bluuebunny/crossref_metadata_2025_split huggingface dataset:
ASSOCIATION OF CARDIOVASCULAR RISK AMONG DIFFERENT COMMON OFFICE BLOOD PRESSURE MEASUREMENT PROTOCOLS IN COMMUNITY-BASED CHINESE POPULATION
Authors: Yong Jingwen , Fan Fangfang , Li Jianping , Zhang Yan 
Published: May 2024

Objective:
The office blood pressure (BP) measurement protocols recommended by the guidelines is inconsistent. We aim to investigate the relationship between different office BP measurement protocols and cardiovascular risk in Chinese community population.

Design and method:
A total of 6098 participants without cardiovascular disease history were included in our study from the community atherosclerosis cohort conducted in Beijing, China, from December 2011 to April 2012. We conducted three measurements using the standard calibration method of Omron HEM-7117 electronic blood pressure monitor, with intervals between consecutive readings exceeding 1 minute. Four common office BP measurement protocols included: the average of the first two BP values; the average of the last two times; triple average value; and if BP fluctuation eceeds 10mmHg, take the average of the last two times; otherwise, take the average of the first two times. The primary endpoint is defined as the major adverse cardiovascular events (MACE) before December 31th, 2021, including acute myocardial infarction, stroke, and cardiovascular death. Cox proportional hazard regression models was used to examine the relationship between BP measurement protocols and MACE. Likelihood ratios and receiver operating characteristic curve (ROC) were also compared, and concordance of models assessed with Harrell C statistic.

Results:
Of all subjects, the mean age was 54.99 (8.41) years old, and 2126 (34.9%) were males. After a mean 9.86-year follow-up, a total of 486 (6.99%) participants experienced MACE. After adjusting for covariates, no difference of events predicted by different office BP measurement protocols was found in the COX analysis. The ROC curves for the different BP measurement protocols also did not show any significant differences (Figure1). There were no differences in the C-index among the different BP models (all P>0.05). These findings were consistent across subgroups stratified by age, gender, and hypertension grades (all P>0.05).

Conclusions:
The performance of all prediction models using four different BP measurement protocols is the same. All four blood pressure measurement protocols can accurately predict prognosis.
OUTCOME-DERIVED DIAGNOSTIC THRESHOLD FOR CENTRAL BLOOD PRESSURE BASED ON CARDIOVASCULAR RISKS USING UK BIOBANK
Authors: Wang Shuqi , Wong Samuel Ys , Yip Benjamin Hk , Lee Eric Kp 
Published: May 2024

Objective:
This study aimed to establish the diagnostic threshold for central blood pressure (BP) and evaluate its clinical usefulness in risk stratification for cardiovascular diseases (CVD).

Design and method:
A cohort study of 34,289 adults without prior CVD was conducted using the UK Biobank dataset. The primary endpoint was a composite of cardiovascular mortality and non-fatal cardiovascular events. The diagnostic threshold was determined by using current brachial BP cutoff with bootstrap and approximation methods. Cox regression models were constructed to evaluate the clinical utility of diagnostic thresholds for central BP in CVD prediction.

Results:
Over a median follow-up of 40 months, 809 composite cardiovascular events occurred. A diagnostic threshold of 135 mmHg for central systolic BP (SBP) corresponded to the threshold of 140 mmHg for brachial SBP. Concurrent assessment of brachial and central BP identified brachial and central normotension (49.84%), isolated brachial hypertension (HT) (2.23%), isolated central HT (3.65%) and concordant brachial and central HT (44.28%). Compared to concordant normotension, hazard ratios for cardiovascular events were 0.81 (0.45, 1.44) for isolated brachial HT, 1.70 (1.23, 2.35) for isolated central HT and 1.51 (1.30, 1.76) for concordant HT. Inclusion of central BP improved model fit and discrimination for predicting CVD beyond brachial BP alone.

Conclusions:
The study determined a diagnostic threshold of 135 mmHg for central SBP. Individuals with central HT had elevated risks of CVD, regardless of brachial HT status. Incorporating central BP enhanced the prediction of CVD risk beyond traditional BP measurement.
APPLICATION OF PHOTO RECOGNITION TO ENCOURAGE PARTICIPATION IN HOME BLOOD PRESSURE MONITORING: A COMMUNITY COHORT OF 18,867 USERS IN HONG KONG
Authors: Tsoi Kelvin Kf , Hao Ziyu , Chen Yize , Chan Howard H , Tsang Davie Mt , Yiu Karen Kl 
Published: May 2024

Objective:
Manual blood pressure recording is still common among the elderly who do not have a blue-tooth measurement device. A mobile application was developed with photo recognition techniques, named HealthCap, to capture blood pressure data from a photo of the measurement device. This study aimed to investigate the acceptance of new technologies for blood pressure data collection among the elderly in Hong Kong.

Design and method:
HealthCap can be downloaded after health talks and other publicity events. Participants aged over 18 years with at least 10 blood pressure records were included. A specific elderly cohort was recruited from elderly centres. Personal interviews were conducted to assess the demographic and health conditions. Nursing calls and social worker engagement were offered for those with suboptimal blood pressure levels. The logistic regression models were used to investigate the acceptance of photo recognition techniques for regular blood pressure monitoring.

Results:
A total of 2,284,026 blood pressure records were collected from 18,867 participants in Hong Kong from June 2018 to November 2023. Among the 8,970 participants who met the inclusion criteria, blood pressure records collected by manual input, photo recognition and a mixture of both methods were 2,621 (29%), 2,475 (28%), and 3,892 (43%) respectively. The mean frequency of blood pressure measurement was 4.2±7.9 times per week. Among a subgroup of 1,321 elderly participants with a mean age of 71 years, blood pressure records collected by manual input, photo recognition, and a mixture of both methods were 386 (29%), 199 (15%) and 736 (56%) respectively. Logistic regression was applied to compare the users of photo recognition and manual input (Table 1). Younger age, lower education levels, elderlies living with children, and those with self-reported memory complaints were shown to have a better usage of the photo recognition technique.

Conclusions:
The general population is welcome for the new technology application for blood pressure management. The participation rate of using photo recognition among the elderly is comparable to the general population. It also engages the participation of those living with family members.
REPRODUCIBILITY OF NIGHT-TIME BLOOD PRESSURE PHENOTYPES. RESULTS FROM THE HARVEST
Authors: Palatini Paolo , Saladini Francesca , Mos Lucio , Vriz Olga , Mazzer Adriano , Zanata Giuseppe , Fania Claudio , Rattazzi Marcello 
Published: May 2024

Objective:
Night-time blood pressure (BP) assessed with ambulatory monitoring has a greater prognostic value than daytime BP but whether this is due to night-time hypertension being more reproducible than daytime hypertension is unclear. The aim of the study was to investigate the reproducibility of ambulatory BP subperiods and nocturnal dipping phenotypes assessed twice 3 months apart in young-to-middle-age untreated subjects screened for stage 1 hypertension.

Design and method:
We investigated 1096, 18-to-45-year old subjects from the HARVEST. Their office BP was 145.8±10.5/93.7±5.8 mmHg. Office BP and 24h BP were measured at baseline and after 3 months. Office, 24-h, daytime and night-time hypertensions, and nocturnal dipping patterns were defined according to the 2023 ESH guidelines. Definitions were based on systolic BP (SBP), diastolic BP (DBP) or either pressure. Agreement was evaluated with Kappa statistics.

Results:
Correlation coefficients between baseline and repeat measurements were 0.44 and 0.45 for office SBP and DBP, 0.68 and 0.66 for 24h, 0.65 and 0.65 for daytime, and 0.59 and 0.57 for nigh-time BPs, respectively. Reproducibility evaluated with weighted Kappa (K) was moderate for 24h hypertension (0.54 for SBP, 0.58 for DBP, 0.48 for either pressure), was lower but still moderate for daytime hypertension (0.42, 0.45, and 0.43, respectively), and was fair to moderate for night-time BP (0.41, 0.37, and 0.36, respectively). Between-measurement agreement was even worse for isolated night-time hypertension (K=0.20), and poor for office hypertension (K=0.14). Non-dipping was present in 31.8%, 31.2%, and 45.0% of participants, respectively, when based on SBP, DBP or either pressure, and showed a fair agreement (K=0.26, 0.23, and 0.30, respectively). Poorer agreement was shown by extreme dipping (K=0.18) and by reverse dipping (K=0.07).

Conclusions:
These data show that within the ambulatory sub-periods, 24h hypertension has the best and night-time hypertension the worst reproducibility. Thus, the better association with adverse outcomes shown by night-time hypertension compared to daytime hypertension in observational studies is not due to a better reproducibility of the former. The agreement was even worse for dipping phenotypes, especially for extreme and reverse dipping. Thus, dipping patterns should be confirmed with repeat ambulatory BP monitoring.
ASSESSMENT OF THE CART-I PLUS FOR CUFFLESS BLOOD PRESSURE MONITORING: A COMPARATIVE STUDY WITH STANDARD ABPM ACROSS DIVERSE PATIENT SUBGROUPS
Authors: Lee Huijin , Lee Hae -YOUNG 
Published: May 2024

Objective:
This study aimed to assess the accuracy of the CART-I Plus device, a novel ring-type cuffless blood pressure (BP) measuring device, across various ages, genders, and medication statuses, in comparison with standard ambulatory blood pressure monitoring (ABPM).

Design and method:
Design and Method: Forty patients were enrolled in the study, with thirty-three completing it. They were asked to simultaneously wear the CART-I Plus device, which measures blood pressure using photoplethysmography, and a standard ABPM device for about 24 hours. To assess the accuracy of the CART-I Plus, we conducted subgroup analyses based on age, gender, and medication status, comparing these specific groups to see how well the device performed across different patient profiles.

Results:
The CART-I Plus demonstrated strong correlation with the ABPM across various patient subgroups divided by age, sex, and medication use. For individuals under 52, Pearson’s correlation coefficients ranged from 0.81 to 0.93. The correlation was similarly robust in participants aged 52 and over (ranging from 0.83 to 0.95), with the highest observed in nighttime diastolic readings (r=0.95). Gender-specific analyses revealed very high correlations in males (up to r=0.98 for nighttime systolic readings) and strong correlations in females, albeit slightly lower. Medication status also showed strong correlations, with those on treatment displaying coefficients from 0.83 to 0.94, and those without from 0.80 to 0.90.

Conclusions:
The CART-I Plus device displays a high degree of concordance with ABPM, suggesting its potential utility for reliable, cuffless BP monitoring across diverse patient populations. The significant correlations in all subgroups, especially in nighttime readings and among those not on medication, underscore its promise for continuous, non-invasive BP measurement in various clinical scenarios.
BLOOD PRESSURE CONTROL WITH APROCITENTAN IN RESISTANT HYPERTENSION
Authors: Narkiewicz Krzysztof , Danaietash Parisa , Kania Grzegorz , Kantola Ilkka , Martinez-garcia Fernando , Sassi-sayadi Mouna , Schlaich Markus P , Toursarkissian Nicole , Wang Ji -GUANG , Weber Michael A , Gimona Alberto 
Published: May 2024

Objective:
The results of the phase 3 PRECISON study demonstrated that in patients with resistant hypertension, aprocitentan in addition to a fixed-dose combination of amlodipine, valsartan, hydrochlorothiazide was well tolerated and superior to placebo in lowering blood pressure at week 4 with a sustained effect at week 40. This pre-planned analysis evaluates the % of subjects with controlled blood pressure according to hypertension guidelines at different timepoints during the study.

Design and method:
In PRECISION, the mean SiSBP and SiDBP were 153 mmHg and 88 mmHg at baseline, across groups. In the 4-week DB part 1, patients were randomized to aprocitentan 12.5 mg, 25 mg and placebo. Thereafter all patients received 25 mg aprocitentan during the SB part 2. At week 36, subjects were re-randomized to 25 mg or placebo up to week 48. The primary endpoint was at week 4 and the key secondary endpoint at week 40. Control was defined as SiSBP <140 or <135 and/or SiDBP < 90 or <85 mm/Hg (trough unattended office BP). The % of patients achieving control was calculated at the end of part 1 (week 4, primary end point), end of part 2 (week 36) and at the timepoint of the key secondary endpoint (week 40).

Results:
At week 4, more patients had SiSBP below 140 mmHg with 12.5 mg (56%) and 25 mg (57%) compared to placebo (44%). The % of patients with controlled SiSBP increased to 64% at the end of part 2 and reached 67% of patients treated with 25 mg during part 3. The % of patients achieving control decreased in those re-randomized to placebo (48%). A similar trend was observed when the threshold of 135 mmHg was considered, with 56% of patients achieving control at week 40 with 25 mg, while in patients re-randomized to placebo the control rate was 35%. 52 to 65% of patients had both SiSBP and SiDBP controlled with aprocitentan 25 mg at week 40.

Conclusions:
Aprocitentan controlled systolic and diastolic blood pressure in up to 67% and 90% respectively, of patients with resistant hypertension.
CARDIAC TROPONIN-T AND N-TERMINAL PRO-B-TYPE NATRIURETIC PEPTIDE RELATED TO OTHER CLINICAL HIGH-RISK FACTORS IN PATIENTS ON AT LEAST TWO ANTIHYPERTENSIVE AGENTS
Authors: Larstorp Anne Cecilie , Halvorsen Lene V. , Hoff Oliver F. , Soraas Camilla L , Kjaer Vibeke N , Aune Arleen , Olsen Eirik , Brobak Karl Marius , Bergland Ola U , Rognstad Stine , Gerdts Eva , Mo Rune , Solbu Marit , Opdal Mimi S , Kjeldsen Sverre E , Rostrup Morten , Hoieggen Aud 
Published: May 2024

Objective:
Cardiac biomarkers are useful in identifying patients with high risk of cardiovascular events. We aimed to identify how cardiac troponin T (cTnT) and N-Terminal Pro-B-Type Natriuretic Peptide (NT-pro-BNP) relate to other clinical high-risk markers in patients with treated essential hypertension in a national multicenter study.

Design and method:
We performed a cross-sectional study of patients with hypertension treated with > =2 antihypertensive agents. Cardiovascular risk factors were identified by interview, blood and urine tests, and physical examination. Ambulatory (ABPM) and office BP were measured with validated devices. High-sensitive cTnT and NT-pro-BNP were measured from stored serum samples at a core laboratory using Elecsys Troponin T Gen 5 STAT and Elecsys pro-BNP II (Roche Diagnostics, Basel, Switzerland). Continuous variables are presented as median (interquartile ranges [IQR]) and categorical variables as percentages. Multivariable logistic regression models were used to test for associations between risk factors and elevated cTnT > =14 ng/L or elevated NT-pro-BNP > =125 ng/L.

Results:
In 550 patients (36.5% women) aged 64 years (IQR 57-72) with daytime ABPM of 143/84 mmHg, 199 patients (36.2%) had high cTnT > =14 ng/L and 138 (25.1%) patients had high NT-pro-BNP > =125 ng/L. Elevated cTnT was independently associated with higher HbA1c (p=0.045) and history of diabetes (p<0.001) when adjusting for age, sex, estimated GFR and pulse pressure. Elevated NT-pro-BNP was independently associated with higher pulse pressure (p=0.008), number of antihypertensive agents (p<0.001), aldosterone/renin ratio (p<0.001), lower HDL (p=0.02), use of antithrombotic (p=0.002) and lipid-modifying (p=0.02) drugs and a history of coronary heart disease (p=0.02) when adjusting for age, sex and estimated GFR.

Conclusions:
We found that elevated cTnT and NT-pro-BNP were independently associated with several clinical markers of increased risk for cardiovascular events in patients with hypertension treated with > =2 antihypertensive drugs, when adjusting for age, sex and estimated GFR. Prospective studies should further explore the potential of these cardiac biomarkers to individualize risk assessment in patients with uncontrolled hypertension.
ANTIHYPERTENSIVE TREATMENT OF MASKED HYPERTENSION GUIDED BY AMBULATORY BLOOD PRESSURE MONITORING: A DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL
Authors: Huang Jian -Feng , Zhang Dong -Yan , An De -Wei , Li Ming -Xuan , Liu Chang -Yuan , Feng Ying -Qing , Zheng Qi -Dong , Chen Xin , Staessen Jan , Wang Ji -Guang , Li Yan 
Published: May 2024

Objective:
Masked hypertension, office normotension combined with out-of-office hypertension, is associated with target organ damage (TOD), but whether antihypertensive treatment guided by out-of-office blood pressure (BP) would reduce TOD is unproven. We aimed to assess TOD change on antihypertensive treatment guided by ambulatory BP monitoring.

Design and method:
Double-blind, placebo-controlled randomized trial at 15 Chinese hospitals. Enrolment started on February 14, 2017 and follow-up ended on October 31, 2021. Patients of either sex, aged 30-70 years, not on antihypertensive drugs were eligible, if at two screening visits 1-week apart office BP was <140/<90 mmHg and the 24-hour, daytime or nighttime ambulatory BP was >=130/>=80, >=135/>=85, or >=120/>=70 mmHg, respectively. Patients had >=1 sign of TOD: ECG left ventricular hypertrophy (LVH), brachial-ankle pulse wave velocity (baPWV) >=1400 cm/s, or urinary albumin-to-creatinine ratio (ACR) >=3.5 mg/mmol in women and >=2.5 mg/mmol in men. Active antihypertensive treatment consisted of allisartan starting at 80 mg/day to be increased to 160 mg/day at month 2 and to be combined with amlodipine 2.5 mg/day at month 4, if the ambulatory BP remained uncontrolled. Matching placebos were used likewise in the control group. The primary endpoint included normalization of baPWV, ACR or LVH or >=20% reduction in baPWV or ACR.

Results:
Of 320 patients (43.1% women; mean age 54 years), 153 were randomized to active antihypertensive treatment and 167 to placebo. At baseline, office BP averaged 130/81 mm Hg and the 24-hour BP 136/84 mm Hg. The prevalence of elevated baPWV, ACR and LVH was 97.5%, 12.5%, and 7.8%. At 1 year, the 24-hour systolic/diastolic decreased by 9.0/5.6 mm Hg (95% CI: 7.5-10.5/4.8-6.5 mmHg) on active treatment and by 1.4/1.0 mm Hg (-0.1-2.8/0.2-1.8 mm Hg) on placebo. Regression of TOD occurred more frequently in patients randomized to active treatment than in those assigned to placebo with 1 year rate of 45.8% (95% CI: 37.9-53.7%) and 25.8% (19.1-32.4%), respectively (P<.001 for between-group differences in BP and TOD). Per-protocol and subgroup analyses were confirmatory.

Conclusions:
Masked hypertensive patients require antihypertensive treatment guided by out-of-office BP monitoring before subclinical TOD progresses to major cardiovascular complications.
RENAL DENERVATION AT THE GEORGES-POMPIDOU EUROPEAN HOSPITAL IN PARIS: THE TRANSITION FROM RESEARCH TO STANDARD CARE IN HYPERTENSIVE PATIENTS
Authors: Gebara Nicole , Al Ahmar Marc , Lorthioir Aurelien , Mallart-riancho Julien , Amar Laurence , Sapoval Marc , Azizi Michel 
Published: May 2024

Objective:
Renal Denervation (RDN) is a minimally invasive intervention for resistant primary hypertension or medication-intolerant patients, transitioning from research to standard care. This prompts our forward-thinking initiative to facilitate this shift.

Design and method:
The approach undertaken in this project is comprehensive and multidimensional, encompassing the definition, assessment, and analysis of various pivotal dimensions in hypertensive patients’ management, focusing on patient’s pathway, legal considerations, RDN techniques and expertise, internal visibility, and cost analysis.

Results:
The patient pathway involves eligibility criteria-based selection, with an interventional radiologist assessing renal artery anatomy. A multidisciplinary meeting validates the procedure’s indication, and with patient consent, the 3-days hospitalization for the procedure is followed by a rigorous 5-years follow-up.
Legally, healthcare professionals consider good clinical practice and liability, implementing proactive measures for compliance and safety. Patient-related legal considerations focus on obtaining informed consent and protecting personal data.
In human resources (HR), a strategy adapts to Generations Y and Z, addressing upcoming changes. Training initiatives encourage professional involvement and reveal potentials. HR management during shortages focuses on optimizing existing staff for quality care. Stakeholders express satisfaction with the training, demonstrating its effectiveness in strengthening skills and confidence in managing RDN patients.
In the marketing aspect, an observational study targeted potentially eligible RDN patients in our Hypertension Unit. Efforts aim to emphasize the uniqueness of the RDN implementation approach to strengthen internal recognition. Due to the lack of social security coverage, limited availability of RDN probes, and logistical constraints, external recruitment remains restricted.
Financially, annual hypertensive patient treatment costs are 422 EUR, with uncomplicated follow-up at 135 EUR per patient. Managing cardio-neurovascular complications costs at least 12,647 EUR per patient in the first year. While the financial benefit of RDN for complicated hypertension is evident, the comparison with uncomplicated cases is subtle and considers the reduction in cardiovascular events and improvement in quality of life. Our registry supports RDN probe reimbursement requests.

Conclusions:
This managerial approach reinforces the belief in the effectiveness of a strategic and systematic method to successfully implement RDN into standard care highlighting the inherent complementarity between management and medicine.