bluuebunny/crossref_metadata_2025_split huggingface dataset:
SECONDARY HYPERTENSION IN THE INTERNAL MEDICINE OUTPATIENT DEPARTMENT OF A PORTUGUESE HOSPITAL
Authors: Féria Rita Palma , Martins Joao Dinis , Moules Pedro , Pina Henrique , Oliveira Joana , Guerra Silvia , Valadas Cristina , Gonçalves Fernando Martos , Araújo José Lomelino 
Published: June 2023

Objective:
Secondary hypertension is an uncommon form of hypertension and universal screening is not beneficial or cost-effective. Consequently, investigation is reserved for selected cases, according to clinical suspicion, and is often referred to a specialist.
The aim of this study was to characterize the evaluation of secondary hypertension in the Internal Medicine Outpatient Department of a portuguese hospital.

Design and method:
This longitudinal retrospective study analysed patients referred to our Internal Medicine Outpatient Department for hypertension evaluation in 2021. Patient records and results were analysed, focusing on indication for evaluation, testing performed and identified causes of secondary hypertension.

Results:
A total of 147 patients were referred for hypertension evaluation, 7 (4,76%) of which were explicitly referred for secondary hypertension screening. Testing was conducted in 105 patients (71,43%), with basic evaluation (CBC, renal function, thyroid function) in 71 patients (48,30%) and additional testing (such as endocrine, renovascular, obstructive sleep apnoea screening) performed in 34 patients (23,13%).
Considering age criteria, resistant hypertension, and other clinical clues, 60 patients (40,82%) had a documented indication for additional testing for secondary hypertension.
Additional testing was requested in 5 patients (3,40%) not meeting these criteria, most of whom needed testing to follow-up investigations ordered in primary care without clear indication.
Conversely, a small proportion (6,12%) met criteria for additional testing that wasn’t requested: 22% already had a previous screening ordered in primary care negative for secondary hypertension; 44% were evaluated for hypertension-mediated organ damage without further screening.
Patients in which specific evaluation was complete at the time of this study, a secondary cause was identified in 9 patients (6.12%), all with a previous diagnosis of Obstructive Sleep Apnea.

Conclusions:
The prevalence of secondary forms identified didn’t significantly differ from the described 5-10% overall prevalence of secondary hypertension and reiterated the identification of OSA as an exceedingly common recognized cause of hypertension.
This study emphasised that extensive testing was mostly non-diagnostic and was associated with inconclusive results leading to further investigations, raising costs and risks. This suggests that careful selection of patients and method of screening by a specialist is beneficial.
ARTERIAL WALL CONDITION IN WOMEN WITH HYPERTENSION AND POSTMENOPAUSAL OSTEOPOROSIS
Authors: Kniazkova Iryna , Bilovol Alexander , Tsygankov Alexander , Frolova Tetyana , Zhadan Andriy , Bogun Maryna 
Published: June 2023

Objective:
The aim of the study was to investigate the indices of arterial stiffness and central aortic pressure in women with hypertension in combination with osteoporosis.

Design and method:
The study included 68 females (mean age 62.7±3.8 years) with hypertension, grade 2 in postmenopause including 35 females with osteoporosis (group 1) and 33 females without signs of osteoporosis (group 2) according to osteodensitometry investigation. The control group consisted of 20 healthy females (mean age 61.3±3.5 years). Before the study, the patients did not receive regular antihypertensive drugs and hormone replacement therapy. In addition to conventional studies the levels of calcium, phosphorus, alkaline phosphatase, deoxypyridinoline, parathyroid hormone, 25(OH) vitamin D, osteocalcin, C-terminal telopeptide of type I collagen in blood were determined. Fracture risk assessment (FRAX), daily blood pressure monitoring, applanation tonometry and dual-energy X-ray absorptiometry were performed.

Results:
It was found that in group 1 the levels of office systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 3.7% and 4.9% (p<0.05) higher than in group 2. According to the data of daily BP monitoring a more pronounced increase of mean daily SBP and DBP by 4.1% and 6.6% (p<0.05) was observed in group 1 in comparison to group 2. Indicators of pressure load according to the time index of hypertension by SBP and DBP were significantly higher by 21.7% and 25.4% during the day and 22% and 18.2% at night (all p<0.05). In patients of group 1 an increase in the aortic augmentation index of wave reflection (Aix) and the augmentation index of wave reflection, adjusted for heart rate (AIx @ HR 75) by 26.6% and 29.8% compared to patients of group 2 respectively, was revealed. It was found that in group 1, compared with the control group and group 2, an increase in pulse wave velocity by 37.2% and 26.4% respectively was detected.

Conclusions:
It was found that in patients with hypertension in combination with postmenopausal osteoporosis, according to office, daily monitoring and applanation tonometry, blood pressure levels and arterial stiffness parameters were significantly higher than in patients with hypertension without osteoporosis.
ARTERYAL HIPERTENSION AND VERY ELDERLY PATIENTS. THE EXPERIENCE OF AN INTERNAL MEDICINE DEPARTMENT
Authors: Grigore Cristiana , Balaceanu Beatrice , Gurau Cristian Dorin , Giuglea Carmen , Dina Ion , Balaceanu Alice 
Published: June 2023

Objective:
The purpose of this study is to highlight the clinical and paraclinical characteristics of fragile hypertensive patients, over 85 years old, admitted to a mixed internal medicine department (Covid and non-Covid) between January 2022 and October 2022.

Design and method:
Between January 2022 and October 2022, 80 patients with a primary or secondary diagnosis of arterial hypertension were admitted, of which only 23 (28.75%) were over 85 years old. Of the 23 patients, 13 (56.52%) were hospitalized with a diagnosis of Sars Cov 2 infection. Regarding the gender distribution, 12 are women (52.17%) and 11 are men (47.82%). Patients comorbidities: 14 patients (60.86%) with different degrees of heart failure, atrial fibrillation (39.13%) - 8 patients and one patient was diagnosed with atrial fibrillation during hospitalization, cognitive disorders and dementia in a proportion of 47.82 % (11 patients) and a significant number of patients were admitted with moderate-severe anemia (13 patients, 56.52%). Of the 9 patients with atrial fibrillation, 5 are male (55%) and 4 (45%) female, cardiac enzymes (troponin and CK MB) are within normal limits in 8 patients. During the medical tests, 3 patients (13.04%) were diagnosed withdifferent of neoplasia. Only 2 patients (8.69%) presented slight dyselectrolytemia (hyponatremia and hypokalemia).

Results:
Pathologies are treated with: angiotensin converting enzyme inhibitors (17.39% - 4 patients), calcium channel blockers (39.13% - 9), anticoagulants (39.13% - 9 patients), diuretics (26.08 %-6 patients) and beta blockers (11 pac-47.82%).
13 patients (56.52%) died and 43.47% were discharged with an improved condition. 9 patients died as a result of Covid multiple organ system failure, 1 death was of cardiovascular cause and 3 non-Covid pulmonary failure deaths.

Conclusions:
Frail patients, older than 85 years, with multiple comorbidities, require detailed investigations and adjustments of medication doses according to their status in order to maintain the discreet balance in which they are.
STUDIES OF THE CORRELATION OF THE TAFI GENE WITH ARTERIAL HYPERTENSION IN PATIENTS WITH CORONARY HEART DISEASE
Authors: Zokirova Muborakhon 
Published: June 2023

Objective:
The purpose of our work was to study the associative relationship and role of the thrombin-activated fibrinolysis inhibitor (TAFI) with hypertension and the severity of coronary heart disease.

Design and method:
The object of the study was 2 groups of patients, 1 group of 35 people with Stable angina and 2 group of 33 people with Unstable angina who voluntarily signed the information consent. The study was conducted by a prospective method in the TMA clinic. in group 1, grade 2 hypertension (40%) and grade 1 hypertension (31.4%), grade 3 hypertension (14.3%) prevail. smoking – 37.1%, inactivity – 48.5%, as well as severe Anxiety-depressive syndrome – 34.3%. In group 2, hypertension 2 (13.6%), hypertension 1 (27.1%) and hypertension 3 degrees (12.1%). smoking and sedentary lifestyle – 45.5% each; overweight – 30.3%. All patients underwent a genetic blood test for TAFI gene polymorphism. In group 2 of patients with NS, the indicators of hypertension of 1 and 2 degrees became reliable, which means that the contribution of arterial hypertension to the development of complications of coronary heart disease is unambiguous. According to EchoCG data, no significant differences in EDV and ESV of LV, as well as LV EF parameters were revealed in the studied groups.

Results:
According to the results of our study, in both groups of respondents from groups 1 and 2, the picture of correlation dependence turned out to be as follows: a strong correlation was found between hypertension, hereditary burden, smoking, inactivity, hypercholesterolemia, as well as malnutrition and patients with diabetes in both groups. The average correlation is determined with hypercholesterolemia in the blood and Anxiety depressive syndrome.

Conclusions:
Together with the factors of coagulation hemostasis and hereditary predisposition to them, the doctor should pay attention to the prevention of Arterial hypertension and smoking in patients with Stable angina pectoris and Unstable angina pectoris.
4-OCTYL ITACONATE ATTENUATES ISOPROTERENOL INDUCED MYOCARDIAL DAMAGE VIA NLRP3 INFLAMMASOME PATHWAY, NRF-2/HO-1 AND MAPK PATHWAY IN AN EXPERIMENTAL MODEL
Authors: Sharma Jatin , Bhargava Poorva , Arya Ds , Bhatia Jagriti 
Published: June 2023

Objective:
Myocardial infarction (MI) is the major cause of morbidity and mortality worldwide. According to the World Health Organisation, more than 9 million deaths occurred due to ischemic heart disease worldwide in 2016. 4-octyl itaconate (4-OI) is a cell permeable derivative of itaconate with potent anti-oxidative, anti-inflammatory and anti-fibrotic properties. Studies have shown that 4-OI inhibits pro-inflammatory cytokines (IL6, IL1beta, TNF alpha) and activates the anti-oxidant Nrf-2/HO-1 pathway. The aim of the study was to investigate the cardio-protective effect of 4-OI in experimental model of Isoproterenol induced myocardial damage.

Design and method:
Adult male albino wistar rats were used in the study. They were randomly divided to five groups i.e., normal control group, isoproterenol control group, 4-OI group (2.5, 5 or 10 mg/kg) for 14 days and 4-OI perse group. On the 15th day, rats were anaesthetized and right coronary artery was cannulated to record hemodynamic parameters. Following this, blood was withdrawn using cardiac puncture, heart was excised and preserved for analysis of biochemical, histopathological and molecular pathway studies.

Results:
Isoproterenol administration to rats resulted in induction of Myocardial damage as shown by impairment in hemodynamic parameters, left ventricular dysfunction and raised cardiac injury markers. Treatment with 4-OI significantly improved hemodynamic and cardiac injury markers (CKMB, LDH). Further, 4OI significantly reduced oxidative stress (enhanced levels of SOD, GSH, decreased MDA levels) and inflammation (reduced levels of TNF alpha, IL-6, IL-1beta and NLRP3). Further it activated the Nrf-2-HO-1 pathway while inhibits the inflammatory NFKB pathway. Apart from this, it also ameliorated apoptosis by decreasing the expression of Bax, caspase-3 and increasing the expression of anti-apoptotic Bcl-2. It also inhibited inflammatory MAPK proteins (JNK, phospho JNK, P38, phospho P38) while enhancing the expression of pro-survival kinases ERK1/2, and Phospho ERK1/ 2.

Conclusions:
Oral administration of 4-OI at a dose of 10 mg/kg ameliorated the severity of isoprotorenol-induced cardio-toxicity in rats via NLRP-3 inflammasome pathway, MAPK and Nrf-2/HO1 pathway and by maintaining morphological structure of heart tissue and oxidative stress profile along with reduced inflammation and apoptosis.
MARKERS OF ENDOTHELIAL DYSFUNCTION IN CORONARY HEART DISEASE PATIENTS DEPENDING ON ARTERIAL HYPERTENSION PRESENCE
Authors: Romanova Valentyna , Kuzminova Nataliia , Romanova Lidiia , Ivankova Anastasiia 
Published: June 2023

Objective:
To evaluate the role of arterial hypertension (AH) on endothelial functional state in the coronary heart disease (CHD) patients.

Design and method:
173 CHD patients were examined (the average age was 57.24±5.12 years): 92 patients with stable angina (45 with II functional class (FC) (23 without and 22 with AH) and 47 with III FC (26 without and 21 with AH) and 81 patients with acute coronary syndromes (ACS)(43–with unstable angina (UA) (22 without and 21 with AH) and 38–with acute myocardial infarction (MI) (20 without and 18 with AH)).
Endothelial dysfunction was assessed by the levels of vasoconstrictor endothelin-1 (ET-1) and the concentration of soluble vascular adhesion molecule (sVCAM), which were determined by ELISA.

Results:
Both markers of endothelial dysfunction increased with an increase in disease severity. The most severe changes were in patients with ACS, although differences between patients with UA and MI were not significant (p>0.05). Levels of ET-1 were significantly higher (p<0.05) in all clinical variants of CHD in patients with AH regarding patients without it. The same tendance (difference with p<0.01 ) was observed with sVCAM levels, but only in stable CHD patients. sVCAM levels raised significantly in ACS patients not only according to the control group, but also patients with stable CHD (p<0.05), but without difference depending on AH presence in both groups with UA and MI (p>0.05).
There were no significant associations between levels of endothelial dysfunction markers and troponin I and T (p>0.05).
The significant relationships between levels of sVCAM and ET-1 on one hand and C-reactive protein on other were noted in both groups with stable CHD and with ACS, regardless of the presence of hypertension.

Conclusions:
Elevated levels of ET-1 and sVCAM in blood of CHD patients are the indicator of atherosclerotic plaque instability and the possibility of ACS development, especially with AH comorbidity.
DEMOGRAPHIC AND CLINICAL CHARACTERISTICS AND IN-HOSPITAL OUTCOME OF HYPERTENSIVE PATIENTS WITH ST SEGMENT ELEVATION MYOCARDIAL INFARCTION
Authors: Kalimuddin Md , Malik Fazilatun-Nesa , Ahmed Nazir , Badiuzzaman Mohammad , Ahmed Mir Nesaruddin , Dutta Ashok , Banik Dhiman , Kanungo Smita , Laila Nazmun , Ara Esmat 
Published: June 2023

Objective:
There is little information on the incidence and prognostic significance of hypertension in ST segment elevation myocardial infarction (STEMI) patients, especially in Bangladeshi population. The study aimed to compare the demographic & clinical characteristics and in-hospital outcome of hypertensive versus non-hypertensive patients with STEMI.

Design and method:
This prospective observational study was conducted from January 2015 to December 2022 at National Heart Foundation Hospital & Research Institute. Patients were divided into two groups: hypertensive and non-hypertensive groups.

Results:
A total of 10378 patients were enrolled in this study. Of them 65.6% (6813) patients were hypertensive, and 34.4% (3565) patients were non-hypertensive. Mean age of the hypertensive group was 55.89 ± 11.18 years and the non-hypertensive group was 53.49 ± 12.25 years (p = 0.001). In hypertensive group, 84.1% patients were male and 15.9% were female & in non-hypertensive group, 90.4% patients were male and 9.6% were female (p = 0.001). Compared to non-hypertensive patients, hypertensive patients were predominantly non-smoker (49.1% vs 39.9%; p = 0.001), diabetic (68.3% vs 32.1%; p = 0.001), dyslipidemic (80.7% vs 77.3%; p = 0.001), obese (37.8% vs 32%; p = 0.001), have positive family history of ischemic heart disease (IHD) (29% vs 22.4%; p = 0.001), prior history of percutaneous coronary angioplasty (3.7% vs 2.1%; p = 0.001), prior history of myocardial infarction (5.8% vs 4.6%; p = 0.007), and chronic kidney disease (48.2% vs 40.2%; p = 0.001). Hypertensive patients had more multi-vessel disease (49.3% vs 42.6%; p = 0.001), higher in-hospital complications (acute left ventricular failure-24.4% vs 21.9%; p = 0.005) and in-hospital death (4.8% vs 4%; 0.04).

Conclusions:
Hypertensive patients with STEMI were predominantly non-smoker, diabetic, dyslipidemic, obese, have positive family history of IHD, chronic kidney disease and had higher in-hospital complications & in-hospital death.
HEART RATE AT OFFICE VISIT AND LONG-TERM CARDIOVASCULAR EVENTS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
Authors: Jaeho Byeon , Choo Eun-Ho , Chang Kiyuk 
Published: June 2023

Objective:
Elevated heart rate at admission or discharge is known to be associated with poor cardiovascular outcomes in patients with acute myocardial infarction (AMI). The association between averaged heart rate at office and cardiovascular outcomes in patients with AMI has been studied scarcely. We investigated the relationship of heart rate at office with long-term cardiovascular outcomes in AMI.

Design and method:
We analyzed a total of 7,840 patients with heart rate measured at least 3 times after hospital discharge between January 2004 and April 2015 from COREA-AMI registry. The values of heart rate measured at office visit were averaged and categorized into four groups by quartiles (<68, 68-74, 74-80, and >80 beats per minute). The primary end point was a composite of cardiovascular death, myocardial infarction, and ischemic stroke.

Results:
During a median of 5.7-year follow up, major adverse cardiovascular events (MACE) affected 1,357(17.3%) patients. The averaged heart rate of higher than 80 beat per minute (b.p.m) was associated with an increased incidence of primary outcomes compared to the averaged heart rate of 68-74 b.p.m as reference. (Adjusted hazard ratio 1.37, 95% CI 1.19-1.58, p<0.0001) Increased heart rate of 1 b.p.m was an independent predictor of MACE (Adjusted hazard ratio 1.025, 95% CI 1.02-1.03, p<0.001). When dichotomized into < 74 or > 74 b.p.m, lower averaged heart rate was not associated with incidence of primary outcomes in patients with LV systolic dysfunction in contrast to those without LV systolic dysfunction.

Conclusions:
Elevated averaged heart rate at office visit after AMI was associated with increased risk of cardiovascular outcomes.
MARKED INCREASES IN PROXIMAL AORTIC CHARACTERISTIC IMPEDANCE AND HENCE FORWARD WAVE PRESSURES BEYOND BRACHIAL BLOOD PRESSURE IN ANGIOGRAPHIC PROVEN CORONARY ARTERY DISEASE
Authors: Peterson Vernice , Els Danelle , Fernandes Daniel Da Silva , Kinsey Jamie -Leigh , Santos Claudia Dos , Sadiq Eitzaz , Naran Ravi , Monareng Taalib , Abdool-Carrim Talib , Cassimjee Ismail , Modi Girish , Norton Gavin , Woodiwiss Angela , Peters Ferande 
Published: June 2023

Objective:
Although indexes of aortic stiffness increase the risk for coronary artery disease (CAD), the extent to which proximal aortic stiffness increases enhance central arterial forward wave pressures beyond changes in peripheral pressures, is uncertain. We aimed to determine whether increases in proximal aortic stiffness, as indexed by aortic characteristic impedance (Zc) translate into an enhanced central arterial pressure for a given brachial BP.

Design and method:
From central pressure, aortic velocity and outflow tract diameter measurements and echocardiography, we determined Zc and arterial pressure wave morphology in 71 patients with angiographic proven CAD and all other cardiac pathology excluded. We compared central arterial function in these patients with 230 age and sex-matched controls from a community study, and in patients with stroke and CLI (n = 287) diagnosed in a hospital setting.

Results:
Adjusting for confounders, including mean arterial pressure, and aortic root diameter, as compared to controls, both Zc and the pressures generated by the product of peak aortic flow (Q) and Zc (PQxZc) were markedly increased in patients with CAD (p<0.0001) and those with stroke or CLI (p<0.005). Moreover, compared to patients with stroke and CLI, those with CAD also had marked increases in both Zc and PQxZc (p<0.0001). Consequently, with adjustments for the same confounders, pressures generated by forward wave pressures (Pf) were markedly increased in patients with CAD as compared to controls and to patients with alternative arterial diseases (p<0.0001). Importantly, after further adjustments for brachial PP or SBP, the higher Pf values in patients with CAD were retained (p<0.005 to <0.0001). However, with adjustments for brachial SBP and confounders, central aortic PP did not differ between groups.

Conclusions:
Independent of confounders and aortic root diameter, a marked increase in proximal aortic Zc occurs in patients with CAD as compared to both controls and patients with arterial disease in alternative beds. This translates into a greater central arterial pulsatile load determined by forward travelling pressure waves, but not peak central PP than that predicted by brachial BP measurements. These data support a need for intense brachial BP lowering in CAD.
ARTERIAL BAROREFLEX FUNCTION IS IMPAIRED DURING THE RECOVERY FROM ACUTE LUNG INJURY IN A BLEOMYCIN-INDUCED RAT LUNG INJURY MODEL
Authors: Wang Hanjun , Rudebush Tara , Zucker Irving 
Published: June 2023

Objective:
Acute lung injury (ALI) and its clinical correlate, the acute respiratory distress syndrome (ARDS), results due, in part, to disruption of the normal capillary endothelial barrier and invokes perturbations of ventilatory control. ALI is associated with autonomic dysfunction and cardiac arrhythmias. In a recent study we suggested that rats were susceptible to cardiac arrhythmia even during the recovery from ALI, in part, due to abnormalities in cardiac sympathetic ganglia. On the other hand, if arterial baroreflex function is altered during the recovery of ALI remains unknown. The primary goal of this study was to examine baroreflex function during the recovery stage from ALI in a bleomycin (Bleo)-induced rat ALI model.

Design and method:
ALI was induced in male SD rats (200-250g) using a single intra-tracheal injection of Bleo (2.5 mg/kg). 4 weeks post Bleo (n = 7) or saline (sham, n = 6), rats were anesthetized with urethane (800 mg/kg ip) and alpha-chloralose (40 mg/kg ip) to measure baroreflex sensitivity. Baroreflex curves were generated by measuring the heart rate (HR) and renal sympathetic nerve activity (RSNA) responses to decreases and increases in mean blood pressure (MAP) by intravenous administration of nitroglycerin (25 μg) followed by phenylephrine (10 μg). Differences between sham and Bleo rats were determined by one-way ANOVA followed by the Tukey post hoc test.

Results:
Compared to sham rats, there was a significant decrease in the RSNA (117.4±11.6 vs. 77.5±8.9 %baseline, P = 0.018) or HR (147.5±9.7 vs. 75.1±11.3 bpm, P<0.001) range in Bleo rats. Minimum RSNA or HR was also decreased in bleo rats compared to sham rats. There was no significant difference in either the slope coefficient or the blood pressure at the midpoint of the range (BP50) between the two groups. There was a significant decrease in peak slope [or maximum gain (Gainmax) in Bleo rats (MAP-RSNA Gainmax: 3.11±0.27 vs. 1.74±0.31, p = 0.017; MAP-HR Gainmax: 3.57±0.31 vs. 1.21±0.14, p<0.001).

Conclusions:
Our data demonstrate impaired baroreflex function during the recovery state from ALI. Autonomic dysfunction may also contribute to increased cardiovascular risk during the recovery stage from ALI.