bluuebunny/crossref_metadata_2025_split huggingface dataset:
P001 AN UNCOMMON CAUSE OF HIGH BLOOD PRESSURE IN YOUNG BASKETBALL PLAYER
Authors: Cueva Torres Franklin Esteban , Guzmán García Santiago , Gupta Shyla , Garcia-Zamora Sebastián , Jaramillo Felipe Rodriguez , Vasquez Erick Hidalgo , Aguirre MD Jorge Nicolás , Samaniego Md Jose Elias 
Published: September 2024

Paragangliomas are rare neuroendocrine tumors that affect approximately 1.5–9 patients per million. They originate from chromaffin cells of the adrenal medulla or sympathetic and parasympathetic ganglia. Paragangliomas account for 10%–20% of retroperitoneal tumors and can manifest at any age. These tumors can secrete catecholamines, leading to symptoms such as hypertension, headaches, and diaphoresis.However, palpitations or tachycardia may also be present. Definitive treatment entails surgical resection, with acceptable rates of morbidity and mortality, necessitating careful patient preparation and intraoperative management.

Case Presentation:
We present the case of a 29-year-old man with a BMI 26,5 kg/m2, who is physically active and without other cardiovascular risk factors, episodic hypertension, headaches and blush. A contrast CT scan of the abdomen revealed a retroperitoneal intercavoaortic mass and 24-hour urine Normetanephrines were significantly elevated, indicating a functional paraganglioma. Laboratory tests revealed an elevated plasma normetanephrine level of 1838 pg/ml (reference values 0 - 180 pg/ml). The patient was prepared for surgery with alpha blockers, followed by beta blockers. Intraoperative blood pressure elevation was managed with intravenous beta blockers. Postoperatively, the patient did not require anti-hypertensives. The tumor, measuring 6x4x3.5 cm, histopathology and immunohistochemistry confirmed the diagnosis of a normetanephrine producing paraganglioma. The genetic study revealed a pathogenic variant in the SDHB gene, specifically the c.166_170delCCTCA (p.Pro56Tyrfs*5) in heterozygosity. This variant is associated with a 49% risk of Pheochromocytoma and Hereditary Paraganglioma, a 14% risk of Renal Carcinoma and susceptibility to Gastrointestinal Stromal Tumors. The c.166_170delCCTCA variant follows an autosomal dominant inheritance pattern, indicating a 50% risk of recurrence.

Conclusions:
The diagnosis of extra-adrenal retroperitoneal paragangliomas remains challenging due to the silent evolution of the condition. It is essential to consider screening patients who are young, and present with resistant arterial hypertension for secondary hypertension.
P002 MICROALBUMINURIA PREDICTS MASKED HYPERTENSION IN CHILDREN WITH OVERWEIGHT AND OBESITY
Authors: Deregibus Maria Ines , Iturzaeta Adriana , Pompozzi Luis Alberto , Romero Cesar 
Published: September 2024

Introduction:
Childhood overweight and obesity are known modifiable risk factors linked to the several forms of hypertension, including Masked Hypertension (MH). However, which are clinical predictors of MH in this special population is not know. Ambulatory blood pressure (ABP) is more often associated with early target organ damage, specifically, microalbuminuria, than on office blood pressure (OBP).

Objective
To evaluate the presence of predictors of MH in children with overweight and obesity.
Material and methods: Cross-sectional, analytical study. Children aged 5 to 16 years with overweight and obesity who consulted two tertiary hospitals in the Autonomous City of Buenos Aires. A standardized clinical history, OBP (Riester model aneroid blood pressure monitor) with a protocolized technique and Ambulatory Blood Pressure Monitoring (ABPM) (Spacelabs 90207 y 90217) were performed.
Several clinical and analytical variables, including Microalbuminuria dyslipidemia and insulin resistance were investigated.
Statistical models to predict ambulatory arterial hypertension (HTN) and MH were carried out using the SAS 9.4 software.

Results:
A total of 409 children were included, median age 11.36 years, 236 males (57.7%); 301 (73.6%) were found to be normotensive, 42 (10.2%) with white coat HTN, 66 (16.1%) had some form of ambulatory HTN: 27 (6%) with true HTN, 39 (9.5%) with MH. Of the total, 6 (1.5%) presented isolated nocturnal HTN. and The median BMI was 28.36.
The univariate and multivariate regression models, adjusted for age and sex, showed systolic OBP (OR 1.1, p<0.001) and microalbuminuria (OR 3.37, p=0.03) as independent predictors of ambulatory HTN. The presence of microalbuminuria was the only predictor of MH in obese children (OR 3.6, p<0,01).

Conclusions:
A prevalence of 9.5% of MH was identified in the overweight and obese pediatric population. The predictors of ambulatory HTN were systolic OBP and microalbuminuria. The latter being the only predictor of MH in this population.
The timely detection of MH and predictors, especially microalbuminuria, in this population shows the importance of using ABPM in pediatrics.
Table 1: Sample characteristics
P004 BODY MASS INDEX IS RELATED TO SUBTYPES OF ARTERIAL HYPERTENSION IN CHILDREN
Authors: Rubio-Elorza Liliana , Álvarez-Montoya Diego , López-Llano Manuela , Gallo-Villegas Jaime , Aristizábal-Ocampo Dagnovar 
Published: September 2024

Background and Objective:
Arterial hypertension (AH) subtypes in the pediatric population may represent distinct pathophysiological subsets, potentially allowing for more targeted interventions and improved blood pressure (BP) management. Emerging evidence suggests that various hemodynamic mechanisms may underlie hypertension development across different age groups. Moreover, overweight and obesity, are closely linked to hypertension and other risk factors. Therefore, this study aims to investigate the relationship between body mass index (BMI) and (AH) subtypes in the pediatric population.

Methods:
A cross-sectional study was conducted, involving 195 records from 189 children referred to an outpatient cardiology center due to suspected BP abnormalities. Each participant underwent 24-hour ambulatory blood pressure monitoring (24-h ABPM) using a device validated. Demographic, clinical, and anthropometric data were collected. The American Heart Association (2022) criteria were utilized to ensure accurate 24-h ABPM recordings and to classify AH subtypes based on average BP, including: i) isolated diastolic hypertension (IDH); ii) non-divergent systolic-diastolic hypertension (ND-SDH) (pulse pressure [PP]<50 mmHg); iii) divergent systolic-diastolic hypertension (D-SDH) (PP>50 mmHg); and iv) isolated systolic hypertension (ISH). BMI Z-Score was calculated using Colombian reference tables, and nutritional status was determined based on World Health Organization recommendations.

Results:
Among the participants, 46.0% were male, with a distribution of nutritional status showing 3% underweight, 37% normal weight, 30% overweight, and 30% obese. The average age was 12.3±3.0 years (range: 5-17 years). 24-h ABPM records revealed that 34.0% had normotension, 33.0% had IDH, 16.0% had ND-SDH, 13.0% had D-SDH, and 3% had ISH. The ANOVA test indicated significant differences in BMI Z-Score values among AH subtypes (P value <0.001) (Figure).

Conclusions:
BMI is related with AH subtypes in children. Specifically, BMI tends to be higher in D-SDH and ISH, which could be characterized by a hyperdynamic state marked by increased activity of the sympathetic nervous system. This finding may help to elucidate the pathophysiology of hypertension in obese children.
P229 INFLUENCE OF ASTHMA ON BLOOD PRESSURE OF CHILDREN AND ADOLESCENTS: THE ASMAVIX PROJECT
Authors: Mill José Geraldo , Mendes Fernanda Duarte , Pimentel Enildo Broetto , Santos Jane Meri , Costa-Reis Neyval , Callo-Quintes Gabriela 
Published: September 2024

Background and Objectives:
Asthma is a prevalent disease in children and the chronic inflammatory may affect blood vessel stiffness and blood pressure (BP). Systolic BP increases progressively along the childhood tending to reach stable values at the beginning of adulthood. Higher BP levels in infancy predispose to hypertension development hypertension in adulthood. Our aim was to investigate the influence of asthma on the age-dependent BP increase in children and adolescents.

Methods
Asthmatic (Asth, n = 166), 7-15 years (67% boys) attending to Public Health Units of Vitória (an industrialized city of the coastal plain of southeastern Brazil) were included. Non-asthmatic children (N-Asth, n =50; 33% boys) living in the neighborhood of Asth were used as controls. Clinic and laboratory exams were performed in an outpatient clinic at the University Hospital. BP was measured with an oscillometric device (Onrom HBP 1100) and large artery stiffness was estimated by carotid-to-femoral pulse wave velocity (cf-PWV; Complior SP-2). The 90th percentile of systolic or diastolic BP was used to identify high BP considering gender, age, and height. Age-dependent BP increase was determined by linear regression with and without adjustment for covariates (gender and body mass index). Statistical significance was set at p<0.05.

Results
Asth and N-Asth groups were similar (p>0.05) considering age (11.7 ± 2.3 vs 11.1 ± 2.1 years), body mass index (20.2 ± 4.2 vs 20.3 ± 5.7 kg/m2), systolic (102 ± 11 vs 104 ± 10 mmHg) and diastolic (62 ± 7 vs 63 ±8 mmHg) BP. However, cf-PWV was higher in Asth (48.9 ± 9.0 vs 44.0 ± 9.1 cm/s; p<0.01). The crude age-dependent systolic BP increase was 34% higher in the Asth group (1.74 mmHg/year; 95%CL 1.06;2.43 vs 1.37 mmHg/year; 95% CL 0.02;2.72). This difference remained similar after adjusting for gender and body mass index (1.47 mmHg/year; 95%CL 0.80; 2.14 vs 1.10; -0.47;2.67). The percentage of children with elevated BP was higher in the Asth group (10.2% vs 4.0%).

Conclusion:
The higher stiffness of large arteries seems to accelerate the systolic BP increase along childhood and adolescence and may predispose to an earlier onset of hypertension in adulthood.
Acknowledgment: This study was supported with grants from ArcelorMittal, CNPq and Fapes.
P017 AFTER 14 YEARS OF WAR - HYPERTENSION IN SYRIA: BETWEEN CLINICAL PRACTICE AND AVAILABLE MEDICATIONS (ANALYTICAL STATISTICAL STUDY)
Authors: Alanan Usama , Keder Houssim 
Published: September 2024

Background:
Hypertension is one of the most common chronic diseases worldwide. It is also one of the most important risk factors related to public health that leads to multiple consequences. On the other hand, hypertension constitutes a heavy burden on health expenditures, especially in developing countries with limited income. Through this study, we aim to identify the reality of hypertension in Syria as a country that has been suffering from war for more than 14 years, through the distribution of doctors practicing and treating hypertension, the availability of various medications to treat it, and the extent to which international guidelines can be applied in clinical practice.

Methods:
Cardiologists and nephrologists were mainly counted and distributed in Syrian cities. Pharmaceutical companies and drug types produced by these companies were also counted, and drugs were distributed according to therapeutic drug groups. A questionnaire was conducted on the most important types of drugs used by doctors according to different indications.

Results:
We found that the largest number of cardiologists and nephrologists are located in the capital, Damascus, with a significant preponderance of cardiologists. We also found a significant shortage in the presence of specialists in the eastern governorates and a severe shortage in the number of kidney doctors in the central, northern and eastern governorates, with most of them being in the capital. There was diversity and distribution in most of the drug categories for treating high blood pressure in the first lines of treatment, noting the lack of sufficient intravenous categories.

Conclusions:
There is a clear shortage in cardiologists and nephrologists in most governorates, with an almost complete absence of intravenous hypertension medications.
P026 A PRESCRIPTION TREND ANALYSIS OF ANTIHYPERTENSIVE PHARMACOTHERAPY ACROSS DIFFERENT SPECIALTIES IN INDIA
Authors: Vishavadia Krunal , Solanki S , Kulkarni G , Prajapati H 
Published: September 2024

Objective:
To evaluate the temporal trends in the prescription patterns of antihypertensive medications among healthcare practitioners in India.

Methods:
The IQVIA (formerly Quintiles and IMS Health) prescription audit data came from prescriptions of a panel of 6000 private sector primary care clinicians for the different classes of antihypertensive drugs; beta-blockers(BB), calcium channel blockers(CCB), angiotensin receptor blockers(ARB), angiotensin-converting enzyme(ACE) inhibitors, and diuretics were examined. The analysis encompassed the period from 2014 to 2022. Additionally, combinations of these drug classes involving two or three medications were also subject to analysis.

Results:
Cardiologists’ prescription rates for antihypertensive medications stood at 21% in 2017 and decreased to 19% by 2023. In 2023, the highest rate of prescribing antihypertensive drugs was observed among consultant physicians, with a rate of 30%, followed by general practitioners at 27%. In addition, during COVID-19, the prescription share of general practitioners was highest (31%). Among antihypertensive medications, the prescription rates for BBs were highest (32%), followed by ARBs & CCBs (25% & 24% respectively). Single-drug formulation of anti-hypertensive medications was the most preferred (60%) among Indian clinicians. Prescription shares of fixed-dose combinations (FDC) of two antihypertensive drugs showed a slight decline (36% in 2017 to 34% in 2023) & FDCs of triple-drug exhibited an upward trend (3% in 2017 to 5% in 2023). Among the two drug FDCs, ARB & diuretics were most preferred (25% prescription share) & triple drug FDCs, CCB, ARB & diuretics were most preferred.

Conclusions:
Cardiovascular medications are prominent in the Indian pharmaceutical market, with antihypertensives standing out as one of the most frequently prescribed treatments. Consultant physicians and general practitioners manage the majority of hypertension cases. Notably, there has been an observed rise in preference for triple-drug combinations of antihypertensive medications, indicating a trend toward a more aggressive approach to hypertension management among Indian clinicians. The insights gleaned from this investigation can further assist healthcare professionals in crafting tailored treatment strategies for individuals grappling with hypertension. Such personalized approaches hold promise in enhancing treatment adherence and ultimately improving the QoL.
P039 INTEGRATED SCREENING FOR HYPERTENSION AND DIABETES MELLITUS IN ROUTINE TUBERCULOSIS CARE IN DELHI, INDIA
Authors: Anand Tanu , Grover Shekhar 
Published: September 2024

Background:
Evidence supports the integration of prevention and management for tuberculosis (TB) with non-communicable diseases (NCDs) like hypertension and diabetes mellitus (DM). Bi-directional screening for TB and DM is already implemented in India, a country with a dual burden of TB and NCDs. However, very limited programmatic data are available on the feasibility of adding other NCDs and their risk factors in such screening programme.

Objective:
To assess the yield, feasibility, and acceptability of a two-stage integrated screening for NCDs and risk factors for NCDs among patients with TB ≥20 years and treated in DOTS centres of two medical colleges in Delhi, between October 2016 and March 2017.

Methods:
It was a mixed-methods, triangulation study with a quantitative component (cross-sectional study using questionnaires, anthropometric measurements and records review) and a qualitative component (descriptive study using interview data).

Results:
Amongst 403 patients screened, the prevalence of hypertension was 7% (n = 28) with 20 new cases detected and 8% for DM (n = 32) with 6 new cases diagnosed. The number needed to screen to find a new case was 20 and 63 for hypertension and DM respectively. The most frequent NCD-risk factors were inadequate vegetable (80%) and fruits (72%) intake, alcohol use (34%), use of smokeless tobacco (33%) and smoking (32%). Clustering of four or more risk factors was associated with increasing age and male sex (p<0.05). Both patients and health providers considered the screening relevant and acceptable. However, waiting time and costs involved in blood tests were considered as bothersome by the patients, while health providers perceived increased workload, inadequate medical supplies and inadequate skills and knowledge as key challenges in implementation of the screening.

Conclusion:
Integrating screening for hypertension and DM and their risk factors in the existing TB programme produces high yield and it is feasible and acceptable by patients and health providers provided the challenges are overcome.
P041 COMMUNITY-BASED STRATEGIES TO IMPROVE HEALTH-RELATED OUTCOMES IN PEOPLE LIVING WITH HYPERTENSION IN LOW MIDDLE-INCOME COUNTRIES: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Boateng Daniel , Nyame Solomon , Heeres Pauline , Gyamfi Joyce , Gafane-Matemane Lebo F , Iwelunmor Juliet , Ogedegbe Gbenga , Grobbee Diederick , Asante Kwaku Opoku , Klipstein-Grobush Kerstin 
Published: September 2024

Background and objective:
Hypertension affects one billion people globally and is a major risk factor for cardiovascular diseases. Currently, it is estimated that high blood pressure (BP) is related to the deaths of more than 10 million people every year. Interventions to mitigate the looming hypertension crisis in low- and middle-income countries (LMIC) need strong community involvement whilst concurrently addressing access to care and quality of care issues. The objective of this systematic review was to evaluate community-level interventions to improve hypertension control among patients living in LMICs.

Methods:
Nine databases were searched (July 22, 2023) for randomized controlled trials (RCTs) and cluster randomized control trials (cRCTs) implementing community-level interventions in adults with hypertension in LMICs. Studies were included based on an explicit focus on BP control. Quality assessment was done using the Revised Cochrane Risk of Bias tool for randomized trials (ROBS 2). Results were presented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Fixed-effect meta-analysis were conducted for studies that reported continuous outcome measures.

Results:
We identified and screened 7125 articles. Eighteen studies were included in the analysis, 7 RCTs and 11 cRCTs. The overall summary effect of BP control from the meta-analysis was significant, risk ratio = 1.48 (95%CI = 1.40–1.57, n=12). For the RCTs risk ratio was 1.68 (95%CI = 1.40–2.01, n=5), and for the cRCTs 1.46 (95% CI = 1.32 – 1.61, n=7). For studies that reported on the individual components of the composite interventions, the risk ratio was 1.27 (95%CI = 1.04–1.54, n=3).

Conclusions:
Community-based strategies are relevant in addressing the burden of hypertension in LMICs. Community-based interventions can help decentralize hypertension care in LMIC and address the access to care gap without diminishing the quality of hypertension control.
P049 RENOVASCULAR HYPERTENSIVE RATS (2K1C) HAVE REDUCED INTRACRANIAL COMPLIANCE INDUCED BY RAISED VENTRICULAR VOLUME COMPARED TO NORMOTENSIVE RATS
Authors: Medeiros Fernanda , Katayama Pedro , Menani José , Andrade Rodrigo , Colombari Eduardo , Colombari Débora 
Published: September 2024

Background and Objective:
Intracerebroventricular (ICV) infusions of increased volumes of saline can be used to study intracranial compliance (ICC). Since the two-kidneys,1-clip (2K1C) rat model of renovascular hypertension has an enhanced baseline level of intracranial pressure (ICP), the present study aimed to verify the effect of ICV infusions of 0.15 M NaCl on ICP and ICC in 2K1C rats.

Methods:
Male Holtzman rats (180-210 g) were randomly separated to be normotensive (NT; sham surgery, n = 5) or with 2K1C (n = 5), done by a partial left renal artery occlusion. Six weeks after, rats were anaesthetized with urethane (1.2 g/kg body weight, i.v.), tracheostomized, placed under artificial ventilation, and had an ICP sensor and a needle inserted into the lateral ventricle for, respectively, ICP recording and ICV 0.15 M infusions (30, 60 and 90 μL, at 100 μL/min). There was a 20-minute interval between each infusion. ICC was calculated by the ratio of volume change to ICP change [ICC = ΔV (μL)/Δ ICP (mmHg)].

Results:
Baseline MAP, ICP, and P2/P1 ratio of 2K1C rats (166 ± 6 mmHg; 15.7 ± 1.7 mmHg; 1.6 ± 0.1, respectively) were higher than the ones in NT rats (94 ± 5 mmHg; 10.1 ±1.4 mmHg; 0.7 ± 0.1 respectively; p<0.05 vs 2K-1C). ICV infusions induced increased ICP in 2K1C rats (19 ±0.5; 42 ±1.2 and 55 ±5.5 mmHg, vs NT: 8 ±0.6; 25 ±3.2 and 36 ± 4.9 mmHg, respectively at 30, 60 and 90 μL infusion; p<0.05). In addition, 2K1C rats presented a reduced ICC only at 30 μl infusion (5.6 ±1.4, vs NT: 11.4 ±0.9; p<0.05).

Conclusions:
These findings suggest that renovascular hypertension impairs ICC to the well-documented increase in ICP.

Support:
FAPESP, CNPq.
P069 VALIDATION STATUS OF BLOOD PRESSURE MONITORS FOR PUBLIC SPACES (KIOSK): STRIDE BP SYSTEMATIC REVIEW
Authors: Kyriakoulis Konstantinos , Menti Ariadni , Mariglis Dimitrios , Kollias Anastasios , Palatini Paolo , Parati Gianfranco , Wang Jiguang , Schutte Aletta , Stergiou George 
Published: September 2024

Background and Objective:
Blood pressure (BP) measurement in public spaces using kiosk devices may be useful in improving hypertension awareness and control. Validation studies of kiosk devices using an established protocol are necessary prior to their use.

Methods:
A PubMed search was performed using the following algorithm: (kiosk OR “public spaces” OR “public space” OR pharmacy OR “public use” OR “waiting room” OR “self-screening”) AND (“blood pressure”), until May 25, 2024.

Results:
An initial search retrieved 307 articles of which 8 were included in the systematic review (Table). 11 validation studies were conducted according to established validation protocols evaluating the accuracy of 8 kiosk BP monitors. All devices were single solid wide-range cuff devices, 3 were embedded in health stations, and 5 were portable. Four validation studies used the Association for the Advancement of Medical Instrumentation (AAMI) 1987/1992/2002 protocol, 4 used the British Society of Hypertension (BHS) 1993 protocol, and each of the remaining studies used the European Society of Hypertension International Protocol (ESH-IP) 2010, the American National Standards Institute (ANSI)/AAMI/International Organization for Standardization (ISO) 2013 protocol, and the 2018 AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018), respectively. All studies were conducted in general populations. Two validation studies regarding a single device concluded that the accuracy criteria were not fulfilled and the device cannot be recommended for use. The remaining studies concluded that the devices under test were accurate and can be recommended for use. However, two of these validation studies were rejected by the STRIDE BP review process due to major protocol violations (single observer for reference BP measurement in one study; no report of validation criterion 2 in the second).

Conclusions:
Kiosk BP measurement in public spaces is an emerging but inadequately investigated BP monitoring method. Although kiosk BP measurement has considerable potential in hypertension screening and monitoring, more research is needed to promote the use of properly validated devices.

Table. Published validation studies of kiosk blood pressure monitors.