bluuebunny/crossref_metadata_2025_split huggingface dataset:
PREVALENCE, AWARENESS AND TREATMENT OF CARDIOVASCULAR RISK FACTORS IN HEALTH PROFESSIONALS IN THE CARDIOVASCULAR FIELD: THE PROTECTO ESH-SIIA STUDY
Authors: Rosei Claudia Agabiti , Del Pinto Rita , Giannattasio Cristina , Bombelli Michele , Dell’Oro Raffaella , Muiesan Maria Lorenza , Grassi Guido , Ferri Claudio 
Published: May 2024

Objective:
Physicians and researchers in the cardiovascular (CV) field are constantly engaged in the promotion of guidelines-directed preventive measures, but whether they are themselves adherent to the same recommendations was only sporadically assessed.

Design and method:
During the annual meeting of the Italian Society of Hypertension (SIIA, October 2022) and the European Society of Hypertension (ESH, June 2023), an observational study on consecutive volunteer health professionals was conducted. Participants underwent three standard sitting and two standing (1-3 minutes) blood pressure (BP) measurements and answered a questionnaire regarding demographic features, modifiable/non-modifiable CV risk factors and related treatments. Hypertension was defined as BP > 140 and/or 90 mmHg or as a pre-existing diagnosis. Orthostatic hypotension was defined as a decrease of systolic BP > 20 mmHg or of diastolic BP > 10 mmHg; orthostatic hypertension was defined as an increase of systolic BP > 20 mmHg or of diastolic BP > 11 mmHg.

Results:
In total, 62 participants from SIIA 2022 (30F, mean age 43.2±14.8 years) and 129 participants from ESH 2023 (65F, mean age 36,6±12.5 years) were enrolled; 49 participants were non-Italian (26 F e 23 M). 80,1% reported regular physical activity; and only 22.5% were on a low-salt diet. Dyslipidemia was the most common risk factor (13.1%), but only 56% participants were on a statin; 9.3% had high BP, of whom 83.3% were unaware; 1.6% and 16.4% had orthostatic hypo- and hypertension, respectively. No significant differences were found regarding the degree of physical activity between Italian or non-Italian participants. Italian women were more often on a low-salt diet than non-Italian women (31% vs 4% p=0.005).

Conclusions:
Despite the specific professional involvement, self-awareness and management of CV risk factors can be improved in the examined exploratory, international sample of health professionals.
ACCURACY AND BLOOD PRESSURE THRESHOLD CONTROL ANALYSIS OF UNATTENDED AUTOMATED OFFICE BLOOD PRESSURE MEASUREMENT: A CROSS-SECTIONAL STUDY BASED ON MULTICENTER POPULATIONS
Authors: Yang Shijie , Zhou Zhanyang , Miao Huanhuan , Yin Zheng , Zhang Yuqing 
Published: May 2024

Objective:
The emergence of unattended automated office blood pressure (u-AOBP) measurement, facilitated by the flourishing development of electronic blood pressure monitors, has been proposed as a potential alternative or complementary approach for assessing patients’ blood pressure status within clinical settings. However, robust evidence is lacking to determine its application in diagnosing hypertension within the clinical practice in China. This study aims to compare u-AOBP values with standard office blood pressure data, assess the correlation between u-AOBP and diagnostic thresholds.

Design and method:
The study involved participants recruited from October 2023 to February 2024 in three hospitals: People's Hospital of Gongyi City in Henan Province, Nangong City Hospital in Hebei Province, and Fuwai Hospital of the Chinese Academy of Medical Sciences. Standardized validated upper arm blood pressure monitors were used to measure blood pressure. Baseline demographic data, anthropometric measurements, u-AOBP, and standard office blood pressure data were collected, along with additional examination results, including echocardiograms and 24-hour ambulatory blood pressure monitoring.

Results:
1. The difference between u-AOBP and awake dynamic average blood pressure was 1.34 mmHg (95% confidence interval: 0.88-3.55 mmHg), and the difference was not statistically significant (P = 0.236).
2. The optimal cutoff values for diagnosing elevated blood pressure using u-AOBP, determined by ROC curve analysis based on awake dynamic blood pressure measurements, were 130.75/83.75 mmHg (sensitivity 89.73%, specificity 27.27%).
3. In participants with a dipper blood pressure diurnal rhythm, there was no statistically significant difference between standard office blood pressure and u-AOBP measurements (P > 0.05). However, in the group including non-dipper rhythm participants, standard office blood pressure was higher than u-AOBP by 5.84/4.98 mmHg (P < 0.05).

Conclusions:
1. Unattended automated blood pressure measurements can reduce, but not eliminate, the white coat effect, with an optimal cutoff value for diagnosing elevated blood pressure determined as 130.75/83.75 mmHg.
2. In individuals with a normal dipper blood pressure diurnal rhythm, standardized u-AOBP values are equivalent to standard office blood pressure.
CEREBRAL SMALL VESSEL DISEASE MEDIATES THE EFFECT OF ARTERIAL STIFFNESS ON COGNITIVE DECLINE IN PATIENTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION
Authors: Müller Patrick , Horndasch Laslo , Neumann Katja , Mattern Hendrik , Cardace Silvio , Arndt Philipp , Pfister Malte , Groscheck Thomas , Vielhaber Stefan , Meuth Sven , Dunay Ildiko , Schmeißer Alexander , Behme Daniel , Schreiber Stefanie , Braun-dullaeus Rüdiger 
Published: May 2024

Objective:
Epidemiological data indicate a high prevalence of cognitive dysfunction and dementia risk in patients with heart failure with preserved ejection fraction (HFpEF). However, underlying mechanisms are yet not fully understood. Common risk factors for HFpEF and cognitive decline are hypertension and arterial stiffness, which are characterized by structural and functional vascular changes causing microvascular dysfunction and end organ damages. We hypothesize that the effect of arterial stiffness on cognition in patients with HFpEF is mediated by microvascular brain disease (cerebral small vessel disease, CSVD).

Design and method:
In this prospective cohort study we included 14 HFpEF patients (age: 66.6 ± 10.0 years) and 11 cognitively normal, healthy controls (age: 69.4 ± 9.4), who underwent comprehensive cardiovascular assessment. Arterial stiffness was assessed with pulse wave velocity measurements. The CERAD-plus neuropsychological test battery was used to estimate cognitive decline. CSVD severity (summary SVD score) was quantified in accordance with the STandards for ReportIng Vascular changes on nEuroimaging criteria (STRIVE) using 3-Tesla brain magnetic resonance imaging.

Results:
Results: Patients with HFpEF showed increased arterial stiffness [F(1,20) = 7.33, p = .014], impaired cognition [F(1,20) = 33.34, p <.001), and higher CSVD burden [F(1,23) = 32.39, p <.001] in comparison to healthy, age-matched controls, whereas arterial stiffness correlated with cognitive dysfunction (r = -.44, p = .046) and summary SVD scores (r = .71, p = .0002). Moreover, summary SVD scores fully mediated the relationship of arterial stiffness and cognition (Figure 1).

Conclusions:
We showed that CSVD mediates the effect of arterial stiffness on cognition in patients with HFpEF. Our study demonstrated the fundamental role of cardiovascular factors in the development of cognitive decline, and the urgent need for interdisciplinary heart-brain research investigating the interrelationship of heart and brain diseases.
Figure 1: Mediation Analysis. CSVD burden (summary SVD scores) fully mediated the relation between arterial stiffness (pulse wave velocity) and cognitive decline (assessed with CERAD-plus). Age was included as covariate into the model. Significant paths are marked with ∗∗/∗∗∗ for p < .01/.001.
ESTIMATING THE PREVALENCE OF CHILDHOOD HYPERTENSION AND ITS CONCOMITANT METABOLIC ABNORMALITIES IN THE NORTHEASTERN REGION OF HUNGARY USING DATA MINING METHODS
Authors: Pall Denes , Kovacs Beata , Nemeth Akos , Daroczy Balint , Karanyi Zsolt , Maroda Laszlo , Zrinyi Miklos , Dioszegi Agnes , Nadro Biborka , Szabo Tamas , Harangi Mariann 
Published: May 2024

Objective:
Childhood hypertension presents a considerable public health challenge worldwide. The number of children diagnosed with hypertension has significantly grown in the past few decades. Therefore, we aim to identify the prevalence of childhood hypertension in our region and its concomitant metabolic abnormalities using data mining methods to analyze a rather large population.

Design and method:
We analyzed data from 3 to 18-year-old children who visited the University of Debrecen Clinical Center's hospital throughout a 15-year study period (from 2007 to 2021) (n = 92,198; boys/girls: 48/52%).

Results:
We identified a total of 3,687 children with hypertension (2,107 boys and 1,580 girls), with a 4% calculated prevalence of hypertension. The prevalence of hypertension was higher in boys (4.7%) compared to girls (3.2%). We found an increasing prevalence in the consecutive age groups in the whole study population (1.54; 2.64; 4.0; 5.49 and 5.56%), and in the boys (1.66; 2.6; 4.57; 6.48 and 8.22%). We found higher BMI values in hypertensive children as compared to the normotensive group in all studied patient groups (25.6; 26.7; 28.1 and 29.7 vs. 20.1; 21.4; 22.6 and 24.6 kg/m2 in the 6-9–year-old, 9-12–year-old, 12-15–year-old and 15-18–year-old groups, respectively). Significantly higher serum uric acid levels were found in children with hypertension (299.2±86.1 vs. 259.9±73.3 μmol/L, p<0.001), while glucose levels did not differ significantly. Significantly higher total cholesterol (4.27±0.95 vs. 4.17±0.88 mmol/L, p<0.001), LDL-C (2.62±0.79 vs. 2.44±0.74 mmol/L, p<0.001) and triglyceride (1.2 (0.85-1.69) vs. 0.94 (0.7-1.33) mmol/L, p<0.001) and lower HDL-C (1.2±0.3 vs. 1.42±0.39 mmol/L, p <0.001) levels were found in hypertensive children. Furthermore, we assessed the rate of significant concomitant diseases in our hypertensive population.

Conclusions:
Childhood hypertension is a chronic disease associated with metabolic complications at presentation. Although the data mining method is not widely used in epidemic studies, it is an excellent way to define prevalence in large patient cohorts. To date, this is the first study providing data on childhood hypertension in Eastern Europe to embrace the benefits of data mining methods.
CARDIOVASCULAR OUTCOMES IMPROVE IN CHILDREN WITH RENOVASCULAR HYPERTENSION FOLLOWING ENDOVASCULAR AND SURGICAL INTERVENTIONS
Authors: Paessler Alicia , Redhead Emily , Arslan Zainab , Patel Premal , Minhas Kishore , Forman Colin , Hollis Paolo , Lava Sebastiano , Ionescu Florin , Manuel Devi , Ray Samiran , Kessaris Nicos , Giardini Alessandro , Ratnamma Vineetha , Dobby Nadine , Tullus Kjell , Simmonds Jacob , Stojanovic Jelena 
Published: May 2024

Objective:
Renovascular hypertension (RVH) is a common cause of hypertension in children. It is caused by renal artery stenosis reducing the blood supply to the renal parenchyma and activating the renin-angiotensin-aldosterone axis, often leading to cardiac remodelling. This is a longitudinal observational study that aims to describe the occurrence of hypertensive changes and their severity and also any improvement in cardiac remodelling after successful endovascular and/or surgical intervention in children with RVH.

Design and method:
All patients with RVH referred to our centre, who had received at least one endovascular intervention, were included. Data was collected by retrospective database review over a 22-year period. We assessed oscillometric blood pressure as well as eight echocardiographic parameters pre- and post-intervention: intraventricular septal diameter (IVSD), posterior wall diameter (PWD), left ventricular internal diastolic diameter (LVIDD), fractional shortening (FS), Relative Wall Thickness (RWT), Left Ventricular Mass (LVM) and Left Ventricular Ejection Fraction (LVEF).

Results:
152 patients met inclusion criteria and had on average two endovascular interventions. Six children presented in frank heart failure. 54.4% achieved normal blood pressure (BP) control after intervention. Average z-scores improved in IVSD, PWD and FS; LVMI and RWT also improved. PWD saw the greatest reduction in mean difference in children with an abnormal (z-score reduction of 0.25, p<0.001) and severely abnormal (z-score reduction of 0.23, p<0.001) z-scores between pre- and post-intervention echocardiograms. 45.9% of children had a reduction in prescribed antihypertensive medications.

Conclusions:
Our study reports improvement in cardiac outcomes after either endovascular or surgical intervention. This is evidenced on BP control and echocardiogram changes in which almost half achieved normalisation in systolic BP readings and reduction in the number of children with abnormal echocardiographic parameters.
ASSOCIATION BETWEEN NORMAL-WEIGHT OBESITY AND BONE MINERAL CONTENT IN CHINESE ADOLESCENTS AGED 12–18 YEARS OLD: A POPULATION-BASED CROSS-SECTIONAL STUDY
Authors: Tian Mei , Ma Xiaoyan , Liu Jianxi , Tong Lingling , Ding Wenqing 
Published: May 2024

Objective:
The effects of normal-weight obesity, which is defined as having a high level of body fat despite a normal body mass index, on the health of bones in adolescents are very limited. Hence, the purpose of this investigation was to explore the relationship between normal-weight obesity and bone mineral content (BMC) among Chinese adolescents.

Design and method:
This cross-sectional study included 1,960 children and adolescents aged between 12 and 18 years who were selected from schools in Yinchuan city by stratified cluster random sampling. Subjects were divided into three groups according to body mass index (BMI) and percentage of body fat (PBF), as follows: normal-weight non-obesity(NWNO), normal-weight obesity (NWO), and obesity (OB).

Results:
The NWNO, NWO, and OB phenotypes in boys were 69.9%, 8.8%, and 21.3%, respectively, and were 35.3%, 48.6%, and 16.1% in girls, respectively. The OB phenotypes had higher BMC than the NWNO phenotype (all p < 0.05), and the NWO phenotype with BMC was significantly lower than NWNO group in boys (p < 0.05). We discovered a significant positive correlation between BMC and the NWO (OR = 1.62, 95% CI = 1.19–2.20), while negative correlation was found between BMC and OW phenotypes in neither boys nor girls.

Conclusions:
Normal-weight obesity adolescents had higher BMC, and there existed sex differences in the effect of PBF on BMC among them.
FLOW-MEDIATED DILATION OF BRACHIAL ARTERY IN CHILDREN AND ADOLESCENTS WITH ESSENTIAL ARTERIAL HYPERTENSION
Authors: Jukic Ivana , Kos Martina , Stupin Ana , Mihaljevic Zrinka , Nad Tihana , Damasek Mia , Drenjancevic Ines , Puseljic Silvija 
Published: May 2024

Objective:
Flow-mediated dilation (FMD) of brachial artery represents non-invasive method that evaluates the endothelial function in macrovasculature, and some studies suggest that FMD possesses an independent prognostic value for the occurrence of future cardiovascular events. It is well accepted that hypertension is associated with impaired endothelium-dependent vascular response in adult patients and reduced vasodilation is considered an initial sign of functional alterations that precede the morphological changes. However, there is a lack of data on hypertension-related endothelial (dys)function in hypertensive children. Thus, present study aimed to evaluate macrovascular endothelium-dependent reactivity.

Design and method:
52 children and adolescents were enrolled in this observational cross-sectional study; 26 healthy normotensive (NT) and 26 with diagnosed essential arterial hypertension (HT), both sexes, 9-17 years old. In addition to anthropometric, and hemodynamic measurements, the endothelial function of brachial artery was evaluated using a method based on the assessment of flow-mediated dilation. Statistical analysis was conducted by Mann-Whitney U test (between groups) and an analysis of covariance (ANCOVA) adjusted for age, gender, BMI and lipid parameters was performed (p< 0.05 was considered statistically significant).

Results:
Although body mass index (BMI) was significantly higher in children and adolescents with essential arterial hypertension compared with normotensive, waist-to-hip (WHR) ratios were similar in both groups. Systolic (SBP), diastolic (DBP) and mean (MAP) arterial blood pressure were significantly higher in the HT compared to the NT group, while there were no difference in heart rate between groups. Endothelium-dependent vasodilation of the brachial artery assessed by ultrasound flow-mediated dilation was significantly decreased in hypertensive children compared to normotensive healthy children (FMD % of dilation NT 10.22 [7.00-17.31] vs. HT 8.68 [6.14-12.98]).

Conclusions:
Even in childhood, essential arterial hypertension has an adverse effect on vascular function and significantly reduces the endothelium-dependent response of brachial artery, independently of age, gender, BMI and lipid parameters. (Trial Registration:NCT05109013)
OFFICE BP MEASUREMENT USING CONICAL CUFFS IN OBESE CHILDREN AND ADOLESCENTS
Authors: Evripidou Kleo , Pitti Julio Alvarez , Chainoglou Athanasia , Goulas Ioannis , Herberigs Karel , Hamdani Gilad , Stabouli Stella ,   Hyperchildnet Working Group 1
Published: May 2024

Objective:
Findings from adult studies suggest that tronco-conical cuffs should be used for accurate blood pressure (BP) measurement in obese individuals with large arm circumference (AC). The aim of the present study was to examine differences in office blood pressure (BP) levels using conical cuffs compared to standard-shaped cylindrical cuffs in obese children and adolescents.

Design and method:
We performed an observational study enrolling 37 obese children and adolescents consequently recruited from the outpatient clinics of the Obesity Unit at General University Hospital Consortium of Valencia. The device used for the office BP measurements was OMRON HBP-1320 (HBP-1320-E). Middle AC was measured in all participants and the appropriate cuff size was selected among five sizes of conical and three sizes of regular cylindrical cuffs.

Results:
Mean participants’ age was 11.8±2.5 years, mean BMI was 28.8±3.4 kg/m2, BMI z-score was 2.1 ± 0.3, and mean AC was 30.0±3.6 cm. There was no statistical significance in BP levels measured by cylindrical compared to conical cuffs (mean difference cylindrical-conical cuff was -0.22±6.55 mmHg for SBP, -0.02±0.81 for SBP z-score, -0.70±4.95 mmHg for DBP, and -0.06±0.44 for DBP z-score). The analysis was repeated after excluding participants aged <9 years old, retrieving similar results. A significant positive association was found between the measurements obtained by cylindrical and conical cuffs in both mean and z-score SBP and DBP values (p <0.001). Bland-Altman analysis showed good agreement, with 94.6% of the values for all BP parameters, lying between the limits of agreement. No proportional bias was detected (p >0.05).

Conclusions:
The use of conical cuffs resulted in similar office BP levels in obese children and adolescents suggesting no advantage in enhancing tolerability and accuracy of office BP measurement in these patients. Although conical cuffs may be considered an alternative for office BP measurements in obese children, their reliability should be confirmed in larger populations and different settings.
Acknowledgments: This abstract is based on the work of the COST Action HyperChildNET (CA19115), with the support of COST (European Cooperation in Science and Technology) and the Horizon 2020 Framework Program of the European Union.
PRIMARY HYPERTENSION AND SECONDARY HYPERTENSION IN CHILDREN - A SINGLE-CENTER EXPERIENCE
Authors: Bujanowicz Adam , Skrzypczyk Piotr , Ofiara Anna , Smyk Katarzyna , Szyszka Michal , Panczyk-tomaszewska Malgorzata 
Published: May 2024

Objective:
Arterial hypertension (AH) occurs in the developmental age in about 4% of patients. There is controversy regarding the prevalence of primary hypertension (PH) and secondary hypertension (SH) in children. The study aimed to characterize the hypertensive patients hospitalized in one pediatric nephrology center.

Design and method:
In 657 patients hospitalized between 2018 and 2022 with suspicion of hypertension, we diagnosed AH in 441 patients. We assessed the following: etiology of AH, age at diagnosis, current age, blood pressure (Z-score), and anthropometric and biochemical parameters.

Results:
In the study group of 441 patients, there were 282 boys and 159 girls. The age of diagnosis was 11.2±5.0, and the current age was 12.5±4.7 years. The causes of AH were: PH in 279 (63.3%), SH in 162 (36.7%): renal - 109, drug-induced - 35, renovascular - 10, hormonal - 3, aortic coarctation - 2, other - 3. Patients with PH were older (14.2±3.4 vs. 9.6±5.1 [years], p<0.001), had higher height Z-score (0.7 ±1.0 vs. 0.0±1.5, p<0.001), BMI Z-score (1.3±1.1 vs. 0.6±1.2, p<0.001) and higher uricemia (5.8±1.5 vs. 5.3±2.1 [mg/dL], p<0.001). The groups didn’t differ significantly in SBP Z-score and DBP Z-score. In children under 10 years of age, out of 120 patients with AH, 34 (28.3%) had PH; in children >=10 years of age, out of 321 patients with AH, 245 (76.3%) had PH. PH was statistically more frequent in boys than in girls (PH - 198 boys, 81 girls, SH - 84 boys, 78 girls, p=0.001). The diagnosis of PH was associated with a higher height Z-score (OR 1.49, 95CI: 1.16-1.91), higher BMI Z-score (OR 1.41, 95CI: 1.12-1.78), and older age (OR 1.33, 95CI: 1.24-1.44).

Conclusions:
1. Currently, primary hypertension may be the most common etiology of hypertension in children.
2. Higher height, higher BMI, and older age rather than blood pressure values suggest a diagnosis of primary hypertension.
COMPARATIVE EFFECTIVENESS OF FREE AND FIXED COMBINED ANTIHYPERTENSIVE THERAPY IN ACHIEVING TARGET BLOOD PRESSURE VALUES IN UNCONTROLLED ARTERIAL HYPERTENSION
Authors: Shukurova Dilafruz , Khamidullayeva Gulnoz , Abdullaeva Guzal , Yusupova Hafiza 
Published: May 2024

Objective:
Aim of our study was to assess the achievement of target blood pressure in uncontrolled hypertensive patients with high and very high-risk, resistant to double AHT, depending on the treatment regimen - free and fixed combinations of three antihypertensive drugs.

Design and method:
The study included 143 patients II-III AH stage, who were on double AHT, who are not reached the target blood pressure level. The average age of patients was 55.8±9.35 years, including men n=70 (49%), women n=73 (51%). All patients underwent a physical examination with three measurements of office blood pressure using the Korotkoff method. Patients were randomized into 2 groups: group 1- triple antihypertensive therapy with a free combination of indapamide, amlodipine, and perindopril (n=71), and 2 nd group- a fixed combination therapy (n=72). Statistics were carried out between the stages before treatment and 6 months.

Results:
Research results. Against the background of triple AHT, target blood pressure levels were achieved in both groups: in group 1, initial SBP/DBP before treatment was 171.29±16.6 mmHg/99.64±9.03 mmHg, in dynamics 128.38±8.5 mmHg/80.89±6.38 mmHg. (p=0.0001); in group 2: initially SBP/DBP before treatment 170.76±17.75 mmHg/100.63±8.39 mmHg, 6 months of therapy 121.95±6.7 mmHg st./77.23±5.59 mmHg (p=0.0001). The results showed a significant decrease in SBP (p=0.0001) and DBP (p=0.0001) in group 2 compared to group 1. At the same time, the primary target level in group 1 was achieved in 83.3%, in group 2 in 94.4% of patients (χ2 = 7.471; p = 0.006). The target blood pressure level <130/80 according to SBP was achieved by 42% and 67% of patients, respectively, for groups 1 and 2 (χ2=11.61; p=0.0001); for DBP – 10% and 33.3%, respectively, for groups 1 and 2 (χ2=9.011; p=0.003).

Conclusions:
Obtained results showed the high antihypertensive effectiveness of 6-month AHT with a triple fixed combination therapy compared to free, achieving the primary target blood pressure level and the main target blood pressure level in a significantly larger number of patients with hypertension on a triple fixed combination of antihypertensive drugs.