bluuebunny/crossref_metadata_2025_split huggingface dataset:
Performance of a cuffless blood pressure monitor in the adult and elderly population - a comparative validation study
Authors: Paggi De Almeida T , Sola J , Theiler K , Damianaki A , Alexandre J , Vermare P , Perruchoud D , Wuerzner G 
Published: November 2023

Abstract

Background
Cuffless blood pressure (BP) monitoring devices are emerging as powerful tools for BP monitoring and management of hypertension, particularly in the elderly, in whom prevalence of hypertension is high. Some cuffless BP monitors allow the hourly and daily tracking of blood pressure. It remains unclear, however, whether cuffless devices yield equivalent performance across age categories.

Purpose
To compare the performance of BP measurements conducted by a cuffless BP monitor in different body positions in adult and elderly participants with a wide range of BP levels.

Methods
2 cohorts of patients (adult, 21-65 years; elderly, 65-85 years) were recruited for a prospective clinical study (NCT04027777) between August/2019–March/2022. During 4 visits over a month, systolic/diastolic BP (SBP, DBP) measurements obtained by the investigated cuffless wrist bracelet were compared to the reference measurement – double auscultation – in a sitting, standing and lying position after a unique initial calibration. The two ISO 81060-2 criteria were used for the comparison of BP measurements by the cuffless monitor and auscultation (BP-reading-level – criterion 1; subject-level – criterion 2) in the sitting position (there are no ISO criteria for other body positions). The mean differences on SBP and DBP between cohorts both at BP-reading-level and at subject-level were compared (unpaired t-test).

Results
96 adult (38±12 years)/35 elderly (73±6 years) were included in the study. Of those, 84 adult/35 elderly patients were investigated in sitting position; 91 adult/35 elderly in all body positions. SBP and DBP were significantly higher in the elderly cohort (SBP 116.4±20.3 vs. 133.9±17.7 mmHg, P≤0.0001; DBP 74.5±12.0 vs. 77.9±11.7 mmHg, P≤0.0001). The results for the analyses at BP-reading-level and subject-level are shown in Table 1. For the analyses on sitting position at BP-reading-level, SBP and DBP for both cohorts were within ISO targets for mean error and SD. At subject-level, the SD of the mean paired differences per subject were within individual ISO targets for SBP and DBP on both cohorts. Statistically significant differences between cohorts were found only at BP-reading-level for all body positions, although the magnitude of differences were not clinically relevant (Table 1, bold and *). Figure 1 highlights the biases and correlations of SBP and DBP readings between the cuffless BP monitor and auscultation for both adult and elderly cohorts.

Conclusions
The cuffless BP monitor investigated in the present study yielded equivalent BP measurements compared to auscultation, with similar performance in the adult and elderly populations.Table 1Figure 1
Effect of initial treatment with a single pill containing quadruple combination of quarter doses of blood pressure medicines versus standard dose monotherapy on ambulatory blood pressure indices
Authors: Nolde J , Atkins E , Marschner S , Hillis G S , Chalmers J , Billiot L , Nelson M R , Reid C M , Hay P , Burke M , Jansen S , Usherwood T , Rodgers A , Chow C K , Schlaich M P 
Published: November 2023

Abstract

Background
The QUARTET trial showed that a combination of four ultra-low-dose blood pressure (BP) medications lowered mean unattended office BP more effectively than initial monotherapy.

Purpose
To investigate the effects of a combination of four ultra-low-dose blood pressure (BP) medications on ambulatory BP changes.

Methods
Australian adults (≥18 years) with hypertension who were untreated or on monotherapy were eligible for participation in the QUARTET study. Overall, 591 participants were randomly assigned to receive either the quadpill (containing irbesartan 37.5 mg, amlodipine 1.25 mg, indapamide 0.625 mg, and bisoprolol 2.5 mg) or an indistinguishable monotherapy control (irbesartan 150 mg). The difference in 24-hour, daytime and night-time systolic and diastolic ambulatory BP at 12 and 52 weeks were pre-defined secondary outcomes. Reported parameters for this analysis were derived from ambulatory BP recordings of 576 participants that fulfilled pre-defined validation criteria.

Results
Of 576 participants, 289 were randomized to the quadpill group and 287 to the monotherapy group. At baseline, 24-h systolic/diastolic BP was 139.2/81.0 mmHg in the monotherapy vs. 139.8/81.3 in the quadpill group, daytime BP was 142.5/83.5 vs 143.4/84.0 mmHg, and night-time BP was 125.1/70.7 vs. 125.4/70.7 mmHg. At 12 weeks, mean 24-h ambulatory systolic and diastolic BP were 7.7 (95%CI: 9.6, 5.8) and 5.3 (95%CI: 6.5, 4.1) mmHg lower in the quadpill versus monotherapy group (p&lt;0.001 for both). Similar reductions were observed for daytime (8.1/5.7 mmHg lower in quadpill compared to montherapy group) and night-time (6.3/4.0 mmHg lower in quadpill compared to monotherapy group) BP (all p&lt;0.001) at 12 weeks. The reduction in systolic and diastolic ambulatory BP variability were more pronounced in the quadpill group at 12 weeks, the 24-h standard deviation was reduced by -1.2 (-1.8, -0.5) mmHg for systolic and -0.9 (-1.5, -0.4) mmHg diastolic BP. The rate of BP control (24 hours BP ≥130 and/or ≥80 mmHg) at 12 weeks was higher in the quadpill group (77% vs 50%; p&lt;0.001). These effects were maintained at 52 weeks.

Conclusion
A quadruple quarter-dose combination compared to monotherapy resulted in greater ambulatory BP lowering across the entire 24-hour period with higher ambulatory BP control rates at both 12 and 52 weeks. These findings further substantiate the efficacy of an ultra-low-dose quadpill-based BP lowering strategy – which has been previously shown not to increase the rate of side effects - and extends it to ambulatory BP measurements.
A physiologic, precision-medicine approach to guided pharmacological treatment of hypertension substantially improves blood pressure in a large community-based cohort
Authors: Romer D , Vered Z , Cleland J , Froehlich J , Perez M , Colangelo F , Crossey R , Bottorff M , Matthews R , Hardtke C , Kaiser R , Granov I , Sobotka P 
Published: November 2023

Abstract

Background
Worldwide blood pressure (BP) control rates remain poor. Hypertension (HTN) guidelines provide BP targets and recommend drug treatment algorithms but ignore the potential to treat the underlying haemodynamic reason.
Patient’s poor adherence to medication is often identified as a potential cause of poor HTN control.

Purpose
To improve rates of BP control by matching patients’ non-invasive haemodynamics to specific pharmacologic treatments and increasing patient engagement.

Methods
13,715 hypertensive patients were identified via the electronic medical record (EMR) from two US primary care groups between 2014 and 2023. Impedance Cardiography (ICG) was done when BP was &gt;140/90. Physiologic measurements included blood pressure, mean arterial pressure, cardiac index, cardiac power index, total peripheral resistance index, stroke index and heart rate (Figure 1). HTN etiology was classified as: Vasoconstriction, Hyperdynamic, or Mixed pattern based on the haemodynamic findings of the ICG. Printed clinical decision support (CDS) tools and later an EMR integrated CDS application were used to communicate recommendations to physicians. Printed reports were shared with patients to increase their engagement. Rates of successful blood pressure treatment were tracked by analysis of EMR data.

Results
The demographics of 13,715 patients were 14% black, 50% women, 17% age 18-49, 45% age 50-69, and 38% age ≥ 70 years. A total of 21,246 ICGs were performed classifying patients as Vasoconstriction 46%, Hyperdynamic with high heart rate (HR) or high stroke index (SI) 25%, and Mixed Haemodynamic (combination of Vasoconstriction and Hyperdynamic) 29% (Figure 1). No demographic features predicted the physiologic grouping. 7,892 patients in the first cohort were treated from 2014 thru 2023 and obtained &gt;90% BP control rate in 2016. This high control rate has been sustained for 6 years. 5,823 patients in the second cohort were treated from 2019 thru 2023 and obtained &gt;86% BP control rate.

Conclusions
Haemodynamic data may help personalize anti-hypertensive therapy and improve control of HTN to &gt;86-90%.
Providing patients with insights about why their BP is high and providing rationale for selecting treatment may motivate their adherence and persistence with therapy.
Hypertension physiology is not predicted by demographic features among patients managed in a primary care setting.Haemodynamic Status (ICG Test Results)
Effects of blood pressure lowering according to baseline cardiovascular disease: systematic review and meta-analysis of randomized trials
Authors: Manta E , Thomopoulos C , Kariori E , Konstantinidis D , Tsioufis P , Polyzos D , Tatakis F , Siafi E , Tsoumpou I , Grigoriou K , Drogkaris S , Tsioufis K 
Published: November 2023

Abstract

Background
Blood pressure (BP)-lowering is accompanied by reduced cardiovascular (CV) outcomes and death in hypertensive patients. There are no data on the effect of BP lowering in patients with a history of CV disease [i.e., coronary heart disease (CHD), stroke, or heart failure with preserved ejection fraction (HFpEF)].

Purpose
To demonstrate the effect of BP-lowering treatment on CV events in patients with different types of baseline CV disease.

Methods
A systematic review was conducted to identify randomized trials in electronic databases (Pubmed and CENTRAL, search from 1966 to 11/2022) for the effect of BP-lowering treatment against placebo or less aggressive BP reduction on fatal or nonfatal cardiovascular outcomes and all-cause death. Trials or subgroups of trials were identified, including patients with a history of CV disease. We excluded heart failure studies with reduced ejection fraction, acute myocardial infarction, or acute stroke. Risk ratios (RR) were calculated with their 95% confidence interval (CI) under the random-effects model.

Results
We included 18 BP-lowering treatment trials with 52,359 CHD patients (mean follow-up, 4.2 years; achieved systolic/diastolic BP, 129.2/76.1 mmHg). Despite the fact that mortality outcomes, stroke, and recurrent CHD were not decreased as a result of BP-lowering therapy, the risk of the combined outcome of major CV events (i.e., myocardial infarction, stroke, and heart failure) was reduced by 11% (95% CI, 3-18%) and the risk of recurrent heart failure hospitalization by 28% (95% CI, 18-38%). In addition, we examined 8 trials with 37,866 patients with a history of stroke (mean follow-up, 2.7 years; achieved systolic/diastolic BP, 136.5/79.8 mmHg), in which BP-lowering treatment reduced recurrent stroke by 18% (95% CI, 7-27%) and CV death by 12% (95% CI, 3-21%). Among 5 heart failure trials with 11,597 patients (mean follow-up, 3.4 years; achieved systolic/diastolic BP, 130.8/76.7 mmHg), the combined outcome of major CV events was decreased by 10% (95% CI, 4-16%), and recurrent heart failure hospitalization by 12% (95% CI, 4-19%).

Conclusions
Maximum CV protection is offered when systolic BP is reduced to levels &lt; 130 mmHg in patients with CHD, to 130-140 mmHg levels in patients with a history of stroke, and to levels of approximately 130 mmHg in patients with heart failure. These findings support the recommendation for more aggressive BP lowering in patients with a history of CHD or optimally treated patients with HFpEF, and for less aggressive BP reduction in post-stroke patients.
Bariatric surgery and blood pressure control in patients with hypertension: a systematic review and meta-analysis
Authors: Huang R , Jing Z Q , Liu Y H , Li Z Y , Wu S S 
Published: November 2023

Abstract

Background
Bariatric surgery remains the most effective method for sustained weight loss in patients with class II or III obesity. However, the effects of bariatric surgery on BP control in obese patients with hypertension are not consistent across studies.

Purpose
The purpose of this study was to compare the effects of bariatric surgery versus nonsurgical treatment on blood pressure control in patients with hypertension.

Methods
Randomized controlled trials evaluating the effects of bariatric surgery versus nonsurgical treatment on blood pressure reduction were searched in PubMed, Embase, Cochrane Database and Cochrane Clinical Trials Registry, and nineteen randomized controlled trials (in 1,375 obese patients) were finally included. The primary outcome was the rate of hypertension remission, and the follow-up periods ranged from 12 to 60 months.

Results
The results showed that bariatric surgery was associated with a higher hypertension remission rate (RR: 4.61, 95% CI: 2.27–9.35, P &lt; 0.0001) and a greater decrease in diastolic blood pressure (WMD: -3 mmHg, 95% CI: -4.28 to -1.72, p&lt;0.00001). However, no significant difference was observed in systolic blood pressure (WMD: -2.4 mmHg, 95% CI: -5.8 to 1, p=0.17). Furthermore, the following metabolic conditions and cardiovascular risk factors were also improved by bariatric surgery in patients with hypertension.

Conclusion
In conclusion, our study confirmed that bariatric surgery was associated with a higher rate of short-to-medium-term hypertension remission and a greater decrease in diastolic blood pressure for patients with hypertension. Bariatric surgery should be considered in these patients.
Efficacy and safety aspects of renal denervation in treatment of arterial hypertension: a systematic review and meta-analysis
Authors: Vukadinovic D , Lauder L , Ukena C , Boehm M , Mahfoud F 
Published: November 2023

Abstract

Introduction
Current guidelines for the management of arterial hypertension 2018 of European Society for Cardiology (ESC) do not recommend use of renal denervation (RDN) (as device-based therapy) for treatment of hypertension except as part of clinical studies. However, in the meantime several randomized sham-controlled clinical trials were designed using second generation radiofrequency (RF) (SPYRAL HTN-OFF MED, SPYRAL HTN-ON MED), ultrasound (RADIANCE-HTN SOLO, RADIANCE-HTN TRIO) or alcohol-mediated renal denervation (TARGET BP-OFF) devices. We aimed to perform a comprehensive meta-analysis from all published and unpublished randomized, sham-controlled clinical trials which explored the effects of renal denervation on blood pressure across different devices.

Methods
We searched MEDLINE and Embase via OVID@ for eligible trials. Of note, we also included unpublished data from the SPYRAL-ON Extension and TARGET BP OFF trials. Pooling the data from all studies, we explored the efficacy (ambulatory and office systolic and diastolic BP) and safety (all cause death, vascular complication, renal artery stenosis &gt;70%, hypertensive crisis) of RDN.

Results
Analysis included 9 eligible trials (i.e. SYMPLICITY HTN-3, ReSET, SPYRAL HTN OFF MED, Desch et al., RADIANCE-HTN SOLO, RADIANCE-HTN TRIO, RADIANCE, TARGET BP OFF, SPYRAL HTN ON MED extension) comprising 2,091 patients (Table 1). RDN reduced ambulatory systolic (-3.10 mmHg, 95% CI -4.22, -1.97, p&lt;0.00001) and office systolic (-5.15 mmHg, 95% CI -6.65, -3.66, p&lt;0.00001) BP and ambulatory diastolic (-1.58 mmHg, 95% CI -2.54, -0.63, p=0.001) and office diastolic (-2.74 mmHg, 95% CI -3.65, -1.83, p&lt;0.00001) BP compared with sham groups. There was no difference concerning ambulatory SBP reduction between trials with ON medication design (-2.94 mmHg, p&lt;0.0001) and those with OFF medication design (-3.37 mmHg, p&lt;0.0001) (p for interaction 0.69). Similarly, office SBP reduction was comparable between trials with (-4.38 mmHg, p&lt;0.0001) and without concomitant antihypertensive drugs prescription (-6.27 mmHg, p&lt;0.00001) (p for interaction 0.22).
The rate of vascular complications (OR 1.21, 95% CI 0.28, 5.25, p=0.80), renal artery stenosis (OR 1.50, 95% CI 0.06, 36.97, p=0.80), hypertensive crisis (OR 1.39, 95% CI 0.50, 3.92, p=0.53) and all cause death (OR 0.52, 95% CI 0.10, 2.83, p=0.45) was not different between treatment and sham groups.

Conclusions
RDN is associated with clinically significant reductions in ambulatory and office SBP as compared with sham in the presence and absence of antihypertensive medication. The procedure use was not associated with an excess in safety events compared with sham group.
The impact of longitudinal changes in BMI and serum uric acid levels on new-onset atrial fibrillation
Authors: Munakata J , Senoo K , Nakata M , Yamaoka M , Kumagai M , Nishimura H , Teramukai S , Matoba S 
Published: November 2023

Abstract

Background
The worldwide prevalence of atrial fibrillation (AF) is already estimated at 33 million and it is still increasing. In order to prevent the increase in the prevalence of AF, it is important to understand the risk of developing AF and to take preventive intervention. Obesity and serum uric acid level (UA) are both associated with the incidence of AF. However, it is unclear about synergistic effect of longitudinal changes in both BMI and UA on the new-onset AF. We assessed the impact of longitudinal changes in BMI and UA on the subsequent incidence of new-onset of AF. We also estimate the number of new-onset AF that could be prevented by maintaining BMI and UA.

Methods
We retrospectively analyzed 17,994 Japanese without a history of AF from a cohort of employees undergoing annual health examinations conducted between April 2013 and April 2022. Exclusion criteria included missing laboratory values, three or fewer visits, developed AF by Visit 3, Visit 1 to 3 was less than 1.5 years or more than 4 years, medication for hyperuricemia, and renal dysfunction (serum Cre≥1.2 mg/dL in men and 1.0 mg/dL in women).

Result
During a follow-up period of 3.77 years, the incidence of AF was 70 (1.04/1,000 person-years). A multivariable Cox regression analysis showed that the new-onset AF was associated with age, gender, weight gain, UA at baseline and increased UA. A multivariable Cox regression analysis with interaction term between weight gain (≥10 kg weight gain since age 20) and increased UA (1 mg/dl) showed that significant increased risk for new-onset AF were age (HR: 3.15, [95%CI; 2.44-4.06], P&lt;0.001), gender (HR: 0.41, [95%CI; 0.20-0.84], P=0.016), weight gain (HR: 1.46, [95%CI; 1.16-1.84], P=0.001), systolic blood pressure at baseline (HR: 1.01, [95%CI; 1.00-1.03], P=0.048), UA at baseline (HR: 1.29, [95%CI; 1.02-1.63], P=0.036), and interaction term (HR:1.93, [95%CI; 1.36-2,72], p for interaction=0.006). Using the prediction model for developing AF including the interaction term, we estimated the number of new-onset AF in Japanese male aged 40-69 years in the next 5 years. An increase in uric acid of 1 mg/dL and BMI of 2 units over the past two years was predicted to result in approximately 460 000 new cases of AF/5 years, but it was estimated that maintaining uric acid levels and BMI could reduce the number of cases by 75% (preventing 344 000 new cases of AF/5 years).

Conclusion
Weight gain and increased uric acid had a synergistic effect on the risk of developing AF. Particularly in men, maintaining serum uric acid levels in those who gained weight (≥10 kg weight gain since age 20) was found to prevent 75% of new-onset of AF over a five-year period, based on our modelling analysis.Multivariable Cox Regression AnalysisEstimated number of AF incidents
Depression and heart failure - the incidence of depressive symptoms assessed by the PHQ9 and their association with HF outcomes
Authors: Certo Pereira J , Presume J , Araujo I , Carvalho Gouveia C , Rodrigues Silva S , Ferreira P , Carvalho R , Pepe B , Maia Das Neves N , Rodrigues C , Henriques C , Marques F , Guerreiro R , Fonseca C 
Published: November 2023

Abstract

Background
Depression is a prevalent, debilitating, and potentially modifiable comorbidity that affects heart failure (HF) patients and is associated with increased mortality and morbidity. Current HF guidelines recommend addressing depression using questionnaires, including the Patient Health Questionnaire-9 (PHQ-9), which is a 9-item questionnaire that can be self-administered in less than 3 minutes.

Objectives
To evaluate the performance of PHQ-9 in a Portuguese cohort of HF patients and present a practical approach for the screening and management of depression in patients with HF.

Methods
We conducted a prospective study enrolling consecutive patients observed in the HF clinic from June 2022 to August 2022. Patients answered the PHQ-9 before the beginning of the appointment, during which the physician evaluated the results and managed them according to the suggested protocol. – figure 1. We then evaluated the severity of depression by PHQ-9 at baseline and its association with the levels of serum NT-proBNP, the severity of HF symptoms, and the incidence of a composite of all-cause mortality and HF exacerbation at 90-days follow-up.

Results
A total of 124 patients were observed in the HF consultation and answered PHQ-9: mean age of 74±12,1years, 68% (n=84) male, 82% (n=102) with NYHA I-II, 48% (n=60) with preserved ejection fraction, 23% (n=29) with a previous diagnosis of depression and on antidepressant therapy.
After the evaluation of PHQ-9, 52% (n=65), 27% (n=33), 10% (n=12), 8% (n=10) and 3% (n=4) had minimal, mild, moderate, moderately severe, and severe depression symptoms, respectively.
In the no previous depression diagnosis group, 49% (n=46) had at least mild depressive symptoms.
The presence of depressive symptoms was associated with higher levels of serum NT-proBNP (r=0.31; p&lt;0.001) and worse HF symptoms assessed by the NYHA classification (p&lt;0,001). Patients who met the composite outcomes (death or HF exacerbation) during follow-up had a significantly higher PHQ-9 score (10±7 vs. 5±5; p&lt;0,001).

Conclusions
This study confirmed the high prevalence of depressive symptoms in this real-world cohort of HF patients and demonstrated that screening for depressive symptoms can be efficiently integrated in the HF consultation. A higher burden of depressive symptoms was associated with higher serum NT-proBNP, more severe symptoms and higher incidence of death or HF admissions.