bluuebunny/crossref_metadata_2025_split huggingface dataset:
LEFT VENTRICULAR GEOMETRIC PATTERNS AND TRIGLYCERIDE–GLUCOSE (TYG) INDEX
Authors: Paini Anna , Bertacchini Fabio , Aggiusti Carlo , Stassaldi Deborah , Capellini Sara , Buso Giacomo , Gatta Roberto , Muiesan Maria Lorenza , Salvetti Massimo 
Published: May 2024

Objective:
Background and aim of the study: the triglyceride–glucose (TyG) index, an indirect index of insulin resistance, has been found associated to the development of heart failure (HF). Left ventricular hypertrophy and concentric geometry are associated to the future risk of cardiovascular events, including heart failure

Design and method:
In 1070 patients undergoing an echocardiogram and laboratory examinations at an ESH Excellence Centre for workup for suspect arterial hypertension (age 56±14 years, 49% males, 75% hypertensives (HT), among them 79% treated) left ventricular mass (LVM) and geometry were assessed. Subjects were divided into 4 LV geometric patterns according to the presence of an increased LV mass index (LVM/h2.7> 47 for females and and > 50 for males) and/or an increased relative wall thickness (RWT> 0.42).

Results:
After echocardiography subjects were classified as follows: 795(74%) with normal LV geometry (NG), 88 (8%) with concentric remodelling (CR), 143(13%) with eccentric hypertrophy (E_LVH) and 44 (4%) with concentric hypertrophy (C_LVH). The TyG was greater in males, in obese and in diabetic patients, and was significantly correlated with age, BMI, eGFR, systolic and diastolic blood pressure, LVM, LVMI and relative wall thickness. TyG remained significantly greater in patients with C_LVH as compared to both patients with NG and to patients with E_LVH, even after adjusting for multiple possible confounders (TyG: 8.5±0.6, 8.9±0.5, 8.6±0.6 and 9.0±0.7 and in patients with NG, CR, EH and CH respectively, ANOVA p < 0.05). The results did not change after excluding diabetic patients

Conclusions:
Conclusion: the triglyceride–glucose (TyG) index, an indirect index of insulin resistance is significantly associated to concentric LVH, independently of several possible confounders. These findings can explain at least in part the association between TyG and the risk of cardiovascular events.
AGE-RELATED BURDEN OF ARRHYTHMIA AND ITS ASSOCIATION WITH AMBULATORY BLOOD PRESSURE PROFILES AND CARDIOVASCULAR RISK LEVELS: RESULTS FROM THE TEMPLAR PROJECT
Authors: Lundwall Kristina , Kahan Thomas , Omboni Stefano 
Published: May 2024

Objective:
Arrhythmia without known AF can be dangerous in subjects >55 years, since silent atrial fibrillation (AF), premature supraventricular contractions (PACs), and premature ventricular contractions (PVCs) all account for worse cardiovascular (CV) prognosis. Blood pressure (BP) levels and variability are important for the development of arrhythmia and CV outcome and might mediate these relations. However, no studies are performed in younger subjects, where extrasystoles occur frequently.

Design and method:
We included 12827 individuals without known AF undergoing a 24h ambulatory BP monitor (ABPM) including an algorithm for AF screening. Misclassification of PACs as silent AF occurs but is rare for PVCs. The arrhythmia burden was defined as the percentage of measurements with possible AF (silent AF and/or PACs) during 24h. Age stratification: (1) 20-40, (2) 41-50, (3) 51-60, (4) 61-70, (5) 71-80, (6) 81-100 years; group sizes were 1050 to 3373 individuals.

Results:
In groups 1-3 there were independent relations between arrhythmia burden and lower systolic and diastolic BP (beta -0.06 to -0.13, p 0.05 to <0.001), lower heart rate (beta -0.07 to -0.18, p <0.001), positive nocturnal dipping pattern (beta 0.04 to 0.07, p 0.05 to 0.005), and lower age (beta -0.04 to -0.25, p 0.02 to <0.001). In group 3 less CV disease (CVD) was related to arrhythmia burden (beta 0.06, p<0.001). In contrast, groups 5 and 6 showed independent relations between arrhythmia burden and higher diastolic BP (beta 0.08 to 0.13, p<0.001), older age (beta 0.11 to 0.10, p <0.001), and (in group 6) higher heart rate (beta 0.10, p <0.001), and negative nocturnal dipping pattern (beta 0.10, p 0.002). CVD was related to arrhythmia burden in groups 4-6 (beta 0.09 to 0.10 p 0.002 to <0.001). For all age groups, systolic and diastolic BP variability was independently related to arrhythmia burden (beta 0.06 to 0.23, p 0.05 to <0.001).

Conclusions:
In individuals without known AF aged <60 years, arrhythmia burden during ABPM is related to a healthier BP profile and less CVD. In individuals without known AF aged >60 years, arrhythmia burden is related to an unfavorable ABPM profile and more CVD.
CORRELATION OF BLOOD PRESSURE AND CLINICAL PRESENTATION WITH ARTERIAL PHENOTYPE IN RENAL FIBROMUSCULAR DYSPLASIA: TOWARDS A NEW CLASSIFICATION OF LESIONS IN THE FEIRI COHORT
Authors: Robberechts Tom , Delmotte Philippe , Lopez-sublet Marilucy , Aparicio Lucas S , Gordin Daniel , Dika Zivka , Van Twist Daan J , Savard Sebastien , Zen Kan , Canning Caitriona , De Leeuw Peter , Minuz Pietro , Januszewicz Andrzej , Van Der Niepen Patricia , Stoenoiu Maria S , Persu Alexandre 
Published: May 2024

Objective:
Currently, fibromuscular dysplasia (FMD) lesions are classified binary as either focal or multifocal. This classification does not account for the observed anatomical variety and severity of lesions. In this study, we developed a more detailed classification and explored its correlation with clinical parameters.

Design and method:
Available renal FMD images (CTA, MRA or angiography) with matching clinical data (+/- 1 year from imaging) were extracted from the European/International FMD Registry (FEIRI). Images were analyzed blinded from clinical data and assigned to 6 categories: focal FMD (group 1), multifocal FMD with typical string of beads with (group 2) or without (group 3) significant narrowing between beads, mild arterial irregularities (group 4), lesions limited to 1-3 beads (group 5), and irregular dilatations (group 6). Relevant clinical data were compared between groups.

Results:
174 cases meeting the inclusion criteria were classified, predominantly group 1 (n=48), group 2 (n= 54) and group 3 (n=46). Groups 4-6 were not included in further analysis due to small sample sizes. A gradient of severity was documented across groups 1 to 3: compared to group 3, patients in group 1 and 2 were diagnosed younger with FMD (38.4 and 47.9 vs 53.5 years, p <0.001) and hypertension (32.9 and 37.0 vs 47.4 years, p<0.001), and had higher mean systolic (153.6 and 147.4 vs 136.0 mmHg, p=0.003) and diastolic BP (95.7 and 89.2 vs 83.1 mmHg, p=0.002), with similar number of antihypertensives. Revascularisation proportion was 87.5%, 59.3% and 19.6% in groups 1, 2 and 3 (p<0.001). In focal FMD, a significantly lower proportion of multivessel FMD and higher proportion of men were found compared to groups 2 and 3.

Conclusions:
Blinded analysis of the FEIRI imaging database confirms the differences between focal and multifocal FMD. More importantly, we introduce new subtypes in multifocal FMD, and show significant correlations between imaging phenotype and clinical parameters. This suggests that centralised analysis of images may predict the hemodynamic impact of lesions. After validation in a larger cohort, this classification may improve objective comparison of arterial lesions between and within FMD registries, as well as in clinical practice.
EFFECT OF HEART FAILURE AND ATRIAL FIBRILLATION ON CARDIORESPIRATORY FITNESS IN HEMODIALYSIS PATIENTS
Authors: Pella Eva , Boutou Afroditi , Boulmpou Aristi , Theodorakopoulou Marieta , Karagiannidis Artemios , Haddad Nasra , Iatridi Fotini , Tsouchnikas Ioannis , Papadopoulos Christodoulos , Vassilikos Vassilios , Sarafidis Pantelis 
Published: May 2024

Objective:
Heart failure (HF) and atrial fibrillation (AF) are highly prevalent in hemodialysis. They are well-known significant modifiers of the disease associations with cardiovascular outcomes, but there is a lack of evidence regarding the effects of HF and AF on cardiorespiratory fitness. This study is the first to examine the possible association of the presence of HF and AF with exercise intolerance in patients undergoing hemodialysis.

Design and method:
This analysis included 40 sex- and age-matched participants [10 hemodialysis patients with HF or AF, 10 hemodialysis patients without HF or AF, 10 patients with HF or AF without chronic kidney disease (CKD) and 10 healthy controls) that underwent CPET and spirometry examinations.

Results:
VO2peak (ml/min/kg) showed a graded increase between hemodialysis patients with HF or AF, hemodialysis patients without HF or AF, non-CKD patients with HF or AF and controls (13.17±2.45 vs 15.26±3.29 vs 19.64±5.84 vs 25.11±6.94 ml/min/kg, p<0.001); VO2peak (ml/min) followed the same pattern (1172±197 vs 1269±314 vs 1817±583 vs 1952±592 ml/min respectively, p=0.001). VO2peak (%predicted), VO2AT (ml/kg/min), VO2AT (ml/min) and maximal work load significantly differ between the study groups, with a tendency for higher values from hemodialysis patients to non-CKD patients with HF or AF and to healthy controls. FEV1 and FVC levels were similar between the study groups. In the whole population, VO2peak (ml/kg/min) showed a positive correlation with hemoglobin (r=0.663, p<0.001) and negative correlations with high-sensitivity cardiac troponin I (r=-0.493, p=0.001) and BNP (r=-0.479, p=0.002).

Conclusions:
Hemodialysis patients have low exercise tolerance, and the presence of HF or AF is associated with further decreased values of VO2peak, the most important determinant of cardiorespiratory fitness.
EFFECT OF RENAL DENERVATION ON BLOOD PRESSURE IN PATIENTS WITH CHRONIC KIDNEY DISEASE AND UNCONTROLLED HYPERTENSION: RESULTS OF A PROSPECTIVE RANDOMIZED SHAM-CONTROLLED STUDY
Authors: Schmieder Roland , Kannenkeril Dennis , Böhm Michael , Mahfoud Felix , Rump Lars C. , Stegbauer Johannes , Van Der Giet Markus , Schiffer Mario , Veelken Roland , Uder Michael , Schmid Axel 
Published: May 2024

Objective:
The activity of the sympathetic nervous system (SNS) is increased in patients with chronic kidney disease (CKD) and endovascular renal denervation (RDN) offers the opportunity to modulate SNS activity and thereby blood pressure.
Hypothesis: In patients with CKD stage 3 and uncontrolled hypertension, endovascular ultrasound-based RDN (uRDN) reduces 24-hour ambulatory BP without adverse safety events.

Design and method:
In a multicenter prospective randomized clinical trial, following the criteria of a blinded sham-controlled design, patients with CKD stage 3 and uncontrolled hypertension despite prescription of 1-5 antihypertensive medications were enrolled. Patients were randomly allocated to either endovascular uRDN using the Paradise™ Renal Denervation System (ReCor Medical, Inc., Palo Alto, CA, USA) or a sham procedure restricted to renal angiopgraphy alone. The primary endpoint was the change in mean 24-hour ambulatory systolic BP at 6 months while on stable medication. Secondary endpoints were changes of other 24h ambulatory BP values, office BP and safety parameters of uRDN. Blinding was to be maintained through 6 months. Due to slow recruitment through 2 years, the trial was prematurely stopped.

Results:
Of 25 randomized patients (mean age 67yrs), 20 subjects had a 6 month visit per protocol. Major cause of CKD was hypertension and/or type-2 diabetes (N=13). There was no difference in clinical characteristics (eGFR, UACR, BMI, HbA1c, comorbidities), pretreatment 24 hour/day/night ambulatory and office BP between the uRDN (N=10) and the sham group (N=10). After 6 months the decrease in 24h(and day) ambulatory diastolic BP was significantly greater in the RDN compared with the sham group (p=0.035 (and 0.030)). Within the uRDN group, 24 hour (and day) ambulatory diastolic BP decreased over time compared to pretreatment values, whereas in the sham group no changes occurred. Systolic ambulatory BP decreased numerically in the uRDN group, but was not significant. No safety concerns related to uRDN emerged.

Conclusions:
In this randomized sham-controlled blinded study, despite its premature stop leading to a small study cohort, we observed a decrease of diastolic BP after endovascular uRDN and no safety signals in these hypertensive patients with CKD.
FEASIBILITY STUDY TO ASSESS THE DELIVERY OF A NOVEL ISOMETRIC EXERCISE INTERVENTION FOR PEOPLE WITH STAGE 1 HYPERTENSION
Authors: Farmer Chris , Rees-roberts Melanie , Santer Ellie , O’Driscoll Jamie , Macinnes Douglas , Short Vanessa , Pellatt-higgins Tracy , Mills Ashley , Gousia Katerina , West Alan , Darby John , Borthwick Rachel , Doulton Timothy , Swift Pauline , Wiles Jim 
Published: May 2024

Objective:
Adherence is low to the lifestyle changes recommended by NICE for patients with hypertension. More easily adopted, effective and manageable exercise interventions are needed. This study determined the feasibility of personalised isometric exercise (IE) for patients with Stage (grade) 1 hypertension in the National Health Service (NHS) in England.

Design and method:
We conducted a multicentre randomised controlled feasibility study delivered through NHS primary/secondary care. Patients included were 18+, with clinic systolic BP (SBP)140-159mmHg, not on anti-hypertensive medication and without significant medical contraindications. Participants were randomised to standard lifestyle advice (control) or standard lifestyle advice plus wall squat IE for a 6-month period (intervention). After excluding people with average home systolic <135mmHg, 41 participants were included (control n=19, IE n=22) (aged 57 ± 15.15yrs). Participants were followed up at 4-weeks, 3-months, and 6-months.

Results:
Healthcare professionals were able to deliver the intervention with high fidelity (100% passed independent delivery check and 84.6% of participants recorded at least 2/3 of exercise heart rates within their target range over 6 months). A sample size for an efficacy trial (primary objective), was determined n= 542, based upon the 35% attrition rate and 14.4mmHg SD of change of SBP from baseline. Qualitative work provided valuable insights into acceptability, feasibility, delivery, and implementation in an NHS setting and for improved follow-on studies. Whilst the study was not powered to detect BP changes, reductions in SBP were observed at all time points.
Figure 1. Marginal means and 95% CI from ANCOVA (Per-protocol population)
Difference between means at each time point were:
4-weeks -2.31 mmHg (95% CI -11.29 to 6.67),
3 months -4.07 mmHg (95% CI, -10.28 to 2.15)
6 months -2.35 (95% CI -11.70-6.99).
Pilot economic analyses suggested the intervention is cost-effective.

Conclusions:
Feasibility of IE has been demonstrated, but deliverability without significant modifications to the wall squat IE prescription protocol due to current NHS constraints would not be possible. Findings support investigating effectiveness of the intervention and justify a full RCT. A sample size of n=542 is needed to establish effectiveness.
POTASSIUM-ENRICHED SALT EFFECTIVELY REDUCES SODIUM INTAKE IN THE NURSING HOME POPULATION OF NORTHERN CHINA: THE CHINA SALT TRIAL
Authors: Meng Xianmin , Dou Xiangfeng , Wei Hua , Li Weiwei , Zhao Jinguo , Zhao Sufang , Liu Yongjuan , Zhang Hongye , Liu Lisheng 
Published: May 2024

Objective:
to explore the promoting effect of long-term consumption of potassium-enriched salt (KCL/NACL=1:1) on dietary salt restriction in the nursing home population.

Design and method:
In northern China, a total of 29 nursing homes were selected using cluster random sampling. The nursing homes were divided into intervention group (using potassium-enriched salt in the dining room) and control group (using regular salt in the dining room). The usage of salt and high-sodium condiments in the dining room was recorded, including the amount of salt used and the number of diners. The average per capita daily sodium intake from condiments (TNA/PD) in the nursing home was calculated, as well as the average per capita daily sodium intake from dietary salt (SNA/PD). The two values were added together to calculate the total per capita daily sodium intake (ANA/PD).

Results:
Over 6 years, a total of 18,046 meals were consumed in the dining room. The intervention group demonstrated a significant reduction in per capita daily sodium intake (ANA/PD) compared to the control group (3.0 vs 5.0g). There was no statistically significant difference in per capita daily sodium intake from condiments (TNA/PD) between the two groups, but the intervention group exhibited a significantly lower per capita daily sodium intake from dietary salt (SNA/PD) compared to the control group (2.2 vs 4.1g). Furthermore, the intervention group consistently maintained a lower urine sodium-to-potassium ratio than the control group. By incorporating potassium-enriched salt, the intervention group achieved an average increase of 1.2±0.31g in daily potassium intake. Subgroup analysis of 24-hour urine results indicated that the intervention group had significantly lower urinary sodium excretion and higher potassium excretion. Following one year of using potassium-enriched salt, the estimated dietary salt intake in the intervention group decreased from approximately 15g to around 9g based on urinary sodium excretion.

Conclusions:
These findings suggest that the utilization of potassium-enriched salt can effectively reduce sodium intake without necessitating alterations in dietary habits.
ASSESSMENT AND MANAGEMENT OF PATIENTS WITH OBESITY AND HYPERTENSION IN EUROPEAN SOCIETY OF HYPERTENSION EXCELLENCE CENTRES. A SURVEY FROM THE ESH WORKING GROUP ON DIABETES AND META
Authors: Antza Christina , Grassi Guido , Weber Thomas , Persu Alexandre , Jordan Jens , Nilsson Peter , Redon Josef , Stabouli Stella , Kreutz Reinhold , Kotsis Vasilios 
Published: May 2024

Objective:
Healthcare providers are faced with an increasing number of patients with obesity and arterial hypertension. Preventing obesity-associated hypertension and appropriately managing patients with established disease are both important. Hence, the aim of our study was to evaluate the clinical care of patients with obesity and hypertension among ESH Excellence Centres (ECs).

Design and method:
We conducted a cross-sectional, worldwide 30-item survey through e-mails.

Results:
In total, 70 representatives of ECs participated (78% men) with 66% of them practicing medicine for more than 30 years and working in well-equipped clinics. Most were internists (41%) and cardiologists (37%) and 73% reported training on the management of obese patients with hypertension. A majority weigh their patients (77%) and evaluate patients for sleep disorders (93%). However, only 47% spend more than 5 min to advise for lifestyle modification in general, 59% for weight loss, 56% for salt intake and 64% for exercise. Finally, a minority of participants ask patients if they like their body (6%) or about previous attempts to lose weight (28%), evaluate 24h urinary sodium excretion rate (22%) and provide written (15%) or personalized (10%) dietary advices. If the patient suffers also from type 2 diabetes mellitus, 66% switch treatment to GLP1 receptor agonists and 60% to SGLT2 inhibitors.

Conclusions:
Most clinicians in ESH ECs are well educated regarding obesity-associated hypertension, and clinics are sufficiently equipped to manage these patients, as well. However, several deficits were reported regarding efforts to address and implement obesity specific aspects and interventions to improve care in patients with obesity and hypertension.
SINGLE-PILL COMBINATION ANTIHYPERTENSIVE THERAPY IN HYPERTENSIVE, OBESE PATIENTS: A PROSPECTIVE, EPIDEMIOLOGICAL STUDY IN ROMANIA
Authors: Vintila Ana -Maria , Dolofan Bogdan , Trambitas Nicoleta , Vittos Oana 
Published: May 2024

Objective:
To assess the blood pressure (BP) management in obese, hypertensive patients under treatment with single-pill combination (SPC) antihypertensive therapy.

Design and method:
Prospective, observational, multicenter study, involving 192 investigators (85 cardiologists and 107 general practitioners) randomly selected from Romanian healthcare system, which included 1299 obese, hypertensive patients (Body Mass Index (BMI) of 30 kg/m2 or higher); 56.22±11years; 53.89% females) (1-month recruitment). The total study duration was 5 months (May-Aug 2023), while the patient observational period was 12 weeks (including 3 visits: baseline, at one month and at three months after inclusion). At enrolment visit each patient received a SPC antihypertensive therapy as per investigator’s decision, based on his/her own best medical judgement and in line with the current practice guidelines. Demographic data, comorbidities and data regarding hypertension and evolution of BP values in relation to the antihypertensive treatments were collected.

Results:
The study population had the following characteristics: BMI 34.35±4.21 kg/m2; 20.94% smokers, 56.81% with CV family history, and 52.12% had comorbidities. Among the patients with comorbidities the most frequently identified were diabetes mellitus type 2 (37.37%), valvular heart disease (20.97%), angina (19.35%) and heart failure (16.24%). At study inclusion the investigators’ perception regarding the cardiovascular (CV) risk was that only 27.02% of patients are in “very high” risk category, while according to SCORE2 and SCORE2-OP the actual calculated CV “very high” risk, was identified in 68.82% of patients.
The most frequent recommended double SPC at study inclusion were perindopril/indapamide (81.68%) and olmesartan/amlodipine (5%).
Hypertension was treated in all patients and systolic and diastolic BP values (SBP and DBP) and heart rate (HR) decreased significantly throughout the study (p<0.001) (Fig. 1).
Analyzing the patients treated with different double SPC a significant decrease in BP and HR values was observed (p<0.001) for the perindopril/indapamide SPC, and olmesartan/amlodipine, respectively (Fig. 2).

Conclusions:
This study showed that single pill antihypertensive combinations are effective in decreasing BP and HR values in hypertensive obese patients, while correct CV risk estimation by clinicians remains challenging in their daily practice, with the tendency of underestimation.
THE ASSOCIATION OF LONG-TERM TRAJECTORIES OF BMI, ITS VARIABILITY, AND METABOLIC SYNDROME: A 30-YEAR PROSPECTIVE COHORT STUDY
Authors: Guo Tongshuai , Zheng Sirui , Chen Tao , Chu Chao , Ren Jie , Sun Yue , Wang Yang , He Mingjun , Yan Yu , Jia Hao , Liao Yueyuan , Cao Yumeng , Du Mingfei , Wang Dan , Yuan Zuyi , Wang Duolao , Mu Jianjun 
Published: May 2024

Objective:
Data on the association between the longitudinal patterns of weight change in early life and the incidence of metabolic syndrome (MetS) in midlife are limited. This study aims to investigate the association of long-term trajectories of body mass index (BMI), its variability, and the risk of MetS in Chinese subjects.

Design and method:
The prospective Hanzhong Adolescent Hypertension study began in 1987, and the present study included 1824 participants with at least five BMI measurements available from 1987 to 2017. We used group-based trajectory modeling to identify different BMI patterns over time. To assess BMI variability, we calculated Standard Deviation (SD), Variability Independent of the Mean (VIM), and Average Real Variability (ARV). We then used a logistic regression model to estimate how BMI patterns and variability relate to the occurrence of MetS in midlife.

Results:
The BMI trajectories were grouped as low-increasing (34·4%), moderate-increasing (51·8%), and high-increasing (13·8%). Compared with the low-increasing group, the RRs (95% CIs) of MetS in moderate- and high-increasing groups were 4·33 [2·68-6·97] and 13·48 [6·54-27·79] (P <0·0001), respectively. Additionally, higher BMI variabilities (SDBMI, VIMBMI, and ARVBMI) were also associated with a higher risk of MetS (all P <0·0001).

Conclusions:
Our study suggests that both early-life BMI trajectories and BMI variability could be predictive of incident MetS. Early detection and intervention of overweight or obesity in BMI is crucial.