bluuebunny/crossref_metadata_2025_split huggingface dataset:
HEMODYNAMICS STRESS TEST USING FINGER-TO-TOE PULSE WAVE VELOCITY IN SUPINE AND SITTING POSITION IN END-STAGE KIDNEY DISEASE
Authors: Khataei Sanam , Rico Élizabeth De , Addhour Saliha , Fortier Catherine , Côté Nadège , Tairi Amira , Agharazii Mohsen 
Published: June 2023

Objective:
Aortic pulse wave velocity (PWV), a measure of arterial stiffness can either be measured by the ratio of distance to pulse transit time or, estimated based on the pulse wave profile (ePWV). Aortic PWV measurements are performed in the supine position as there is no added hydrostatic pressure along the arterial path, and the recording of the arterial pressure waveform of the femoral arterial is easier to perform. However, finger-to-toe PWV (ftPWV), a surrogate for aortic PWV, can easily be performed in other positions, such as the sitting position, giving the opportunity to examine arterial wall properties in a dynamic manner. The aim of the study was to observe the impact of the position (supine vs sitting) on the ePWV and on the measured ftPWV in patients with end-stage kidney disease.

Design and method:
In a cross-sectional study involving adult hemodialysis patients, we performed vascular assessments in the supine and the sitting position within the first 2 hours of their hemodialysis session. The ePWV was obtained using the Mobil-O-Graph and ftPWV was obtained using the pOpmètre®. Three measures were taken with each device. Generalized estimated equations were then used to calculate the average of ePWV and ftPWV with respect to each position.

Results:
In 46 patients (17 females), the average age was 71±12 years and the blood pressure was 136±24 /77±15 mmHg. The ePWV was 10.8 m/s (IC95% :10.1-11.4 m/s) in the supine position and 10.7 m/s (IC95%: 10.0-11.3 m/s) in the sitting position. However, the ftPWV was 12.1 m/s (IC95%: 9.6-14.7 m/s) in the supine position but it increased to 22.0 m/s (IC95%: 15.0-29.0 m/s) in the sitting position. This increase of 9.8 m/s was highly significant (P = 0.006) even though the brachial blood pressure and the heart rate had barely changed.

Conclusions:
This study shows that finger-to-toe PWV increases in the sitting position, offering us the opportunity to explore this postural changes in PWV as a possible vascular stress test.
IMPACT OF BODY POSITION ON ARTERIAL STIFFNESS OF ELASTIC AND MUSCULAR ARTERIES
Authors: Rico Elizabeth de , Côté Nadège , Addour Saliha , Khataei Sanam , Legault Laurent , Tairi Amira , Philibert Emy , Fortier Catherine , Agharazii Mohsen 
Published: June 2023

Objective:
Arterial stiffness is assessed through determination of pulse wave velocity (PWV) over an arterial segment of interest. Measurements are traditionally done in a supine position, which is both practical for high quality arterial pressure wave recordings, and the stability of pressure exerted on the arterial wall along the arterial path. The aim of this project was to study the effect of body position on the stiffness of elastic and muscular arteries.

Design and method:
This study was conducted with healthy adults. Aortic (cf-PWV) and brachial stiffness (CR-PWV) were repeatedly measured in three different positions (supine, 30̊ and 60̊) using the Complior Analyse. Brachial blood pressure (Mobil-O-graph) was also measured in each position. Generalized Estimating Equations in SPSS were performed to establish changes of PWV between positions.

Results:
In 23 healthy individuals (65% female, mean age of 36±15 years, and mean systolic (SBP) and diastolic blood pressures (DBP) of 120±2 mmHg and 76±2 mmHg, respectively), CF-PWV increased progressively with body tilting (8.7 (CI95% = 8.0–9.4) m/s supine, 9.4 (CI95% = 8.8–10.0) m/s at 30̊ and 9.5 (CI95% = 8.8–10.1) m/s at 60̊) (p<0.001)). On the other hand, CR-PWV didn’t significantly change with body tilting (8.7 (CI95% = 8.0–9.3) m/s supine, 8.8 (CI95% = 8.0–9.6) m/s at 30̊ and 8.9 (CI95% = 8.1–9.6) m/s at 60̊). SBP didn’t significantly change with body tilting (120 (CI95% = 116-125) mmHg supine, 121 (CI95% = 116–125) mmHg at 30̊ and 122 (CI95% = 117-126) mmHg at 60̊), while DBP increased (76 (CI95% = 71-80) mmHg supine, 78 (CI95% = 73–83) mmHg at 30̊ (p<0.022) and 81 (CI95% = 77-85) mmHg at 60̊ (p<0.001)). Heart rate also increased with body tilting (68 (CI95% = 64–72) BPM supine, 69 (CI95% = 65–73) BPM at 30̊ and 77 (CI95% = 72–82) BPM at 60̊ (p<0.001)).

Conclusions:
These preliminary results show that elastic and muscular arteries tend to react differently to body positions, without significant changes in arterial stiffness of medium muscular arteries in the arm.
DETERMINANTS OF ELASTIC AND STIFFENING PULSE PRESSURE COMPONENTS: RESULTS OF THE NEW HUNGARIAN ABPM REGISTRY
Authors: Nemcsik János , Páll Dénes , Takács Johanna , Koller Ákos , Járai Zoltán 
Published: June 2023

Objective:
Pulse pressure (PP) received relative less attention in the guidelines regarding its potential role in the hypertension-mediated target organ damage. Recently it has been proposed that PP can be divided into two components: elastic PP (elPP) and stiffening PP (stPP). Thus the aim of our study was to explore the determinants of 24-hour, daytime and nighttime elPP and stPP in a new national ambulatory blood pressure monitoring (ABPM) database.

Design and method:
ABPM data were collected from the Hungarian ABPM Registry between February 2021 and August 2022. The Hungarian ABPM Registry is a an ongoing multicenter, open-label, observational non-interventional study. Meditech ABPM-06 monitors were used for ABPM measurements. Basic patients’ data were documented in electronic case report forms and were later analyzed together with ABPM data. elPP and stPP were calculated according to Gavish et al (DOI:10.1097/HJH.0000000000003258).

Results:
14817 ABPM data were analyzed. The average age of the subjects was 55.29 ± 15.1 years, 7845 (48.9%) of them were men. 24h, daytime and nighttime elPP were 47.42 ± 8.89, 46.45 ± 9.34 and 45.93 ± 10.94 mmHg, respectively. 24h, daytime and nighttime stPP were 8.51 ± 5.86, 9.15 ±6.56 and 8.62 ± 7.81 mmHg, respectively. Under the age of 50 years all elPPs were significantly lower in women compared to men, while all stPPs were lower in both sexes in age under 50 (p<0.05). Independently from age and sex, obesity increased all elPPs, while under the age of 50 years nighttime stPP was elevated only in obese women (p<0.05). The independent determinants of daytime and nighttime elPPs were age, systolic blood pressure (sBP), obesity and diabetes with adding ischemic heart disease in case of 24h elPP. The independent determinants of 24h and daytime stPPs were age, sBP and diabetes, while in case of nighttime stPP age, sBP and sex.

Conclusions:
The new Hungarian ABPM Registry underline the importance of PP and its elastic and stiffening components. The evaluation of their determinants can help to better understand the pathomechanisms responsible for the development of hypertension-mediated target organ damage.
DIFFERENCES IN AMBULATORY BP LEVELS AND INTENSITY OF ANTIHYPERTENSIVE TREATMENT BETWEEN MEN AND WOMEN UNDERGOING PERITONEAL DIALYSIS
Authors: Georgianos Panagiotis , Vaios Vasilios , Vareta Georgia , Georgianou Eleni , Sgouropoulou Vasiliki , Varouktsi Garyfallia , Tsinari Ariti , Zebekakis Pantelis , Liakopoulos Vassilios 
Published: June 2023

Objective:
The aim of the present study was to compare the ambulatory blood pressure (BP) levels and intensity of antihypertensive treatment between men and women with end-stage kidney disease receiving long-term peritoneal dialysis (PD).

Design and method:
Following a case-control design, 48 male PD patients from Northern Greece were matched for age and history of heart failure with 48 female patients in a 1:1 ratio. All patients underwent 24-hour ambulatory BP monitoring with the oscillometric device Mobil-O-Graph (IEM, Stolberg, Germany). The BP-lowering medications actually taken by the patients were prospectively recorded.

Results:
Age, dialysis vintage and the burden of cardiovascular comorbidities did not differ between men and women. There were no significant sex differences in ambulatory systolic BP (24-hour period: 129.0±17.8 vs. 128.5±17.5 mmHg, P = 0.138; daytime: 129.6±17.5 vs. 129.7±17.4 mmHg, P = 0.991; nighttime: 127.0±19.8 vs. 125.9±18.8 mmHg, P = 0.776). However, the levels of ambulatory diastolic BP were consistently higher in men than in women over the entire 24-hour period (81.5±12.1 vs. 76.8±10.3 mmHg, P<0.05) as well as during daytime (82.5±11.8 vs. 78.1±10.4 mmHg, P<0.05) and during nighttime (78.8±13.9 vs. 73.8±11.1 mmHg, P<0.05). The proportion of patients with 24-hour ambulatory BP <130/80 mmHg was numerically lower in men than in women (35.4% vs. 43.8%), despite the greater intensity of antihypertensive treatment in men. As compared with women, men were receiving a higher average number of BP-lowering medications daily (2.4±1.1 vs. 1.8±1.1, P<0.05) and were being treated more commonly with beta-blockers (85.1% vs. 66.7%, P<0.05) and dihydropyridine calcium-channel-blockers (70.2% vs. 43.8%, P = 0.01).

Conclusions:
The present study shows that among patients undergoing PD, the ambulatory BP levels and intensity of antihypertensive treatment are higher in men than in women. Prospective observational studies are needed to explore whether these sex differences in the severity of hypertension contribute to a higher risk for adverse health outcomes in men receiving long-term PD.
PROGNOSTIC SIGNIFICANCE OF BLOOD PRESSURE FLUCTUATIONS IN THE MORNING AND EVENING FOR CARDIOVASCULAR OUTCOMES
Authors: Cheng Chi-Chen , Chang Wei-Lun , Chuang Shao-Yuan , Lee Yu-Hsuan , Huang Chi-Jung , Cheng Hao-Min , Chiang Chern-En , Chen Chen-Huan , Asayama Kei , Ohkubo Takayashi , Niiranen Teemu J. , Boggia José , Staessen Jan A. 
Published: June 2023

Objective:
Independent of office blood pressure (BP) levels, home BP is associated with the occurrence of cardiovascular events. Abnormal diurnal variations in BP have been linked to cardiovascular disease (CVD). However, data on diurnal patterns of home BP, the morning and evening BP difference (MEdiff), are scarce. This study looked into the relationship between all MEdiff indices and cardiovascular outcomes.

Design and method:
The association was assessed using data from the International Database of Home Blood Pressure in Relation to Cardiovascular Outcome (IDHOCO), which comprised 6753 patients from five cohorts. We found 1254 patients who had taken home BP readings every morning and every evening for more than 14 days. The MEdiff over a 13-day period, omitting the first day, for each patient were used to calculate the average (MEdiff_sbp_avg), minimum (MEdiff sbp_min), and maximum (MEdiff_sbp_max) values. MEdiff is defined as morning (6AM-8AM) minus evening BP (8PM-10PM) measures. The prognostic values of these parameters were assessed using Cox proportional hazards models. Factors adjusted in the base model included age, sex, body mass index, total cholesterol, high-density lipoprotein cholesterol, smoking status, prevalence of diabetes, history of cardiovascular disease, and antihypertensive drug treatment.

Results:
Only MEdiff_min_sbp strongly predicted CVD (183 events; mean follow-up time of 13.4 years), but MEdiff_avg_sbp (hazard ratio: 0.906, 95% CI: 0.087-1.018 per SD), MEdiff_max_sbp (0.949, 0.846-1.064 per SD) did not. Spline regression analysis with thresholds of -17 mmHg and -4 mmHg revealed a U-curve association between MEdiff_min_sbp and the risk of CVD outcomes. Three groups were identified by MEdiff_min_sbp: lower than -17 mmHg (Low, n = 574), between -17 and -4 mmHg (medium, n = 568) and higher than -4 mmHg (high, n = 112). Compared to the low group, the high group had a significantly higher risk of CVD (1.353, 1.052-1.739), in the models with adjustment for the mean of the morning and evening SBP values, and MEdiff_avg_sbp or various BP variability indices.

Conclusions:
MEdiff_min_sbp was strongly associated with an increased risk of cardiovascular outcomes, suggesting that it could be a useful BP index for describing abnormal BP diurnal variations for CVD risk prediction.
A KETOGENIC DIET REDUCES TISSUE SODIUM CONTENT: AN EXPLORATORY STUDY
Authors: Shoumariyeh Tarik , Trattnig Siegfried , Zaric Olgica , Mcintyre Christopher , Oberbauer Rainer , Kovarik Johannes Josef 
Published: June 2023

Objective:
Hypertension and diabetes are a substantial global public health problem. The prevalence of these diseases will further increase in the near future, leading to increased health and socioeconomic costs. Hence efficient therapeutic approaches are urgently needed. It has been previously shown that nutritional approaches including a very-low carbohydrate, or a ketogenic diet potentially decrease body weight, blood pressure and glucose levels in patients with type 2 diabetes along with an overall significant reduction in their pill burden. However, the detailed physiological mechanisms underlying the observed induction and maintenance of diabetes remission remain largely unknown.
Previous studies have shown that the skin could be a buffer system for sodium and that skin sodium content could be both a pathogenic cause and a marker of hypertension and salt sensitivity.
Since a nutritionally created metabolic milieu such as nutritional ketosis can lower blood pressure, we hypothesize that this dietary approach also reduces tissue sodium content.

Design and method:
By using 7-T 23Na MRI technique, we performed an exploratory study and analyzed skin and muscle sodium concentration before, and after a 6-week ketogenic diet in three healthy probands. Nutritional ketosis was verified by frequent check of blood ketone (beta-hydroxybutyrate; BOHB) levels greater than 0.3 mmol/L.

Results:
Preliminary data of our planned exploratory study (in patients with chronic kidney disease and type 2 diabetes mellitus and healthy probands) demonstrated that compared to baseline 6 weeks of ketogenic diet decreased tissue sodium content in the skin (16.6 ± 2.1 vs. 12.6 ± 2.1 mmol/L), in the medial gastrocnemius muscle (20.5 ± 0.9 vs. 16.7 ± 0.7 mmol/L), in the lateral gastrocnemius muscle (19.7 ± 1.0 vs. 16.0 ± 1.0 mmol/L) and in the soleus muscle (13.1 ± 0.8 vs. 11.5 ± 0.5 mmol/L).

Conclusions:
Our results indicate a massive reduction of tissue sodium concentration in healthy volunteers in response to a ketogenic diet which might be associated with the observed clinical benefits and be implicated in the anti-hypertensive effects of this powerful dietary intervention. Findings of this study could have an impact on future treatment strategies of various chronic diseases.
SKIN SODIUM CONTENT AS A PREDICTOR OF BLOOD PRESSURE RESPONSE TO RENAL DENERVATION
Authors: Günes-Altan Merve , Schmid Axel , Kannenkeril Dennis , Linz Peter , Ott Christian , Bosch Agnes , Schiffer Mario , Uder Michael , Schmieder Roland 
Published: June 2023

Objective:
In patients with treatment resistant hypertension (TRH), renal denervation (RDN) emerged as an adjacent therapeutic option. It has been detected that patients with TRH have elevated Sodium (Na) content in muscle and skin. This analysis aimed at evaluating whether tissue Na content predicts blood pressure (BP) response after RDN.

Design and method:
Radiofrequency device based endovascular RDN was performed in 53 patients with uncontrolled TRH (office BP> = 140/90 mmHg and diagnosis confirmed by 24-h ambulatory BP monitoring) in our certified RDN center. Office and 24-h ambuatory BP were measured at baseline and after 6 months. To assess tissue Na content 23Na-MRI was performed at baseline prior to RDN. We splitted the study cohort based on the median systolic 24-h ambulatory BP reduction after 6 months into responders and non-responders and compared tissue Na content and baseline characteristics between these groups. The study was registered at http://www.clinicaltrials.gov (NCT01687725).

Results:
53 patients were followed up for at least 6 months. Office systolic and diastolic BP were reduced by -12.9±21.1 mmHg and -7.7±12.5 mmHg and 24-h ambulatory systolic and diastolic BP were reduced by -8.6±14.0 mmHg and -4.7±9.5 mmHg after 6 months. Responder could be characterized as patients with low tissue sodium content in skin, more female patients, patients with aldosteron-antagonists, high baseline 24-h night-time heart rate and high LDL-cholesterol (see table, only p<0.10 are shown). This results remained significant after adjustment for baseline 24-h SBP. Similar results were obtained if the two groups were created based on the median of 24-h day-time and night-time BP reduction after 6 months.

Conclusions:
We identified Na in skin, sex, 24-h night-time heart rate, aldosterone antagonists and LDL-cholesterol as predictors of the systolic BP response. We conclude that 23Na-MRI may assist to select patients with uncontrolled TRH who will have a clinically meaningful BP reduction following RDN treatment.
COMPRESSION OF RENAL ARTERIES BY THE DIAPHRAGMATIC CRUS: PROPOSAL FOR A NEW CLASSIFICATION
Authors: Basset Thomas , Ghelfi Julien , Thony Frederic , Mathieu Rodiere , Mathieu Finas , Gilbert Ferretti , Olivier Ormezzano 
Published: June 2023

Objective:
Renal artery entrapment (RAE) is a rare cause of hypertension, and its management remains debated between surgical and endovascular approaches. The aim of this study was to propose an updated classification of RAEs.

Design and method:
This retrospective study included all patients referred to our center between 1995 and 2021 with a diagnosis of RAE confirmed by CT scan. The primary objective was to describe the type of renal artery (RA) compression (ostial or truncular location and focal or long extension). The association between the type of compression and age, side of compression and high origin of the RA was also evaluated.

Results:
Forty patients with 45 RAE were included. The compression was focal and ostial in 22 arteries (49%), long and truncular in 13 RA (29%) and focal and truncular in 10 RA (22%), of which 2 RA (4%) originated from the thoracic aorta with a transdiaphragmatic passage. From this distribution, an updated classification with 4 types of RAE was proposed including: type 1: ostial compression, type 2: long truncular compression, type 3: focal truncular entrapment and type 4: truncular entrapment with intrathoracic RA origin. There was no association between the type of RAE and the patient's age (p = 0.09) or the side of compression (p = 0.42). Type 2 and type 4 RAEs were associated with a higher origin of the compressed artery (p = 0.04).

Conclusions:
This study proposed an updated classification of RAE with four type of compressions. Knowledge of these conditions may be helpful for a future treatment algorithm.
CARDIAC MANIFESTATION IN PATIENTS WITH TAKAYASU'S ARTERITIS IN THE CONTEXT OF ALTERATION OF VENTRICULAR-ARTERIAL COUPLING
Authors: Galita Andreea Madalina , Andrei Oana 
Published: June 2023

Objective:
Takayasu's arteritis is a chronic, progressive inflammatory disease of the large vessels, diffusely disseminated. Thus, it can affect any organ system and can have a wide range of clinical manifestations. In the absence of control of triggering factors and in the absence of treatment, the long-lasting evolution of the inflammation and the detection in advanced stages has led to the appearance of vascular stiffness and left ventricular hypertrophy. Therefore, the decrease in both arterial and ventricular elastance has led to a decrease in mechanical work and myocardial efficiency, which is the expression of altered ventricular-arterial coupling.

Design and method:
We present the case of a 25-year-old patient, with no significant personal history, admitted to our clinic for the management of high blood pressure values. Biologically, the patient has stage IV chronic kidney disease and significant inflammatory syndrome. The echocardiography shows significant concentric ventricular hypertrophy, with mild systolic dysfunction, due to diffuse hypokinesia and low ventricular mechanical work. Given the multiple arguments of renovascular pathology, we took a native CT angiography which showed circumscribed lesions in the vertebral arteries, carotid, upper mesenteric and left subclavian artery. Therefore, we suspect the Takayasu's arteritis as a possible diagnosis and the treatment with systemic corticosteroid was started, which led to the decrease of the inflammatory syndrome and to the reduction of the inflammation at carotid arteries level, evidenced by a vascular Doppler ultrasound.

Results:
Ventricular-arterial coupling is important for understanding the pathophysiological mechanisms underlying both arterial and left ventricular remodeling. The development of advanced imaging techniques has led to the possibility of non-invasive analysis of the ventricular-atrial relationship which is important for determining the mechanical work, and thus for a better understanding of the mechanisms that led to the development of ventricular hypertrophy.

Conclusions:
Although left ventricular hypertrophy is common in patients with high blood pressure, in a young patient thorough investigation of other possible etiologies has an important role in therapeutic management. Contrary to the literature data, in the present case there is an association between the episodes of severe hypertension and the ones of arteritis activity.
ASSOCIATION BETWEEN SYSTOLIC BLOOD PRESSURE AND CHANGE IN EGFR OVER TIME IN A MULTI-ETHNIC COHORT: THE HELIUS STUDY
Authors: Tonkin-Hill Gina , Bouwmeester Thomas , Vriend Esther , Galenkamp Henrike , Valkengoed Irene Van , Collard Didier , Vogt Liffert , Born Bert-Jan van den 
Published: June 2023

Objective:
The assess the extent to which blood pressure relates to progression of CKD, among different ethnicities with disparate cardiorenal risk. We assessed the relationship between baseline systolic blood pressure (SBP) and change in renal function over time in a multi-ethnic population.

Design and method:
This analysis used baseline and follow-up data from 9 828 participants in the prospective Healthy Life in an Urban Setting (HELIUS) cohort study, a population-based study, including individuals of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan descent. Linear regression and interaction analysis were used to assess the association between baseline SBP and change in eGFR over time.

Results:
Overall eGFR decreased by -0.30 ml/min/1.73m2 (95%CI[-0.42, -0.19], p<0.001) per 10 mmHg increase in baseline SBP after 6.3 (SD 1.1) years of follow-up. This curve steepened from a SBP of 120 mmHg onwards to -0.44 ml/min/1.73m2 (95%CI[-0.61, -0.27], p<0.001) for every 10 mmHg increase in SBP. The association was significantly influenced by ethnicity (p<0.001), diabetes (p = 0.003) and albuminuria (p = 0.002), but not by age or sex. Individuals with albuminuria or diabetes had a more than 3 times larger SBP related eGFR decline compared to those without diabetes or albuminuria. Dutch, African Surinamese and Moroccan participants had a slightly steeper eGFR decline, but the direction of effect was consistent across all subgroups.

Conclusions:
Our findings confirm the relation between SBP and eGFR over time in different ethnic groups, steepening from a SBP of 120 mmHg onwards and may help to further guide strategies for preventing hypertension related CKD.