bluuebunny/crossref_metadata_2025_split huggingface dataset:
MAY MEASUREMENT MONTH 2023 IN CROATIA, CLOSE TO GUINNESS RECORD
Authors: Jelakovic Bojan , Soldo Ana , Skopic Olgica Velkovski , Abramovic Inga , Jelakovic Ana , Josipovic Josipa , Lang Valerija Bralic , Mihalic Mirjana , Domislovic Marija , Capak Krunoslav , Bubas Marija 
Published: May 2024

Objective:
According to recent nationwide study EHUH 2 the crude prevalence of hypertension in Croatia is 50.9%. Although significant improvement in treatment and control of hypertension was achieved in last two decades, health literacy is still very poor. May Measurement Month was venue to collect new information which could help us in preparing future public health activities.

Design and method:
Croatian Hypertension League joined the MMM 2023. We decided to collect data during our permanent public health action – Hunting the Silent Killer, and together with Croatian Pharmacy Chamber to include 329 community pharmacists (still underused health professionals). Most of examinations and measurements were done in local pharmacists (83%). In total 10 488 subjects were examined (64% women, average age 58 ys), and in 8614 blood pressure (BP) was measured three times (average value od 2nd and 3rd measurement was used for analyses-132.6/79.1 mmHg and 75.7 b/min). All measurements were done using the same BP device (Microlife BP B3).

Results:
A high number of subjects was diagnosed with high BP before action (41.3%), and 14% did not know whether they have hypertension. BP was measured never or before than 12 months in 15.4%. The average number of antihypertensive drugs was 1.8. Surprisingly, only 5.2% answered that they often forget or took drugs only when they needed it. There were 19.9% smokers and 16.3% ex-smokers. We found 3% to vape, but also there were 2.9% ex-vapers. No physical activity was reported by 43.3%. Alcohol was consumed daily or at least once per week in 11.2%. Low birth weight (< 2.5 kg) was reported by 9% of participants.

Conclusions:
Data we have collected during MMM action are very valuable, albeit some answers probably do not reflect the truth. One of the greatest achievements was establishment of community pharmacists network what is in line with our aim of including pharmacists more in treatment of hypertension and all other chronic non-communicable diseases.
Acknowledgement: We are thankful to Salvus Microlife for donation of BP devices
HIGHER INCIDENCE OF CARDIOVASCULAR EVENTS IN A LARGE REAL-WORLD DATABASE IN THE TRIENNIUM 2020-2022 COMPARED TO A PRE-COVID TRIENNIUM IS INDEPENDENT OF CARDIOVASCULAR RISK FACTORS
Authors: Battistoni Allegra , Gallo Giovanna , Morisco Carmine , Piccinocchi Gaetano , Piccinocchi Roberto , Fini Massimo , Proietti Stefania , Bonassi Stefano , Trimarco Bruno , Volpe Massimo 
Published: May 2024

Objective:
We evaluated the incidence and relative risk of major cardiovascular events in a large real-world population from a primary care database in a region at moderate cardiovascular risk in the period 2020-2022 (e.g. during COVID-19 pandemic).

Design and method:
This is a retrospective cohort analysis using the whole database of a cooperative of general practitioners in the city of Naples, Italy (COMEGEN). All individuals aged >18 were followed up to three years. These data were compared with those derived from the same database in the years 2017-2019, considered as a pre-COVID 19 period.

Results:
Anonymized data from of 228,266 patients in the period 2020-2022 were considered for statistical analysis (these included 31,764 subjects with a molecular diagnosis of COVID 19). In the 2020-2022 population demographic features and the prevalence of major cardiovascular risk factors (hypertension, diabetes, hypercholesterolemia and smoking) did not differ from those reported in the 2017-2019 cohort (Table 1). On the contrary, the incidence of individuals with a new diagnosis of major adverse cardiovascular and cerebrovascular events was significantly higher in the 2020-2022 compared to the 2017-2019 triennium (Table 1).

Conclusions:
We report a substantial increase of cardiovascular events during the COVID-19 triennium which is independent of risk factors. Whether this is caused to direct cardiovascular consequences of SARS-CoV-2 (diagnosed or undiagnosed) infection or to other factors such as the reduced access to healthcare facilities cannot be clarified by our present study.
STOPPING ANTIHYPERTENSIVE TREATMENT AMONG HYPERTENSIVE PATIENTS IN PRIMARY CARE: THE STOP-TRIAL
Authors: Jean-marc Boivin , Ferreira Joao , Duarte Kevin , Lamiral Zohra , Rossignol Patrick , Girerd Nicolas 
Published: May 2024

Objective:
Objective: Frequently antihypertensive therapy (AHT) is initiated without the confirmation of high blood pressure (BP) outside the office. Such AHT initiation based solely on office BP measurements may lead to overtreatment of otherwise non-hypertensive people who do not have a clinical indication for AHT. Therefore, identifying people in whom AHT can be safely discontinued is clinically important. The STOP-Trial aimed to identify factors associated with one-year normal BP maintenance after discontinuation of monotherapy or low-dose dual AHT among people with controlled BP and no cardiovascular target-organ damage.

Design and method:
Design and Method: We performed a multicenter non-randomized open-label trial screening people without target organ damage on AHT. AHT could be discontinued if BP was confirmed as controlled based on repeated home blood pressure measurements (HBPM) (i.e.,<135/85mmHg). The primary endpoint was one-year normal BP maintenance as assessed by HBPM.

Results:
Results: Among 401 screened individuals, 218(54.4%) were included after confirming they had controlled BP in HBPM and AHT was consequently discontinued. Among these 218 individuals, 73(33%) exhibited normal BP in HBPM at one year without any AHT (Figure).
In univariable analysis, baseline office BP measurements were not significant predictors of the primary outcome whereas HBPM were.
On multivariable analysis, higher average SBP and DBP on HBPM prior to AHD stop was associated with lower rates of one-year normal BP (OR for 5 mmHg of respectively, SBP=0.72, 0.56-0.94, p=0.014, and DBP=0.56, 0.41-0.77, p=0.0003).
The best cut-offs of SBP and DBP on HBPM prior to AHD stop to predict the primary outcome was SBP=122.5mmHg and DBP=74.5mmHg. Patients with SBP<122.5 and DBP<74.5mmHg at HBPM prior to AHD stop had 65% chance of normal one-year BP without treatment.
Regarding safety, one patient had a severe adverse event (ischemic stroke).

Conclusions:
Stopping AHT was feasible in patients without cardiovascular damage who had mono or low-dose dual AHT and maintained at one year in 33% of the population. HBPM measurements under treatment predicted well the success of AHD removal and HBPM consequently appears to be an efficient tool to select patients in whom AHD discontinuation may be safely considered.
AWARENESS, TREATMENT, AND CONTROL OF HYPERTENSION USING OPPORTUNISTIC SCREENING PROGRAMS: EVIDENCE FROM THE MAY MEASUREMENT MONTH CAMPAIGN, 2017-2019
Authors: Razo Christian , Beaney Thomas , Poulter Neil R. , Prabhakaran Dorairaj , Schutte Aletta E. , Johnson Catherine , Roth Gregory A. 
Published: May 2024

Objective:
To evaluate adult (>18 years) hypertension awareness, treatment, control, and comorbidities using three years of May Measurement Month (MMM) data (2017-2019).

Design and method:
Up to three sitting blood pressure (BP) readings as well as lifestyle and comorbidity data (self-reported diabetes, myocardial infarction, stroke and overweight/obesity) were collected from participants. Missing BP readings were imputed through multiple imputation, leveraging available BP measurements and sociodemographic variables. Hypertension was defined using the average of the second and third BP readings (systolic BP >140 mmHg and/or diastolic BP >90 mmHg or taking antihypertensive medication). For those with hypertension, hypertension awareness was defined as self-report of previous diagnosis or current medication use, while control was defined as BP <140/90 mmHg among people on medication. Logistic regression models were used to analyze lifestyle factors and main comorbidities associated with hypertension awareness, treatment and control.

Results:
Among 2,907,848 participants from 95 countries, 34.2% had hypertension. Among those with hypertension, 60.1% were aware, 57.0% were medicated, 32.0% were controlled and 22.8% had at least one additional chronic condition. Of those with hypertension who were on medication, 57.0% were controlled. Europe had the highest proportion of individuals with hypertension while Sub-Saharan Africa had the lowest awareness, treatment and control rates (Figure 1). Hypertension treatment and control were higher in individuals with comorbidities (Figure 2-3). Adjusting for age, sex and survey year, those with comorbidities were more likely to be aware of their hypertension while participants from low-income countries and smokers were less likely to be aware. Individuals from low-income countries and smokers were less likely to receive treatment, while those with comorbidities were more likely to get treated. Middle-income individuals were more likely to receive treatment but less likely to be controlled than high-income individuals (Figure 3).

Conclusions:
MMM provides a means of measuring hypertension, awareness, treatment, and control rates, particularly in resource-limited countries. Data suggests heterogeneity in awareness, treatment and control and poorer hypertension management in individuals without comorbidities, informing global strategies for improved hypertension prevention, detection and management.
CHRONIC KIDNEY DISEASE INCIDENCE AND CARDIORESPIRATORY FITNESS ASSOCIATION IN HYPERTENSIVE PATIENTS
Authors: Kokkinos Peter , Pittaras Andreas , Faselis Charles , Samuel Immanuel , Patel Samir , Doumas Michael , Gollie Jared , Grassos Harris , Myers Jonathan 
Published: May 2024

Objective:
Chronic hypertension (HTN) is considered a strong risk factor for developing chronic kidney disease (CKD). Increased cardiorespiratory fitness (CRF) is associated with lower CKD risk. However, the CRF-CKD association in patients with HTN has not been assessed. Thus, we examined the the association between CRF and the risk of developing CKD in hypertensive patients.

Design and method:
Hypertensive individuals (n=471,579; age 63.0+8.8 years) with normal kidney function prior to HTN and no evidence of ischemia indicated by a maximal standardized exercise treadmill test (ETT). The cohort was part of the ETHOS study (n=750,302). We established five CRF categories based on age-and-gender-adjusted peak metabolic equivalents (METs) achieved: Least-Fit (4.5±1.2 METs; n=106,955); Low-Fit Fit (6.9±1.1 METs; n=122,612); Moderate-Fit (8.3±1.2 METs; n=91,995); Fit (10.3±1.2 METs; n=111,472); and High-Fit (13.2±1.6 METs; n=38,545). CKD risk across CRF categories was assessed by multivariable Cox Regression analysis, adjusted for age, blood pressure, body mass index (BMI), alcohol abuse, traditional risk factors, and medications.

Results:
During 6,146,773.0 person-years of follow-up (median 12.9 years), 58,701 individuals developed CKD (9.6 events/1,000 person-years of observation). The CRF-CKD association was inverse, independent of comorbidities and graded. The risk of developing CKD was 9% lower for each 1-MET increase (Hazard Ratio [HR] 0.91; 95% confidence interval [CI] 0.90-0.93). When CKD risk was assessed across CRF categories using the Least-fit category as the referent, the risk was 20% lower (HR 0.80; CI 0.78-0.81, p<0.001) for those in the Low-fit category (6.9±1.1 METs). The risk declined progressively with increased CRF and was 49% lower for those in the highest CRF category (HR 0.49; CI 0.47-0.51, p<0.001). Similar findings were observed in the subgroup of hypertensive patients with diabetes mellitus (n=192,966).

Conclusions:
We noted an inverse and dose-response association between CRF and CKD incidence. The risk was attenuated significantly beyond a MET level of 6.9±1.1 METs, suggesting that moderate increases in exercise capacity lowers the risk of developing CKD in hypertensive patients.
RESIDENCE AT HIGH ALTITUDE IS ASSOCIATED WITH LOWER CONVENTIONAL AND AMBULATORY BLOOD PRESSURE THAN LIVING AT SEA LEVEL IN THE GENERAL POPULATION OF PERU. HIGHCARE-LAPS STUDY
Authors: Bilo Grzegorz , Villafuerte Francisco C. , Zanotti Lucia , Soranna Davide , Nava Sara , Rusconi Valentina , Pengo Martino F. , Croce Alessandro , Lombardi Carolina , Macarlupu Jose Luis , Bermudez Daniela , Sosa Jose’ Manuel , Carcamo Cesar P. , Zambon Antonella , Parati Gianfranco 
Published: May 2024

Objective:
Acute exposure to hypoxia at high altitude (HA) leads to an increase in blood pressure (BP) in healthy individuals and in hypertensive patients. Little is known, however, about the effect of long-term HA residence on BP. Available data based on conventional BP measurements are inconsistent and no general population studies using 24-h ambulatory BP monitoring (ABPM) have been conducted.
Aim of HIGHCARE-LAPS was to compare BP levels and cardiovascular risk profile among population-based samples of subjects residing in Peruvian communities living at different altitudes. BP-related data are reported in this paper.

Design and method:
Study participants were recruited by sex- and age-stratified random multistage cluster sampling from the general adult population residing permanently in urban areas at different altitudes in Peru (Lima, <500m, Huancayo 3287m, Juliaca 3824m, Cerro de Pasco 4330m). In all participants questionnaire-based information, conventional BP (3 seated measurements with a validated oscillometric device, HEM7121 OMRON, Japan), 24-hour ambulatory BP (A&D TM2430, Japan) and laboratory variables were obtained.

Results:
The study included 206 lowlanders and 595 highlanders. Highlanders were slightly younger, had lower BMI, oxygen saturation and prevalence of antihypertensive medication use and higher haematocrit. In highlanders all conventional and ambulatory BP values were lower and heart rate values higher than in lowlanders. Comparisons between lowlander and highlander samples and for individual sites at different altitudes are reported in the Table.
The difference in 24-hour systolic BP between highlanders and lowlanders remained significant (7.2 mmHg, p<0.001) in a linear multiple regression model adjusting for age, sex, BMI, 24-hour heart rate, respiratory rate, and haematocrit. These covariates were selected by LASSO method from a set also including lifestyle-related variables.

Conclusions:
Permanent residence at high altitude is independently associated with lower conventional and ambulatory BP levels than low altitude residence in the general population of Peru. This relationship does not seem to be explained by lifestyle differences. Mechanisms behind this difference and its impact on cardiovascular risk should be further investigated. Also, comparative studies with other highland populations with different adaptive characteristics would allow to understand better the effects of HA residence on cardiovascular health.
U-SHAPED RELATIONSHIP BETWEEN BLOOD PRESSURE AND ALL-CAUSE MORTALITY IN OLDER ADULTS: THE SHIZUOKA STUDY
Authors: Asahina Aya , Usui Takeshi , Tabara Yasuharu 
Published: May 2024

Objective:
Not only high blood pressure (BP) but also low BP was suggested to be associated with all-cause mortality in older adults. However, the actual mechanism responsible for the association between low BP and mortality has not been identified. This study aimed to investigate a possible confounding of antihypertensive drug use, potential comorbidities, and functional disability, as well as random error in BP measurement, in the association between low BP and all-cause mortality. A possibility of reverse causation (i.e., lower BP was caused by cardiovascular frailty at the end of life) was also investigated.

Design and method:
We use the Kokuho Database in a local government, which is a prefecture-wide large dataset including data on annual health checkup and health and care insurance claims. This longitudinal observational study analyzed 337,988 individuals aged &#8805; 65 (mean age: 73.5) years. The earliest day of participation in the annual health checkup during the study period from 2012 to 2020 was defined as baseline. Data on comorbidities, prescribed antihypertensive medications, functional disability levels, and incidence of stroke and all-cause mortality were obtained from the insurance claims database.

Results:
During a mean follow-up period of 5.3 years, there were 27,497 cases of all-cause mortality and 11,090 cases of stroke. A U-shaped association was observed between systolic BP and all-cause mortality in participants aged &#8805; 75 years. The hazard ratio of systolic BP <110 mmHg for all-cause mortality was 1.14 (95% confidence interval: 1.07–1.21, P < 0.001). Meanwhile, the hazard ratio of BP &#8805; 150 mmHg was 1.16. The U-shaped association remained significant in the subanalyses of individuals without severe comorbidities, antihypertensive drug use, or functional disability. Similar results were also observed in the analysis excluding early-mortality cases within 3 years after the baseline, as well as in the analysis using the average systolic BP measured during at least two different occasions within a 3-year period as a baseline value. In contrast, stroke risk increased linearly with increasing BP.

Conclusions:
Low BP was associated with all-cause mortality in older adults. The U-shaped association may not be attributed to the previously suggested factors.
ASSOCIATION BETWEEN BLOOD PRESSURE LEVELS AND COGNITIVE IMPAIRMENT IN PATIENTS WITH HEART FAILURE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Zhang Fangjing , Zhang Yong , Zhang Kefan , Di Xiaofan , Yu Jing , Bai Feng , Wang Qiongying 
Published: May 2024

Objective:
The prevalence of cognitive impairment in heart failure patients is up to 43%. The study showed that that the risk of cognitive impairment in heart failure is 1.67 times that in the non-heart failure population. Similarly, high blood pressure is strongly associated with an increased risk of cognitive impairment. However, it is unclear whether the blood pressure level participates in the development of cognitive impairment in patients with heart failure. The objective of this Meta-analysis was to explore the effect of blood pressure levels on cognitive function in patients with heart failure.

Design and method:
Using keywords to search online literature on all studies on heart failure and cognitive function between January 1950 and December 2022. The investigator screened the literature by inclusion exclusion criteria. Statistical analysis of the findings of the studies included in the meta-analysis was performed using the Revman.

Results:
(1)A total of 80 studies on patients with heart failure were cognition through literature screening, and 20 studies met the inclusion and exclusion criteria in the meta-analysis. (2) Meta-analysis data on the correlation between blood pressure level and cognitive function in heart failure patients indicate that: In patients with heart failure, patients with concurrent hypertension showed a greater cognitive decline compared with the normal blood pressure group. At different blood pressure control levels, the odds ratio for cognitive impairment in heart failure patients with blood pressure control within the target range was 1.72 (95% confidence interval 1.15–2.42). In the same level of blood pressure control range, there was no statistically significant difference in cognitive function in patients with preserved ejection fraction compared with patients with reduced ejection fraction.

Conclusions:
This meta-analysis showed that blood pressure in heart failure is at different levels and the degree of cognitive impairment varies, indicating that there has a degree of influence on their cognitive function. However, after analyzing and comparing cognitive function in patients with heart failure with preserved ejection fraction, there was no significant statistical difference between the effects of blood pressure levels on cognitive function in the two groups.
LEFT VENTRICULAR HYPERTROPHY AFTER RENAL TRANSPLANTATION: SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Tian Zhejia , Bergmann Kai , Kaufeld Jessica , Schmidt-ott Kai , Melk Anette , Schmidt Bernhard 
Published: May 2024

Objective:
Left ventricular hypertrophy in end-stage renal disease patients undergoing renal replacement is linked to an increased risk for cardiovascular diseases. Dialysis does not completely prevent or correct this abnormality, and the evidence for kidney transplantation varies. This analysis aims to explore the relationship between kidney transplantation and left ventricular hypertrophy.

Design and method:
MEDLINE and Scopus were systematically searched in October 2023. All cross-sectional and longitudinal studies that fulfilled our inclusion criteria were included. Outcome was left ventricular mass index. We conducted a meta-analysis using a frequentist random effects model. Meta-regression was applied to examine the left ventricular mass index changes dependent on various covariates. Sensitivity analysis was employed to handle outlying or influential studies and address publication bias. All analyses were conducted using R version 4.3.2.

Results:
From 7416 records, 46 studies met the inclusion criteria with 4122 included participants in total. Longitudinal studies comparing LVMI in renal transplant recipients before transplantation and thereafter demonstrated an improvement of left ventricular mass index after kidney transplantation - 0.44 g/m2 [-0.60; -0.28] (SMD [95% confidence interval]). By meta-regression analysis blood pressure was identified as predictor of LVMI change. A younger age at the time of kidney transplantation and well-controlled anemia were also associated with regression of left ventricular hypertrophy. In studies longitudinally comparing kidney transplant recipients with patients staying on dialysis no difference was detected -0.09 g/m2 [-0.33; 0.16] (SMD [95% confidence interval]). Meta-regression using changes of systolic blood pressure as covariate showed an association between higher blood pressure and an increase in left ventricular mass, regardless of the modality of renal replacement treatment.

Conclusions:
In conclusion, our results indicated a potential cardiovascular benefit, defined as the regression of left ventricular hypertrophy, after kidney transplantation. This benefit was primarily attributed to improved blood pressure control rather than the transplantation itself.