bluuebunny/crossref_metadata_2025_split huggingface dataset:
IS THERE A DOSE OF CYPROTERONE ACETATE LOW ENOUGH TO AVOID HYPERTENSION DEVELOPMENT IN YOUNG TRANSGENDER WOMEN?
Authors: Kuzior Agnieszka , Rios-Gomez Carlos , Santana-Ojeda Borja , Leon-Durango Ricardo Jose De , Hernandez-Lazaro Alba , Arnas-Leon Claudia , Acosta-Calero Carmen , Ortiz-Hernandez Catherine Pino , Perez-Rivero Jennifer Maria , Martinez-Martin Francisco Javier 
Published: June 2023

Objective:
Cyproterone acetate (CPA) is a progestagen receptor agonist and androgen receptor antagonist widely used in gender-affirming hormonal therapy (GAHT) for transgender women. It is devoid of the mineralocorticoid blocking effect of native progesterone, thus its combination with oestradiol may elicit hydrosaline retention and hypertension. In a retrospective analysis we have found that using CPA for 5 years in young transgender women increases very significantly their SBP and their incidence of hypertension. Due to risks such as meningioma and liver toxicity, the European Medicines Agency (EMA) recommends avoiding doses >10 mg/day if possible; however, present guidelines for GAHT recommend doses up to 100 mg/day. While lower doses may be effective and safer, the dose-dependence for hypertension development with CPA has not been studied. We undertook to study the association between the cumulative dose of CPA in young transgender women and their incidence of hypertension.

Design and method:
Retrospective review of the clinical records of female transgender people <30-years-old treated with oestradiol + CPA for 5 years. All subjects gave informed consent. They were stratified by quartiles of cumulative CPA intake. We were unable to use doses < 25 mg/day, as only 50 mg pills are available.

Results:
Data were obtained from 56 subjects. The global adjusted annualized incidence of hypertension 4.96% vs. 0.98% in the reference population (transgender women treated with oestradiol without antiandrogen). By quartiles the incidences were 2.52%/4.13%/5.76%/7.31%, p <0.001 (Figure 1A). Their global adjusted SBP increase was 14 vs. 3 mmHg; by quartiles 7/11/16/22 mmHg, p <0.001 (Figure 1B).

Conclusions:
We found a clear dose-dependence for the incidence of hypertension associated with CPA in young transgender women, but even the lowest doses we were able to manage did significantly increase the risk. We cannot however rule out that doses as low as 10 mg/day may be effective and safer. We believe that the present recommendations of high CPA doses for GAHT should be reconsidered.
PRIMARY ALDOSTERONISM: THE EFFECT OF SPECIFIC TREATMENT ON RENAL FUNCTION
Authors: Concistrè Antonio , Petramala Luigi , Ricca Ilaria Della , Servello Adriana , Circosta Francesco , Cavallaro Giuseppe , Letizia Claudio 
Published: June 2023

Objective:
The aim of the study was to evaluate the changes in eGFR in patients with idiopathic primary aldosteronism (IHA) and with aldosterone-secreting adenoma (APA) after specific therapy.

Design and method:
From January 2018 to March 2022, we consecutively enrolled 99 patients with PA distinguishing 75 with IHA (mean age 53.41±11.97 years) and 24 with PA (average age 48.79±8.96 years). We evaluated anthropometric, biochemicals and hemodynamic parameters at diagnosis and 12 months after pharmacological or surgical therapy.

Results:
Patients with IHA, pharmacologically treated with mineralocorticoid receptor antagonists (MRAs), showed a higher incidence of chronic renal failure and a faster progression of renal damage than in patients with APA who underwent unilateral adrenalectomy. The reduction of eGFR was significantly greater in patients with IHA than in APA (92.03±17.58 vs 86.63±18.89 mL/min/1.73m2, p <0.001). Systolic blood pressure (SBP) levels and increased aldosterone-to-renin ratio were found to be independent predictors of renal function decline (ß = 0.034; p = 0.045 and ß = 0.248; p = 0.032, respectively).

Conclusions:
Our results show that patients with PA undergoing surgical treatment have a better renal outcome than those receiving drug therapy. An early diagnosis of APA would allow intervention before renal damage occurs.
PHEOCHROMOCYTOMA AS A RARE CAUSE OF MYOCARDIAL INFARCTION
Authors: Avetisyan Kristine , Chirkinyan Mkrtich , Mnacakanyan Anahit 
Published: June 2023

Objective:
A 41-year-old man was admitted to the cardiac care unit with acute chest pain radiating to his left arm. For the previous 20 years, he had episodes of high blood pressure accompanied by shivering, sweating, anxiety, and headaches. Electrocardiography revealed ST elevation in the II, III, and aVF leads, as well as reciprocal ST depression in the I and aVL leads. Echocardiography showed hypokinesis of the mid inferior and basal inferior segments. Troponin level increased from 0.005 to 0.177 ng/ml. Aneurysms in the coronary arteries were discovered during an urgent coronary angiography. The patient was prescribed aspirin, angiotensin-converting enzyme inhibitor, and calcium channel blocker and discharged from the hospital.

Design and method:
Further testing included computed tomography (CT) of the aorta and coronary arteries. The aorta had no pathological findings, but the right coronary artery was dilated in the middle segment. A CT scan of the abdomen revealed a mass in the left adrenal gland, and later abdominal and retroperitoneal magnetic resonance imaging revealed a lipid-poor left adrenal mass. Biomarkers of adrenal gland function were evaluated and blood adrenalin (150 pg/ml normal range ‹125pg/ml) and noradrenalin (680pg/ml normal range ‹600pg/ml) levels were mildly elevated. The 24-hour urinary vanillylmandelic acid level was elevated (76,6umol vs. the normal range of 68umol). Cortisol and aldosterone levels in the blood were within normal ranges. Lateral transperitoneal adrenalectomy was eventually performed successfully.

Results:
Histological examination of the mass revealed a pheochromocytoma. The patient's blood pressure returned to normal after the left adrenalectomy, and episodes of sweating and anxiety accompanied by an acute increase in blood pressure disappeared.

Conclusions:
Pheochromocytoma is a rare neuroendocrine tumor that can cause life-threatening cardiovascular complications such as myocardial infarction and cardiac arrhythmias. Unfortunately, the clinical pattern of pheochromocytoma frequently remains without typical manifestations and needs detailed laboratory and radiological confirmation. This case emphasizes the importance of a comprehensive assessment of the patient with arterial hypertension, even in the presence of subclinical sympathetic overactivity.
INTERMACHINE VARIABILITY BETWEEN THE SPHYGMOCOR CVMS AND SPHYGMOCOR XCEL DEVICE IN YOUNG HEALTHY ADULTS: A PILOT STUDY
Authors: Vandecruys Marieke , Smet Stefan De , Leunis Sofie , Beir Jasmine De , Nagler Evi , Calders Patrick , Monbaliu Diethard , Cornelissen Véronique , Craenenbroeck Amaryllis H. Van 
Published: June 2023

Objective:
Carotid-femoral pulse wave velocity (cf-PWV) is considered the gold-standard measure for arterial stiffness. The SphygmoCor CVMS uses applanation tonometry on the carotid and femoral arteries, synchronized with an ECG signal. The more recent SphygmoCor XCEL eliminates the need for ECG gating by utilizing leg cuff detection of the femoral pulse in conjunction with carotid tonometry. The latter method is more time-efficient, but may yield different cf-PWV values. The aim of this pilot study is to validate the use of the SphygmoCor XCEL against the SphygmoCor CVMS.

Design and method:
Measurements of the right carotid and femoral artery were conducted using the SphygmoCor CVMS (AtCor Medical), immediately followed by the SphygmoCor XCEL (AtCor Medical). These measurements were performed under standardized conditions, namely in a fasted state and after 15 minutes of rest in a supine position in a quiet room (20̊). All measurements were done in triplicate and were repeated when they did not meet the quality control guidelines, as defined by the manufacturer. The mean difference and SD of the difference between the two devices was calculated and visualized through scatter plot and Bland-Altman analysis. Correlation coefficient as well as intraclass correlation (ICC) was calculated.

Results:
A total of nine (5 females) non-smoking, physically active individuals were included, with a MEDIAN age of 21 years (21-36) and MEDIAN BMI of 21.8 (18,4-25,8). Mean cf-PWV measured by SphygmoCor CVMS was 8.11 ± 0.69 m/s and by SphygmoCor XCEL was 7.61 ± 0.16 m/s. Measurements by both techniques were significantly correlated (R = 0,75; P<0,05; Fig1). The mean difference between the two measurement techniques was 0.50 ± 0.81 m/s, which is ‘acceptable’ according to the ARTERY Society guidelines. Bland-Altman analysis revealed limits of agreement ranging from -1.09 to 2.09 m/s. A ‘moderate’ agreement was documented (ICC = 0.51).

Conclusions:
In this pilot study, the SphygmoCor XCEL demonstrated acceptable agreement with the SphygmoCor CVMS. Bland-Altman plots show that with higher cf-PWV values, there could be a tendency towards overestimation of the cf-PWV by the SphygmoCor EXCEL. Further validation is needed in larger cohorts and other populations.
ARTERIAL STIFFNESS IS A DETERMINANT OF THE WHITE-COAT EFFECT IN YOUNG SUBJECTS IN THE INITIAL STAGES OF HYPERTENSION
Authors: Saladini Francesca , Rattazzi Marcello , Vriz Olga , Mos Lucio , Garavelli Guido , Cozzio Susanna , Mazzer Andrea , Garbelotto Raffaella , Palatini Paolo 
Published: June 2023

Objective:
The white-coat effect (WCE) evaluated from the difference between office and ambulatory blood pressure (BP) is often pronounced in young hypertensive subjects chiefly in people with isolated systolic hypertension (ISHY). The WCE in this setting is considered to merely reflect the alarm reaction to doctor's visit and to be a benign phenomenon. However, the WCE might be amplified in subjects with stiffer arteries. The aim of this study was to investigate whether the WCE in the young is influenced by individual vascular characteristics and whether this putative association may differ according to hypertension subtype.

Design and method:
We examined 371 young-to middle age participants (mean age 31.1±8.7 years, 74.7% males). BP phenotypes were identified using ambulatory BP with a 24-hour BP cut-off of 130/80 mmHg. ISHY was present in 24.2 % of participants, isolated diastolic hypertension in 20.0%, systolic-diastolic hypertension in 30.1%, and normotension in 25.7%. Vascular stiffness was assessed by radial-carotid pulse wave velocity (PWV) and vascular compliance by radial tonometry. 24-hour urinary catecholamines were measured with HPLC in 101 participants. The association of WCE with arterial functional indexes was assessed with multivariable linear regression analysis controlling for ambulatory BP. Improvement in the models was expressed by the difference in the Akaike index(↗ AIC)

Results:
In the whole group, PWV was a significant predictors of the WCE with a ↗AIC of 9.9 (p = 0.001). In addition, a negative association was found between the WCE and large artery (p = 0.001) or small artery (p = 0.002) compliance. Twenty-four-hour urinary epinephrine and nor-epinephrine were totally unrelated to WCE. PWV was a significant predictor of the WCE also among the participants with ISHY with a ↗AIC of 8.2 (p = 0.002). This association was not present in the participants with isolated diastolic hypertension (p = 0.15) or systolic-diastolic hypertension (p = 0.28).

Conclusions:
These data indicate that arterial stiffness rather than sympatho-adrenergic activity is an important determinant of the surrogate measure of the WCE in young subjects in the initial stage of hypertension. This association was confirmed in the subgroup of participants with ISHY suggesting that in some individuals ISHY may not be a benign condition.
ESTIMATED PULSE WAVE VELOCITY AND ALL-CAUSE AND CARDIOVASCULAR MORTALITY IN GENERAL POPULATION - (EHUH STUIDY -CROATIAN SCIENTIFIC FOUNDATION)
Authors: Radunovic Danilo , Blagus Luka , Bosnjak Vito , Domislovic Marija , Glavic Mihaela Marinovic , Kos Jelena , Vrkic Tajana Zeljkovic , Pecin Ivan , Jelakovic Ana , Premuzic Vedran , Dika Zivka , Domislovic Viktor , Prelevic Vladimir , Gellineo Lana , Capak Krunoslav , Jelakovic Bojan 
Published: June 2023

Objective:
Carotid-femoral pulse wave velocity (cfPWV) was recommended by guidelines as biomarker and independent predictor of cardiovascular (CV) events. Measurements of cfPWV is demanding and expensive method. It was suggested that an estimated PWV (ePWV) could be used. Our aim was to analyze the predictive role of ePWV for CV and all-cause mortality in general population.

Design and method:
In stratified random sample of 1087 subjects from the general Croatian adult population (EH-UH study) (men 42.4%, average age 53 +/-16) subjects were followed for 17 years. Mortality data were obtained from Croatian Institute of Public Health. In the follow-up period 1060 patients had all the data on death. ePWV was calculated using formula: ePWV = 9.587-0.402 × age + 4.560 × 10-3 × age2-2.621 × 10-5 × age2 × MBP + 3.176 × 10-3 × age × MBP-1.832 × 10-2 × MBP. MBP = (DBP) + 0.4(SBP-DBP).

Results:
At the end of follow up period 228 deaths (all-cause mortality 20.9%; CV, stroke, cancer, dementia and degenerative diseases, cold, others 43.4%, 10.5%, 28.5%, 5.2%, 3.1%, 9.3%, respectively). In the 2nd ePWV tertile there were more deaths due to cancer than from CV disease (46% vs. 30%), while in the 3rd tertile we observed opposite (20.5% vs. 51.04%). In the analysis of survival of subjects classified into the ePWV tertiles when all-cause and CV death and mortality were observed, the probability of survival of the 3rd tertile compared to the 2nd and 1st tertiles were significantly lower (p< 0.001 Log Rank test (Mantel-Cox)) (Figure 1). In unadjusted model, in Cox regression ePWV was significant predictor for CV death and for each increase of 1m/s there was 14% increase risk for CV death. In multivariate analyses ePWV was neither independent predictor for all-cause nor for CV mortality (p>0.05). However, in u subgroup of subjects with higher CV risk we found ePWV to be a significant predictor of CV deaths (ePWV (m/s) β 1.108; p<0.029; HR 3.03,95% CI 1.118-8.211).

Conclusions:
In general population ePWV is associated with higher all-cause and CV mortality, although not independently of other risk factors. However, in a subgroup of subjects with high CV risk, ePWV was significant and independent predictor of CV mortality. Further studies are needed before ePWV could be recommended in general clinic work.
OBESITY AND DYSLIPIDEMIA IN WOMEN LIVING IN THE CROATIAN RURAL AREA DAMAGED BY AN EARTHQUAKE. “THE SILENT KILLER HUNT”- CROATIAN SOCIETY OF HYPERTENSION PROJECT
Authors: Prgomet Luka , Bilic Katarina , Skelin Juraj , Vogrinc Dora , Vujanic Sara , Vuksic Antonia , Zeljko Lucija , Jelakovic Bojan 
Published: June 2023

Objective:
Obesity is a worldwide health issue that negatively impacts many aspects of normal life. There are many tests and parameters that can give insight into someone's health status, one of them being the lipid panel.
Our aim was to assess the association between anthropometric parameters and lipid status (HDL, LDL, total cholesterol and triglycerides) of women in the Croatian rural area damaged by an earthquake.

Design and method:
We collected blood samples of 165 female subjects (opportunistic screening), In addition, we measured by using a metabolic scale with a body composition monitor: three different fitness indicators: body mass index (BMI), waist circumference (WC) and mid-upper arm circumference (MIAC).

Results:
Average values of BMI, WC, and MIAC were 29.8 ± 6.04 kg/m2, 98.1 ± 15.90 cm, 31.6 ± 4.30 cm, respectively, and average values of LDL-cholesterol, HDL-.cholesterol, triglycerides, and total cholesterol were 3.34 ± 0.93 mmol/l, 1.44 ± 0.33 mmol/l, 1.57 ± 0.90 mmol/l, 5.48 ± 1.08 mmol/l, respectively. HDL-cholesterol shows a significant negative correlation with the BMI (r = -0.168, p = 0.031) WC (r = -0.168, p = 0.032) MIAC (r = -0.200, p = 0.010) and a significant positive correlation of triglycerides with BMI (r = 0.162, p = 0.038) WC (r = 0.244, p = 0.002); MIAC (r = 0.174, p = 0.026).

Conclusions:
Based on the given results we can conclude that the prevalence of dyslipidemia in women living in rural areas is very high. Observed association with HDL-cholesterol and triglycerides with anthropometric measures points to a need to consider those two lipid parameters equally serious as total and LDL cholesterol. Simple and reliable measurements, like waist circumference and BMI, could be used in the assessment of someone's health status since they provide us with valuable insights into their lipid profile.
VISCERAL FAT IS ASSOCIATED WITH HIGH BLOOD PRESSURE IN A RURAL POPULATION FROM THE CROATIAN RURAL AREA DAMAGED BY AN EARTHQUAKE
Authors: Petrinovic Martina , Abramovic Inga , Lonic Jakov , Mestrovic Dora , Sovic Ariana , Strabic Adrijana , Jelakovic Bojan 
Published: June 2023

Objective:
This study aimed to find whether there is an association between an increased percentage of visceral fat and high blood pressure in the rural population.

Design and method:
Blood pressure (BP) was measured following ESH guidelines using Microlofe oscillometric device. Visceral fat was measured using a metabolic scale with a body composition monitor. Subjects who had a visceral fat of 11 % or less were categorized as group 1, whereas participants with a visceral fat of 12 % or more were categorized as group 2. The collected data were statistically analyzed with the help of Jamovi 2.2

Results:
The measurements showed a statistically significant difference between the mean diastolic BP of the tested groups (80 mmHg vs. 83.4 mmHg; p = 0.014). We failed to find differences in systolic BP (p>0.05)

Conclusions:
In this study, we proved the association between high visceral fat percentage and elevated diastolic BP. Some of the potential mechanisms linking obesity to hypertension include metabolic, endothelial and vascular dysfunction, maladaptive inflammatory response and neuroendocrine imbalances.
GLOBAL PREVALENCE OF HYPERTENSION AMONG ART-NAÏVE ADULTS LIVING WITH HIV: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Ebasone Peter Vanes , Dzudie Anastase , Peer Nasheeta , Kengne Andre Pascal 
Published: June 2023

Objective:
Cardiometabolic diseases have been suggested to be more frequent in people living with HIV (PLWH), resulting from the chronic inflammatory effects of the virus, effects of antiretroviral therapy (ART) and other factors that operate in the general population. Most studies have focused on assessing the prevalence of hypertension in PLWH on ART. Therefore, this study aimed to estimate the global prevalence of hypertension in the ART-naïve PLWH and to compare the prevalence among ART-naïve, ART-treated and HIV-negative subgroups. PROSPERO Registration: CRD42021226001.

Design and method:
We searched PubMed-MEDLINE, CINAHL, SCOPUS, Academic-Search Premier, Africa-Wide Information and Africa-Journals Online databases to identify relevant studies published before September 2022. We included Cross-sectional, cohort and case-control studies reporting baseline data on the prevalence of hypertension among ART-naïve adults living with HIV, worldwide. Two authors independently screened, selected, extracted data, and conducted methodological quality assessments. Data reported were pooled using random-effects meta-analysis.

Results:
Eighty studies across five continents comprising 204,876 ART-naive PLWH with mean/median ages ranging from 32 – 50 years were included. Most studies were from Africa; 43 (54%). The pooled prevalence of hypertension was 13.6% (95%CI: 10.5 - 17.0) among 39 studies that used a standard definition of hypertension (The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: JNC 7). The prevalence was 13.8% (95%CI: 10.4 - 17.5) based on a blood pressure cut-off of 140/90 mmHg only. There was no significant difference in hypertension prevalence by region, age, CD4 count, viral load, and publication year. Among the 9 studies that reported the prevalence by ART and HIV status, it was 9.6% (95%CI: 5.3 – 14.8), 17.7% (95%CI: 9.6 – 27.4) and 19.3% (95%CI: 10.1 – 30.5) in the ART-naïve, ART-treated and HIV negative subgroups respectively (p = 0.044). There was substantial heterogeneity (all I2 >90%, and all p<0.0001). There was no evidence of publication bias (all Egger test p >0.1286).

Conclusions:
The prevalence of hypertension in ART-naïve adults living with HIV worldwide is lower than in ART-treated and HIV-negative adults and does not differ by age, CD4 count, viral load, publication year and region.
ACTUAL AND PERCEIVED BLOOD PRESSURE AND LDL-CHOLESTEROL CONTROL IN HYPERTENSIVE PATIENTS WITH DYSLIPIDEMIA: A CROSS-SECTIONAL EPIDEMIOLOGICAL STUDY IN CROATIA (SNAPSHOT STUDY)
Authors: Pecin Ivan , Johnson Neil , Bayle Sabine 
Published: June 2023

Objective:
Assess BP and LDL-C control rates and cardiovascular (CV) risk in hypertensive patients with dyslipidemia in Croatia, based on stricter recommendations from recent European guidelines, and compare them with physicians’ assessment.

Design and method:
The cross-sectional observational multicenter epidemiological SNAPSHOT study involved 116 general practitioners in Croatia and included 1298 hypertensive patients with dyslipidemia.

Results:
91.7% of patients had additional risk factors. 57.9% were 65 years-old or older (65.8±9.7 years), 47.3% men, 42.6% obese (mean BMI 29.6±4.6 kg/m2) and 17.6% smokers. 55.4% had comorbidities: diabetes mellitus (34.1%), coronary artery disease (21.0%), and peripheral arterial disease (9.6%). Mean systolic/diastolic BP was 135.5±13.3 / 80.3±8.5 mmHg, total cholesterol 203.2±52.7 mg/dL, HDL-C 53.9±13.8 mg/dL, LDL-C 119.4±45.1 mg/dL, triglycerides 160.8±109.7 mg/dL.
Cardiovascular risk was estimated by investigators as “high”/“very high” for 30.1% and 31.4% of patients, respectively, whereas calculated CV risk according to guidelines (SCORE CHART 2-OP) was “high”/“very high” for 38.0% and 38.5% of patients, respectively. These results showed that 46.6% of investigators estimated CV risk accurately, while 34.3% underestimated it.
Hypertension was treated in 99.1% of patients and BP considered as controlled by investigators in 79.5% of patients, whereas actual control based on guidelines’ recommendations was achieved by 23.9%. Similarly, dyslipidemia was treated in 79.4% of patients and LDL-C considered as controlled by investigators in 54.2%, whereas actual control was achieved by only 12.8% according to guidelines. Only 2.9% of patients were actually controlled for both BP and LDL-C whereas 45.3% of patients were considered as controlled for both BP and LDL-C by investigators.
66.4% of patients were treated with single-pill combinations for hypertension, 8.6% for dyslipidemia, and only 5.5% received treatment for both hypertension and dyslipidemia in a single pill.

Conclusions:
Actual BP and LDL-C control rates in Croatia remain rather low and are often overestimated by physicians. Physicians often underestimate CV risk, which is difficult to evaluate in clinical practice. Improving physician education about guidelines’ recommendations and need for treatment intensification could offer an opportunity to further improve risk factor control. Single-pill combination usage for dyslipidemia and for both hypertension and dyslipidemia remains rather low.