bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between hepatic steatosis and blood pressure: analysis of the NHANES 2017- 2020
Authors: Wattanachayakul P , Rujirachun P , Phichitnitikorn P , Lopimpisuth C , Lalitnithi P , Tantisattamo E 
Published: November 2023

Abstract

Background
Recent studies have shown that hepatic steatosis is associated with increased risk of incidence hypertension and cardiovascular events, whether the association between hepatic steatosis stratified by controlled attenuation parameter (CAP) grading and blood pressure remains unclear.

Methods
We examined a cross-sectional study from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 that included participants ≥18 years old. CAP, the indicator for hepatic steatosis, was obtained from Fibroscan™ and was stratified into four grading groups, including absent (S0): CAP &lt;238 dB/m, mild (S1): 238-260 dB/m, moderate (S2): 260-290 dB/m, severe (S3): 290-400 dB/m. We used multiple linear regression to examine the association between the degree of hepatic steatosis and blood pressure.

Results
Of 9,698 patients with Fibroscan™ results, the mean age was 44+/-20 years old, and 49.9% were female. We observed that White individuals accounted for 33.7%, followed by Black (26.3%), Mexican American (12.5%), Asians (11.7%), Hispanic (10.1%), and others (5.6%). The mean SBP and DBP were 121±18 and 72±11 mmHg, respectively. Participants with S1, S2, and S3 steatosis had significantly higher SBP values of 4.7, 6.1, and 8.1 mmHg and DBP values of 3.4, 4.8, and 7.1 mmHg, respectively, compared with those without steatosis (S0) (β SBP S1: 4.7, 95%CI 3.4, 5.9; S2: 6.1, 95%CI 5.0, 7.3; S3: 8.1, 95%CI 7.2, 9.0 and β DBP S1: 3.4, 95%CI 2.7, 4.2; S2: 4.8, 95%CI 4.1, 5.5; S3: 7.1, 95%CI 6.6, 7.7). After adjusting for age, gender, race, BMI, smoking status, diabetic status, and serum creatinine, a positive correlation between hepatic steatosis and blood pressure was still observed. Specifically, there was a 1.7, 1.6, and 2.7 mmHg statistically increase in SBP values and a 1.8, 2.3, and 3.9 mmHg increase in DBP values among participants with S1, S2, and S3 steatosis, respectively. (β SBP S1: 1.7, 95%CI 0.5, 3.0; S2: 1.6, 95%CI 0.4, 2.8; S3: 2.7, 95%CI 1.6, 3.8 and β DBP S1: 1.8, 95%CI 0.9, 2.7; S2: 2.3, 95%CI 1.5, 3.1; S3: 3.9, 95%CI 3.2, 4.6).

Conclusion
The degree of hepatic steatosis is positively associated with blood pressure values. However, further studies are required to demonstrate the long-term clinical outcomes of this observed relationship.
Blood pressure variability as a prognostic factor in patients with acute myocardial infarction. Data from the ACS-BP study
Authors: Konstantinou K , Koumeli A , Apostolos A , Dimitriadis K , Sakalidis A , Papelis K , Fragoulis C , Mantzouranis M , Vaina S , Tsioufis K 
Published: November 2023

Abstract

Background
Blood pressure variability (BPV) is considered a modern cardiovascular risk factor. There are many data relating BPV to mortality, risk of stroke and target organs damage mainly in hypertensive patients.

Purpose
The purpose of the present study is to investigate whether BPV in patients with acute myocardial infarction (AMI) who all underwent percutaneous coronary intervention (PCI) was associated with short and and/or long-term cardiovascular mortality.

Methods
A total of 402 patients (67.2% male, mean age: 62.7 years, 70.1% hypertensive, 46.9% STEMI) underwent 24-ambulatory blood pressure monitoring (ABPM) during hospitalization for MI. Both during their hospitalization and in a period of 6 and 12 months, they were reviewed to assess cardiovascular mortality. BPV extracted from the ABPM recordings using the coefficient of variation (CV) of systolic (SBP) and diastolic (DBP) blood pressure. Patients were classified into 4 quartile-intervals based on CV.

Results
After full adjustment of data (age, sex, type of ACS, BP, Diabetes, Chronic Kidney Disease &lt;3rd stage) patients in the quartile with the highest CV of SBP (Q4 n= 92) have a higher in-hospital (OR = 2, 07, 95% CI: 1.02-2.99, p=0.001), 6-month (OR = 1.94, 95% CI: 1.22– 3.170, p&lt;0.001) and long-term (1-year follow-up) mortality (OR = 1.81, 95% CI: 1.08-2.77, p=0.03) compared to patients presenting lower BPV and classified in the corresponding quartiles (Q1-Q3, n=310). Corresponding results were obtained from the control of the CV of DBP.

Conclusions
In the context of patients admitted for AMI and underwent PCI, higher post-infarction BPV of both SBP and DBP expose these patients to a higher risk of short - and long-term mortality. Consequently, monitoring of BPV in patients with AMI may identify patients with potential hemodynamic instability and contribute to early clinical decision-making.
Estimation of blood pressure levels in healthy newborns
Authors: Oliveira Blackman A , Oliveira G S O , Melo J O M , Bernardes M P B , Piantino V P , Bicudo G B , Haubert N H , Moura M D R M , Machado L B O M 
Published: November 2023

Abstract

Background
Adequate blood pressure (BP) parameters in newborns are essential indicators of clinical stability for neonates. Despite its importance, the BP measurement in the delivery room are mainly collected from sick newborns in neonatal units. Current normative values are pivotal.

Methods
A prospective observational [AOB1] study selected 1167 healthy-term newborns in a private hospital [AOB2] in Brazil from August 2019 to September 2022. The Ethics Committee approved the research The gestational age considered full-term was between 37 and 42 weeks. Blood pressures were measured in the delivery room within the first two hours of life using an MX-600 GE automatic oscillometer device, following the hospital's standardized protocol.

Results
The mean systolic blood pressure (SBP) values were 68,0 ± 12.1 mmHg, diastolic blood pressure (DBP) 49,0 ± 12.3 mmHg. The 5th percentile of SBP corresponded to 48 mmHg and DBP to 32 mmHg, while the 95th percentile was 90 mmHg of SBP and 73 of DBP mmHg.[AOB3]

Conclusion
This study provided current blood pressure values from healthy neonates along with systolic, diastolic, and mean blood pressure ranges. These parameters serve as a valuable reference for dealing with the management of heathy terms newborns.Systolic BP Diastolic BP Mean pressure
Estimation of antihypertensive effect after initiating continuous positive airway pressure treatment in Japanese patients with sleep disordered breathing
Authors: Takama N , Ueba S , Isobe I , Sano Y , Amanai S , Kuno T , Ishibashi Y , Kato T , Ishii H 
Published: November 2023

Abstract

Introduction
It is true that patients with cardiovascular diseases including hypertension have already suffered from sleep disordered breathing (SDB). Furthermore, Continuous Positive Airway Pressure (CPAP) treatment shows antihypertensive effect by improving sympathetic nervous activity. On the other hand, we reported that CPAP treatment had a beneficial effect on hypertension, but 70% patients still remain inadequately treated. As a result, we need the strict blood pressure follow up for patient with SDB after initiating CPAP treatment at ESC congress 2022.

Purpose
Our aim in this study is to estimate the antihypertensive effect after initiating CPAP treatment, also estimate the differences of CPAP effect by focusing on Japanese non-obese body.

Methods
All patients were conducted full night polysomnography. One-hundred eighty patients showed obstructive SDB {apnea hypopnea index (AHI) &gt;20/hour}, and CPAP treatment were initiated. We divided into three groups by using body mass index (BMI). Group A showed BMI &lt; 25 kg/m2 (n = 59). Group B showed 25 ≦BMI &lt; 30 kg/m2 (n = 68), and Group C showed 30 ≦ BMI kg/m2 (n = 53). If patients had already taken blood pressure-lowering agents, they had to continue blood pressure-lowering agents without changing other agents or dose intensification. According to Japanese society of hypertension guidelines for the managements of hypertension 2019 (JSH2019), we estimated the improvement of blood pressure to assess effectiveness of CPAP treatment after six-month follow up.

Results
The study group consisted of 180 SDB patients (152 males, 28 females). The mean age was 53 ± 12 years. Figure 1 showed polysomnographic data before initiating CPAP treatment. Group A was significantly lower apnea hypopnea index (AHI) than in Group B and C (p &lt; 0.0001). Figure 2 showed the changes of blood pressure after initiating CPAP treatment (six-month). There was no significant difference respect to changes of systolic blood pressure (ΔSBP), but Group A showed the tendency for worsening SBP compared with other groups.

Conclusions
We could estimate that CPAP treatment had only limited effects in antihypertensive effect for Japanese patients, who especially had non-obese body and lower AHI level. We need the strict blood pressure follow up for patient with SDB after initiating CPAP treatment.Figure
Adherence to ESC guidelines for antihypertensive drug therapy: real-world survey from an EU country
Authors: Selvek M , Vallova K , Muzik R , Tulejova H , Istokovicova P , Tkac I , Hatala R 
Published: November 2023

Abstract

Background
Achieving optimal BP control in hypertensive patients (pts) remains a continuous challenge worldwide. Multiple factors are responsible for the low rates of BP control with suboptimal drug choice playing a key role. Practice guidelines should serve as evidence based foundation for optimal antihypertensive drug therapy but their impact in the real-world is variable.

Purpose
This retrospective study aimed: 1. To assess the prescription pattern of main classes of antihypertensive drugs and its association with comorbidities. 2. To compare prescription before and after the publication of the 2018 ESC/ESH guidelines for management of arterial hypertension, translated into local language (in 2019). Thus, prescriptions in the years 2018 and 2020 were compared. Dual combination of ACEi/ARB + CCB/thiazide-like diuretics (THI) or triple combination of ACEi/ARB + CBB + THI were considered as guidelines directed first line drugs (FLAD) i.e. adherence to guideline. Spironolactone (MRA) was considered as recommended drug for patients requiring ≥4 drugs.

Methods
We analysed prescribed drug therapy in a large patient cohort from the years 2018 and 2020 with 264 237 and 272 934 hypertensive pts, respectively. Pts were considered hypertensive after meeting at least one of two criteria: 1. Having been prescribed ≥ 121 standard drug doses of antihypertensive drugs in the year before the studied period. 2. Having at least 2 medical visits with the diagnosis of hypertension within 2 years before the studied period. Following comorbidities were considered as potential modifiers of drug therapy: ischemic heart disease (IHD), chronic heart failure (CHF), atrial fibrillation (AF), diabetes (DM) and chronic kidney disease (CKD).

Results
Overall, first line therapy was prescribed to 21.5% and 22.4% of pts in the year 2018 and 2020, respectively (p&lt;0.0001). In pts taking ≥3 drugs 30.4% did not use THI, in those taking ≥4 drugs only 10.7% used spironolactone (MRA). Selected results are in the attached table.

Conclusion
Adherence to guideline recommended FLAD in this large survey improved but remained low during the first year after publishing ESC 2018 guidelines: only 22.4% of pts received FLAD in this cohort where 58.6% were free of comorbidities. In pts with AF, the use of FLAD was the lowest with 7.3%. Preferred use of BB and low use of THI and MRA were mostly behind this trend. BB (alone or in combination) were the most prescribed drug group – to 57.3% of pts both in 2018 and 2020. Their prescription was high in all pts with comorbidities, notably worrisome for diabetic pts (66.0%). Continuous efforts to improve dissemination of knowledge of FLAD according to guidelines appear mandatory.Attached table
Immediate post-ablation renal nerve stimulation predicted blood pressure reductions 6 months following renal denervation
Authors: Wang T D , Huang H C 
Published: November 2023

Abstract

Background
Renal denervation (RDN) has been recognized as an alternative treatment strategy for blood pressure (BP) control. There is no consensus on which intra-procedural parameters could reliably predict BP-lowering responses following RDN, which usually occur months later.

Purpose
This study aimed to evaluate systolic BP (SBP) changes induced by renal nerve stimulation (RNS) during RDN and its associations with BP-lowering responses 6 months following RDN.

Methods
Seventeen patients with hypertension who underwent radiofrequency RDN between February 2019 and March 2021 were prospectively included. RNS was performed immediately before and after RDN in bilateral proximal and distal main renal arteries under general anesthesia. The responder was defined as 24-hour SBP reduction of ≥10 mmHg 6 months following RDN.

Results
RNS-induced SBP changes significantly decreased after RDN in all 4 sites of bilateral main renal arteries (all p&lt;0.05). The mean 24-hour SBP were 144±16 mmHg and 131±15 mmHg at baseline and 6 months after RDN, respectively. Nine (53%) patients were responders. Compared to non-responders, the responders had significantly lower RNS-induced SBP changes in proximal main renal arteries immediately after RDN (right, 15.3±9.6 mmHg vs. 31.6±9.6 mmHg, p=0.005; left, 11.6±6.9 mmHg vs. 27.9±10.2 mmHg, p=0.002). All 7 patients with RNS-induced SBP increases of &lt;20 mmHg after RDN in bilateral proximal main renal arteries were responders.

Conclusions
An RNS-induced SBP increase of &lt;20 mmHg in bilateral proximal main renal arteries immediately after RDN was associated with significant 24-hour SBP reductions 6 months following RDN. Whether RNS-induced SBP changes could predict or even guide RDN strategies awaits further verifications.
Central systolic blood pressure as a risk for the accelerated progression of arterial stiffness
Authors: Takahashi T , Shina K , Fujii M , Nakno H , Tomiyama H , Chikamori T 
Published: November 2023

Abstract
In the arterial tree, the systolic blood pressure (SBP) exhibits a pressure gradient from central to peripheral and is higher in the periphery because of pressure wave reflection.
However, this gradient is attenuated with the elevation of central SBP (cSBP) in case with abnormal pressure wave reflection in arterial tree. It remains unclear whether increase of the cSBP might be an independent risk for the accelerated progression of arterial stiffness.
Using the latent growth curve model (LGCM) analysis, this prospective observational study was conducted to examine whether elevation of the cSBP might be an independent risk for the accelerated progression of arterial stiffness in middle-aged Japanese men.In this 9-year prospective observational study, 3862 middle-aged Japanese men (42 ± 9 years old) without cerebrocardiovascular disease at the study baseline underwent annual measurements of the brachial-ankle pulse wave velocity (baPWV), and cSBP, estimated by radial pressure wave analysis as the second peak of radial pressure wave form (SBP2).
During the follow-up period (6.4 ± 2.5), significant increases of baPWV and SBP2 were observed in all subjects. Analysis using the LGCM confirmed that the SBP2, a maker of cSBP (B=0.260, P &lt; 0.001) was significant determinants of the slope of annual changes of baPWV during the study period.
Our finding suggests that elevated cSBP is an independent risk for the accelerated progression of arterial stiffness in middle-aged Japanese men.
Genetic predisposition to high blood pressure and out-of-office hypertension: insights from a population sample in Liechtenstein
Authors: Narula S , Mohammadi-Shemirani P M , Aeschbacher S , Chong M R , Le A , Theriault S , Grossman K , Pare G , Risch L , Risch M , Conen D 
Published: November 2023

Abstract
Genetic predisposition is a risk factor for office hypertension. We tested whether genetic background could identify individuals with ambulatory daytime hypertension in a sample of white Europeans from Liechtenstein. We evaluated two measures of predisposition to hypertension: family history and polygenic risk scores (PRS). Our analytic sample contained 1444 participants aged 25 to 41. 12% of participants had office hypertension, while 37% had out-of-office hypertension. The correlation between blood pressure PRS and family history of hypertension was low (R2 = 4.96x10-3), but both were strongly associated with ambulatory blood pressure (2.2 mmHg per 1 SD increase [95% CI: 1.6, 2.7] & 2.4 mmHg increase with positive family history [95% CI: 1.3, 3.4], respectively). PRS provides incremental improvement in predicting ambulatory systolic blood pressure beyond a validated blood pressure prediction algorithm (ΔAIC = -33), whereas family history does not (ΔAIC = 1). The difference in performance between a baseline algorithm for identifying ambulatory systolic daytime hypertension (positive likelihood ratio of 6.87 [95% CI: 5.56, 8.49]; negative likelihood ratio of 0.45 [95% CI: 0.39, 0.51]) and the same model with PRS integrated (positive likelihood ratio of 7.69 [95% CI: 6.18, 9.57]; negative likelihood ratio of 0.43 [95% CI: 0.37, 0.49]) was modest. In conclusion, in a European sample from Liechtenstein, PRS and family history represent distinct constructs associated with ambulatory blood pressure. Unlike family history, polygenic risk scores provide incremental information identifying individuals with ambulatory hypertension. However, these gains are modest and warrant further development to improve performance at the point-of-care.
Different systolic blood pressure targets and outcomes: a systematic review and meta-analysis of randomized trials
Authors: Manta E , Thomopoulos C , Konstantinidis D , Tatakis F , Tsioufis P , Tsoumpou I , Iliakis P , Siafi E , Drogkaris S , Andrikou I , Zamanis I , Tsioufis K 
Published: November 2023

Abstract

Background
Blood pressure (BP)-lowering is accompanied by a reduction of fatal or nonfatal outcomes in hypertensive patients. However, the achieved systolic BP target associated with higher outcome benefits remains unsettled.

Purpose
The aim was to determine the effects of BP-lowering treatment on outcome incidence at different achieved systolic BP strata.

Methods
A systematic review was conducted to identify randomized trials in electronic databases (Pubmed and CENTRAL, search between 1966 and 11/2022) for the effect of BP-lowering treatment against placebo or less aggressive treatment on the composite outcome of major cardiovascular (CV) events (i.e., myocardial infarction, stroke, and heart failure). Selected studies reported outcomes in patients with or without a history of previous CV disease. Studies were categorized according to the achieved level of systolic BP in the active or more actively treated group. Risk ratios (RR) were calculated with their 95% confidence interval (CI) under the random-effects model.

Results
We included 51 primary prevention studies (i.e., 16 trials in which systolic BP was lowered to values no less than 140 mmHg, n=36,189 patients; 22 trials with achieved systolic BP between 130 and 140 mmHg, n=84,952; and 13 trials with achieved systolic BP less than 130 mmHg, n=41,660) and 44 secondary prevention studies (i.e., 11 trials in which systolic BP was lowered to values no less than 140 mmHg, n=12,518 patients; 19 trials with achieved systolic BP between 130 and 140 mmHg, n=71,449; and 14 trials with achieved systolic BP less than 130 mmHg, n=39,085). For a standard systolic/diastolic BP reduction of 10/5 mmHg, the relative risk of the composite outcome was reduced in all achieved systolic BP strata, without a significant trend from higher to lower systolic BP targets, in both prevention groups. In addition, there was no difference in the absolute risk reduction of the combined outcome, as calculated by the number of events prevented in every 1000 patients treated for 5 years, between the systolic BP targets in each prevention group. However, only in primary prevention did a significant negative incremental trend from higher to lower systolic BP targets for the residual risk of the combined outcome become apparent.

Conclusions
Although antihypertensive treatment provides CV protection to all hypertensive patients, the lower systolic BP target is associated not only with outcome benefits but also with a lower rate of residual risk in primary prevention only.
Early lowering of LDL-C is a more cost-effective strategy than lowering LDL-C later in life: a cost-effectiveness analysis using Mendelian Randomisation
Authors: Morton J , Marquina C , Lloyd M , Watts G F , Zoungas S , Liew D , Ademi Z 
Published: November 2023

Abstract

Background
Early control of low-density lipoprotein-cholesterol (LDL-C) is an effective way to reduce the risk of coronary heart disease (CHD). However, a comprehensive assessment of cost-effectiveness of different lipid-lowering strategies (LLS) for primary prevention of CHD across different ages is lacking.

Objective
To assess the cost-effectiveness of four different LLS initiated at ages 30, 40, 50, and 60 years on the primary prevention of CHD from the UK National Health Service perspective.
Design, setting and participants: We developed a microsimulation model, based on the causal effect of LDL-C on myocardial infarction (MI) or coronary death derived from Mendelian randomisation, comparing initiation of an LLS to current standard of care (control). Data were primarily drawn from 458,727 participants of the UK Biobank study with available data on date of birth, LDL-C, and who were free of MI at first assessment (between 2006 and 2010), with follow-up until 2021.
Interventions: The four LLS were: 1) low/moderate intensity statins; 2) high intensity statins; 3) low/moderate intensity statins and ezetimibe; and 4) inclisiran.
Main outcomes measures: The incremental cost-effectiveness ratio (ICER), defined as the incremental healthcare costs divided by the incremental quality-adjusted life years (QALYs) for each LLS compared to control, with 3.5% annual discounting.

Results
The most effective intervention, low/moderate intensity statins and ezetimibe, was projected to lead to a gain in QALYs of 0.068 per person at age 30 and 0.026 at age 60 compared to control (Figure). The age of intervention with the lowest ICER was age 40, with ICERs of £2,524 (95% uncertainty interval: 1,383, 3,796), £4,466 (3,163, 6,134) £11,118 (8,632, 14,177), and £1,405,123 (1,117,1113, 1,789,012) per QALY gained for strategies 1-4 from age 40 years, respectively (Table).

Conclusions
LDL-C lowering from early ages is a more cost-effective strategy than late intervention. The approach to primary prevention of CHD may improve with a shift to early and sustained lowering of LDL-C.
Figure – Results of 1,000 probabilistic sensitivity analyses presented in a common cost-effectiveness plane, by age of intervention. Inclisiran excluded due to very high costs. Solid line: £20,000 per quality-adjusted life year (QALY) willingness-to-pay threshold; dashed line: £30,000 per QALY willingness-to-pay threshold. Any dot to the right of these lines is considered cost-effective.
Table – Summary of LLS interventions by age of intervention.
Abbreviations: MI – Myocardial infarction; YLL – Years of life lived; QALYs – Quality-adjusted life-years; ICER – Incremental cost-effectiveness ratio.FigureTable