bluuebunny/crossref_metadata_2025_split huggingface dataset:
CASE REPORT OF A RARE CAUSE OF SECONDARY HYPERTENSION ILLUSTRATING THE IMPORTANCE OF CARDIO-OBSTETRICS PRECONCEPTION COUNSELING
Authors: Meister Theo , Soria Rodrigo , Bubulyte Laura , Spano Giancarlo , Vladimirmakalo Vladimir , Raio Luigiraio , Rexhaj Emrush 
Published: June 2023

Objective:
Our objective is to illustrate the value of preconception management of rare case of secondary hypertension namely Middle Aortic Coarctation (MAC), which is characterized by a constriction of the upper abdominal aorta. During pregnancy, MAC can lead to feto-maternal unfavorable hemodynamic balance (Fig.1). On the one hand, elevation of the arterial blood pressure (BP) of the upper part of the body increases the maternal cardiovascular risk i.e. stroke or aortic dissection. On the other hand, hypo-perfusion of the lower part of the body reduces uterine perfusion, increases fetal risk of preeclampsia, placental insufficiency or fetal growth restriction.

Design and method:
Here, we report the case of a 30-year-old woman with severe hypertension and plans to become pregnant. She previously underwent percutaneous transluminal angioplasty (PTA) and aortic stenting and presented with elevated BP in both arms (right 177/117 mmHg, left 180/121 mmHg) and decreased ABI bilaterally (Tab. 1). A computed tomography angiography of the aorta was performed showing an aortic stent in a supraceliac position with 79% in-stent stenosis. She underwent a new PTA with in-stent re-stenting (Fig. 2).

Results:
Post PCA, the four extremities BP measurements showed a reduction of her BP values and a normalization of the ABI bilaterally (Table 1). 24h-ABPM confirmed the BP reduction (mean 24h- systolic BP of 135 mmHg, diastolic BP of 101 mmHg), but still remaining-elevated. Therefore, we started an antihypertensive treatment with a successful BP control (125/82 mmHg).

Conclusions:
The management of MAC in already pregnant women can be particularly challenging. Indeed, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are contraindicated. Furthermore, PTA during pregnancy expose the fetus to radiation and reports for CoA angioplasty and stenting during pregnancy are very limited. Herby, we decided on an interventional rather than conservative approach. This case illustrates the importance of preconception screening and treatment of chronic hypertension in women with plans to become pregnant. It highlights the fact that secondary causes of hypertension do not have to be overlooked in this population.
ANTIFIBROTIC POTENTIAL OF ANGIOTENSIN (1-7) IN HEMODYNAMICALLY OVERLOADED RAT HEART
Authors: Sykora Matus , Kratky Vojtech , Kopkan Libor , Tribulova Narcis , Bacova Barbara Szeiffova 
Published: June 2023

Objective:
Heart failure is a clinical syndrome characterized by cardiac dysfunction due to structural abnormalities of the myocardium that results in the inability of the heart to eject sufficient volume of the blood to the circulation. HF is a major cause of morbidity and mortality in the world. The ECM is a highly dynamic structure controlling the proper functioning of heart muscle. ECM remodelling with enhanced deposition of collagen due to hemodynamic overload impairs cardiomyocyte adhesion and electrical coupling that contributes to cardiac mechanical dysfunction and arrhythmias.

Design and method:
We aimed to explore ECM and connexin-43 (Cx43) signalling pathways in hemodynamically overloaded rat heart as well as the possible implication of Ang(1-7) to prevent/attenuate adverse myocardial remodelling. Males, 8 weeks-old, normotensive Hannover Spraque-Dawley rats (HSD), hypertensive Ren-2 transgenic rats (TGR) and Ang(1-7)-transgenic rats (TGR(A1-7)) underwent aortocaval fistula (ACF) to produce volume overload. 5 weeks later, were right and left ventricular tissue samples used for biometric, biochemical, and proteomic analyzes.

Results:
Cardiac hypertrophy in response to volume overload was significantly less pronounced in TGR(A1-7) comparing to HSD rats. Moreover, a marker of fibrosis, hydroxyproline, was increased in both ventricles of volume overloaded TGR while reduced in Ang(1-7) right heart ventricle. Protein level and activity of MMP-2 were reduced in both ventricles of volume overloaded TGR/TGR(A1-7) compared to HSD. SMAD2/3 protein levels were decreased in the right ventricle of TGR(A1-7) compared to HSD/TGR in response to volume overload. In parallel, Cx43 and pCx43 implicated in electrical coupling were increased in TGR(A1-7) versus HSD/TGR. PKC↑ and PKC↗ showed a decrease in the TGR group compared to HSD and a decrease in the TGR(A1-7) ACF group compared to HSD and TGR after ACF in both chambers.

Conclusions:
It can be concluded that Ang(1-7) exhibits cardioprotective and anti-fibrotic potential in condition of cardiac volume overload. If we look at the results comprehensively, it can be concluded that Ang(1-7) exhibits cardioprotective and antifibrotic potential in condition of cardiac volume overload. Supported by grants VEGA 2/0006/23, APVV 21-0410.
ROLE OF METALLOPROTEINASES AND ROS GENERATION IN THE AORTA OF ELASTASE-2 KNOCKOUT MICE IN ABDOMINAL AORTIC ANEURYSM MODEL
Authors: Mestriner Fabiola , Ribeiro Mauricio S. , C Ariel Emiliano Souza DO , Dugaich Vinicius Flora , Mel Marcela M. Blascke DE , Bruch Pedro , Kovacs Henrique Z. , Vasconcelos Jocianny , Francisco Daniely F. , Corsi Carlos , Campos Ligia Borges , Neto Julio , Costa Rafael Menezes DA , Castro Michele Mazzaron de , Passaglia Rita Tostes , Becari Christiane 
Published: June 2023

Objective:
Elastase-2 (ELA-2) enzyme generates angiotensin-II (AngII) in arteries and is implicated in abnormal vascular remodeling in animal models. Our group demonstrated previously that ELA-2 knockout (ELA-2KO) mice were less susceptible to developing an aorta dilation in response to AngII infusion. This study hypothesizes that metalloproteinases and ROS generation in ELA-2KO mice mediate less susceptibility to aorta dilation and abdominal aortic aneurysm (AAA).

Design and method:
Male wild type (C57bl/6, WT) and ELA-2KO (CELA-2aTm1Bdr) mice were treated with either saline or AngII (2.28g/g/min) for twenty-eight days by subcutaneously mini-pumps infusion. Mice were divided into four groups: WT treated with saline (WT+SAL, n = 5), ELA-2KO treated with saline (ELA-2KO+SAL, n = 5), WT treated with AngII (WT+AngII,n = 5), and ELA-2KO treated with AngII (ELA-2KO+AngII, n = 5). The vascular ultrasound (US) was done before treatment and once a week during 28 days of treatment. The MMP- 2 and MMP-9 analyzes were done by zymography, ROS generation by DHE analyses, and alfa-actin expression by immunofluorescence in all aorta mice groups. ANOVA and Kruskal Wallis tests were used to compare the average between groups. This study is approved by CEUA (n.131/2019).

Results:
AngII treatment was associated with increased MMPs expression in the WT group aorta (WT+AngII vs. WT+SAL p<0.05). The aorta ELA-2KO group showed no difference in MMPs in response to AngII infusion compared to ELA-2KO+SAL group (p = 0.81). The ROS generation had upregulated in aorta ELA-2KO+Ang II mice compared to ELA-2KO+SAL (p<0.001) and aorta WT+AngII compared with WT+SAL (p<0.0001). AngII treatment was associated with decreased ROS generation in the aorta ELA-2KO+AngII group compared with WT+AngII (p = 0.0051). The alfa-actin expression was similar in all groups. Our data demonstrate that AngII treatment did not increase the expression of MMPs in aorta ELA-2KO but was associated with an upregulation for ROS generation.

Conclusions:
Taken together, this suggests that ELA-2KO mice's resistance to developing an aorta dilation/AAA is related to MMPs and ROX generation. Our results also highlight the importance of the local/tissue response in the pathophysiology of AAA.
LONG TERM EFFECT OF RENAL DENERVATION ON 24 HOUR ABPM AND BLOOD PRESSURE LOAD IS LARGELY DEPENDENT OF BASELINE ARTERIAL STIFFNESS
Authors: Postadzhiyan Arman , Tochev Sotir , Andreeva Lora , Velchev Nizar Rifai Vassil , Finkov Bojidar 
Published: June 2023

Objective:
The aim of the study was to evaluate the long term effect of renal sympathetic denervation (RSD) on 24h ambulatory blood pressure measurement (ABPM) and blood pressure load (BP load) in patients with resistant hypertension depending of the baseline arterial stiffness status.

Design and method:
Consecutive patients with resistant hypertension who underwent RSD workout at the University Hospital Saint Anna, Sofia, ESH Excellence center of hypertension, were included. RSD was performed on the grounds of resistant hypertension defined as mean daytime systolic BP >135 mmHg or diastolic BP >85 mmHg in 24-hr ambulatory blood pressure measurement (ABPM) despite the intake of at least three antihypertensive agents, including a diuretic. Cardio ankle vascular index (CAVI) was measured using the VaSera system (Fukuda Denshi Co, Japan). RSD was performed with the Symplicity Flex™ catheter (Medtronic, Minneapolis, MN, USA) according to a standardized protocol.

Results:
The study included 32 patients with treatment-resistant hypertension and performed successful RSD. CAVI was measured before the intervention and the results of the procedure on 24h daytime, nighttime and 24 blood pressure and systolic and diastolic BP load were evaluated by serial ABPM measurements. A long-term effect of the RSD, reported as a reduction in 24-hour systolic blood pressure above 10 mmHg at month 12, was found in 22 patients (68.8%). Despite similar baseline out-of-office and office blood pressure and concomitant antihypertensive therapy, patients with lower arterial stiffness had a more significant blood pressure effect of renal denervation, a result that persisted within 12 months of follow-up. Along with reduction of all ABPM parameters more profound and clinically meaningful change of BP load during daytime, nighttime and 24h period was also noticed in this group of patients. (Table 1)

Conclusions:
The long term effect of renal denervation on 24h ABPM and BP load is largely dependent of baseline arterial stiffness. The results of the present study justify the incorporation of arterial stiffness evaluation in clinical decision workout of the procedure.
PHARMACOGENOMICS-GUIDED DRUG THERAPY FOR HYPERTENSION
Authors: Sun/Ningling Ningling Sun , Shu/Chang Chang Shu , Zhang/Yanwei Yanwei Zhang 
Published: June 2023

Objective:
The hypertension control rate is only 16.8% in China, and superior reasonable treatment is contributive to improve the rate. This study is aimed to evaluate whether pharmacogenomics-guided drug therapy is superior to conventional therapy in lowering blood pressure.

Design and method:
DNA samples were collected from 93 hypertensive patients. All patients entered a 4-week conventional treatment period, and then entered a 4-week pharmacogenomics-guided drug therapy period (the antihypertensive regimen was adjusted according to the pharmacogenomic report). The hypertension control rate and reduction of blood pressure (BP) were analyzed. High-throughput targeted sequencing panel was designed to detect efficacy and adverse-related genes of 24 commonly used antihypertensive drugs (5 types) and 52 gene loci were analyzed related to drug Efficacy (E): “E-”, “E”, “E+”, Tolerance (T): “T-”, “T”, “T+” and Metabolic (M): “M-”, “M”, “M+”. Clinical drug administration was guided according to relevant judgement results.

Results:
Compared with the conventional therapy group, the hypertension control rate of office and home blood pressure in the precise treatment group increased by 14.75% and 25.81%, respectively. The reduction of BP in the precise treatment group was greater than conventional therapy group ( Table and Figure).

Conclusions:
Compared with conventional therapy, the pharmacogenomics-guided drug therapy can control blood pressure more effectively.
Table. Comparison of Reduction in Office Systolic Blood Pressure (SBP)and Home SBP between the Precise Treatment Group and the Conventional Therapy Group
Figure: Comparison of Reduction in Office SBP and Home SBP between the Precise Treatment Group and the Conventional Therapy Group
NOVEL TARGETED HEALTH PSYCHOLOGY CLINIC REFERRAL IMPROVES BLOOD PRESSURE: PRELIMINARY RESULTS OF A RETROSPECTIVE STUDY
Authors: Jenkins Sian , Cross Ainslea , Khunti Kamlesh , Gupta Pankaj 
Published: June 2023

Objective:
Despite hypertension medications being widely available, many patients do not have adequately controlled blood pressure. Consequently, alternative interventions are required to support patients. Recently, we have established a novel health psychology clinic to provide additional support to help patients improve blood pressure control.
This retrospective study compared outcomes before and after referral to a targeted health psychology clinic. Our aim was to determine the effectiveness of this novel clinic on patient outcomes with a view to improving the service and support rollout in other departments.

Design and method:
Patient notes referred to the Health Psychology clinic were reviewed from October 2020 to December 2022 (audit number: 11703). Patient data was linked anonymised and details reflecting key outcomes, demographics and specific psychology interventions were extracted.

Results:
In the preliminary findings, 11 patients were included for analysis. Patient age ranged from 28-79 years, 18% were female and 45% were White. Patients were prescribed a mean of 3.1 hypertension medications. The mean time between the first blood pressure reading and final reading was 44.1±27.8 weeks, with a mean number of 6.6±6 visits to the clinic. Interventions were tailored to each patient's need. Four patients were supported with anxiety management, three used biofeedback and three used breathing techniques. Two patients were supported with weight management, with one patient losing 31.7kg in 6 months.
The mean systolic blood pressure (SBP) change was -11.55±17.78 mmHg (P = 0.0568), and diastolic blood pressure (DBP) was -5.80±13.15 mmHg (P = 0.1965). Two patients had increased blood pressure for unknown reasons. When these two cases were removed from analysis, the overall mean changes for SBP were -18.11±11.30 mmHg (P = 0.0013) and -9.88± 11.03mmHg for DBP (P = 0.0690). Of these blood pressure readings, 7 were conducted in the office, 2 at home, and 1 with 24hour ABPM.

Conclusions:
Our preliminary findings show that targeted psychological support for hypertensive patients experiencing difficulties with anxiety or depression may improve blood pressure. Health psychology interventions may be suitable to support patients where medication alone does not support optimum hypertension management. Further large prospective studies are needed to confirm these findings.
FACTORS ASSOCIATED WITH PROGRESSION OF ARTERIAL STIFFNESS IN ISCHEMIC STROKE SURVIVORS: THE NORWEGIAN STROKE IN THE YOUNG STUDY
Authors: Eilertsen Rune Krogh , Midtbø Helga , Sindre Rasmus Bach , Waje-Andreassen Ulrike , Gerdts Eva 
Published: June 2023

Objective:
Progressive arterial stiffening may contribute to risk for recurrent cardiovascular events in ischemic stroke survivors. Few studies have investigated sex differences in prospective change in arterial stiffness in this patient group.

Design and method:
Arterial stiffness by carotid-femoral pulse wave velocity (PWV) and ambulatory 24-hours blood pressure (BP) were assessed in 81 women and 190 men included in the Norwegian Stroke in the Young (NOR-SYS) study at 3 months and 5.5 years after the incident ischemic stroke.

Results:
At baseline patients were 49.5 ± 9.9 years old. Women had less prevalent hypertension (48 % vs. 62 %, p<0.05) than men, while age, obesity and smoking prevalence did not differ significantly. During follow-up, BP increased from 129/79 mmHg to 133/83 mmHg in women (p<0.05) and remained statistically unchanged in men (136/83 vs 139/84 mmHg, p = 0.10). Among patients with hypertension, 79% of women were treated at baseline and 77% at follow-up (p = ns), while antihypertensive treatment increased from 82% to 87% in men (p<0.05). Daily smoking was reduced from 47% to 21% in women and from 51% to 21% in men (both p<0.001). Fewer women than men were treated with statins at follow-up (63% vs. 76%, p<0.05). PWV was lower in women than in men both at baseline (7.3 m/s vs. 8.1 m/s) and at follow-up (7.3 m/s vs. 8.0 m/s, both p<0.001), but the average change during follow-up did not differ between genders. In linear regression analysis, increase in PWV was associated with higher 24-hour systolic BP, and lack of antihypertensive treatment at follow-up (both with p<0.05); while no association was found with sex, smoking at follow-up or statin treatment (Table1).

Conclusions:
In ischemic stroke survivors, 5-year increase in PWV did not differ between the sexes and was associated with higher 24-hour systolic BP and lack of antihypertensive treatment, pointing to the importance of antihypertensive treatment in this patient group.
LIPOPROTEIN (A): TREATMENT IN THE METABOLIC CONTEXT
Authors: Joaquim Meireles-Brandao , R. Meireles-Brandao Lucia , Rui Coelho , Francisco Rocha-Goncalves 
Published: June 2023

Objective:
Lipoprotein(a) [Lp(a)] is an independent cardiovascular risk factor but is closely associated with other similar risk factors that are manageable with appropriate treatment and guidance. We aimed to study the impact of using combined therapy for managing Lp(a) levels in patients at high cardiovascular risk but without major adverse cardiovascular events, in primary prevention.

Design and method:
We conducted a retrospective observational study in 516 patients randomly selected from a group of 1677 patients who attended cardiovascular risk and metabolism consultations between 1995 and 2015. The disorders observed and therapies used were classified into nosological and pharmacological groups, respectively. Cardiovascular risk was calculated based on the Framingham risk score, the European Society of Cardiology's SCORE and the American College of Cardiology's ASCVD Risk Estimator, and changes in patients’ lifestyle were assessed.

Results:
Significant differences (p<0.001) were found in almost all metabolic variables, except fasting insulin and C-peptide. Lp(a) levels were also significantly reduced (p<0.001). Carotid intima-media thickness improved, decreasing from 2.90 mm to 1.40 mm; however, there was no reduction in the number of cases of vascular stenosis. Of patients with hepatic steatosis (85.5%), 40.7% presented hepatomegaly, but liver function was only altered in a few patients (14.5%). Lipid-lowering therapy, especially statins, significantly decreased Lp(a), benefiting from synergy with other treatments aimed at other metabolic situations associated.

Conclusions:
Lp(a) is a key overall indicator of vascular risk and should be considered a target in context of combined therapy. Besides a healthy lifestyle, primary prevention should include combined drug therapies to address all cardiovascular risk factors and to delay the atherosclerotic process.
CLINICAL EFFICACY AND SAFETY OF TREATMENT WITH BISOPROLOL AND HYDROCHLOROTHIAZIDE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Cicero Arrigo , Tocci Giuliano , Kennedy Cormac , Grassi Davide , Fogacci Federica 
Published: June 2023

Objective:
To assess the blood pressure (BP) lowering effect and the safety profile of treatment with bisoprolol and hydrochlorothiazide in patients affected by hypertension.

Design and method:
The study was designed in according to guidelines of the 2020 preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement.
A systematic literature search was conducted in multiple electronic databases to identify the randomized controlled clinical studies investigating the effect of combined treatment with bisoprolol and hydrochlorothiazide on BP. Effect sizes for changes in SBP and DBP were expressed as mean differences (MDs) and 95% confidence intervals (95%CIs). For safety analysis, odds ratios (OR) and 95% CI intervals were calculated using the Mantel-Haenszel method.

Results:
Data were pooled from 5 clinical studies. Meta-analysis of available data showed that treatment with Bisoprolol / Hydrochlorothiazide significantly reduced SBP [MD: -8.35 mmHg, 95%CI (-11.44, -5.25) mmHg, P <0.001, compared to control; MD: -9.88 mmHg, 95%CI (-12.62, -7.14) mmHg, P <0.001, compared to placebo] and DBP [MD: -7.62 mmHg, 95%CI (-11.20, -4.04) mmHg, P <0.001, compared to control; MD: -8.79 mmHg, 95%CI (-11.92, -5.67) mmHg, P <0.001, compared to placebo]. Moreover, BP response rate and BP control rate after treatment with Bisoprolol / Hydrochlorothiazide were significantly greater compared to control [Response rate: OR: 4.86 mmHg, 95%CI (2.52, 9.37), P <0.001; Control rate: OR: 1.67 mmHg, 95%CI (1.11, 2.51), P = 0.014]. Finally, treatment with Bisoprolol / Hydrochlorothiazide was associated with a reduced risk of any AE and peripheral edema compared to control.

Conclusions:
Our results show that treatment with Bisoprolol/Hydrochlorothiazide has favorable effects on BP and an good safety profile.
THE INFLUENCES OF ACHIEVED BLOOD PRESSURE ON CARDIOVASCULAR OUTCOMES IN HYPERTENSIVE PATIENTS WITH DIFFERENT LEFT VENTRICULAR GEOMETRIC PATTERN: A PROSPECTIVE COHORT STUDY IN CHINA
Authors: Yicheng Zhu , Yingqing Feng 
Published: June 2023

Objective:
Intensive antihypertensive therapy might bring additional benefits for hypertensive patients with high risks of cardiovascular diseases. The left ventricular(LV) geometric patterns could reasonably stratify cardiovascular risks in hypertensive patients, which might facilitate the selection of individuals who were more suitable for intensive antihypertensive therapy.

Design and method:
This investigation is a community-based, multi-center, prospective cohort study to investigate the geographical profile of cardiovascular disease risk across China. In total, 7680 hypertensive patients were recruited. Firstly, we divided all individuals into four subgroups, including normal geometry(NG), concentric remolding(CR), eccentric hypertrophy(EH) and concentric hypertrophy(CH) based on the diagnostic thresholds recommended by the EACVI/ASE and EMINCA study respectively, respectively. Secondly, we defined the primary endpoint as composite endpoints including the stroke, hospitalization for heart failure and coronary artery disease. We exhibited the hazard ratios of patients with different achieved systolic blood pressure (achieved SBP>140mmHg, 130<SBP< = 140mmHg, and SBP< = 130mmHg) after receiving anti-hypertensive therapy from general practitioners in the NG, CR, EH and CH subgroups based on the diagnostic thresholds of echocardiographic measurements from EMINCA study and EACVI/ASE guideline respectively.

Results:
We firstly validated that the diagnostic thresholds based on EMINCA study could preferably stratify cardiovascular risks for Chinese hypertensive patients considering the racial differences (Figure 1). And we demonstrated the additional benefits from intensive antihypertensive therapy featured by a SBP target lower than 130mmHg only occurred in the patients with CH regardless of according to the diagnostic thresholds from EMINCA study and EACVI/ASE guidelines (Figure 2). Intriguingly, we found the unexpected negative correlation between achieved SBP and occurrence of the primary endpoint in the patients with CR, exhibited by higher cardiovascular risks of patients with a achieved SBP below 130mmHg (Figure 2), which might be due to that CR patients were positively associated with extracardiac organ damage and might be more susceptible to the hypotension and organ hypoperfusion.

Conclusions:
The patients with CH might profit additionally from intensive anti-hypertensive therapy, but it needs to be more cautious in the patients with CR.