bluuebunny/crossref_metadata_2025_split huggingface dataset:
EVALUATION OF CARDIOVASCULAR RISK FACTORS IN CHILDREN AGED 6-16 YEARS OLD AND THEIR EVOLUTION AT EARLY ADULTHOOD IN A 10-YEAR FOLLOW UP STUDY
Authors: Ntretsiou Helen , Benas Dimitrios , Trivilou Paraskevi , Pavlidis George , Oikonomidis Ignatios , Attilakos Achilleas , Iliodromitis Efstathios , Triantafyllidi Helen 
Published: May 2024

Objective:
Objective: Obesity and arterial hypertension in children represent well recognized main risk factors for cardiovascular (CV) events during adult life. We aimed to investigate any changes regarding several CV risk (CVR) factors of children aged 6-16 years old after a 10-year follow-up period.

Design and method:
Design and method: A cohort of 143 healthy children 6-16 years old (79/64 boys/girls, aged 9±2 years) was initially evaluated regarding CVR factors [obesity, blood pressure (BP), aortic stiffness, lipid profile] plus food habits/sports activity. At 10-years follow-up, 62/143 (43%) young adults were re-evaluated (33/31 boys/girls, aged 20±2 years old).

Results:
Results: Obesity, found in 45% of children, was accompanied by increased BP (p<0.001) and a less favorable low density lipoprotein cholesterol (LDL-C)/triglycerides profile (p=0.001). In a 10-year follow-up, obesity and exercise improved (p<0.001 and p=0.005), BP was elevated (p<0.001) at levels of high normal (40% of young adults), aortic stiffness increased (p<0.001), LDL-C and high density lipoprotein cholesterol (HDL-C) decreased (p=0.004 and p<0.001), triglycerides increased (p=0.04), and food approached the western model of nutrition (less fish/fruits). In children and young adults, body mass index (BMI) was associated with age (Beta=0.47, p<0.001 and Beta=0.36, p=0.004), systolic BP (Beta=0.46 and Beta=0.52, p<0.001), and LDL-C (Beta=0.27 and Beta=0.44, p<0.001).

Conclusions:
Conclusions: An increased incidence of obesity associated with systolic BP and accompanied by a less favorable lipid profile was found in children. At 10-years re-evaluation, obesity was partly improved, systolic BP had reached the high-normal levels in a substantial number of young adults while lipid profile was less favorable compared to baseline evaluation. Our results highlight the evolution of CVR factors from childhood to early adulthood.
STRICTER AMBULATORY BLOOD PRESSURE CONTROL IS POSSIBLE IN PATIENTS AFTER KIDNEY TRANSPLANTATION AND IS ASSOCIATED WITH REGRESSION OF LEFT VENTRICULAR HYPERTROPHY: POST HOC ANALYSIS
Authors: Seeman Tomas , Gilik Jiri , Vondrak Karel , Feber Janusz 
Published: May 2024

Objective:
The recently published analysis of the 4C-T study demonstrated an association of stricter cumulative office blood pressure (BP) control with lower left ventricular mass (LVM) in children after kidney transplantation. The aim of our study was to investigate whether stricter control of ambulatory BP is also associated with improved LVMI and regression of left ventricular hypertrophy (LVH) in pediatric kidney transplant recipients.

Design and method:
A post-hoc analysis of nineteen patients (median age at baseline 9.7 years, range 3.3–15.1, median time after transplantation 4.3 years, range 1.0-13.1) from our previous ESCORT trial who had echocardiography performed at baseline (T0), 1 (T1), 2 (T2) and 3 (T3) years was performed. Cumulative 24-hour mean arterial pressure (MAP) Z-scores (CMAPz) were calculated according to 4C-T study (Sugianto et al. 2023). Left ventricular hypertrophy (LVH) was defined as LVMi>40 g/m^2.7 in girls >9 yrs of age and LVMi>45 g/m^2.7 in boys >9 yrs of age; in children <=9 yrs the LVH was defined as LVMi >95th percentile (Khoury et al 2009).

Results:
The median CMAPz decreased from a median +0.27 (IQR=-0.09 to +0.38) in the 1st year down to -0.06 (IQR=-0.26 to +0.32) in the 2nd year (p=0.02) and to +0.05 (IQR=-0.32 to 0.27) in the 3rd year (p=0.04) of follow-up. The prevalence (number) of children with LVH was 26% (5/19) at T0, 16% (3/19) at T1, 23% (3/13) at T2 and 0% (0/11) at T3 (trend in proportions p=0.06). All 5 children with elevated LVMi>0.9 at T0 decreased / normalized their LVMi at T3 (p=0.07), on contrary children without LVH at baseline did not significantly change their LVMi during follow-up.

Conclusions:
This first prospective interventional study demonstrated an association between stricter cumulative ambulatory MAP and regression of LVH in patients after kidney transplantation. Our data suggest that aiming stricter ambulatory BP can improve the often unfavourable cardiac phenotype in these patients. However, randomized control trial is required to confirm our findings.
RELATIONSHIP BETWEEN NEW SURROGATE MARKS OF INSULIN RESISTANCEAND AND BONE MINERAL CONTENT IN CHINESE ADOLESCENTS
Authors: Tian Mei , Ma Xiaoyan , Liu Jianxi , Tong Lingling , Ding Wenqing 
Published: May 2024

Objective:
To analyze the relationship between the new simplified insulin resistance index and bone mineral content (BMC) in adolescents and its evaluation effect on low bone mass, so as to provide scientific basis for early identification and prevention of skeletal-related diseases in adolescents.

Design and method:
A total of 1594 adolescents aged 12-18 years in Yinchuan were selected by stratified cluster sampling. Binary Logistic regression was used to analyze the relationship between insulin resistance index and low bone mass, and receiver operating characteristic (ROC) curve was constructed to analyze its evaluation effect on low bone mass.

Results:
After adjusting for confounding factors, the new simplified insulin resistance index was positively correlated with BMC level (TyG: r = 0.113, TyG-BMI: r = 0.576, TG / HDL-C: r = 0.205) (all P < 0.001). After further adjustment of obesity index, the relationship between IR index and BMC turned into negative correlation. Logistic regression results showed that IR was a protective factor for low bone mass (TyG: OR = 0.74, 95% CI: 0.54∼1.03, TyG-BMI: OR = 0.95, 95% CI: 0.94∼0.95, TG / HDL-C: OR = 0.40, 95% CI: 0.26∼0.62) (all P < 0.05). After adjusting the obesity index, the above results were completely reversed. IR was a risk factor for low bone mass in girls (TyG: OR = 4.95, 95% CI = 1.29∼18.95; TG / HDL-C: OR = 4.38,95% CI = 1.04∼18.50) (all P < 0.05). ROC curve showed that TyG-BMI had the best evaluation effect on low bone mass(AUC=0.80,95%CI: 0.769∼0.825)(P<0.001).

Conclusions:
TyG-BMI can be used to identify low bone mass, which is of great significance for early prevention of bone-related diseases in adolescents. The relationship between IR and BMC is affected by obesity indicators. It is necessary to understand the complex relationship between IR, fat and bone mass more clearly.
RHYTHMICITY IN 24 HOUR BLOOD PRESSURE MEASUREMENTS AFTER PEDIATRIC KIDNEY TRANSPLANTATION AND ITS RELATION TO CARDIOVASCULAR END ORGAN DAMAGE
Authors: Grabitz Carl , Svatovski Todor , Özmen Mahmut , Jabarulla Mohamed Yaseen , Oeltze-jafra Steffen , Memaran Nima , Schaefer Franz , Wühl Elke , Melk Anette 
Published: May 2024

Objective:
Cardiovascular risk factors, especially arterial hypertension, are very common after kidney transplantation (KTx) during childhood. Ambulatory blood pressure monitoring (ABPM) is the gold standard of hypertension diagnostics. The present study analyzes circadian and ultradian rhythms in ABPM and their association with left ventricular mass and aortic pulse wave velocity as markers of cardiovascular end organ damage.

Design and method:
From a prospective international multicenter observational study ABPMs of 151 children and adolescents after KTx could be analyzed. They were compared to a healthy cohort of 299 schoolchildren matched for gender and body length. Partial Fourier analysis was used to examine oscillatory fluctuations at 24, 12, 8 and 6 hours (h) period lengths in order to detect rhythms in both mean arterial pressure (MAP) and heart rate (HR). These rhythms could be further characterized in their amplitude as well as their acrophase which is the time interval until maximum amplitude after midnight.

Results:
In patients after KTx, a 12h rhythm in the MAP (figure panel A) and an 8h rhythm in HR were significantly more frequent than in healthy children. No difference in rhythm frequency was found for the other period lengths. Amplitudes in MAP were significantly smaller after KTx (24h, 8h, 6h) and MAP acrophases were significantly longer (24h, 12h, 8h) than in the control group (figure panel B and C). Significantly smaller amplitudes and longer acrophases were observed in the KTx cohort for HR as well.
Data assessing cardiovascular end organ damage was available for children after KTx: We observed a positive correlation of 24h MAP amplitude with arterial pulse wave velocity (r=0.19; p=0.036) and a comparable trend with 8h MAP amplitude (r=0.31; p=0.053). Left ventricular mass did not correlate with any of the rhythm parameters after KTx.

Conclusions:
Our analysis demonstrates altered circadian and ultradian cardiovascular rhythmicity after KTx. Compared to healthy children, the described rhythms are flattened and delayed. Interestingly, there was a correlation of MAP amplitudes with vascular stiffness that warrants further investigation. Hence, we are going to analyze follow-up ABPM measurements in the described cohort after KTx.
FEASIBILITY OF SCHOOL-BASED SCREENING FOR HIGH BLOOD PRESSURE IN CHILDREN: THE HEALTHY HEARTS @ SCHOOL STUDY
Authors: Glenning Jonathan , Sheeran Freya , Quach Jon , Cheung Michael , Best Stephanie , Quinlan Catherine , Mynard Jonathan 
Published: May 2024

Objective:
High blood pressure (BP) in childhood is associated with end organ damage and cardiovascular events in mid-adulthood. Community-based BP screening may improve equitable access and awareness, but robust methodology is required. Accordingly, our aim was to assess the acceptability and feasibility of a two-stage school-based BP screening program incorporating targeted 24-hour ambulatory blood pressure monitoring (ABPM).

Design and method:
One-hundred-ninety-eight children (59% male, 7.6–12.7 years) in grades 3-6 were recruited from three primary schools in Melbourne, Australia. Following an education session for all children in these grades, BP was measured five times in students after parental consent, using the auscultatory method, alternating between arms and after five minutes of rest. Those with an average BP >85th percentile (AAP thresholds) or a risk factor for high BP had these measurements repeated two weeks later, along with ABPM. Families and students also completed an optional questionnaire post-program.

Results:
At the first assessment, 11 (5.6%) and 10 (5.0%) had elevated or hypertensive BP respectively (14.6% combined if using just the first measure). Fifty-nine (29.8%) were selected for the second assessment (including 10 with obesity, 15 born premature, four with a history of congenital heart disease, and nine with BP >85th percentile, but <90th percentile), of which 52 attended. ABPM indicated that 11 (5.6%) and five (2.5%) had white coat hypertension based on assessment one and two respectively, three (1.5%) had sustained hypertension (based on either assessment stage), and two (1%) had masked hypertension. Three additional participants each had either high BPs during school assessment but did not undertake, or had inconclusive, ABPMs. Overall, 11 (5.6%) were referred to a doctor for medical follow-up. The majority of students (67%) reported that ABPM was tolerable (‘bothersome’ score <8/10 for day and/or night). 96% of families approved of the program and 90% welcomed it as part of their child's schooling.

Conclusions:
These data indicate that a school-based BP screening program is acceptable and feasible, and that measuring BP on multiple occasions, and with targeted ABPM, is pivotal for minimising false positives and unnecessary referrals.
PREVALENCE OF HYPERTENSION, OBESITY AND NUTRITIONAL BEHAVIORS IN PRIMARY SCHOOL STUDENTS
Authors: Aysegul Ilgaz 
Published: May 2024

Objective:
Hypertension and obesity seen in childhood are among the important public health problems while creating risks for diseases in both childhood and adulthood. Nutritional habits are one of the important factors in the development of obesity. This study aimed to determine the frequency of hypertension, obesity and the nutritional behaviors in primary school students.

Design and method:
This descriptive research was conducted with 210 primary school students aged 6-9. The blood pressure was measured to determine the frequency of hypertension, the Feeding Behavior Scale was used to determine nutritional behaviors, height and weight were measured to identify obesity status.

Results:
The mean age of the children was 7.21±0.69, the systolic blood pressure was 98.2±8.69, the diastolic blood pressure was 64.30±7.25 and the body mass was 16.66±3.43. The nutritional behavior scale total score was found to be 2.48±4.18. It was detected that 12.4% of primary school students were slightly overweight and 5.2% were obese. Hypertension was detected in 4.8% of the children, isolated systolic hypertension in 2.4%, and isolated diastolic hypertension in 2.4%. It was determined that there was a relationship between body mass index and systolic blood pressure and diastolic blood pressure (p<0.05), but there was no relationship between nutritional behavior score (p>0.05).

Conclusions:
It was determined that obesity rates were higher in primary school students, and the higher the body mass index, the higher the blood pressure. It can be said that interventional studies are needed to reduce obesity and hypertension in childhood.
ARE ADOLESCENTS CONSUMING MORE SALT THAN RECOMMENDED?
Authors: Shah Kriya , Athavale Bahaar , Vijan Shradha , Kamat Shambhavi , Shah Hardik 
Published: May 2024

Objective:
To study and compare the amount and pattern of sodium (Na) consumption in urban and rural school-going adolescents in Western India and identify high risk groups for conducting awareness programs.

Design and method:
1850 subjects (urban- 935; rural- 915; Males-1012, Females -838) aged 14 - 17 years were recruited with prior permission from 5 schools in and around Mumbai. Data pertaining to demography, anthropometry and eating habits was collected. A self-administered semi-quantitative Food Frequency Questionnaire was used to record consumption pattern of 22 high salt containing food items, divided into 5 categories (bakery, fried, packed, preserved and fast foods). Each participant‘s sodium consumption from these food items was calculated. Additional sodium consumption from regular meals was excluded. Data was analyzed using standard growth charts and MS Excel.

Results:
Only 13% of subjects added table salt. 67% and 81% brought homemade food for snacks and lunch respectively. Median Sodium consumption of the study population was 573 mg/day (∼ 1.5 g salt) (Q1-Q3:254 - 851 mg/day). There was no statistically significant difference (p> 0.05) in the Median Na consumption of girls (454 mg/day) and boys (489 mg/day). Daily Median Na consumption was not significantly different (p < 0.05) in urban students (624 mg/day) as compared to rural (592 mg/day). Bakery and fried foods together comprised 51% of sodium consumption among the rural population, whereas all five food categories had almost equal representation in the urban population. 54% subjects’ BMI (34% urban, 20% rural) was above the normal range. Higher BMI values correlated significantly with higher daily Na consumption (p =0.001, Mann-Whitney test).

Conclusions:
The salt intake over and above the usual dietary salt consumption was high (∼ 2 g per day for urban and ∼1.8 g/day for rural adolescents). Nearly half the study population was found to be either overweight or obese. This double whammy has a singular potential for producing future hypertensives. Thus, targeted awareness and counselling programs for salt reduction in adolescents is the urgent need of the hour.
OBSTRUCTIVE SLEEP APNEA REMAINS A RISK FACTOR FOR MAJOR ADVERSE CARDIOVASCULAR AND CEREBROVASCULAR EVENTS IN HYPERTENSVIE PATIENTS UNDER TREATMENT: THE UROSAH DATA
Authors: Yao Xiaoguang , Li Nanfang , Heizhati Mulalibieke , Wang Yingchun , Zhang Delian , Luo Qin , Hu Junli , Wang Menghui , Zhu Qing 
Published: May 2024

Objective:
The impact of the co-occurrence of hypertension and obstructive sleep apnea (OSA) on the risk of long-term cardiovascular disease (CVD) outcomes has not been extensively studied in the Asian population, and the residual effect of OSA on CVD in patients under antihypertensive treatment is not clear. The study aimed to explore the impact of OSA on the risk of CVD outcomes in a large-scale Asian cohort under antihypertensive treatment using retrospective design.

Design and method:
Hypertensive patients who underwent polysomnography (PSG) test in January 2011 to December 2013 were recruited from the UROSAH cohort, which was conducted in Hypertension Center of People's Hospital. OSA was defined as apnea hypopnea index over 5. Outcomes were extended major adverse cardiovascular and cerebrovascular events (MACCE), including the first occurrence of nonfatal myocardial infarction, nonfatal stroke, revascularization, rehospitalization due to unstable angina or heart failure and all-cause death. Cox regression analysis was performed to explore the effect of OSA and hypertension coexistence on MACCE.

Results:
A total of 3329 hypertension patients were enrolled, of whom 2585 patients (about 77.7%) suffered from OSA. During a median follow-up period of 7.0 years, 415 patients developed extended MACCE. The incidence of extended MACCE was significantly greater in patients with OSA than those without OSA (hazard ratio [HR]: 1.59; 95% confidence interval [CI]: 1.27-1.99; P<0.001). Overall, patients with OSA had an increased risk of cardiac events of 57% compared to those without OSA [HR (95%CI): 1.57 (1.04-2.39), P=0.034] and the association did not change in further sensitivity analysis. Particularly in uncontrolled hypertension, OSA was found to have a 93% increased risk of cardiac events, compared with patients without OSA (P=0.036).

Conclusions:
Untreated OSA seemed to be a factor affecting the prognosis of cardiac events in hypertensive patients, although the association between OSA and cardiac events would be attenuated by the pharmacological-induced blood pressure control, which highlights the need to treat OSA.
INTERMEDIATE AND LONG-TERM BLOOD PRESSURE OUTCOMES IN POSTPARTUM HYPERTENSION – AN INTERIM ANALYSIS OF THE BASEL POSTPARTUM HYPERTENSION REGISTRY
Authors: Hotz Leana , Socrates Thenral , Wenker Céline , Subeedhja Subeedhja , Rana Alessandro , Piattini Leana , Strobel Noémie , Vorster Viviane , Menzinger Zoë , Eichler Sophia , Mayr Michael , Lapaire Olav , Mosimann Beatrice , Vischer Annina , Burkard Thilo 
Published: May 2024

Objective:
Postpartum hypertension (PPHT) affects 10% of all pregnancies and has various aetiologies including chronic hypertension (CH), hypertensive disorders of pregnancy (HDP) including preeclampsia (PE), and de novo PPHT. Women with PPHT are at an elevated risk for persistent hypertension and for developing cardiovascular and renal disease, but most outcome data is based on PE. Here, we investigated mean 24-hour blood pressure (24hBP) and renal target organ damage using microalbuminuria as a surrogate marker in the intermediate and long-term postpartum period.

Design and method:
In total 370 participants were prospectively enrolled in the PPHT registry including women with HDP and/or PPHT. 24hBP measurement and urinary analysis were conducted 3 (V3) and 12 (V12) months after delivery. Normotensive 24hBP was defined as mean systolic/diastolic 24hBP <130/<80 mmHg and microalbuminuria was defined as albumin/creatinine ratio >= 3 mg/mmol.

Results:
The mean age was 34.0 (±5.4) years. The proportion of CH was 44/370 (11.9%), gestational hypertension 118/370 (31.9%), preeclampsia, eclampsia or HELLP 205/370 (55.4%) and de novo PPHT 68/370 (18.4%). Data regarding V3 and V12 was available in 246 and 114 participants. Antihypertensive treatment was prescribed at baseline, V3, and V12 in 85.4%, 18.7% and 18.4% of participants. Prevalence of microalbuminuria at baseline, V3, and V12 was 84.9% 29.9%, and 16.9% respectively. The mean (±standard deviation) systolic 24hBP at V3 was 121.7(11) mmHg and mean diastolic 77.3(8.6) mmHg respectively. At V12, mean systolic 24hBP was 119.5(8.5) mmHg and diastolic 24hBP 75.6 (6.9) mmHg. Detailed 24hBP values and proportions of systolic and diastolic blood pressure control in participants with and without antihypertensive treatment are presented in Table 1.

Conclusions:
One year after giving birth, elevated albumin/creatinine ratio as a surrogate for renal target organ damage persisted in approximately 1 out of 6 participants. Blood pressure control was documented in approximately 3/4 of the participants at the one-year postpartum follow-up. Nevertheless, a relevant number of participants were hypertensive or still under treatment one year after birth. Therefore, continued follow-up and cardiovascular risk assessment in this population should be warranted.
EFFECT OF ANTIHYPERTENSIVE DEPRESCRIBING ON SERIOUS ADVERSE EVENTS, MORTALITY, AND CARDIOVASCULAR DISEASE: LONG-TERM FOLLOW-UP OF THE OPTIMISE RANDOMISED CONTROLLED TRIAL
Authors: Sheppard James , Temple Eleanor , Wang Ariel , Smith Anne , Pollock Stephanie , Ford Gary , Hobbs Richard , Kenealy Nicola , Lown Mark , De Lusignan Simon , Mant Jonathan , Mccartney David , Payne Rupert , Williams Marney , Yu Ly -Mee , Mcmanus Richard 
Published: May 2024

Objective:
Deprescribing of antihypertensive medications is recommended for some older patients with polypharmacy and frailty. The OPTIMISE trial showed that this can be achieved without affecting blood pressure control at 3-month follow-up. This longer-term follow-up study aimed to examine the impact on serious adverse events (SAEs), mortality and cardiovascular disease (CVD) outcomes after at least 3 years.

Design and method:
Participants aged 80 years or older, with systolic blood pressure <150 mmHg, and receiving at least 2 antihypertensive medications were randomised (1:1) to a strategy of antihypertensive medication reduction (removal of one antihypertensive) or usual care. Participants were followed-up via their primary and secondary care electronic health records, at least 3 years after randomisation. The primary outcome was SAEs, defined as hospitalisation or death from any cause. Secondary outcomes included mortality, stroke, myocardial infarction and major CVD events. Analyses were undertaken using Cox proportional hazards modelling.

Results:
Among 569 randomised participants (intervention=282; control=287) with a mean age 85 years (276 [48.5%] women), 564 (99.1%) were followed-up for a median of 3.9 years. Medication reduction was sustained in 109 participants (52.7% of those alive in the intervention group) at 3 years. Participants in the intervention group were prescribed fewer antihypertensives than the control group (mean difference -0.35, 95%CI -0.52 to -0.18). Overall, 202 (72.1%) patients in the intervention group and 218 (76.8%) patients in the control group experienced SAEs during follow-up (adjusted HR 0.93, 95%CI 0.76-1.12). There was no evidence of a difference in mortality (aHR 0.81, 95%CI 0.58-1.13), stroke (aHR 0.91, 95%CI 0.40-2.06), myocardial infarction (aHR 0.86, 95%CI 0.42-1.77) or CVD events (aHR 1.00, 95%CI 0.68-1.46).

Conclusions:
Medication reduction was sustained in half of those attempting it, with no evidence of harm from SAEs, mortality or CVD after almost four years. These findings suggest that deprescribing antihypertensive medication is safe in older patients living in the community with controlled blood pressure.