bluuebunny/crossref_metadata_2025_split huggingface dataset:
In-hospital bowel ischemia and mortality trends of left ventricular assist device placement in the USA from 2017 to 2020
Authors: Perry J , Sinclair S , Kibwey Peterkin K P , Adarsh Balaji A B , Allen Mcnamara A M , Akinti O A , Khan A 
Published: October 2024

Abstract

Background
Left ventricular assist devices (LVADs) are critical for treating advanced heart failure patients. Yet, insights into clinical outcomes, particularly concerning bowel ischemia and mortality, remain scarce.

Purpose
We aimed to examine temporal trends of in-hospital mortality and bowel ischemia among heart failure patients with LVAD between 2017 and 2020.

Methods
The National Inpatient Sample was queried from 2017 to 2020 to identify all adults with congestive heart failure who underwent LVAD implantation using the International Classification of Diseases 10th Revision codes. The Cochran-Armitage test was used to assess the linear trend of in-hospital bowel ischemia with LVAD. Multivariable regression analysis was conducted to evaluate the association of LVAD placement with in-hospital mortality and bowel ischemia. The Elixhauser comorbidity index was used to adjust for confounders. Linear logistic results are represented as adjusted odds ratios (ORs) with their respective 95% Confidence Intervals (CIs).

Results
Of a total of 19,410 LVAD placements, 189 (0.97%) patients developed bowel ischemia of any type. The mean age of these patients was 58 years, with a predominance of males (68%). A trend analysis revealed an increasing occurrence of bowel ischemia following LVAD placement over the years (trend: 1%, p &lt; 0.001). Specifically, the proportion of LVAD patients with bowel ischemia was 0.8% in 2017 (OR = 6, 95% CI 3.6-13, p &lt; 0.001), increased slightly to 0.9% in 2018 (OR = 6.2, 95% CI 3.4-11.7, p &lt; 0.001), followed by a decrease to 0.73% in 2019 (OR = 4.2, 95% CI 2.4-7.5, p = 0.02), and then a rise to 1.53% in 2020 (OR = 7.2, 95% CI 4-12.9, p &lt; 0.001), as illustrated in Figure 1. Across all years, LVAD placement was associated with a significant risk for developing bowel ischemia (OR= 6.9, 95% CI 5-9.6, p &lt; 0.001).The mortality rate among patients who developed bowel ischemia post-LVAD insertion was significant, with a rate of 50% in 2017 (OR = 5.3, 95% CI 1.3-20, p = 0.01), escalating to 67% in 2018 (OR = 10, 95% CI 2.4-43, p &lt; 0.002), and stabilizing at 57% for both 2019 (OR = 8, 95% CI 1.8-37.3, p &lt; 0.006) and 2020 (OR = 6.7, 95% CI 2.3-19.1, p &lt; 0.001), as detailed in Table 1. The overall in-hospital mortality for patients with LVAD and bowel ischemia was 58% (OR = 7, 95% CI 4-14, p &lt; 0.001).

Conclusions
The study indicates rising trends in-hospital bowel ischemia and fluctuations in mortality rates in LVAD patients from 2017 to 2020. Despite its rarity, LVAD placement carries a notable risk of bowel ischemia, which significantly affects mortality. This underscores the need for vigilant monitoring and management.Figure 1Table 1
Comparative analysis of muscle sympathetic nerve activity in patients afflicted with orthostatic hypertension versus conventional hypertension
Authors: Hirai T , Ikeda T , Murai H , Sugimoto H , Mukai Y , Tokuhisa H , Kobayashi D , Takata S , Sakata K , Usui S , Takamura M 
Published: October 2024

Abstract

Introduction
Standing places a significant hemodynamic burden on the cardiovascular system. In healthy individuals, neurohumoral reflex mechanisms, particularly the arterial baroreflex, maintain blood pressure during standing. However, in some cases, the counterregulatory response can be excessive, resulting in a condition known as orthostatic hypertension (OrthoHT), which appears to be linked to an increased cardiovascular risk. Epidemiologically, orthostatic hypertension has been reported in 5-30% of hypertensive patients. Furthermore, in recent years, it has garnered attention as a responder group in renal denervation therapy.

Purpose
In hypertensive patients, sympathetic hyperactivity is expected to exacerbate cardiovascular risk. However, the relationship between OrthoHT and sympathetic nerve activity remains poorly understood. This study aims to assess the differences in sympathetic nerve activity between OrthoHT and conventional hypertensive patients using muscle sympathetic nerve activity (MSNA) measurements.

Methods
We conducted an examination of hypertensive patients undergoing drug treatment at our clinic between April 1, 2023, and June 30, 2023, to identify cases of OrthoHT. Only patients with essential HT were included in the HT group; patients diagnosed with secondary HT were excluded. HT patients with other active CV diseases (i.e., symptomatic cerebral/coronary artery diseases or heart failure) and/or severe renal dysfunction (estimated glomerular filtration rate &lt;30 mL/min/1.73 m2) were also excluded. OrthoHT was defined as a sustained increase in systolic blood pressure ≥20 mmHg and/or diastolic blood pressure ≥10 mmHg within 3 minutes of standing. MSNA was recorded from the left peroneal nerve using a tungsten microelectrode at supine position. We measured MSNA in the cases for which consent was obtained. Statistical analyses were performed using SPSS software.

Results
Among the 183 cases, 31 were diagnosed with OrthoHT, and 7 of them consented to MSNA measurement. Of the 11 cases of hypertensive patients who consented, two groups were well age-matched. We assessed body mass index, resting systolic blood pressure, diastolic blood pressure, heart rate, blood glucose level, creatinine, cholesterol, brain natriuretic hormone, and ejection fraction measured by echocardiography, but found no significant differences between the two groups.
OrthoHT patients exhibited elevated MSNA burst frequency (28.3 +/- 5.7 vs. 38.4 +/- 12.2 bursts/min, P &lt; 0.05) and burst incidence (44.6 +/- 11.1 vs. 61.1 +/- 21.3 bursts/100 heartbeats, P &lt; 0.05) at rest.

Conclusions
OrthoHT is associated with sympathetic hyperactivity compared to normal hypertensive patients, contributing to an increased cardiovascular risk.
The influence of the daily salt-intake on the antihypertensive action and atrial natriuretic peptide level in patietns with angiotensin receptor neprilysin inhibition
Authors: Sato T , Watanabe S , Aizawa Y 
Published: October 2024

Abstract

Background
The angiotensin receptor–neprilysin inhibitor (ARNI) is a drug which acts through angiotensin receptor blocking effect and the increase in atrail natriuretic peptide (ANP) through neprilysin inhibitor in hypertension (HT). These combined effects result in a reduced risk of hospitalization for heart failure or death from cardiovascular causes. ANP is also known for its various cardioprotective effects including vasodilator and natriuretic action. Acording to Guyton's pressure-natriuresis curve, the efficacy of angiotensin receptor blocker drugs is diminished in HT cases with high daily salt inatke. However, whether the effect of ARNI on HT is attenuated in patients with high daily salt intake remains unclear.

Purpose
The present study investigated the influence of a daily salt intake on the antihypertensive action and ANP level in patients with ARNI.

Methods
Fourty-four consecutive essential HT patients on ARNI were enrolled. Blood pressure and ANP level were measured at baseline (before taking ARNI) and 3 weeks later. ARNI (200mg) was prescribed and maintained during the study. In addtion, the daily salt intake was calculated using creatinine and natrium levels in urine, age, and body weight according to Japanese hypertensive guideline at baseline and 3 weeks later.

Results
The average age was 70±8 years old. About 50% (N=23) was male. The mean sytolic and diastolic blood pressure was 148±14mmHg and 89±10mmHg, respectively. The mean daily salt intake was 9.5±2.2 g/day at baseline. The mean ANP level was 529±300pg/ml.
At follow up (3 weeks later), the mean systolic and diastolic blood pressure significanly went down to 132± 18 mmHg and 70± 9 mmHg, respectively (p=0.03). ANP level also increased from 529±300pg/ml to 793±580pg/ml. However, the mean daily salt intake was almost same as the baseline at 9.4±3.2 g/day.
The patients were divided into 2 groups; high daily salt intake (N=20 with mean daily salt intake 10.5±1.7g/day)) and low daily salt intake (N=24 with 8.4±3.1g/day) groups compared to the baseline. The absolute and percentage changes in systolic blood pressure were almost same in the high and low daily salt intake groups (-12.7±15.8mmHg vs -13.7±14.2mmHg, p=0.75; -5.8±6.5% vs.-7.0±9.6%, p=0.58, respectively). However, the change rate in ANP level was significantly higer in the high daily salt intake group than in the low daily salt intake group (155±63 vs. 12±16%, p=0.01).

Conclusion
ARNI demonstrates effectiveness in lowering the blood pressure even in patients with higher salt intake, unlike angiotensin receptor blocker. In cases with high salt intake, the notable increase in ANP levels may contribute to decreasing blood pressure through vasodilator and natriuretic action.
Manganese-enhanced magnetic resonance imaging in diabetic cardiomyopathy
Authors: Joshi S , Singh T , Loganath K , Spath N , Kershaw L , Dattani A , Singh A , Semple S , Williams M , Van-Beek E , Gulsin G , Mccann G , Dweck M , Newby D E 
Published: October 2024

Abstract

Aim
To investigate myocardial calcium handling using manganese-enhanced magnetic resonance imaging in patients with type 2 diabetes in the presence and absence of heart failure with reduced ejection fraction.

Methods
In a prospective case-control study, 14 healthy volunteers, 24 patients with type 2 diabetes with normal left ventricular function (early stages of diabetic cardiomyopathy), 20 patients with heart failure with reduced ejection fraction, and 20 patients with both heart failure with reduced ejection fraction and type 2 diabetes (late stages of diabetic cardiomyopathy) underwent cardiac manganese-enhanced magnetic resonance imaging.

Results
Mean myocardial manganese uptake was 8.3±1.3 mL/100 g of tissue/min in healthy volunteers, falling to 6.5±0.9 mL/100g of tissue/min in patients with type 2 diabetes and lowest in patients with heart failure (4.5±1.0 mL/100g of tissue/min). Patients in late stages of diabetic cardiomyopathy had lower myocardial manganese uptake compared to patients in early stages of diabetic cardiomyopathy (4.9±0.7 versus 6.5±0.9, p&lt;0.001). Furthermore, patients with both type 2 diabetes and heart failure had suppressed myocardial manganese uptake compared to patients with heart failure without type 2 diabetes (4.9±0.8 versus 5.7±1.1 mL/100g of tissue/min, p=0.01). On multivariable analysis, type 2 diabetes and left ventricular ejection fraction were the independent predictors of myocardial manganese uptake in patients with heart failure, after adjusting for age, sex, ischaemic heart disease, hypertension, and hyperlipidaemia.

Conclusions
Patients with either heart failure or type 2 diabetes have impaired myocardial calcium handling, and these effects appear to be additive. Type 2 diabetes and impaired left ventricular systolic dysfunction are independent predictors for abnormal myocardial calcium handling, and this may play an important role in the pathogenesis of diabetic cardiomyopathy.
Ten-year major clinical outcomes between first- and second-generation drug-eluting stents in hypertensive patients underwent percutaneous coronary intervention
Authors: Rha S , Choi S Y , Choi B G , Cha J , Hyun S , Kang J , Chu W , Park S , Choi C U , Park C G 
Published: October 2024

Abstract

Background
There are very limited long-term clinical outcome data comparing first-generation (1G) versus second-generation (2G) drug-eluting stents (DES) in patients with hypertension. The authors sought to compare the efficacy and safety 2G-DES with 1G-DES in hypertension patients who underwent percutaneous coronary intervention (PCI) during ten-year clinical follow-up periods.

Methods
Finally, a total of 1,631 eligible hypertensive patients who underwent PCI with 1G-DES (paclitaxel-, sirolimus-eluting stent, n = 715) or 2G-DES (zotarolimus [endeavor, endeavor resolute]- or everolimus-eluting stent [promus element, xience], n = 916) were enrolled. The study endpoints were individual and composite clinical outcomes up to ten-year.

Results
After PSM, two propensity-matched (PSM) groups (452 pairs) were generated. During the ten-year follow-up period, the 2G-DES group had a lower incidence of target lesion revascularization (TLR; hazard ratio [HR], 0.54; 95% confidence interval [CI], 0.35 – 0.82; p = 0.004), target vessel revascularization (TVR; HR, 0.66; 95% CI, 0.46 – 0.94; p = 0.022), any revascularization (HR, 0.65; 95% CI, 0.48 – 0.88; p = 0.006), total major adverse cardiac events (MACE; HR, 0.70; 95% CI, 0.55 – 0.90; p = 0.005), TLR MACE (HR, 0.69; 95% CI, 0.49 – 0.98; p = 0.037), and MACCE (HR, 0.69; 95% CI, 0.54 – 0.88; p = 0.002, table).

Conclusion
In our single-center, all-comer registry, 2G-DES had better efficacy especially repeat revascularization and MACE as compared with 1G-DES in hypertensive patients during 10-year follow-up periods.
Risk factors for cardiometabolic multimorbidity: an analysis of 4 million participants from May Measurement Month 2017-2019
Authors: Janssen-Telders C , Schlaich M , Schutte A E , Stergiou G , Poulter N R , Beaney T 
Published: October 2024

Abstract

Background
Cardiometabolic multimorbidity (CMM), defined as the presence of two or more cardiometabolic conditions, presents a significant global challenge due to aging populations and a growing prevalence of cardiometabolic diseases. However, evidence regarding the risk factors for CMM is scarce, particularly in low- and middle-income countries. May Measurement Month (MMM) is the largest annual global campaign collecting data on blood pressure (BP) and cardiometabolic diseases.

Purpose
To determine the proportion of hypertension in people with CMM and risk factors associated with CMM, from the three MMM campaigns in 2017-2019.

Methods
A total of 3 397 746 participants (≥18 years) were included, arising from 103 countries. CMM was defined as having two or more of three cardiometabolic diseases: myocardial infarction, stroke, and diabetes. Hypertension was defined as a systolic BP≥140mmHg and/or diastolic BP≥90mmHg, using the average of the second and third of three readings and/or taking antihypertensive medication. A multivariable logistic mixed effects regression model was used to examine associations between CMM and potential risk factors, including age, sex, BMI category, smoking status, and alcohol consumption in the model, with random effects for country.

Results
Amongst all participants, 316 940 (9.3%), 62 731 (1.8%), and 28 491 (0.8%) had one, two or three cardiometabolic conditions, respectively, and 91 222 (2.7%) had CMM. The proportion with hypertension increased with an increasing number of cardiometabolic conditions: 29.6% in those with none, and 63.0%, 68.6% and 71.2% in those with one, two, or three conditions, respectively. In a fully adjusted model, females had 16% (OR = 1.16, 95% CI: 1.12-1.20, p-value &lt;0.001) higher odds of having CMM than males (Figure). Increasing age was associated with higher odds of having CMM, the highest risk being found in participants ≥70 years. Participants who were underweight, overweight, or obese, were more likely to have CMM than those with a healthy weight. Of the risk factors studied, current smoking was associated with the highest odds for CMM, (OR = 12.8, 95% CI: 12.62-13.04, p-value&lt;0.001) compared with not smoking. Participants consuming alcohol at least once per week had 74% lower odds (OR = 0.26, 95% CI: 0.25-0.27, p-value &lt;0.001) of having CMM compared with those who never or rarely consumed alcohol (Figure 1).

Conclusions
The risk of CMM increases with female sex, older age, abnormal weight, and smoking. Additionally, CMM is associated with a higher likelihood of having hypertension. Efforts targeting high-risk populations with modifiable CMM related-risk factors are crucial for prevention of CMM.Figure 1.Risk factors for CMM
Increasing trends in hypertension-related mortality in European Union 27 countries from 2011 to 2019
Authors: Zuin M , Rigatelli G , Mazza A 
Published: October 2024

Abstract

Background
Arterial Hypertension (HT) is one of the most common chronic cardiovascular disease in adults and a leading cause of disability and mortality worldwide. However, update data regarding the HT-related mortality trends in Europe are lacking. Therefore, we assess the age- and sex- specific trends in HT-related mortality in the 27 European Union Member States (EU-27) between years 2011 and 2029.

Methods
Data were retrieved from the free publicly available EUROSTAT death certificate database to examine age-adjusted HT-related mortality rates (AAMR) (per 100.000 people) and relative average annual percentage change (AAPC) across all European Union 27 countries (EU27) from 2011 to 2019 using the International Classification of diseases, Tenth Revision (ICD-10) codes I10-I13 and I15. To calculate annual trends in HT-related mortality, we assessed the average annual percent change (AAPC) and relative 95% confidence intervals (CIs) using Joinpoint regression analysis.

Results
Over the study period, 254.540 HT-related deaths (157,081 males) were listed in EU27. Age-adjusted HT-related death increased from 9.12 to 10.7 per 100,000 people [AAPC: +1.5% (95% CI: 0.8-2.0), p&lt;0.001]. Specifically, the HT-related mortality increased in males [AAPC: +1.8 (95% CI: 0.9-2.6) while decreased in women [AAPC: -1.1 (95% CI: -2.0 to 0.2), p=0.001]. Additionally, the HT-related mortality rates increased in northern [+1.5 (95% CI: 0.7 to 2.3), p&lt;0.001] and eastern [AAPC: +3.9 (95% CI: 2.3 to 5.4), p&lt;0.001] EU-27 states. Conversely, the AAMR plateaued in southern [AAPC: -0.1 (95% ci: 0.6 to 0.7), p=0.96)] and western EU-27 countries [AAPC: 1.0 (95% CI: -0.1 to 2.1, p=0.07] over the same period.

Conclusions
In EU27, HT-related mortality increased from 2011 to 2019, especially in men. However, significant disparities in HT-related mortality rates still exist between different European regions.
Adherence to treatment in patients with arterial hypertension at the wartime conditions in Ukrainian population
Authors: Tseluyko V 
Published: October 2024

Abstract

Background
Adherence to therapy significantly affects the course and prognosis of the disease. However, the impact of military operations and related factors on adherence to therapy has not been studied.

Purpose
The aim of the study was to evaluate additional factors influencing adherence to antihypertensive treatment in wartime.

Materials and Methods
A total of 1299 patients with arterial hypertension from different regions of Ukraine included into the study. All regions were divided into 3 zones: active hostilities; regions with moderate intensity; relatively calm regions. Besides traditional factors (age, education, concomitant pathology, type of therapy), the individual patients’ status was included to analysis as being a resident of a given region, an immigrant from an occupied territory or from a region of hostilities, or a person temporarily displaced. Analysis was performed in 4 treatment groups: 1 – fixed three-component combination olmesartan medoxomil/ amlodipine/ hydrochlorothiazide, 2 – fixed two-component combination olmesartan/ hydrochlorothiazide, 3 – fixed two-component therapy with olmesartan/ amlodipine, 4 - other antihypertensive therapy. Adherence was assessed at 1, 2 and 3 treatment months. Uni- and multivariate statistical analyses was performed to identify factors independently associated with treatment adherence.

Results
In total, 50 patients stopped the drug during the first month (3.8%), 9.8% stopped medication after 2 months, and 19.1% after 3 months. When analyzing patients' adherence depending on whether or not the doctor arrived from another region, we found that the percentage of patients who stopped treatment was almost twice higher if the doctor was displaced (32%), compared to doctors who remained in the places (18%). Based on results of comparative analysis, adherence to therapy was influenced by several factors: age, presence of concomitant coronary artery disease, staying in a high-risk region, number of pills, and prescribed drug. After 3 months adherence was 89% in patients who received 1 tablet per day, 84% - 2 tablets, 82% - 3-5 tablets, and 52% - more than 5 pills. The highest adherence was observed with the three-component pill and with combination of olmesartan and amlodipine. These combinations showed higher adherence compared to other types of therapy. Patient's level of education had no effect on adherence to therapy. Multivariate regression analysis showed, that age over 55 years (p=0.01) and patient’s being in dangerous area (p&lt;0.0001) had significant independent negative influence on adherence. The use of two-component combination olmesartan/amlodipine or three-component therapy significantly increased adherence (p&lt;0.0001).

Conclusion
In the wartime adherence to antihypertensive treatment depends both on previously known and specific factors - activity of hostilities in the region, as well as relocation of both patients and prescribing physicians to another region.
Antihypertensive treatment during pregnancy and maternal and fetal outcomes
Authors: Vaclavik J , Ramik Z , Jarkovsky J , Zouharova A , Pohlova R , Jirova J 
Published: October 2024

Abstract

Introduction
Arterial hypertension affects about 5-10% of pregnancies and has detrimental effects on pregnancy outcomes in both the mother and fetus. The study aimed to analyse the outcomes of pregnancy in women treated for arterial hypertension in pregnancy in the Czech Republic.

Methodology
Nationwide data on all births and abortions in the period 2012-2022 in the Czech Republic were obtained from the National Registry of Reproductive Health (NRRZ) and the National Registry of Reimbursable Health Services (NRHZS). Women who had the diagnosis I10 within one year before pregnancy and were prescribed any antihypertensive drug from selected ATC groups (C02, C03, C07, C08, C09) were classified as pre-existing hypertension. Women diagnosed with O13 or I10 during pregnancy were classified as pregnancy induced hypertension. Hypoxia in the new-born was defined as pH &lt;7.1 or Apgar score &lt;8 present after delivery. For all factors, univariate logistic regression was used to calculate the odds ratios (OR) of adverse outcomes.

Results
There were total of 1,154,648 deliveries in the 11-year period. 95,215 women had hypertension in pregnancy, out of these 21,094 (22.2%) were treated with antihypertensive drugs. Odds ratios for caesarean section, pre-term delivery, low birth weight, new-born hypoxia and pre-eclampsia in women using different antihypertensive classes and drugs are shown in the Table. Risk of maternal and fetal complications was found to be higher with calcium channel blockers (mainly amlodipine) compared to methyldopa and beta blockers. Among beta blockers, bisoprolol had the most favourable safety profile. Although used in limited numbers, diuretics, verapamil, ACE-inhibitors and angiotensin receptor blockers (ARBs) appeared to be comparably safe to methyldopa. Combination of multiple antihypertensive drugs was associated with higher risk of adverse outcomes.

Conclusion
Bisoprolol, verapamil and diuretics seem to have the risk of adverse maternal and fetal outcomes comparable to methyldopa. Amlodipine and multiple antihypertensive drug combinations are associated with increased risk.Table