bluuebunny/crossref_metadata_2025_split huggingface dataset:
PREDICTING NEW CASES OF HYPERTENSION IN PRIMARY CARE WITH A MACHINE LEARNING TOOL
Authors: Norrman Anders , Hasselström Jan , Ljunggren Gunnar , Wachtler Caroline , Eriksson Julia , Kahan Thomas , Wändell Per , Gudjonsdottir Hrafnhildur , Lindblom Sebastian , Ruge Toralph , Rosenblad Andreas , Brynedal Boel , Carlsson Axel C 
Published: May 2024

Objective:
Many individuals with hypertension remain undiagnosed and therefore untreated. Consequently, there is a pressing need to pinpoint patients at risk of developing hypertension to avoid cardiometabolic morbidity and mortality. We aimed to develop a predictive model for hypertension using diagnostic codes from prevailing electronic medical records in primary health care.

Design and method:
This sex- and age-matched case-control (1:5) study included patients aged 30–65 years living in Stockholm County, Sweden with a newly recorded diagnosis of hypertension during 2010–19 (cases) and individuals without a recorded hypertension diagnosis during 2010–19 (controls), in total 507,618 individuals. Patients with diagnoses of cardiovascular diseases or diabetes were excluded. A stochastic gradient boosting machine learning model was constructed using the 1,309 most registered ICD-10 codes from primary health care during the three years preceding the diagnosis of hypertension.

Results:
The model showed an area under the curve (95% confidence interval) of 0.748 (0.742–0.753) for females and 0.745 (0.740-0.751) for males for predicting newly diagnosed hypertension (Figures 1 and 2). The sensitivity was 63% and 68%, and the specificity 76% and 73%, for females and males, respectively (Table 1). The 25 diagnoses that contributed the most to the model for females and males all exhibited a normalized relative influence > 1%, as detailed in Tables 2a and 2b. The diagnoses contributing most to the model, all with an odds ratio of marginal effects > 1 for both sexes were dyslipidemia and obesity, along with people encountering health services in other circumstances, painful conditions, and anxiety.

Conclusions:
This machine learning model, developed with artificial intelligence based on earlier diagnoses within primary health care may contribute to identification of patients at risk of developing hypertension.
FEASIBILITY OF WATCH-TYPE CUFF-LESS BLOOD PRESSURE MEASUREMENT DEVICE IN DAILY BLOOD PRESSURE MONITORING
Authors: Lee Youngro , Seo Jongmo , Lee Haeyoung 
Published: May 2024

Objective:
Cuff-less blood pressure (BP) measurement devices integrated into smartwatches have gained prominence for daily monitoring, yet limited studies provide the analysis of real-world BP data collected by such devices. In this study, we evaluated the feasibility of photoplethysmographic BP measuring smartwatch by analyzing data collected in real-world.

Design and method:
The campaign, “Smartwatch Blood Pressure Monitoring Challenge with Korean Hypertension Society”, was held in June 1-14, 2023 and 896 participants reported 35592 BP values measured by smartwatch (Samsung Galaxy Watch 6, approved in Korean Ministry of Food and Drug Safety). Participants were instructed to measure BP daily, in the morning (5AM-8AM) and evening (6PM-9PM) for two weeks, with initial calibration and re-calibration after the first week. We evaluated 1) BP difference between before and after re-calibration, and 2) difference in morning and evening BP. We also evaluated the determining factors of the BP differences.

Results:
Morning and evening BP values showed significant difference, higher in the evening by 1.42±5.25 mmHg (p<0.05). However, the diurnal variation was much smaller than reported in other studies using conventional BP monitoring devices. ANOVA identified significant variables for evening-morning differences, including basal metabolic rate, skeletal muscle mass, total body water, average systolic BP (SBP), diastolic BP (DBP), and heart rate in the morning (p < 0.01 in both ITT and PP). Participants who have evening-morning difference higher than the third quartile, where evening SBP was significantly higher than morning SBP, exhibited smaller variable sizes. Turkey’s Honest Significant Difference showed that this relationship is statistically significant between Q1-Q4 and Q2-Q4 in all variables.
The calibration stability was assessed by the difference in average BP before and after calibration, resulting in an SBP difference of 4.64±4.73 mmHg and DBP of 3.66±3.62 mmHg, smaller than a 2021 campaign (6.8±5.6mmHg). When the difference of average was measured between same period of time (morning versus morning and evening versus evening), SBP of 5.39±5.22 mmHg and DBP of 4.3±3.99 mmHg.

Conclusions:
In conclusion, watch-based devices may not detect clinical-level BP variability, but refining calibration protocols offers improvement potential.
THREE-YEAR NIGHTTIME BLOOD PRESSURE REDUCTIONS AFTER RADIOFREQUENCY RENAL DENERVATION IN PATIENTS WITH UNCONTROLLED HYPERTENSION AND CHRONIC KIDNEY DISEASE
Authors: Schlaich Markus , Mahfoud Felix , Narkiewicz Krzysztof , Ruilope Luis , Williams Bryan , Schmieder Roland E , Mancia Giuseppe , Sharif Faisal , Ribichini Flavio , Fahy Martin , Böhm Michael 
Published: May 2024

Objective:
Nocturnal hypertension (HTN), highly prevalent in chronic kidney disease (CKD), is strongly associated with cardiovascular risk, and is difficult to control with pharmacotherapy. An additional therapy such as radiofrequency renal denervation (RF RDN) may effectively lower nighttime BP in hypertensive patients with CKD, long-term.

Design and method:
Patients with uncontrolled HTN enrolled into the Global SYMPLICITY Registry (GSR) DEFINE were evaluated. All patients underwent RF RDN and were grouped by their estimated glomerular filtration rate (eGFR): <60mL/min/1.73m2 (CKD) or eGFR more than or equal to 60mL/min/1.73m2 (non-CKD). Nighttime systolic BP (NSBP) changes at 3yrs after RF RDN were compared between groups.

Results:
As of March 2023, a total of 3331 patients with uncontrolled BP were enrolled of which 805 (24.2%) had CKD. CKD group were 64±12yrs old, 47.3% female, 54.9% had diabetes, and 56.9% had cardiac disease. Of those, 12.3% had eGFR <30mL/min/1.73m2 (Figure 1A). The baseline NSBP was higher in the CKD vs non-CKD groups (149.0±22.9mmHg vs 144.9 ± 21.0mmHg; p=0.0002), whilst prescribed 5.2±1.7 vs 4.8 ± 1.7 antihypertensive drugs, respectively (p<0.0001).
3yrs after RF RDN, significant NSBP change was observed in the CKD group (-7.8mmHg), similar to the non-CKD group (-8.4mmHg; adjusted p=0.64; Figure 1B). The eGFR changed similarly in both groups (CKD -4.7±17.4mL/min/1.73m2 vs non-CKD -7.0±17.0mL/min/1.73m2; p=0.34). There was also no significant difference between groups for changes in daytime SBP, sodium, potassium, or creatinine.

Conclusions:
In this large registry cohort of patients with CKD and uncontrolled BP, nocturnal HTN was prevalent, and RF RDN significantly reduced NSBP after 3 years. RDN, in addition to pharmacotherapy, may help to reduce the risk of long-term cardiovascular events in these high risk patients.
SEX DIFFERENCES IN A CARDIOVASCULAR DISEASE RISK SCORE AND ITS COMPONENTS AS PREDICTORS FOR MULTIMORBIDITY IN THE UK BIOBANK
Authors: Harris Katie , Wang Wendy , Carcel Cheryl , Peters Sanne , Woodward Mark , Chalmers John 
Published: May 2024

Objective:
This study will examine sex differences in the association of a cardiovascular disease risk score and its components (age, treated or untreated systolic BP, total and HDL cholesterol, diabetes and smoking) with cardiovascular and other outcomes (myocardial infarction (MI), stroke, dementia, ESKD, death and multimorbidity).

Design and method:
This study uses the UK Biobank - a prospective population-based cohort study, that recruited over 500,000 (aged 40 to 69 years) women and men between 2006 and 2010, with continuing follow up for outcomes. The Pooled Cohort Risk Equation, designed to estimate 10-year atherosclerotic cardiovascular disease (ASCVD) risk, was applied to predict 10-year risk of MI, stroke, dementia, ESKD and multimorbidity. Participants with any of these diseases at baseline were excluded from these analyses.
Cox regression models were used to model the sex specific association (hazard ratio (HR) with 95% confidence interval (CI)) of the ASCVD risk score and each of the components separately with outcomes. C-statistics were used to determine the predictive ability of the ASCVD risk score compared with the individual components on outcomes.

Results:
There were 355,466 UK Biobank participants (55% women) eligible for inclusion in these analyses.
Compared with having an ASCVD risk score <=2.5% (low risk), the risk of multimorbidity for those with an ASCVD risk score >7.5% (intermediate – high risk) was higher in women (HR 2.60; 95%CI (2.52, 2.69)) than men (2.17 (2.08, 2.27)). Corresponding results were 7.08 (6.13, 8.18) and 4.01 (3.54, 4.54) for MI; 3.53 (3.04, 4.41) and 2.69 (2.24, 3.22) for stroke. The corresponding risks for dementia, ESKD and death were also higher in women than men.
ASCVD risk score was a better predictor of multimorbidity than each of the separate individual components, for women and men. This finding held for all other outcomes apart from dementia where age yielded the highest c-statistics.

Conclusions:
Utilisation of cardiovascular risk scores may provide utility in predicting other diseases individually and in combination (multimorbidity). Clinicians should also be cognisant of a higher risk of events in women compared to men with comparable ASCVD risk scores.
THE IMPORTANCE OF CARDIAC MAGNETIC RESONANCE IMAGING IN THE ASSESSMENT OF THE RISK OF CARDIAC ARRHYTHMIAS IN PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Wysocki Andrzej , Gac Pawel , Poreba Rafal , Michalek-zrabkowska Monika , Kraik Krzysztof , Poreba Malgorzata , Martynowicz Helena , Mazur Grzegorz , Dziadkowiec-macek Barbara , Fulek Michal , Macek Piotr 
Published: May 2024

Objective:
Arterial hypertension leads to organ changes, including left ventricular hypertrophy. The increased mass of left ventricle increases the risk of cardiac arrhythmias, which enhances the risk of sudden cardiac death. Cardiac magnetic resonance imaging (CMRI) can identify the presence of myocardial fibrosis by assessing late gadolinium enhancement (LGE). The aim of the study was to assess the relationship between the presence of late gadolinium enhancement at the right ventricular insertion point (RVIP) determined by CMRI and the occurrence of cardiac arrhythmias in patients with arterial hypertension.

Design and method:
30 patients with essential hypertension were qualified for the study, 18 men and 12 women, the average age of the subjects was 55.5 ± 12.4 years. All subjects underwent cardiac magnetic resonance imaging and 24-hour Holter ECG monitoring. Based on the presence of LGE at the right ventricular insertion point, assessed by CMRI, the subjects were divided into two subgroups. The first subgroup consisted of subjects with LGE at the right ventricular insertion point (RVIP + subgroup), while the second subgroup consisted of subjects without LGE at the right ventricular insertion point (RVIP - subgroup).

Results:
Subjects with LGE at the right ventricular insertion point were characterized by higher maximum and minimum heart rates in 24-hour Holter ECG recordings compared to subjects without LGE at the right ventricular insertion point (p < 0.05). In subjects with LGE at the right ventricular insertion point, Holter ECG evaluation revealed a statistically significantly higher number of single premature supraventricular beats, single premature ventricular beats and supraventricular tachycardias compared to subjects without LGE at the right ventricular insertion point (p < 0.05). The regression analysis performed showed that a longer time from the diagnosis of hypertension and the occurrence of LGE at the right ventricular insertion point assessed using CMRI are independent risk factors for cardiac arrhythmias (p < 0.05).

Conclusions:
Cardiac magnetic resonance imaging by identifying of late gadolinium enhancement at the right ventricular insertion point may be a useful diagnostic method in assessing the risk of cardiac arrhythmias in a group of patients with arterial hypertension.
THE IMPACT OF THE COVID-19 PANDEMIC ON OFFICE AND 24-HOUR BLOOD PRESSURE PHENOTYPES (ESH ABPM COVID-19 STUDY)
Authors: Ostrowska Aleksandra , Wojciechowska Wiktoria , Rajzer Marek , Reinhold Kreutz , Weber Thomas , Bursztyn Michael , Persu Alexandre , Stergiou George , Kielbasa Grzegorz , Parati Gianfranco , Bilo Grzegorz , Grassi Guido , Mancia Giuseppe , Januszewicz Andrzej 
Published: May 2024

Objective:
The COVID-19 pandemic had a huge impact on access to healthcare and on the presence of follow-up visits in ambulatory care. This study evaluated the influence of the COVID-19 pandemic on blood pressure (BP) control and phenotypes as assessed by office and 24-hour ambulatory BP monitoring (ABPM).

Design and method:
Clinical and BP data were collected from 33 centers including Excellence Centers of the European Society of Hypertension. Two groups of patients with treated hypertension were compared. Group1 (pandemic): including participants who had ABPM twice - at visit 2 during the COVID-19 pandemic and visit 1 performed 9-15 months prior to visit 2. Group2 (pre-pandemic): had ABPM in two visits, performed before the pandemic within 9-15 months interval. In the current analysis we determined BP phenotypes among all patients. The following phenotypes were distinguished: masked uncontrolled hypertension (MUCH), white coat uncontrolled hypertension (WUCH), sustained controlled hypertension (SCH) and sustained uncontrolled hypertension (SUCH), according to ESH 2023 Guidelines. We analyzed whether these phenotypes changed between visits.

Results:
Of overall 1620 patients included in the study, we excluded those with missing ABPM or clinical data precluding to define BP phenotypes. Patients with uncontrolled hypertension on both visits and patients switching between MUCH and WUCH were also excluded. Finally, data of 983 patients, 423 (43%) in the pandemic group and 560 (57%) in the pre-pandemic group were analyzed. At baseline (visit 1), BP phenotypes prevalence did not differ between groups. In the pandemic group, the prevalence of SUCH increased during follow up (9% vs 20.8%, p<0.001), while the prevalence of SCH remained unchanged between visits (43.7% vs 46.3%, p=0.45). In contrast, in the pre-pandemic group, the prevalence of the SCH increased during follow-up (41.3% vs 55%, p <0.001). On visit 2 in the pandemic group, the prevalence of SCH was lower than in the pre-pandemic group (46.3% vs 55%, p=0.007). In multivariable adjusted analysis, the only significant factor influencing the negative changes of BP phenotypes was the COVID-19 pandemic period.

Conclusions:
These results indicate a negative impact of the COVID-19 pandemic on BP control assessed by BP phenotypes.
LEFT VENTRICULAR REMODELING IN RELATION TO INTERACTION BETWEEN BLOOD PRESSURE AND SODIUM RENAL HANDLING AND INTAKE IN UNTREATED CHINESE PATIENTS
Authors: Cheng Yi -BANG , Chan Chak -MING , Xu Ting -YAN , Li Yan , Wang Ji -GUANG 
Published: May 2024

Objective:
Whether or not renal sodium handling was associated with left ventricular remodeling independent of blood pressure (BP) is uncertain.

Design and method:
Consecutive untreated patients referred for ambulatory BP monitoring were recruited. Two-dimensional echocardiography was performed to measure left ventricular properties. Fractional excretion of lithium (FELi) and fractional distal reabsorption rate of sodium (FDRNa) were calculated as markers of proximal and distal sodium handling, respectively.

Results:
The 952 untreated patients (51.0% women; mean age, 50.8 years) included 614 (64.5%) ambulatory hypertension and 138 (14.5%) with left ventricular hypertrophy. FELi and FDRNa averaged 21.5% and 95.9%, respectively. In multivariable-adjusted analyses, per 1-SD increment in systolic/diastolic BP (+12.4/9.0 mm Hg) and reduction in FELi (-11.3%) and FDRNa (-2.4%) were associated with 0.19/0.19 and 0.19/0.20 mm higher interventricular septal wall thickness (IVS), respectively, 0.10/0.12 and 0.18/0.22 mm higher left ventricular posterior wall thickness (LVPW), respectively, and 2.99/2.68 and 2.17/1.95 g/m2 higher left ventricular mass index (LVMI), respectively. Associations of IVS and LVPW with FELi and FDRNa were tighter than with BP (P<0.001), whereas the opposite trend was observed for LVMI (P<0.001). There was significant (P<0.045) interaction between urinary sodium excretion and FELi in relation to LVPW and LVMI. Only in tertile 1 of FELi, LVPW and LVMI were positively associated with urinary sodium excretion (P<0.040). The interaction between urinary sodium excretion and FDRNa in relation to left ventricular structure was nonsignificant (P>0.25).

Conclusions:
Renal sodium handling as assessed by FELi and FDRNa, were independently associated with left ventricular remodeling, particularly with ventricular wall thickening.
LARGE DIVERGENCES IN TARGET GROUPS OF ESH 2023 BP-LOWERING STRATEGIES IN OLDEST-OLD PATIENTS ACCORDING TO THEIR FUNCTIONAL AND/OR FRAILTY STATUS
Authors: Jagiello Kacper , Piotrowicz Karolina , Grodzicki Tomasz , Gasowski Jerzy , Kujawska-danecka Hanna , Zdrojewski Tomasz 
Published: May 2024

Objective:
Treatment individualization is part of good clinical practice. Part of it is medication de-escalation in older adults with limited life expectancy or advanced frailty syndrome. The 2023 ESH guidelines for treatment of hypertension, for the first time made provision for tailored medication use based on functionality and age of the patient.
We aimed to assess whether the 2023 ESH Guidelines strategy for antihypertensive treatment individualization aligns with the widely adopted treatment strategy based solely on frailty status.

Design and method:
We used data from a cross-sectional, nationwide survey of health determinants in non-institutionalized older persons in Poland that was conducted from 2018 to 2019 (PolSenior2). For the current analysis, we extracted data for hypertensive persons aged 80 years and older. Based on Fried criteria we categorized participants into fit, pre-frail, and frail. The Mini-Mental State Examination was used to screen for cognitive impairment, and the basic Activities of Daily Living for functional screening. We also checked the classification-assignment based on the ESH 2023 functional categorization (fit, slowed but autonomous for most activities, severely dependent) that is proposed for assessment of eligibility to tailored antihypertensive treatment. We then checked the concordance between the classifications.

Results:
The mean (SD) age of 1458 participants (52% women) was 86.0 (4.7). According to Fried’s definition, 47.9% were pre-frail and 46.4% frail, respectively. Based on the ESH 2023 approach, 10.3% of participants were classified as severely dependent who required treatment individualization and prioritization (91.3% of them frail) and 66.3% as fit who should be treated as usual (59.2% of them pre-frail and 33.1% frail, according to Fried’s frailty criteria). We found the correlation between the two classifications to be low (Spearman’s r=0.39, p<0.05) with the kappa coefficient of 0.11 (p<0.05).

Conclusions:
In the community-dwelling hypertensives, aged 80+ years, who are candidates for individualized antihypertensive therapy, there was discrepancy between frailty status and the ESH 2023 functional criteria for antihypertensive treatment individualization. A thoughtful approach should be taken to standardize the methodological concepts and fine-tune them according to specific clinical needs.
GLYCOSYLATED FIBRONECTIN AS A NOVEL PREDICTOR FOR THE MATERNAL AND FETAL COMPLICATIONS OF PREECLAMPSIA
Authors: Kluivers Anna , Neuman Rugina , Saleh Langeza , Visser Willy , Danser Jan 
Published: May 2024

Objective:
The aim of this study was 1) to evaluate glycosylated fibronectin (GlyFn) as a novel predictor for preeclampsia (PE)-related maternal and fetal complications, and 2) to compare the predictive value of GlyFn versus that of the soluble Fms-like tyrosine kinase-1/placental growth factor (PlGF) (sFlt-1/ PlGF) ratio.

Design and method:
This was a secondary analysis of a prospective multicenter cohort study involving 524 pregnancies either suspected of (but not confirmed with) PE, with gestational hypertension (GH), or with confirmed PE and/or HELLP syndrome (PE/HELLP). In all patients sFlt-1, PlGF and GlyFn were measured at the time of inclusion. Logistic regression was conducted to study the association between GlyFn and PE-related complications. A traditional model (incorporating gestational age at biomarker measurement, parity, diastolic blood pressure and proteinuria at inclusion), to which GlyFn and the other biomarkers were added, was used for multivariable analysis.

Results:
In GH and PE/HELLP, GlyFn levels were significantly elevated (P=0.002 and P=0.02, respectively), compared to women with suspected PE. GlyFn correlated positively with sFlt-1 and the sFlt-1/PlGF ratio, and negatively with PlGF. GlyFn alone performed better than the traditional model with regard to the prediction of maternal but not fetal complications, and this was also true for sFlt-1, PlGF and their ratio. Combining the traditional model with GlyFn increased the C-index for maternal complications further, and on top of the traditional model the GlyFn/PlGF ratio yielded the best results for predicting fetal complications in the overall cohort, while in women with a gestational age <37 weeks this was also true for the prediction of maternal complications.

Conclusions:
GlyFn is a novel biomarker for PE diagnosis and its complications, and its role might be particularly relevant in patients with PE below 37 weeks of gestation.
SURVEY OF THE ADHERENCE TO THE ANTIHYPERTENSIVE THERAPY IN URBAN BULGARIAN POPULATION
Authors: Gruev Ivan , Garkov Kiril 
Published: May 2024

Objective:
Adherence to the therapy is the Achilles heel of the management of the arterial hypertension. The aim of our study was to address the problem from the patient's perspective.

Design and method:
We asked 497 urban Bulgarian patients (aged between 35 and 70 years) with arterial hypertension, about their attitude and adherence to the prescribed therapy.
80% of the survey was done online and 20% were computer-assisted personalized interviews among older subjects. Quality control was done by GPS tracking of the interviewer, control of the duration of the survey, logical control of the interviews and 10% phone calls for confirmation with the patients.

Results:
We found out that 61% of the patients take 2 or more tablets daily for the treatment of hypertension.
The preferred intake time was in the morning in 69% of the answers, but the predominant therapeutic regime was twice daily among 56% of the patients.
In 56% of patients the number of pills remained the same during their follow up visits and in 26% -the number increased.
83% of patients with hypertension declared positive attitude towards their therapy, but 55% of them, admitted that they miss some of the doses of the prescribed medications. Asked about the reason for that, most of them- 63% answered: “I forgot to take them”. 30% of the hypertensive patients repeatedly perform “pill holidays”- stopping their therapy usually in the summer.
Only 25% of the studied population were fully aware about the risks of non compliance.
Being asked about how to improve their adherence, 44% of the patients answered they would prefer 1 tablet per day.

Conclusions:
Conclusion: Many Bulgarian urban patients experience difficulties to adhere to their antihypertensive treatment. Reducing the number of pills by increasing the use of SPCs could be one of the answers to the problem.