bluuebunny/crossref_metadata_2025_split huggingface dataset:
HOME BLOOD PRESSURE DURING NIGHT-TIME SLEEP AS A BETTER TREATMENT TARGET FOR PATIENTS WITH HYPERTENSOIN: A PROOF-OF-CONCEPT RANDOMIZED CONTROLLED TRIAL
Authors: Lee Eric Kam-pui , Yip Benjamin Hk , Yan Bryan , Wong Samuel , Chung Wai -Ho , Chow Kam -Fai , Han Jing -Hao , Leung Shuk -Yun , Choi Shirley , Yu Esther , Mihailidou Anastasia , Mcmanus Richard 
Published: May 2024

Objective:
Nocturnal blood pressure (BP) has been shown be a stronger predictor of cardiovascular disease and death compared to daytime, office, and 24-hour BP, the feasibility of implementing repeated measurement of nocturnal BP and treating it to target with medications has not been examined. This pilot randomized controlled trial (RCT) aimed to determine the feasibility of measuring home nocturnal BP and treating nocturnal systolic BP (SBP).

Design and method:
This RCT utilized blocked and stratified (sex/age) randomization to assign hypertensive patients in a 1:1 ratio to the control or intervention group. Participants were patients with daytime hypertension (SBP >=135mmHg) and nighttime hypertension (SBP >=120mmHg) based on a 24-hour ambulatory BP measurement (ABPM). In the intervention group, patients were instructed to measure their nocturnal BP for three days using the WatchBP home N device, measuring 3 BP readings per night during sleep (maximum possible nocturnal BP readings = 9) a week before the doctor’s visit. In the control group, patients were asked to measure their BP in the morning and evening for seven consecutive days using the same device before the consultation. Medications were adjusted every four weeks until respective BP targets (SBP <135mmHg for the control group and <120mmHg for the intervention group) were reached or until the study endpoint (6 months).

Results:
Within one year, we successfully recruited 78 patients, with a dropout rate of 5.1% (n=4). Both groups had similar baseline characteristics, including age, sex, and BP levels on ABPM. The feasibility of targeting home nocturnal BP measurements was confirmed, with patients in the intervention group providing >=6 nocturnal BP readings in 77.5% of the 160 follow-ups and had similar medication adherence to patients in the control group. At the 6-month, both groups showed similar 24-hour, daytime, and nighttime BP levels, office BP levels, lifestyle adherence, number of visits to primary care clinics, and hospitalizations.

Conclusions:
This proof-of-concept RCT demonstrates the feasibility of targeting home nocturnal BP as the primary treatment goal for patients with hypertension. A full RCT will examine whether nocturnal BP should be a primary treatment target for hypertension.
THE INTERPLAY BETWEEN SYMPATHETIC NERVOUS SYSTEM OVERACTIVITY, BLOOD PRESSURE LEVELS AND NON-ALCOHOLIC FATTY LIVER DISEASE IN HYPERTENSIVE PATIENTS
Authors: Kakouri Niki , Andrikou Ioannis , Konstantinidhs Dimitrios , Siafi Eirini , Manta Eleni , Koullias Manolis , Papageorgiou Haralampos , Grigoriou Kalliopi , Leontsinis Ioannis , Iliakis Panagiotis , Mantzouranis Emmanouil , Tsioufis Panagiotis , Tousoulis Dimitrios , Thomopoulos Costas , Dimitriadhs Kyriakos , Tsioufis Costas 
Published: May 2024

Objective:
Non-alcoholic fatty liver disease (NAFLD) is the most important cause of chronic liver disease and a marker of increased cardiovascular risk. The purpose of this study was to investigate the interrelations between sympathetic nervous system (SNS) tone, as assessed by microneurography, blood pressure levels and NAFLD in hypertensive subjects.

Design and method:
131 newly diagnosed untreated hypertensive patients (mean age 55±10 years, 63 males, office systolic/diastolic blood pressure 141±21/89±9 mmHg) without a history of cardiovascular disease were included in the study. NAFLD was diagnosed by liver ultrasound, and then patients were categorized into two groups according to the presence or absence of fatty liver. SNS over-activity levels were assessed by direct recording of muscle sympathetic nerve activity (MSNA), based on an established technique (microneurography).

Results:
Hypertensive subjects with NAFLD (n=79) compared to controls (n=52) were younger (53±10 vs. 57±9 years, respectively, p=0.01) and had higher body mass index (33±9 vs. 26±3 kg/m2, p<0.001). They also had statistically significant higher levels of office blood pressure (systolic/diastolic blood pressure 142±14.8 vs 140±14.6 mmHg, 90±10 vs 87±8 mmHg, respectively). Subjects with fatty liver had also higher levels of triglycerides (122±50 vs 104±43 mg/dl, p<0.04), while there was no statistically significant difference between the two groups in hemoglobin A1c, total cholesterol and glomerular filtration rate. Hypertensive subjects with NAFLD showed greater activation of the sympathetic nervous system, with increased levels of MSNA compared to the control group (45 ± 9.5 vs. 39 ± 7 bursts per minute, respectively, p<0.04). Also, according to the multiple logistic regression analysis, MSNA proved to be an independent determinant for the presence of NAFLD (OR 1.13, 95% CI 1.01-1.26, p=0.03).

Conclusions:
Higher stimulation of sympathetic nervous system, as reflected by MSNA, is significantly associated with the presence of NAFLD in hypertensive subjects, which is also related to higher office systolic blood pressure. These findings may partly explain the increased cardiovascular risk of hypertensive patients with NAFLD.
A NOVEL ELECTRO-HYDRAULIC ACOUSTIC THERAPY REDUCES BLOOD PRESSURE IN HYPERTENSIVE PATIENTS WITH CHRONIC KIDNEY DISEASE: 12-MONTH FOLLOW-UP
Authors: Wolak Talya , Lerman Amir , Glikson Michael , Sukholutsky Ivetta , Silberman Shuli , Lerman Lilach 
Published: May 2024

Objective:
Arterial hypertension (HTN) coexisting with chronic kidney disease (CKD) presents a significant global healthcare challenge, with limited effective clinical interventions. Electro-Hydraulic Acoustic Therapy (eHAT), a lower-energy modality vs. lithotripsy, emerges as a promising technique for relieving ischemia and promoting tissue regeneration. We hypothesized that eHAT would reduce blood pressure (BP) and preserve renal function in patients with hypertension and CKD.

Design and method:
Twenty medically treated patients with HTN and Stage IIIa/b CKD enrolled in this prospective, single-arm study were treated over 3-weeks with six eHAT sessions (2400 shockwaves/kidney; 0.09 mJ/mm2 at 2.66Hz; NephrospecTM, Curespec, Yehud, Israel). Follow-up (FU) visits at 1, 3, 6, and 12 months involved measurements of attended and unattended office BP, ambulatory BP and estimated glomerular filtration rate (eGFR).

Results:
The treatment was well tolerated. All BP measurements strongly tended to decline over 12 months and showed a similar pattern.(Table 1, Figs. 1-3), whereas eGFR was well preserved (Table 1, Fig. 4).

Conclusions:
Conclusion. eHAT is a tolerable and safe procedure and, moreover, a 3-week regimen tends to reduce BP and preserve eGFR in patients with HTN and CKD.
Therefore, eHAT may constitute a novel, safe, and non-invasive alternative therapeutic approach in the management of HTN in the context of CKD.
NIGHTTIME BLOOD PRESSURE ASSESSED USING HOME MONITORING IN HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES/PREDIABETES: ASSOCIATION AND AGREEMENT WITH AMBULATORY MONITORING
Authors: Ntousopoulos Vasileios , Kollias Anastasios , Bountzona Ioanna , Destounis Antonios , Menti Ariadni , Theodosiadi Aikaterini , Kyriakoulis Konstantinos , Stergiou George 
Published: May 2024

Objective:
To investigate the agreement between nighttime blood pressure (BP) measurements using home (HBPM) or ambulatory BP monitors (ABPM) in individuals with hypertension and type 2 diabetes mellitus (DM2) or prediabetes.

Design and method:
Adults with hypertension (treated or untreated) and DM2 or prediabetes underwent ABPM (measurements at 20 minutes intervals, Microlife WatchBP03) and HBPM (duplicate morning/evening measurements for 7 days, 3 nights with 3 measurements/night, Microlife WatchBP Home-N). Nighttime hypertension was defined as BP >= 120/70 mmHg (systolic/diastolic). Nighttime BP dipping was calculated as the ratio of nighttime BP decline to the daytime levels. Individuals with nighttime BP dip (systolic and/or diastolic) <10% were classified as non-dippers.

Results:
Data from 113 participants were analyzed (mean age [SD] 65±9.1 years, 67% men, body mass index 30.7±4.8 kg/m2, 84% with DM2, 22% cardiovascular disease, 94% treated hypertension). Average daytime HBPM was 129.2±13.2/73.3±7.8 mmHg and ABPM 126.7±12.1/72.5±7.4 mmHg (systolic/diastolic, p<0.01/p=NS), whilst nighttime HBPM was 115.3±13.1/63.6±7.6 mmHg and ABPM 113.9±13.4/63±7.1 mmHg (systolic/diastolic, p<0.05/p=NS). Strong correlation was observed between HBPM and ABPM levels: daytime r=0.71/0.74 and nighttime 0.86/0.78, systolic/diastolic, p<0.01)]. Good agreement was also found between ABPM and HBPM in diagnosing nighttime hypertension (81%/90%; kappa=0.55/0.70 systolic/diastolic). Among the participants, 32%/31% were classified as non-dippers (HBPM/ABPM, p=NS), with a 74% agreement (kappa=0.41) in detecting non-dippers.

Conclusions:
These preliminary findings indicate that in individuals with hypertension and DM2 or prediabetes, nighttime BP assessed by a novel home monitor is feasible and shows strong correlation and satisfactory agreement with reference ABPM in detecting nighttime hypertension and non-dipping.
MICROWAVE TISSUE DIGESTION AND FLAME ATOMIC ABSORPTION SPECTROSCOPY FOR MEASURING TISSUE SODIUM CONTENT IN HYPERTENSIVE AND CARDIOVASCULAR RISK PATIENTS
Authors: Van Duin Robert , Oppelaar Jetta J. , Heisel Annalena G.U. , Annor Ataa Akua Kromo , Wouda Rosa , Van Zuilen Kirsten , Naessens Daphne M.P. , De Vos Judith , Bakker Erik Ntp , Hagner Matthias , Conradt Frieder , Engberink Rik H. Olde , Vogt Liffert 
Published: May 2024

Objective:
Skin sodium accumulation has been demonstrated in hypertensive patients and may contribute to the pathophysiology of hypertension. Various methods are available for measuring tissue sodium content. However, the accuracy and reproducibility of these methods remain unknown. Dry ashing is the most used digestion method, but is expensive, time consuming and has a risk of incomplete digestion. This study compared microwave digestion, dry ashing, and two electrolyte quantification methods for quantifying tissue sodium and potassium.

Design and method:
We compared microwave digestion (Ethos LEAN Compact Microwave Digestion System, Milestone SRL) and dry ashing (Nabertherm S27) as sample preparation methods, and flame atomic absorption spectroscopy (FAAS, Model 425 Flame Photometer, Sherwood Scientific) and inductively coupled plasma optical emission spectrometry (ICP-OES, Varian 720-ES, Varian Inc.) as electrolyte quantification methods. Skin and muscle samples were obtained from rats and mice, and human skin samples were used. Tissues biopsies were cut in three pieces and digested separately. The methods were compared using interclass correlation coefficient (ICC) and Bland-Altman analysis. The third piece of tissue was microwave-digested by another operator to test inter-operator reproducibility by calculating the ICC and absolute overall mean difference.

Results:
With microwave digestion and FAAS median (IQR) human skin concentration was 114.8 (99.2-157.0, n=12) mmol/L, confirming tissue sodium storage. When including all tissues, FAAS and ICP-OES showed high agreement for sodium (ICC 0.98, bias -0.00008 mmol/g, n=141 and potassium (ICC 0.98, bias -0.005 mmol/g, n=141). Microwave digestion and ashing showed agreement for sodium (ICC 0.93, bias -0.002 mmol/g, n=61) and potassium (ICC 0.93, bias -0.02 mmol/g, n=61). The inter-operator agreement was good for sodium (ICC 0.95, absolute mean difference (SD) 0.044 mmol/g (0.073), n=70) and potassium (ICC 0.96, absolute mean difference (SD) 0.031 mmol/g (0.032), n=70).

Conclusions:
Microwave digestion with FAAS is a reliable and consistent method for sodium and potassium trace analysis in animal and human tissues compared to ashing and ICP-OES, respectively. This method showed more quantification of cations than the most frequently reported method, representing an easier, and less time-consuming way to quantify tissue sodium in hypertension and cardiovascular research.
HYPERTENSION, UNCONTROLLED HYPERTENSION AND RESISTANT HYPERTENSION: PREVALENCE, COMORBIDITIES AND PRESCRIBED MEDICATIONS IN 228,406 ADULTS RESIDENT IN URBAN AREAS. A POPULATION-BAS
Authors: Sartorio Andrea , Romano Simone , Rigon Giulio , Albrigi Martina , Tebaldi Giacomo , Cristin Luca , Burrei Giulia , Fava Cristiano , Minuz Pietro 
Published: May 2024

Objective:
Although hypertension is the leading cause of cardiovascular disease and premature death worldwide, it remains difficult to control. The prevalence of uncontrolled and resistant hypertension (RH) may be underestimated and can reach up to 50% of all hypertensive patients. The aim of this observational study was to analyze the prevalence of hypertension, uncontrolled hypertension and RH, and their associations with risk factors or diseases in a large cohort of patients referred to primary care physician.

Design and method:
In a population of 228406 adults, we only collected data from people with a diagnosis of arterial hypertension for a total of 43,526 patients. For this purpose, we used the MySQL database, run by Azalea.NET, built on the medical records of 150 General Practitioners (GPs). Patient data included sex, age, blood pressure (BP) values, number of antihypertensive drugs and presence of major cardiovascular comorbidities. We classified patients with RH as those treated with 3 different antihypertensive agents, with recorded BP greater than or equal to 140/90 mmHg, or patients taking 4 or more medications.

Results:
The prevalence of hypertension was 19.06%, that of resistant hypertension was 2.46% of the whole population and 20.85% of the hypertensive group. Thirteen thousand hundred, forty-six patients (30.20% of the hypertensive group) had uncontrolled BP (greater than or equal to 140/90 mmHg), whereas 16,577 patients did not have BP measurements done in the last 2 years (38.09% of the hypertensive group). Patients with uncontrolled BP were mainly female, used less drugs and showed a lower prevalence of all major cardiovascular comorbidities, except for diabetes. Instead, patients with RH had a significantly higher prevalence of all considered comorbidities compared to those without RH.

Conclusions:
Our results evidence that a broad number of patients with hypertension, especially those without comorbidities or with a low number of antihypertensive drugs, do not achieve adequate BP control. To improve the clinical management of these patients it is very important to increase the collaboration between GPs and clinical specialists of hypertension.
ANTIHYPERTENSIVE DRUG THERAPY AND RISK OF DEMENTIA: REAL-WORLD EVIDENCE FROM A LARGE OLD POPULATION
Authors: Rea Federico , Corrao Giovanni , Mancia Giuseppe 
Published: May 2024

Objective:
Evidence exists that lowering high blood pressure reduces the risk of dementia. However, the generalizability of this evidence to very old and frail patients remains uncertain. The aim of this study was to evaluate the protective effect of adherence to antihypertensive treatment on the risk of dementia in a large and heterogeneous general population.

Design and method:
A nested case–control study was carried out by including the cohort of 215,547 patients from Lombardy (Italy), aged >=65 years, who started antihypertensive drug therapy during 2009-2012. Cases were the 13,812 patients who developed dementia or Alzheimer’s disease during follow-up (up to 2019). Up to five controls were selected for each case. Adherence to drug therapy was measured by considering the proportion of days of the follow-up covered by the drug prescriptions. Conditional logistic regression was used to model the risk of outcome associated with adherence to antihypertensive drugs. Sensitivity analyses were performed to account for possible sources of systematic uncertainty.

Results:
The incidence of dementia showed a progressive increase with age, while the incidence of Alzheimer’s disease showed the highest incidence among patients aged 80-84 years. Progressive increase in adherence to treatment was associated with a progressive decrease in the risk of dementia. Compared to patients with very low adherence, those with high adherence exhibited a 24% risk reduction. This was also the case in each stratum of sex, age, and clinical status, including very old subjects (>=85 years) and those characterized by a very high risk of early mortality (36% at 1 year). Similar results were obtained when outcomes were decomposed, i.e. Alzheimer’s disease and other dementias were separately analysed.

Conclusions:
In elderly hypertensive patients from a general population, increased adherence to antihypertensive drugs was associated with a reduction in the risk of dementia regardless of the patients’ clinical status and age.
COMPARING BLOOD PRESSURE CONTROL TARGETS GLOBALLY: AN ANALYSIS OF THE MAY MEASUREMENT MONTH 2022 CAMPAIGN IN 60 COUNTRIES
Authors: Beaney Thomas , Kerr Gabriele , Schlaich Markus , Schutte Aletta , Stergiou George , Poulter Neil 
Published: May 2024

Objective:
Many contemporary hypertension guidelines recommend controlling blood pressure (BP) to less than 130/80 mmHg in most people, but it is unclear how control rates compare globally to the hitherto ubiquitous control target of 140/90 mmHg. In this analysis, we compare global and regional BP control rates based on targets of 140/90 mmHg versus 130/80 mmHg from the latest May Measurement Month 2022 (MMM22) campaign, an opportunistic screening campaign which aims to raise awareness of BP.

Design and method:
In MMM22, adults aged 18 years or over were screened via convenience sampling in 60 countries using a single standardised protocol. Three seated BP measurements were taken, and a questionnaire was administered collecting information including demographics, co-morbidities and antihypertensive medication use. Hypertension was defined as systolic BP 140 mmHg or more, and/or diastolic BP 90 mmHg or more, based on the average of the second and third BP readings, or the taking of antihypertensive medication. Multiple imputation using chained equations was used to estimate BP readings, where missing for any participant.

Results:
A total of 765,718 participants were screened during MMM22, of whom 282,488 (36.9%) were hypertensive. Of those with hypertension 51.4% were on antihypertensive medication, of whom 52.7% were taking only a single drug. Of those on antihypertensive medication, 54.2% had BP <140/90 mmHg and 28.2% had BP <130/80 mmHg. Of all hypertensives, 27.8% had BP <140/90 mmHg and 14.5% had BP <130/80 mmHg. There were large differences between regions, ranging from 13.5% of those on medication being controlled to <130/80 mmHg in South-East Asia and Australasia, to 37.4% in Europe.

Conclusions:
MMM22 identified significant numbers of people worldwide with inadequately treated hypertension. Of those treated for hypertension, only half were controlled to <140/90 mmHg and less than one third to the stricter target of <130/80 mmHg. Most of those on antihypertensive medication were prescribed only a single drug class, highlighting the scope for achieving better control using antihypertensive drug combinations as recommended by current guidelines.
COMPUTATIONAL FLUID DYNAMIC SIMULATIONS TO ASSESS HEMODYNAMICAL SIGNIFICANCE OF FIBROMUSCULAR DYSPLASIA–RELATED RENAL ARTERY STENOSIS: A FEASIBILITY STUDY
Authors: Soliveri Luca , Stoenoiu Maria Simona , Bozzetto Michela , Meris Francesco , Robberechts Tom , Remuzzi Andrea , Caroli Anna , Persu Alexandre 
Published: May 2024

Objective:
Fibromuscular dysplasia (FMD), is a potentially curable cause of renovascular hypertension occurring predominantly in women. Percutaneous angioplasty is the recommended treatment in young patients with hemodynamically significant stenosis. Unfortunately, there is currently no established non-invasive method to estimate pressure gradients and thus the hemodynamical impact of FMD-related stenosis. The aim of our study was to assess the feasibility of an image-based computational fluid dynamic (CFD) method for non-invasively assessing fractional flow reserve (FFR) and trans-stenotic pressure gradients in patients with FMD-related renal artery stenosis.

Design and method:
For each subject included in the study a 3D model was reconstructed from CT images and CFD simulations were performed using SimVascular software, as shown in Figure 1a. A steady state aorta inflow, derived from peak-systolic velocity measurements and scaled according to the vessel cross-section, was imposed. The aorta-outlet resistance was calibrated to match the pressure measurements obtained from each patient. The resistances at the end of renal arteries were calculated based on peak-systolic velocities measured by ultrasound. FFR (distal pressure/proximal pressure) and pressure gradients were assessed across each renal artery.

Results:
The analysis included 10 women, 6 with FMD-related stenosis (30-63 years, 2 focal and 4 multifocal) and 4 controls: 2 with atherosclerotic renal artery stenosis (58 and 64 years) and 2 healthy subjects (50 and 51 years). Representative examples of pressure CFD findings are shown in Figure 1b. The results of FFR and pressure gradients for each of the 10 subjects (20 arteries) are shown in Table 1. A wide range of FFRs (0.57 to >0.95) and pressure gradients (up to 73 mmHg) was observed, with values consistent with visually estimated severity of lesions.

Conclusions:
The proposed CT-to-CFD pipeline represents a promising non-invasive approach to assess the hemodynamical significance of FMD-related artery stenosis and may thus inform on the need for revascularization. Future studies involving catheter-based pressure gradient measurements are needed to validate the proposed pipeline. Besides pressure gradients, FFR measurements may represent an interesting parameter to evaluate the need for revascularization, as was shown in coronary arteries.