bluuebunny/crossref_metadata_2025_split huggingface dataset:
Arterial hypertension in the era of obesity bias: the impact of obesity status on pharmacological treatment intensification in patients with diabetes
Authors: Heiden Telo G , Matzenbacher L S , Friedrich Fontoura L , Avila G O , Gheno V , Brum M A B , Teixeira J B , Erthal I N , Schneiders J , Schaan B D , Alessi J , Telo G H 
Published: October 2024

Abstract

Background
Obesity is recognized as a significant risk factor for several chronic conditions, such as diabetes and hypertension. Despite the growing healthcare needs of individuals with obesity, they often encounter obesity bias, potentially impacting the quality of medical care they receive.

Purpose
The aim of this study was to explore the impact of obesity on the appropriateness of antihypertensive treatment decisions in individuals with concurrent diabetes and hypertension.

Methods
In this multicenter cross-sectional study, patients with type 2 diabetes and arterial hypertension who were receiving outpatient care across four centers in Southern Brazil were enrolled. Participants were categorized into two groups based on their Body Mass Index (BMI): eutrophic (BMI &lt;25.0 kg/m²) and patients with obesity (BMI ≥30.0 kg/m²). The primary outcome evaluated was the difference in pharmacological treatment decisions for hypertension between groups, considering individualized hypertension targets from American Diabetes Association (ADA), European Society of Hypertension (ESH), and European Society of Cardiology (ESC). Analysis was conducted on whether patients failed to receive necessary treatment intensification, comparing groups through multivariable logistic regression.

Results
The study comprised 204 individuals with type 2 diabetes and arterial hypertension, including 53 eutrophic and 151 patients with obesity. It was observed that patients with obesity more frequently fail to receive appropriate treatment intensification when compared to eutrophic individuals. This finding was statistically significant across the hypertension targets set by the ESH (adjusted Odds Ratio [OR] 2.03 [95% Confidence Interval [CI] 1.08-3.83], p = 0.022), ESC (adjusted OR 1.94 [95% CI 1.03-3.65], p = 0.035), and ADA (adjusted OR 2.01 [95% CI 1.07-3.79], p = 0.021).

Conclusion
The study indicates that obesity may contribute to disparities in the management of hypertension, suggesting a link between obesity status and therapeutic inertia in treating arterial hypertension among these patients.
Injectable angiotensinogen inhibition therapy for hypertension: a systematic review and meta-analysis
Authors: Gomez V , Yadav A , Gmach Taffarel L , Bozko Collini M , Villa Martignoni F 
Published: October 2024

Abstract

Introduction
Hypertension is the leading risk factor worldwide for cardiovascular mortality, and the development of kidney disease. Management of hypertension involves multiple approaches that involve daily tablet ingestion, with high rates of non-adherence. There is an unmet need for innovative interventions to improve adherence to treatment.

Purpose
We aimed to perform a systematic review and meta-analysis to investigate the role of injectable angiotensinogen (AGT) inhibitors, such as Zilebesiran and IONIS-AGT-LRx, in the treatment of hypertension.

Methods
PubMed, Embase, and the Cochrane Library were systematically searched for randomized controlled clinical trials (RCTs) comparing injectable AGT inhibitors versus placebo. Efficacy was assessed through mean changes in angiotensinogen, systolic blood pressure (SBP), and diastolic blood pressure (DBP). We also examined safety endpoints. We computed pooled mean differences (MD) or risk ratios (RR) for continuous and binary outcomes, respectively, under a random-effects model with a 95% confidence interval (CI).

Results
Four studies were included for a total of 512 patients, of whom 279 (54.5%) were male, with a mean age of 57 years old; 349 (68.2%) were white. The mean baseline SBP was 142 ± 19.9 mmHg. In a pooled analysis, mean change of AGT decreased significantly with injectable AGT inhibitor compared with placebo (MD -77.86 %; 95% CI -107.49 to -48.23; p&lt;0.01). Similarly, mean change in SBP (MD -14.15 mmHg; 95% CI -19.53 to -8.78; p=0.30) and DBP (MD -8.49 mmHg; 95% CI -9.98 to -7.00; p=0.78) were also significantly lower in the injectable AGT inhibitor group compared with placebo. AGT inhibitors were well tolerated, without associations with serious adverse events, adverse events related to discontinuation, death, hyperkalaemia, or hypotension. However, there was an increase in injection site reaction with these agents compared with placebo (RR 5.86; 95% CI 1.14 to 30.17; p=0.83).

Conclusions
In this meta-analysis of RCTs, injectable AGT inhibitors were associated with a significant decrease in mean AGT, SBP, and DBP as compared with placebo. There were no significant differences between groups in serious adverse events, although injection site reaction was more common in patients treated with injectable AGT inhibitors.Forest plot of mean change in SBP
Degree of joint risk factor control and incident all cause dementia in hypertensive patients
Authors: Chen M , Ning Y , Zhao C , An J , Tang M , Tse G , Chan S , Lei X , Qiang H , Yu H , Bai C , Yan Y , Wang D , Li G 
Published: October 2024

Abstract

Background
Hypertension (HT) is a known modifiable risk factor for dementia. This study evaluates the impact of effectively controlling multiple modifiable risk factors in HT patients on the incidence of dementia.

Methods
Data from the UK Biobank (2006-2010) were used in this longitudinal study, including essential HT patients and non-HT participants, excluding those with pre-existing dementia or less than two years of follow-up. The study focused on seven risk factors: physical activity, smoking status, blood pressure, body mass index, glycosylated hemoglobin levels, lipids, and urinary Albumin-to-Creatinine Ratio. The Cox model evaluated the association between the degree of risk factor control and the incidence of dementia, while linear regression models analyzed the brain abnormalities among different risk factor control groups.

Results
Of 291,720 participants, 86,675 had HT. Over a median follow-up of 14.3 years, dementia developed in 2,002 HT and 1,379 non-HT participants. Compared with non-HT individuals, a gradual decrease in dementia risk in HT patients with the number of well-controlled risk factors was observed (hazard ratio: 2.01 [95% confidence interval (CI) 1.73-2.34] to 1.25 [95% CI 1.13-1.40]). While within HT patients, with the highest level of control lowering the risk to 0.63 (95% CI [0.54-0.73]). Moreover, HT patients with better well-controlled risk factors had lower geometric mean for white matter hyperintensity volume and increased total brain parenchymal volume, gradually narrowing the gap with non-HT individuals.

Conclusion
In HT patients, a higher degree of well-controlled risk factors seemed to be associated with progressively lower risks of dementia and brain abnormalities.HRs of all-cause dementia in patientsGMRs of different risk factors on target
Mildly decreased egfr modifies the association between uric acid and risk of kidney function decline: a 5-year population-based cohort study
Authors: Li Z Y , Wu S S , Li D , Wang G , Zhang N , Zhao F , Hao J , Yang C L , Song J S , Gu X Z , Huang R C 
Published: October 2024

Abstract

Background
the role of uric acid (UA) in chronic kidney disease (CKD) remains controversial. In this study, the effects of UA levels on risk of kidney function (KF) decline in patients with normal or mildly decreased KF at baseline were investigated.

Methods
Data were extracted from the community-based Tongzhou Cohort Study. The cohort of 4246 patients was divided into the normal KF group (estimated glomerular filtration rate [eGFR] ≥ 90 mL/min/1.73 m2) or mildly decreased KF group (60 ≤ eGFR &lt; 90 mL/min/1.73 m2). The primary endpoint was the risk of kidney function decline, which defined as a composite of a ≥ 30% decrease in eGFR from baseline or new onset of CKD diagnosed during the annual checkups.

Results
A total of 284 participants reached the primary endpoint during the 5-year follow-up period. There was a significant interaction between UA levels and baseline eGFR (p &lt; 0.001). Restricted cubic spline analysis revealed a U-shaped association between baseline UA levels and the risk of decreased KF for participants with normal KF (cut-off value = 5.0 mg/dL; pnonlinear = 0.025) and a linear association for participants with mildly decreased KF (pnonlinear = 0.384). The odds ratio of an increase in UA levels by 1 mg/dL was 1.15 [95% confidence interval (CI) 1.02–1.31, p = 0.028] for the primary endpoint and 1.15 (95% CI = 1.01–1.31, p = 0.037) for new onset of CKD for participants with mildly decreased KF.

Conclusion
The association between uric acid and risk of KF decline was U-shaped in participants with normal KF while linear in participants with mildly decreased KF.
Blood pressure polygenic risk scores associate with resistant hypertension in individuals with type 1 diabetes
Authors: Sanez Taehtisalo H , Antikainen A , Mutter S , Lithovius R , Groop P H , Kontula K K , Hiltunen T P , Sandholm N 
Published: October 2024

Abstract

Background
Hypertension is a major risk factor of global disease burden, but treatment goals are often not met. A subset of individuals with hypertension is affected by treatment-resistant hypertension (RHTN), and they suffer from increased cardiovascular morbidity and mortality. Early identification of individuals at risk of RHTN could lead to more efficient antihypertensive drug treatment.

Purpose
The aim of this study was to investigate whether polygenic risk scores (PRS) for systolic (SBP) and diastolic blood pressure (DBP) predict RHTN in individuals with or without type 1 diabetes (T1D).

Methods
We performed association analyses between PRSs and RHTN in two Finnish cohorts: The Finnish Diabetic Nephropathy Study (FinnDiane) and the Finnish individuals of the LIFE Study (LIFE-Fin).
FinnDiane is an ongoing, observational nationwide study aiming to identify genetic and clinical risk factors for complications of T1D. We included data from 778 adults (476 with RHTN and 302 with controlled hypertension).
LIFE is a randomized, double-blind study evaluating long-term effects of losartan compared with atenolol in patients with signs of left ventricular hypertrophy. We used SBP and DBP data from 378 Finnish individuals (173 with RHTN and 205 with controlled hypertension) at the four-year visit of the study.
In FinnDiane, RHTN was defined as SBP ≥130 or DBP ≥85 mmHg and the use of three or more antihypertensive drugs, or SBP &lt;130 and DBP &lt;85 mmHg and the use of four or more antihypertensive drugs. In LIFE-Fin, RHTN was defined as SBP ≥140 or DBP ≥90 mmHg and the use of three or more antihypertensive drugs. Controlled hypertension was defined as the use of three or fewer antihypertensive drugs and SBP &lt;130 and DBP &lt;85 mmHg in FinnDiane, and as SBP &lt;140 and DBP &lt;90 mmHg in LIFE-Fin.
We calculated a PRS for each participant using genome-wide association study data for 1,098,015 genetic variants; the variant-specific data were derived from UK Biobank based PRS-CS-method computed PRSs (1).

Results
We observed significant associations of SBP and DBP PRSs with RHTN in FinnDiane (OR 1.56 [1.30; 1.87], P = 1.8e-6, and OR 1.25 [1.04; 1.50], P = 0.02, per one-SD increase of the PRS value) when adjusted for age, sex, estimated glomerular filtration rate and body mass index. The association between SBP PRS and RHTN remained significant when T1D individuals with or without albuminuria were analysed separately. Neither SBP nor DBP PRSs were significantly associated with RHTN in LIFE-Fin.

Conclusion
Higher SBP PRSs associate with higher risk of RHTN in individuals with T1D, with or without albuminuria, but not in nondiabetic individuals with hypertension. It remains to be investigated whether general blood pressure genetics contribute to RHTN in the general population.
Influences of cardiovascular disease on the relationship between baseline systolic blood pressure and adverse outcomes in diabetes: insights from large population-based study
Authors: Cai A , Feng Y Q , Nie Z Q 
Published: October 2024

Abstract

Objective
To evaluate the influences of cardiovascular disease (CVD) on the relationship between baseline systolic blood pressure (SBP) and adverse outcomes in diabetes.

Methods
This is an observational study of 16431 community-dwelling adults with diabetes and 7.8% had CVD. The relationship between SBP (either as a categorical or continuous variable) with major adverse cardiovascular event (MACE) and all-cause death were evaluated by baseline CVD status using multivariable-adjusted Cox proportional hazard models and restricted cubic spline.

Results
After a median follow-up of 3.4 years, 2145 (13.1%) MACE and 1025 (6.2%) all-cause death occurred. In the overall participants there was a linear relationship between SBP and MACE (P-nonlinear=0.55) and a U-shaped relationship between SBP and all-cause death (P-nonlinear=0.002). In participants free of CVD, in reference to SBP &lt; 120 mmHg group, the risks for MACE increased as SBP category (120-129, 130-139, and ≥ 140 mmHg) advanced (P-trend &lt; 0.001) and there was a linear relationship (P-nonlinear=0.75; Figure 1A); while the risks for all-cause death were lower in SBP of 120-139 mmHg and 140-159 mmHg groups while higher in SBP ≥ 160 mmHg group, and there was a U-shaped relationship (P-nonlinear&lt;0.001; Figure 1B). Notably, in participants with existing CVD the relationship between SBP with MACE and all-cause death did not show any specific pattern.

Conclusion
The relationship between baseline SBP with MACE and all-cause death varied substantially by baseline CVD status. Future studies to investigate the threshold of initiating BP-lowering treatment and the appropriate BP target in diabetes may consider applying a CVD-based stratification strategy.
Impact of appendicular skeletal muscle mass on effect of intensive blood pressure control
Authors: Pei J , Wang X 
Published: October 2024

Abstract

Background
Appendicular skeletal muscle mass (ASM) is associated with cardiovascular diseases (CVDs) and chronic kidney diseases (CKDs). However, whether low ASM affects the efficacy of intensive systolic blood pressure control is currently uncertain.

Purpose
To examine the impact of low ASM on the effects of intensive SBP control on cardiovascular and kidney outcomes.

Methods
Data from the Systolic Blood Pressure Intervention Trial (SPRINT) and the Action to Control Cardiovascular Risk in Diabetes Blood Pressure (ACCORD-BP) trials was used. The primary outcome was a composite of myocardial infarction, acute coronary syndrome without myocardial infarction, stroke, heart failure, and cardiovascular death. The prespecified incident CKD was defined as a &gt;30% decrease in estimated glomerular filtration rate to a value &lt;60 mL/min/1.73 m2.

Results
A total of 14,017 patients were included in this study, 2203 (15.7%) of whom had low ASM. Over a median follow-up of 3.26 years, 1,032 primary outcomes and 460 incident CKD were observed. Patients with low ASM had a significantly higher risk of primary outcome and CKD. Intensive SBP control effects on cardiovascular outcomes were not significantly different on a relative scale or absolute scale. But low ASM significantly amplified the increased risk of CKD associated with intensive SBP control, on an absolute scale (P for interaction = 0.04).

Conclusions
Low ASM is one of the markers of increased risk of CVD and CKD, and it did not affect the cardiovascular benefits of intensive treatment, but significantly amplified the increased risk of CKD associated with intensive SBP control.
Interaction between subclinical carotid atherosclerosis endotype and biological sex: a study from IMPROVE cohort
Authors: Chen Q , Bergman O , Ziegler L , Baldassarre D , Tremoli E , Strawbridge R , Eriksson P , Gigante B 
Published: October 2024

Abstract

Background
Carotid-intima media thickness (c-IMT) is a measure of subclinical carotid atherosclerosis and a predictor of future atherosclerotic cardiovascular events (ASCVD). We have recently generated, using an artificial intelligence approach, four endotypes (E) of subclinical atherosclerosis, i.e. subgroups of individuals predisposed to both c-IMT progression and ASCVD. Each E is defined by a set of demographic, clinical, and molecular data and characterize individuals with a low (E1), intermendiate (E2), high (E3) and very high (E4) cardiovascular risk profile. We observed an unbalanced distribution of males and females across the 4 endotypes, with a higher prevalence of female in the low risk E1.

Purpose
To estimate the interaction between biological sex and the 4 endotypes on measures of c-IMT progression and ASCVD risk.

Methods
We performed our study on 3121 individuals from the IMPROVE cohort, which includes participants with at least three ASCVD risk factors. We estimated the interaction between biological sex and the endotypes generated in the IMPROVE on (1) c-IMT and carotid plaque measurements after 30 months of follow-up (c-IMTfastest-progr, Area of plaquesbulb-progr) by linear regression (β, SE) and (2) with the 3-year ASCVD risk by Cox [hazard ratio (HR), 95% confidence interval (CI)] regression model. Crude estimates were adjusted by batch effect for biomarker measurement, geographical region and/or baseline ultrasonographic measures. Adjusted models further included ASCVD common risk factors.

Results
As shown in Figure 1, we did not observe any significant interaction between endotypes and biological sex on 30-month carotid ultrasound progression measures, and 3-year-ASCVD risk. In both the crude and adjusted models on c-IMTfastest-progr, Area of plaquesbulb-progr, and 3-year ASCVD, the p-value for interaction ranged from 0.18 to 0.98. While E4 was associated with the strongest cardiovascular risk profile in both males and females.

Conclusions
Our results indicate that the association between endotypes and progression of subclinical atherosclerosis and ASCVD risk mirrors a specific risk profile not entirely explained by differences in biological sex.
Independent and joint associations of urinary potassium excretion with cardiovascular death: a national population-based cohort study
Authors: Lin C , Tian Y , Li X 
Published: October 2024

Abstract

Background
Elevated potassium excretion is associated with lower blood pressure, as well as reduced risks of cardiovascular disease (CVD) death. However, the impact of varied sodium levels on this association remains a topic of debate, and the mediators of this association besides blood pressure remain uncertain.

Purpose
To examine the joint association of potassium and sodium with CVD mortality risk, and to identify potential mediating factors of this association.

Methods
Based on the ChinaHEART (China Health Evaluation And risk Reduction through nationwide Teamwork) project, participants aged 35-75 from 239 sites across all 31 provinces in the mainland of China were recruited from November 2014 to December 2022. We collected spot urine samples from participants and estimated 24-hour sodium and potassium excretion using the Kawasaki formula. Death records were captured through data linkage with the National Mortality Surveillance System and Vital Registration. Multiple regressions were used to analyze the association between potassium excretion and CVD death, as well as to examine the addictive interaction of potassium and sodium.

Results
This study included 270,991 participants with a mean age of 55.8±9.8 years, and 60.5% of them were female. The mean potassium excretion was 54.36±12.58 mmol/d , which was higher in males and people living in the north. Findings revealed a positive correlation between low urinary potassium levels and CVD death , and the lowest adjusted hazard rate for CVD mortality was 0.65 (95% CI: 0.58-0.73) in the group with the highest potassium excretion (i.e. ≥64.27 mmol/d) compared with the reference group (&lt;43.79 mmol/d), after adjusting for sociodemographic characteristics, medical histories, and lifestyles. Age modified the association between potassium excretion and risk of CVD death (P for interaction=0.031). In addition to systolic blood pressure (16.6%), heart rate (2.2%) also served as the significant mediator between urinary potassium excretion and CVD death. The relative excess risk of interaction (RERI) of lower potassium excretion and lower sodium was significantly positive (RERI=0.22, 95% CI: 0.02-0.42), which implied the synergy effect.

Conclusion
Potassium intake in the Chinese population is evidently lower than the guideline recommendations, and increasing potassium intake, especially in the population aged &lt;65 years, may reduce the risk and burden of cardiovascular and other diseases. Moreover, when sodium intake is insufficient, supplementation with both sodium and potassium salt can achieve greater health benefits.Graphic abstract
The Cardiovascular Disease Burden Associated with secondhand smoke, 1990-2019: an age-period-cohort analysis of the Global Burden of Disease study
Authors: Jiang H , Liu Z , Wei P J , Ouyang W , Wang S Z , Zhang F W , Pan X B 
Published: October 2024

Abstract

Background
Over the past three decades, global regions have shown significant differences in the burden of cardiovascular disease (CVD), and secondhand smoke is a major risk factor contributing to this burden. Nevertheless, a comprehensive understanding of the global trends and associations between second-hand smoke and cardiovascular disease is lacking.

Methods
Using data from the Global Burden of Disease (GBD) study 1990-2019, an age-period-cohort (APC) analysis was conducted to investigate trends in cardiovascular disease-related mortality in populations affected by secondhand smoke globally over the past 30 years and its association with age, period, and birth cohort.

Results
Over the past 30 years, the number of cardiovascular deaths caused by secondhand smoke has increased significantly worldwide, from 432.6 thousand in 1990 (95% UI: 357.4-508.3) to 598.5 thousand in 2019 (95% UI: 489.7-713.5), an increase of 38.4% (95% UI: 26.8%-49.5%). In 2019, cardiovascular disease accounted for 45.9% of all deaths attributable to secondhand smoke in both men and women globally. Among cardiovascular diseases, ischemic heart disease became the main component, accounting for 66.4% compared with stroke. The gender composition of cardiovascular deaths due to secondhand smoke is slightly lower in men (46.5%) than in women (53.5%). Longitudinal analyses using age-time-cohort models show that global CVD-related mortality from secondhand smoke has improved overall over the past three decades, but there are differences between regions, genders, and CVD subtypes. It is worth noting that the higher the socio-demographic index (SDI) level, the greater the reduction in mortality, with a staggering 39.1% reduction in high SDI areas (95% UI: 35.6%-42.3%), in sharp contrast to virtually no change in mortality in low SDI areas (0.1% (95% UI: -52.4%-62.2%)). During the period 2003-2007, cardiovascular disease-related mortality decreased significantly, with an average annual percentage change of -1.48%.

Conclusion
The study highlights the importance of using secondhand smoke as a modifiable risk factor for the global burden of cardiovascular disease. Further research is vital to understand the factors that lead to differences in countries and regions at different levels of development, gender differences and differences in cardiovascular disease subtypes.