bluuebunny/crossref_metadata_2025_split huggingface dataset:
HOME BP MONITORING IMPROVES THE DIAGNOSIS OF HYPERTENSION IN HEMODIALYSIS PATIENTS
Authors: Leonidou Kalia , Kontogiorgos Ioannis , Georgianos Panagiotis , Vaios Vasilios , Karligiotis Apostolos , Georgianou Eleni , Zebekakis Pantelis , Stergiou George S. , Liakopoulos Vassilios , Kollias Anastasios 
Published: June 2023

Objective:
Although routine blood pressure (BP) measurements taken shortly before or after dialysis provide imprecise reflection of interdialytic ambulatory BP, this method continues to form the basis for the diagnosis of hypertension among patients on hemodialysis. Home BP monitoring (HBPM) is a guideline-recommended technique that may improve the diagnosis of hypertension in this population. Using 44-hour ambulatory BP monitoring (ABPM) as the reference-standard method, this study aimed to compare the diagnostic performance of home versus routine pre- and postdialysis BP recordings in hemodialysis patients.

Design and method:
In 70 stable patients with end-stage kidney disease receiving thrice-weekly hemodialysis, BP was assessed with the following methods: (i) routine predialysis and postdialysis BP measurements averaged over 2 weeks; (ii) HBPM for 7 days (dublicate morning and evening measurements, Microlife WatchBP Home N); (iii) ABPM (20 min intervals over an entire interdialytic interval - 44 hours, Microlife WatchBPO3).

Results:
The mean age of the patients was 65.3±13.3 years; 45 patients (64%) were males, and 62 (88.7%) had a known history of hypertension. The mean [95% confidence interval (CI)] of the difference between ambulatory systolic BP (SBP) and (i) predialysis SBP was 11.43 (8.24, 14.62) mmHg, (ii) postdialysis SBP was 3.9 (0.37, 7.56) mmHg, and (iii) home SBP was 8.61 (6.05, 11.17). The area under the receiver operating characteristic curve for the detection of an ambulatory daytime SBP equal or higher than 135 mmHg was significantly higher for home SBP measurements 0.934 (95% CI: 0.871-0.996) as compared to predialysis 0.778 (95% CI: 0.643-0.913) and postdialysis 0.766 (95% CI: 0.623-0.909) BP recordings (P = 0.02 for both comparisons). 1-week averaged home SBP at the cut-off point of 141.0 mmHg provided the best combination of high sensitivity (85.7%) and high specificity (92.9%) in diagnosing systolic ambulatory hypertension.

Conclusions:
The present study shows that among patients on hemodialysis, HBPM for 1 week provides greater accuracy than 2-week averaged routine pre- and postdialysis BP recordings in the diagnosis of hypertension confirmed by the reference-standard method of interdialytic ABPM.
HEALTHY VASCULAR AGEING PROTECTS COMMUNITY DWELLING ELDERLY FROM ALL-CAUSE MORTALITY: 5-YEAR EVIDENCE FROM THE NORTH SHANGHAI STUDY
Authors: Zhongyuan Ren , Jia Ruonan , Xu Yawei , Zhang Yi , Zhao Yifan 
Published: June 2023

Objective:
Healthy vascular ageing (HVA) defined by normal pulse wave velocity (PWV) has been recognized as a valuable indicator of vascular status. And HVA strongly correlates with preclinical targeted organ damage (TOD). While the long-term benefit of HVA remains to be investigated. The study aims to investigate the long-term outcome of population with HVA based on large registered North Shanghai Study.

Design and method:
Since Jun. 2014, 3363 community-dwelling elderly Chinese (age larger than 65 years) were enrolled in the Northern Shanghai Study. HVA was defined as normal carotid femoral PWV that stratified by age and blood pressure. TOD was measured and categorized as vascular TOD indicated by carotid-femoral PWV and ankle-brachial index, cardiac TOD indicated by left ventricular hypertrophy and diastolic dysfunction, and renal TOD indicated by estimated glomerular filtration rate and urinary albumin/creatinine ratio. Follow-up outcome including all-cause mortality, cardiovascular and non-cardiovascular mortalities were evaluated.

Results:
1016 participants (30.2%) with HVA were identified. Compared with non-HVA group, although no gender difference, HVA group had younger age, lower blood pressure, lower body mass index (BMI), and milder TODs. Through a follow-up period of 5.7±1.8 years, 233 (6.9%) all-cause deaths, including 94 (2.8%) cardiovascular deaths were observed. Participants with HVA showed significantly higher survival from all-cause deaths (Log-rank P = 0.002) and cardiovascular deaths (Log-rank P = 0.003), but statistically non-significant survival from non-cardiovascular deaths (Log-rank P = 0.098). Subgroup analysis showed that HVA was a significant protective factor in female (HR 0.412 (0.245, 0.692), P = 0.002), participants aged 65-70 (HR 0.417 (0.194, 0.897), P = 0.025), participants with BMI<25 (0.570 (0.386, 0.842) P = 0.005), and participants with at least 1 TOD (HR 0.634 (0.444, 0.907), P = 0.013). Moreover, the protective value of HVA was only significant in participants without cardiac TOD (0.681, (0.464, 0.998), P = 0.049), participants with renal TOD (0.547, (0.354, 0.844), P = 0.006), and participants with vascular TOD (0.461 (0.251, 0.848), P = 0.013).

Conclusions:
In community-dwelling elderly, HVA could be a significant protective factor for all-cause deaths, especially in subpopulation of female, age 65-70, BMI<25 and with renal and/or vascular TOD.
PREDICTABILITY OF LOW OFFICE SYSTOLIC BLOOD PRESSURE FOR LOW HOME SYSTOLIC BLOOD PRESSURE IN THE PATIENT CONSIDERED FOR DOWN TITRATION OF ANTIHYPERTENSIVE MEDICATION
Authors: Shin Jinho , Lee Yonggu , Heo Ran , Kim Hyun Jin , Kim Byung Sik , Shin Jeong-Hun , Pyun Wook Bum 
Published: June 2023

Objective:
With the recent trend of intensive blood pressure (BP) control strategy, some patients are considered for down-titration when office systolic BP (SBP) go below 120 mmHg. Considering many factors related to visit to visit BP variability and the discrepancy between office and out of office BPs, the predictability of low office SBP for low home SBP needs to be studied.

Design and method:
In a retrospectively study design, during 2020.09.01∼2022.05.31, patient recommended for home blood pressure monitoring (HBPM) for the decision for down-titration by physician's discretion. Physician's discretion was regarded to be present when OSBP < 120 mmHg. Additionally, patient data in the next visit in whom incidental home SBP were < 120mmHg were added for the analysis for the predictability and concordance of low office SBP for the low home SBP in the next visit, and the sustainability of the low office SBPs were calculated.

Results:
Among 82 enrolled patients, 69 patients with complete pre-HBPM office SBP, office SBP and HBPM data at the next visit were available were analyzed. Home SBP (112.1±8.9 mmHg, p<0.001 for both) were significantly lower than pre-HBPM (123.0±17.8 mmHg) office SBP and office SBP at the next visit (122.5±12.9 mmHg). Among 33 patients with low pre-HBPM office SBP, 28 patients (85.5%) showed low home SBP. Low pre-HBPM office SBP were sustained in 17 patients (51.5%). Among 59 patients with low home SBP, 31 patients (52.5%) were pre-HBPM office SBP were 120 mmHg or higher. At the time of HBPM, overall concordance rate between low office SBP and low home SBP were 33.3% (23 patients).

Conclusions:
The predictability of office SBP for low home SBP is good enough to decide down-titration at the next visit and the low office SBP were sustained in more than a half. But a half of low home SBP patients is detected incidentally by HBPM. Whether routine HBPM for down-titration will be needed for patients’ safety needs further study.
CONSENSUS TOWARDS THE UTILISATION OF BISOPROLOL IN COMBINATION WITH TELMISARTAN IN INDIAN PATIENTS WITH HYPERTENSION
Authors: Sawhney Jps , Garg Rajeev , Makkar Jitendra , Dani Sameer , Guha Santanu , Dalal Jamshed , Ray Saumitra , Agarwal Rajeev , Kaul Upendra , Solanki Dharmesh 
Published: June 2023

Objective:
To formulate a consensus statement for the utilization of bisoprolol in combination with telmisartan based on the contemporary evidence and the real-world experiences of the Indian cardiologists

Design and method:
A virtual collaborative educational initiative was convened from November 2022, to December 2022, through a series of 8 nationwide virtual interactive meetings by leading cardiologists (n = 90) at the forefront of cardiovascular care (CERTAIN Study Group). The cumulative clinical experience was approximately 2,500-man-years, who rated their level of agreement for 14 questions with each item on a 5-point Likert scale. This was preceded by a contemporary evidence-based discussion on the contemporary updates for hypertension and for the combination of bisoprolol (beta blocker) and telmisartan (ARB). Weighted mean for the Likert scale was calculated and consensus was pre-defined as a score > 100. GraphPad 9.4.0 and ANOVA were used for statistical analysis.

Results:
The highest agreement score was for the concurrence for the diabetes have consistently higher risks over the whole BP range (127), bisoprolol is a suitable choice for management of Left Ventricular Dysfunction post MI (124), bisoprolol has impactful clinical implications for modulation of resting heart rate in patients with CAD (123), telmisartan has a distinctive pharmacological properties that translate into a clinically relevant approach for management of hypertension (122), bisoprolol is beneficial in patients with hemodialysis (120), bisoprolol in combination with telmisartan is useful in patients with co-morbidities (115), bisoprolol has modulatory properties for the impact of remodelling in patients with heart failure (111), bisoprolol in combination with telmisartan is a useful tool to manage hypertension. (Figure). The highest mean response scores (±SD, 95% CI) for consensus were for agree (25±10, 95% CI 19 to 31) followed by strongly agree (14±11, 95% CI 7.6 to 20)

Conclusions:
We observed a high preference for the combination of bisoprolol with telmisartan for use in patients with hypertension with comorbidities. We attribute this to a high level of perceived effectiveness, based on the recent clinical trials.
BLOOD PRESSURE MEASUREMENTS IN HYPERTENSIVE PATIENTS OVER 60 YEARS OLD IN A PRIMARY CARE HEALTH CENTER NEAR BY A BIG CITY: WHAT ABOUT THE THERAPEUTIC GOALS?
Authors: Filippelli Leila Ayelen Miserque , Lemo Tatiana , Miserque Wadit 
Published: June 2023

Objective:
Until today we have no universal worldwide definition about the value to be used to determine if the patient have arterial hypertension or not, even worse in the elderly, such an special population with all the risk arround to not have blood pressure (BP) under control.
It is that according to differents guidelines that we relies on for diagnosis and treatment.
For example, for the European Society of Cardiology/European Society of Hypertension (ESC/ESH) is defined as a systolic BP (SBP) greater than or equal to 140 mmHg or a diastolic BP (DBP) greater than or equal to 90 mmHg, Against to the American College of Cardiology and the American Association of Cardiology (ACC/AHA) that define as a normal BP less than 120/80 mmHg. Meanwhile for the Argentine Society of Cardiology (SAC) BP would be less than 130 and/or 85 mmHg.
To determine if the hypertensive population that participated in this study meets the therapeutic goals proposed in the guidelines or not.

Design and method:
We included patients older than 60 years old previusly diagnosed with arterial hypertension who where attended between march and june in 2022, retrospectively. They were classified according to age and sex and blood pressure value at the time of the evaluation, taken according to recommendations.

Results:
855 hypertensive subjects were recruited (female 28%, 71,9±7,8 years); with an average SBP of 138.9±17,4 mmHg, an average DBP of 85.9±12,9 mmHg and an average mean pressure (MAP) of 103.5±13,8 mmHg.
Table 1 shows the results obtained for SBP, DBP, and MAP according to age.

Conclusions:
No matter which guideline is taken as reference, the vast majority of the hypertensive population studied continues without controlling their BP values, finding themselves above the goals of any of the mentioned guides, knowing the great risk that this can cause in this such a special population. More universal studies are needed to achieve a global reference value.
SMARTPHONE-BASED OPHTHALMOSCOPY TO DIAGNOSE HYPERTENSIVE CRISIS IN THE EMERGENCY DEPARTMENT: A PILOT STUDY
Authors: Kalic Haris , Broddin Bregt E.K. , Kramer Suzanne C. , Mostard Guy J.M. , Buijs Jacqueline , Twist Daan J.L. van 
Published: June 2023

Objective:
Suspected hypertensive crisis requires comprehensive evaluation in the emergency department(ED). Fundoscopy is of pivotal importance to diagnose grade III&IV hypertensive retinopathy which requires prompt intravenous blood pressure control. However, routine fundoscopy by ophthalmologists is time-consuming and delays treatment. In this pilot study, we introduced smartphone-based ophthalmoscopy to evaluate its feasibility as a faster alternative.

Design and method:
We retrospectively evaluated ED length of stay in all patients who underwent smartphone-based ophthalmoscopy for suspected hypertensive crisis. Smartphone-based ophthalmoscopy included 30-second retinal video recordings performed by residents, which were remotely evaluated by an ophthalmologist. Patients were matched in a 1:3-ratio to a historical cohort who underwent conventional fundoscopy by an ophthalmologist. We evaluated ‘total time in ED(TTED)’ which is time in waiting room(TIW) until ED-discharge for all patients and ‘true treatment time(TTT)’ defined as TTED minus TIW for a subset of patients.

Results:
38 patients with hypertensive crisis underwent smartphone-based ophthalmoscopy. 5 were excluded because of technical difficulties requiring conventional fundoscopy and 2 due to inadequate time-registration. Consequently we included 31 patients and matched them with 93 controls. Mean TTED was 196±65min for the smartphone-group and 225±75min for the control-group(p = 0.059). Mean TTT (available for 19 and 81 patients, respectively) was significantly lower in the smartphone-group: 171±64min vs. 217±75min(p = 0.015). Additional survival analysis revealed shorter ED-stay in the smartphone-group (p = 0.030 & p = 0.011 for TTED & TTT, respectively).

Conclusions:
The use of smartphone-based ophthalmoscopy in suspected hypertensive crises was feasible and associated with reduction of treatment time in the ED as compared to conventional fundoscopy by an ophthalmologist.
ELUCIDATING LOCAL PHOSPHODIESTERASE 3A SIGNALING AS A BASIS FOR GAINING INSIGHT INTO HYPERTENSION-DRIVING MECHANISMS
Authors: Liu Tiannan , Zuhlke Kerstin , Sholokh Anastasiia , Klussmann Enno 
Published: June 2023

Objective:
Mutant PDE3A causes hypertension by driving mechanisms that increase peripheral vascular resistance. However, the media to lumen ratio of vessels in mutant PDE3A rat models varied between second-order mesenteric arteries and thoracic aorta. This observation may be related to alterations of the mutant PDE3A in its intracellular location, its hyperactivity and aberrant phosphorylation, which could lead to altered compartmentalized cAMP signaling. PDE3A hydrolyzes cAMP. Therefore, we hypothesized that alterations in compartmentalized cAMP signaling in vascular smooth muscle cells (VSMC) contributes to the hypertension.

Design and method:
Three different VSMC models were established: VSMCs from rat thoracic aorta, VSMCs from rat secondary mesenteric arteries and VSMCs expressing mutant PDE3A that were differentiated from human induced pluripotent stem cells. The expression levels of PDE3A and candidate genes were detected by immunofluorescence microscopy, Western blotting and qPCR based on results of RNA sequencing. cAMP and Ca2+ signaling pathways are being evaluated by FRET technology and Ca2+ imaging.

Results:
VSMCs differentiated from human induced pluripotent stem cells could detect abundant expression of vascular smooth muscle cell markers. Differential expression levels of PDE3A and the two screened candidate genes were found in different types of VSMCs.

Conclusions:
Elucidating differences in cAMP and Ca2+ cycling between different types of VSMCs yielded new insight into the mechanisms of hypertension. The mutant PDE3A signaling may be a starting point for an innovative, PDE3A compartment-specific pharmacological concept for the treatment of hypertension.
PEAK HOME BLOOD PRESSURE AS AN EARLIER AND STRONG NOVEL RISK FACTOR FOR STROKE: THE PRACTITIONER-BASED NATIONWIDE J-HOP STUDY EXTENDED
Authors: Kario Kazuomi , Tomitani Naoko , Fujiwara Takeshi , Okawara Yukie , Kanegae Hiroshi , Hoshide Satoshi 
Published: June 2023

Objective:
While home blood pressure (BP) measurement is recommended for hypertension management, the clinical implications of peak home BP values have not been well studied. This study investigated the association between pathological threshold or frequency of peak home BP and cardiovascular events in patients with > = 1 cardiovascular risk factor.

Design and method:
The Japan Morning Surge-Home Blood Pressure(J-HOP) study enrolled participants from 2005–2012 with extended follow-up from December 2017 to May 2018, which generated the dataset for this analysis. Average peak home systolic BP (SBP) was defined as average of the highest three BP values on 14-day measurement period. Patients were divided into quintiles of peak home BP, and the risk of stroke, coronary artery disease (CAD) and atherosclerotic cardiovascular disease (ASCVD; stroke+CAD) was determined.

Results:
In 4231 patients (mean 65 years) followed for 6.2years there were 94strokes and 124CAD events. The adjusted hazard ratio (HR) (95% CI) for the risk of stroke and ASCVD in patients with average peak home SBP in the highest versus lowest quintile was 4.39(1.85–10.43) and 2.04(1.24–3.36), respectively. Risk was greatest for stroke in the first 5 years: HR 22.66(2.98–172.1). The pathological threshold of average peak home SBP for 5-year stroke risk was 176 mmHg. There was a linear association between the number of times peak home SBP >175 mmHg and stroke risk.

Conclusions:
Peak home BP was a strong risk factor for stroke, especially within the first 5 years. We propose exaggerated peak home SBP >175 mmHg as an early and strong novel risk factor for stroke.
SEASONAL EFFECT ON BLOOD PRESSURE VARIABILITY IN HYPERTENSIVE PATIENTS ASSESSED BY DIFFERENT MEASUREMENT METHODS
Authors: Kollias Anastasios , Kyriakoulis Konstantinos , Menti Ariadni , Ntousopoulos Vasileios , Destounis Antonios , Kalogeropoulos Petros , Myrsilidi Aikaterini , Stergiou George S. 
Published: June 2023

Objective:
The seasonal variation in temperature is well known to affect the level of blood pressure (BP). However, its impact on BP variability is uncertain. This study investigated the seasonal variation in BP variability in hypertensive patients assessed using office and out-of-office BP measurements.

Design and method:
Adult hypertensives on stable antihypertensive drug treatment were assessed with office (OBP), home (HBP), and ambulatory BP (ABP) measurements in winter, next summer, and in the next winter. BP variability was quantified using the standard deviation (SD) and coefficient of variation (CV).

Results:
Fifty-eight participants had complete data for winter and summer (mean age 65.2±7.9 [SD], 64% males, 21% obese, 48% smokers, 11% diabetes, 18% cardiovascular disease, 28% on a single antihypertensive drug, 38% on 2 drugs, 34% on > 2 drugs). OBP, HBP and daytime ABP were lower in summer than in winter (P<0.01), whereas nighttime ABP was unchanged (P = NS) (Figure). SD and CV for systolic OBP were higher in winter than summer (P<0.01/<0.05, respectively). BP variability assessed by HBP and ABP measurement did not differ in winter and summer (Figure). Forty participants had complete data for winter-summer-next winter. OBP, HBP and daytime ABP were higher in the second winter compared with summer excluding any order effect. Respective CV values showed no difference (p = NS).

Conclusions:
These preliminary data suggest that despite the considerable impact of seasonal changes in temperature on the levels of BP, its variability is not affected. Thus, variability appears to be an intrinsic feature of the individual's BP behaviour, which is largely unaffected by extrinsic seasonal factors.
ASSOCIATION OF AMBULATORY AND HOME BLOOD PRESSURE VARIABILITY FOR CARDIOVASCULAR OUTCOMES
Authors: Narita Keisuke , Hoshide Satoshi , Kario Kazuomi 
Published: June 2023

Objective:
Although blood pressure (BP) variability (BPV) is reportedly associated with cardiovascular prognosis, there is no evidence that either ambulatory BPV (ABPV) or home BPV (HBPV) is a superior clinical marker.

Design and method:
We analyzed the association of ABPV and HBPV with cardiovascular prognosis in 1,319 hypertensive outpatients who underwent both home and ambulatory BP measurements in the Japan Morning Surge-Home Blood Pressure (J-HOP) study. BPV is evaluated by standard deviation (SD), coefficient of variation (CV), and average real variability (ARV) of 24-h ambulatory and average morning and evening home systolic BP.

Results:
During the median 6.9 years of follow-up, 109 cardiovascular events occurred. All SD, CV, and ARV of HBPV were significantly associated with cardiovascular risk even after adjusted by ABPV (1-SD of HR [95%CI] in SD, CV, and ARV of HBPV: 1.47 [1.23–1.75]; 1.48 [1.24–1.75]; and 1.33 [1.14–1.54]). In the model improvement using goodness-of-fit, HBPV values significantly improved the model predictability when adding to the model including confounding factors and mean 24-h ambulatory SBP and ABPV values. However, these relationships were not shown in ABPV parameters.

Conclusions:
Based on the findings from this study using both ambulatory and home BP monitoring in the same individuals, HBPV, i.e., day-to-day BPV, was suggested to have superiority in predicting for cardiovascular incidence compared to ABPV, i.e., short-term BPV through 24-hours.
ASSOCIATION BETWEEN MASKED NOCTURNAL HYPERTENSION AND DEPRESSION DISORDER IN COVID-19 POSITIVE PATIENTS
Authors: Koh Jong Hoon , Kim Miyoung , Kang Minjong 
Published: June 2023

Objective:
An effect of depression for masked hypertension are scarce. We evaluated the prevalence and clinical characteristics of masked nocturnal hypertension (MNH) under hypertension in COVID 19 positive patients

Design and method:
The study evaluated 158 hypertensive patients with COVID 19 positive and depression disorder, evaluated by self BP monitoring. Among the participants, classified as masked nocturnal hypertension(MNHT) ( Daytime BP below 135/85 mmHg and night-time BP over 120/70 mmHg.

Results:
COVID 19 positive patients with depressive symptoms had a significantly higher incidence of hypertension in women compared to men with depressive symptoms. In the logistic regression analysis, the presence of depressive symptom was significantly associated with masked hypertension with COVID 19 positive independently of age, body mass index, education level, and current smoking and drinking status.

Conclusions:
COVID 19 positive patients with Depressive symptoms were highly associated with the incidence of hypertension among middle aged women and The highly significant predictive risk factor of depression disorder might be high nighttime BP. Comparison of clinic BP with either daytime high BP or awake high BP