bluuebunny/crossref_metadata_2025_split huggingface dataset:
EVALUATION ON CLINICAL APPLICATION OF LOW-DOSE TRADITIONAL QUADRUPLE ANTIHYPERTENSIVE COMPOUND PREPARATION IN CHINA
Authors: Sun/Ningling Ningling Sun , Chen/Yuanyuan Yuanyuan Chen , Wang/Hongyi Hongyi Wang , Xi/Yang Yang Xi 
Published: June 2023

Objective:
To evaluate whether a relatively old multi-drug SPC prescription can be adapted to current treatments of hypertension.

Design and method:
1. In a retrospective, real-world study, 22148 patients with hypertension who visited 4 hospitals in China from 2011 to May 2016 were selected as the subjects. A comparison was conducted between treatment with compound reserpine and triamterene tablets (Reserpine/Triamterene CAS) and with four other single-pill combinations (SPCs) (losartan/hydrochlorothiazide, valsartan/hydrochlorothiazide, irbesartan/hydrochlorothiazide, and amlodipine/valsartan) for 20 days. The compliance rate was analyzed after patients’ propensity score matching analysis. 2. A meta-analysis of 7 randomized controlled trials on the safety and efficacy of compound reserpine and triamterene tablets published from 2000 to 2020 was conducted.

Results:
1. Treatment with 1 compound reserpine and triamterene tablet daily (R/L) resulted in a blood pressure compliance rate (BP < 140/90 mmHg) of 63 to 68%. Compared with valsartan/amlodipine, R/L achieved a compliance rate of 63% vs 50%; with valsartan/hydrochlorothiazide, of 64% vs 59%; with losartan/hydrochlorothiazide, of 67% vs 57%, and with irbesartan/hydrochlorothiazide, of 68% vs 59%. All P values were < 0.05 (Figure 1).
2. Seven studies were included in the meta-analysis. In five studies, the overall response rate of hypotensive treatment with compound reserpine and triamterene tablets was higher in efficacy study compared with other hypotensive drugs (OR = 2.23, 95% CI: 1.32 ∼ 3.75) (Figure 2), and there was no significant difference in the incidence of adverse reaction with compound reserpine and triamterene tablets in the 6 trials included in the safety study (OR = 0.91, 95% CI: 0.68 ∼ 1.22) (Figure 3).

Conclusions:
China is faced with high prevalence of hypertension, low control rate, and scarce medical resources and economic resources in primary medical care, but ultra-low-dose SPC (R/L) can improve the antihypertensive effect and reduce the incidence of adverse reactions (Figure 4) through the synergistic effect among different components of the drug and has good patients’ compliance and low price. We confirmed that through systematic review and meta-analysis, ultra-low-dose SPC (R/L) is suitable for the treatment of hypertension, especially those with refractory hypertension.
YOGIC EXERCISE- ITS EFFECT ON BLOOD PRESSURE AND DEPRESSION SCORE IN MYOCARDIAL INFARCTION
Authors: Prasad Avneesh 
Published: June 2023

Objective:
To study the effect of yoga on blood pressure and Beck's depression inventory score in myocardial infarction cases

Design and method:
Our study was conducted on 200 patients randomized into test group (n = 100) who were subjected to conventional treatment and yoga and control group (n = 100) who were subjected to conventional treatment.
The study was conducted on patients diagnosed as myocardial infarction having age >18 years and patient's consent. Patients with hemodynamic instability, heart failure, past yoga, arrhythmia, pacemaker, autonomic neuropathy and musculoskeletal disease were excluded.
Initially, assessment of clinical & biochemical parameters were performed. Blood pressure was noted and Beck's depression score was calculated by filling a questionnaire. Yoga was taught to the test group on 4th day after MI and were encouraged to perform 10 minutes of pranayam, shavasan and transcendental meditation each . Follow up after 18 weeks for assessment of blood pressure & depression score was done. The study was conducted for 2 years.

Results:
After 18 weeks of intervention, among the yoga group a significant improvement (p = 0.001)was seen for systolic BP(2.09%) & diastolic BP (2.09%) . A significant improvement was seen among the control (p = 0.001) for systolic (2.06%) and diastolic BP (1.48%). A significant improvement was noted for Beck's depression inventory score (p = 0.001) among the yoga(19.76%) as well as control group (11.52%).
A statistically significant decrease in control group was seen for systolic blood pressure when compared to the yoga group (p = 0.01) after 18 weeks. A decrease was seen for diastolic blood pressure (p = 0.44) and Beck's depression inventory score (p = 0.304) among yoga group in comparison to control group that was statistically insignificant.

Conclusions:
It was concluded from study that a significant decrease in systolic & diastolic BP and Beck's depression score was found when intragroup comparison was done. A significant decrease was seen among controls for systolic BP and statistically insignificant decrease was seen for diastolic BP and Beck's Depression score among yoga group after 6 weeks.
Therefore, large multicenter trials with more sample size is needed to ascertain the effect of yoga on blood pressure and depression score.
QUANTITATIVE ANALYSES OF THE ESC GUIDELINES ON SPORTS CARDIOLOGY AND EXERCISE
Authors: Koller Akos , Takacs Johanna 
Published: June 2023

Objective:
Exercise and sports are important components of preventing/delaying the development of cardiovascular disease (CVD) as evidenced by reduced all-cause morbidity and mortality. Because of that, the European Society of Cardiology (ESC) published “2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease” (GL-SCE) summarizing recommendations and supporting evidence to ‘prescribe’ various types of exercise and sports regimens that can be used to prevent, delay, or alleviate CVD. Thus we aimed to assess quantitatively the efficacy of the GL-SCE providing help in the sport- /exercise-related treatment decision-making in specific cardiovascular condition

Design and method:
An analytic study was conducted on the GL-SCE regarding the Classes of Recommendations (CLASS) and the Levels of Evidence (LEVEL) (n = 159). Then LEVEL areas under CLASS were calculated to form a Certainty Index (CI: -1 to +1).

Results:
The frequency of CLASS I and CLASS III was relatively high in GL-SCE (52.2%) and GL-CS) (in Clinical Settings: 50.7%). Yet, the most frequent LEVEL was C (41.2%–83.8%), indicating only a relatively low quality of scientific evidence in GL-SCE. The GL-SCE showed a relatively high CI (+0.57), 78.4% Certainty, and 21.6% Uncertainty.

Conclusions:
The GL-SCE provides substantial help in decision-making through the recommendations
(CLASS), but the supporting evidence (LEVEL) in most cases is only lower quality, which is well reflected in the newly developed Certainty Index identifying issues that should be clarified and investigated in future studies.
ASSESSMENT OF THE PHYSICAL CAPABILITIES OF HEART FAILURES AFTER CARDIOVASCULAR REHABILITATION: ABOUT 125 CASES FROM FEBRUARY 2021 TO DECEMBER 2022
Authors: Alassane Ngaide Aliou , Gaye Ngone Diaba , Mingou Joseph Salvador , Diouf Marguerite , Houenassi M L Colomb , Diop Khadim Rasso , Diouf Youssou , Kane Abdoul 
Published: June 2023

Objective:
The objective of this work was to evaluate the effects of cardiac rehabilitation on the physical abilities of patients with heart failure, to compare the parameters of the stress test, the 6-min walk test and cardiac ultrasound before and after cardiac rehabilitation.

Design and method:
This is a descriptive and analytical cross-sectional study with retrospective and prospective data collection which took place from February 1, 2021 to December 31, 2022. Patients with heart failure of all etiologies combined who received an outpatient cardiovascular rehabilitation program. Data were collected on a pre-established survey form and included anamnestic, clinical, paraclinical and 6-min walk test data. Informed consent was obtained. Data analysis was performed with SPSS version 18 software. Any difference less than 0.05 was considered statistically significant.

Results:
During this study, the frequency of rehabilitated heart failure patients out of the total number of rehabilitated patients for all etiologies was 45.59%. The average age was 57.97 with extremes at 41 and 74 years. The most represented age group was that of 61 to 70 years (35.5%). The predominance was male with a sex ratio of 2.1. The cardiovascular risk factors found were dominated by dyslipidemia (80.6%), physical inactivity (71%), high blood pressure (41.90%) and diabetes (38.70%). The level of cardiovascular risk was high in 48.39% and very high in 35.48% of cases. Coronary disease was the main etiology of heart failure with 80.65% of cases. Systolic blood pressure increased from 126.87 to 126.42 mmhg (p = 0.91), diastolic blood pressure from 78.74 to 74.48 mmhg (p = 0.090) and resting heart rate from 79.23 bpm to 67.06 bpm (p = 0.000). The average LVEF increased from 38.75 to 45.26% (p = 0.001), the number of METS from 4.42 to 7.48 (p = 0.000), as well as the 06-minute walk test from 328 m to 470 m (p = 0.000). No deaths or rehospitalizations were observed during the study.

Conclusions:
The study shows that cardiovascular rehabilitation is beneficial in heart failure patients with a marked improvement in symptoms, physical capacity and quality of life.
NET CLINICAL BENEFIT OF A REDUCED DOSE OF DIRECT ORAL ANTICOAGULANTS IN NON-VALVULAR ATRIAL FIBRILLATION: A META-ANALYSIS OF RANDOMIZED TRIALS
Authors: Drogkaris Sotirios , Konstantinidis Dimitrios , Thomopoulos Costas , Ntalakouras John , Siafi Eirini , Tatakis Fotis , Kolokathis Konstantinos , Mantzouranis Emmanouil , Chalmoukou Konstantina , Kariori Maria , Kouremeti Maria , Paliodimou L. , Tsivgoulis Georgios , Dimitriadis K. , Tsioufis Konstantinos 
Published: June 2023

Objective:
To evaluate the net clinical benefit of a reduced dose of direct oral anticoagulants (DOACs) compared to warfarin in nonvalvular atrial fibrillation.

Design and method:
We searched three electronic databases covering the period until end-February 2021. All-cause death, non-fatal stroke/systemic embolism, and major bleeding events, with or without the inclusion of myocardial infarction, were used to define two different net clinical benefit outcomes. In addition, we evaluated different component outcomes of net clinical benefit as secondary outcomes. Finally, each outcome's risk ratios and 95% Confidence Intervals (CI) were calculated (random-effects model).

Results:
In the four randomized trials included (n = 29,779 patients), the net clinical benefit - with or without the inclusion of myocardial infarction - of low-dose DOACs, compared to warfarin, was a 12% (95% CI, 7%-16%) or a 10% (95% CI, 5%-13%) reduction of events, respectively. Compared to warfarin, the reduced dose of DOACs decreased death outcomes, major bleeding events, and hemorrhagic stroke, whereas all thrombotic outcomes were not different among the groups.

Conclusions:
DOACs at low doses present a more favorable net clinical benefit profile than warfarin.
SIESTA DIPPING AND CIRCADIAN BLOOD PRESSURE PATTERNS IN ACUTE ISCHEMIC STROKE
Authors: Kakaletsis Nikolaos , Ntaios George , Milionis Haralampos , Karagiannaki Anastasia , Chouvarda Ioanna , Dourliou Vasiliki , Ladakis Ioannis , Kaiafa Georgia , Vemmos Konstantinos , Savopoulos Christos 
Published: June 2023

Objective:
The purpose of this study was to investigate the alterations of blood pressure (BP) during the midday (siesta time) and the changes of circadian BP patterns in acute phase of ischemic stroke (AIS) with the severity of stroke and their predictive role for the 3 months outcome.

Design and method:
A total of 228 AIS patients (prospective multicenter follow-up study, NCT01915862) underwent 24-hour ambulatory blood pressure monitoring (ABPM) every 20 minutes within 48 hours from stroke onset using an automated oscillometric device. Clinical and laboratory findings were recorded. Mean BP parameters during day (7:00-22:59), midday (13:00-16:59) and night (23:00-6:59) and siesta and nocturnal dipping were calculated. Endpoints were death and disability/death at 3 months.

Results:
Siesta SBP dippers had less severe stroke, lower incidence of hypertension and SBP/DBP on admission, lower levels of serum glucose and WBC and delayed initiation of ABPM compared to risers. There was a reverse relation of siesta SBP dipping with both nocturnal dipping (r = -0.27, p<0.001) and the severity of stroke (r = -0.13, p = 0.049). The “double dippers” (siesta and nocturnal dipping) had the least severe stroke, the lowest SBP/DBP on admission and heart rate from ABPM and lower risk of an unfavorable outcome, while the “double risers” had the opposite results, by an approximately 5-fold risk of death/disability at 3 months.

Conclusions:
These findings indicate different circadian BP patterns according to stroke severity during the acute phase of AIS, potentially driven by patient's physical stress and maybe alterations of the sympathetic nervous system activity, which should be considered as markers of patient's state and prognosis.
ISCHEMIC STROKE THE CAUSE OF MORTALITY IN LOW INCOME COUNTRIES EXPERIENCE OF MAKWALLA HEALTH CARE SERVICES
Authors: Dennis Anthony 
Published: June 2023

Objective:
Ischemic stroke is the third leading cause of mortality in low income countries. The main aim of this study was to determine the rate and predictors of in-hospital mortality due to ischemic stroke in the Makwalla health care center and the University of Abuja Nigeria.

Design and method:
The study was Conducted from April 2019-May 2021 at the Makwalla health care center and the University of Abuja Teaching hospital. A census using restrospective cohort study design was conducted on medical records of adult patients with the diagnosis of ischemic attending the medical inpatient ward of the health facilities between November 2017 and September 2020.
Cox hazard regression was used to determine the predictors of hospital Mortality. A two sided statistical test at 5% level of significance was used.

Results:
The main (+SD) duration of hospital stay was 11.5(10.04) days of total 208 patients 26(12.5%) Patients died in the hospital. Cox regression revealed that only a decrease in renal function particularly elevated serum creatinine (AHR = 8.848,95% CI:1:616-67.437) was associated with a statistically significant increase of in-hospital mortality. The symptom onset to admission time varied greatly among patients and ranged from 1 hour to 168 hours.

Conclusions:
The in hospital Mortality associated Ischemic stroke found to be high . Mainly elevation serum creatinine was highly associated with poorer out come in terms of in-hospital morality. Much work should be done on improving the knowledge and awareness of the community regarding ischemic stroke and stroke in general to encourage early medical seeking behavior and reduce mortality and long term disability.
THE EFFECT OF ALLOPURINOL AND FEBUXOSTAT ON BLOOD PRESSURE IN ADULTS WITH CHRONIC HYPERURICEMIA
Authors: Pigazzani Filippo , Jennings Claudine , Rogers Amy , Mackenzie Isla , MacDonald Thomas 
Published: June 2023

Objective:
To observe the effect of the xanthine oxidase inhibitors Allopurinol and Febuxostat on blood pressure in adults with chronic hyperuricemia.

Design and method:
This was a sub-study of the Febuxostat versus Allopurinol Streamlined Trial (FAST). FAST was a randomised controlled trial comparing the cardiovascular safety of febuxostat and allopurinol in individuals with symptomatic hyperuricemia previously receiving allopurinol. At the screening visit, patients were invited to participate in the Blood Pressure (BP) sub-study. A validated BP monitor and an instruction booklet were provided. Each set of home BP measurements was taken over four consecutive days, three times each in the morning and evening. BP was recorded at baseline (on allopurinol therapy), after 7-days allopurinol washout, and 8 weeks after randomisation to febuxostat or allopurinol. Differences in BP in the allopurinol and febuxostat group were evaluated. The relationship between serum uric acid level reductions and BP changes was also assessed.

Results:
Between December 2012 and January 2014, 298 FAST participants consented to the BP sub-study. 223 participants who submitted a complete set of BP data were included in the analysis; 104 were randomised to Allopurinol and 119 to Febuxostat. Baseline characteristics were balanced between groups. Overall mean change in BP from washout to 8 weeks of randomised treatment was not significant in either group [Mean BP change in Allopurinol arm: SBP -0.10 mmHg (95% CI -1.76,1.56), p = 0.9; DBP 0.50 mmHg (95% CI -1.82,2.81), p = 0.6. Mean BP change in Febuxostat arm: SBP -0.77 mmHg (95% CI -4.20,2.67), p = 0.7; DBP -0.41 mmHg (95% CI -2.56,1.73), p = 0.7]. No significant BP differences were observed between groups at each time point. Reduction in serum uric acid by > 60 μmol/L at 8 weeks on either therapy was not associated with statistically significant changes in BP.

Conclusions:
There was no significant difference in the effect of allopurinol or febuxostat on blood pressure after 8 weeks of randomised therapy in the FAST study. Larger reductions in serum uric acid at 8 weeks had no effect on BP change.
EFFECTS OF PCSK-9 INHBITORS ON ARTERIAL STRUCTURE AND FUNCTION: PRELIMINARY RESULTS
Authors: Maloberti Alessandro , Vatta Alessandro , Grasso Alice , Garofani Ilaria , Morelli Martina , Giani Valentina , Fortuna Matteo , Gualini Elena , Giannattasio Cristina 
Published: June 2023

Objective:
One of the latest chapters in the research for new and stronger lipid lowering therapies has led to the development of PCSK9 inhibitors. In addition to the benefit on lipid profile, a limited number of studies have been published showing a possible improvement in vascular function and structure following their administration. To evaluate the effects of PCSK9 inhibitors on structural (via carotid Intima Media Thickness – IMT) and functional (carotid-femoral Pulse Wave Velocity – cf-PWV - and brachial artery Flow Mediated Dilatation - FMD) arterial properties.

Design and method:
Twenty-two dyslipidemic patients with a clinical indication to PSCK9 inhibitors were prospectively recruited at the Cardiology Rehabilitation of ASST Grande Ospedale Metropolitano Niguarda Hospital (Milan, Italy). Anthropometric, clinical and therapeutic data were recorded. Each patient underwent instrumental examinations to assess cf-PWV, IMT and FMD at T0 (before the start of therapy), T1 (after 6 months) and T2 (after 12 months).

Results:
In the 22 patients who reached 6 months of follow up there was a significant reduction in LDL cholesterol (from 127.8±31.7 to 47.4±29.1 mg/dl, p<0. 0001) while there was no significant difference in arterial parameters (cf-PWV: from 10.5±3.5 to 9.4±2.3 m/s, p = 0.092; FMD: from 11.4±8.1 to 9.8±8.3%, p = 0.407; IMT: from 775.6±192.8 to 768.7±144.7, microm, p = 0.854). Similar results were also obtained in the 12 patients who reached one year of follow-up: LDL from 129.4±29.1 to 48.8±21.9 mg/dl, p<0.0001; cf-PWV from 10.4±3.3 to 10.5±2.9, p = 0.874; FMD from 12.0±9.1 to 11.0±5.6%, p = 0.930; IMT from 745.1±203.9 to 770.0±127.3 microm, p = 0.710.

Conclusions:
Our study confirm the strong LDL reduction with PCSK9 inhibitors that are needed in order to reach the targets set by the ESC 2019 guidelines. In contrast, they do not show a significant effect on arterial function and structure in terms of cf-PWV, FMD and carotid IMT.
EFFICACY OF BETA-BLOCKERS ON BLOOD PRESSURE CONTROL, MORBIDITY AND MORTALITY ENDPOINTS IN HYPERTENSIVES OF AFRICAN ANCESTRY: AN INDIVIDUAL PATIENT DATA META-ANALYSIS
Authors: Tsabedze Nqoba , Naicker Darshni , Mrabeti Sanaa 
Published: June 2023

Objective:
Beta-blockers have been reported to sub-optimally lower central aortic blood pressure and cause an increased stroke incidence. There is a paucity of data regarding beta-blocker efficacy in patients of African origin. We proposed that an individual patient data meta-analysis (IPD-MA) focusing on the efficacy of traditional and second or third-generation beta-blockers (STGBBs) in the whole and African hypertensive population may provide new insights.

Design and method:
A single-stage IPD-MA analysed the efficacy of STGBBs in the setting of other anti-hypertensives for lowering mean arterial pressure (MAP) and reducing the occurrence of composite outcome (total cardiovascular mortality, stroke and myocardial infarction).

Results:
A total of 11860 participants were included in the analysis, of which 3864 (32.5%) were on STGBB. STGBBs reduced the MAP by 1.75 mmHg (95% confidence interval (CI): 1.16 - 2.33; p<0.001) in the whole population and by 1.93 mmHg (95% CI: 0.86 - 3.00; p<0.001) in 3880 African hypertensives, outperforming angiotensin-converting enzyme inhibitors (ACE-I) in the whole population studied and ACE-I and calcium channel blockers in the African population. Confounding through beta-blocker use in established cardiovascular disease resulted in STGBBs being associated with an adjusted odds ratio of 1.33 (95 % CI: 1.06 - 1.65; p = 0.015) of the composite outcome while controlling for age, gender, race and smoking history. STGBBs were not associated with an increase in the odds of stroke in African hypertensives nor the whole population.

Conclusions:
STGBBs reduced the MAP comparably to other anti-hypertensives. No increase in the odds of stroke was found.
MEDICATION ADHERENCE AND GENDER DIFFERENCE IN HYPERTENSIVE PATIENTS
Authors: Radic Josipa , Dogas Hana , Vuckovic Marijana , Kolak Ela , Gelemanovic Andrea , Nenadic Dora Bucan , Radic Mislav 
Published: June 2023

Objective:
One of the major clinical problems in the management of arterial hypertension (AH) is adherence to the medical regimen. Failure to adhere affects not only patients causing disease progression, reduced functional abilities as well as lower quality of life, but also the healthcare system due to medication waste and increased hospital visits and admissions. Data about hypertensive medication adherence in our region are lacking. Therefore, we aimed to assess medication adherence in our hypertensive patients in order to identify possible strategies to improve and enhance mentioned adherence.

Design and method:
This study included 324 participants with AH, of which 51.2 % were men, and with an overall median age of 64 years (IQR = 17). Along with the 24-hour ambulatory blood pressure measurement, each patient completed a medication adherence questionnaire, Morisky Medication Adherence Scale (MMAS-8). This self-reported questionnaire consists of 8 questions with a total score ranging from 0 to 8 and a lower score indicates lower adherence to the prescribed pharmacological antihypertensive therapy.

Results:
51 (15.7%) participants had low, 114 (35.2%) had moderate and 159 (49.1%) had high medication adherence. There was no significant difference in MMAS-8 score regarding age (p = 0.334), however, men were found to have -higher adherence to antihypertensive therapy than women (58.5% vs. 41.5% had high adherence, respectively, p = 0.018).

Conclusions:
The results of our study showed that more than half of our hypertensive patients (50.9%) are not completely adherent to antihypertensive medication. Among all of them women were found to have lower adherence compared to men. Low medication adherence could lead to substantial worsening of disease as well as increased health care costs in care of hypertensive patients. Therefore, the presented results highlight the need for patient education and support to increase patient adherence in order to reduce cardiovascular risk.