bluuebunny/crossref_metadata_2025_split huggingface dataset:
IMPACT OF PREVIOUS DIAGNOSIS OF HYPERTENSION ON RENAL FUNCTION IN HEART FAILURE PATIENTS
Authors: Diaz Javier , Calderon Jose M. , Martínez Fernando , Sauri Inma , Fernandez Antonio , Trillo Jose L. , Lidon Laura , Redon Josep 
Published: June 2023

Objective:
The aim of this study is to evaluate the impact of previous diagnosis of HTN in the reduction of the estimated glomerular filtration rate (eGFR) and the development of chronic kidney disease (CKD) in heart failure (HF) patients by using real world data.

Design and method:
The study population was selected from a database with electronic health records information from 2012 to 2016 of patients older than 24 years of age. Patients with an active diagnosis of HF at some point during this period were selected, and then stratified according to the presence of previous diagnosis of hypertension. eGFR and Kidney Disease Global Outcomes (KDIGO) risk scale during the observational period were analyzed. Two events were studied using survival and Cox proportional hazards regression models: i) reduction of 20% compared to basal eGFR value and ii) increased risk in the KDIGO scale. Other clinically relevant factors were selected as adjustment variables: age, sex, comorbidities (atrial fibrillation, diabetes, dyslipidaemia and coronary heart disease) and drugs used for HF treatment or anticoagulation.

Results:
The study population included 80631 HF patients, 37426 of them classified with the KDIGO scale. The proportion of patients with hypertension was 87% and the mean baseline eGFR was 64.2 ml/min/1.73m2. The average age was 75.63 years and 54.7% women. Significant increments in risk were found in patients diagnosed of hypertension for the two events, being 1.28 (CI95% 1.21–1.36) for the eGFR reduction and 1.36 (CI95% 1.25–1.48) for the KDIGO increased risk (Figures). This effect increased as the baseline CKD risk was higher, with 1.45 (CI95% 1.37–1.53) times the risk in the case of base high-risk group (eGFR at baseline <60ml/min/1.73m2; N = 5980) compared to the low risk one (N = 15460).

Conclusions:
Hypertension is a very prevalent comorbidity of patients with HF, and has a negative impact on kidney function, increasing the risk of reduction of eGFR and development of CKD. The prognosis is significantly worse as the baseline risk is higher.
ESTIMATED VERSUS MEASURED AORTIC STIFFNESS IN DIALYSIS POPULATION: IMPLICATIONS OF SEX, AGE AND DIABETES
Authors: Cote Nadege , Fortier Catherine , Agharazii Mohsen 
Published: June 2023

Objective:
Aortic stiffness is measured through determination of carotid-femoral pulse wave velocity(cfPWV). More recently, authors have proposed to estimate PWV (ePWV) with age and brachial mean blood pressure (MBP) using an equation for the normal population and another for subjects with cardiovascular risk factors. However, patients with end-stage kidney disease are at extremely high risk of cardiovascular disease and have an altered circulatory system due to no perfusion of the kidneys. Therefore, the aim of this study was 1)examine the reliability of the ePWV as compared to measured cfPWV, and 2)examine if sex, age and diabetes have an impact on the relationship between ePWV and cfPWV in this population.

Design and method:
This is a cross-sectional study of 317 adults treated by chronic hemodialysis(n = 252) or peritoneal dialysis(n = 65). cfPWV was measured using second derivative algorithm through simultaneous recording of carotid and femoral arteries in triplicates(CompliorSP) using 80% of the direct distance between the carotid and femoral arteries. ePWV was calculated using the formula for subjects with cardiovascular risk factors from the Reference Values for Arterial Stiffness Collaboration.

Results:
In 317 patients(68%men), with a mean age of 65 ± 15 years, 43% had diabetes, 91% had hypertension and 52% had cardiovascular disease. MBP, cfPWV and the difference between ePWV and cfPWV(↗PWV) were respectively 92 ± 17mmHg, 10.8 ± 3.2m/s and 0.36(-5.87 – 11.84) in the overall group.
Male sex, first and second age tertiles, and diabetes were associated with a negative ↗PWV. ePWV underestimated cfPWV in men (-0.80, 95%CI: -1.17 – -0.43, p < 0.001), in patients from the first (18-60 years)(-0.64, 95%CI: -0.94 – -0.32), p < 0.001) and second (60 - 73 years)(-0.50, 95%CI: -1.01 – 0.01,p = 0.053) tertiles of age, and in patients with diabetes(-1.08, 95%CI: -1.55 – -0.60, p < 0.001). ePWV was relatively accurate to estimated cfPWV in women (0.28, 95%CI: -0.09 – 0.66, p = 0.132) and in patients from the last age tertile(73 - 89 years)(0.05, 95%CI: -0.51 – 0.66,p = 0.866).

Conclusions:
These findings suggest that sex, age tertiles and diabetes impact the relationship between ePWV and cfPWV in our cohort of patients on dialysis; therefore the formula used to estimate PWV may benefit from better integrating these determinants for a more accurate ePWV.
INTRACRANIAL PRESSURE WAVEFORM AND HYPERTENSION
Authors: Costa Matheus Martins Da , Lima Lucas Monteiro , Costa Thiago Oliveira , Alves Ana Carolina Rodrigues , Correia Mikaelle Costa , Vitorino Priscila Valverde O. , Sousa Ana Luiza Lima , Frigieri Gustavo , Barroso Weimar Kunz Sebba 
Published: June 2023

Objective:
Noninvasive intracranial pressure waveforms for estimation of intracranial hypertension have been previous validated and a P2/P1 ratio over 1,2 shows a good correlation with this damage. 1,2,3 In animal models, with induced hypertension, it has been observed a significative increase in P2/P1 ratio 2 weeks later. 4 Our objective, as a proof of concept, was to observe followed treated hypertensive patients concerning the rate of P2/P1 behavior.

Design and method:
The evaluation procedure of noninvasive intracranial pressure waveforms have been performed in 62 treated hypertensive patients with 7 minutes length. First and last minutes were discarded as well any test with poor quality wave signal at any moment. Data concerning systolic and diastolic blood pressure (BP) measured with OMRON automatic device HBP 1100 were obtained at the same moment as well the variables of age, body mass index (BMI), anti-hypertensive drugs and a history of diabetes (DM), stroke (ST) or myocardial infarction (MI). Descriptive statistics tests were used through the measurement of central tendency (mean), dispersion (standard deviation) and frequency (percentage). T Student and ANOVA as parametric tests and qui squared for categorical variables.

Results:
Data from 52 patients were validated. Mean age of 64,6 years, 63,5% female, BMI 28,4 +- 5,4 Kg/m2, 48,1% with diabetes. Mean systolic and diastolic office BP measurements of 141,6 +- 25,4 mmHg and 85,2 +- 14,7 mmHg respectively and 53,8% with controlled hypertension (systolic BP < 140 mmHg and diastolic BP < 90 mmHg). P2/P1 ratio over 1,2 has been found in 75% of the sample and there were no differences concerning controlled and non-controlled hypertension, number of anti-hypertensives drugs, or comorbidities as DM, ST or MI but at this moment we have to consider the small size of the sample to achieve enough power to detect these differences or correlations.

Conclusions:
The prevalence of 75% of P2/P1 ratio over 1,2 (equivalent to intracranial hypertension) deserves attention from scientific community since it raises a question about blood-brain barrier protection and can help to explain the huge association between hypertension and cerebrovascular diseases.
CLINICAL AND DEMOGRAPHIC DETERMINANTS OF PULSE WAVE VELOCITY TRAJECTORIES IN HYPERTENSIVE PATIENTS: A RETROSPECTIVE STUDY
Authors: Eula Elisabetta , Khettab Hakim , Pappaccogli Marco , Rabbia Franco , Boutouyrie Pierre , Bruno Rosa Maria 
Published: June 2023

Objective:
Arterial stiffness (AS) is a strong predictor of cardiovascular disease and all-cause mortality. Its behaviour over time, assessed through repeated measurements, is still largely unexplored. The aim of this study was to assess the clinical and demographic determinants of trajectories of carotid-femoral pulse wave velocity (cf-PWV) in a cohort of French hypertensive adults.

Design and method:
From a population of 7806 patients referred to HEGP Pharmacology Unit (Paris, France) from 1981 to 2022, we selected those who had at least 3 cf-PWV recordings over time. Those with missing treatment information or rare vascular diseases were excluded. Cluster of trajectories analysis was performed and multinomial regression was used to detect differences in baseline characteristics between the identified clusters.

Results:
564 patients were included in the analysis (median follow-up was 4.2 [3.2-6.4] years). Four clusters of stiffness trajectories were identified: low-stable (A, n = 199), medium-stable (B, n = 184), high-increasing (C, n = 127), and high-low-high (D, n = 54) clusters (Figure 1). Mean BP (MBP) and cf-PWV at baseline were progressively higher in the medium-stable, high-increasing, and high-low-high clusters compared to the stable one (MBP was 96 ± 12, 99 ± 12 and 101 ± 15 mmHg in clusters B, C, and D vs 92 ± 12 mmHg in cluster A; cf-PWV was 9.7 ± 1.2, 11.6 ± 1.6 and 15.3 ± 2.7 m/s in clusters B, C, and D vs 7.7 ± 1.0 m/s in cluster A; all p < 0.001).
On multinomial regression analysis, older age, higher MBP, and diabetes were associated to increased probability of belonging to either C or D clusters when compared to the stable one. Anti-hypertensive treatment with blockers of renin-angiotensin system (RAS) was associated with a decreased probability of belonging to the C or D clusters (Table 1).

Conclusions:
This real-life data obtained by repeated cf-PWV assessments on a large time span shows that patients who will experience PWV worsening over time are characterized by older age, higher MBP and diabetes at baseline. The use of RAS blockers has a protective effect on PWV trajectories.
URINE SODIUM-TO-POTASSIUM RATIO DOES NOT ACCURATELY REFLECT DIETARY SODIUM-TO-POTASSIUM RATIO
Authors: Vliet Myrthe van , Zwager Charlotte , Rauh Manfred , Titze Jens , Engberink Rik Olde 
Published: June 2023

Objective:
High sodium intake is associated with an increased risk of cardiovascular disease, whereas a high potassium intake is associated with a reduced risk. Dietary counselling requires accurate estimation of sodium and potassium intake, but 24-hour urine sodium and potassium excretion demonstrated not to reflect actual intake. Urine sodium-to-potassium (Na/K) ratio is a promising alternative as it may be less affected by aldosterone-induced rhythmic changes in total body sodium and potassium content, is less influenced by incomplete urine collections, and incorporates both the effect of sodium and potassium. Our study assesses whether 24-hour urine Na/K ratio is superior in predicting dietary intake compared to 24-hour urine sodium or potassium excretion.

Design and method:
A post-hoc analysis was performed on data from the long-term sodium balance studies Mars105 and Mars520. Ten healthy participants received a diet with a known sodium and potassium content and collected 24-hour urine samples for 105 or 205 days. We calculated the log fold difference between dietary intake and urine content of sodium, potassium and Na/K ratio. We compared these estimates of accuracy using a mixed-effects model with a random intercept per subject. We analysed whether the accuracy differed among 6, 9 and 12 grams salt intake or was affected by the number of 24-hour urine collections.

Results:
Urine Na/K ratio underestimated dietary Na/K ratio with a median difference of -0.21 (IQR -0.47 to 0.09). Compared to sodium and potassium assessment, the Na/K ratio was significantly less accurate in predicting intake (Figure 1A). Only for the 6 gram salt phase the Na/K ratio did not perform significantly worse than sodium measurements. Increasing the number of 24-hour urine measurements to three or seven improved accuracy of the Na/K ratio, although it remained inferior to separate assessment of sodium and potassium excretion (Figure 1B).

Conclusions:
The 24-hour urine Na/K ratio is less accurate than 24-hour urine sodium excretion for estimation of dietary intake in a controlled setting.
PROMOTING PATIENT HYPERTENSION SELF-MANAGEMENT BEHAVIORS WITH THE EVIDENCE-BASED PROGRAM, HEALTH COACHES FOR HYPERTENSION CONTROL
Authors: Dye Cheryl , Williams Joel , Evatt Janet 
Published: June 2023

Objective:
To improve patient self-management of hypertension with a peer-led, community-based educational program which activates participants to make lifestyle changes by delivering personally relevant and meaningful information addressing psychosocial determinants of self-management behaviors.

Design and method:
The eight-session educational curriculum, Health Coaches for Hypertension Control (HCHC), was developed using the US National Institute of Health Stage Model approach to behavioral intervention development. In Stage II and III it was tested for efficacy through implementation with 146 participants using a pre- and posttest evaluation design including process, impact, and outcome measures. In Stage IV, it was evaluated for changes in knowledge and psychosocial measures using a batch randomization to intervention or wait-control group with 185 participants.

Results:
Stage IV research revealed that compared with control group participants, a higher proportion of treatment group participants moved from the cognitive to behavioral stages of motivational readiness for being physically active (P < .001), practicing healthy eating habits (P = .001), handling stress well (P = .001), and living an overall healthy lifestyle (P = .003). They also demonstrated a greater average increase in perceived competence for self-management, F(1.134) = 4.957, P = .028, and a greater increase in mean hypertension-related knowledge, F(1.160) = 16.571, P < .0005. The US Department of Health and Human Services, Administration for Community Living designated HCHC as an Evidence-Based Program in 2018. Since that time, Stage V (“implementation and dissemination”) research has demonstrated that HCHC has been successfully disseminated both in-person and on-line in 15 US states.

Conclusions:
HCHC is recommended as an extension of clinical patient education to support increasing health system interest in promoting sustainable patient outcomes through effective self-management. An agency wishing to disseminate HCHC would need to secure a license agreement to use copyrighted materials and arrange for certification of Master Trainers by the HCHC program manager. Master Trainers may then offer HCHC themselves or train lay leaders to offer the program.
BRD4 INHIBITION ATTENUATES OBESITY-RELATED MICROVASCULAR DYSFUNCTION: ROLE OF ENDOTHELIUM AND PERIVASCULAR ADIPOSE TISSUE
Authors: Mengozzi Alessandro , Costantino Sarah , Duranti Emiliano , Mohammed Shafeeq , Gorica Era , Armenia Silvia , Cappelli Federica , Taddei Stefano , Masi Stefano , Paneni Francesco , Virdis Agostino 
Published: June 2023

Objective:
Bromodomain and extraterminal (BET) proteins, particularly BRD4, are epigenetic readers modulating transcriptional programs implicated in inflammation, cancer and renal disease. Though several findings suggest that BET proteins’ inhibition might be particularly relevant in the cardiometabolic field, an apparent evidence gap hinders its therapeutic potential. We aimed to define the impact of BRD4-related inflammatory response in the early stages of obesity to exploit the therapeutic potential of its inhibition.

Design and method:
Healthy controls (n = 13) and patients with obesity without other comorbidities (n = 13) were included in a case-control study. Small arteries from visceral fat depots were mounted on a pressurised myograph to assess vasorelaxation to acetylcholine and inhibition to L-NAME at baseline and after incubation with RVX-208 (an FDA-approved BRD4 inhibitor), canakinumab (targeting IL-1beta), tocilizumab (targeting IL-6 receptor) and infliximab (targeting TNF-alpha). The experiments were conducted, in parallel, on two vessels, one mounted with perivascular adipose tissue (PVAT) and the other without PVAT. Vascular- and PVAT-specific levels of NAPDH-derived ROS, mtROS and nitric oxide availability were assessed by confocal microscopy. Gene expression was evaluated by qPCR.

Results:
In patients with obesity, microvascular function and nitric oxide availability were reduced, where NADPH- and mtROS were increased. BRD4, TNF-alpha, IL-1beta and IL-6 expression levels were higher in the vessel wall and the PVAT of patients with obesity. In these patients, RVX-208 substantially attenuated microvascular dysfunction. The effect was more significant in vessels with intact PVAT, implying a restoration of the PVAT anti-contractile phenotype (Figure). The exploration of the distinct inflammatory pathways showed that the amelioration observed with BRD-4 inhibition was higher than with canakinumab, tocilizumab or infliximab. Peculiarly, anti-IL-1beta restoration of microvascular function was not affected by the presence of the PVAT, while the ones observed with the targeting of IL-6 receptor and TNF-alpha were.

Conclusions:
The inhibition of BRD4 restores microvascular dysfunction in patients with obesity by modulating pan-inflammatory response involving distinct IL-1beta, IL-6 and TNF-alpha pathways and restoring PVAT anti-contractile properties. Epigenetic drugs might represent a promising therapeutic strategy to rescue microvascular dysfunction, a hallmark of early cardiometabolic disease.
TRENDS IN PREVALENCE OF HYPERTENSION IN PREGNANCY IN THE CZECH REPUBLIC BETWEEN 2012-2021
Authors: Vaclavik Jan , Jarkovsky Jiri , Pohlova Radka , Jirova Jitka , Zouharova Anna 
Published: June 2023

Objective:
Arterial hypertension affects about 5-10% of pregnancies and has detrimental effects on pregnancy outcomes in both the mother and fetus. The aim of this study was to analyze the trends of the prevalence of hypertensive diseases in pregnancy in the Czech Republic during the past decade.

Design and method:
Nationwide data on all births and abortions in the period 2012-2021 in the Czech Republic were obtained from the National Registry of Reproductive Health (NRRZ) and the National Registry of Reimbursable Health Services (NRHZS). Women who had the diagnosis I10 whithin one year before pregnancy and were prescribed an antihypertensive drug from selected ATC groups (C02, C03, C07, C08, C09) were classified as pre-existing hypertension. Women diagnosed with O13 or I10 during pregnancy and prescribed a drug from selected ATC groups were classified as pregnancy induced hypertension. Descriptive statistics were used to evaluate the prevalence.

Results:
There were 105,790 births in 2012 and 108,350 births in 2021. The proportion of women with pre-existing hypertension was almost unchanged between 2012 - 2021, between 0.86 - 0.94%. The overall proportion of women with hypertension in pregnancy and lifebirth delivery was also stationary and oscillated between 5.6% - 5.9% (Table 1). A higher prevalence of hypertension was found in women with deliveries of children with lower gestational age. The number of abortions decreased from 37,897 to 28,547 between 2012 - 2021. The proportion of women with abortion/stillbirth and hypertension detected before pregnancy increased from 1.05% to 1.38% in this period, the overall proportion of women with hypertension in pregnancy terminated by abortion/stillbirth increased from 1.2% to 1.6% (Table 2). For all pregnancies, the prevalence of hypertensive diseases in pregnancy remained relatively unchanged and oscilated between 4.44% - 4.74% (Table 3) during the reporting period.

Conclusions:
The prevalence of hypertension in pregnancy in the Czech Republic remained almost unchanged in the period 2012 - 2021 and was similarly high as in other Western countries.
SERUM COPEPTIN AS A PROGNOSTIC MARKER IN PRE-ECLAMPSIA
Authors: Jaques David , Dufey Anne , Wuerzner Grégoire , Othenin-Girard Véronique , Tejada Begona Martinez De , Pechere Antoinette , Ponte Belen 
Published: June 2023

Objective:
Pre-eclampsia (PE) is as a risk factor for subsequent cardiovascular and kidney disease. Serum copeptin correlates with adverse kidney outcomes in the general population and is increased during PE as compared to healthy pregnancy. We describe the association between copeptin and subsequent kidney outcomes in pregnant women.

Design and method:
We enrolled 372 patients with PE and 82 with healthy pregnancy in this prospective cohort study. Serum copeptin was measured at 6 weeks post-partum (PP). Office blood pressure (BP), eGFR and albuminuria were measured at 6 weeks as well as at 1 year PP in a sub-group of 110 patients. Interaction effect was tested using likelihood ratio test (LRT).

Results:
As compared to healthy controls, patients with PE were less frequently Caucasian, more likely smokers and had higher body mass index (p < 0.05). At 6 weeks PP, copeptin levels were similar between groups. At one year PP, systolic BP (SBP), diastolic BP (DBP) and albuminuria were higher in PE as compared to control patients (p < 0.05) while eGFR was similar between groups. A significant interaction existed between copeptin and PE status regarding DBP at 1 year PP (p = 0.045 for LRT). A similar but borderline interaction existed between copeptin and PE status for albuminuria at 1 year PP (p = 0.126 for LRT).

Conclusions:
At 6 weeks PP, women who suffered from PE do not have increased copeptin levels as compared to healthy controls. However, in case of PE only, copeptin levels are associated with subsequent adverse kidney outcome. Whether this association is causal and would represent a potential therapeutic target remains to be tested.
PREGNANCY-RELATED COMPLICATIONS IN PRIMARY ALDOSTERONISM: A EUROPEAN SURVEY
Authors: Forestiero Vittorio , Landau Ester , Roa Juan Solorzano , Riancho Julien , Burrello Jacopo , Sconfienza Elisa , Monticone Silvia , Reincke Martin , Quinkler Marcus , Azizi Michel , Boulestreau Romain , Mulatero Paolo , Amar Laurence 
Published: June 2023

Objective:
Hypertensive pregnancy disorders, affecting 4 - 25% of pregnancies according to countries’ income, represent a major cause of maternal and fetal morbidity and mortality. Data on pregnancy's complications in patients with primary aldosteronism (PA) are scarce, despite PA being the most frequent cause of secondary hypertension. We did an international survey to collect maternal and fetal pregnancy-related complications in a cohort of women with PA recruited from 5 Hypertension Excellence Centers in Europe.

Design and method:
We included consecutive women aged 18 - 45 years who were pregnant either after or <1-year before diagnosis of PA and excluded those who were pregnant after unilateral adrenalectomy for PA. PA diagnosis was made in each center according to guidelines. Information on maternal and fetal issues was obtained through medical records and patients’ interviews.

Results:
We included 78 women aged 30 ± 6 years, 33% nulliparous, 14% with past pre-eclampsia, 53% with hypokalemia, 4% smokers, 7% with type II diabetes, 4% with chronic kidney disease. They had 97 pregnancies, of which 43 occurred <1 year before PA diagnosis and 54 after a median of 18 months from PA diagnosis. All women had either chronic or new onset gestational hypertension (12%). Excluding 7 spontaneous miscarriages, pregnancy-related complications occurred during 43 out of 90 pregnancies (44%), including proteinuria in 36 (40%), pre-eclampsia in 27 (30%), placental abruption in 2 (2%) and intrauterine fetal death in 6 pregnancies (7%). There was a high rate of delivery morbidity including 30% of pre-term births occurring at a median of 34 weeks of gestational age, and 35% of cesareans sections. A total of 23 out of 84 (27%) newborns had a low birth weight (<2500 g) and 22 (26%) underwent neonatal intensive care. When compared to historical control cases from a systematic review, women with PA showed similar rates of maternal complications vs women with essential chronic hypertension, but higher rates of fetal complications (Figure 1).

Conclusions:
Our data emphasize the importance of PA screening in young hypertensive women prior pregnancy, to ensure 1) appropriate and early treatment of PA, and 2) strict follow-up during pregnancy.