bluuebunny/crossref_metadata_2025_split huggingface dataset:
HYPERTENSION MANAGEMENT OF CKD PATIENTS REFERRED TO HYPERTENSION EXCELLENCE CENTRES IN 27 COUNTRIES; ON BEHALF OF THE ESH HYPERTENSION AND KIDNEY WORKING GROUP
Authors: Halimi Jean -MICHEL , Sarafidis Pantelis , Persu Alexandre , Kurtz Reinhold , Vogt Liffert 
Published: May 2024

Objective:
Real-life management of hypertensive patients with chronic kidney disease (CKD) is unclear and may vary across countries. Our aim was to identify unmet needs and heterogeneity of management in this population of patients in Europe and the Midlle-East through our network of European Society of Hypertension (ESH) Excellence Centers.

Design and method:
A survey was conducted in 2023 by the ESH to assess management of CKD patients referred to ESH-Hypertension Excellence Centres (ESH-ECs) at first referral visit. The questionnaire contained 64 questions with which ESH-ECs representatives were asked to estimate pre-existing CKD management quality and data for their management are reported here.

Results:
Overall, 88 ESH-ECs from 27 countries participated (fully completed surveys: 66/88 (75.0%).
ESH-ECs reported that 28% (median, interquartile range: 15-50%) had pre-existing CKD, of whom 10% (5-30%) were previously referred to a nephrologist, while 30% (15-40%) had resistant hypertension. The reported rate of previous recent (<6 months) estimated glomerular filtration rate (eGFR) and urine Albumin-Creatinine Ratio (UACR) testing were 80% (50-95%) and 30% (15-50%), respectively.
The reported use of renin-angiotensin system blockers was 80% (70-90%). When a nephrologist was part of the ESH-EC teams the reported rates for SGLT2 inhibitors (27.5% (20-40%) vs 15% (10-25), p=0.003), GLP1-RA (10% (10-20%) vs 5% (5-10%), p=0.003) and mineralocorticoid receptor antagonists (20% (10-30%) vs 15% (10-20%), p=0.05) use were greater as compared to ESH-ECs without nephrologist participation.
The rate of reported resistant hypertension, recent eGFR and UACR results and management of CKD patients prior to referral varied widely across centres in Europe countries and in the Middle-East.

Conclusions:
Our results indicate deficits regarding CKD screening, use of nephroprotective drugs and referral to nephrologists before referral to ESH-ECs but results varied widely across centres. This information can be used to build specific programs to improve care in hypertensives with CKD.
THE EFFECT OF DARK AND WHITE CHOCOLATE ON BLOOD PRESSURE AND RENAL PERFUSION AS ASSESSED WITH DOPPLER ULTRASOUND IN HEALTHY VOLUNTEERS
Authors: Pruijm Menno , Gargiulo Louise , Brito Wendy , Hendriks-balk Marielle , Theiler Kenji , Wuerzner Gregoire 
Published: May 2024

Objective:
Dark chocolate (DC) is rich in calories but also in cocoa, a substance with anti-oxidative and antihypertensive properties. Acute intake of DC vasodilates coronary arteries, but the effect on blood pressure and renal hemodynamics is poorly understood. The aim of this randomized, placebo controlled study was to investigate whether DC induces changes in blood pressure and renal perfusion as assessed with Doppler ultrasound, both at rest and during sympathetic stimulation, as compared to cocoa-free white chocolate (WC).

Design and method:
Seventeen healthy volunteers aged 42±14 years (47% women) were randomized to eat 1g/kg of DC (70% cocoa) or 1g/kg of WC. The renal resistive index (RRI), a proxy of intra-renal vascular resistance, was measured just before and two hours after chocolate consumption. Blood pressure (BP) and heart rate were measured with a Finapress device. At each time point, a 3-minute handgrip test was performed as sympathetic stimulus; during the handgrip, supplementary RRI values were measured. Two weeks later, the same exams were repeated with the other type of chocolate.

Results:
DC intake decreased RRI from 0.62±0.04 to 0.60±0.04 (p=0.039), whereas RRI did not change after the intake of WC (before: 0.62±0.05, after: 0.62±0.04, p=0.47), see Figure. DC had no effect on BP in persons consuming >50g/chocolate/week, whereas SBP increased from 115±17 to 122±15 mmHg (p=0.02) in non regular chocolate eaters. Handgrip exercise also lowered the RRI from 0.62 to 0.57 (p=0.001) and flattened the Doppler curves, while increasing SBP (from 115±15 to 139±16mmHg, p=0.001). In women, the effect on RRI was attenuated by the ingestion of DC.

Conclusions:
The ingestion of DC lead to an acute reduction in RRI, suggesting intra-renal vasodilatation, whereas WC had no effect. BP only increased in non-regular DC eaters, suggesting that regular DC eaters got accustomed to the BP-modifying effects of DC. Handgrip exercise led, surprisingly, also to reductions in RRI, especially in young participants. Whether this is a sign of or sympathetically induced intra-renal vasodilatation or vascular reactivity needs further study.
PRACTICE-BASED BLOOD PRESSURE MANAGEMENT IN 1000 PATIENTS USING THE CUREAPP HT DIGITAL THERAPEUTICS FOR HYPERTENSION
Authors: Nomura Akihiro , Takagi Yusuke , Tanigawa Tomoyuki , Kario Kazuomi 
Published: May 2024

Objective:
The HERB-DH1 randomized controlled trial recently demonstrated significant reductions in ambulatory, home, and office blood pressures in essential hypertension patients using a novel digital therapeutics (DTx) app for hypertension (CureApp HT, CureApp, Inc.) for up to six months. However, its effectiveness in clinical practice, particularly regarding the influence of patient age and concurrent antihypertensive medication use, remains underexplored. This study aims to assess blood pressure changes in the first 1000 hypertensive patients prescribed the DTx app in a practice-based real-world data (RWD) cohort.

Design and method:
Deidentified data from the CureApp HT clinical information database were analysed. The primary endpoint was the change in morning home SBP from baseline to week 12. Key secondary endpoints included changes in morning home SBP from baseline to week 24, and app engagement rates from baseline to week 12 and 24. We also compared home morning SBPs between the practice-based RWD cohort and the historical HERB-DH1 control group using analysis of covariance.

Results:
The practice-based RWD cohort (mean age, 54.8 ± 11.6 years; 48.9% female; baseline morning home SBP, 132.8 ± 12.9 mmHg; and median app engagement rate, 91.7%) showed reductions in morning home SBP of -4.9 mmHg (CI, -5.6 to -4.2) at week 12 and -6.1 mmHg (CI, -7.3 to -5.0) at week 24, both significantly larger than those in the HERB-DH1 control group. Subgroup analysis revealed pragmatic SBP reductions with DTx in patients aged equal or more than 65 years or on antihypertensive medication at baseline, populations previously excluded in the HERB-DH1 trial.

Conclusions:
Conclusions: Significant reductions in morning home SBP were observed in the first 1000 hypertensive patients prescribed the DTx app compared to the HERB-DH1 control group. These findings might suggest importance of the DTx app’s engagement and effectiveness that could extends to elderly patients and those on antihypertensive medication.
EFFECT OF DASH VS. MEDITERRANEAN DIET ON METABOLIC SYNDROME PREVALENCE IN ADULTS WITH HIGH NORMAL BLOOD PRESSURE OR GRADE 1 HYPERTENSION: A RANDOMIZED CONTROLLED TRIAL
Authors: Filippou Christina , Thomopoulos Costas , Konstantinidis Dimitrios , Dimitriadis Kyriakos , Tatakis Fotis , Siafi Eirini , Manta Eleni , Drogkaris Sotirios , Stathoulopoulou Maria , Polyzos Dimitrios , Grigoriou Kalliopi , Kakouri Niki , Tsoumpou Ioanna , Andrikou Ioannis , Kasiakogias Alexandros , Tsioufis Konstantinos 
Published: May 2024

Objective:
Lifestyle interventions are recommended as the first-line treatment to control metabolic syndrome components. However, studies directly comparing the effects of the Dietary Approaches to Stop Hypertension (DASH) vs. the Mediterranean diet (MedDiet) on metabolic syndrome prevalence are currently lacking. Thus, we aimed to assess the effects of a 3-month intensive dietary intervention implementing salt restriction either alone or on top of the DASH and MedDiet compared to no/ minimal intervention on metabolic syndrome prevalence in never drug-treated adults with high normal blood pressure (BP) or grade 1 hypertension.

Design and method:
We randomly assigned individuals to the control group (CG, n = 60), salt restriction group (SRG, n = 60), DASH diet with salt restriction group (DDG, n = 60), or MedDiet with salt restriction group (MDG, n = 60). All patients were followed monthly for 3 months in individual sessions. Patients in the CG received general advice on dietary principles for BP control. For the patients in all three intervention groups, the goal was to limit sodium intake to 2,000 mg/ day (equivalent to 5,0g salt/ day). In addition, patients in the DDG and the MDG received an individualized dietary plan with six daily sample menus to facilitate the adoption of the assigned dietary pattern. Anthropometric indices, dietary intake, office BP, and fasting blood samples were evaluated pre- and post-intervention.

Results:
According to the intention-to-treat analysis, at 3 months post-intervention, the DDG and the MDG had lower odds ratio (OR) (95% CI) of metabolic syndrome compared to the CG [0.29 (0.12, 0.72), and 0.15 (0.06, 0.41), respectively], whereas the SRG and the CG did not differ regarding the odds of metabolic syndrome. Moreover, comparisons among the three intervention groups revealed that only the MDG had lower odds of metabolic syndrome compared to the SRG [0.25 (0.09, 0.67)].

Conclusions:
On a background of salt restriction, only the MedDiet was superior to salt restriction alone for metabolic syndrome prevalence reduction, but the DASH and MedDiet reduced the prevalence of metabolic syndrome to the same extent.
CHARACTERIZATION OF EARLY FUNCTIONAL, STRUCTURAL AND MOLECULAR ALTERATIONS IN A RAT MODEL OF CARDIORENAL SYNDROME TYPE IV: ROLE OF BMP-2
Authors: Sanz-gómez Marta , Vázquez-sánchez Sara , Manzano-lista Francisco Javier , Palma-guzmán Paloma , Guzmán-aguayo Ana Karen , Bragado-garcía Elvira , Kreutz Reinhold , Ruiz-hurtado Gema , Fernández-alfonso María S. 
Published: May 2024

Objective:
Cardiorenal Syndrome type IV (CRS-IV) is a common complication of chronic kidney disease (CKD) and a high-risk syndrome with poor prognosis. However, pathogenic mechanisms remain elusive. Our objective was to characterize early cardiac structural, functional, and molecular alterations in Munich Wistar Frömter (MWF), a rat model with established CKD.

Design and method:
Cardiac function, rhythm and structure were analyzed in aging 22- and 45-week-old Wistar and MWF rats (n=8/group) by electrocardiogram (ECG) and cardiac magnetic resonance imaging (CMRI). Hearts were dissected after the sacrifice and ventricle mRNA was extracted for q-RT-PCR.

Results:
From 22 weeks of age, MWF showed a defective ventricular repolarization (longer QT, QTc, JT and Tpeak-Tend) compared to Wistar rats. These ventricular electrical alterations relate to the presence of left ventricular (LV) hypertrophy supported by increased heart weight, LV wall thickness and higher expression of atrial and brain natriuretic peptides (Anp and Bnp). MWF rats also exhibited significantly lower systolic, diastolic and stroke volumes and a reduced cardiac output with no changes in the ejection fraction compared to Wistar rats.
At 45 weeks of age, the PR interval and P duration were increased in MWF rats compared to Wistar, indicating the development of atrial conduction dysfunction. LV expression of bone morphogenetic protein 2 (Bmp-2), which has been proposed as an antifibrotic cytokine, was 4-fold higher in MWF, whereas Tgf-beta was significantly lower and negatively correlated with Bmp-2 in MWF.

Conclusions:
During aging CKD evolves into CRS-IV through the development of LV hypertrophy and dysfunction followed at later ages by atrial damage. Since Bmp-2 downregulates profibrotic Tgf-beta expression it appears that the observed upregulation of Bmp-2 may represent an adaptive, however non-compensatory, cardiac response in the development of CRS-IV in this model.
HEALTHY METABOLIC STATUS: HOW FREQUENT IS THE TRANSITION TO A METABOLICALLY UNHEALTHY PHENOTYPE?
Authors: Palatini Paolo , Saladini Francesca , Mos Lucio , Vriz Olga , Mazzer Adriano , Garavelli Guido , Berton Giuseppe , Rattazzi Marcello 
Published: May 2024

Objective:
The clinical significance of metabolically healthy overweight/obesity (OwOb) is controversial. One main issue not yet resolved is whether a healthy metabolic status is stable or just temporary. Conversion to a metabolically unhealthy phenotype may imply a considerable increase in cardiovascular risk. Aim of the present study was to determine the frequency of the transition from metabolically healthy to metabolically unhealthy status and vice versa over the long term.

Design and method:
We examined 965, 18-to-45-year-old participants from the HARVEST study. Mean age was 33.1±8.6 years and BP 145.5±10.6/93.5±5.7 mmHg. Participants were classified into four groups according to whether they had normal weight or OwOb and were metabolically healthy (no abnormal metabolic syndrome parameter) or unhealthy (one or more abnormal parameter). After baseline assessment, non-pharmacological measures were implemented following the recommendations of current international guidelines. Changes in body weight and metabolic status were evaluated after a 7.5-year follow-up.

Results:
At baseline, 132 participants (13.7%) were normal-weight metabolically healthy, 331 (34.3%) normal-weight metabolically unhealthy, 91 (9.4%) OwOb metabolically healthy, and 411 (42.6%) OwOb metabolically unhealthy. At follow-up end, these percentages were, 10.3%, 28.2%, 9.4%, and 52.1%, respectively (p<0.0001). Only 32.6% of metabolically healthy normal-weight subjects remained metabolically healthy, while 36.4% transitioned to unhealthy status, and 31.1% to OwOb. Follow-up changes in body weight (mean±SEM) were +1.9±0.8, 2.6±0.7, and 8.6±0.8 Kg, respectively, in the three groups (p<0.001). Similarly, among the metabolically healthy OwOb participants only 31.9% remained metabolically healthy. Among the metabolically unhealthy OwOb subjects, 79.6% remained metabolically unhealthy, 8.3% transitioned to healthy status and 12.2% achieved normal weight. Body weight changes in the three groups were +2.3±0.3, +2.2±1.1, and -9.4±0.9 Kg, respectively (p<0.001).

Conclusions:
These data show that metabolically healthy status is a highly unstable condition in either normal-weight or OwOb individuals. Lifestyle counselling produced significant beneficial effects in one fifth of metabolically unhealthy OwOb patients, who achieved healthy metabolic status and/or normal weight. Given the instability of healthy metabolic status, it is important to advise also metabolically healthy people to maintain or adopt a healthy lifestyle and to decrease body weight in OwOb individuals.
ASSOCIATION OF LONG-TERM TIME IN TARGET RANGE FOR SYSTOLIC BLOOD PRESSURE SINCE CHILDHOOD WITH ARTERIAL STIFFNESS IN MIDLIFE: A 36-YEAR PROSPECTIVE COHORT STUDY
Authors: Wang Yang , Qi Han , Jia Hao , Wang Dan , Sun Yue , Du Ming -Fei , Hu Gui -Lin , Man Zi -Yue , Chu Chao , Chang John , Delles Christian , Zhang Ling , Mu Jian -Jun 
Published: May 2024

Objective:
Elevated blood pressure (BP) in childhood is associated with adult hypertension and arterial stiffness. We aimed to determine the independent association of time in target range (TTR) for systolic blood pressure (SBP) from childhood to midlife with arterial stiffness in midlife.

Design and method:
Using data from the ongoing cohort of Hanzhong Adolescent Hypertension study, 1959 children and adolescents aged 6 to 18 years were enrolled at baseline. We assessed SBP-TTR from childhood to adulthood for 36 years, with the target range of SBP defined as 90th – 95th percentile for age, sex, and height in childhood, and 110 to 130 mmHg in adulthood.

Results:
During the 36 years of follow-up, the risk of arterial stiffness gradually decreased with increasing TTR for SBP. After fully adjustment for traditional cardiovascular risk factors, comparing the highest vs. lowest quartiles of TTR for SBP, the odds ratios (ORs) [95% confidence intervals (CIs)] were 0.642 (0.452-0.911) for the risk of arterial stiffness in adulthood. TTR remained significantly associated with arterial stiffness despite adjustment for mean SBP or SBP variability. In addition, males with highest quartile of SBP-TTR was significantly associated with a decreased risk of arterial stiffness [OR 95% CI, 0.432 (0.262-0.710)], while no significant difference was found in females compared with the lowest TTR group.

Conclusions:
Higher long-term TTR for SBP from childhood to adulthood was associated with a decreased risk of arterial stiffness in adulthood independent of mean BP or BP variability. Therefore, SBP-TTR from an early age might serve as a modifiable risk factor for future cardiovascular diseases in later life.
SYSTEMATIC REVIEW OF MEDICATION ADHERENCE IN PATIENTS WITH HYPERTENSION IN INDIA
Authors: Agarwal Annika , Osman Hanad , Patel Prashanth , Mathur Sandeep Kumar , Bernieh Dennis , Gupta Pankaj 
Published: May 2024

Objective:
It is estimated that there are around 220 million adults in India with hypertension and only 12% have their blood pressure under control. Non-adherence in hypertension is a key factor that contributes to uncontrolled blood pressure. The extent of non-adherence in people with hypertension in India is currently unknown.

Design and method:
A systematic review was carried out using PubMed/MEDLINE to identify relevant studies from inception until July 2022 and included all articles in English of adults with hypertension and any study which had adherence (or equivalent terms) in the title or abstract. Data was analysed using SPPSS28.

Results:
The initial search identified 433 papers and on screening, 49 papers were found to meet the inclusion criteria. A total of 15,577 patients were studied. The mean age ranged from 26.1 to 69.3 yr. The median percentage of males was 37.5% (range 0% to 86.7%). The median value of patients that had less than primary school education was 25.2% (range 2.3% to 98.5%). The median of patients that had the condition for over 5 years was 40.0% (range 33.6% to 63.0%). 83.35% (30/36) studies took place in tertiary care and 53.3% (8/15) were in a rural setting and rest were either in urban or mixed setting.
The vast majority 84.4% (38/45) used standardised questionnaires to assess nonadherence. 45 studies had quantifiable data on non-adherence with the median non-adherence rate of 54.0% (range 4%- 98.5%).
Non-adherence was not significantly associated with mean age (P = 0.310), gender (P = 0.800), level of education (P = 0.468), duration of condition (P = 0.823), rural vs. urban setting (P = 0.805) or primary vs. tertiary care setting (P = 0.089).

Conclusions:
This is the first systematic review to evaluate the extent of non-adherence in patients in India with hypertension. The median nonadherence rate was more than 50% with a wide variation in rates across the studies. There were no factors identified that correlated with the extent of non-adherence. Further standardised studies are needed to understand and address this important issue in India.
ADHERENCE TO HYPERTENSION GUIDELINES AMONGST GENERAL PRACTITIONERS - A CASE BASED QUESTIONARY
Authors: Moczar Csaba , Tóth-szeles Roland 
Published: May 2024

Objective:
Hypertension is one of the most prevalent cardiovascular diseases. General practitioners have an important role in the treatment, which is why being up-to-date on treating this common disease is crucial.

Design and method:
Our goal was to measure general practitioners’ adherence to national hypertension treatment guidelines. We used a case-based questionnaire to represent the real-life practice as much as possible. We reached the general practitioners of the country via a Google questionnaire. In the first part, we obtained consult and asked about sociodemographic data. After these, we presented 5 cases separately. Each case had different cardiovascular risk factors, anamnesis, physical, laboratory, and diagnostic findings with different blood pressure values. GPs had to decide whether they would treat the case with drug(s), if so, with which drug type, for what systolic and diastolic target values, and what risk factors they would consider before choosing the treatment. These were multiple-choice questions.

Results:
We managed to reach out to 88 general practitioners. Most of them were familiar with the national hypertension guidelines; however, less so with the Hungarian Cardiovascular Consensus Conference recommendations. The indication of whether or not to treat a person was adequate in almost every case. The drugs to go with were coherent with the recommendations, although a tiny group started the therapy with combinations. There was also a significant number of those who chose beta-blockers as the first line of therapy. Among the target values, however, there was a considerable amount of uncertainty. The concomitant risk factors were considered when choosing the drug in most cases.

Conclusions:
Although the number of participants in our study was low, there were some trends that we could withdraw from it. Most colleagues are familiar with the guidelines for hypertension treatment. Most choose correctly whether to treat a patient. There was considerable uncertainty regarding the target values for different cardiovascular-risk patients. The doctors consider most of the risk factors upon choosing the starting drug treatment. There is still a meager percentage who start with combination therapy despite its superiority to monotherapy.
RISK DRIVERS FOR NON-ADHERENCE IN PATIENTS TREATED FOR HYPERTENSION
Authors: Dolgin Kevin , Jaegly Alexandre , Dabasinskas Linas , Pociute Simona , Drumea Dumitru 
Published: May 2024

Objective:
Adherence to treatment remains an unmet need in hypertension with important clinical and financial consequences for patients, HCPs, and health systems.
The objective of this study is to identify the behaviors of patients treated for hypertension, and specially the drivers of risk of non-adherence across 3 European countries: UK, Spain, and France.

Design and method:
Two questionaries were utilized for data collection: a sociodemographic and medical patient questionnaire and the SPUR questionnaire, a validated Patient-Reported Outcome Measurement tool developed by Observia.
The questionnaires were taken by 122 patients with hypertension who were recruited through patient panels on random basis to avoid selection bias.

Results:
The recruited patient population presented following characteristics: mean age 57 years, 60% male, with the most common comorbidities being diabetes (40% of patients), dyslipidemia (33%), and depression (25%).
The transversal analysis in three countries showed the most important behavioral drivers of non-adherence:
- Time (score∗: 53-66) - patients underestimating future benefits of the treatment over the burden of taking it today.
- Treatment risks (score∗: 44-45) – patients are concerned about potential side effects of the treatment.
- Societal (score∗: 40-44) - patients worry about the impact that hypertension has on their social life (i.e., at work, social activities, interaction with acquaintances).
The next three drivers for the RNA were the underestimation by the patient of the disease gravity, financial difficulties, and family life (immediate driver). This was common for all the countries of the study.

Conclusions:
The results provide insights on the main behavioral drivers of non-adherence to hypertension treatment.
These results should be confirmed in a larger population to be used as the basis for developing patient engagement programs to increase adherence. These should be co-constructed with HCPs and patients themselves to efficiently target identified main drivers of non-adherence in hypertension.
∗The drivers of risk of non-adherence are scored using Observia's proprietary SPUR algorithm, more information can be found in publications on SPUR.