bluuebunny/crossref_metadata_2025_split huggingface dataset:
MANAGEMENT OF HYPERTENSION IN THE EARLY POSTPARTUM: A RANDOMIZED CONTROLLED TRIAL
Authors: Bortolotto Luiz , Marques Rossana , Maia Sabina , Araujo Andre 
Published: May 2024

Objective:
Although managing arterial hypertension during pregnancy has been widely discussed, few studies have dealt with the postpartum period. Consequently, the treatment of hypertension in the postpartum generally relies on specialist opinion and guidelines supported by a low level of evidence. We aim to evaluate blood pressure control during the immediate postpartum in hypertensive women who had used methyldopa during pregnancy, comparing continuation of that drug with switching it for captopril.

Design and method:
A single-blind, randomized clinical trial involving 172 postpartum women with arterial hypertension who had previously used methyldopa during pregnancy at a minimum dose of 750 mg/day for at least one week prior to delivery. Following delivery, the patients were randomized either to continue with methyldopa (minimum dose 250 mg, three times a day) (methyldopa group, n=88) or to switch to captopril at an initial dose of 25 mg, three times a day) (captopril group, n=84). Logistic regression was used to compare the groups regarding the potential to maintain blood pressure below 140/90 mmHg at over 50% of measurements postpartum.

Results:
In the 48 hours following delivery, no significant differences were found in blood pressure control between the groups (methyldopa 92.0% versus captopril 95.2%), in the incidence of side effects, or postpartum depression (captopril median score 4.0; IQR: 1.0-9.0 versus methyldopa 4.0; 0.0-9.8) (P>0.05). There was no statistically significant difference between the groups with respect to any other clinical endpoint (mean number of hypertensive crises, time until control of blood pressure, need to add other drugs, or maternal and neonatal complications).

Conclusions:
Continuation of antihypertensive treatment with methyldopa in the postpartum yielded similar results to switching it for captopril, both with regard to the efficacy in controlling blood pressure and the safety of the treatment
IMPACT ON GLOBAL CARDIOVASCULAR RISK OF EARLY USE OF ANTI-HYPERTENSIVE AND LIPID-LOWERING THERAPY IN FIXED-COMBINATION: PRACTICAL IMPLICATIONS OF THE GUIDELINES RECOMMENDATIONS
Authors: Torin Gioia , Schiavon Laura , Napoli Ettore , Molinari Leonardo , Roversi Rossella , Pontesilli Giulia Maria , Zuin Marco , Cuppini Stefano , Mazza Alberto 
Published: May 2024

Objective:
The 2018 ESH/ESC guidelines for the management of arterial hypertension strongly recommended the use of single-pill combination therapy as first-line treatment, approach confirmed also in the recent 2023 ESH guidelines. On the contrary, the 2019 ESC guidelines for the management of dyslipidemia recommended a stepwise treatment approach. This strategy is also applied in Italy through AIFA note 13, a regulatory tool which defines prescription and reimbursement of lipid-lowering drugs by the National Health Service. The aim of the study was to evaluate prospectively the effects of anti-hypertensive (HTT) and lipid-lowering therapy (LLT) in fixed-combination on global cardiovascular (CV) risk, in a group of hypertensive and dyslipidemic patients in primary prevention.

Design and method:
143 patients (mean age 60.2±10.9 years, 49% male) were consecutively enrolled in our center from 2018 to 2022. The subjects were defined hypertensives for systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) values >140/90 mmHg or in HTT, and dyslipidemic for non-HDL cholesterol values >130 mg/dL or in LLT. CV risk was calculated at baseline and at 1-year of follow-up with SCORE-2 and SCORE-2 OP algorithm, after starting anti-hypertensive (at the morning) and lipid-lowering therapy (after lunch) in single-pill combination. Categorical variables were compared with the X2 test while differences between continuous variables were evaluated by the analysis of variance for repeated measures. The prevalence of independent predictors of improvement vs. worsened/stable in SCORE-2 risk was assessed by the Poisson regression analysis.

Results:
SCORE-2 improved in 69.9% of cases. Adherence to treatment was 94%. Modification of antihypertensive and lipid-lowering therapy, reduction in SBP of 5 mmHg and adherence to treatment independently predicted the improvement in SCORE-2 (Figure). On the contrary, obesity and mild chronic renal failure (CKD) were associated with a worsening in SCORE-2.

Conclusions:
The early use of both HTT and LLT in fixed combination seems to improve in the medium-term the global CV risk. Therapeutic adherence has the same impact on CV risk as the modification of anti-hypertensive and lipid-lowering therapy.
PREVALENCE OF NONADHERENCE ONE YEAR PRIOR TO STROKE
Authors: Tavares Sofia , Lobo Mariana , Monteiro Isabel , Costa Teresa , Medeiros Teresa 
Published: May 2024

Objective:
Estimate the prevalence of nonadherence to anti-hypertensive treatment in the year prior to patients’ admission to a Stroke Unit between October 2022 and October 2023.

Design and method:
We conducted a retrospective non-blinded analysis. Data of hypertensive patients admitted in a level B Stroke Unit from October 1st 2022 to October 31st 2023 due to ischemic stroke, hemorrhagic stroke or transient ischemic attack (TIA) was collected. Patients deceased before November 2023 were excluded due to data unavailability. At the admission moment (by local protocol) all patients were questioned if they took their medication daily, those records were also collected. We analysed data from the national prescription software platform and obtained the purchases from the prior 18 months to ensure enough pill acquisition for the year previous to the event. Descriptive analysis was performed using SPSS Statistics 23®

Results:
One-hundred-and-forty-five patients were included, 111 for ischemic stroke, 24 for hemorrhagic stroke and 10 for TIA. Forty-seven patients were excluded due to death (n=20), absence of medication/new diagnosis (n=27) or missing data (n=2). Seventy-eight were male (52.4%), the mean age was 76.1 years (±27.2) and 53.1% (n=77) had 3 or more modifiable cardiovascular risk factors. Sixty-nine were treated with only one anti-hypertensive drug and 13 with 3 or more drugs. Only 8 were treated with poly-pill combinations, the majority of the drugs were prescribed to be taken daily (n=135) and the number of pills per package ranged from 28 to 60 pills. Only 27 bought enough anti-hypertensive medication for 365 days. Ninety-four (64.8%) bought for less than 300 days and 75 (51.7%) for less than 250 days. Only 11.7% (n=17) assumed nonadherence at hospital admission.

Conclusions:
Adherence is hard to evaluate in real-world experience. The purchase of anti-hypertensive drugs does not confirm adherence, however, we consider it is highly unlikely that the patients who purchase drugs for less than 250 days for a year were adherent to therapy.
A FATAL CASE OF THERAPEUTIC NON-ADHERENCE IN HYPERTENSION
Authors: Silva Ana João , Martins Benedita , Cadavez Hugo 
Published: May 2024

Objective:
This case report aims to reinforce the importance of therapeutic adherence and multidisciplinary approach in the effectiveness of treatment for hypertension.

Design and method:
To write this case report, an exhaustive review of the patient's clinical process was carried out, considering his follow-up in primary health care, hospitalizations and hospital consultations of various specialties.

Results:
This case report describes the clinical case of a 57-year-old male patient, with a personal history of hypertension diagnosed 10 years ago, complicated with mild concentric left ventricular hypertrophy. He also had anxiety disorder, without other relevant personal history. The systolic blood pressure profile was 150-220 mmHg and the diastolic profile was 90-120 mmHg. Since diagnosis, he was medicated with multiple associations of angiotensin converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, diuretics and beta blockers and followed up in an Internal Medicine consultation from 2015 to 2017, always persisting poor therapeutic adherence and suspension of medication on his own initiative due to alleged adverse effects. In 2021, he was referred to Psychiatry consultation due to therapeutic refusal, having been diagnosed with probable paranoid personality disorder. Due to the lack of insight into the psychogenic component and resistance to therapeutic interventions, it was decided to maintain an expectant attitude towards psychiatric pathology and consequently to hypertension. In 2023, the patient died suddenly at home, at the age of 57, of undetermined causes. He underwent a forensic autopsy, identifying a stroke as the cause of death.

Conclusions:
In Portugal, cerebrovascular diseases represent the main cause of mortality, with high blood pressure contributing to 51% of deaths due to stroke. Controlling modifiable risk factors, with a particular focus on hypertension, is essential to reduce premature mortality from cerebrovascular disease. Family doctors are in a privileged position to monitor hypertensive patients. This case report serves as a warning so that they can identify early therapeutic adherence problems, promoting a multidisciplinary approach with the aim of resolving them.
APPLICATION POSSIBILITIES OF DIETARY COUNSELING SUPPORT SOFTWARE IN THE TREATMENT AND PREVENTION OF HYPERTENSION
Authors: Simonová Erika , Varga László , Horváth Balázs 
Published: May 2024

Objective:
Interpersonal counseling led by dietitians, based on empirical knowledge about behavioral change processes, is particularly effective in the treatment of hypertension. However, there are limitations that raise doubts about the accessibility of dietary counseling for everyone, tailored to their specific needs.
Our goal was to demonstrate that a well-chosen telemedicine method can effectively support dietary education.

Design and method:
Participants with hypertension received dietary advice based on the principles of the DASH diet and underwent regular blood pressure measurements for a period of 3 months. Their measured values and dietary logs were recorded in an application synchronized with a dietetic software. Using the software, the parameters logged by the patients (calories, fiber, sodium, potassium) were analyzed in detail based on the blood pressure values.

Results:
Our results will demonstrate that the introduction of a properly selected telemedicine method can assist patients in adopting a lifestyle change, providing timely and effective care. Significant improvements were observed in energy and nutrient intake, indicating the effectiveness of education, as patients, due to their increased knowledge, consciously chose healthier diets. As a result, the systolic values decreased on average by 13.35 mmHg, and the diastolic values decreased by an average of 11.7 mmHg during the course of the study.

Conclusions:
A dietary approach targeting blood pressure modification should be an important strategy in the prevention of cardiovascular diseases. Extensive literature confirms that various dietary components and numerous diets can influence blood pressure. The strongest evidence for lowering blood pressure or preventing high blood pressure through dietary intervention is in favor of DASH and the Mediterranean diet, and there are clear benefits to higher potassium intake, limiting sodium, and increasing fiber consumption.
BODY COMPOSITION PREDICTS HYPERTENSION USING MACHINE LEARNING METHODS: A COHORT STUDY
Authors: Drissi Hamed Bazrafshan , Bazrafshan Mehdi , Nematollahi Mohammad Ali , Jahangiri Soodeh , Asadollahi Arefeh , Salimi Maryam , Dehghan Azizallah , Mashayekh Mina , Roshanzamir Mohamad , Gholamabbas Ghazal , Alizadehsani Roohallah , Bazrafshan Hanieh , Islam Sheikh Mohammed Shariful 
Published: May 2024

Objective:
Hypertension is one of the most important and preventable causes of cardiovascular disease (CVD), stroke, chronic kidney disease, and dementia which caused approximately 8.5 million deaths in 2015, in low & middle income countries. Hypertension depends on well known risk factors such as age, gender, family history, smoking, alcohol consumption, central obesity, overweight and physical inactivity. Evidence shows that body fat distribution is a more vital determinant of cardiovascular morbidity and mortality than increased fat mass. In the past few years, growing number of researchers have used machine learning and data mining algorithms to diagnose and treat health conditions such as heart11 and brain12 diseases. Their non-invasive nature and accuracy have enabled health professionals to quickly identify at-risk individuals and use more efficient preventive and managing strategies.
In this study, we used machine learning approaches to investigate whether BIA-derived body composition indices predict hypertension in a cohort of patients.

Design and method:
Data from a cohort study was used. Body composition analysis was done using bioelectrical impedance analysis (BIA); weight, basal metabolic rate, total and regional fat percentage (FATP), and total and regional fat-free mass (FFM) were measured. We used machine learning methods such as Support Vector Classifer, Decision Tree, Stochastic Gradient Descend Classifer, Logistic Regression, Gaussian Naïve Bayes, K-Nearest Neighbor, Multi-Layer Perceptron, Random Forest, Gradient Boosting, Histogram-based Gradient Boosting, Bagging, Extra Tree, Ada Boost, Voting, and Stacking to classify the investigated cases and fnd the most relevant features to hypertension.

Results:
4663 records were included (2156 were male, 1099 with hypertension, with the age range of 35–70 years old). Arm FFM, basal metabolic rate, total FFM, Trunk FFM, leg FFM, and male gender were inversely associated with hypertension, but total FATP, arm FATP, leg FATP, older age, trunk FATP, and female gender were directly associated with hypertension. AutoMLP, stacking and voting methods had the best performance for hypertension prediction achieving an accuracy rate of 90%, 84% and 83%, respectively.

Conclusions:
By using machine learning methods, we found that BIA-derived body composition indices predict hypertension with acceptable accuracy.
RELATIONSHIP OF BLOOD PRESSURE VARIABILITY WITH HEART RATE VARIABILITY IN PATIENTS WITH PERMANENT ATRIAL FIBRILLATION
Authors: Ntousopoulos Vasileios , Menti Ariadni , Tsiachris Dimitrios , Stergiou George , Kollias Anastasios 
Published: May 2024

Objective:
To investigate the relationship between blood pressure (BP) variability and heart rate variability (HRV) in patients with atrial fibrillation (AF).

Design and method:
Patients with permanent AF were subjected to manual auscultatory BP measurements in the office (5 consecutive measurements, mercury sphygmomanometer; 2 observers simultaneously), and a 1-minute single-lead electrocardiogram (ECG) simultaneously with BP measurements. Intra-observer BP variability was assessed with standard deviation (SD) and coefficient of variation (CV), while HRV was assessed using SD (SDRR) and CV (CVRR) of ECG R-R intervals and the root-mean square differences of successive R-R intervals (RMSSD).

Results:
52 participants with permanent AF were analyzed (mean age [SD] 76±9.8 years, 64% males, mean systolic/diastolic BP 118.4±20.2/69.3±10.1 mmHg, heart rate [HR] 76.4±16.3, 92% treated hypertensives). None of the BP variability indices was correlated to the HRV indices. HR was inversely correlated with HRV indices (SDRR r=-0.63 and RMSSD r=-0.65, both p<0.01). In a sub-analysis of participants in the highest quartile of HR (>87 bpm) the SD of diastolic BP was correlated with SDRR (r=0.62, p<0.05) and showed a trend of correlation with CVRR and RMSSD (r=0.54/0.55, p=0.06/0.05 respectively). Likewise, the CV of diastolic BP showed a trend towards a positive association with SDRR, CVRR and RMSSD (r=0.54/0.44/0.49, p=0.06/0.13/0.09 respectively). No significant correlations were observed for systolic BP variability indices. In multivariable linear regression analysis in this subgroup (HRV indices as independent variables), SDRR was the only independent determinant for the SD of diastolic BP (β= 0.03, p<0.05).

Conclusions:
These preliminary findings suggest that in patients with permanent AF, HRV appears to be associated with the variability of diastolic BP when HR is above 87 bpm.
EUROPEAN SOCIETY OF HYPERTENSION PROTOCOL FOR VALIDATING NOVEL CUFFLESS BLOOD PRESSURE MONITORS DURING HANDGRIP ISOMETRIC EXERCISE
Authors: Kollias Anastasios , Stathopoulou Panagiota , Kyriakoulis Konstantinos , Avolio Alberto , Mukkamala Ramakrishna , Stergiou George 
Published: May 2024

Objective:
According to the recent European Society of Hypertension (ESH) validation protocol for cuffless blood pressure (BP) devices, a novel isometric handgrip exercise test can be used as an alternative procedure to the bicycle test for assessing BP increase accuracy. This study evaluated the BP and heart rate (HR) response during the ESH handgrip exercise test.

Design and method:
Four baseline BP/HR measurements (R1-R2-R3-R4; mercury sphygmomanometer; 1-min intervals) were performed in resting sitting posture. The maximum grip strength of the dominant hand was determined using a grip strength dynamometer. Handgrip exercise was then performed using resistance set to 30% of the maximum grip strength (using a device with adjustable grip strength). Participants performed an ‘initial exercise session’ to induce BP increase via 12 sets of 8 repetitive handgrips alternating between hands (6 sets per hand, starting with the dominant one). Then, the first post-exercise reference BP measurement (R5) was obtained. Afterwards, a maintenance phase followed with 6 sessions of 4 sets of 8 repetitive handgrips with BP/HR measurements after each session (R6-R7-R8-R9-R10-R11). Resting BP was determined as the average of R3 and R4, whereas the average of R5-R7-R9-R11 was used for determining post exercise reference BP/HR levels.

Results:
45 individuals were analyzed [age 47±12 years, body mass index (BMI) 27±4 kg/m2, 69% males, 33% on antihypertensive therapy, resting systolic/diastolic BP 124±16/81±11 mmHg, HR 75±13 beats/min]. In 22% of the participants resting systolic BP was >= 140 mmHg. The average exercise-induced systolic BP increase was 7±5 mmHg. A systolic BP increase >= 8 mmHg, >= 10 mmHg, <5 mmHg was observed in 38%, 27%, and 33% of the participants respectively. No significant changes were observed in diastolic BP (1±3 mmHg) and HR (1±4 beats/min). There was a trend towards an inverse association between BMI and systolic BP increase (r= -0.27, P=0.07).

Conclusions:
The ESH handgrip exercise validation test for cuffless BP devices produces sustained increases in systolic BP in a considerable proportion of participants, similar to the bicycle test. Thus, this test is useful for validating the ability of cuffless devices to track BP increases.
RELATIONSHIP OF DAILY BLOOD PRESSURE PROFILE AND ARTERIAL STIFFNESS
Authors: Srojidinova Nigora , Duysenbaeva Aziza , Khafizova Lola , Urishbaev Ravshan 
Published: May 2024

Objective:
To study the blood pressure daily profile in patients with hypertension (HNT) depending on the pulse wave velocity (PWV).

Design and method:
We studied 88 treated patients with HNT. The ambulatory BP monitoring (ABPM) was recorded with a Medicom-combi device (Russia) using the oscillometric method. PWV was determined using the SphygmoCor (AtCor Medical Pty Ltd, Australia). Statistical analysis was performed using the SPSS 24.0 software package.

Results:
Patients were divided into 2 groups depending on PWV level: the first group had a PWV < 10 m/s, and the second group had a PWV > 10 m/s. The mean PWV in the groups was 7.79±1.38 vs. 14.13±1.85 m/s, respectively (p<0.007). Office SBP and DBP didn’t differ between groups. Patients of the second group had significantly higher mean daily SBP (113.64±16.64 vs 128.23±16.91 mm Hg, p=0.0001), mean daytime SBP (116.77±8.99 vs 129.36±7.8 mm Hg, p=0.0001), and mean nighttime DBP (66.26±9.7 vs 71.64±7.1 mm Hg, p=0.04). The load index (LI) of daytime and nighttime SBP was higher in patients with PWV > 10 m/s. LI of SBP daytime: 9.72±15.82% vs. 27.74±35.24%, respectively, p = 0.001. LI of SBP nighttime: 18.34±26.44% vs. 44.2±38.81%, respectively, p = 0.001. Variability and nocturnal falls of SBP and DBP also didn’t differ between the groups. The number of dippers by SBP and DBP was higher in patients with normal PWV, but not significantly: 18% and 12% vs. 13% and 9%, SBP: χ2 = 0.04, p = 0.83; DBP: χ2 = 0.19, p = 0.45. The number of non-dippers by SBP and DBP was significantly higher in the first group: 65% and 66% vs. 50% and 50%; SBP: χ2 = 4.6, p = 0.032; and DBP: χ2 = 5.25, p > 0.05. However, the number of night-pickers by SBP and DBP significantly prevailed in the second group: 17% and 19% vs. 36.4% and 32%, respectively; SBP: χ2 = 9.2, p = 0.003, DBP: χ2 = 5.58, p = 0.019. There were no over-dippers in both groups.

Conclusions:
Hypertensive patients with high PWV values had more pronounced disorders in their daily blood pressure profile.
VASCULAR AGE AS A KEY FOR A TEAM-BASED APPROACH TO MANAGE BLOOD PRESSURE AND CARDIOVASCULAR RISK BETWEEN COMMUNITY PHARMACISTS AND PRIMARY HEALTH CARE CENTERS (TOGETHER)
Authors: Rodilla Enrique , Aichberger Monika , Ardelt Florian , Baixauli Vicente , Cinza Sergio , Fernandez Marisol , Garcia Luis , Mayer Christopher , Pereira Telmo , Santschi Valérie , Weber Thomas 
Published: May 2024

Objective:
Hypertension (HTN) is the main cause of premature death worldide. Previous studies in Portugal, Austria and Spain have shown that estimating arterial stiffness in Community Farmacies (CPh) improves its management. The main objective is to evaluate whether empowering hypertensive subjects by determining arterial stiffness in CPh increases the rate of HTN control. Secondary objective is to establish paths of lasting cooperation between Primary Care (PC) doctors and CPh.

Design and method:
TOGETHER is a randomized study in Portugal, Austria and Spain. All consecutive expected 1260 subjects entering CPh will be offered blood pressure measurement and ambulatory blood pressure monitoring (ABPM) for those cases with high values. 140 CPh will be randomly grouped into a usual care arm (health education associated with HTN and communication of the results to PC). In the experimental care group, early vascular aging (EVA) will additionally be assessed estimating oscillometric pulse wave velocity. The concept and therapeutic options of EVA will be explained to patients and PC. HTN will be treated by PC according to usual clinical practice. After 6 months a second evaluation with ABPM will be performed and HTN control will be compared between the two arms. The degree of patient-doctor interaction and economic implications will be determined through validated surveys.

Results:
TOGETHER will address five fundamental unmet needs: 1) lack of HTN screening programs; 2) the concept of cardiovascular risk is difficult to understand. The EVA concept (“Your arteries are 10 years older than you”) is simple and more informative; 3) understanding CV risk on an individual basis (individual EVA) should improve patient adherence and reduce physician inertia; 4) TOGETHER will implement health educational programs, combined with the concept of EVA; 5) there is an objective need to improve collaboration and develop a team-based approach to HTN care between CPh and PC.

Conclusions:
The complementary strengths and organizational settings of CPh and PC will allow TOGETHER to create new strategies for early identification and intervention in HTN, ranging from lifestyle to medical treatment, taking social, economic, and behavioral aspects into account.