bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between the cumulative excessive systolic blood pressure and left ventricular mass index
Authors: Lee Y , Kim B S , Kim H J , Shin J H , Park H C , Shin J 
Published: October 2024

Abstract

Background
Ambulatory blood pressure (ABP) has been increasingly adopted in day-to-day clinical practices. Although clinicians can access an enormous amount of information regarding an individual’s blood pressures (BPs) through the ABP monitoring (ABPM), to date, only the mean BP is utilized as the diagnostic threshold of hypertension and the therapeutic target for BP control and no other indices were widely used to assess the burdens of high BP in the ABPM. Because elevated systolic BPs (SBPs) cumulatively damage the myocardium and induce hypertrophy and fibrosis, we hypothesized that the summated value of BP readings beyond a target level may be the better indicator of the overall BP loads than the mean BP value.

Methods
The Korean ABP registry is a multicenter prospective longitudinal cohort study performed in outpatients with hypertension. Among 5,965 patients enrolled in the registry, 951 patients with valid ABPM records and appropriate echocardiography measurements included in the study. The left ventricular mass (LVM) was normalized using the height2.7(m) (LVM index [LVMIH2.7] = LVM/Height2.7). The cumulative excessive SBP CE-SBP) was defined as the summation of the products of excessive SBPs (≥135 mmHg during wake, ≥10 mmHg during sleep) and the durations of the excessive SBP (Figure 1).

Results
The CE-SBP was non-linearly associated with both the office SBP and the mean SBP, but the association strength was much greater with the mean SBP than with the office SBP (R2=0.902 vs. R2=0.430). In linear regression models, the association of the CE-SBP with the LVMIH2.7 (R2=0.112 [0.074-0.149]) was greater than that of the office SBP (R2=0.072 [0.040-0.103]), the mean SBP (R2=0.082 [0.049-0.116]) or the mean SBP during sleep (R2=0.99 [0.063-0.134]). Non-linear regression models using restrictive cubic spline fits also showed that the association strength was greater with the CE-SBP (R2=0.117 [0.078-0.155]) than with the office SBP, mean SBP or mean SBP during sleep (Figure 2). Left ventricular hypertrophy (LVH) defined as the LVMIH27 ≥54 g/m2.7 was better predicted with the CE-SBP than with the other SBPs. The association between the CE-SBP and LVMIH27 was stronger in the patients not taking antihypertensive medications (R2=0.121) and strongest in those with the non-dipper pattern (R2=0.125). Combination with the variability indices (successive variation and average real variability) during sleep or the maximum SBP during sleep significantly improved the association strength of CE-SBP with LMMIH27, whereas the combination with the mean SBP or the variability indices during the entire period did not, in the linear models.

Conclusion
The CE-SBP was more strongly associated with the LVMIH27 than the office SBP and the mean SBP in the ABPM. This result suggests that the CE-SBP may be the better indicator of overall BP loads than the office SBP or the mean SBP in the ABPM, in patients with hypertension.Figure 1Figure 2
The expanding role of semaglutide in cardiovascular disease and its the effect on blood pressure
Authors: Kennedy C , Hayes P , Cicero A F G , Dobner S , Le Roux C , Mc Evoy J W , Zgaga L , Hennessy M 
Published: October 2024

Abstract

Background
Following the SELECT and STEP-HF trials, the use of GLP1 agonists in cardiovascular disease is expanding. The effect of these treatments on blood pressure (BP) is an important consideration when targeting excess body weight (BW) to improve cardiovascular risk. In particular, the BP response of participants with extreme BW reduction is unknown.

Purpose
To determine relationship between the BP response to semaglutide treatment and change in BW.

Methods
Individual participant data from two randomised placebo-controlled trials (STEP 1 and 3) examining the effect of semaglutide 2.4mg on BW over 68 weeks were included. Firstly, the change in SBP comparing those on semaglutide to placebo was analysed with baseline systolic BP (SBP) and change in BW as covariates in an ANCOVA model. Then, Pearson’s correlation coefficient for changes in SBP and BW was assessed for participants on semaglutide treatment. Finally, the SBP and diastolic (DBP) response on semaglutide was analysed for five categories of BW change. Super responders were identified – those with &gt;30% body weight reduction. Analyses were performed using R Software version 4.0.3.

Results
2365 trial participants were included in the pooled analysis, of which 1590 were treated with semaglutide. When adjusted for baseline SBP and change in BW, the reduction in SBP on semaglutide compared with placebo was -1.78mmHg (95%CI -2.94 to -0.62). This compared with a SBP change of -5.07 (95%CI -6.09 to -4.05) when adjusted for baseline BP alone. For those on semaglutide, the correlation between SBP and BW change was weak but significant (r=0.1978, p&lt;0.001; Figure 1). A strong correlation was evident for categories of BW change and both SBP (r=0.9824, p&lt;0.001; Figure 2) and DBP (r=0.9925, p&lt;0.001). 9.7% of those on semaglutide were super responders and this group had a mean SBP change of -12.55mmHg.

Conclusions
The effect of semaglutide on SBP, compared to placebo, is attenuated when adjusted for change in BW. Consistent with this, for those on semaglutide treatment, BP change correlates with BW change. When treating patients with semaglutide regular BP review is required, particularly for those with large reductions in BW.
Do more with less? Impact of personalized very low doses of amlodipine in the PERSONAL-CovidBP trial
Authors: Collier D , Taylor M , Godec T , Shiel J , Saxena M , Patel M , Goldsmith P , Deeming N , Poulter N , Gabe R , Mcmanus R , Caulfield M 
Published: October 2024

Abstract

Introduction
The Personal-CovidBP study1 tested remote patient use of a drug-device combination of a smartphone application (App) to record blood pressure (BP), novel personalized milligram-by-milligram drug (amlodipine) dose, and relevant side effects daily during the COVID-19 pandemic.

Purpose
In supplementary data analyses, we examined the effect of using small doses (1 mg) and small increments (1-2 mg) of amlodipine on the BP response and side effects.

Methods
In this community-based trial with remote monitoring and remote medical management from the investigational site, hypertensive participants aged 18 years + with poor BP control (prior 7 day mean of 135 mmHg systolic BP or above and/or 85 mmHg diastolic BP and above) were enrolled to intervention with open label dose titration over 14 weeks, allowing personalized dosing of liquid amlodipine (1–2 mg steps from 1–10 mg daily).

Results
205 patients were enrolled into the intervention group between October 2020 and July 2021. Average BP in intervention fell from 141/87 to 131/81 (difference −10/6 p &lt; 0.001). Even low doses or small increments: 1 or 2 mg amlodipine or 5 mg to 6 mg, produced meaningful BP responses. Here we report that the addition of amlodipine during the study reduced blood pressure regardless of being amlodipine naive at baseline (n=141), or receiving amlodipine 2.5mg or 5mg at baseline (n=62). The response slopes were comparable, and mean reductions in SBP were consistent across groups: -11.7 (95% CI: -12.9 to -10.6); -9.4 (-11.1 to -7.7); respectively (Figure 1). For the amlodipine naive, the majority (76%) achieved BP control at low doses (&lt;1 to 3mg) with occurrence of side effects increasing with dose (Figure 2).

Conclusions
Our real-world remote care study demonstrated that very low doses of amlodipine as little as 1 mg were effective and for 1mg-3mg gained BP control in the majority and were associated with fewer side effects which is consistent with previous meta-analyses.2
Personalized treatment titration was effective even at very low doses and also regardless of whether amlodipine naive or not at baseline.Changes in SBP- baseline amlodipine useAmlodipine dose at control vs oedema
Nighttime blood pressure reductions after radiofrequency renal denervation through 24 months in patients with uncontrolled hypertension: pooled analysis from the SPYRAL HTN trials
Authors: Kario K , Mahfoud F , Townsend R R , Kandzari D E , Weber M A , Schmieder R E , Tsioufis K , Fahy M , Boehm M 
Published: October 2024

Abstract

Introduction
Studies have shown that elevated nighttime and early morning systolic blood pressure (SBP) are associated with the highest risk for cardiovascular (CV) events. Radiofrequency renal denervation (RF RDN) is an interventional therapy to reduce BP in patients with uncontrolled hypertension (HTN). Although sustained, durable reductions in office and 24-h ambulatory systolic BP (SBP) after RDN have been observed, whether the therapy produces similar, durable nighttime and early morning SBP reductions requires further evaluation.

Objective
To assess whether RF RDN significantly reduces nighttime SBP through long-term follow-up, in addition to other times of the day.

Methods
We pooled data from patients with uncontrolled HTN undergoing RF RDN using the latest-generation Symplicity SpyralTM multi-electrode catheter from the published SPYRAL HTN-OFF and -ON MED clinical trials. Office and 24-h ambulatory SBP were evaluated from baseline through 24 months. We also assessed BP changes during specific, diurnal time ranges including nighttime (1am-6am), early morning (7am-9am), and daytime (9am-9pm). The number of antihypertensive drugs and drug burden (determined by number of classes and prescribed dosage) from urine and plasma drug testing were tabulated from baseline through 24 months.

Results
Outcomes from 388 patients undergoing RF RDN were pooled for this analysis. Patients were on average 54±10yrs old, 26.8% female, mean BMI was 31.3±6.0, 45.1% with &gt;10yrs diagnosis of hypertension, 7.7% with type 2 diabetes, 9.8% with obstructive sleep apnea, 47.7% with a history of smoking. The baseline nighttime SBP was 139±11mmHg, morning SBP was 154±15mmHg, and daytime SBP was 156±9mmHg. At baseline, 92.5% of patients had nocturnal hypertension (BP ≥120/70 mmHg) and took 1.0±1.2 antihypertensive drugs.
12 months after RF RDN, 30.6% of patients no longer had nocturnal hypertension (p&lt;0.0001). The mean nighttime SBP change at 12 months was -10.8±15.4mmHg, morning changed was -12.8±20.4mmHg, and daytime changed was -12.2±13.6mmHg (Figure). The mean 24-h ambulatory SBP change at 12 months was -11.9±12.4mmHg, and the office SBP change was -17.7±15.4mmHg . Patients took 1.8±1.1 antihypertensive drugs at 12 months. Results from 24 months, not currently available, will also be presented for the first time.

Conclusions
In this pooled cohort of RDN patients with uncontrolled hypertension, nocturnal hypertension was highly prevalent. Clinically meaningful reductions at 12 months throughout the 24-hr circadian cycle, including at nighttime and early morning SBP, are consistent with the "always on" effect of RDN. Results from 24 months will also be presented for the first time at ESC. As an adjunctive therapy to pharmacotherapy, RDN may help to reduce CV risk by lowering nighttime and morning SBP.
Carotid-Femoral pulse wave velocity progression in hypertensive patients is associated with subsequent cardiovascular outcomes
Authors: Maloberti A , Rebora P , Occhino G , Andreano A , Intravaia R C M , Tognola C , Toscani G , Peraro G , Morelli M , Pezzoli S , Cavalieri D'oro L , Russo A , Giannattasio C 
Published: October 2024

Abstract

Background
Arterial stiffness (Pulse Wave Velocity - PWV) is associated with CV events and mortality. However, little is known on the relationship of its progression (ΔPWV) over time with CV outcomes.

Purpose
The aim of our study was to evaluate the relationship between PWV progression and all-cause mortality and CV events in hypertensive subjects.

Methods
We enrolled 402 consecutive hypertensive outpatients. At baseline anamnestic, clinical, BP, laboratory data and PWV were assessed. We performed a PWV follow-up examination at a median time of 3.7±0.5 years. Patients were subsequently followed for a median time of 10.1 (IQR 9.5 -10.5) years recording all-cause mortality and CV events.

Results
At baseline the mean age was 53.2±13.0 years, SBP and DBP were 141.8±17.5 and 86.8±10.5 mmHg and PWV was 8.5±1.9 m/s. Despite an improvement in BP control (- 9.2±19.5 and -8.0±12.3 for SBP and DBP respectively), at follow-up the population showed a PWV increase (ΔPWV +0.6±1.9 m/s). Progressors (ΔPWV ≥ 0.5 m/s, 204 patients, 50.7%) had a significantly lower survival probability and higher cumulative incidence of composite events, while no differences were seen for CV events (unadjusted analysis). At cox multivariable analysis neither ΔPWV ≥ 0.5 m/s (progressors) nor ΔPWV (as a spline function) were associated with CV events and with all-cause mortality.
However, the association with survival probability and cumulative incidence of CV events, as a composite outcome, was significant (HR = 2.32, 95% CI: 1.33 – 4.04, p=0.003).

Conclusions
In conclusion, our study shows that PWV progression of at least 0.5 m/s is frequent in hypertensive patients and that it is associated with a significantly higher risk of developing CV events or dying (composite outcome).
High physical activity relates to higher risk of incident carotid plaque components
Authors: Zuo L , Kavousi M , Voortman T , Ikram M K , Bos D 
Published: October 2024

Abstract

Background
The rupture of carotid atherosclerotic plaque, primarily driven by plaque components, is among the leading causes of ischemic stroke. Although physical activity (PA) stands as a major modifiable target for prevention of atherosclerotic diseases, recent studies suggested a potential adverse impact of high-volume PA on atherosclerotic plaque burden in athletes. Data remains scarce from the community-dwelling population regarding to the impact of PA on the longitudinal change of carotid plaque components.

Objectives
To assess the association between PA and the incidence of carotid plaque components and explore whether the association of PA with stroke and all-cause mortality differs by the presence of plaque components.

Methods
Between 2007 and 2012, in a community- dwelling cohort in Netherlands, 1327 stroke-free persons (mean ± standard deviation age 72 ± 9 years, 45% women) with carotid atherosclerosis (carotid intima-media thickness &gt; 2.5 mm) were invited for magnetic resonance imaging (MRI) to assess carotid plaque components. From these, 696 persons (1267 carotid arteries) underwent a follow-up MRI between 2014 and 2017 (median between-scan interval 6 years). Carotid plaque components included calcification, intraplaque hemorrhage (IPH), and lipid-rich necrotic core (LRNC). The volume of moderate, vigorous and total PA (unit: metabolic equivalent task hour, MET-h) was assessed using LASA Physical Activity Questionnaires around the time of the first MRI scan. Participants were followed for the occurrence of stroke or all-cause mortality until December 31, 2019. Generalized estimation equation and Cox regression models were used in the analyses, with adjustments for plaque size and other cardiovascular risk factors.

Results
Compared to lowest quintile PA group, participants in the highest quintile total PA group had a higher risk of new onset of plaque components, odds ratio (95%CI) 2.69 (1.21; 5.94) for calcification, 1.35 (0.82; 2.24) for LRNC and 1.93 (1.12; 3.34) for IPH (Figure 1). Similar associations were observed for vigorous PA but not for moderate PA. Over a median follow-up of 9.5 years, 118 persons suffered a stroke and 298 died. As shown in table 1, baseline IPH, rather than LRNC or calcification, modulated the associations of PA with stroke and all-cause mortality (P-interaction &lt;0.05): higher total PA was associated with a lower risk of stroke among IPH-free persons, with the hazard ratio (95% CI) of 0.929 (0.867; 0.996) per 10 MET-h/week increase; no associations between PA and stroke were found among those with IPH. Similar associations were found between vigorous PA and all-cause mortality.

Conclusions
Among the middle-aged and elderly with subclinical atherosclerosis, high level PA, especially high vigorous PA, may lead to an unstable carotid plaque. The beneficial effect of PA on stroke and all-cause mortality is only among persons with a stable carotid plaque profile, especially without IPH.
The impact of pre-myocardial infarction exercise frequency on prognosis in acute myocardial infarction patients
Authors: Gu T S , Hu S T , Zhang Y K , Jiang C , Zhang J K , Wu X , Liu X , Liu T , Chen K Y 
Published: October 2024

Abstract

Background
Acute myocardial infarction (AMI) is a critical cardiovascular event often associated with significant morbidity and mortality. Despite the acknowledgment of regular physical activity as vital for cardiovascular health, its influence on post-AMI prognosis in patients with varying pre-AMI exercise frequencies remains to be fully explored.

Purpose
This study aimed to investigate the outcomes of AMI patients based on their exercise frequency prior to the occurrence of AMI, comparing those with regular exercise (once or more per week) versus those with infrequent or no exercise.

Methods
This study included acute myocardial infarction cohorts from 71 secondary or tertiary hospitals between January 1, 2010 and June 30, 2023. Inclusion criteria comprised AMI patients evaluated for exercise frequency using the Community Health Questionnaire before hospitalization. The primary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE), net adverse clinical events (NACE), and all-cause mortality, with secondary outcomes comprising the individual components of MACCE and NACE. Propensity score matching (PSM) was employed to adjust for differences in clinical characteristics between the two groups. Multivariable Cox regression and robust multivariable Cox regression were conducted before and after PSM to evaluate the impact of exercise frequency on outcomes.

Results
The final study population consisted of 77,427 participants (42.1% in the High-frequency exercise group). The median follow-up duration was 1595 days, the mean age was 66.03±11.82 years, 65.6% were male. Compared to individuals with infrequent exercise before AMI, those with regular exercise exhibited significantly lower risks of MACCE [aHR 0.93 (0.91-0.96), p&lt;0.001], NACE [aHR 0.91 (0.89-0.93), p&lt;0.001], and all-cause mortality [aHR 0.90 (0.87-0.92), p&lt;0.001]. However, regular exercise before AMI was associated with an increased risk of coronary revascularization [aHR 1.12 (1.07-1.17), p&lt;0.001]. These findings remained consistent in the robust multivariate Cox regression analysis conducted after adjusting for differences between the two groups with PSM (Figure 1). After PSM, survival analysis indicated that the incidence of primary outcomes was lower in individuals with high exercise frequency before AMI compared to those with low exercise frequency before AMI, with all-cause mortality rates of 23.1% vs. 35.4%, MACCE rates of 26.4% vs. 36.2%, and NACE rates of 36.9% vs. 36.2%, all with log-rank p-values &lt;0.001.

Conclusions
This study underscores the protective role of regular physical activity prior to AMI in reducing adverse post-AMI outcomes. Promoting pre-AMI physical activity can be a key element in preventive cardiology, potentially improving prognosis and decreasing the likelihood of cardiovascular events post-AMI.Figure 1
GJA4 gene inhibition may represent a potential target for novel antithrombotic therapies
Authors: Sa D , Mendonca M I , Sousa F , Abreu G , Rodrigues M , Henriques E , Freitas S , Borges S , Guerra G , Ornelas I , Drumond A , Sousa A C , Palma Dos Reis R 
Published: October 2024

Abstract

The GJA4 gene encodes a protein called connexin 37, a component of gap junctions in vascular endothelial cells, crucial in regulating endothelial function and influencing inflammation, platelet adhesion and thrombus formation. This gene deletion in mice diminished thrombus formation in vitro in human blood. In these circumstances, connexin inhibition with pharmacological agents may represent potential avenues for developing novel antithrombotic agents.

Aim
To investigate whether the GJA4 rs618675 T&gt;C variant is a risk factor for progressing atherosclerosis and cardiovascular (CV) events in an asymptomatic free of apparent CAD from a Portuguese population.

Methods
A prospective study was performed with 1421 individuals without apparent CV disease (73.6% male, aged 52.2±8.3 years) followed during an extended period of 7.2±5.1 years). GJA4 rs618675 T&gt;C variant was genotyped by TaqMan real-time PCR technique (Applied Biosystems). Conventional, anthropometric, biochemical and clinical risk factors were studied. Bivariate analysis and multivariate Cox regression adjusted for age, gender, traditional risk factors, biochemical markers, and the genotypes under study was performed to determine which variables were, significantly and independently, associated with CV events. Kaplan-Meier's estimate assessed the prognosis.

Results
Bivariate analysis showed that 50.6% of wild genotype (TT) carriers had CV events vs. 66.2% without events. Of the risk genotype (CC) carriers, 10.1% had CV events, and 3.4% did not. After the Kaplan-Meier analysis, the TT carriers had 90% CV event-free survival time and the CC risk carriers had only 64% of event-free survival. Finally, after adjustment, CC genotype remained in the equation with an HR of 3.1 (p=0.003) and CT heterozygous with HR of 1.6 (p=0.043), together with Hypertension (HR 3.0; p&lt;0.0001), Smoking habits (HR 2.3; p=0.001) and Diabetes (HR 1.9; p=0.015).
Conclusion: The CC risk genotype of the GJA4 rs618675 represented an independent risk factor for progressing atherosclerosis and CV events in a Portuguese Population. Thrombus formation often begins with the adhesion of platelets to the endothelium, and connexin 37 may influence this process. The inhibition of connexin 37 emerges as a promising candidate for future cardiovascular prevention as well as for the development of new antithrombotic drugs.