bluuebunny/crossref_metadata_2025_split huggingface dataset:
RELATIONSHIP BETWEEN CLINIC AND AMBULATORY BLOOD PRESSURE AND MORTALITY IN PATIENTS WITH PREVIOUS STROKE
Authors: Armario Pedro , Gomez-choco Manuel , Garcia-sanchez Sonia , Ruilope Luis M , Williams Bryan , De La Sierra Alejandro 
Published: May 2024

Objective:
The aim of this study was to evaluate the association between clinic and ambulatory BP and mortality in patients with a previous stroke

Design and method:
Observational cohort study from the Spanish Ambulatory Blood Pressure Registry. Mortality data (date and cause) were ascertained by a computerized search of the vital registry of the Spanish National Institute of Statistics. For each study participant, follow-up was from the date of his or her recruitment to the date of death, or December 31st, 2019, whichever occurred first. Cox models were used to estimate associations between clinic and ambulatory BP and mortality, adjusted for clinical confounders (age, sex, BMI, smoking, diabetes, and dyslipidemia), and additionally for alternative measures of BP.

Results:
From the 59 124 individuals included in the Registry, we selected 2,183 with a previous stroke. Mean age was 67.5 ± 11.8 years, 43.6% were female. During a median follow-up of 9.7 years (IQR 7.7–11.3), 632 (29.5%) participants died, including 236 from cardiovascular causes (62 ischemic heart disease deaths, 83 stroke deaths, and 28 heart failure deaths). In the confounder-adjusted model, clinic systolic BP was not associated with the risk of all-cause or cardiovascular mortality. In contrast, systolic BP indices obtained through ABPM (24h, day and night) were all associated with all-cause and cardiovascular mortality. In the simultaneous adjustment of daytime and night-time systolic BP, only night-time systolic BP remained significantly associated with all cause and cardiovascular death: OR 1.36 (1.21-1.52) and 1.45 (1.21-1.73), respectively. For diastolic BP, only night-time BP was associated with all-cause and cardiovascular mortality: OR 1.33 (1.18-1.49) and 1.58 (1.32-1.89), respectively. Reverse dipper pattern (risers) was also associated with all-cause mortality: OR 1.56 (1.18-1.86) and cardiovascular mortality: OR 1.81 (1.27-2.57).

Conclusions:
In patients who have suffered a previous stroke, night-time blood pressure is the BP estimate most closely associated with all-cause and cardiovascular mortality.
SEVERE COURSE OF PARAGANGLIOMAS IN CHILDREN WITH SUCCINATE DEHYDROGENASE MUTATIONS – A REPORT OF TWO CASES
Authors: Skrzypczyk Piotr , Soltyski Jaroslaw , Bujanowicz Adam , Ambroziak Urszula , Grat Michal , Toutounchi Sadegh , Niemczyk-cieslak Elzbieta , Niemczyk Kazimierz , Furmanek Mariusz I. , Panczyk-tomaszewska Malgorzata 
Published: May 2024

Objective:
Paragangliomas and pheochromocytoma (PPGL) are rare causes of arterial hypertension (AH) in children. This study aimed to present the clinical course in two adolescents with PPGL tumors due to succinate dehydrogenase mutations.

Design and method:
We analyzed age, gender, clinical manifestations, laboratory findings, including plasma methoxycatecholamines, genetic and imaging findings, pharmacological and surgical treatment, and outcome.

Results:
Case 1: A 14-year-old boy presented with tinnitus, dizziness, and balance disorders. A computed tomography (CT) revealed a paraganglioma in the area of the left internal jugular vein bulb, causing ear and bone destruction. The boy was diagnosed with AH; his plasma normetanephrine was 343pg/mL (normal range: 18-138), metanephrine and 3-methoxytramine were normal. The patient was started on doxazosin, and the tumor was removed. A genetic study showed a pathogenic variant in the SDHD gene (c.33C>A). PET/CT showed another tumor between the inferior vena cava and diaphragm. A successful tumor resection was performed. Currently, the boy is 17 years old, methoxycatecholamine levels are normal. The patient has AH (primary hypertension) and is treated with rampiril and amlodipine.
Case 2: A 17.5-year-old girl was admitted to the hospital due to headaches and AH lasting about six months. Laboratory tests revealed a markedly elevated plasma normetanephrine - 8734.59pg/mL (normal range: 16-142) and a slightly elevated 3-methoxytramine - 25.52pg/mL (normal range < 14). CT showed a large tumor (11x7x7cm) at the level of the diaphragm, modeling the heart, liver, and inferior vena cava. Whole-body PET/CT and MIBG scintigraphy did not detect other tumors. A genetic test showed a pathogenic variant in the SDHB gene (c.181dupT). The girl was treated with doxazosin. Surgical treatment included two transarterial embolizations, followed by surgical removal of the tumor. Currently, the patient is 18 years and 2 months old, has normal methoxycatecholamines, and does not require antihypertensive drugs. The same variant of the SDHB gene was found in the patient's father and older brother.

Conclusions:
1.PPGL can have an unusual clinical course in children, and patients may present with a variety of symptoms
2.Pediatric patients with PPGL require genetic tests and individualized, multidisciplinary medical care.
THE SUBCLINICAL INFLAMMATION IN PEDIATRIC PATIENTS WITH PRIMARY HYPERTENSION AND WHITE COAT HYPERTENSION
Authors: Dziedzic-jankowska Katarzyna , Bujanowicz Adam , Szyszka Michal , Stelmaszczyk-emmel Anna , Skrzypczyk Piotr 
Published: May 2024

Objective:
Adult and experimental data indicate the vital role of inflammation in the pathogenesis of primary hypertension. The study aimed to evaluate subclinical inflammation in patients with primary hypertension (PH) and white coat hypertension (WCH).

Design and method:
In 56 untreated pediatric patients with PH, 40 with WCH, and 30 healthy individuals (CG – control group), we evaluated high sensitivity C-reactive protein (hsCRP), interleukin 18 (IL18) concentrations, complete blood count-derived markers of inflammation, office and ambulatory blood pressure, and selected clinical and biochemical parameters.

Results:
hsCRP was significantly higher in PH patients compared to CG (PH vs. CG: 4.9±5.2 vs. 2.8±5.4 [mg/dL], p=0.002), and neutrophil and monocyte counts were significantly higher in PH and WCH patients compared to CG (PH vs. WCH vs. CG, neutrophils: 3.89±1.44 vs. 3.40±1.75 vs. 2.63±0.96 [∗10^3/μL], p=0.001, monocytes: 0.56±0.17 vs. 0.53±0.18 vs. 0.46±0.14 [∗10^3/μL], p=0.026). Receiver operating characteristic analysis revealed good prognostic profiles for hsCRP (area under curve [AUC]=0.668, p=0.0005), neutrophil (AUC=0.691, p=0.0001), lymphocyte (AUC=0.615, p=0.0230), monocyte (AUC=0.622, p=0.0148), and platelet counts (AUC=0.606, p=0.0364), as well as the neutrophil-to-lymphocyte ratio (AUC=0.619, p=0.0181), monocyte-to-neutrophil ratio (MNR) (AUC=0.617, p=0.0204), and platelet-to-mean platelet volume ratio (AUC=0.606, p=0.0370) as predictors of the presence of primary hypertension. In multivariate analysis monocyte-to-lymphocyte ratio (MLR) and platelet count (beta=0.217, p=0.011; beta=0.191, p=0.036) were significant predictors of office diastolic blood pressure Z-score, neutrophil count predicted 24h systolic blood pressure Z-score (beta=0.365, p=0.005); MLR, lymphocyte count, IL-18, and MNR predicted 24 h diastolic blood pressure Z-score (beta=0.305, p=0.002; beta=0.253, p=0.010; beta=-0.197, p=0.019; beta=-0.189, p=0.029), and neutrophil count together with IL-18 predicted 24h mean arterial pressure Z-score (beta=0.210, p=0.027; beta=-0.209, p=0.012).

Conclusions:
1.Patients with primary hypertension and white coat hypertension are characterized by similar levels of subclinical inflammation, significantly higher compared to healthy peers. 2. Complete blood count-derived indices, especially neutrophil count and MLR, can be an important adjunct to the clinical evaluation of pediatric patients with primary hypertension.
ASSOCIATION BETWEEN SINGLE POINT INSULIN SENSITIVITY ESTIMATE AND METABOLIC PHENOTYPE IN CHINESE ADOLESCENTS AGED 12–18 YEARS OLD
Authors: Tian Mei , Ma Xiaoyan , Liu Jianxi , Tong Lingling , Ding Wenqing 
Published: May 2024

Objective:
To study the relationship between single-Point Insulin Sensitivity Estimator (SPISE) and metabolic phenotypes of obesity in adolescents in Yinchuan City, and to provide a basis for the prevention and control of adolescent obesity and related metabolic diseases.

Design and method:
A total of 1 573 adolescents aged 12 to 18 years were randomly selected by stratified cluster sampling in Yinchuan City from 2017 to 2020, and they were surveyed using questionnaires, physical measurements, body composition measurements, and laboratory tests. According to the diagnostic criteria for metabolic abnormalities and the definition of obesity based on the body mass index, the subjects were divided into four metabolic phenotypes: metabolically healthy normal weight, metabolically healthy obesity, metabolically unhealthy normal weight, and metabolically unhealthy obesity. The association between SPISE and the metabolic phenotypes was analyzed using multivariate logistic regression.

Results:
The SPISE levels in the metabolically unhealthy normal weight,metabolically healthy obesity, and metabolically unhealthy obesity groups were all lower than those in the metabolically healthy normal weight group (P<0.001). Multivariate logistic regression analysis showed that after adjusting for gender and age, higher SPISE levels were protective factors for adolescents to develop metabolic unhealthy normal weight, metabolically healthy obesity, and metabolically unhealthy obesity phenotypes (OR=0.89, 0.04, and 0.04, respectively; P<0.001).

Conclusions:
Increasing SPISE can reduce the risk of the development of metabolic unhealthy/obesity. In the prevention of adolescent obesity and related metabolic diseases, attention should be paid to the monitoring of SPISE index, so as to reduce the risk of adolescent obesity and cardiovascular and metabolic abnormalities.
ANALYSIS OF THE MEDIATING EFFECT OF NONTRADITIONAL LIPID PARAMETERS IN THE RELATIONSHIP BETWEEN BODY MASS INDEX AND BLOOD PRESSURE IN CHINESE ADOLESCENTS
Authors: Ma Xiaoyan , Tian Mei , Liu Jianxi , Tong Lingling , Ding Wenqing 
Published: May 2024

Objective:
To analyze the mediating role of non-traditional lipid parameters in the relationship between body mass index (BMI) and blood pressure in children and adolescents, and to provide a reference basis for the development of hypertension prevention and treatment strategies in children and adolescents.

Design and method:
A stratified whole-group random sampling method was used to select 1796 children and adolescents aged 12 to 18 years from middle and high schools in Ningxia for physical examination and laboratory testing, and a mediating effect model was used to analyze the mediating effect of nontraditional lipids on the relationship between BMI and blood pressure.

Results:
Among the nontraditional lipid parameters, all of them were significantly associated with blood pressure except Non-HDL-C (all P<0.001); three of them, Remnant Cholesterol (RC), TG/HDL-C and RC/HDL-C, had significantly higher effects on blood pressure than the others (all P<0.001). HDL-C, RC and RC/HDL-C partially mediated the relationship between BMI and blood pressure, with the three mediating effects accounting for 5.2%, 6.9%, and 7.5% of the relationship between BMI and diastolic blood pressure and 4.4%, 3.0%, and 3.8% of the relationship between BMI and systolic blood pressure, respectively (all P<0.001).

Conclusions:
Nontraditional lipid parameters are associated with blood pressure and partially mediate the relationship between BMI and blood pressure, and more attention should be paid to the role of monitoring nontraditional lipid parameters in the management of blood pressure in children and adolescents.
WHITE COAT HYPERTENSION IN EX-PRETERM CHILDREN ASSOCIATES WITH HIGHER NGAL LEVELS
Authors: Chainoglou Athanasia , Sarafidis Kosmas , Taparkou Anna , Farmaki Evangelia , Chrysaidou Katerina , Gidaris Dimos , Kollios Konstantinos , Kotsis Vasilios , Stabouli Stella 
Published: May 2024

Objective:
As preterm birth is a risk factor for hypertension (HTN), biomarkers for early detection of HTN in childhood is an emerging need. The aims of the study were to evaluate serum biomarkers in ex-preterm children and examine for associations with blood pressure (BP) phenotypes using both office BP and ambulatory BP monitoring to classify BP levels.

Design and method:
This prospective case-control study included 52 children and adolescents born prematurely (ex-preterms) and 22 ones born at full term (controls). All participants underwent office and ambulatory BP monitoring, and assessment of serum biomarkers at the same clinic visit. Neutrophil gelatinase-associated lipocalin (NGAL), matrix metalloproteinase-2, -9 (MMP-2, -9), and Cystatin C (CysC) were measured using enzyme-linked immunosorbent assay.

Results:
Mean age of the population was 10.74±3.55 years. 31% of the ex-preterm children and 23% of the controls had white-coat hypertension (WCH). Among ex-preterm children and adolescents 17% had ambulatory HTN and 31% had white-coat HTN. Among controls 23% had WCH while none of the children and adolescents in the control group had ABP HTN. NGAL, CysC, MMP -2, and -9, levels did not differ between BP phenotypes in the study population. When ex-preterm group was analyzed separately, NGAL levels were found higher in ex-preterm children with WCH compared to children with normal BP in the ex-preterm group [57.89 (IQR 50.79) versus 34.58 (IQR 46.22), p=0.018}. Receiver operator curve analysis showed that NGAL could be a significant predictor of WCH in the ex-preterm group with area under the curve (AUC) of 0.718 (95% CI 0.56-0.87, p = 0.005) (Figure).

Conclusions:
As WCH is common in ex-preterm children and adolescents and is associated with higher NGAL levels, regular BP measurement in children with history of prematurity or low weight at birth is recommended because of their increased risk of HTN and cardiovascular disease in the future.
FIBROSIS AS AN ADDITIONAL RISK FACTOR FOR STROKE DEVELOPMENT IN HYPERTENSIVE PATIENTS WITH ATRIAL FIBRILLATION (RETROSPECTIVE STUDY)
Authors: Hazarapetyan Lusine , Zelveian Parounak , Grigoryan Svetlana 
Published: May 2024

Objective:
Atrial fibrillation (AF) is a common issue that is increasingly prevalent, particularly in hypertensive patients and leads to severe complications, notably stroke. Several prothrombotic factors are elevated in AF, contributing to an increased risk of stroke. Tissue factor (TF) is the main initiator of the blood coagulation cascade, also involved in inflammation and fibrogenesis. Atrial fibrosis plays a central role in creating the substrate for AF, with the Transforming Growth Factor (TGF-B1) identified as a key cytokine involved in the pathogenesis of atrial fibrosis. The aim of this study is to investigate the relationship between atrial fibrosis and the risk of developing transient ischemic attack (TIA) or stroke in hypertensive patients with AF (retrospective study).

Design and method:
We observed 445 hypertensive patients with nonvalvular AF over three years (2017-2019). Clinical examination included a study of complaints, physical, laboratory, and instrumental examination, along with additional biochemical blood tests, such as TF, hsCRP, IL-6, and TGF-B1. Blood tests were determined using the ELISA method. Treatment regimens for all patients included standard therapy (anticoagulants, antiarrhythmic, and symptomatic medication). Studies were conducted based on open-label protocols, using the universal statistical packages SPSS 13.0.

Results:
The obtained results have shown that among the 445 hypertensive patients with AF within three years, TIA or stroke was detected in 128 patients (28.8%). We found that in these patients, the level of TF is statistically elevated compared to other patients with AF (1350±65 vs. 850±33 pg/ml). Hypertensive patients undergoing TIA or stroke exhibited a significant increase in levels of inflammatory and fibrosis markers compared with other hypertensive patients with AF. Significant differences between hsCRP levels were observed (8.6±1.4 vs. 4.2±1.6, p=0.002); IL-6 levels (6.4±0.8 vs. 3.6±1.2 pg/ml, p=0.043); and TGF-B1 levels (1240±75 vs. 900±43 pg/ml, p=0.02). Moreover, plasma levels of hs-CRP were higher among AF patients at high risk of stroke (3 or more) according to CHA2DS2-VASc (p=0.002).

Conclusions:
We have demonstrated that fibrosis and inflammation markers, along with coagulation cascade markers, are additional prognostic criteria contributing to the development of TIA or stroke in hypertensive patients with AF.
DEVELOPMENT AND INTERNAL VALIDATION OF A PREDICTION MODEL TO PREDICT THE PROBABILITY OF FUTURE RECURRENCE OF HYPERTENSION IN PATIENTS WITH HYPERTENSIVE DISORDERS OF PREGNANCY
Authors: Sun Yancui 
Published: May 2024

Objective:
This study aimed to obtain a clinical prediction model for the future recurrence of hypertension in women with a history of gestational hypertension or Preeclampsia-Eclampsia by analyzing the basic data and laboratory indicators in their pregnancy.

Design and method:
We retrieved hypertensive disorders of pregnancy (HDP) patients of the First Affiliated Hospital of Dalian Medical University and the Second Affiliated Hospital of Dalian Medical University from 2001 to June 2021. After telephone follow-up, a total of 605 pregnant women with previous HDP were followed up. The baseline data of the cases were followed by binary logistic regression analysis according to the follow-up hypertension outcome, Nomogram plotted according to independent risk factors, and the model discrimination was tested by operating characteristic curve (ROC), The reproducibility of the model was verified by internal validation on the development dataset (Bootstrap self-sampling method, internal cross-validation and Jackknife validation), verify the calibration of the model through the calibration curve (Hosmer-Lemeshow goodness of fit test), and Validation of clinical predictive value by Decision Curve Analysis (DCA).

Results:
data analysis showed that A total of 200 (33.06%) pregnant women with a previous history of HDP had recurrent hypertension during follow-up (median follow-up time was 5 years). The predictors in the Nomogram were the highest diastolic blood pressure (DBP) during pregnancy, the highest systolic blood pressure (DBP) during pregnancy, peak Alkaline phosphatase value, age at delivery, peak uric acid value, and positive urine protein, Contrary to the remaining 5 predictors, a low level of peak alkaline phosphatase value predicted a high risk of postpartum hypertension. the Area Under Curve (AUC) of ROC about the nomogram was 0.797, and a similar C-index was obtained in the internal validation, and this model show a high fitting degree in the calibration curve and show clinical predictive value.

Conclusions:
The results of this study can provide predictive indicators for women with HDP to suffer from hypertension after delivery, which can be used for clinical decision-making, and aid with follow-up blood pressure monitoring and the selection of primary prevention treatment groups.
THE EFFECTS OF OLMESARTAN/AMLODIPINE ADMINISTERED IN THE MORNING OR AT NIGHT ON NOCTURNAL BLOOD PRESSURE IN CHINESE PATIENTS WITH MILD-MODERATE ESSENTIAL HYPERTENSION (OMAN TRIAL)
Authors: Ye Runyu , Zhang Xin , Liu Xueting , Sun Lirong , Chen Xiaoping 
Published: May 2024

Objective:
The clinical evidence of antihypertensive chronotherapy remains controversial. This study aimed to compare the effects of morning and bedtime antihypertensive administration on the nocturnal blood pressure (BP) reduction and the circadian rhythm of hypertensives.

Design and method:
A randomized, multicenter, open-label clinical trial was conducted in China from March, 2022. Patients aged 18-75, not taking or stopped using antihypertensive drugs for 2 weeks, were recruited. At baseline, all patients received 24-h ambulatory BP measurement (ABPM) and office BP measurement (OBPM), and were randomized to the morning (06:00-10:00 AM, group 1) or the bedtime dosing group (6:00-10:00 PM, group 2). Each patient received one tablet of olmesartan/amlodipine (OA) (20/5 mg) daily for 4 weeks, and then followed up every 4 weeks for 12 weeks. The OA dosage was adjusted based on the ABPM and OBPM. Patients with uncontrolled BP at the first follow-up received an increased dosage to 1.5 tablets, and increased to 2 tablets if BP was uncontrolled after 4 weeks of dosage increase.

Results:
700 patients were recruited (mean age 56.54±10.52 years; 45.5% female), with 382 finished the 12-week follow-up and were included in the analysis (follow-ups are continuing). At week 4, the mean BP differences of ABPM and OBPM did not differ significantly between groups. At week 12, compared with group 1, patients in group 2 showed significantly greater reductions from baseline in nighttime systolic BP (SBP) (between-group difference -5.04mmHg, 95% confidence interval (CI): -8.38 to -1.70), and diastolic BP (DBP) (-3.03mmHg, 95% CI -5.08 to -0.97); with better nocturnal SBP control (67.4% vs. 76.7%, P=0.04), and decrease in nocturnal BP load. The proportion of non-dipper or reverse dipper increased from 52.3% to 54.4% in group 1 (P=0.64), and dropped from 57.9% to 45.5% in group 2 (P<0.01). The incidence of nocturnal hypotension (SBP/DBP<100/90mmHg) did not differ.

Conclusions:
Compared with morning dosing, bedtime dosing can better control nocturnal BP, and improve the circadian rhythm without increasing the risk of nocturnal hypotension. It represents a reasonable strategy to optimize BP control, especially nocturnal BP control.
CHARACTERISTICS OF DIFFERENT HYPERTENSION STAGES IN CHINA —RESULTS FROM A NATIONAL CROSS-SECTIONAL UPPDATE STUDY
Authors: Xie Kun , Gao Xiufang , Bao Liwen , Shan Ying , Li Yong 
Published: May 2024

Objective:
We sought to investigate the prevalence and characteristics of patients with hypertension stage 1, 2, and 3 according to 2023 ESH guidelines for the management of hypertension.

Design and method:
A cross-sectional study was carried out in 90 centers from 15 cities in China from 2017-2018. Patients aged over 18 years with essential hypertension were investigated. Hypertension stage 1 was defined as uncomplicated hypertension without hypertension-mediated organ damage (HMOD), diabetes, cardiovascular disease (CVD) and without chronic kidney disease (CKD) >=stage 3. Hypertension stage 2 was defined as presence of HMOD, diabetes, or CKD stage 3. Hypertension stage 3 was defined as presence of CVD or CKD stage 4 or 5.

Results:
A total of 4286 patients were included, 56% of whom were male. Hypertension stage 1, 2, and 3 account for 28%, 50%, and 22% respectively. Ninety-three % of the total patients were having antihypertensive therapy. The average BP was 133±12/85±11 mmHg, 146±17/83±12 mmHg, and 143±19/84±13 mmHg in hypertension stage 1, 2, and 3 respectively. Lipid lowering therapy accounted for 40%, 49%, and 71% respectively, which was relatively low. The average LDL-C level was 3.0±1.0mmol/L, 2.9±1.0mmol/L, and 2.6±1.4mmol/L respectively, which was far from the goal of LDL-C management. Homocysteine was 11.2±9.6 μmol/L, 13.6±9.1 μmol/L, and 19.0±11.2 μmol/L, which increased from stage 1 to stage3.

Conclusions:
Hypertension stage 2 accounted for half of the patients with hypertension in China. The average blood pressure was much higher in stage 2 and stage 3. Only 71% of hypertension stage 3 were having lipid lowering therapy and LDL-C levels were far from the recommended goal. Homocysteine was positively associated with hypertension stage.