bluuebunny/crossref_metadata_2025_split huggingface dataset:
WHAT IS THE SMALLEST CHANGE IN PULSE WAVE VELOCITY MEASUREMENTS THAT CAN BE ATTRIBUTED WITH CERTAINTY TO CLINICAL CHANGES IN ARTERIAL STIFFNESS? A RANDOMIZED CROSS-OVER STUDY
Authors: Podrug Mario , Sunjic Borna , Koren Pjero , Dogas Varja , Mudnic Ivana , Boban Mladen , Jeroncic Ana 
Published: June 2023

Objective:
Pulse wave velocity (PWV), a direct measure of arterial stiffness, is a promising biomarker of cardiovascular risk and a cardiovascular surrogate outcome. However, there is no general agreement on the expected reproducibility of PWV which hampers identification of the smallest change in PWV that is clinically significant. The objectives of this study were to estimate the reproducibility of PWV measurements over the course of two weeks in a diverse group of participants and under experimental conditions that are clinically relevant (two observers, morning/afternoon sessions, different number of visits); and to investigate factors that could reduce this reproducibility.

Design and method:
Using the SphygmoCor CvMS and Arteriograph devices, we were able to estimate the level of PWV reproducibility as the range of intra-subject values that were observed during the study. Every participant was recorded a total of 12 times with each device, spread out over the course of three visits spaced one week apart, with each visit consisting of two morning and two afternoon recordings. Multilevel mixed-effect models were used to identified factors affecting large discrepancies between consecutive PWV measurements for each device.

Results:
We show that current guidance on PWV-estimation (at least two PWV measurements, and if their difference exceeds 0.5 m/s, a third measurement) is suboptimal because PWV range for most participants was outside 1 m/s threshold, which has been proposed as minimal clinically-important-difference. The best reproducibility was yielded with median of 4 measurements and 1.1 m/s threshold. Regarding PWV reproducibility and repeatability, which are frequently used interchangeably in studies, while the range showed distinct difference between them, commonly used relative measures of variability, such as coefficient of variability, were comparable. We also found that different physiological variables were predictors of discrepancy between consecutive measurements for two devices, which is likely due to their distinct modes of operation.

Conclusions:
The evidence base for PWV reproducibility is limited, and more research is needed to deepen our understanding of variation in arterial stiffness over time, as well as fluctuations within a population group and in an intervention setting.
SERUM PROTEOMIC PROFILING OF CAROTID ATHEROSCLEROSIS: A POPULATION OUTCOME STUDY
Authors: Cauwenberghs Nicholas , Verheyen Astrid , Sabovcik Frantisek , Ntalianis Evangelos , Brguljan Jana , Kuznetsova Tatiana 
Published: June 2023

Objective:
Circulating proteins linked to atherosclerosis may improve cardiovascular (CV) disease prediction. Here, we applied proteomic profiling, feature selection and unbiased clustering to identify proteins associated with carotid atherosclerosis and integrate them in a protein-based classification system for prediction of future CV events.

Design and method:
491 community-dwelling participants (mean age, 58±11 years; 51% women) underwent carotid ultrasonography and proteomic profiling (CVD II panel, Olink Proteomics) at baseline. Subsequently, we collected cardiovascular outcome for a median follow-up period of 10.2 years. We applied partial least squares (PLS) and a machine learning algorithm (Random Forest, RF) to identify proteins associated with carotid intima-media thickness (cIMT) and the presence of atherosclerotic plaques. Next, we assessed the association of future CV events with protein-based phenogroups defined by unbiased clustering (Gaussian Mixture modelling) based on influential proteins in PLS and RF.

Results:
Of 92 measured proteins, 13 were labelled as important by PLS and RF and were independently associated with cIMT and/or the presence of plaques after multivariable adjustment: pro-adrenomedullin, agouti-related protein, brother of CDO, CD40 ligand, CD84, GLO1, HB-EGF, HSP27, lipoprotein lipase, lymphotactin, PAR-1, PDGF subunit B and TGM2. Based on these proteins, the clustering algorithm subdivided the cohort into two distinct phenogroups. Compared to the first (n = 174), participants in the second phenogroup (n = 317) had: i) a more unfavourable lipid profile with higher total cholesterol and triglycerides and lower HDL cholesterol (P<0.014 for all), but no differences in other CV risk factors such as age, blood pressure, smoking status and diabetes mellitus (P>0.061 for all); ii) higher cIMT (P = 0.0020); and iii) a significantly higher risk for future CV events during follow-up (multivariable-adjusted hazard ratio (95% CI) versus cluster 1: 2.63 (1.25 to 5.56); P = 0.01).

Conclusions:
Carotid atherosclerosis was linked to proteins reflecting haemostasis, angiogenesis, blood pressure regulation and inflammation. Focused proteomic phenomapping adequately identified individuals at high risk for future CV events and may thus complement current CV risk stratification strategies.
IMPROVEMENT OF PREDICTIVE UTILITY OF NATRIURETIC PEPTIDE FOR HEART FAILURE WITH PRESERVED EJECTION FRACTION WITH APELIN IN TYPE 2 DIABETES MELLITUS PATIENTS
Authors: Berezin Alexander , Fushtey Ivan , Berezin Alexander 
Published: June 2023

Objective:
Apelin plays a pivotal role in adverse cardiac remodeling and the occurrence of heart failure (HF) with reduced ejection fraction in type 2 diabetes mellitus (T2DM). The purpose of the study was to investigate whether serum levels of apelin predict HF with preserved ejection fraction (HFpEF) in patients with T2DM

Design and method:
The study was retrospectively involved 76 T2DM individuals aged from 41 to 65 years (48 patients with overt HFpEF and 28 non-HFpEF patients). Healthy control group was consisted of 25 individuals matched with age and sex. Serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), apelin, and high sensitive C-reactive protein (hs-CRP) were determined by ELISA

Results:
Serum levels of apelin and NT-proBNP were significantly increased in patients with HFpEF (7.74 ng/mL, 95% CI = 6.31-8.25 ng/mL and 954.8 pmol/mL, 95% CI = 476.2-1764.3 pmol/mL, respectively) when compared with non-HFpEF diabetics (2.26 ng/mL; 95% CI = 1.70-2.90 ng/mL; and 113.5 pmol/mL, 95% CI = 75.4-144.9 pmol/mL, respectively) and healthy volunteers (1.52 ng/mL 95% CI = 1.12-2.13 ng/mL and 67.8 pmol/mL, 95% CI = 49.1-87.4 pmol/mL; respectively). Apelin levels correlated positively with body mass index (r = 0.32, P = 0.001), serum uric acid (r = 0.30, P = 0.016), HDL cholesterol (r = 0.28, P = 0.001), hs-CRP (r = 0.26, P = 0.001) and were negatively associated with ejection fraction (r = 0.34, P = 0.002), and age (r = -0.30, P = 0.001). The ROC curve showed that the best fitted cut-off point for the apelin to NT-proBNP ratio was 0.82 units (area under curve = 0.76; sensitivity = 69.5%, and specificity 94.2%, P = 0.001). In multivariate logistic regression analysis the apelin to NT-proBNP ratio < 0.82 × 10-2 units independently predicted (odds ratio = 1.44; 95% confidence interval: 1.18 – 2.77; P = 0.001) HFpEF in T2DM patients.

Conclusions:
Apelin to NT-proBNP ratio < 0.82 × 10-2 was independent predictor for HFpEF in T2DM patients
ASSOCIATION OF ANGIOTENSIN-CONVERTING ENZYME I/D POLYMORPHISM AND HYPERTENSION AMONG YOUNG ADULTS: A PILOT STUDY FROM DELHI
Authors: Suokhrie Seyielenuo , Devi Naorem Kiranmala 
Published: June 2023

Objective:
Angiotensin converting enzyme (ACE) gene is a potent vasoconstrictor and directly involved in cell proliferation, differentiation, apoptosis and angiogenesis. Studies have reported that ACE gene activates the conversion of angiotensin I to angiotensin II and also inactive bradykinin. Bradykinin is a vasodilator which bring about its proteolysis which binds to the plasma membrane receptor and helps to produce the arteriolar constriction resulting in the rise of systolic and diastolic blood pressure. Blood pressure is additionally influenced by the interaction of genetic and other environmental factors, therefore this study tries to find an association between angiotensin-converting enzyme I/D polymorphism and hypertension among young adults

Design and method:
The present study was a cross sectional study conducted among young adults either sex from the age group of 18-30 living in Delhi, India. Standardized questionnaire was administered to collect data on demographic and physiological measurement. Overnight fasting intravenous blood of 5ml was collected on non-EDTA coated tube which were subjected to DNA extraction by salting out process (Miller, 1988). The extracted DNA was then aliquoted and amplified by allele-specific PCR followed by genotyping on 2% agarose gel (Rigat et al. 1990). The DNA was then screened for ACE I/D gene polymorphism. Statistical analysis was done using SPSS 2022 version.

Results:
The overall prevalence of hypertension in the given population was 25.3%. There was no significant difference in the distribution of ACE I/D genotypes wherein 17.4% of hypertensives were of the II genotype, 47% of ID genotype and 34.8% of the DD genotype.

Conclusions:
Although there was no significant association of ACE genotype with hypertension, which may be due to the small sample size but the significance of this study hints towards the importance of early detection and modifying lifestyle to improve overall health.of the individual as well as on the community level.
DESIGNING A CLINICAL TRIAL PROTOCOL INCLUDING PHYSICAL AND MENTAL ACTIVITIES TO EXPLORE BLOOD PRESSURE DYNAMICS FOR MEDICAL DEVICE DEVELOPMENT
Authors: Villeneuve Emma , Anglade Daniel , Sandre-Ballester Caroline , Auclair Loïc , Mastrosimone Marine , Bonnet Stéphane , Delalleau Alexandre , Gerbelot Rémi , Perriollat Mathieu , Blandin Pierre 
Published: June 2023

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 initial cohort of the clinical trial (NCT05393401, approved by Human Research Review Board (CPP SM I) and Health French Ministry) includes five healthy subjects (1F/4M, age [37-60] years). Each subject is monitored with a medical-grade continuous BP meter, and a multi-sensing homemade platform integrating gold standard cuff measurements. The latter gathers PPG sensors, an ECG, a nasal cannula. The subject undertakes the following exercises: rest, static and dynamic strength exercises with a Pilates fitness ring, mental calculation, guided relaxation, and wall sit exercise. Each phase lasts 3 minutes, except the relaxation (10 minutes) and is followed by a 3-minute recovery.

Results:
The impact of each activity is quantified by the range of mean arterial pressure (MAP), i.e. the difference between the initial value and the extremum during the interval. As the table shows, the highest median impact is achieved with the dynamic ring (+39 mmHg) and the wall sit (+33mmHg). The static ring and the stress occurred by the calculation exercise have a lower impact with an increase of 21mmHg and 19mmHg. Finally, the effect of the relaxation is verified with a median decrease of 13 mmHg.

Conclusions:
These preliminary results (trial still running) show that building an accurate BP meter requires exploring the full range of BP in response to various physiological mechanisms. Therefore, it is necessary to combine relaxing and physical activities. Their impact vary among subjects and activities and illustrate that special care should be taken using real-time monitoring.
HIGH PREVALENCE OF NEW HYPERTENSION AND EARLY VASCULAR AGING: A REPORT FROM MAY MEASUREMENT MONTH 2019 SCREENING PROGRAMME IN BULGARIA
Authors: Postadzhiyan Arman , Yotov Yoto , Tisheva Snezana , Nikolov Fedya , Ramchev Konstantin , Raev Dimitar , Gruev Ivan 
Published: June 2023

Objective:
Hypertension remains a major public health issue with inadequate control worldwide. The May Measurement Month (MMM) initiative by the International Society of Hypertension was implemented in Bulgaria in 2019 aiming to raise hypertension awareness and control. Increased arterial stiffness may indicate high cardiovascular risk, but little is known about its prevalence at the population level.

Design and method:
Adult volunteers (>18 years) were recruited through opportunistic screening in 21 of 28 administrative areas in the country. Information on medical history and triplicate sitting blood pressure (BP) measurements were obtained using validated automated upperarm devices. Aortic pulse wave velocity (aoPWV) was estimated, using age, systolic BP, and waveform characteristics. Using age-specific percentiles from a nonhypertensive group, we defined healthy (HVA) and early (EVA) vascular aging.

Results:
A total of 3678 participants were analyzed [mean age 58.8±16.5 years, men 37.2%, 71.2% had BP measurement in the last 12 months]. Mean BP was 135/82 mm Hg. In all, 45.4% of participants had elevated BPs (>140/90 mm Hg), 58.3% out of 1910 participants with known hypertension, and 31.4% out of 1768 participants without known hypertension. In all, 4,67% of participants had aoPWV below 10th reference percentile (HVA), with a negligible proportion above 50 years. In total, 40.5% were above the 90th reference percentile (EVA), with proportions rising from one-quarter in youngest partcipants bellow 50 to one-half in oldest participants. In participants with EVA, BP was elevated during the measurement in 82.6%. Among participants without established HTN, according to European guidelines in 18.4 % BP was elevated, when measured during the campaign. The lowest proportion of newly diagnosed hypertension was found in HVA group – 4.8% and the highest 30% in EVA group. Figure 1 gives information for blood pressure measured according to quintiles of vascular aging groups.

Conclusions:
The prevalence of hypertension in Bulgaria is high, with considerable potential for improving awareness, treatment, and control. The high prevalence of early vascular aging and higher incidence of newly diagnosed hypertension in this group of patient at early age is alarming.
ASSOCIATION OF MORTALITY OUTCOMES WITH ARTERIAL PARAMETERS DERIVED FROM THE 24-HOUR AMBULATORY BLOOD PRESSURE MONITORING
Authors: Li Mingxuan , An Dewei , Cheng Yibang , Huang Jianfeng , Sheng Changsheng , Huang Qifang , Zhang Dongyan , Wang Ying , Guo Qianhui , Xu Tingyan , Wang Jiguang , Li Yan 
Published: June 2023

Objective:
Arterial stiffness, as a subclinical target organ damage, was an independent predictor of cardiovascular events. Parameters calculated from the 24-hour ambulatory blood pressure monitoring (ABPM), such as ambulatory arterial stiffness index (AASI), symmetrical AASI (sAASI), the 24-hour pulse pressure (PP) and its components expressed as elastic PP (elPP) and stiffening PP (stPP), can be used to indirectly assess arterial stiffness. Up to now, few studies have compared the associations of health outcomes with these parameters.

Design and method:
Out-patients who completed 24-hour ABPM (Mobil-O-Graph, Germany) at Ruijin Hospital (Shanghai, China) from 2017 to 2020 were recruited. All-cause and cardiovascular mortality (ICD10 codes I00-I99) was ascertained according to the death registry in Shanghai Municipal Center for Disease Control and Prevention. Standardized hazard ratios (HR) and 95% confidence intervals were computed with Cox regression models and adjusted for 24-hour mean arterial blood pressure and other confounders.

Results:
Among the 29,519 participants (mean age 52.9 years, 46.8% males) followed up for a median of 2.8 years, 244 participants died, and 78 died from cardiovascular events. In unadjusted analyses, all studied ambulatory arterial parameters were all associated with all-cause (HR, 1.41-1.87; P<0.001) and cardiovascular (HR, 1.55-2.17; P<0.001) mortality. After multivariable adjustment, AASI, the 24-hour PP, elPP and stPP remained significantly associated with all-cause (HR, 1.18-1.35; P<0.014) and cardiovascular (HR, 1.28-1.38; P<0.048) mortality, while the associations became non-significant for stPP in relation to cardiovascular death, and for sAASI with all-cause and cardiovascular outcomes.

Conclusions:
Arterial parameters derived from the 24-hour ABPM were independently associated with mortality outcomes, with some differences in the associations among different parameters.
SHOULD WE REALLY STOP OFFICE BLOOD PRESSURE MEASUREMENT? A QUALITATIVE STUDY
Authors: Jean-Marc Boivin , Manon Grocolas , Savy Dy , Joelle Kivits 
Published: June 2023

Objective:
To assess patients’ perception of Office Blood Pressure (OBP) measurement during a General Practitioner (GP) visit.

Design and method:
Qualitative study conducted by semi-directed individual interviews of 31 patients, from November 2020 to October 2021 in the Eastern region of France, using a thematic and comprehensive analysis.

Results:
Patient attachment to OBP measurement was high. It was an expected act, allowing the evaluation of their health status and therefore a source of reassurance, and furthermore deemed an integral part of the visit and «check-up ». Patients trusted GPs’ BP measurements with the latter being perceived as falling within their role and competence. A lack of OBP measurement was considered as an omission of the GP's duty. It was moreover considered as a gold-standard by hypertensive patients performing Home Blood Pressure Measurements (HBPM).

Conclusions:
OBP measurement remains an essential act for patients, both from a medical and practitioner-patient relationship standpoint. Although the expansion of connected medicine will lead to a better acceptance of electronic devices in the management of hypertension, OPB measurement should be continued with the view of maintaining the quality of the physician-patient relationship.
HUNGARIAN AMBULATORY BLOOD PRESSURE MONITORING REGISTRY REVEALED THAT HYPERTENSION IS HIGHLY PREVALENT BOTH IN ALREADY DIAGNOSED AND TREATED PATIENTS AND IN SUSPECTED HYPERTENSIVES
Authors: Jarai Zoltan , Nemcsik Janos , Pall Denes , Takacs Johanna , Koller Akos 
Published: June 2023

Objective:
In 2021 the Hungarian Society of Hypertension initiated a program to promote the nationwide use of ambulatory blood pressure (BP) monitoring (ABPM) (Hungarian ABPM Registry) aiming to increase the awareness of high BP and to monitor the efficacy of therapies. The goal was to collect and analyze the ABPM values of treated hypertensive (HT) and newly diagnosed patients (nHT) and assess the influence of other risk factors, comorbidities and patient characteristics.

Design and method:
Adults (18-100 years old) can be included into this ongoing, multicenter, open-label, observational study. Data collection to an electronic case report form is performed by GPs, internists, and cardiologists. Meditech ABPM-06 monitors are used. Data of the current analysis were collected between 21.02.2021-5.10.2022. 15 835 ABPMs were performed; due to missing data or protocol deviation 1018 patients were excluded from the analysis.

Results:
10212 patients were HTs, 4571 were nHTs (69% and 31%, respectively). 76% of nHT patients were untreated during ABPM. Mean 24-hour systolic and diastolic BP was 134.03±14.6 mmHg and 79.3±10.1 mmHg, respectively. There was no difference in the 24-hour mean systolic BP between nHT and HT patients (134.08±14.9 mmHg vs. 133.91±14.6 mmHg, respectively, p = NS). Two-third of the patients (all: 68.2%, HT: 68.5%, nHT: 67.6%) were hypertensive according to ABPM measurements. Obesity (BMI>30 kg/m2) doubled the risk of hypertension in both groups (OR = 2.18 [2.03;2.34] for 24-hour average), but it had a higher impact in nHTs (OR = 2.57[2.22;2.98] for 24-hour average in nHT and OR = 2.12[1.94;2.30] for 24-hour average in HT patients). Snoring increased the risk of hypertension in both group of patients (OR = 1.45[1.34;1.56] for 24-hour average) irrespectively of gender, and – interestingly – it had a greater impact on the daily values of BP (day: OR = 1.51[1.40;1.62] and night: OR = 1.32[1.22;1.42]).

Conclusions:
The new ABPM Hungary Registry revealed hypertension in the majority of screened individuals, regardless of gender or treatment. In addition, in both gender, obesity, snoring, increased the risk of hypertension. These data underline the importance of ABPM in the screening for and treatment of hypertension leading to the earlier and more effective treatment.
ASSESSING WORKFLOW, SATISFACTION, AND POTENTIAL COST REDUCTION WHEN USING A CUFFLESS AMBULATORY BLOOD PRESSURE MONITOR
Authors: Eisenkraft Arik 
Published: June 2023

Objective:
Hypertension is a major risk factor for cardiovascular diseases. Ambulatory blood pressure monitoring (ABPM) is used for the diagnosis of hypertension, however, currently-used devices have several drawbacks complicating their use and accuracy. We tested the workflow of a wearable photoplethysmography (PPG)-based cuffless device when compared to the traditional cuff-based ABPM device.

Design and method:
Patients were recruited in a single community clinic and randomly assigned to either a cuff-based or a PPG-based 24-hour ABPM test. An assessment team recorded the time to complete each workflow component with each device. Questionnaires on user experience and workflow were filled by physicians, nurses, and recruited patients.

Results:
Workflow assessment of onboarding patients showed that it was faster with the PPG-based device than with the cuff-based device (301.17±58.39 seconds vs 1185±172.34 seconds on average, respectively). The PPG-based device received a higher score in all aspects of usability. The direct manpower cost reduction was calculated as 108,000 USD per year for 4,500 tests.

Conclusions:
The PPG-based device has several advantages when compared to the traditional cuff-based ABPM device, potentially increasing both patient and medical staff satisfaction, and as a result, increasing compliance. This could help improve the diagnosis and treatment of hypertension in the community.