bluuebunny/crossref_metadata_2025_split huggingface dataset:
DIETARY HABITS OF POPULATION IN THE CROATIAN RURAL AREA DAMAGED BY AN EARTHQUAKE. “THE SILENT KILLER HUNT”- CROATIAN SOCIETY OF HYPERTENSION PROJECT
Authors: Bosnic Klara , Brcic Alojzija , Bozic Katarina , Bogdanic Jakov Emanuel , Jurkovic Ana Marija , Vuksan-Cusa Zrinka , Jelakovic Bojan 
Published: June 2023

Objective:
A healthy diet is a crucial modifying factor for a healthy life. The World Health Organization (WHO) recommends taking at least 400 g or 5 portions of fruits and vegetables daily. Unsaturated fats found in fish are preferred to saturated fats found in fatty meat. Salt intake should be limited to 5 g daily and people should be careful with hidden salt that is found in bread, smoked meat, and spices. It is recommended that daily sugar intake is less than 10% of total daily energy intake.
We aimed to investigate the dietary habits of the adult population living in a rural area damaged by the earthquake.

Design and method:
The survey was performed using a modified food consumption questionnaire. In this analysis, we included 214 participants older than 18 years of age (opportunistic screening).

Results:
The study revealed unhealthy dietary patterns in terms of low consumption of fish, rare fruit and vegetable intake and high incidence of red and smoked meat consumption. A total of 60.7% of participants consume less than 3 portions of fruits and vegetables per day and only 7.5% take the recommended 5 or more portions per day. Very few subjects do eat fish (8.4%) or eat it a few times a month (53.3%). A total of 44.4% of subjects eat red meat up to 2 times a week and 21.5% of them eat it every day. A total of 37.4% of people consume smoked processed meat on a weekly basis, while 16.8% eat it every day. Almost one-third of survey respondents (31.3%) reported eating sweets and cakes on a daily basis.

Conclusions:
Major consumption of red and smoked meat, high intake of sugar and low intake of fruits, vegetables and fish indicates that further education of the population of rural areas and promotion of a healthy diet is needed in order to ameliorate their dietary behaviors.
NOCTURNAL HYPERTENSION IS ASSOCIATED WITH HEART FAILURE RE-HOSPITALIZATION IN PATIENTS WITH HEART FAILURE AND PRESERVED EJECTION FRACTION
Authors: Huang Gang , Xu Jun Bo , Zhang Zhen , Wu Jin 
Published: June 2023

Objective:
Nocturnal hypertension is reported as a risk factor for cardiovascular disease. This study was to explore the potential association between nocturnal hypertension and heart failure (HF) rehospitalization in patients with HF and preserved ejection fraction(HFpEF).

Design and method:
Totally, 538 patients with HFpEF were consequently recruited in this study and followed up until they were readmitted for HF or the end of this study. Cox regression analysis was used to reveal the potential association between nighttime blood pressure (BP) levels, nocturnal hypertension and nocturnal BP patterns and HF rehospitalization. Kaplan-Meier curve was used to assess the cumulative events free rate between groups.

Results:
The mean age of the study population was 77.14±8.68 years, and 41.2% was men. After a median follow up duration of 10.93 (4.19, 21.13) months, 176 (32.7%) patients with HFpEF were readmitted for HF. Cox analyse had revealed that nighttime systolic blood pressure (BP) level (Hazards ratio(HR):1.018, 95% confidence interval(CI): 1.008-1.028, p = 0.001), nightime diastolic BP level (HR:1.024, 95%CI:1.007-1.042, p = 0.007), nocturnal hypertension (HR:1.688, 95%CI:1.229-2.317, p = 0.001) were associated with HF rehospitalizaiton. Kaplan-Meier analysis had demonstrated that patients with nocturnal hypertension had significantly lower events free rate (Log rank test, p<0.001). Furthermore, patients with a riser pattern had a higher risk of HF rehospitalization (HR:1.828, 95%CI:1.055-3.166, p = 0.031) and lower events free rate (Log rank test, p = 0.003) than those with a dipper pattern.

Conclusions:
Nighttime BP levels, nocturnal hypertension and a riser pattern are independently associated with HF rehospitalization in patients with HFpEF. Well controlled nighttime BP levels should be emphasized and considered in patients with HFpEF.
IMPACT OF PROLONGED NOCTURNAL HYPOXEMIA ON LONG-TERM CLINICAL OUTCOMES IN PATIENTS WITH PRE-CAPILLARY PULMONARY HYPERTENSION
Authors: Huang Zhihua , Liu Zhihong , Luo Qin , Zhao Zhihui , Zhao Qing , Zhang Yi , Li Xin , Duan Anqi , Hu Meixi 
Published: June 2023

Objective:
Obstructive sleep apnea (OSA) and/or nocturnal hypoxemia is prevalent in patients with pulmonary hypertension (PH). However, the pathophysiological determinants of adverse outcomes remain ambiguous. We aimed to investigate the prognostic significance of various sleep parameters for long-term prognosis in patients with pre-capillary PH.

Design and method:
Consecutive patients diagnosed with precapillary pulmonary hypertension (PH) by right heart catheterization who underwent overnight cardiorespiratory polygraphy for the assessment of OSA were enrolled. Time-to-event analysis was performed investigating cardiorespiratory indices (apnea-hypopnea index [AHI] and percentage total recording time <90% [T90]) and clinical worsening using the log-rank test and multivariable Cox proportional hazard models adjusted for multiple confounders.

Results:
Of 440 eligible Chinese patients with PH, 134 (30.5%) had OSA and 147 (33.4%) had nocturnal hypoxemia (T90 greater than 10%). Over a median follow-up of 12.1 months, 72 (16.4%) patients experienced clinical worsening. AHI did not predict a higher risk of incident CW (hazard ratio [HR]: 0.98, 95% confidence interval [CI]: 0.932-1.001, P = 0.225), whereas T90 was associated with an increased risk of CW (HR: 1.01, 95% CI 1.00-1.01, P = 0.018). The likelihood of CW increased by 8% per 10-unit increase in T90 (HR: 1.08, 95% CI 1.020-1.14, P = 0.018). Patients with nocturnal hypoxemia carried an HR of 1.89 for CW events (HR: 1.89, 95% CI 1.19-3.00, P = 0.007) and these associations persisted after covariates adjustments. Clinical worsening-free survival probability over two-year follow-up periods for patients with nocturnal normoxemia and hypoxemia were 87% and 76.9%, respectively (Log-rank P = 0.006), while the trend towards a non-statistical significance of patients with and without OSA. The association of nocturnal hypoxemia reflected by T90 and CW remained robust across different subgroups and did not potentially interact with potential effect modifiers including age, gender, BMI, and pulmonary hemodynamic parameters (P for interaction >0.05).

Conclusions:
In patients with precapillary PH, nocturnal hypoxemia defined by T90 was a robust risk predictor of long-term clinical worsening. Investigation of nocturnal hypoxemic burden in PH may aid in the early risk-stratification in patients with precapillary PH.
ARTERIAL HYPERTENSION IN PREGNANCY - PULSE WAVE VELOCITY EVALUATION AS A PROGNOSTIC MARKER
Authors: Carvalho Simão Almeida , Costa Carlos , Martins Maria João , Martins Nancy , Cruz Andreia , Ribau Verónica , Jaria Elisabete , Brás Susana , Leitão Cátia , Neves Ana Briosa , Bastos José Mesquita 
Published: June 2023

Objective:
In the general population, arterial stiffness is associated with a higher incidence of cardiovascular complications. Little is known whether this same trend is observed in pregnant women with hypertension. The authors presented in 2020, a series of 234 pregnant women complicated by arterial hypertension submitted to 24-hour ambulatory monitoring (ABPM). They concluded that the absence of nocturnal pressure drop, especially diastolic pressure, was associated with a worse maternal-fetal outcome. The aim of this work is to present preliminary results of PWV in pregnant women with hypertension, and its relationship with an aggravated maternal-fetal outcome, as well as its relationship with the findings previously obtained with ABPM.

Design and method:
Observational study of 22 pregnant women who underwent VOP (Complior Analyze) and ABPM (Spacelabs 90207), between July 2015 and July 2022. Event was defined by: maternal death, fetal or neonatal death, preeclampsia or eclampsia, gestational diabetes, prematurity, fetal growth retardation, or dystocia due to uncontrolled hypertension.

Results:
The mean age and BMI were 31.0 ± 6.0 years and 27.2 ± 4.3 kg/m2. PWV showed mean values of 6.2 ± 0.9 m/s, and ABPM values for the studied population, SBP 24h 117.8 ± 8.6mmHg; DBP 24h 73.3 ± 8.8 mmHg; daytime SBP 123.8 ± 8.5 mmHg; daytime DBP 78.4 ± 7.9 mmHg; nocturnal SBP 106.9 ± 9.7mmHg; Night DBP 63.4 ± 9.2 mmHg. Pearson's correlation coefficient was calculated to measure the linear correlation between the variables and a hypothesis test was performed to conclude on the hypothesis of correlation between the variables.
Analysis with Pearson's correlation showed a negative correlation between PWV values and nocturnal DBP and SBP decreases in percentage, which infers that nocturnal decrease values decrease when PWV values increase. In the case of the correlation between PWV and nocturnal SBP decrease, the correlation coefficient was -0.495 (p = 0.016). In the case of the correlation between PWV and nocturnal fall in DBP, the correlation coefficient was -0.425 (p = 0.043).

Conclusions:
In line with what was previously demonstrated, the results suggest that a higher PWV, pathophysiological related to alterations in vessel elasticity, pro-inflammatory status
HYPERTENSION AND ANTIHYPERTENSIVE THERAPY IMPAIR RESPIRATORY FUNCTION
Authors: Dzhuryak Valentyna , Sydorchuk Larysa , Voroniuk Kseniia , Sydorchuk Ruslan , Petrynych Oksana , Kazantseva Tetyana , Sokolenko Alina , Yarynych Yulia , Kushnir Oksana 
Published: June 2023

Objective:
Tight relationship between respiratory and vascular system appear obvious and several studies showed an association between lung function and hypertension. Furthermore, antihypertensive treatment itself might have an effect on lung function. Thus, the aim of this study was to determine association of hypertension and its treatment with respiratory function.

Design and method:
In order to evaluate the respiratory system functional state in hypertensive patients we studied 107 patients (mean 49,5±2,7 years old) with mild (1st group), moderate (2nd group) essential hypertension (EH) and neurocirculatory hypertensive asthenia (3d group), for control we observed 30 healthy subjects (4th group). Furthermore, stratification of treatment non-compliant and compliant patients was made to observe the possible impact of antihypertensive treatment. All patients had no chronic respiratory disease in anamnesis and were randomized dependently from the blood pressure levels. Parameters of the respiratory system function were examined by computer spirography.

Results:
Such predictive and active parameters of computer spirography as Maximum Voluntary Ventilation (MVV), Forced Vital Capacity (FVC), Forced Expiratory Volume after 1s (FEV1), FEV1 as % of Inspiratory Vital Capacity (FEV1%VCIN), FEV1 as % of FVC (FEV1E), and Peak Inspiratory Flow (PIF) did not significantly differ between 1st, 3d and 4th observed groups. But in the 1st and a little bit less in the 3d groups data of active parameters mentioned above were insignificantly lower (p>0.05) compared to healthy individuals. In the 2nd group patients MVV, FEV1%VCIN, FEV1E were uncertainly lower (p>0.05) than in the 1st and 3d groups, but were still border-normal with tendency to forming combined respiratory and heart failure. Antihypertensive treatment was associated with a deterioration in FEV1 by -150.3±12.78 ml (p = 0.01) and in FVC by -190.2±20.05 ml (p<0.01). With both high blood pressure and antihypertensive medication as individual variables in one regression model, only medication decreased FEV1 and FVC statistically significantly (p<0.01).

Conclusions:
Thus, a tendency for aggravation of the active parameters of respiratory function in patients with arterial hypertension is dependent on the blood pressure levels and use of antihypertensive medications.
EARLY INDICES OF SUBCLINICAL CARDIOVASCULAR DAMAGE IN PATIENTS WITH ESSENTIAL HYPERTENSION AND PRIMARY ALDOSTERONISM. A PRELIMINARY OBSERVATIONAL STUDY
Authors: Burrei Giulia , Sabba’ Giulia Elena , Rosin Elena , Franzin Angelica , Biasotto Andrea , Giontella Alice , Cattazzo Filippo , Bonafini Sara , Marcon Denise , Romano Simone , Bortolotti Stefano , Fava Cristiano , Minuz Pietro 
Published: June 2023

Objective:
In hypertensive patients, the activation of the renin-angiotensin-aldosterone system is associated with an increase of subclinical vascular and cardiac damage. Our study aimed to compare some early markers of cardiovascular organ damage between patients with essential hypertension and patients with secondary hypertension, in particular primary aldosteronism.

Design and method:
Fifty-seven hypertensive patients (mean age: 44,4±13,6 years, 60.7% males) were included, 47
with essential hypertension and 10 with primary hyperaldosteronism. Peripheral blood pressure (pBP), central blood pressure (cBP) and pulse wave velocity (PWV) were assessed by the SphygmoCorXCEL. The carotid Intima-Media Thickness (cIMT) and the carotid Distensibility Coefficient (cCD) were measured by a scanner connected with an image acquisition and analysis system (CardiovascularSuite). Left ventricular mass index (LVMI) and relative wall thickness (RWT) were evaluated by transthoracic echocardiography.

Results:
Patients with primary aldosteronism have higher cIMT and PWV values compared to patients with essential hypertension (0.7±0.1mm vs. 0.6±0.1 mm, p = 0.02 and 8.6±2.5 m/s vs. 7.2±1.5 m/s, p = 0.02; respectively). By linear regression, age was the only variable independently associated with cIMT.
On the other hand, various factors such as age, the diagnosis of primary aldosteronism, pSBP and cSBP were independently associated with PWV.
Although not statistically significant, LVMI and RWT tended to be higher in the group with primary aldosteronism in comparison to patients with essential hypertension (14.3% vs. 0% exhibited concentric hypertrophy and 42.8% vs. 28.1% showed findings consistent with concentric cardiac remodelling). No differences were found in cDC values between the two groups.

Conclusions:
The results of this study confirm a possible deleterious impact of aldosteronism on cardiovascular damage in hypertensive patients, more evident for PWV than for cIMT or DC. This fact could suggest a possible different effect of the abnormal hormone secretion at different vascular districts.
CARDIOVASCULAR RISK PROFILE OF REFRACTORY HYPERTENSION DIAGNOSED BY ABPM AND HBPM IN A COHORT OF RESISTANT HYPERTENSION
Authors: Santos Taissa Lorena dos , Margallo Victor da Silva , Pimenta Carlos Filipe dos Santos , Cavalcanti Aline de Hollanda , Nemer Camila Bello , Fortes Carolina de Carvalho , Sousa Vitória Miriam da Silva de , Chedier Bernardo , Muxfeldt Elizabeth Silaid 
Published: June 2023

Objective:
Refractory hypertension (RefHT) is considered an extreme phenotype of resistant hypertension (RHT) and has recently been defined as uncontrolled blood pressure (BP) despite the use of 5 or more antihypertensives including a long-acting thiazide diuretic and a mineralocorticoid receptor antagonist. The objective of this study is to evaluate the clinical profile and characterize the cardiovascular (CV) risk involved through the analysis of hypertension-mediated organ damage (HMOD) and established cardiovascular disease.

Design and method:
This is a cross-sectional study of a historical cohort of patients with RHT who underwent a standardized protocol consisting of: a questionnaire to record cardiovascular risk factors (physical inactivity, smoking, obesity, dyslipidemia, and diabetes), hypertension-mediated organ damage (albuminuria, chronic kidney diseases (CKD) stage 3, left ventricular hypertrophy (LVH) diagnosed by transthoracic echodopplercardiogram, and arterial stiffness measured by pulse wave velocity) and established CV diseases (coronary diseases, stroke, heart failure, peripheral arterial disease, and CKD stage 4 or 5). All of them were submitted to 24-hour ABPM and 5-day HBPM (triplicate morning and evening measurements).

Results:
A total of 354 patients (23.9% male; mean age 60.4 ± 11.1 years old) was included in the study. The prevalence of RefHT was 20.3% (72 patients) by ABPM and 18.9% by HBPM (67 patients).
In both groups, refractories were younger with higher levels of albuminuria. Refractory patients diagnosed by the ABPM had a higher prevalence of stroke (18.1% vs 9.6%) and established CV diseases (45.8% vs 33.7%) than resistant patients. We did not observe differences regarding LVH (75.0% vs 71.8%), arterial stiffness (13.1% vs 16.4%) and CKD stage 3 (22.2% vs 27.0%).
In turn, refractory patients diagnosed by HBPM had a higher prevalence of heart failure (7.5% vs 2.8%), also showing similar prevalence of LVH (76.1% vs 71.6%), arterial stiffness (12.7% vs 16.4%), and CKD stage 3 (22.4% vs 26.8%).

Conclusions:
Refractory hypertensives presented a cardiovascular risk profile similar to resistant hypertensives, despite the lack of blood pressure control. Possibly the pharmacological treatment with spironolactone acting on the neurohumoral axis of hypertension may have an impact on the clinical course and survival of these patients.
IMPACT OF ROUTINE BRAIN IMAGING ON THE PROGNOSIS OF PATIENTS WITH LEFT-SIDED VALVE INFECTIVE ENDOCARDITIS WITHOUT NEUROLOGICAL MANIFESTATIONS
Authors: Oh Jin Kyung , Jung Jongtak , Lee Seung-Ah , Lee Sahmin , Chang Euijin , Kang Chang Kyoung , Choe Pyoeng Gyun , Kim Yong-Jin , Kim Nam Joong , Song Jong-Min , Kang Duk-Hyun , Song Jae-Kwan , Oh Myoung-Don , Park Wan Beom , Kim Dae-Hee 
Published: June 2023

Objective:
There are limited data on the impact of routine use of brain magnetic resonance imaging (MRI) on the prognosis of neurologically asymptomatic patients with left-sided infective endocarditis (IE).

Design and method:
Among patients diagnosed with possible or definite IE in two tertiary referral centers, we identified 527 left-sided IE patients without neurological symptoms or signs at the time of diagnosis. Patients who underwent brain MRI within 1 week after the IE diagnosis were classified as the routine brain imaging group (n = 216), and the rest were categorized as the control group (n = 311). All endpoints were compared after adjustment using inverse probability of treatment weighting (IPTW).

Results:
During a median follow-up of 57 months, the routine brain imaging group had a similar risk of 3-month all-cause mortality to the control group in the multivariate analysis (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.24–1.14) and IPTW-adjusted cohort (HR, 0.59; 95% CI, 0.25–1.42). The risks of attributable mortality (defined as death directly related to IE) and fatal neurological events were also similar between the two groups in the multivariable analysis and IPTW-adjusted cohort. In the subgroup analysis, the routine brain imaging group showed more favorable outcomes in cases of large vegetation (> 10 mm) or acute-onset microorganisms.

Conclusions:
Routine use of brain MRI in left-sided IE patients without neurological manifestations is not associated with improved clinical outcomes. However, routine brain imaging in appropriate clinical settings, such as in cases of large vegetation or acute-onset microorganisms, could improve clinical outcomes.
VASODILATION IS THE PREDOMINANT FACTOR OF BLOOD PRESSURE LOWERING DURING DEVICE-GUIDED SLOW BREATHING– ANALYSIS BY WAVE SHAPE PARAMETERS OF PULSE WAVE ANALYSIS
Authors: Mengden Thomas , Bachler Martin , Marschal Philip , Sehnert Walther , Wassertheurer Siegfried 
Published: June 2023

Objective:
There is evidence that device-guided slow breathing with direct biofeedback of pulse arrival time (PAT) leads to favorable changes (increase) in PAT and blood pressure (decrease). Slow breathing modulates peripheral blood flow and may decrease blood pressure by vasodilation.
The objectives of the study presented here was to identify hemodynamic mechanisms of the blood pressure lowering effect of device-guided breathing observed in a previously published study (Mengden Blood Pressure Monitoring 2023).

Design and method:
Patients with a systolic BP 130-160 mmHg or treated essential hypertension (21 females / 23 males) were trained to perform repeated and unattended device guided slow breathing exercises for 10 minutes and 5 minutes cool down over 5 days.
Furthermore, they were skilled to perform a self-measurement of blood pressure before and after the breathing exercise using a validated upper-arm device.
A simple device was used to measure pulse arrival time by electrocardiography and photoplethysmography connected with a smartphone or tablet to provide biofeedback. Using pulse wave analysis, time to systolic peak (tsys) and time to dicrotic notch (tnotch) were measured and normalized to RR interval, i.e., as tsys / tT and tnotch / tT.

Results:
Oscillometric self measured blood pressure showed a reproducible decrease in systolic blood pressure of 5 mmHg (p<0.01, SD 8 mmHg).
Absolute tsys increased by 13ms (p<0.001, SD 36 ms) and relative tsys / tT increased by 0.013 (p<0.001, SD 0.033) by the end of the exercise compared to baseline after cooling down (15 min). Similarly absolute tnotch increased by 11ms (p<0.001, SD 31 ms) as well as relative tnotch / tT in total by 0.011 (p<0.001, SD 0.036) compared to baseline.

Conclusions:
The delayed arrival of the first pulse wave maximum and the prolonged ejection time after adjustment for heart rate can be assumed here as a surrogate of a decreasing afterload. It is thus evident from this perspective that vasodilation is an important factor of blood pressure lowering during device-guided breathing.
DIETARY SODIUM RESTRICTION REDUCES NOCTURNAL BLOOD PRESSURE IN PATIENTS WITH TREATMENT RESISTANT HYPERTENSION
Authors: Hornstrup Bodil , Hoffmann-Petersen Nikolai , Lauridsen Thomas Guldager , Bech Jesper Nørgaard 
Published: June 2023

Objective:
Patients with treatment resistant hypertension (TRH) are characterised by lack of blood pressure (BP) control despite antihypertensive treatment. They are at particular risk of cardiovascular disease and more likely to experience BP increase as a response to sodium loading than other individuals.
In this study, we aimed to analyse if self-performed dietary sodium restriction could be implemented in patients with TRH. Moreover, we aimed to analyse the effect of this on nocturnal and 24h BP, and how BP changes were correlated to changes in plasma levels of BNP, nitric oxide and body water content.

Design and method:
The study was conducted as an interventional cross-over study including patients with TRH from 20-70 years. Patients were screened with 24h ambulatory BP monitoring initiated after observed intake of usual antihypertensive medication. They were included if 24h systolic BP>130/80 mmHg. Study participation included two periods of 14 days; a standard period with usual diet and an interventional period with instructed dietary sodium restriction and handed-out sodium-free bread. At the end of each period, patients were examined with 24h BP monitoring, 24h urine collection (sodium excretion), blood samples (nitric oxide, BNP), and bioimpedance measurement (body water content).

Results:
Participation was completed by 15 patients with mean age 59 years and mean 24h BP 144/82 mmHg. Mean baseline urinary sodium excretion was 192(86) mmol/24h (11.2 grams of salt).
As seen in Table 1, sodium excretion was reduced to 91 mmol/24h equalling 5.3 grams of salt. BP levels were reduced significantly. Plasma levels of nitric oxide increased significantly, and this was correlated to the change in 24h BP. Total body water content and plasma levels of BNP was reduced significantly. The changes in BP were not correlated to changes in sodium excretion, body water or BNP.

Conclusions:
Self-performed dietary sodium restriction could be implemented resulting in a significant reduction in BP levels. BP change was not related to changes in body water or sodium excretion. Increased levels of nitric oxide may be evidence of improved endothelial function and may be one of the involved mechanisms in BP decrease following sodium restriction