bluuebunny/crossref_metadata_2025_split huggingface dataset:
PROGNOSTIC IMPACT OF RENIN ANGIOTENSIN ALDOSTERONE SYSTEM INHIBITOR IN HYPERTENSIVE PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE IMPLANTATION
Authors: Mancusi Costantino , Basile Christian , Fucile Ilaria , Luca Nicola De , Franzone Anna , Esposito Giovanni 
Published: June 2023

Objective:
The purpose of this study was to determine the prognostic impact of baseline treatment with RAAS inhibitors (RAASi) on all-cause mortality in a population of patients with severe AS who underwent transcatheter aortic valve implantation (TAVI).

Design and method:
The study included 373 patients with AS who had undergone TAVI. Analyses were undertaken on the subgroup of hypertensive individuals (n 327) with 2 years of follow-up. Clinical characteristics were compared using Kruskal-Wallis non-parametric test for independent samples and study-stratified multivariable Cox proportional hazards regression models was built according to baseline RAASi therapy status. A second analysis was undertaken by categorizing patients receiving RAASi medication (n 222) into those receiving angiotensin II receptor blockers (ARBs) (n 110) and those receiving angiotensin-converting enzyme inhibitors (ACEi) (n 112).

Results:
Taking RAASi at baseline in the hypertensive patients group was significantly related to gender (Women 56,8%), heart failure (25,7%), chronic kidney disease (CKD) (25,7%), atrial fibrillation (AF) (19,4), being on calcium-channel blocker (26,6%) or anti-platelet therapy (68,5%) (all p < 0,05). All-cause mortality occurred in 23 (10,4%) of the patients on RAASi, 9 (8,2%) on ARBs and 14 (12,4%) on ACEi.
In univariate COX regression model treatment with a RAASi was related with a reduction in 2-year all-cause mortality (EXP 0.46, p 0.011). After multivariable correction for significant confounders the association was not statistically significant (p = 0.08). Analyzing ACEi ARBs separately baseline ARB therapy was associated with significant reduction in all-cause mortality (EXP 0.44, p 0.028) (Figure) that was confirmed in multivariate analysis (EXP 0.42, p 0.038) with no impact in baseline ACEi use (Table).
Heart failure (EXP 2.87, p < 0.001), atrial fibrillation (EXP 2.39, p 0.005) and chronic kidney disease (EXP 2.08, p 0.02) were all related with an increased 2-year all-cause mortality, but after multivariable correction only heart failure remained statistically significant.

Conclusions:
ARBs, but not ACEi, are independently associated with a decreased risk of 2-year all-cause death in a cohort of hypertensive patients with severe AS who underwent TAVI. While it is true that these results have molecular basis, additional research is required to corroborate these findings.
IDENTIFYING HYPERTENSION IN TEENAGERS: DIFFERENCES BETWEEN EUROPEAN AND AMERICAN GUIDELINES
Authors: Eason Stephen , Sayers Merlyn 
Published: June 2023

Objective:
Since the measurement of blood pressure is an element in the qualification of volunteers presenting for blood donation, there is an opportunity to identify, in these ostensibly healthy individuals, those who might be at heightened risk of hypertensive heart disease. Since the classification of blood pressure differs when using the American College of Cardiology/American Heart Association and European Society of Cardiology/European Society of Hypertension guidelines, we took this opportunity to compare the prevalence of suspected hypertension in teenagers as differently identified by the two systems.

Design and method:
Participants in the study were American volunteer blood donors, age 16 to 19, who donated between the years 2015 and 2021 at an independent, community blood program serving some 200 hospitals. There were 87,051 females and 59,498 males. Systolic (SBP) and diastolic (DBP) blood pressures were measured using automated equipment (Welch Allyn, ProBP). The cut points chosen for hypertension were, by ACC/AHA criteria, > = 130 (SBP) or > = 80 mmHg (DBP). The ESC/ESH criteria for hypertension were > = 140 (SBP) and/or > = 90 mmHg (DBP).

Results:
The table shows percentages of male and female teenagers considered hypertensive by American and European guidelines.

Conclusions:
There are significant differences between the American and European guidelines in the diagnosis of hypertension in teenagers, with a higher prevalence by American guidelines. The risk for hypertension is higher in males than females by both guidelines.
ASSOCIATIONS OF LONG-TERM VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY WITH SUBCLINICAL KIDNEY DAMAGE AND ALBUMINURIA IN ADULTHOOD: A 30-YEAR PROSPECTIVE COHORT STUDY
Authors: Wang Yang , Zhao Peng , Chu Chao , Du Ming -Fei , Zhang Xiao -Yu , Zou Ting , Hu Gui -Lin , Jia Hao , Liao Yue -Yuan , Ma Qiong , Wang Dan , Desir Gary V. , Delles Christian , Chen Fang -Yao , Mu Jian -Jun 
Published: June 2023

Objective:
Recent evidence indicates that long-term visit-to-visit blood pressure variability (BPV) may be associated with the risk of cardiovascular disease. We therefore aimed to determine the potential associations of long-term BPV from childhood to middle age with subclinical kidney damage (SKD) and albuminuria in adulthood.

Design and method:
Using data from the ongoing cohort of Hanzhong Adolescent Hypertension study, which recruited children and adolescents aged 6 to 18 years at baseline, we assessed BP variability by standard deviation (SD) and average real variability (ARV) for 30 years (6 visits). Presence of SKD was defined as estimated glomerular filtration rate (eGFR) between 30 and 60 ml/min/ 1.73 m2 or elevated urinary albumin-to creatinine ratio (uACR) at least 30 mg/g. Albuminuria was defined as uACR greater than 30 mg/g.

Results:
During a follow-up of 30 years, of the 1771 participants, 204 SKD events occurred. After adjustment for demographic, clinical characteristics and mean BP during 30 years, higher SDSBP, ARVSBP, SDDBP, ARVDBP, SDMAP, ARVMAP and ARVPP were significantly associated with higher risk of SKD [ORs (95% CIs) were 1.14(1.06 - 1.23), 1.15(1.08 - 1.21), 1.12(1.06 - 1.17), 1.16(1.08 - 1.25), 1.12(1.07 - 1.17), 1.18(1.10 - 1.27) and 1.11(1.03 - 1.21), respectively]. When we used cumulative exposure to BP from childhood to adulthood instead of mean BP as adjustment factors, results were similar. In addition, greater long-term BPV was also associated with the risk of albuminuria [ORs (95% CIs) were 1.07(1.03 - 1.10) for SDSBP, 1.13(1.06 - 1.20) for ARVSBP, 1.11(1.06 - 1.17) for SDDBP, 1.14(1.06 - 1.23) for ARVDBP, 1.18(1.09 - 1.27) for ARVMAP and 1.08(1.01 - 1.17) for ARVPP]. Long-term BP variability for 30 years from childhood to middle age was associated with higher risk of SKD and albuminuria in adulthood, independent of mean BP or cumulative exposure to BP during follow-up.

Conclusions:
Identifying long-term BP variability from early age may assist in predicting kidney disease and cardiovascular disease in later life.
THE ASSOCIATION BETWEEN BLOOD PRESSURE VARIABILITY AND DEMENTIA: A TWO-SAMPLE MENDELIAN RANDOMIZATION STUDY
Authors: Jia Pingping , Tsoi Kelvin 
Published: June 2023

Objective:
This study aims to investigate the causal inference by applying a mendelian randomization (MR) study using single-nucleotide polymorphisms (SNPs) from the genome-wide association study (GWAS) based on the UK biobank.

Design and method:
The genetic instruments were chosen from BPV GWAS based on UK Biobank data. Four GWA studies were used for the genetic evaluation of dementia, including (1) The International Genomic of Alzheimer's Project (IGAP) GWAS for dementia; (2) and (3) UK Biobank GWAS for proxy phenotypes of Alzheimer's dementia: the maternal and paternal family history (MFH and PFH-UKBB); (4) A combined GWAS meta-analysis from the abovementioned three GWAS results. The following exclusion criteria were applied for SNPs: (1) confounding SNPs by searching hypertension and artery stiffness GWAS; (2) significant SNPs that are associated with dementia in the datasets; (3) palindromic SNPs with an effect allele frequency between 0.4 and 0.7. Proxy SNPs were manually selected for some SNPs. (4) only SNPs with linkage disequilibrium r2 < 0.01 were selected as genetic instruments, also known as independent SNPs. The effect/reference alleles were checked to ensure the consistency of the base pair between BPV and dementia GWAS, which is also known as data harmonization. After data harmonization, four MR methods were employed to measure the causal effect: IVW-MR with random effect, IVW-MR with fixed effect, MR-Egger, and weighted median MR.

Results:
Finally, six independent SNPs were chosen as instrument variants for SBPV, and five for DBPV. Significant causal effects of SBPV on dementia were found in the PFH-UKBB dataset, and the odds ratio of dementia per 10-unit increase in SBPV was 1.028, 1.015, and 1.015 for MR-Egger, weighted median, and IVW-MR, respectively (Table 1). In contrast, only one significant result was found for DBPV in MFH-UKBB. No significant results were found on other datasets.

Conclusions:
Along with the evidence from different observational studies, this GWAS study demonstrates that systolic blood pressure variability is a potential causal risk factor for Alzheimer's dementia, while the evidence from diastolic blood pressure variability is still uncertain.
PATIENTS WITH VERY HIGH RISK OF CARDIOVASCULAR ADVERSE EVENTS DURING CARFILZOMIB THERAPY: PREVENTION AND MANAGEMENT OF EVENTS IN A SINGLE CENTER EXPERIENCE
Authors: Mingrone Giulia , Astarita Anna , Colomba Anna , Catarinella Cinzia , Cesareo Marco , Airale Lorenzo , Paladino Arianna , Leone Dario , Vallelonga Fabrizio , Bringhen Sara , Gay Francesca , Veglio Franco , Milan Alberto 
Published: June 2023

Objective:
Carfilzomib (CFZ) improves the prognosis of multiple myeloma (MM) patients, but has shown cardiovascular toxicity. The cardiovascular adverse events (CVAEs) risk stratification now seems well established, while little is known about the course and management of patients with high risk or CVAEs during therapy. So, we aimed to describe our specialistic experience in decision-making to support health professionals in selecting the best management strategies to prevent and treat CVAEs.

Design and method:
From January 2015 to September 2022, 194 patients with indication to CFZ underwent baseline evaluation of CVAEs risk and were prospectively followed. We proposed a novel approach with inducible ischemia imaging tests for patients at high baseline CV risk to rule out clinical conditions that could contraindicate the starting of CFZ.

Results:
After baseline evaluation, 16 (8.2%) patients resulted at high risk of CVAEs: 13 (6.7%) patients performed inducible myocardial ischemia imaging test and 3 (1.5%) could not receive CFZ for CV contraindications. 178 (91.7%) patients started CFZ: 82 (46%) experienced arterial hyperten-sion-related events and 37 (20.8%) major CVAEs (Fig. 1); 19 (10.7%) patients had to suspend or remodulate CFZ.

Conclusions:
Together with baseline risk stratification also subsequent cardiovascular clinical and diagnostic follow-up appeared critical to identify clinical conditions that could contraindicate the anti-cancer therapy.
EARLY LIFE CARDIOVASCULAR RISK FACTOR TRAJECTORIES AND VASCULAR AGING IN MIDLIFE: A 30-YEAR PROSPECTIVE COHORT STUDY
Authors: Wang Yang , Wang Jie , Du Ming -Fei , Zhang Xi , Chu Chao , Wang Dan , Liao Yue -Yuan , Ma Qiong , Jia Hao , Hu Gui -Lin , Yan Yu , Sun Yue , Chang John , Delles Christian , Lu Yao , Mu Jian -Jun 
Published: June 2023

Objective:
Vascular aging, as assessed by structural and functional arterial properties, is an independent predictor of cardiovascular outcomes. We aimed to explore the associations of individual cardiovascular risk factors from childhood to midlife and their accumulation over a 30-year span with vascular aging in midlife.

Design and method:
Using data from the ongoing cohort of Hanzhong Adolescent Hypertension study, 2180 participants aged 6 to 18 years at baseline were followed for over 30 years. Distinct trajectories of systolic blood pressure (SBP), body mass index (BMI), and heart rate (HR) from childhood to midlife were identified by group-based trajectory modeling. Vascular aging was assessed by carotid intima–media thickness (cIMT) or brachial-ankle pulse wave velocity (baPWV).

Results:
We identified 4 distinct SBP trajectories, 3 distinct BMI trajectories and 2 distinct HR trajectories from childhood to midlife. Persistently-increasing SBP, high-increasing BMI, and high-stable HR were all shown to have a positive association with baPWV in midlife. For cIMT, similar associations were observed for persistently-increasing SBP and high-increasing BMI. After further adjustment for SBP, BMI and HR at the time of vascular assessment in 2017, associations were also observed for cardiovascular risk factor trajectories accumulation with baPWV (↓ = 0.656 (95%CI, 0.265 - 1.047)] and with cIMT [↓ = 0.045 (95%CI, 0.011 - 0.079)] in adulthood.

Conclusions:
Longitudinal exposure to individual cardiovascular risk factors from childhood to midlife and cardiovascular risk factor accumulation were associated with an increased risk of vascular aging in midlife. Our study lends support for early targeting of risk factors in order to prevent cardiovascular disease later in life.
ASSOCIATION OF HIGH BLOOD PRESSURE WITH POST-TRAUMATIC STRESS DISORDER IN UKRAINIAN WOMEN SEEKING ASYLUM IN POLAND: A PILOT STUDY
Authors: Shalimova Anna , Stoenoiu Maria Simona , Cubala Wieslaw , Burnier Michel , Persu Alexandre , Narkiewicz Krzysztof 
Published: June 2023

Objective:
Post-traumatic stress disorder (PTSD) and its components have been associated with hypertension, particularly in military servants, war veterans and more recently in populations exposed to chronic violence. However, to our knowledge, this association has not been investigated in refugees. The objective of this study was to explore the potential association between high blood pressure and PTSD in Ukrainian women seeking asylum in Poland.

Design and method:
From September to December 2022, 55 Ukrainian women refugees were enrolled in dormitories from Sopot (Poland). Blood pressure (BP) was measured using validated oscillometric devices. Hypertension was defined as systolic BP > = 140 mmHg, diastolic BP > = 90 mmHg or being on antihypertensive treatment. Relevant demographic and clinical data were obtained. Furthermore, subjects filled validated questionnaires for depression, stress and anxiety (DASS) and post-traumatic stress disorder (PTSD) (PCL-5). Subjects with and without hypertension were compared for both general and psychological characteristics.

Results:
Thirty out of 55 subjects were found to be hypertensive. Compared to subjects with normal BP in absence of drugs (mean BP: 117.8/75.6 mmHg, n = 25), hypertensive subjects (mean BP: 138.1/85.8 mmHg, n = 30) were older (57.2 ± 11.1 vs. 39.1 ± 0.8 years, p < 0.00001) and had a higher BMI (29.0 ± 5.4 vs. 23.8 ± 4.4 kg/m2, p = 0.003). Furthermore, despite a similar personal situation (socio-economic background, direct exposure to war, time since arrival in Poland, with or without children/relatives), hypertensive subjects were more often feeling unsafe at the time of examination (4-items scale, p = 0.001) and scored higher for PTSD score (24.9 ± 17.0 vs. 16.3 ± 12.9, p = 0.038), particularly regarding intrusion (cluster B, p = 0.039) and hyper-arousal (cluster E, p = 0.002) dimensions, but not for DASS score (22.4 ± 14.2 vs. 17.2 ± 11.5, p = 0.14).

Conclusions:
This preliminary analysis is consistent with an association between high BP and both feeling of being unsafe and PTSD score in Ukrainian women refugees. Our results need confirmation using 24-hour BP monitoring and in a larger sample. In the absence of difference in personal background and exposure to war, these associations may reflect underlying differences in expression of emotions and coping abilities, as previously shown in other populations exposed to violence or with difficult-to-treat hypertension.
CORRELATION BETWEEN LOW DIASTOLIC BLOOD PRESSURE AND SEVERITY OF CORONARY ARTERY DISEASE USING SYNTAX SCORE
Authors: Amrawy Ahmed Mahmoud El , Zaki Amr Mahmoud , Azeem Ahmed Mokhtar Abd El 
Published: June 2023

Objective:
Hypertension remains a leading cause of morbidity and mortality, and the optimum blood pressure target remains debated, especially in coronary artery disease, given concerns for reduced myocardial perfusion if diastolic blood pressure is too low. The aim of this work was to study the relationship between diastolic blood pressure (DBP) and severity, and burden of coronary artery disease (CAD) as quantified by SYNTAX Score.

Design and method:
Six hundred consecutive stable patients with signs or symptoms of CAD who underwent elective coronary angiography were included in the study. Patients were divided into three groups according to SYNTAX Score as low, intermediate, and high.

Results:
Patients were predominantly males (72%), their age ranged from 35 - 82 years, with mean age of 59.55 ± 9.44 years. 426 patients (71%) were hypertensive, 82.1%,69.4%,70% of high, intermediate, and low SYNTAX groups respectively had hypertension.
SYNTAX score ranged from 2.0 – 53.0 with a mean of 17.32 ± 9.87. In DBP group <60 mmHg, SYNTAX score ranged from 8.0 – 53.0 with a mean of 26.47 ± 10.59. In DBP group 60 – 69 mmHg, SYNTAX score ranged from 5.0 – 45.50 with a mean of 22.13 ± 7.77. In DBP group 70 – 79 mmHg, SYNTAX score ranged from 3.0 - 34.0 with a mean of 13.91 ± 7.09. In DBP group > = 80 mmHg, SYNTAX score ranged from 2.0 – 46.50 with a mean of 12.90 ± 8.21, SYNTAX score was significant higher in DBP groups <60 and 60 – 69 mmHg than other groups (p < 0.001).
High atherosclerotic burden was identified by the presence of intermediate or high SYNTAX score. The frequency of high atherosclerotic burden was significantly increased with decreasing DBP, for mean SYNTAX Scores of 41.1, 35.6, 10 and 13.3 in DBP <60, 60 – 69, 70 – 79, and > = 80 mmHg; p < 0.0001 for all. There was negative significant correlation between diastolic blood pressure and SYNTAX score (rs = -0.471, p < 0.001).

Conclusions:
A low DBP level had an independent association with high SYNTAX Score. Lower DBP, particularly <60 mmHg, may be important to recognize a potential pathophysiological contribution of too low DBP in the development of complexity and increased atherosclerotic burden, which is identified by the presence of intermediate or high SYNTAX Score in stable patients with obstructive CAD.
ASSOCIATION OF CUMULATIVE SYSTOLIC BLOOD PRESSURE LOAD AND STROKE IN PATIENTS WITHOUT DIABETES
Authors: Zhao Yifan , Li Moran , Zhang Yi 
Published: June 2023

Objective:
The purpose of this study was to assess the association between cumulative systolic blood pressure (SBP) load and risk of stroke in patients without previous stroke and diabetes.

Design and method:
The present study was a post hoc analysis of patients enrolled in the SPRINT study. Cumulative SBP load was defined as the area under curve for SBP values >120 or 130 or 140mmHg respectively (named SBP load120, SBP load130 and SBP load 140 respectively) divided by the area under curve for all measured SBP values over a 48-month exposure period. Hazard ratios for the association between cumulative SBP load with stroke were estimated using Cox models.

Results:
Only SBP load130, but not mean SBP, SBP standard deviation (SBP SD), time at therapeutic range (TTR); had a well-correlation with the incidence of stroke according to the restricted cubic spline curve (RCS). Grouping participants with tertiles of cumulative SBP load130 distinguished the incidence of stroke by K-M curve. Different Cox models indicated SBP load130 was an independent risk factor for stroke. For the prediction of stroke, only cumulative SBP load130, but not SBP load120 and SBP load140, outperformed mean SBP, TTR, SBP SD in terms of C-statistics and net reclassification indexes.

Conclusions:
Cumulative SBP load may provide better prediction of stroke compared with traditional BP measures among patients without previous stroke and diabetes. 130mmHg could be the best cutoff value for predicting incidence of stroke by SBP load.
ASSOCIATION BETWEEN LONG-TERM EXPOSURE TO ANTIHYPERTENSIVE DRUGS AND RISK OF CANCER: A LARGE POPULATION-BASED RETROSPECTIVE COHORT STUDY
Authors: Franchi Matteo , Torrigiani Ginevra , Kjeldsen Sverre E. , Corrao Giovanni , Mancia Giuseppe 
Published: June 2023

Objective:
Several meta-analyses have examined whether antihypertensive drugs alter the risk of cancer. However, in most studies follow-up was relatively short and adherence to antihypertensive drugs was not accounted for. We analysed the relationship between long-term exposure to antihypertensive drugs and risk of cancer.

Design and method:
Retrospective population-based cohort study based on healthcare utilization databases of Lombardy Region (Italy). We selected all individuals aged 40 - 85 years newly dispensed with at least one antihypertensive drug from between 2009 and 2011, and with no previous history of cancer. Exposure to angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), calcium channel blockers (CCB), beta-blockers (BB), thiazides/thiazide-likes, loop diuretics and mineralocorticoid receptor antagonists (MRA) was evaluated by using an “as-treated” approach, according to which each cohort member was classified based on the duration of exposure to each class of drugs. Patients were followed-up from the date of the first dispensation of antihypertensive drug and ended at the earliest date between onset of cancer, migration, death or December 31, 2020. The association between the duration of exposure to each class of drug (considered as a time-dependent covariate) and cancer risk was evaluated by Cox regression models, adjusted for sex, age and the Multisource Comorbidity Score, and mutually adjusted for the exposure to each class of drugs.

Results:
The study cohort included 339,842 new users of antihypertensive drugs (median age 59 years, 49.5% males). During a median follow-up of 10.2 years, 36,778 cancers occurred. There was no evidence of consistent significant associations of the risk of cancer with ACEI, ARB and thiazides. An increasing but weak risk was associated to a medium-long term exposure to CCB and with a long-term exposure to BB. With the limit that the number of users was much smaller, exposure to MRA was associated to a significant increase in the risk of cancer at all exposure levels.

Conclusions:
In our study, treatment adherence allowed a more accurate evaluation of true exposure to a potentially carcinogenic drug influence. The results showed an increased risk with the exposure to some antihypertensive agents, in particular with the MRA.