bluuebunny/crossref_metadata_2025_split huggingface dataset:
EXERCISE AS MEDICINE; CHRONOTHERAPY IN HYPERTENSION MANAGEMENT
Authors: Rayamajhi Supratik , Currie Katharine , Mcmohan Jill , Duwadi Ayushma , Tonson Anne , Joshi Amey 
Published: May 2024

Objective:
Adequate blood pressure regulation is a critical target in the management of hypertension and CVD. Circadian rhythms are increasingly recognized for their impacts on health outcomes including vascular function and metabolism. We posited that optimized exercise combined with chronotherapy will lead to meaningful improvements in BP, vascular health, and cardiovascular outcomes by coordinating the timing of interventions with diurnal rhythms.

Design and method:
Our studies, funded by National Institute of Health (NIH), are focused on ambulatory BP monitoring (ABPM) to capture circadian variations in BP, including nocturnal BP and morning surge. In particular, the project focuses on the efficacy of physical activity to improve nocturnal BP. We are using a 48-hr period of ABPM to reliably access nocturnal BP, which has not been implemented in other exercise studies focusing on ambulatory BP, in addition to measuring sleep with actigraphy. Given nocturnal BP is recognized as a strong indicator of cardiovascular health and outcomes, examining how interventions modify this ambulatory BP outcome is needed to understand the effect of the intervention on health and future risk.

Results:
Our preliminary data on all non-Hispanic 22 female subjects included 7 African Americans with average age of 68 and average BMI of 30.6. Mean seated BP (all BP values reported in mm of Hg) was 135/73 while awake BP from ABPM was 135/76 and awake central BP (calculated with device using a proprietary algorithm) was 126/78. Mean asleep BP determined from analysis of wrist actigraphy data was 117/61 and mean asleep central BP was 112/64. Mean nocturnal BP (calculated by average of the 4 lowest systolic blood pressure measures during the asleep period, waiting at least 1 hour after going to bed) was 116.7/61.6. Average nocturnal systolic dip was 30.4 and nocturnal diastolic dip was 14.4 with percentage nocturnal dips at 20.3% and 14.2% respectively.

Conclusions:
In our preliminary results, we found that evening exercise as chronotherapy in hypertensive post-menopausal patients showed significant nocturnal dipping of blood pressure.
OVERWEIGHT AND OBESITY AND ITS ASSOCIATION WITH HYPERTENSION IN COLOMBIA: PURE COHORT
Authors: Montoya Isabela Gomez , Uribe Maria Gabriela Ruiz , Quiñones Daniela Hernandez , Bello Daniel Martinez , Mayorga Maritza Perez , Lopez-lopez Jose Patricio , Lopez-jaramillo Patricio 
Published: May 2024

Objective:
To assess the association between overweight and obesity with blood pressure levels and incident hypertension in a prospective cohort with 12 years of follow-up.

Design and method:
Individuals aged 35 to 70 years from the Prospective Urban Rural Epidemiology Colombia cohort study were included. Participants with a history of hypertension and diabetes at baseline were excluded. Overweight and obesity was defined as a body mass index (BMI) greater or equal to 25 kg/m2. Blood pressure (BP) was measured at baseline and every 3-year follow-up. Hypertension was defined as a self-reported history of hypertension, baseline systolic BP greater or equal to 140 mmHg, diastolic BP greater or equal to 90 mmHg, or use of BP-lowering medications. Overweight and obese participants were propensity score matched using a 1:1 ratio with non-overweight participants. We used conditional logistic regression to evaluate the association between overweight, obesity, and hypertension, calculating the odds ratio and a 95% CI. Systolic BP and diastolic BP were analyzed in a linear mixed model as response variables, with matching pairs as random effects. The regression models were adjusted by sex, age, physical activity, tobacco use, alcohol use, education, waist-hip ratio, the alternative healthy eating index score, grip strength adjusted by weight, triglyceride-glucose index, and systolic BP at baseline. We established a p-value of <0.05 as significant.

Results:
Of 7500 participants, 1146 were matched, obtaining 573 pairs. The mean BMI was 25.2 kg/m2 (SD 4.02). The frequency of women was higher in the overweight group (68.1% vs. 60.9). The baseline SBP in overweight participants was 116.92 (SD 12.62) and 118.30 (SD 11.74) in non-overweight. 37.2% of overweight participants developed hypertension, but only 29.7% in non-overweight at follow-up. There was a 32% higher risk of hypertension in overweight participants (OR 1.32 95% CI:1.08-1.61). Being overweight and obese was associated with a higher increase in SBP of 2.53 mmHg (CI: 0.74-4.31) and DBP levels of 2.80 mmHg (CI: 1.68-3.93) at follow-up.

Conclusions:
Overweight and obesity, independently of other risk factors were associated with increased hypertension incidence and with higher SBP and DBP levels at 12 years of follow-up.
EFFICACY OF A PSYCHOTHERAPEUTIC GROUP ON PATIENTS WITH OBESITY AND HYPERTENSION
Authors: Gabos Priscila , Watanabe Danielle , Bortolotto Luiz 
Published: May 2024

Objective:
To evaluate the effectiveness of (brief obesity group therapy) BOG as a psychological treatment compared to a control group (CG) in reducing weight, BMI and blood pressure and metabolic profile in patients with obesity and heart disease. To evaluate the effectiveness of the BOG on improving repertoires for coping with stressful situations related to obesity. Verify changes in behaviors that cause emotional suffering and relief from suffering based on the perception of participating patients.

Design and method:
Controlled clinical trial with patients with obesity and cardiovascular (CV) disease (hypertension, coronary artery disease and/or heart failure). Method: Clinical data (weight, BMI, blood pressure (BP), blood glucose, cholesterol levels, triglycerides) were collected from the electronic medical records before and after the intervention in BOG e CG. Quantitative variables (clinical data and coping strategies) expressed by means and standard deviations were compared by the T-Student test. Qualitative variables (behaviors causing emotional suffering, emotional reactions) were analyzed by thematic content analysis and Wilcoxon test

Results:
Thirty-eight patients with obesity and CV disease were studied, 19 for each group. After the BOG group therapy, there was a significant (p<0.05) reduction in BMI, weight, and systolic BP of the patients (Before: 39±6 kg/m2, 102±22 kg, 149±24 mmHg vs. after 34±7 kg/m2, 91±24 kg, 132±13 mmHg). In CG, there was a significant (p<0.05) increase in BMI, weight and systolic BP (Before: 35±5 kg/m2, 91±27 kg, 161±28 mmHg vs. after 36±5 kg/m2, 93±21 kg, 171±31 mmHg). We did not observe significant differences in laboratory variables in both groups. It was observed an improvement in the use of active coping, positive reinterpretation and self-distraction and a reduction in the use of maladaptive copings of self-blame, denial and behavioral disinvestment. A reduction in negative feelings, an increase in positive feelings and an attenuation of the desire to eat were identified.

Conclusions:
BOG was effective and brought clinical benefits in patients with obesity and CV disease, with significant reductions in weight, BMI and systolic BP, in addition to improvements in psychological aspects. It should be considered as a psychological treatment.
OBESITY AND VITAMIN D INSUFFICIENCY IN HYPERTENSIVE PATIENTS
Authors: Cherif Abdelghani Bachir , Bennouar Salam 
Published: May 2024

Objective:
Our objective was to study the association between obesity and vitamin D status and to compare vitamin D levels before and after supplementation according to weight status in hypertensive patients.

Design and method:
A retrospective cohort study, involving 1455 patients. Student's paired-samples t-test was used to compare vitamin D levels before and after supplementation. The Pearson Correlation “r” test was used to analyze the correlation between vitamin D, anthropometric indices (body mass index (BMI) and waist circumference (WC)) and systole blood pressure (SBP).

Results:
A negative correlation was noted between the anthropometric indices (BMI and WC) and the vit D level. A highly significant variation was reported between the level of 25(OH) D before and after supplementation (p<0.001), however, the response to vitamin D supplementation in obese patients was significantly lower than in normal weight subjects. The univariate analysis showed a significant association between obesity and male gender (p = 0.02), SBP (p = 0.08), the cumulative number of cardiovascular risk factors > 5 (p = 0.07). The multivariate analysis showed a significant association between obesity and male gender (p = 0.02), SBP (p = 0.08), the cumulative number of cardiovascular risk factors > 5 (p = 0.07). presence of obesity (p=0.01) and SBP more 150 mmhg (p=0.03) were predictor factors of poor response to vit D supplementation.

Conclusions:
Vitamin D deficiency is very common in obese subjects, specific recommendations for supplementation should be adopted according to body weight, diabetes and hypertension.
U-SHAPED ASSOCIATION OF WEIGHT-ADJUSTED-WAIST INDEX AND ARTERIAL STIFFNESS AMONG US HYPERTENSIVE PATIENTS: A POPULATION-BASED STUDY
Authors: Wei Taotao , Lin Xin , Yu Jing 
Published: May 2024

Objective:
The weight-adjusted-waist index (WWI) is an innovative measure of obesity that appears to surpass body mass index (BMI) in assessing lean body mass and fat mass. This study aimed to evaluate the relationship between WWI and arterial stiffness in hypertensive adults in the United States.

Design and method:
This study included 9,753 adults diagnosed with hypertension from the National Health and Nutrition Examination Survey (NHANES) spanning from 2007 to 2016. The WWI was computed by dividing waist circumference (WC) by the square root of body weight, with arterial stiffness (represented by estimated pulse wave velocity, ePWV) as the outcome. Weighted multiple linear regression and smooth curve fitting were used to test for linear and nonlinear associations. Threshold effects were determined using a two-part linear regression model. Additionally, subgroup analyses and interaction tests were conducted.

Results:
Among the participants included, the mean WWI was 11.32 ± 0.76. After multivariable adjustment, WWI showed a significant nonlinear association with ePWV. A U-shaped association between WWI and ePWV was observed. Specifically, WWI below the threshold (WWI < 10.41) was negatively associated with arterial stiffness [β=-0.50, 95%CI:(-0.57, -0.43)], while WWI above the threshold (WWI > 10.41) was positively associated with arterial stiffness [β=0.09, 95%CI:(0.07-0.11)].

Conclusions:
Our study indicates a U-shaped association between WWI and arterial stiffness among hypertensive adults in the United States. However, this needs to be confirmed in large clinical trials.
WEIGHT LOSS IN HYPERTENSIVE PATIENTS WITH OBESITY UNDER THE INFLUENCE OF LIRAGULTIDE IS ASSOCIATED WITH A REDUCTION IN INSULIN RESISTANCE AND INCREASED EFFECTIVENESS OF THERAPY
Authors: Koval Sergiy , Rieznik Larisa , Starchenko Tetyana , Penkova Marina , Lytvynov Vadim 
Published: May 2024

Objective:
One of the most important areas of treatment for patients with arterial hypertension (AH) with abdominal obesity (AO) is reduction of body weight (BW), which can be achieved using the glucagon-like peptide-1 (GLP-1) receptor agonist liraglutide. Objective: to study the relationship between the degree of weight loss under the influence of liraglutide and the effectiveness of antihypertensive and lipid-lowering therapy in hypertensive patients with AO.

Design and method:
42 patients with AH of 2-3 degrees and AO of I-II degrees (24 men) aged from 46 to 60 years were examined using standard methods. Insulin resistance (IR) was determined by HOMA-IR. All patients received three-component antihypertensive therapy (a fixed combination of perindopril, indapamide and amlodipine) and, due to elevated low-density lipoprotein-cholesterol (LDL-C), atorvastatin in optimal doses. Liraglutide was administered as daily subcutaneous injections at a daily dose of 0.6 mg, with a gradual weekly dose increase of 0.6 mg to reach 3.0 mg/day. The duration of observation was 16 weeks.

Results:
After 16 weeks of treatment with liraglutide, 30 patients (71%) (the first subgroup) experienced a decrease in BW of 5% or more compared to baseline. At the same time, in 13 patients (29%) (second subgroup) BW decreased by less than 5% compared to the initial level or did not decrease. In the first subgroup of patients, a significant decrease in IR was detected from (5.06 ± 1.14) to (2.40 ± 1.22), p<0.05), whereas in the second subgroup the IR indicator did not change significantly. Among patients of the first subgroup, a significantly higher frequency of achieving target levels of “office” blood pressure (in 100% of patients) and target levels of LDL-C (in 73% of patients) was found in comparison with patients of the second subgroup (in 69% of patients, p<0.05) and in 39% of patients, p<0.05), respectively).

Conclusions:
A pronounced decrease in BW in hypertensive patients with AO under the influence of liraglutide is associated with a significant decrease in IR and also with a significant increase in the effectiveness of both antihypertensive and lipid-lowering therapy.
DEPRESSIVE SYMPTOMS AND MULTIPLE CHRONIC CONDITIONS:FINDINGS FROM THE CHINA HEALTH AND RETIREMENT LONGITUDINAL STUDY ON AGING AMONG MIDDLE-AGED AND OLDER ADULTS
Authors: Ma Weiping , Zhu Huarui , Zhang Ling 
Published: May 2024

Objective:
This study aimed to explore the risk associations of depressive symptoms with hypertension, diabetes mellitus, hyperlipidemia, heart disease, and stroke among Chinese middle-aged and older adults and to provide a scientific basis for screening high-risk groups for chronic diseases.

Design and method:
A total of 8,255 middle-aged and older adults from the China Health and Retirement Longitudinal Study (CHARLS) in the 2020 waves were included. Depressive symptoms were measured using the 10-item version of the Center for Epidemiological Studies Depression Scale (CESD-10). The association between depressive symptoms and multiple chronic diseases was assessed using multivariable logistic regression analysis.

Results:
The mean age of the 8255 included subjects was (59.12±8.93) years and the detection rate of depressive symptoms was 25.34%. The differences in the detection rate of depressive symptoms among middle-aged and elderly people of different gender, age, living conditions, marital status, smoking status, alcohol consumption, and types of diseases such as hypertension were statistically significant (P<0.05). After adjusting for several variables, Logistic regression analysis showed that the associations between depressive symptoms and heart disease (OR=2.108, 95% CI: 1.601-2.775), diabetes mellitus (OR=1.396, 95%CI: 1.009-1.932), and stroke (OR=1.929, 95%CI: 1.028-3.622) were statistically significant (P < 0.05), whereas no significant association was found between depressive symptoms and hypertension and hyperlipidemia (P>0.05).

Conclusions:
The data showed that depressive symptoms were significantly associated with chronic diseases, including diabetes, heart disease, and stroke, suggesting that necessary measures should be taken to reduce the occurrence of depressive symptoms and the prevalence of multiple Chronic diseases, improve the mental condition of middle-aged and elderly people, and improve their quality of life.
OCCUPATIONAL THERAPY COMBINED WITH ADAPTED PHYSICAL ACTIVITY IN FRAIL ELDERLY SUBJECTS PRESENTING COMORBIDITY WITH HYPERTENSION
Authors: D’Amico Ferdinando , Grasso Rosetta , D’Amico Rossella 
Published: May 2024

Objective:
The study investigates the effectiveness of a home care project combining occupational therapy and adapted physical activity in frail elderly patients presenting comorbidity with hypertension.

Design and method:
33 elderly patients treated for hypertension in either mono/combined therapy have been examined (15 Males - 18 Females - mean age 79 + 4 years). The design of the study included before and after a 12-month-monitoring: 1) Clinical blood pressure measurement (PA); 2) Ambulatory blood pressure monitoring (ABPM); 3)Echocardiography; 4)Cumulative Illness Rating Scale (CIRS); 5) Short Physical Perfomance Battery (SPPB). CIRS stood for all diseases scoring 3 or more. SPPB combined results of balance tests-gait speed-chair stand showing frailty for scores between 5 and 9. Frail subjects alternated the adapted physical activity with a 3-day-per-week occupational therapy programme aimed at strengthening balance&walking and monitored by an occupational therapist via telephone.

Results:
21 subjects (M 10, F 11) scored 7.5 in SPPB (Group A); 12 subjects (M 5, F 7) scored 10.2 (Group B). Clinical BP measurement showed prevalence of uncontrolled hypertension (PAS 160±3-PAD 96±34 mmHg, p<0.005) in group A (frail subjects after SPPB evaluation). In monitoring before and after the functional examination we evaluated: 1) BP: SBP 158+21 vs 138+14 mmHG (p<0.01), DBP 96+12 vs 88+10 mmHg (p<0.01)-2) PP 74.12+2 vs 57+4 mmHg (p<0.05)-3) LVM 133/110 gr/m2 vs LVM 130/110 gr/m2, LVM/h > 58/45 gr/h 2.7 vs LVM/h > 55/45 gr/h 2.7 (0.01)-4) SPPB 7.5 vs > 8.6 scores in the frail subjects group.

Conclusions:
The adapted physical excercise programme applied to elderly subjects suffering from hypertension resulted in a combined PP-LVM control. The combined medication and adapted excercise-occupational therapy determined both PP-LVM control and strengthening of physical ability in frail elderly subjects presenting comorbidity with hypertension.
BLOOD PRESSURE VARIABILITY AND FRAILTY IN THE OLDER PEOPLE: THE HYPER-FRAIL-BPV STUDY
Authors: Croce Alessandro , Bilo Grzegorz , Pengo Martino F , Zambon Antonella , Soranna Davide , Riccò Alice , Ornago Alice Margherita , Bellelli Giuseppe , Parati Gianfranco 
Published: May 2024

Objective:
Blood pressure (BP) exhibits considerable variability that tends to increase with age. Frailty is a geriatric syndrome characterized by a reduction in physiological functional reserve and ability to maintain homeostasis, resulting in an increased vulnerability to adverse events. Frailty prevalence increases with age therefore BP variability (BPV) can be significantly increased in older frail patients. Nevertheless, the management of hypertension in older and frail patients has received little attention in the literature and represents an unresolved clinical question. We aimed to evaluate short term BPV in a cohort of elderly hypertensive patients and evaluate its association with frailty.

Design and method:
In this monocentric cross-sectional study we recruited hypertensive patients aged 75 years or older, evaluated at the Hypertension Center of Istituto Auxologico italiano IRCCS from May 2022 to August 2023. All patients underwent 24-hour blood pressure monitoring and a comprehensive geriatric assessment. Frailty was assessed through the Frailty Index (FI) according to the Rockwood's accumulation model. Based on the FI patients were classified as Fit (FI < 0.15), Pre-Frailty (0.15 < FI < 0.25) or Frailty (FI > 0.25).

Results:
131 patients were recruited and a total of 106 patients were analysed because of missing data. The median age was 80 years [76-83], included patients were predominantly females (73%). Overall, 23 were fit, 50 in the pre-frailty category and 33 were frail. For each of the 7 systolic BPV indices considered, we fitted a multivariable linear model to estimate their relationship with continuous FI adjusting for age, sex, BMI, short physical performance battery, mini mental state examination, presence of falls in the last year, median 24h systolic blood pressure, mean diastolic 24h blood pressure and mean 24h heart rate. A significant positive association was observed only for SD night as depicted in Table 1.

Conclusions:
Nighttime BPV was associated with frailty in a cohort of elderly hypertensive subjects. The mechanisms behind this association and its impact on cardiovascular risk stratification in elderly patients should be further investigated.
UNVEILING THE GAPS: HYPERTENSION CONTROL BEYOND THE CASCADE OF CARE FRAMEWORK
Authors: Silberzan Lena 
Published: May 2024

Objective:
While the cascade of care framework established a typical “aware-treated-controlled” path to hypertension control, less is known about alternative paths to hypertension control.
This study aimed to: (i) Identify untypical paths to hypertension control; (ii) Assess social factors associated with untypical hypertension control scenarios.

Design and method:
This analysis included 170,263 French adults aged 25-69 in CONSTANCES population-based epidemiological cohort between 2012 and 2020. Blood pressure (BP) measurements following a standardized protocol during clinical examinations and hypertension history were obtained at inclusion. Pharmacological treatment data were collected from the Système National des Données de Santé (SNDS) database. Hypertension was defined by systolic BP>140/90 mmHg and/or antihypertensive treatment. Awareness, treatment, and control were assessed through participant declarations, reimbursement for antihypertensive drugs, and BP measurements, respectively. Social factors and cardiovascular morbidities associated with untypical control paths were examined using logistic regressions.

Results:
In our study, 30.8% (n=52,434) of respondents had hypertension. While the care cascade identified 13% of hypertensive respondents achieving control, this percentage rose to 19% when considering the alternative “unaware-treated-controlled” path (n=9,980). Consequently, one-third of hypertension control was not captured by the typical cascade framework.
The untypical path to control was associated with female gender (adjusted odds ratio [aOR], 1.68 [95% confidence interval (CI), 1.52-1.86]), younger age (aOR1-unit decrease, 1.08 [95% IC, 1.08-1.09]), higher education level (aORmost educated 1/4 vs less educated 1/4, 1.43 [95% IC, 1.25-1.64]), and comorbidity with another cardiovascular disease (aOR, 6.47 [95% IC, 5.79-7.23]). Northern African origin (aORvs Majority population, 1.32 [95% IC, 1.05-1.66]) was also positively associated with untypical control path, while Sub-Sahara African origin was negatively associated with untypical control path (aORvs Majority population, 0.46 [95% IC, 0.29-0.71]).

Conclusions:
This study underscores that adhering strictly to a sequential cascade of care approach may exclude socially characterized groups not fitting into defined categories. Revision of the cascade of care framework, incorporating diverse treatment modalities and recognizing potential patient reentries, is suggested to accurately assess hypertension control.