bluuebunny/crossref_metadata_2025_split huggingface dataset:
PREDICTIVITY OF ESTIMATED PULSE WAVE VELOCITY FOR FATAL AND NONFATAL OUTCOMES IN RURAL POPULATION
Authors: Domislovic Marija , Baric Mirta Abramovic , Matijevic Vesna , Bosnic Zvonimir , Brzic Ivan , Capak Krunoslav , Prelevic Vladimir , Radunovic Danilo , Jelakovic Ana , Josipovic Josipa , Jelakovic Bojan 
Published: May 2024

Objective:
Our study assesses the predictive value of arterial stiffness measured by estimated pulse wave velocity (ePWV) for fatal and nonfatal outcomes in general rural adult population.

Design and method:
This was a prospective observational study (1175 adult subjects) from the ENAH rural project in Croatia. Subjects were followed up for an average of 11.3 (8.3-13.65) years. Mortality data were collected from the National Institute for Public Health, and data for morbidity from the medical records of local physicians. ePWV was calculated using a validated equation.

Results:
In total, there were 264 deaths (22.5%), and 171 (14.5%) subjects experienced one of the non-fatal outcomes (myocardial infarction, atrial fibrilation, heart failure, stroke, TIA, dialysis). Kaplan Meier analysis (KMa) showed that survival is lower in group with ePWV>10m/s compared with group with ePWV<10m/s (HR=12.8, 95%CI 9.9-16.6, p<0.001) (Figure 1A). Similarly, KMa showed that survival to non-fatal outcome is lower in group with ePWV>10m/s compared to group with ePWV<10m/s (HR=1.50, 95%CI 1.0-2.1, p=0.008), Figure 1B. In the multivariate analysis of predictors for fatal outcome, male gender and ePWV maintained statistical significance in predicting increased risk for death (HR 1.75, 95%CI 1.18-2.61, p=0.006 and HR 1.81, 95%CI 1.08-3.04, p=0.030, respectively). In the multivariate analysis, significance was not confirmed for any predictor for non-fatal outcomes, however, in the multivariate analysis for composite fatal and non-fatal outcome results showed that men were exposed to a greater risk compared to women (HR=1.54; 95%CI 1.14-2.08, p=0.006), and ePWV showed to be a risk factor (HR=1.94, 95%CI 1.50-2.51, p<0.001).

Conclusions:
ePWV was found to be significant independent predictor for cardiovascular deaths and composite fatal and non-fatal outcomes suggesting that this simple and reliable measure of arterials stiffness could be recommended for clinical work at least in remote rural areas where measurements of arterial stiffness is not feasible.
RISK FACTORS FOR CHRONIC HYPERTENSION 5 YEARS AFTER A PREGNANCY COMPLICATED BY PREECLAMPSIA: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Voskamp Lotte , Rousian Melek , Koerts Joni J , Steegers-theunissen Regine Pm , Danser Ah Jan , Verdonk Koen 
Published: May 2024

Objective:
Around 30% of women with preeclampsia develop chronic hypertension, a well-known risk factor for cardiovascular diseases, within ten years after pregnancy. This systematic review aimed to summarize risk factors associated with chronic hypertension during a 5-year follow-up period after pregnancies complicated by preeclampsia.

Design and method:
Embase, Medline, Web of Science, Cochrane Central and Google Scholar were searched with terms “preeclampsia” and “hypertension” or “cardiovascular risk” up to October 27, 2023. Observational studies published in English reporting prevalence of chronic hypertension (defined as blood pressure >140 />90 mmHg or prescription of antihypertensive drugs) after 5 years for distinct characteristics of women with preeclampsia were eligible for inclusion. Two researchers independently screened titles and abstracts and evaluated full text articles for inclusion. Study quality and risk of bias were assessed using the ErasmusAGE score. Where possible, a meta-analysis was conducted.

Results:
Thirty-three studies were included, involving 230939 patients and reporting 30 risk factors. Studies were of cohort (n=25) and case-control (n=8) design, with a median quality score of 6/10. Preeclampsia in a subsequent pregnancy was strongly associated with chronic hypertension (11 studies, N=139900). A meta-analysis of 5 studies (N=569) showed no association between early-onset preeclampsia <34 weeks of gestation and chronic hypertension (RR 1.90, 95%CI 0.76-4.74). Other factors associated with chronic hypertension were maternal age, body mass index, preconceptional blood pressure, severe preeclampsia defined as blood pressure >160/>110 mmHg or proteinuria >5g/24 hours, HELLP syndrome before 29 weeks of gestation, higher left ventricular mass index 8 months postpartum and a family history of preeclampsia. No associations with preterm birth, birthweight or laboratory parameters describing liver and renal function were observed. Notably, eclampsia showed a negative association with chronic hypertension.

Conclusions:
Preeclampsia in a subsequent pregnancy was the most consistently reported risk factor for chronic hypertension beyond 5 years after pregnancy. Early-onset of preeclampsia and preterm birth are not associated with chronic hypertension within this 5-year period. Maternal body mass index and blood pressure are key factors to include in a postpartum risk assessment for chronic hypertension after preeclampsia.
MEDIATION BY ANTIHYPERTENSIVE DRUG ADHERENCE IN THE IMPACT OF AMBULATORY BLOOD PRESSURE MONITORING ON THE CARDIOVASCULAR OUTCOMES IN THE NEWLY TREATED HYPERTENSION PATIENT
Authors: Shin Jinho , Kim Kwang-IL , Kim Hack-Lyoung , Ihm Sang Hyun 
Published: May 2024

Objective:
Non-adherence has been a growing challenge for breakthrough in the improvement of hypertension control. As the standard method for out of office BP measurement, we reported that ambulatory BP monitoring (ABPM) is also associated with improved antihypertensive drug adherence and improved CV outcome. But the magnitude of the contribution of improved adherence by ABPM on the better CV outcomes is uncertain.

Design and method:
In the database of The Korean National Health Insurance System, 27357 newly prescribed hypertension patients performed ABPM before the prescription were propensity score matched with the randomly selected 118594 newly prescribed patients without ABPM during 2008.1∼2009.12. Among them, 25312 patients without history of cardiovascular diseases were followed. Primary composite end points were any event of ischemic stroke, intracranial hemorrhage, and acute myocardial infarction. Secondary composite end points were any event of the primary composite end points, and admission for heart failure. Proportion mediated (PM) by good adherence was calculated by using the equation for non-linear outcome model, i.e., PM = natural direct effect (NDE) x [natural indirect effect (NIE)-1]/(NDE x NIE-1).

Results:
Age of the subject was 49.7+/-12.4 years and the proportion of the female was 41.1%. Median follow-up duration was 8.58 years. Adjusting the covariate and the adherence as the mediator, the hazard ratio of ABPM was 0.65 (95% CI:0.58, 0.74), p <0.0001) and 0.72 (95% CI: 0.66, 0.79, p <0.0001) for the primary and the secondary composite outcomes, respectively. In the mediation analysis, PNDE was 0.71 (95% CI: 0.64, 0.79) and TNIE was 0.95 (95% CI: 0.88, 1.02). PM was calculated as 11.1% (p <0.0001). When considering the interaction term of ABPM∗adherence in the log linear model, PNDE was 0.76 (95% CI: 0.64, 0.91) and TNIE was 0.93 (95% CI: 0.93, 0.83). PM was calculated as 19.1% (p < 0.0001).

Conclusions:
ABPM before antihypertensive drug prescription could have a good impact on both the drug adherence and CV prognosis. The contribution of good drug adherence to the overall impact of ABPM on improved cardiovascular outcomes is minor.
PATIENTS’ BELIEFS, MEDICATION ADHERANCE AND CONTROLLED HYPERTENSION AMONG HYPERTENSIVE PATIENTS IN VIETNAM
Authors: Ho Hien , Nguyen Minh Tam , Huynh Van Minh , Vo Tam , Tran Binh Thang , Heytens Stefan , Devroey Dirk , Vo Nu Hong Duc , Dang Thi Thanh Nha , Doan Pham Phuoc Long , Nguyen Vu Phong , Le Phuoc Hoang , Hoang Anh Tien 
Published: May 2024

Objective:
Medication adherence and controlled hypertension have low prevalence rates in Vietnam. Global research has highlighted associations between patients’ beliefs, hypertension knowledge, and medication adherence. Despite this, limited information exists on these aspects among Vietnamese hypertensive patients. This study aims to investigate patient beliefs and medication adherence among hypertensive individuals in community health centers in Vietnam.

Design and method:
In this cross-sectional study, patient beliefs and medication adherence among hypertensive patients were examined using the Belief about Medicine Questionnaire (BMQ) and Medication Adherence Report Scale (MARS-5). Additionally, demographic information, patients’ knowledge about hypertension, and data on controlled hypertension were collected. Descriptive, analytical, and multivariate logistic regression analyses were conducted using SPSS 29 software.

Results:
The study involved 761 hypertensive patients, with 55.7% being men. Findings revealed a mean medication adherence score of 21.8 (SD: 4.6). The MARS-5 score was higher in the ethnic majority (22 ± 4.3) and older patients (22.1 ± 4.1). The mean score for BMQ-Specific Necessity was 18.3 (SD 3.8), while BMQ-Specific Concern was relatively low at 14.4 (SD: 3.8). BMQ-General Overuse and BMQ-General Harm mean scores were 10.8 (SD: 2.6) and 9.9 (SD: 2.8), respectively. The BMQ-Specific Necessity score in older patients and those in urban areas had significantly higher scores than their counterparts in rural areas (p < 0.05). However, no difference was observed in patient beliefs and medication adherence based on gender. Patients with higher education or a high mean score for BMQ-Specific Necessity exhibited greater hypertension knowledge and better medication adherence (p < 0.001). Furthermore, patients with a higher mean score of medication adherence exhibited more controlled hypertension.

Conclusions:
Hypertensive patients in Vietnam exhibit high scores of necessity and low scores of concern regarding medication, with associations noted between patients’ knowledge and medication adherence. This study also revealed a low mean score of medication adherence among hypertensive patients. These findings highlighted the requirement for a holistic approach to deal with this concern. Healthcare planners and general practitioners should actively explore patients’ beliefs, enhance hypertension knowledge, and promote medication adherence for effective hypertension management.
A DIRECT COMPARISON OF TWO OBJECTIVE METHODS FOR DETECTION OF NON-ADHERENCE IN PATIENTS WITH UNCONTROLLED HYPERTENSION
Authors: Hamsund Ida Regine Bilet , Waldum - Grevbo Bård , H⊘ieggen Aud , Amro Amin , Olsvold Nina , Halvorsen Lene Vernås 
Published: May 2024

Objective:
Uncontrolled hypertension remains a major health challenge leading to premature death and cardiovascular morbidity. We have previously reported a prevalence of non–adherence to antihypertensive drugs from 8-30% of patients studied by either directly observed therapy (DOT) or serum drug concentrations (S- conc.) of antihypertensive medication. We aimed to investigate the prevalence of non–adherence in patients with uncontrolled hypertension consecutively referred to our outpatient clinic and to compare results from DOT and s-conc. in the same patient.

Design and method:
Nine, of planned 20 patients referred to 24-hour ambulatory blood pressure measurement (ABPM) were included in these preliminary results. Inclusion criteria was uncontrolled blood pressure (office SBP >140 mmHg) despite the use of three antihypertensive drugs. ABPM were measured at baseline and repeated after 3-4 weeks, the second time following DOT. S-conc. of antihypertensive drugs were measured by ultra-high-performance-liquid-chromatography tandem mass spectrometry at baseline and 24 hours after DOT. Patients with s-conc. of at least one drug below a predefined reference level were considered to be non–adherent. At the final visit patients evaluated how they experienced the DOT and s-conc. measurements by a visual analogue scale (VAS score) from 0 –10.

Results:
Of nine patients (age 36-79), five adherent (54,5%) and four (45,5%) non-adherent were detected by s-conc. Baseline mean for Ambulatory systolic blood pressure (ASBP) at visit one was 138±19 mmHg and mean ASBP after DOT 134±14 mmHg (p = 0,33). ASBP fell by 12±9 mmHg after DOT in the non-adherent group compared to a rise by 2±10 mmHg in the adherent group (p=0,079). Five patients completed the VAS evaluation, none of them experienced DOT or measuring s-conc. unpleasant.

Conclusions:
The difference in ASBP after DOT in the two groups showed a clear trend. Preliminary data in patients with uncontrolled hypertension show that both DOT and measurement of serum concentrations of antihypertensive drugs are reliable methods for detecting non–adherence and are well accepted by the patients. These methods may be used complementary in the outpatient clinic.
VALUE OF THE PROGNOSTIC MODEL FOR THE DIAGNOSIS OF HYPERTENSION USING AI ALGORITHMS
Authors: Abdullaev Akbar , Alyavi Anis , Alyavi Bakhromkhon , Uzokov Jamol , Iskhakov Sherzod , Muminov Shovkat , Ashirbaev Sherzod , Virkhov Igor 
Published: May 2024

Objective:
Hypertension is a prevalent cardiovascular condition associated with significant morbidity and mortality. While various prognostic models exist for predicting hypertension, incorporating artificial intelligence (AI) algorithms may enhance diagnostic accuracy and prognostication. However, the value of such AI-based prognostic models in hypertension diagnosis and risk stratification remains to be fully elucidated. This study aimed to evaluate the value of a prognostic model for the diagnosis of hypertension using AI algorithms by assessing biomarkers, predictors for worse prognosis, and clinical outcomes with Kaplan-Meier analysis and Cox regression models.

Design and method:
A retrospective cohort study was conducted on 256 smoker individulas with a mean age of 56.2 ± 12.8 years. Participants were followed up for a median duration of 6.5±2.6 years. Clinical and laboratory data, including cardiovascular biomarkers and predictors of hypertension, were collected at baseline. An AI-based prognostic model was developed using machine learning algorithms to predict hypertension diagnosis and prognosis. Kaplan-Meier analysis was performed to evaluate the cumulative incidence of hypertension, while Cox regression models were utilized to assess predictors of worse prognosis.

Results:
During the follow-up period, 42% of patients developed hypertension. The AI-based prognostic model demonstrated excellent diagnostic accuracy in predicting hypertension development, with 78% sensitivity and 75% specificity. Additionally, several predictors were identified for worse prognosis in hypertensive patients, including abdominal obesity, glucose intolerance, dyslipidemia. Cox regression models confirmed the independent association between high-risk classification by the prognostic model and cumulative incidence of hypertension (hazard ratio [HR], [1.15]; 95% confidence interval [CI], [1.05-1.26]; p < 0.05).

Conclusions:
Our findings suggest that an AI-based prognostic model holds promise for the diagnosis of hypertension and risk stratification. Incorporating AI algorithms into prognostic models may enhance diagnostic accuracy and improve outcomes in patients with hypertension. Further research is warranted to validate these findings in larger cohorts and optimize the AI-based prognostic model for clinical implementation.
BLOOD PRESSURE ESTIMATION FROM PPG-BASED PULSE ARRIVAL TIME
Authors: Villeneuve Emma , Anglade Daniel , Sandre-ballester Caroline , Auclair Loïc , Fuchs Olivier , Blandin Pierre 
Published: May 2024

Objective:
Cuff blood pressure monitoring is uncomfortable, limited for daily-routine and it provides sparse measurements in time. To enable continuous non-invasive monitoring, a new cuffless blood pressure (BP) meter based on photoplethysmography (PPG) is assessed in a first clinical trial. It aims at exploring the relationship between BP variations and optical features, including a wide range of intra-individual BP variations.

Design and method:
The cohort of the clinical trial (NCT05393401, approved by Human Research Review Board (CPP SM I)) includes 11 healthy subjects (5F/6M, age [19-60] years). Each subject undertakes a sequence of physical / mental activities and relaxation. The subject is monitored with PPG and ECG sensors at a sampling rate of 1 kHz. Measurements are realized with PPG sensors on the wrist, directly above the radial artery that was located by ultrasound. All these signals are collected and synchronised by a custom-built multi-sensing platform that was designed in-house. The Pulse Arrival Times (PAT) are computed from ECG R-peaks and PPG signals for each heartbeat, and then averaged every 20 s. In parallel, the subject's BP is measured every 20 s with a medical-grade continuous meter.

Results:
The collected dataset provides a wide range of variations of the PAT (0.23 +/- 0.19 s) and of the systolic BP (132 +/- 19 mmHg). Based on this dataset, a Gaussian process model is trained with cross-validation to predict the systolic BP from PAT values. The Root Mean Square Error (RMSE) is 18 mmHg. The Bland-Altman plot shows the distribution of residuals as a function of the mean of both measured and predicted BP. 95% of predicted values are within +/- 32 mmHg around the target.

Conclusions:
Thanks to the measurement protocol based on both active periods and relaxation, it is possible to measure a wide range of PAT and BP values with healthy subjects. Such variations are necessary to build a reliable prediction model. Future work will improve this preliminary model by taking into account instant heartrate and individual physiological parameters.
UNATTENDED AUTOMATIC BLOOD PRESSURE MEASUREMENTS VS. CONVENTIONAL OFFICE READINGS IN PREDICTING HYPERTENSION-MEDIATED ORGAN DAMAGE
Authors: Stopa Marek , Zieba Katarzyna , Tofilska Anna , Bilo Grzegorz , Rajzer Marek , Olszanecka Agnieszka 
Published: May 2024

Objective:
Hypertension, a major cardiovascular risk, requires accurate blood pressure measurement. Conventional office measurements (OBPM) are error-prone and systematically biased by the white coat effect. Unattended office blood pressure measurement (UOBPM) is emerging as an alternative to mitigate this bias. However, its ability to predict hypertension-mediated organ damage (HMOD), indicating disease progression, remains debated. This study compares UOBPM with OBPM in terms of their association with various HMODs, including left ventricular hypertrophy (LVH), left atrial enlargement (LAE), left ventricular systolic and diastolic dysfunction, intima-media complex (IMT) thickening, microalbuminuria and abnormal pulse wave velocity (PWV).

Design and method:
Hypertensive patients without overt cardiovascular disease were recruited, interviewed, and examined. Subsequently, blood pressure measurements were conducted in standard conditions in a randomized sequence in each patient:
1) UOBPM: After 5 minutes of solitary rest in the examination room, blood pressure was automatically measured three times at 1-minute intervals with OMRON HEM 907 device.
2) OBPM: After 5 minutes of rest, a physician performed three automated measurements at 1-minute intervals with the same device.
Subsequent evaluations aimed to detect HMODs, including echocardiography, carotid artery ultrasound, PWV assessment, and laboratory tests. Receiver operating characteristic (ROC) analysis was performed for each HMOD in both measurement groups, and the areas under the ROC curves were compared.

Results:
The study enrolled 219 patients(55% females, mean age 55 ±14 years). The average systolic blood pressure in UOBPM was lower by 4,2 mmHg (p<0,001) compared to OBP while the difference in diastolic pressure was 1,9 mmHg (p<0,001). Both measurement methods were associated with the presence of the following HMODs: LAE, IMT thickening, and abnormal PWV. Neither method allowed for the prediction of LVH, systolic and diastolic dysfunction of the left ventricle, elevated ACR, or the presence of atherosclerotic plaques in the carotid arteries. Furthermore, ROC curve analyses revealed no difference between the two methods in predicting HMOD (Table 1).

Conclusions:
Both measurement techniques exhibited satisfactory predictive ability for the presence of certain HMOD. However, based on the study results, no significant differences could be inferred between the two methods with respect to their predictive performance.
IMPACT OF THE NUMBER OF OFFICE BLOOD PRESSURE MEASUREMENTS ON THE CLASSIFICATION OF BLOOD PRESSURE IN PATIENTS WITH ATRIAL FIBRILLATION
Authors: Ntousopoulos Vasileios , Menti Ariadni , Tsiachris Dimitrios , Stergiou George , Kollias Anastasios 
Published: May 2024

Objective:
To investigate the impact of the number of auscultatory or oscillometric blood pressure (BP) measurements taken in the office on the classification of BP in patients with atrial fibrillation (AF).

Design and method:
Patients with permanent AF were evaluated in a single office visit with consecutive alternating BP measurements using a mercury sphygmomanometer (5 measurements, 2 observers simultaneously) and an automated oscillometric upper-arm cuff BP monitor (4 measurements; Microlife BP B3 AFIB). BP was stratified according to the 2023 European Society of Hypertension (ESH) guidelines.

Results:
53 participants were analyzed (mean age [SD] 76±9.8 years, 62% men, 91% with treated hypertension). The mean±SD of systolic/diastolic BP with the auscultatory and oscillometric method were 118.2±20.4/69.2±10.4 and 122.3±19.2/73.1±11.7 mmHg respectively (p<0.05/0.05). Systolic office BP based on the increasing number of measurements is shown in the graph. The prevalence of individuals with optimal, normal, high-normal BP, grade 1, and grade 2 hypertension based on the auscultatory technique was: 51/17/8/17/8% (1 measurement), 59/8/15/11/8% (average of 2 measurements), 59/13/9/11/8% (3 measurements), 62/9/6/15/8% (4 measurements), and 59/13/8/15/6% (5 measurements) (p=NS for all comparisons with the single measurement). Correspondingly, with the oscillometric method: 40/21/11/19/9% (1 measurement), 43/17/15/17/8% (2 measurements), 49/15/15/13/8% (3 measurements), and 53/11/15/15/6% (4 measurements) (p=NS for all comparisons with the single measurement). The agreement in diagnosing individuals with BP >120/80 mmHg between the 1st and the average of 1st-3rd measurements was 92/91% (kappa=0.85/0.81) with the auscultatory and the oscillometric method respectively.

Conclusions:
These preliminary results indicate that the standard ESH recommendation to perform triplicate office BP measurements is also applicable in patients with AF.