bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE IMPACT OF OBESITY ON CARDIOVASCULAR RISK IN PATIENTS WITH PRESERVED EJECTION FRACTION: INSIGHTS FROM CENTRAL BLOOD PRESSURE ANALYSIS
Authors: Kim Geehee 
Published: May 2024

Objective:
The classic concept of heart failure (HF), pump failure, has now faded and the preserved pump function in HF with preserved ejection fracture (HFpEF) has received more spotlight as we enter an aging society. HFpEF is a syndrome that represents a variety of phenotypes caused by various factors, and recently, its relationship with obesity has drawn attention. In this study, we evaluated the impact of obesity and blood pressure (BP) on cardiovascular (CV) risk in patients with HFpEF.

Design and method:
From June 2011 to December 2016, a total of 2,910 patients were enrolled and followed up until August 2022. Radial tonometry was used by measurement of central BP (CBP), and skilled personnel who completed validation for inter- and intra-observer variability performed echocardiography examinations. The primary endpoint was a composite outcome of CV disease.

Results:
A total of 1,993 patients with an EF of 50% or more were included during a median follow-up period of 7.4 years. As body mass index (BMI) increased from normal levels, the occurrence of CV events tended to increase (less than 25 of BMI; 627[61, 9.7%], 23 to 25 of BMI; 511[57, 11.2%], 25 to 28 of BMI; 572 [47, 8.2%], more than 28 of BMI; 283 [35, 12.4%]) and as a result, CBP also tended to increase sequentially. According to the univariate Cox proportional hazard model, the increase of 10 mmHg in CBP was shown to increase the risk of CV events by 20% in patients with a BMI of less than 23, while it was shown to decrease the risk by 18% in patients with a BMI between 25 and 28. However, statistical significance was not achieved for patients with a BMI between 23 and 25 or those with a BMI of 28 or more.

Conclusions:
In this study, we evaluated that there is an increasing trend in the incidence of CV events with increasing BMI, especially, that patients with lower BMI are important to control BP and CBP.
RELATIONSHIP BETWEEN OBESITY, WEIGHT CHANGE AND LONG-TERM BLOOD PRESSURE VARIABILITY IN PATIENTS WITH HYPERTENSION
Authors: Ilic Marina Deljanin , Stojanovic Sanja , Krstic Ivana , Ilic Stevan , Stojanovic Milovan 
Published: May 2024

Objective:
To examine the interaction between obesity, weight change and long term visit-to-visit systolic blood pressure variability (SBPV) in patients with hypertension.

Design and method:
Study involved 270 randomly selected hypertensive patients (132 men and 138 women, average age 67.54±9.64y). At first visit appropriate diet was recommended, and patients were followed for 60 months. The study comprised three visits during the follow up period. Obesity was evaluated through body weight (BW), body mass index (BMI), and waist circumference (WC). Visit-to-visit SBPV for each patient was defined using the standard deviation from 3 values of systolic blood pressure (SBP). High SBPV was defined as standard deviation of SBP (SBP-SD) above the 4th quartile.

Results:
Values of SBP and SBPV were significantly higher (p< 0,009 and p<0,002) in the group of obese (n= 61 pts), than in the group of non-obese patients (n=209 pts). During follow-up period of 60 months, average decrease of BP for 31/3 mmHg, SBPV for 8.2 mmHg, BMI for 3.8 kg/m2, WC for 10.2 cm and BW for 10.7 kg in examined hypertensive pts were recorded, but the reduction in BW and SBPV was higher in obese than in non-obese group: BW 12,28 vs 9,24kg; SBPV 8,92 vs 7,74 mmHg (P<0,05 for both). The highest SBPV, was recorded in the 4th quartile of distributions of SBP-SD in the group of obese patients compared to the non-obese patients (41.02±5.76 vs 35.48±0; p<0,001). There was statistically stronger correlation between SBP-SD and BMI as parameter of total obesity compared to large waist circumference as parameter of central obesity (p<0.01).

Conclusions:
Results of the study, showed that obesity is strongly associated with higher SBPV across study visits. During 60-months follow-up, reduction of body weight was associated with reduction of blood pressure values and long term visit-to-visit systolic blood pressure variability.
VALIDITY OF AMBULATORY BLOOD PRESSURE MONITORING RESULTS IN OBESE INDIVIDUALS WITH AND WITHOUT ARTERIAL HYPERTENSION AND OBSTRUCTIVE SLEEP APNEA SYNDROME
Authors: Jug Juraj , Matovinovic Martina , Jelakovic Ana , Jelakovic Bojan 
Published: May 2024

Objective:
Ambulatory blood pressure monitoring (ABPM) in obese patients can be very challenging. Cuff size and thickness of the subcutaneous adipose tissue are usually the main limiting factors for performing an accurate measurement. The aim was to analyze whether there is a higher number of invalid ABPMs in obese patients with comorbidities: arterial hypertension and obstructive sleep apnea (OSAS) compared to obese normotensive patients and without OSAS.

Design and method:
The cross-sectional study included 161 obese patients (123 female, 38 male) who visited the daily hospital of the Reference Center for obesity treatment during 2023. Used ambulatory blood pressure monitor (ABPM) device was Mobil-o-graph ng 24h APBM, version 20. ABPM was considered valid if the patient had > 70% correct measurements and lasted > 20 hours. Anthropometric measures were measured in all patients: body weight, height, body mass index (BMI), neck, waist, and hip circumference. OSAS was confirmed by polysomnography with an apnea-hypopnea index > 30 events/h. Spearman's chi2 test and Student's t-test were used in statistical processing in Statistica v.12.0.

Results:
The share of valid APBM findings deteriorated with higher BMI (r = -0.625, p < 0.001). 28.95% of men and 46.67% of women had valid ABPM, mostly significantly lower BMI (37.88 vs. 44.26 kg/m2, p < 0.001) and younger age compared to those with incorrect measurement (51.79 vs. 46.31 years, p = 0.027). Hypertensive patients (n=101) had statistically significantly less valid ABPM findings than normotensive patients (chi2 = 4.468, p < 0.05). There were fewer correct measurements with a larger neck circumference of the patient (r= -0.3897, p < 0.01), with no correlation for waist and hip circumference. Obese patients with OSAS had significantly fewer valid ABPMs than those without OSAS (chi2 = 4.961, p < 0.05), with even worse results if they also suffered from hypertension (chi2 = 10.783, p < 0.01).

Conclusions:
The validity of ABPM was significantly lower in obese men, hypertensive patients, and OSAS patients. It also depended on the neck circumference of patients regardless of waist and hip circumference. Larger multicentric studies are needed to confirm these findings.
COMPARISON BETWEEN 2021 NATIONAL HYPERTENSION GUIDELINES AND 2023 EUROPEAN SOCIETY OF HYPERTENSION GUIDELINES
Authors: Artero Melania Priego , Salgueiro Maria Cecilia , Borrell Joan Torras , Bonet Jordi Rosinach , Nadal Oriol Rebaglliato , Camps Mencia Benítez , López Beatriz Arnal , Costa Mar Serrat , Vila Laura Camps , Pineda Mireia Gibrat , Bacardit Núria Soldevila , Blanco Carles Albaladejo , De Tuero Gabriel Coll , Bargallo Ernest Vinyoles , Coll Maria Antònia Vila , Von Wichman Mariano De La Figuera 
Published: May 2024

Objective:
After the recent publication of the 2023 European Society of Hypertension (ESH) guidelines, it became necessary to evaluate the need to updating our national guidelines, which were based on the prior 2018 ESH guidelines published.
The objetive was to compare our national guidelines and 2023 ESH guidelines and describe the differences.

Design and method:
Fifteen hypertension specialists from our working group and members of national society of family doctors reviewed both guidelines. Afterwards, in different meetings, updates to our guidelines were discussed and eventually agreed. Here we present some of the major changes in this update.

Results:
Some of the changes to highlight would be the description of the diagnosis of isolated diastolic hypertension (SBP<140mmHg and DBP>90mmHg), the disappearance of the metabolic syndrome, the incorporation of serological and genetic biomarkers in the initial evaluation, and a new goal for alcohol intake (abstinence compared to the previous goal of <20mg/day). The control objectives have not changed, except for patients with chronic kidney disease, who are now recommended to lower their blood pressure to 130/80mmHg (if tolerated in under 80 years-old patients), compared to prior recommendation of 140/80mmHg.
We have decided to maintain our proposal for the integration of in-person and virtual visits, as well as the specific chapters that describe high blood pressure (HBP) management in special situations such as in HIV patients, mental health and urinary incontinence. However, new ESH guidelines describe new approaches such as the inclusion of non-medical healthcare professionals for the HBP follow-up, which endorses the importance of the BP measurements out of the clinic, and specific management for transgender and gender-diverse individuals.
Both guidelines highlight how useful can be the use of the technology, even though some changes are yet to be validated.

Conclusions:
After reviewing the guidelines, we believe there is a trend towards a new healthcare model, which can be better implemented with a wider vision of the current situation and trends, informed by both sets of guidelines. It is worth highlighting the trend towards greater patient empowerment in the management and monitoring of hypertension supported by new technologies.
OBSTRUCTIVE SLEEP APNEA AND TARGET BP VALUE IN NON-OBESE HYPERTENSIVE PATIENTS
Authors: Mikhailova Oksana , Elfimova Eugenia , Ershov Alexey , Litvin Alexander , Chazova Irina 
Published: May 2024

Objective:
To assess obstructive sleep apnea impact on the target blood pressure (BP) value achievement in non-obese hypertensive patients.

Design and method:
In this prospective cross-sectional study were included 305 patients (mean age 60.0 years old [48.0; 67.0], 203 men) with different stages and grades of arterial hypertension (AH). All patients have been receiving antihypertension therapy, prescribed by their cardiologist, for at least 3 weeks before inclusion in the study. During the study, office systolic and dyastolic blood pressure (SBP and DBP resp.) were assessed (oscillometric method, Omron, Japan) and home sleep respiratory monitoring (SomnoChek, Weinmann, Germany) was done in all patients.

Results:
Two groups were formed: non-target BP group (BP>140/90 mm Hg, n=164) and target BP group (BP<140/90 mm Hg, n=141). Comparative data analysis included such indicators as: age, body mass index (BMI), apnea/hypopnea index (AHI), desaturation index (DI) and minimum oxygen saturation (min SaO2), revealed only differences between age (61.0 years old [50.0; 68.0] versus 57.0 years old [47.0; 66.0] resp., p=0.03) and BMI (32.5 kg/m2 [29.7; 38.1] vs. 31.6 kg/m2 [27.8; 35.5] resp., p=0.02).
The analysis of non-obese patients’ data (BMI <30 kg/m2, n=100) didn’t reveal differences by age, but a higher value of AHI and DI were determined in patients with non-target BP, as well as higher BMI; similar differences were not found in obese patients (BMI>30 kg/m2, n=205) (Table 1). In two-factor logistic regression analysis (included AHI and BMI) AHI was the only predictor of non-target BP in patients without obesity, while BMI had no predictive value (Table 2).

Conclusions:
Even mild or moderate obstructive sleep apnea may be an important negative factor in achieving BP targets in non-obese patients, unlike the other clinical cases with AH.
MASKED HYPERTENSION IN PATIENTS WITH METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE – AN UNDERESTIMATED RISK?
Authors: Martin Anna , Lang Sonja , Demir Münevver , Goeser Tobias , Steffen Hans -Michael , Kasper Philipp 
Published: May 2024

Objective:
Metabolic dysfunction-associated steatotic liver disease (MASLD) and hypertension are major cardiovascular risk factors sharing a bi-directional relationship. Although nearly half of MASLD patients are suffering from arterial hypertension, data on the prevalence of different hypertension phenotypes (e.g. masked hypertension) in this patient population are scarce. Masked hypertension, which is defined by normal office blood pressure but elevated blood pressure in the ambulatory 24-hour blood pressure measurement (24-h-ABPM), often remains undetected, although it has a comparable risk for adverse cardiovascular events as sustained hypertension. Therefore, the identification of this hypertension phenotype in MASLD patients seems highly relevant.

Design and method:
To analyze the prevalence of masked hypertension and to improve hypertension management in MASLD patients we integrated a 24-h-ABPM-based hypertension screening and control program among MASLD patients in our outpatient liver department. A total of 226 MASLD patients were recruited during regular follow-up visits and recording of office blood pressure and 24-h-ABPM measurements were performed according to a standardized protocol.

Results:
For the final analysis, 218 data sets were evaluated. The median age of the included 218 patients was 51 years, 48.2% were female. 101 (46.3%) MASLD patients had prior history of hypertension.
At the time of ABPM 93 (92.1%) of these patients received antihypertensive treatment. Masked hypertension was identified in 46 (21.1%) MASLD patients, 20 (43.5%) of whom were receiving antihypertensive treatment (masked uncontrolled hypertension). Interestingly, 14 (30.4%) MASLD patients with masked hypertension had isolated nocturnal masked hypertension. Furthermore, a non-dipping blood pressure pattern was recognized in 28 (60.9%) MASLD patients with masked hypertension.

Conclusions:
Due to the high rates of masked hypertension and abnormal nocturnal blood pressure dipping, which both represent important risk factors for adverse cardiovascular events, the establishment of hypertension screening and management programs in this high-risk population seems urgently needed. Controlled hypertension reduces the risk of cardiovascular events in this vulnerable population and, due to the strong link between MASLD and hypertension, possibly also slow the progression of MASLD to advanced liver fibrosis or cirrhosis.
BELIEFS, RECOMMENDATION, AND INFLUENCING FACTORS OF CARDIOVASCULAR PROFESSIONALS ON CARDIAC REHABILITATION IN CHINA: A CROSS-SECTIONAL STUDY
Authors: Hu Xuechen , Zang Jiabin 
Published: May 2024

Objective:
This study aims to understand the values, attitudes and beliefs of cardiovascular healthcare staff in China, along with the current landscape and influencing factors regarding the recommendation of cardiac rehabilitation (CR).

Design and method:
A nationwide cross-sectional study of 1096 cardiovascular doctors, nurses and rehabilitation therapists was included by convenience sampling from December 19, 2023 to January 9, 2024 through an online survey platform. Questions on personal information, knowledge on CR, recommendation, and the Chinese version of the Recommending Cardiac Rehabilitation(ReCaRe) Scale were administered. Descriptive, univariable analyses and multivariable logistic regressions were conducted.

Results:
A total of 1096 valid questionnaires were collected. Among the surveyed individuals, 626 had recommended CR to patients (56.9%). The ReCaRe scale's total score was 58.7±6.4, with scores in three dimensions: perceived severity and susceptibility 28.9±4.2 (average 4.0±0.6), perceived service accessibility 8.1±2.9 (average 2.7±1.0), and perceived benefit and barriers 22.7±2.4 (average 3.8±0.4). The results show that healthcare professionals’ perceive severity and susceptibility was the primary decision-making factor in recommending cardiac rehabilitation, followed by perceived benefits and barriers, while perceived service accessibility was the least impact factor. The influencing factors for medical professionals to recommend CR include: age(age>40 vs age<=40: OR=1.75, 95%CI=1.12-2.71, P=0.013), professional title(specialist or higher vs resident: OR=2.44, 95%CI=1.69-3.54, P<0.001), work type(doctor vs nurse: OR=2.11, 95%CI=1.48-3.00, P<0.001; rehabilitation therapist vs nurse: OR=2.28, 95%CI=0.47-11.04, P=0.308), hospital type(general hospital vs community healthcare center: OR=2.38, 95%CI=1.36-4.14, P<0.002; specialized hospital vs community healthcare center: OR=7.21, 95%CI=1.03-50.32, P=0.046), department(cardiac department vs general medicine department: OR=9.22, 95%CI=1.44-58.87, P=0.019; rehabilitation department vs general medicine department: OR=15.92, 95%CI=1.94-130.27, P=0.010), resources available of cardiac rehabilitation(yes vs no: OR=3.78, 95%CI=2.57-5.54, P<0.001), and knowledge of CR (knowing a little vs unfamiliar: OR=3.57, 95%CI=2.52-5.05, P<0.001; familiar vs unfamiliar: OR=18.26, 95%CI=11.26-29.61, P<0.001). Unexpectedly, ReCaRe score had no effect on medical staff's recommendation of CR (all P>0.05).

Conclusions:
Healthcare professionals’ perceive severity and susceptibility was their primary decision-making factor in recommending CR. The influencing factors for their recommendation of CR include: age, professional title, work type, hospital type, department, resources available of cardiac rehabilitation and knowledge of cardiac rehabilitation.
ONE-YEAR CHANGES IN ARTERIAL STIFFNESS AND CENTRAL AORTIC PRESSURE IN HYPERTENSIVE PATIENTS WITH AORTIC ANEURYSM AFTER ENDOVASCULAR ANEURYSM REPAIR
Authors: Gurevich Aleksandra P. , Sagynbaeva Ay-churek O. , Emelyanov Igor V. , Ionov Mikhail V. , Vanyurkin Almaz G. , Belova Julia K. , Chernyavskiy Mikhail A. , Konradi Aleksandra O. 
Published: May 2024

Objective:
To assess the dynamics of arterial stiffness and central blood pressure (CBP) and investigate the factors affecting them in thoracic and abdominal aortic aneurysms patients with hypertension one year after [thoracic] endovascular aneurysm repair ([T]EVAR).

Design and method:
Patients older 18 y.o. without clinically significant arrhythmias were included. Before [T]EVAR and a year later, the following examination was performed: measurement of peripheral blood pressure and CBP, heart rate (HR), augmentation index (AIx), central pulse height at the point of maximum rise of direct pulse wave (PT1h), timing of reflected pulse wave (Tr) and carotid-femoral pulse wave velocity (cfPWV) by SphygmoCor (AtCor Medical, Australia).

Results:
Fifty patients were included (mean age 68±9 y.o., 41 males, 16 thoracic aortic aneurysms patients, 34 abdominal aortic aneurysms patients), and 23 were examined again onsite. At one year after [T]EVAR, there was an increase in cfPWV (+2.6 m/s, p<0.001), PT1h (+5 mm Hg, p=0.026), peripheral pulse pressure (+7 mm Hg, p=0.039), HR (+5 bpm, p=0.025). CBP and AIx did not change. The graft length directly affected (β=0.42), and HR exerted inverse (β=-0.52) association with the lengthening of Tr. Six cardiovascular complications were registered during follow-up.

Conclusions:
Implantation of the graft is associated with increased cfPWV, irrespective of the aneurysm location. The rise of PT1h one year after [T]EVAR may reflect a decrease in aortic compliance and a deterioration in the damping function of the aorta. The absence of CBP and AIx dynamics is probably explained by the features of the reflected wave postoperatively. Decreased HR and implantation of more extended grafts are predictors of increased Tr.
DECIPHERING THROMBOTIC MICROANGIOPATHY: A CASE-BASED EXPLORATION OF DISTINGUISHING FEATURES BETWEEN MALIGNANT HYPERTENSION AND THROMBOTIC THROMBOCYTOPENIC PURPURA
Authors: Chadachan Veerendra , Pandit Nihar , Chin Brendan Jonathan 
Published: May 2024

Objective:
Patients with severe hypertension can present with systemic signs of thrombotic microangiopathy (TMA), i.e., thrombocytopenia and microangiopathic hemolytic anemia (MAHA), and/or renal failure. Determining the underlying disease causing TMA is essential for selection of the optimal therapy. We aim to elucidate key factors for distinguishing TMA due to malignant hypertension from TMA due to thrombotic thrombocytopenic purpura (TTP).

Design and method:
We present here a case study focussing on a challenging clinical scenario involving TMA. Through detailed examination of the patient's presentation, laboratory findings, and response to treatment, the report takes you through a diagnostic journey emphasising the unique aspects of TMA in malignant hypertension as compared to TMA in TTP.

Results:
A 44 year old male was admitted with 2 weeks history of exertional breathlessness, orthopnea and severe headache with vomiting. On examination his BP was severely elevated at 253/150 mmHg and he had features of acute pulmonary edema (APO). Initial investigations Significant anemia (hemolytic picture with elevated LDH, low haptoglobin and Indirect hyperbilirubinemia) with thrombocytopenia. Peripheral blood film revealed fragmented RBCs(2-4/hpf), Severe renal failure Creatinine 757umol/L urea 30.9mmol/L Na 129mmol/L, K 2.6mmol/L. MRI Brain revealed features suggestive of Posterior reversible encephalopathy syndrome (PRES). He was diagnosed with hypertensive emergency complicated by APO, PRES and Acute kitney injury from MAHA. He was admitted to ICU and treated with IV GTN infusion, hydralazine and diuretics. He was also started on hemodialysis. Renal failure work-up-HbA1c 4.4, nonreactive viral markers, negative autoimmune serology (C3/C4 normal, Anti-dsDNA <25, ANA <80, ANCA negative). Secondary Hypertension work-up - negative for Renal artery stenosis, Conns, Cushings, Phaeochromocytoma and Thyroid disorders. ADAMTS-13 Activity: 28%, DCT Negative. He was closely monitored, continued on hemodialysis and his blood pressure well-controlled with consequent improvement in LDH, bilirubin, Hemoglobin, and thrombocytopenia. He did not require to be treated with plasma exchange.

Conclusions:
The report contributes valuable insights into the differentiation of these two related yet clinically distinct entities, providing guidance for clinicians to appropriately tailor the therapeutic interventions. Further research is essential for refining diagnostic criteria to enhancie the precision of therapeutic strategies in these complex medical scenarios.