bluuebunny/crossref_metadata_2025_split huggingface dataset:
EXTREME CARDIOVASCULAR RISK IN CARDIOLOGICAL REHABILITATION: PREVALENCE AND IMPACT ON PATIENT'S FUNCTIONAL IMPROVEMENT
Authors: Maloberti Alessandro , Senini Eleonora , Fabbri Saverio , Ciampi Claudio , Regazzetti Matteo , Monticelli Massimiliano , Pirola Roberto , Giannattasio Cristina 
Published: June 2023

Objective:
Among patients at very high cardiovascular risk, some are more likely to experience recurrent cardiovascular events. In may 2022, an article was published in the European Heart Journal proposing different definitions of patients at extreme cardiovascular risk. However, the process of defining the patient at extreme cardiovascular risk is still ongoing and more data also on its prevalence are needed. To assess the prevalence of patients at extreme cardiovascular risk in cardiological rehabilitation, to evaluate the clinical features of these patients. Furthermore, we want to establish how the extreme cardiovascular risk condition correlates with the functional improvement obtained during cardiac rehabilitation.

Design and method:
The study included 938 patients suffering from atherosclerosis who attended the cardiological rehabilitation of Niguarda Hospital in Milan. Patients diagnosed with non-ischemic heart failure or congenital heart disease have been excluded. Patients classified as at extreme cardiovascular risk were compared with the remaining patients and a multivariate linear regression was performed with absolute functional improvement as the dependent variable.

Results:
Among 938 patients, 26.9% belong to the category of extreme cardiovascular risk. Patients at extreme cardiovascular risk showed a higher average age (67.8 ± 10.4 vs 64.1 ± 11.1 years; p <0.001), a higher prevalence of significant comorbidities (peripheral arterial disease, cerebrovascular disease, chronic kidney disease, dyslipidemia, diabetes, hypertension) and a lower functional improvement during cardiac rehabilitation (102.9 ± 68.6 vs 138.1 ± 86.5 m; p < 0.001). At multivariate analysis extreme cardiovascular risk remains a significant determinant of the absolute functional improvement at Six-Minute Walking Test obtained during cardiac rehabilitation with b = -0.137 and p = 0.035, together with female sex (b = -0.136; p = 0.035).

Conclusions:
Extreme cardiovascular risk is a widespread condition among patients with chronic coronary syndrome and adversely affects the patient's functional improvement during cardiac rehabilitation. The identification of patients at extreme cardiovascular risk is a goal to be pursued in order to intensify secondary prevention strategies.
SIMULTANEOUS RECORDING OF CENTRAL BP AND ARTERIAL STIFFNESS DURING ECHO CORRELATES BETTER WITH LV DIASTOLIC FUNCTION THAN ROUTINE EXAMINE
Authors: Torbas Olena , Botsiuk Yurii , Sirenko Yuriy 
Published: June 2023

Objective:
ASE guidelines for the diagnostics of the left ventricle (LV) of diastolic dysfunction in 2016 suggested using the method of non-invasive assessment of central blood pressure (CBP) and the augmentation index (Aix) in order to obtain more detailed information in patients with arterial hypertension (AH). Routine determination of CBP does not allow the procedure to be performed simultaneously with ultrasound, so that can affect the results of the study because hemodynamics can change significantly during this time. The BAT 41-2 device, developed in Ukraine, allows the performing of two studies at the same time. The purpose of this analysis was to determine whether this approach is better than routine research.

Design and method:
We included 37 patients with AH grade 2. An echocardiographic examination was done according to ASE guidelines for the diagnosis of diastolic dysfunction of the left ventricle in 2016, including evaluation of transmitral E/A and E/e’ ratios, deceleration time (Dt) and isovolumic relaxation time (IVRT). Routine examination of CBP and Aix standardized for heart rate 75 (Aix@75) was measured with Sphygmocor (ArCor, Australia) according to a standardized protocol. Simultaneous measurement of CBP and Aix@75 was done with BAT41-2 device (IKS-Techno, Ukraine). Simultaneous measurement was done during standard echo views were recorded while the routine examination was done 30-90 min after the ultrasound diagnostic was done. To evaluate associations we used Spearman correlation analysis with the IBM SPSS 26.0 software package.

Results:
In our analysis, we did not find any correlations of E/A with any of the other parameters. Both routine and simultaneous CBP measurement were associated with LV IVRT but for simultaneous CBP measurement, this association was greater (R = 0.197, P = 0.043, and R = 0.340, P = 0.049 respectively). E/e’ significantly correlated with routine Aix@75 and simultaneous Aix@75, but again the last association was more strong (R = 0.495, P = 0.037 and R = 0.504, P = 0.014 respectively). Simultaneous Aix@75 was also more associated with IVRT (R = 0.438, P = 0.010) than routine (R = 0.210, P = 0.038).

Conclusions:
Simultaneous registration of CBP and AiX during echocardiography is more associated with LV diastolic function parameters than a routine examination.
SEX DIFFERENCES IN PULSE WAVE AND SUBENDOCARDIAL VIABILITY RATIO IN HYPERTENSIVE PATIENTS
Authors: Barbato Vincenzo , Grillo Andrea , Pierro Giuliano Di , Rovina Matteo , Puato Massimo , Parati Gianfranco , Salvi Paolo , Bernardi Stella , Fabris Bruno 
Published: June 2023

Objective:
Myocardial ischemia represents the main cause of morbidity and mortality in hypertensive patients in both women and men, although some difference in pathophysiology and in the exposure to risk factors may explain the lower global cardiovascular risk of women. Sex differences in the structure and function of the cardiovascular system may affect the aortic pressure wave and the functional balance in myocardial perfusion determined by central aortic pressure, which may lead to myocardial ischemia and type 2 myocardial infarction.

Design and method:
In a population of 318 treated hypertensive patients (162 females, 156 males) referring to a single Hypertension centre (University of Trieste, Italy), we measured peripheral blood pressure and performed arterial applanation tonometry (PulsePen, DiaTecne, Italy) to determine central blood pressure waveform, aortic pulse wave velocity (PWV), augmentation index (AIx), pulse wave separation analysis with timing and amplitude of forward (fT, fP) and backward reflected (bT, bP) waves, and the subendocardial viability ratio (SEVR), i.e. the ratio between diastolic and systolic pressure-time index, as a risk marker of myocardial ischemia.

Results:
Despite similar peripheral systolic and diastolic blood pressure values, heart rate and PWV between sexes, females showed a longer forward pressure wave duration (119.8±38.6 vs 105.0±30.4 ms, p<0.0001) and lower amplitude (52.7±19,4 vs 57.1±19.3 mmHg, p = 0.039) compared to males. Backward pressure waved were similar in timing and amplitude between males and females. The difference in forward wave caused a marked higher AIx (19.5±12.4 vs 11.9±14.9, p<0.0001) and a lower SEVR (101.6±24.4 vs 108.5±27.7, p = 0.018) in women compared to men.

Conclusions:
Hypertensive women and men showed significant differences in forward pressure wave, causing a significant increase in AIx and a decreased SEVR in women compared to men. This may have important implications in sex-specific risk and myocardial ischemia.
EVALUATION IN REAL LIFE OF ‘SUIVI-HTA’, A FREE APPLICATION FOR HOME BLOOD PRESSURE MONITORING
Authors: Jeune Sylvain Le , Sautenet Bénédicte , Duband Benjamin , Feit Bertrand , Lequeux Benoît , Artifoni Mathieu , Ledieu Guillaume , Deliege Pierre-Guillaume , Delsart Pascal , Girerd Xavier , Lamirault Guillaume 
Published: June 2023

Objective:
Home Blood Pressure Monitoring (HBPM) is key to improve blood pressure control. To help hypertensive patients adopt HBPM and doctors use the results in their practice, the French ‘Fondation de Recherche en Hypertension Artérielle’ has developed the Suivi-HTA application, available since September 2020. We therefore aimed at carrying out a first real-life evaluation of the utilization of this application among hypertension specialists and their patients.

Design and method:
The survey was carried out in France between October 2020 and March 2021 in 8 hospitals and 2 private practices based on a standardized questionnaire assessing the acceptability and effective use of the application, as well as the doctor's opinion on patient satisfaction.

Results:
The survey included 135 hypertensive patients, 38% were women, 57% were over 55 years old. Only 27% regularly performed HBPM. If the application was offered, it was well accepted (women 65%, men 80%) with a more important rejection rate in hypertensives over 55 years old (26% vs. 3%, p<0.0003) and with more comorbidities (31% vs. 7%, p = 0.0005). Rejection was mainly related to digital technology (no smartphone or tablet, lack of knowledge on downloading or using applications). Among the 113 patients who agreed to test the application, 98 (87%) effectively performed HBPM, 77 (67%) did so using Suivi-HTA, of which 60 (53%) generated and transmitted a HBPM report. According to the doctor's opinion, 88% patients who have used Suivi-HTA will be future users of the application. Patient satisfaction with the application was assessed as “good” for 93% patients.

Conclusions:
This national survey shows that the Suivi-HTA application has a good rate of acceptance and effective use among hypertensives. It also generates a very positive opinion in the medical community. However, age and presence of comorbidities were risk factors for reduced acceptance, in connection with the difficulties to digital accessibility. It would therefore be interesting, while globally promoting the use of HBPM in hypertensive patients, to develop specific strategies targeting patients with more comorbidities and/or at higher cardiovascular risk.
CORRELATION BETWEEN HOME AND AMBULATORY BLOOD PRESSURE MEASUREMENT: DIAGNOSIS AND MONITORING OF HYPERTENSION
Authors: Hamdani Achref , Ajra Zaineb , Bayar Mohamed Fehmi , Gheni Refaat , Rashikou Lamia , Hmida Riadh Ben , Ounissi Taha , Elhadj Zied Ibn 
Published: June 2023

Objective:
Home Blood Pressure Measurement (HBPM) and Ambulatory Blood Pressure Measurement (ABPM) are 2 valid approaches to measure out of office blood pressure to confirm and monitor hypertension. The objective of our study was to compare the results of HBPM to ABPM considered as the reference technique and to determine its contribution in the management of hypertension

Design and method:
An analytical cross-sectional study including 100 patients aged > 18 years, followed at the outpatient cardiology clinic of the Mohamed Taher Maamouri university hospital in Nabeul over a six months period (July-December 2021). Patients were asked to measure blood pressure (BP) at home as instructed by the physician using validated blood pressure self-measurement devices (MICROLIFE BP A3 PLUS, MICROLIFE BP A2 Basic and Beurer BM 40 ). Laying of ABPM was performed immediately after the HBPM using a Bravo Mini validated device from Sun Tech Medical. The correlation was analyzed using Pearson correlation coefficient (r).

Results:
Our population was composed of 47 women and 53 men. The mean age was 59.14±13.12 years. HBPM and ABPM were realized in 84% of cases for monitoring hypertensive patients and in 16% of cases to confirm newly diagnosed. The diagnosis of hypertension was confirmed in 75% by HBPM and in 62.5% by ABPM. White coat uncontrolled hypertension (WCUH) was noted in 31% of cases by HBPM and in 25% by ABPM and masked uncontrolled hypertension (MUCH) was noted in 6% of cases by HBPM and in 8.3% by ABPM. The difference between HBPM and ABPM was not statistically significant for the detection of MUCH (p = 0.320) and WCUH (p = 0.198). A strong correlation was found between HBPM and ABPM of systolic BP (P <0.001; r = 0.728; Curve A) as well as of diastolic BP (P <0.001; r = 0.773; Curve B).

Conclusions:
HBPM has a value very close to ABPM. So, it's important to increase its availability in clinics, outpatient clinics and even in private practice given its lower cost and better availability compared to ABPM for the diagnosis of hypertension and its monitoring.
BLOOD PRESSURE CONTROL IN PUBLIC AND PRIVATE BRAZILIAN HEALTHCARE SERVICES
Authors: Amorim Kecia , Vitorino Priscila Valverde O , Feitosa Audes Diogenes M. , Lopes Lais Rocha , Camafort Miguel , Sousa Ana Luiza Lima , Barroso Weimar Kunz Sebba 
Published: June 2023

Objective:
To compare office and home blood pressure (BP) measurements of treated hypertensive patients followed in public and private healthcare in a Brazilian multicenter study.

Design and method:
A cross-sectional study. The datas were exported from TeleMRPA plataform to an excel file containing the variables to be analyzed. Public and private healthcare units were coordinated by same cardiologists and followed same guidelines concerning BP treatment. Descriptive statistics were used through the measure of central tendency (mean), measure of dispersion (standard deviation) and measure of frequency (percentage). For inferential statistics, the unpaired t-student test was used. A 95% confidence interval and a significance level of p<0.05 were considered.

Results:
The sample consisted of 3.043 study patients: 1.842 (60.5%) of them at private and 1,201 (39.5%) at public healthcare services with a mean age of 58± 12.2 years [public = 59±11.3; private = 58±12.8, p = 0.18], BMI of 28.9±5.2 Kg/m2 [public = 29.4±5.7; private = 28.6±4.8, p<0.001]. Concerning office BP values, Systolic BP [public = 144±25.5mmHg; private = 130±17.2mmHg, p<0.001] and Diastolic BP [public = 87±14.4mmHg; private = 81±10.2mmHg, p<0.001] and at home BP the average Systolic BP[public = 134±20.8mmHg and private = 123±13.6mmHg, p<0.001] and Diastolic BP [public = 82±13mmHg; private = 76±8.9mmHg, p<0.001].

Conclusions:
Hypertensive patients followed at public healthcare services have greater BMI and higher level of BP than private services. Better care is suggested and necessary for public health care, including actions to reviewing the classes of anti-hypertensive drugs and their fixed or non-fixed combinations in order to reduce cardiovascular outcomes.
HOME BLOOD PRESSURE MONITORING WITH A DIGITAL BLOOD PRESSURE COACH. A PROSPECTIVE ANALYSIS OF INDIVIDUAL USER DATA
Authors: Beger Christian , Rüegger Dominik , Lenz Anna , Wagner Steffen , Haller Hermann , Schmidt-Ott Kai -Martin , Volland Dirk , Limbourg Florian P. 
Published: June 2023

Objective:
The influence of baseline BP category and measurement duration on home blood pressure monitoring (HBPM) are still poorly defined, particularly when used in conjunction with a digital application.

Design and method:
This is a prospective analysis of real-world user data from a digital BP-coach (Manoa app ) in the period from April 2020 (release of the Manoa app) to November 2021 in Germany. The app was freely available in Germany during this period in all major app stores (iOS, Android).
We analysed temporal BP changes and performed BP classification tracking in users with self-reported hypertension performing HBPM with a digital and interactive blood pressure coach.

Results:
Of 3175 users who enrolled in HBPM, 74.1% completed the first measurement period. Overall, mean systolic BP dropped significantly after the first day, but stratification by BP category demonstrated that initial category influenced BP course. BP classification tracking revealed that time to reach final BP category was dependent on baseline category, with users in categories high-normal and grade 1 hypertension requiring more days to decrease BP class volatility and to reach their definitive BP class. This was driven by an intense switching between directly neighbouring categories until the middle phase of the HBPM period, while more distant class switching occurred less often and only early on. Overall, > 90% of users maintained their category by day 5. Omitting the first day from analysis lead to therapeutically relevant reclassification in 3.8% of users. Users who completed at least two HBPM periods (n = 864) showed a mean SBP/DBP decrease of 2.6/1.6 mmHg, which improved hypertension control from 55.6% to 68.1%.

Conclusions:
With a digital HBPM-protocol, five consecutive measurement days are required for a reliable diagnosis and BP categorization. However, especially at therapeutic thresholds, additional measurement days are often required. Excluding day 1 from the protocol resulted in blood pressure reclassifications in 8.4% of all cases, with therapeutic relevance in 3.8% of cases.
The optimal length of HBPM period depends on BP category. HBPM with a digital coach is associated with a reduction in average BP and improvement in BP control.
CHANGE IN ARTERIAL STIFFNESS AND AMBULATORY BLOOD PRESSURE IN PATIENTS WITH RHEUMATOID ARTHRITIS: THE JOINTHEART STUDY
Authors: Linde Anja , Gerdts Eva , Fevang Bjørg Tilde Svanes , Eilertsen Rune , Kringeland Ester , Alsing Christian Lillebø , Midtbø Helga 
Published: June 2023

Objective:
Use of disease modifying antirheumatic drugs (DMARDs) has been associated with reduction in blood pressure (BP) and arterial stiffness in clinical trials, but real-word data is lacking. We investigated change in ambulatory BP and arterial stiffness in outpatients with rheumatoid arthritis (RA) eligible for initiation or change in targeted synthetic (ts) or biological (b) DMARDs.

Design and method:
Eighty-nine consecutive RA patients (age 53±13, 68% women) were examined at initiation of ts/bDMARDs and repeated after 22 months. Ambulatory BP, carotid-femoral-pulse wave velocity (cfPWV) and Disease Activity Score in 28 joints using C-reactive protein (DAS28) were measured at baseline and at follow-up. High cfPWV was defined as cfPWV > 10 m/s in accordance with guidelines.

Results:
At follow-up, 20% used tsDMARDs, 57% bDMARDs and 67% had achieved remission or low disease activity. DAS28 decreased from 3.9±1.3 at baseline to 2.8±1.2 at follow-up (p<0.001).
The ambulatory systolic BP increased (116±11 mmHg vs 120±13 mmHg, p = 0.010), while the ambulatory diastolic BP decreased (76±7 mmHg vs. 73±8 mmHg, p = 0.001) from baseline to follow-up. Body mass index (BMI) increased from 26.5±5.2 kg/m2 to 27.1±4.9 kg/m2, p = 0.009. Changes in ambulatory systolic and diastolic BP were associated with presence of diabetes at baseline, but not DAS28 or use of ts or bDMARDs. Mean cfPWV increased from 7.8±1.6 m/s at baseline to 8.5±1.8 m/s at follow-up (p<0.001). The prevalence of high cfPWV increased from 10.8% to 16.3 %, p = 0.03. DAS28 (beta = 0.32, p = 0.01) and diabetes at baseline (beta = 0.39, p = 0.001) were associated with increase in cfPWV, independent of achieved remission/low disease activity at follow-up, baseline systolic BP, BMI, age, sex and use of antihypertensive drugs.

Conclusions:
In outpatients with RA, higher disease activity at baseline was associated with an increase in arterial stiffness during follow-up, despite DMARD therapy and significant decrease in disease activity.
THE SYNERGISTIC EFFECTS OF PROINFLAMMATORY CYTOKINES ON CARDIOVASCULAR FUNCTION AND SYMPATHETIC OUTFLOW IN RAT
Authors: Wei Shunguang , Cao Yiling , Yu Yang 
Published: June 2023

Objective:
Inflammation has been implicated in the pathophysiology of cardiovascular dysfunction and neurohumoral activation in cardiovascular diseases. Our previous work has demonstrated that proinflammatory cytokines (PICs) in cardiovascular/autonomic brain regions contribute significantly to the sympathetic excitation and cardiac dysfunction in heart failure and hypertension. Notably, the chronic inflammatory conditions in these disease settings are caused by numerous inflammatory cytokines and chemokines. Given that the elevated levels of a single effector cytokine in the pathophysiological condition are insufficient to cause a significant change in hemodynamic and sympathetic responses, how PIC-driven neuroinflammation promotes sympathetic activation remains unclear. This work sought to determine whether PICs in the brain have a synergistic action to exaggerate their inflammatory effects on hemodynamic and sympathetic responses in rats.

Design and method:
Blood pressure (BP, mmHg), heart rate (HR, beats/min) and renal sympathetic nerve activity (RSNA, % change) were continuously recorded for 4-5 hours in urethane anesthetized male Sprague Dawley rats. The inflammatory cytokines tumor necrosis factor-↑ (TNF-↑), interleukin (IL)-1↓, IL-6 and vehicle were injected intracerebroventricularly (ICV).

Results:
We found that while ICV injection of TNF-↑, IL-1↓ or IL-6 alone at a low dose (10 ng, respectively) did not induce significant changes in BP, HR and RSNA, the combined injection of all three cytokines at the same dose (10 ng) elicited a substantial (*p<0.05) increase in BP (18.2 ± 2.1*), HR (62 ± 7*) and RSNA (94.5 ± 5.2 %*), that began within 15-20 mins. These responses peaked at 2-3 hours after ICV injection and remained elevated for the rest of the recording period. Additionally, ICV injection of TNF-↑, IL-1↓ or IL-6 alone at a high dose (50 ng, respectively), produced a dramatic and long-lasting increase in BP, HR and RSNA, that closely resembles the time course and response pattern induced by ICV injection of all three cytokines concurrently at the low dose (10 ng).

Conclusions:
These data suggest a synergistically excitatory action of PICs in the brain on sympathetic outflow. Interventions that simultaneously target multiple cytokines may have an extended anti-inflammatory effect of reducing sympathetic excitation in hypertension and heart failure.
BLOOD PRESSURE PROFILE IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Triqui Chifa , Khadhar Mariem , Jerbi Mouna , Hadded Sarra , Aoudia Raja , Gaied Hanene , Goucha Rim 
Published: June 2023

Objective:
High blood pressure (HBP) is often associated with chronic kidney disease (CKD). It can be a cause or a complication of the latter.
The aim of this work was studying the clinical characteristics and the therapeutic modalities prescribed in our hypertensive patients monitored in nephrology consultation.

Design and method:
It was a retrospective descriptive study conducted at the nephrology consultation from January 2020 to January 2022. The stage of chronic kidney disease was defined according to the KDIGO classification. A therapeutic target achieved was defined by a Systolic Blood pressure<140 mmHg and a Disyslotic Blood Pressure<90 mmHg.

Results:
Our population included 53 hypertensive patients who were followed for chronic kidney disease. The mean age was 70.16 [46-90] with a M/F sex ratio of 1.3. The stage of chronic kidney disease was 1,2,3,4 and 5 in 2 patients (3.77%), 7 patients, (13.2%), 25 patients (47.16%), 8 patients (15.09%) and 11 patients (20.75%) respectively. Hypertension was classified as grade 1, 2 and 3 in 18 (33.16%), 6 (11.32%) and 3(5.6%) patients respectively.
The mean systolic blood pressure in our patients was 137.55+/-21.54 mmHg and the mean diastolic was 78.62+/-11.37mmHg.
Left ventricular hypertrophy on ultrasound was found in 4 patients (7.54%).
Blood pressure was balanced in 42 (79.4%) patients, of whom 29 were on a calcium channel blocker alone or in dual therapy, 27 patients were on a combination containing a blocker of the rennin angiotensin aldosterone system, 17 patients were on beta blocker,14 patients were on dual therapy containing a loop diuretic and 13 patients were on a central antihypertensive.
The therapeutic target was not reached in 11 patients, among whom there was a dietary deviation in 4 patients, nonadherence to treatment in 6 patients and sleep apnea in 1 patient. Five patients were in stage 4 and 5 of chronic kidney disease.

Conclusions:
Blood pressure control is an important part of the follow-up of hypertensive patients in nephrology. Hypertension can increase the morbidity and mortality of the chronic kidney disease.