogenous and exogenous SNCA for ECs. Exogenous treatment with recombinant SNCA (rSNCA) promoted eNOS activation and nitric oxide production via Gab1/PI3K/Akt pathway in ECs, followed by cGMP production in co-cultured vascular smooth muscle cells. Treatment with rSNCA also suppressed TNF-alpha induced NF-kappaB activation in ECs. As to endogenous SNCA, replicative senescence showed attenuation of SNCA expression in ECs and siRNA-mediated silencing of SNCA induced eNOS inactivation and cell senescence assessed by beta-gal activity along with decreased Sirt1 expression and increased p53 expression. SNCA overexpression displayed NF-kappaB inactivation in ECs. In ex vivo study, aortas from SNCA knockout mice showed impairment of acetylcholine-induced relaxation possibly due to eNOS dysfunction. In in vivo study utilizing atherosclerosis model of SNCA/ApoE double-knockout mice showed exaggerated expression of inflammatory genes which play important roles in atherogenesis.

Conclusions:
In conclusion, these results indicate exogenous and endogenous SNCA in ECs might physiologically maintain cerebral vascular integrity. Aging or aggregation-related loss-of-function of SNCA in ECs might be partially correlated with age-related hypertension or clinical features of dementia with Lewy body such as fluctuating cognitive function and marked sensitivity of antipsychotic which could be modified by cerebral blood flow and vascular permeability.
ANGIOTENSIN-CONVERTING ENZYME INHIBITORS AND ANGIOTENSIN RECEPTOR BLOCKERS IN STROKE PREVENTION: A SYSTEMATIC REVIEW AND META-ANALYSIS INVOLVING 297,451 PATIENTS
Authors: Alosaimi Manal , Roos Nur Aishah Che , Alnakhli Anwar Mansour , Cleland John , Padmanabhan Sandosh 
Published: April 2021

Abstract

Objective
: To assess the impact of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) on risk of stroke in patients with or at high-risk of cardiovascular diseases (CVD)

Design and method:
A meta-analysis of randomized-controlled trials was performed. Bibliographic databases were searched until 31 July 2019 for ACEIs & ARBs trials versus placebo or active therapy & supported with head-to-head trials in participants with or at high-risk of CVD. Only trials with at least 100 participants & at least one year's follow-up were included. Trials were excluded if they were redacted or combined ACEIs with ARBs. Outcome was fatal & non-fatal stroke: including ischaemic and haemorrhagic stroke excluded transient ischaemic attack (TIA). Dichotomous outcome data was analysed using risk ratio (RR) measure and its 95% confidence interval (CI) with random-effects model. A random-effects meta-regression analysis was performed to explore role systolic blood pressure (SBP) reduction achieved.

Results:
This study included 72 trials with 297,451 patient-years of follow-up. Compared with placebo, both ACEIs and ARBs reduced the risk of stroke by 14% & 9%; respectively (ACEIs: RR, 0.86; 95% CI, 0.76–0.98; p = 0.02 & ARBs: RR, 0.91; 95% CI, 0.86–0.97; p = 0.003). No difference was observed when ACEIs & ARBs were compared with active (ACEIs: RR, 1.14; 95% CI, 1.04–1.26; p = 0.006 & ARBs: RR, 0.94; 95% CI 0.79–1.12; p = 0.50). Pooled data from trials comparing ARBs to ACEIs showed no difference in stroke event rates (RR, 0.96; 95% 0.87–1.06; p = 0.42). A meta-regression analysis revealed that the relative risk reduction of stroke by ACEIs (p = 0.03) and ARBs (p = 0.01) therapy was proportional to the magnitude of SBP reduction achieved.

Conclusions:
In patients with or at high-risk of CVD, evidence from placebo-controlled trials & head-to-head trials demonstrated that ARBs to be as effective as ACEIs on preventing of stroke. Cerebro-protective effect of ARBs & ACEIs therapies are strongly associated with BP reduction.
THE ROLE OF CAROTID ECHO DOPPLER IN TREATMENT AND PREVENTION OF CEREBROVASCULAR DISEASE IN NON DIABETIC AND DIABETIC POPULATION AT HIGH RISK
Authors: Revnic Cristian Romeo , Revnic Flory 
Published: April 2021

Abstract

Objective:
Stroke, the third leading cause of death is a cardiovascular disease that affects the blood vessels supplying blood to the brain. Diabetes mellitus which is one of the main risk factors of cerebrovascular disease (CVD). Aim: Echo Doppler evaluation of arteries in diabetic and non-diabetic elderly patients.

Design and method:
Patient selection: We selected 112 patients admitted in Neurology Clinic of Vlad Voiculescu Cerebrovascular Institute Bucharest: 63 non diabetics mean age 63 years with acute ischemic stroke (CT scan confirmed)in carotid territory or a TIA and 59 diabetic patients with risk factors: obesity and arterial hypertension mean age 62.8 included into this study, independently from the presence or absence of acute ischemic stroke investigated by CT/MRI.

Results:
The carotid Echo-Doppler examination applying a 4 MHz transducer for extracranial and transcranial vascular Doppler investigation performed in both groups of patients revealed that simple carotid plaques, bilateral carotid stenoses (CS), and unilateral CS associated with contralateral carotid occlusion (CO) occurred with higher frequency in the non-diabetic patients, than in diabetic ones. On the other hand, the remaining other findings, such as unilateral CS, unilateral CO, S/O of intracranial carotid artery (ICA) and vertebral/subclavian S were more frequent in the diabetic group.

Conclusions:
The findings allow us to conclude that the correct and early treatment of diabetes as well as a possible lowering of the risks for cerebrovascular disease are obligatory steps in the primary and secondary prevention of the cerebral ischemic events in diabetic patients with carotid atheromatous lesions. There are several approaches to reduce the risk of stroke in diabetics and physical exercise is a low cost with maximum benefit upon health status contributing to lowering of high blood pressure, and of HDL. This consideration may help the physicians to have a deeper understanding of the pathophysiology, and to implement the necessary treatment and prevention of CVD in the diabetic population of high-risk.