bluuebunny/crossref_metadata_2025_split huggingface dataset:
EPLERENONE VS IRBESARTAN AS FIRST LINE THERAPY IN OBESE HYPERTENSIVE PATIENTS: BASELINE CHARACTERISTICS FROM HEBRO STUDY
Authors: Iliakis Panagiotis , Kouremeti Maria , Drogkaris Sotirios , Siafi Eirini , Andrikou Ioannis , Dimitriadis Kyriakos , Konstantinidis Dimitrios , Thomopoulos Costas , Tsioufis Konstantinos 
Published: June 2023

Objective:
Obesity is significantly associated with adverse cardiovascular outcomes. The relationship between obesity and hypertension is well described. However, little is known about the impact of aldosterone blockade using eplerenone on hypertensive obese patients as first line therapy. The aim of this study is to compare the efficacy between eplerenone-based strategy and irbesartan-based strategy in obese hypertensive individuals.

Design and method:
A prospective, randomized, open-labeled, multicenter trial enrolled 80 hypertensive patients aged 30 to 75 years old, with obesity [body mass index BMI >or = 30 kg/m2)], evaluated by home BP, office BP and ambulatory BP measurements. Subjects randomly received 25mg eplerenone twice or 150mg irbesartan once daily. The primary endpoint is the difference in ambulatory BP measurements after 6 months follow-up period and the secondary endpoints are the differences in left ventricular hypertrophy and albuminuria after 6 months follow-up period.

Results:
At baseline, there were no significant differences between the two study arms regarding gender (men 49,3%, p = 0.732), age (53.9± 10.4 in the eplerenone arm vs. 56.1 ± 10 in the irbesartan arm, p = 0.326), BMI (34.2 ± 3.3 vs. 34.9 ± 3.3, p = 0.376, respectively), renal function (mean eGFR 84.6 ± 16.4 vs. 81.3± 13.1, p = 0.358, respectively) and the presence of diabetes mellitus (9.8% vs 10.5%, p = 0.910, respectively).
Moreover, there were no significant differences regarding home BP (142.5/88.5 mmHg ± 8.6/7.3 vs. 141.8/89.4 mmHg ± 8.3/6.7, p = 0.716 and p = 0.558 respectively), office BP (146.3/91.3 mmHg ± 8.2/9.4 vs. 145.1/92.3 mmHg ± 9.1/9.1, p = 0.506 and p = 0.547 respectively) and ambulatory BP (140.9/85.5 mmHg ± 8.4/8.8 vs. 140.1/84.7 mmHg ±7.8/7.5, p = 0.662 and p = 0.667 respectively).
Regarding left atrial geometry, evaluated by left atrial volume index (LAVI), there was no significant difference (30.7 mL/m2± 11.1 vs. 30.6 mL/m2 ± 16.9, p = 0.979, respectively). Finally, regarding arterial stiffness evaluated by pulse-wave velocity, there was no significant difference (9.5 m/s ± 1.7 vs. 10.1 m/s ± 2.4, p = 0.435, respectively)

Conclusions:
In conclusion, the two study arms did not differ in most baseline characteristics, suggesting true homogeneity among comparison arms. Soon, we anticipate the results from the primary endpoint completion.
SEQUENTIAL NEPHRON BLOCKADE VERSUS DUAL RENIN-ANGIOTENSIN SYSTEM BLOCKADE IN TRUE RESISTANT HYPERTENSIVE PATIENTS: A SYSTEMATIC REVIEW
Authors: Yugar Louise Buonalumi Tacito , Prado Luis Gustavo Sedenho , Melo Silvia Elaine Ferreira , Tacito Lucia Helena Bonalume , Vilela-Martin José Fernando , Junior Heitor Moreno , Toledo Juan Carlos Yugar 
Published: June 2023

Objective:
True resistant hypertension (RHTN) is a challenging medical condition in which the blood pressure remains uncontrolled despite the use of three different classes of antihypertensive agents at maximum tolerated dose. In order to reduce the sodium and volume overload in these patients and bring the blood pressure to acceptable levels, several pharmacologic agents that promote sequential nephron blockade (SNB) or dual renin- angiotensin system blockade (DRASB) can be used. Therefore, this review aims to evaluate the data presented in some clinical trials comparing the SNB to the DRASB.

Design and method:
A systematic search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was conducted in MEDLINE, Cochrane Library, EMBASE and LILACS, resulting in a total of 123 articles. One abstract and 4 randomized controlled trials were selected to be assessed in this review.

Results:
Both treatments decreased systolic blood pressure and diastolic blood pressure in ambulatory blood pressure monitoring. In one of the protocols, the decreases in the SNB group were significantly greater than in the DRASB group. A sub-analysis showed that the improvements in blood pressure were significant only in those with acceptable adherence to treatment. The two interventions reduced office blood pressure, with one study indicating that the reduction was superior in SNB. In markers of arterial stiffening and aging, there were no significant improvements. Pulse wave velocity and common carotid artery stiffness were similar in both groups and tended to decrease. One of the studies showed improvement in echocardiographic parameters for diastolic dysfunction.

Conclusions:
Despite the improvements in blood pressure in both groups, SNB therapy has a higher potential as a treatment for RHTN, especially when there is good adherence to the medication. Also, SNB tended to improve arterial stiffness and diastolic dysfunction. Nonetheless, there is a need for more studies for a better evaluation of these outcomes.
AORTIC STIFFNESS IS INDEPENDENTLY ASSOCIATED WITH INTRACRANIAL CAROTID ARTERY CALCIFICATION IN PATIENTS WITH ISCHEMIC STROKE
Authors: Gozdalski Jacek , Nowicki Tomasz , Kwarciany Mariusz , Kowalczyk Kamil , Narkiewicz Krzysztof , Gasecki Dariusz 
Published: June 2023

Objective:
Intracranial carotid artery calcification (ICAC), as a strong contributor to the occurrence of ischemic stroke, might be present in the medial or intimal arterial layer. Traditional vascular risk factors are associated with ICAC; however, its association with new markers of vascular function are less understood. The paper aims to evaluate the relationship between carotid-femoral pulse wave velocity (CF-PWV) and ICAC subtypes.

Design and method:
We enrolled 65 patients with acute ischemic stroke. CF-PWV, systolic, diastolic and mean blood pressure, and pulse pressure (SBP, DBP, MBP, PP) were measured within 6±2 days of stroke onset.
CT was performed within 24 hours of stroke onset and ICAC on the stroke site was classified by two methods: volume- and score-based. Tertiles of ICAC volume were determined, and low-grade ICAC (T1) was regarded as a reference. According to the score-based method, medial and intimal ICAC subtypes were determined. Data were analyzed with multivariate logistic regression.

Results:
Medial and intimal ICAC subtypes were found in 34 (52%) and 24 (37%) patients, respectively. In 11% of patients no ICAC calcifications were found. CF-PWV was higher in patients with high-grade ICAC (OR = 1.56, 95%CI = 1.03-2.35, p = 0.035). CF-PWV was higher in patients with the medial ICAC subtype than in patients with the intimal ICAC subtype (OR = 1.60, 95%CI = 1.00-2.55, p = 0.049) after adjustment for age, MBP, diabetes mellitus, arterial hypertension, hyperlipidemia, and smoking status.

Conclusions:
Our study demonstrates that among patients with ischemic stroke, aortic stiffness is independently associated with ICAC, and that medial ICAC, compared with intimal ICAC, is accompanied by more advanced aortic stiffness.
ISCHEMIC STROKE AFTER CORONARY BYPASS SURGERY IN PATIENTS WITH TYPE 2 DIABETES, HYPERTENSION, AND TRIPLE VESSEL DISEASE
Authors: Jain Rajesh , Husseini Siyamak Jalal , Shogli Mohammadreza , Fesseha Hermon Eyob 
Published: June 2023

Objective:
We want to investigate this case, what are the various Risk factors for Ischaemic stroke as a major complication, and how to reduce this life-threatening complication in high-risk patients with diabetes, hypertension, and triple vessel disease.

Design and method:
A 55-year-old patient with TVD Tripple vessel disease without acute MI (myocardial infarction) needed CABG. His angiographic score and uncontrolled diabetes suggested open heart surgery.
He did not have carotid or aortic plaque or other issues during the pre-op examination.
He underwent on-pump CABG, cardiac aortic bypass with two saphenous veins (on the RCA and OM1), and anastomosis of the left internal thoracic artery on the LAD.
The pumping duration was 150 minutes. The patient was weaned from the pump, the surgery was completed, the sternum was closed, and the patient was transferred to the intensive care unit.
When we decided to extubate the patient after 12 hours, we noticed his limb movement was not symmetrical. He was paralyzed on the left side.
There was significant left hemisphere ischemia on brain CT, which was consistent with CVA.
Once brain hemorrhage was excluded, the neurologists started administering heparin to treat the ischemic stroke.

Results:
Patients with severe stenosis and 3VD require intervention or CABG treatment; however, in this instance, the areas of stenosis were not appropriate for stenting, and the patient's uncontrolled diabetes was another reason suggestive of open-heart surgery.
Three crucial aspects have shocked us and that all surgeons may find challenging.
Uncontrolled diabetes can significantly contribute to the damage of medium and small blood vessels, and chronic hypertension can cause micro tears and blood clots in the vessels. These three variables can result in tiny damage. Long pump time and these two variables contributed to blood stagnation in the patient. In addition, the patient may have been more vulnerable to ischemic attacks.

Conclusions:
We may have avoided this complication by administering the following measures
HEMODIALYSIS EFFECTS ON AUTONOMIC FUNCTION: RESULTS OF LINEAR AND NON-LINEAR ANALYSIS OF HEART-RATE-VARIABILITY AT REST AND IN RESPONSE TO PHYSICAL AND MENTAL STRESS TESTS
Authors: Faitatzidou Danai , Dipla Konstantina , Theodorakopoulou Marieta , Koutlas Aggelos , Karagiannidis Artemios , Tsouchnikas Ioannis , Giamalis Panagiotis , Dimitriadis Chrysostomos , Zafeiridis Andreas , Papagianni Aikaterini , Sarafidis Pantelis 
Published: June 2023

Objective:
Cardiac arrhythmias are the most common cause of death in hemodialysis. Autonomic dysfunction plays a central role in this arrhythmogenic background. Previous studies on hemodialysis-related changes in heart-rate-variability(HRV) give contradictory results. This study investigated HRV indices both at rest and in response to physical and mental stimulation maneuvers at multiple time-points around and during the hemodialysis procedure.

Design and method:
Autonomic function was assessed by linear and non-linear HRV indices at pre-dialysis, during-dialysis(3 equal time-periods), post-dialysis, and on the non-dialysis day in 36 hemodialysis patients. Continuous measurement of beat-by-beat heart-rate was recorded with Finometer-PRO(The Netherlands) at rest and after orthostatic, sit-to-stand, handgrip and mental-arithmetic test.

Results:
The RMSSD, SD1, and SD2 indices significantly increased during dialysis(early-HD, mid-HD, late-HD periods) compared with the pre-dialysis levels(p<0.05) and returned to baseline post-dialysis(RMSSD: 54.39±83.73 vs 137.98±109.53* vs 119.85±97.34* vs 144.47±88.74* vs 85.82±121.43msec, *p<0.05 vs pre-dialysis and post-dialysis). No differences were detected in the above indices between the pre-dialysis and non-dialysis day. However, post-dialysis, the HRV responses to orthostatic and sit-to-stand tests were more exaggerated than in the pre-dialysis measurements (p<0.05). The HRV responses both at resting and physical tests in the non-dialysis day were similar to the pre-dialysis levels. HRV indices in mental-arithmetic test during hemodialysis were much higher than at the non-dialysis day(RMSSD: 77.05 (180.41) vs 19.75 (105.47)msec; p = 0.031) were detected.

Conclusions:
Hemodialysis causes marked changes in autonomic function. Resting HRV indices return to baseline post-dialysis, but HRV responses to physical stress remain exaggerated and return to baseline on the non-dialysis day. Detecting patients with significant autonomic dysfunction may help towards reduction of arrhythmia risk through individualized approaches.
HIGH SALT DIET ALTERS CEREBROVASCULAR RESISTANCE IN RESPONSE TO ORTHOSTATIC TEST IN HEALTHY YOUNG INDIVIDUALS
Authors: Drenjancevic Ines , Dumancic Dijana , Stupin Ana , Goswami Nandu 
Published: June 2023

Objective:
High salt (HS) diet has been shown to impairs vascular reactivity in animal models, by increasing vasoconstriction to different stimuli. Response to orthostasis occurs via activation of baroreceptor reflex leading to increase in total peripheral resistance that prevents significant fall of arterial blood pressure (ABP) while standing up, aiming to preserve cerebral perfusion pressure. We recently showed that HS diet physiologically suppresses sympathetic arm of autonomic control in healthy humans (Stupin et al. Nutrients 2021; 13:1731. https://doi.org/10.3390/nu13051731). Present study aimed to assess the effect of HS diet on cerebral vasoreactivity in response to orthostatic load.

Design and method:
Twenty-seven young healthy participants (F:21, M:6, age range 19–24) consumed 7-day low-salt (LS) diet (<2.3 g NaCl /day) and afterwards 7-day HS diet (>11.2 g NaCl/day). In response to orthostatic test cerebral and systemic hemodynamic parameters, arterial blood pressure, heart rate variability and heart rate, and were recorded simultaneously with transcranial Doppler ultrasound and The Task Force® Monitor.

Results:
Subjects maintained normotension during HS diet. Diastolic blood pressure, as well as mean cerebral blood flow (CBF) and the velocity time integral decreased, while cerebral pulsatility index increased after standing up following both dietary protocols. However, while no change was observed in total peripheral resistance, cerebrovascular resistance significantly increased in response to orthostasis only after HS diet. Baroreflex sensitivity (BRS), sympathetic neural control, serum plasma renin activity and aldosterone, and urine noradrenaline and vanillylmandelic acid concentration was significantly decreased in HS diet.

Conclusions:
Results demonstrated that following 7-day HS diet, enhanced cerebral autoregulation preserves CBF and is manifested as increased cerebral vascular resistance, in conditions with blunted BRS and sympathetic activity.
The study has been published in Eur J Appl Physiol. 2023 Jan 4. doi: 10.1007/s00421-022-05124-w. Online ahead of print.
USE OF ANTIHYPERTENSIVE DRUG CLASSES DURING THE COVID-19 PANDEMIC. A CROSS-SECTIONAL, NATION-WIDE STUDY 2019-2021
Authors: Dobrowolski Piotr , Prejbisz Aleksander , Bozek Gabriel , Kon Beata , Machnie Aneta , Urbanski Filip , Madry Roman Topor , Kreutz Reinhold , Januszewicz Andrzej , Milkowski Maciej 
Published: June 2023

Objective:
To assess changes in the use of antihypertensive drug classes during the COVID-19 pandemic, data of all patients who filled a prescription for an antihypertensive drug in Poland were analyzed.

Design and method:
Patients who filled at least one prescription from ATC groups C02-03, C07-10, C10BX in each of the years 2019, 2020 and 2021 were extracted from the obligatory prescription database of the National Health Service in Poland. We have excluded patients with a diagnosis of heart failure. The frequencies of use of antihypertensive drug classes – beta-blockers (BB), angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB), calcium channel blockers (CCB), thiazide diuretics (TD), thiazide-like diuretics (TLD), loop diuretics (LD), mineralocorticoid receptor antagonists (MRA) and alpha-blockers (AB) - and their combinations were analyzed for the years 2019, 2020 and 2021 respectively.

Results:
In the years 2019, 2020 and 2021 – 10,328,341, 9,478,949 and 9,637,595 patients fulfilled the inclusion criteria. Among the main groups of antihypertensive drugs, the most used drug groups were BB (62.0, 62.8 and 63.7%), ACEi (52.9, 52.7 and 46.8%) and CCB (34.5, 35.2 and 35.9%). ARB were used by 26.8, 27.3 and 28.2% of patients. Diuretics were used by: TD 14.2, 13.9 and 14.1%; TLD 23.3, 22.8 and 22.6%, LD 13.0, 12.8 and 12.9%, AA 8.5%, 8.3%, 8.5%. AB were rarely used (4.5, 4.5, and 4.5%). Among patients taking two anithypertenisve drugs, the most common combination was BB+ACEi 23.5, 19.7 and 18.7%. BB+other anithypertensive drugs was used by 48.6, 46.9 and 45.7% of patients. ACEi/ARB+TD/TLD and ACEi/ARB+CCB combinations were used by 24.3, 23.4 and 23.6% and 17.4, 17.6 and 18.4% of patients, respectively. Among patients taking three drugs, BB+ACEi/ARB+TD/TLD combination was used by 29.8, 26.4, 25.7% of patients, followed by combinations: BB+ACEi/ARB+CCB 21.3, 19.8 and 19.9% and ACEi/ARB+CCB+TD/TLD 15.2, 17.2 and 18.5% of patients.

Conclusions:
The COVID-19 pandemic had little impact on changes in the frequency of use of individual antihypertensive drug groups. A slight increase in the use of the two and three drugs’ combinations recommended by the ESC/ESH 2018 guidelines was observed in 2021 compared to 2019.
THERAPEUTIC COMPLIANCE IN HYPERTENSIVE PATIENTS: A CROSS SECTIONAL STUDY
Authors: Karim Hatim Amine Zahidi Badaoui , Haboub Meryem , Arous Salim , Bennouna El Ghali , Drighil Abdenasser , Azzouzi Leila , Habbal Rachida 
Published: June 2023

Objective:
The improvement of medication compliance is a necessity for a better management of arterial hypertension (AH), especially in cardiac patients, with a high risk of progression to heart failure.
We aim to evaluate the level of therapeutic compliance in hypertensive patients followed in cardiology consultation, and to seek the factors related to a bad compliance.

Design and method:
Through a descriptive and cross-sectional epidemiological study, we evaluated the therapeutic compliance of 154 hypertensive patients treated for 6 months, using a questionnaire called the compliance evaluation test to define patients with good therapeutic compliance, those with minimal compliance problems and those with poor compliance. The factors of poor compliance were sought in univariate analysis and then in multivariate analysis

Results:
In our hypertensive population, the compliance evaluation test showed 34.8% of patients with good compliance, 46.8% with minimal compliance problem and 18.4% with poor compliance to antihypertensive treatment. Poor compliance was associated with older age, male sex, lack of health insurance, and low education. But in multivariate analysis, only the presence of complications was an independent risk factor for poor compliance.

Conclusions:
Our study showed low adherence to antihypertensive therapy, particularly among those who already have complications from hypertension. Our health care system needs to develop a management plan that addresses our own determinants of adherence to improve adherence to antihypertensive medications.
GENETIC VARIATION AND PREDICTED PHENOTYPES IN CYP2C9, CYP2C19, CYP3A4, CYP3A5 AND CYP2D6 GENES AMONG 552 PATIENTS WITH UNCONTROLLED TREATED HYPERTENSION
Authors: Rognstad Stine , Halvorsen Lene Vernås , Søraas Camilla Lund , Aune Arleen , Brobak Karl Marius , Olsen Eirik , Bergland Ola Undrum , Kjær Vibeke Nordheim , Hjørnholm Ulla , Tuv Silja Skogstad , Nordal Kristin Reiersen , Svarstad Anja Camilla , Gerdts Eva , Mo Rune , Høieggen Aud , Kjeldsen Sverre Erik , Rostrup Morten , Larstorp Anne Cecilie K. , Opdal Mimi Stokke 
Published: June 2023

Objective:
Altered drug metabolism may be a contributing factor to uncontrolled hypertension. Beta-blockers, alpha-blockers, calcium antagonists and angiotensin receptor blockers undergo hepatic metabolism by cytochrome P450 (CYP) enzymes. Genetic variation can contribute to interindividual variation, lack of treatment response or side effects with discontinuation of treatment. We aimed to determine common CYP gene variations in patients with treated but uncontrolled hypertension and to compare the distribution with the prevalence in the overall Caucasian population.

Design and method:
In this national multicenter study we mapped CYP2D6, CYP2C9, CYP2C19, CYP3A4 and CYP3A5 polymorphisms in 552 patients prescribed > = 2 antihypertensive agents and with systolic daytime ambulatory blood pressure (ABPM) > = 135 mmHg. On the (MALDI-TOF) MassARRAY analyzer, single nucleotide variants and small insertions/deletions (indels) were investigated with the VeriDose Core Panel and CYP2D6 copy-number variation with the VeriDose CYP2D6 CNV Panel (Agena Biosciences). Each allele is associated with either normal, decreased, absent, increased or unknown enzyme function based on activity scores defined by the The Clinical Pharmacogenetics Implementation Consortium (CPIC) and describe function and phenotypes for genes (IM = Intermediate metabolizer, PM = poor metabolizer, RM = rapid metabolizer and UM = ultra-rapid metabolizer).

Results:
94% of patients were Caucasian. Mean daytime ABPM was 146/84 mmHg (135-190/55-106 mmHg), median age 63 (26-86) years and 35% were female. The distributions of the predicted phenotypes (illustrated in colors in Figure) for each enzyme did not differ from that reported in Caucasian population by The Pharmacogenomics Knowledgebase (PharmGK) (gray). 11% had normal phenotype in all five enzymes whereas 49% had > = 2 enzymes affected by gene variants.

Conclusions:
The phenotype distribution of five relevant CYP genes in patients with uncontrolled hypertension did not differ from the general Caucasian population. Dosing guidelines based on CYP2D6 genotype currently exist for metoprolol, but for other antihypertensive drugs further investigation is needed. The low proportion of patients with five normal enzymes and the high proportion with > = 2 enzymes affected suggest that pharmacogenetic CYP-testing may be useful for individualizing drug treatment in patients with uncontrolled hypertension.
SUPER HYPERTENSION OR VERY SEVERE HYPERTENSION IN A SUB-SAHARAN COUNTRY: EPIDEMIOLOGICAL, CLINICAL, THERAPEUTICAL AND EVOLUTIVE OF THESE PARTICULAR PATTERNS
Authors: Ouankou Christian Ngongang , Kapi Leana Oriane Chendjou , Kuate Liliane Mfeukeu , Njonnou Sylvain Raoul Simeni , Lekpa Fernando Kemta , Folifack François Jérôme Kaze , Choukem Simeon Pierre 
Published: June 2023

Objective:
To describe the epidemiological, clinical, therapeutical and evolutive patterns of super hypertension in Yaounde University Teaching Hospital.

Design and method:
This study is an observation cohort over a period of 9 months (January 2016 to September 2016). We recruited from members of the public who accepted voluntary blood pressure screening offered in various localities in Yaounde, and were aged 18 years or over.

Results:
Of a total of 6.519 people, 1.875 (28.8%) presented a high blood presure. Amongst them, 37 presented a super hypertension (a systolic blood pressure 250 mmHg and/or diastolic blood pressure 150 mmHg in presence or not of complications), corresponding to a prevalence of 2% of all hypertensive patients. Our cohort comprised 33 of these individuals who accepted the invitation to participate in the study. The mean age was 49.3 years, with a sex- ratio of 0.7. Twenty-three (70%) of the patients were known hypertensive for a mean time of 10 years, out of 9% were regularly rewieved, but none on medications. The mean of cardiovascular risk factors was 7, with 91% who had an excess salt intake. Dyspnea and headache were the main symptoms. The means systolic blood pressure and diastolic blood pressure were respectively 244.9 mmHg and 144.8 mmHg. Twenty-six (78.8) patients were either overweight or obese. We noticed a fundoscopy stage II or III in 21.1% of the cases. Seventy percent of the cases had left ventricular hypertrophy on electrocardiogram and 18.2 on echography. Complications were noticed on admission in 60.6% of all cases, it's was mainly signs of renal failure. Acute kidney injury occurred in 15.15% of the cases during follow-up. The average rate of blood pressure control over 6 months was 3%. The main cause of poor blood pressure control was lack of therapeutic compliance. We noticed refractory high blood pressure in 4 (12.1%) cases and registered one death at the 3rd month of follow up due to acute kidney injury.

Conclusions:
Super hypertension is a youth's pathology. Its early detection reduces significantly the high morbi-mortality. However, its efficient management needs minimal additional resources.