bluuebunny/crossref_metadata_2025_split huggingface dataset:
ETHNIC DIFFERENCES IN RISK FACTORS FOR COGNITIVE DECLINE AND DEMENTIA, IN INDIVIDUALS WITH DIABETES: RESULTS FROM THE ADVANCE TRIAL
Authors: Harris Katie , Gong Jessica , Shah Mitva , Hajat Shakoor , Xu Ying , Carcel Cheryl , Woodward Mark , Chalmers John 
Published: June 2023

Objective:
Ethnic differences in risk factors for dementia remain underexplored. This project will estimate ethnic differences on the associations between risk factors, and treatment effects, with cognitive decline (CD) and/or dementia, in individuals with type 2 diabetes (T2D).

Design and method:
This study uses the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial of 11,140 individuals with T2D from 20 countries. Multivariable adjusted multinomial logistic regression models were used to examine the associations between baseline characteristics and odds of subsequent CD/dementia, by Asian and non-Asian ethnicity.

Results:
There were 4242 (38%) participants of Asian ethnicity. During 5-years (median) follow-up, 1827 participants (40% Asian) had CD/dementia (1718 with CD only (41% Asian); 21 with dementia only (19% Asian); 88 with CD and dementia (32% Asian)), and 929 (30% Asian) died without CD/dementia.
Participants of Asian ethnicity had a higher odds of CD/dementia than non-Asians (odds ratio [OR] [95% confidence interval (CI)], 1.25 [1.09, 1.44]). In both Asians and non-Asians, older age, longer diabetes duration was associated with greater odds of CD/dementia; higher years at education completion and taller stature reduced the odds of CD/dementia.
Higher baseline cognitive function was associated with a lower odds of CD/dementia in non-Asians 0.93 [0.90, 0.96], but not in Asians 1.01 [0.97, 1.04]. Stroke/transient ischaemic attack, retinal disease, higher body mass index, waist circumference, and current smoker (vs. never), were associated with a higher odds of CD/dementia in non-Asians but not in Asians. Moderate/vigorous physical activity vs none/mild was associated with a higher odds of CD/dementia in Asians 1.26 [1.10, 1.45] but a lower odds in non-Asians 0.81 [0.68, 0.97].
There was no evidence that intensive glucose control (vs. standard control) or blood pressure lowering (vs. placebo) conferred a lower risk of CD/dementia, overall nor by ethnicity.

Conclusions:
People of Asian ethnicity had a 25% higher risk of CD/dementia than non-Asians in this study. There were some differential effects of risk factors for CD/dementia by ethnicity. More data from Asian populations are required to verify ethnic differences and the mechanisms that underlie these differences.
DETERMINANTS OF OFFICE BLOOD PRESSURE VARIABILITY AND INSTABILITY IN CHILDREN, ADOLESCENTS AND YOUNG ADULTS
Authors: Theodosiadi Aikaterini , Ntineri Angeliki , Kollias Anastasios , Kyriakoulis Konstantinos , Menti Ariadni , Ntousopoulos Vasileios , Stathopoulou Panagiota , Zeniodi Maria , Stambolliu Emelina , Vazeou Andriani , Stergiou George S. 
Published: June 2023

Objective:
To evaluate the determinants of office blood pressure (BP) variability and instability within a single visit in young individuals.

Design and method:
Apparently healthy individuals aged 6-25 years referred for elevated blood pressure (BP) were subjected to triplicate office BP measurements in a single visit and 24h ambulatory BP monitoring. BP variability and instability were assessed separately for systolic and diastolic BP using: (i) standard deviation (SD) (ii) coefficient of variation (CV) (iii) average real variability (ARV) (iv) maximum office BP (Max) (v) maximum-minimum office BP difference (MMD) (vi) ratio of difference between 1st-3rd measurement to the average office BP (Relative change). White-coat effect was defined as the difference between office and daytime ambulatory BP.

Results:
320 individuals were analyzed (mean age 13.6±3.6 years, 66.8% males, BMI z-score 1.12±0.96, average office BP 122.6±16.6/72.6±10.7 mmHg, 24h ambulatory BP 119.3±11.5/67.8±6.8). Based on office and 24h ambulatory BP, 21.3% of the participants had white-coat hypertension, 8.1% masked and 16.6% sustained hypertension. Age was associated with SD (r = 0.23, p<0.001), CV (r = 0.11, p<0.05), Max (r = 0.54, p<0.001) and MMD (r = 0.23, p<0.001) of office systolic BP, and Max (r = 0.29, p<0.001) and ARV (r = 0.12, p<0.05) of diastolic. In multivariable log-linear regression models [(independent variables: age, sex, BMI z-score, heart rate, office BP, white-coat effect (> = 5/6 mmHg systolic/diastolic, 75th centile)], office BP was an independent determinant for indices of systolic BP variability and instability [SD (↓ = 0.01, p<0.001), ARV (↓ = 0.01, p<0.001), Max (↓ = 0.01, p<0.001), MMD (↓ = 0.01, p<0.001) and Relative change (↓ = 0.001, p<0.05)], and for CV (↓ = -0.06, p<0.001) and Max (↓ = 0.01, p<0.001) of diastolic. White-coat effect was a significant determinant for CV of office systolic BP (↓ = 0.15, p<0.05) and Relative change of office diastolic BP (↓ = 0.03, p<0.05).

Conclusions:
These results suggest that in healthy children, adolescents, and young adults the indices of office BP variability and instability within the first visit seem to be determined by the level of office BP and the magnitude of the white-coat effect.
RISK FACTORS FOR ARTERIAL STIFFNESS IN ADOLESCENCE
Authors: Sokolovic Imana , Sokolovic. Sekib 
Published: June 2023

Objective:
To investigate the arterial stiffness and risk factors in adolescence.
Arterial stiffness often (AS) results from the degenerative process of the media layer of elastic arteries causing rigidity of the arteries. Arterial stiffness increases with age and it is associated with several risk factors as a disease predictor. But, arterial stiffness can be also increased in a healthy arteries as well. The increased sympathetic activity promotes vasoconstriction of resistant blood vessels i.e. arteries and arterioles that result in peripheral vasoconstriction. Adolescence age is the most important period of life for promoting future health. The certain dynamic risk factors in adolescence like, emotional dysregulation, psychological family stress, education pressure, lack of sleep, gambling, substance abuse, smartphone overuse and obesity can cause arterial stiffness.

Design and method:
The prospective open randomized study was designed. Adolescence age between 10 and 19 years have been investigated for increased arterial stiffness and risk factors. The inclusion criteria was healthy adolescence, while exclusion criteria was any disorder present. Arterial stiffness, non-invasive blood pressure and pulse wave datas have been measured using Agedio device. The risk factors were evaluated in every subject. The vascular age have been outlined as the final measure.

Results:
The preliminary results indicate the increase of Augmentation Index and Coefficient of Reflection. The average percentage of Augmentation Index was 40% and Coefficient of Reflection 65% (normal value 28% and 60% respectively). The main risk factors were educational pressure, lack of sleep and smartphone influence. The vascular age was on average, 3 years higher than biological age.

Conclusions:
Arterial stiffness in adolescence is increased mainly by peripheral vasoconstriction, manifested with Augmentation index and Coefficient of wave Reflection.
IMPACT OF ANTHROPOMETRIC AND METABOLIC PARAMETERS ON LEFT VENTRICULAR MASS IN YOUTHS
Authors: Annaloro Alessandra , Invernizzi Chiara , Ponce Francisco , Deutsch Christine , Lurbe Empar , Grassi Guido , Alvarez Julio 
Published: June 2023

Objective:
Even though childhood obesity is an increasing epidemic, little is known about obesity on mediated organ damage. Left ventricular mass index (LVMI) is the main parameter assessing the presence of abnormalities on the heart in children and adolescents, however there is a lack of knowledge on its association with obesity status. Therefore, the objective of the study is to assess the impact of weight status, hemodynamic and metabolic parameters on LVMI.

Design and method:
Seventy-eight patients aged 5-16 yr attending the outpatient clinic of cardiovascular risk were enrolled and assessed for anthropometric variables, office blood pressure (OBP), laboratory blood tests (uric acid, lipid, and glycemic profile), and 2-D echocardiography was performed for cardiac mass and geometry evaluation. In addition, patients were classified based on the presence of insulin resistance.

Results:
The mean age of patients was 12.03 yr and males were 53.8%. Ten subjects were normal weight, 11 overweight, 39 obese, and 18 severely obese.
No significant differences in values of OBP were observed among weight groups: 65 (83.3%) were normotensive, 7 high normal (9%), and 6 hypertensives (8%).
A statistically significant positive correlation was observed between LVMI and obesity markers (BMI r = 0.383, waist circumference r = 0.461); Relative wall thickness and left atrial diameter were significantly correlated with BMI and waist circumference.
BP parameters were not correlated to other variables, and differences in LVMI among BP phenotypes were non-significant, although a weak correlation was observed with systolic OBP (r = 0.291).
When dividing the population by insulin resistance, adjusted by age, sex, and pubertal status, LVMI was significantly higher in the insulin-resistant group (32.34 g/m 2.7 (6.47) vs 37.27 g/m 2.7 (12.1), p = 0.037).

Conclusions:
Obesity and insulin resistance are the main determinants of LVMI in our population. In a cohort of children and adolescents with similar characteristics by laboratory parameters, obesity still appears to induce early preclinical damage at cardiac level in terms of mass and geometry irrespectively of the blood pressure phenotype.
FACTORS ASSOCIATED WITH POOR BLOOD PRESSURE CONTROL IN SEDENTARY NOMADIC HYPERTENSIVES IN SOUTHERN ALGERIA
Authors: /Abdelhalim Taleb Taleb , Farah Hamida , Yousra Djebbar , Abdelghani Bachir Cherif 
Published: June 2023

Objective:
the objectives of this study were to determine the proportion of uncontrolled hypertension in a nomadic hypertensive population and to investigate the factors associated with this poor control.

Design and method:
this is a descriptive cross-sectional study including 135 sedentary nomads recruited with known hypertension, without distinction of sex or skin color. The blood pressure was taken between eight and 12 a.m., on both arms, in the supine position, after resting for an average of five minutes. We looked for the classic cardiovascular risk factors (age greater than or equal to 50 years for men and 60 years for women, physical inactivity, overweight/obesity, tobacco, diabetes and dyslipidemia) and calculated the overall cardiovascular risk according to the model of framingham. A sbp greater than or equal to 140 mmhg and/or a dbp greater than or equal to 90 mmhg was considered as uncontrolled blood pressure. A univariate and then multivariate analysis by logistic regression (using the spss program version 22.0) were carried out in search of factors associated with poor blood pressure.

Results:
of the 135 hypertensives, 62 were women (46%), sex ratio is 1.2. The modifiable cardiovascular risk factors in addition to hypertension were dominated by dyslipidemia (19.9%) and diabetes (13.2%). The global cardiovascular risk calculated according to the framingham method was low in 19.3%, moderate in 24.0%, high in 14.8% and very high in 10.9% of cases. The proportion of uncontrolled hypertension was 73.8% (n = 118 including 76 women and 42 men). This poor blood pressure control was linked (multivariate analysis) to age greater than or equal to 60 years, physical inactivity, low socioeconomic level, high to very high cardiovascular risk, antihypertensive monotherapy, duration of treatment greater than or equal to ten years, associated treatment and non-adherence to treatment.

Conclusions:
three quarters of hypertensives in our study were poorly controlled by antihypertensive treatment. The factors of this poor control were age greater than or equal to 60 years, low socioeconomic status, high to very high cardiovascular risk, antihypertensive monotherapy, duration of treatment, associated treatment and non-compliance with treatment.
CIRCADIAN BLOOD PRESSURE PROFILE IN RELATION TO LOW BACK PAIN DISABILITY INDEX
Authors: Stolarz-Skrzypek Katarzyna , Góra Katarzyna , Skrzypek Maciej , Kaleta Blazej , Wróbel Piotr , Rajzer Marek , Wojciechowska Wiktoria 
Published: June 2023

Objective:
Cross-sectional observations within population cohorts have linked low back pain with hypertension in men, but not in women. The aim of the current study was to analyze 24-hour blood pressure profile in hypertensive men and women reporting low back pain.

Design and method:
The study group included 85 hypertensive patients (29 M/56 F, mean age 60.6 +/- 8.3 years) with episodes of low back pain during 3 weeks before examination. All patients received antihypertensive medications in the scheme of combination therapy and none of them was on chronic painkillers. Standardized questionnaire was used to collect information on life style factors. Twenty-four hour blood pressure monitoring was provided (Spacelabs 90207) and values of 24h, daytime and nighttime blood pressure were calculated, as well as nighttime blood pressure dipping. Oswestry Low Back Pain Disability Questionnaire was used to calculate disability index. Multivariable regression was used to asses the association between blood pressure an disability index, while accounting for covariates.

Results:
In the whole study population, no association was found between disability index and 24-hour systolic (parameter estimate: -0.053 +/- 0.23 mm Hg per 1 point increase in disability index, p = 0.86) or diastolic blood pressure (-0.018 +/ 0.14 mm Hg per 1 point increase, p = 0.90). When analyzing men and women separately, we observed in women increased daytime diastolic blood pressure with increasing disability index (+0.29 +/- 0.16 mm Hg, p = 0.044), that resulted in more prominent day-night difference with increasing disability index (+0.42 +/- 0.14% per 1 point increase in disability index). Blood pressure values over 24 hours or nighttime blood pressure was not associated with disability index. None of associations between blood pressure values and low back pain disability index were not found in men.

Conclusions:
Low back pain, as assessed by standardized questionnaire of disability index, is associated with elevated daytime blood pressure in hypertensive women, that might lead to more difficulties in achieving target blood pressure in this group of patients.
CLINICAL AND DEMOGRAPHIC CHARACTERISTICS OF PATIENTS WITH COEXISTENT HYPERTENSION AND TYPE 2 DIABETES MELLITUS: RESULTS FROM THE LARGEST RETROSPECTIVE EMR STUDY FROM INDIA
Authors: Natarajan Vidhya , Dalal Jamshed , Chandra Praveen , Chawla Rajeev , Hazra Prakash , Chawla Manoj , Ponde Chandrashekhar , Naqvi Mujtaba , Gaurav Kumar , Dhanaki Gauri , Rathod Rahul , Kotak Bhavesh 
Published: June 2023

Objective:
Common end-organ manifestations of diabetes and hypertension predispose patients to develop cardiovascular diseases (CVD). The data on coexistent hypertension and diabetes mellitus (dual disease) in India is scarce. In patients with dual disease CVD risk is amplified, therefore necessitating better understanding of their current clinical characteristics and care gaps.

Design and method:
This was an EMR based, retrospective, multicenter, cross sectional, database study to evaluate the demographic and clinical profile of adult patients with age more than 18 years having coexistent Hypertension and Type 2 Diabetes in India. Data of patients with Type 1 Diabetes Mellitus, Familial Hypercholesterolemia and pregnant females were excluded

Results:
Data of 6722173 (6.7 million approx.) patients with age more than or equal to 18 years registered in EMR from January 2021 to December 2021 was extracted from the EMR database. Out of these patients, 279072 (4.15%) patients were found to have coexistent hypertension and diabetes mellitus. Mean age was noted to be 57.9 years and 52% of them were males. The mean BMI of the patients was 28.07 kg/m2, and 72% of patients had an above normal BMI (>24.99). The mean SBP and DBP in mmHg were noted to be 141.08 and 84.05, respectively. Only 9.3% and 22% of patients had a normal SBP and normal DBP, respectively. The mean HbA1c of the patients was 8.47% with only 27.7% of patients having HbA1C <7%. ARBs (16.2 %) and combination of anti-hypertensive with diuretics (10.9 %) were most used for hypertension. Biguanides and its combination with sulphonylureas were used in 53.5% and 32% of patients with diabetes, respectively.

Conclusions:
The findings suggests that control of dual disease in India is inadequate despite current therapy being offered, this puts patients at a higher risk for early-onset CVD. Hence, there is an urgent need to create awareness and optimize management of coexistent hypertension and diabetes.
PROGNOSTIC IMPACT OF FRAILTY ON FUNCTIONAL AUTONOMY IN OLDER ADULTS WITH HYPERTENSION
Authors: Ceolin Ludovica , Rivasi Giulia , Turrin Giada , Tortu’ Virginia , Capacci Marco , Rossi Lorenza , Corsi Carolina , Mossello Enrico , Ungar Andrea 
Published: June 2023

Objective:
To date, few studies have evaluated frailty in older adults with hypertension and the most appropriate tool to quantify frailty in this population has yet to be identified. The present study aimed to investigate the prognostic impact of frailty on decline of functional autonomy in a sample of hypertensive older adults.

Design and method:
We performed a longitudinal observational study including patients aged 75 or older evaluated at the Hypertension Clinic and Memory Clinic of the Division of Geriatric and Intensive Care Medicine, Careggi Hospital, Florence. Participants underwent a multidimensional geriatric assessment including frailty evaluation using three frailty scales (Fried Frailty Phenotype, Clinical Frailty Scale [CFS], Frailty Index) and two physical performance measures (gait speed and Short Physical Performance Battery [SPPB]). The primary outcome was reduction of autonomy in daily activities according to the Barthel Index (functional decline). The predictive performance of different frailty measures was evaluated based on ROC curve analysis, sensitivity, specificity and accuracy.

Results:
Among 99 hypertensive older adults (mean age 81, 59% women, median follow-up 13 months), functional decline occurred in 39% of patients. Participants with functional decline had a higher prevalence of cognitive impairment and frailty according to all the frailty scales used and a worse physical performance. Frailty Index and CFS showed the best predictive performance (AUC 0.715 and 0.708, respectively), followed by physical performance measures (AUC 0.691). All frailty measures showed good specificity (66-79%) and moderate sensitivity (54-70%). Gait speed showed the highest accuracy (71%) and achieved 57% sensitivity and 79% specificity, resulting in better predictive performance than the SPPB.

Conclusions:
The CFS and gait speed - easily applicable even in non-geriatric settings – may represent useful instrument to detect frailty and predict functional decline in hypertensive older adults.
GLUCOSE METABOLISM AND ATRIAL FIBRILLATION IN HYPERTENSIVE PATIENTS
Authors: Lytra Thekla , Kyvelou Stella Maria , Biotis Nikolaos Vythoulkas , Anastasiou Theocharis , Karpanou Evaggelia , Vyssoulis Gregory 
Published: June 2023

Objective:
We evaluated the association of abnormal glucose metabolism with risk of atrial fibrillation in hypertensive patients.

Design and method:
The study comprised 34.280 consecutive patients (51,87% males, mean age 58 years) with uncomplicated essential hypertension. The diagnosis of hypertension was based upon repeated office blood pressure measurements, 24 hours ambulatory blood pressure monitoring, clinical and laboratory evaluation. Patients were divided into four metabolic groups: normal glucose (NG), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and type 2 diabetes mellitus (DM2). Then subdivided into three subgroups: sinus (SR), paroxysmal (PAF) and sustained (SAF) atrial fibrillation. Average glucose (eAG), hemoglobin A1c (HbA1c), insulin, homeostatic model assessment for insulin resistance (HOMA-IR) and the variation of them in relation to rhythm were assessed in each subgroup, corrected for confounders.

Results:
Among the patients (45,3%) with NG there was significant difference of all glucose metabolic parameters in correlation to three rhythms (glucose p = 0,004, eAG, HbA1c, insulin, HOMA-IR, p<0,001). These indices were higher, in SAF and in PAF compared to the SR subgroup (glucose p = 0,011, the rest indices p<0,001).
In group IFG (20,3%), comparison of three rhythm indicated significant difference of glucose indices (glucose, eAG p<0,05, HbA1c, insulin, p<0,001) and they were increased in PAF in contrast to SR patients (p<0,05). Additionally, the insulin and the HbA1c were higher in SAF comparison the SR patients, (p<0,05). The eAG was comparably higher in SAF versus the PAF group, (p<0,05).
In group IGT (17,3%), the patients had difference in levels of indices depending the rhythm (eAG, HbA1c, insulin, HOMA-IR p<0,05). Particularly the patients with SAF had higher levels of insulin and HOMA-IR than those who had SR (p<0,05).
In group T2DM (16,9%), there was significant difference in glucose parameters dependent the rhythm (glucose p = 0,031, insulin p = 0,002, eAG, HOMA-IR, HbA1c p<0,001). The subgroup PAF showed higher values in eAG, HbA1c, HOMA-IR, (p<0,05) and the subgroup SAF in glucose, insulin, eAG, HOMA-IR (p<0,05), HbA1c (p<0,001) in compare to SR subgroup, respectively.

Conclusions:
Prediabetes and diabetes increase the risk of atrial fibrillation in hypertensive patients in a level response way.