bluuebunny/crossref_metadata_2025_split huggingface dataset:
FREQUENCY OF MEDICAL OUT-PATIENT VISITS AND USE OF HOME BLOOD PRESSURE MONITORING IN HYPERTENSIVE PATIENTS IN FIVE EUROPEAN COUNTRIES
Authors: Burnier Michel , Azizi Michel , Persu Alexandre , Prejbisz Aleksander , Cunha Vitoria , Gupta Pankaj , Vaclavik Jan , Versmissen Jorie , Kreutz Reinhold 
Published: June 2023

Objective:
We assessed the frequency of out-patient visits for hypertension and the use of home blood pressure monitoring (HBPM) in 5 European countries.

Design and method:
We used the data of a web-based questionnaire developed by the Working group on Lifestyle, Cardiovascular Therapy and Adherence to investigate patients’ perspectives on hypertension management. Eligible participants were adult men and women, living in France, Germany, Italy, Spain and UK, with a confirmed diagnosis of hypertension. Data were collected through patients’ organizations and internet from January to March 2022.

Results:
From January to March 2022, we included 2757 participants, 46% women, 94% older than 60 y, 71% with hypertension duration >5y, 95% (91% for >3 months) treated with a mean of 1.7 antihypertensive pills /day (all medications: 4.1 pills/day). The out-patient visit frequency was monthly in 3% of the participants, once every 1 to 3 months in 23%, once every 3 to 6 months in 28%, once every 6 to 12 months in 30%, and less than once a year in 13%. There was large between-country variability in visit frequency (e.g., once every 1 to 3 months: 5% in UK, 21% in Germany, and 42% France; once every 6 to 12 months: 47% in UK, 23% in Germany, and 13% in France). Overall, 67% of participants performed HBPM themselves and 13% with an external help. HBPM was done on a regular basis in most patients (17% every day, 26% several times a week, 35% several times a month) while 8% did HBPM only when not feeling well. HBPM was performed more frequently in Germany and less in UK. Patients at higher cardiovascular risk did HBPM more frequently.

Conclusions:
There are no strong evidence-based recommendations on the frequency of out-patient visits for hypertension during long-term follow-up. Our survey shows a large variability between European countries in the way patients are followed. Moreover, strong implementation of HBPM is found in all countries, but the ESH protocol is not strictly followed. Therefore, studies are needed to define the most cost-effective hypertension follow-up and ESH recommendations for HBPM should be reinforced.
HELLENIC CARDIORENAL MORBIDITY SNAPSHOT (HECMOS). HIGH PREVALENCE OF DIFFICULT-TO-CONTROL HYPERTENSION IN CARDIOLOGY INPATIENTS WITH COMORBIDITIES
Authors: Iliakis Panagiotis , Ntalakouras Ioannis , Valatsou Aggeliki , Kakouri Niki , Papaioannou Nikos , Sawafta A. , Lambropoulos S. , Vlad Id , Moschos N. , Albanis G. , Koudounis G. , Koufou E. , Chatzieleutheriou C. , Foukarakis E. , Thomopoulos Costas , Marketou Maria , Stamatelopoulos K. , Zarifis I. , Vasilikos V. , Tsioufis Konstantinos 
Published: June 2023

Objective:
Uncontrolled hypertension (HTN) remains a major public health problem, especially among older people with multiple comorbidities. We aimed to show the prevalence of uncontrolled HTN among the HECMOS participants.

Design and method:
HECMOS was a nationwide crossection survey of cardiorenal morbidity among 923 cardiology inpatients on the 3rd of March 2022 via an electronic case report form. Uncontrolled HTN was defined under the current ESH/ESC HTN guidelines, while patients with an estimated glomerular filtration rate below 60 ml/min/1.73m2 were considered as cases of chronic kidney disease (CKD).

Results:
HTN prevalence was linearly related to patients’ age, whereas difficult-to-control HTN showed a similar trend, found to be higher among patients older than 80. There was a statistically significant difference (p = 0,001) in HTN prevalence between patients aged over 60 years (60 - 69:71,1%, 70 - 79:74,1%, >OR = 80:79,0%) and younger participants (<40:3,1%, 40 - 49:33,3%, 50 - 59: 48,5%). HTN history was similarly reported among cases of Heart Failure (HF), Diabetes Mellitus (DM), Atrial Fibrillation (AF), and CKD, the four more prevalent morbid conditions in our sample. Nevertheless, HTN prevalence was higher in CKD and DM patients than in others without CKD or DM (76.6% vs. 63.6%, 77.6% vs. 61.4%, respectively, p = 0.001).

Conclusions:
In this nationwide opportunistic survey, HTN and difficult-to-control HTN was highly prevalent among cardiology inpatients of older age, CKD, and DM.
PROFILE OF ELDERLY HYPERTENSIVE PATIENTS IN NEPHROLOGYCONSULTATION: ABOUT 61 CASES
Authors: Triqui Chifa , Khadhar Mariem , Hadded Sarra , Jerbi Mouna , Aoudia Raja , Gaied Hanene , Goucha Rim 
Published: June 2023

Objective:
Hypertension is a cardiovascular risk factor and a cause of morbidity and mortality, especially in elderly population.
The aim of this work was studying the profile of elderly hypertensive patients, the associated risk factors and the proposed therapeutic modalities.

Design and method:
It was a retrospective descriptive study conducted in nephrology consultation from January 2020 to January 2022. Hypertensive patients over 65 years old were included. Cardiovascular risk was stratified according to the ESC 2019 recommendations. Chronic kidney disease (CKD) stage was defined according to the KDIGO classification. Therapeutic target was defined as Systolic Blood Pressure (SBP) <150mmHg.

Results:
Sixty-one patients were included,mean aged 72.5 years with a sex ratio M/F 1.25. The average age at the time of discovery of hypertension was 60.12 years [38-85]. Fifty-five patients were followed for nephropathy (90.16%). The dominant stages of CKD were 3 and 4 (in 28 and 12 patients respectively).
Among our population, thirty-four patients were diabetic (55.73%), 21 were dyslipidemic (34.42%), 12 patients had coronary disease (19.67%) and seven patients were active smokers (11.47%).
Among the diabetic patients, hypertension was considered as a diabetic macroangiopathy in 15 patients (44.11%). Metabolic syndrome was found in 21 patients (34.42%). Thirteen patients were classified as very high cardiovascular risk, 34 as high risk, and 9 as moderate risk. The mean SBP was 140mmHg+/-24.28. Vascular nephropathy was found in 28 patients (45.9%) and left ventricular hypertrophy in 3 patients (4.91%).
The therapeutic target was achieved in 42 patients (68.85%) of whom 24 were on a calcium channel blocker, 28 were on a Renin-angiotensin-aldosterone (RAAS) blockers, 15 on a combination containing a loop diuretic and 10 on a central antihypertensive.
Treatment complications requiring a change in therapy were orthostatic hypotension in 3 patients on a central antihypertensive and hyperkalemia with acute renal failure in five patients on a RAAS blockers.

Conclusions:
Hypertension in the elderly is associated with multiple comorbidities mainly diabetes. Regular follow-up of this population with adaptation of treatment is necessary to reduce mortality rate and prevent complications related to hypertension and treatment.
PREVALENCE AND DETERMINANTS OF VASCULAR AGING IN AUSTRIA – A HOLISTIC VIEW: THE LEAD STUDY
Authors: Danninger Kathrin , Weber Thomas , Asgar Shervin , Breyer Marie-Kathrin , Breyer-Kohansal Robab , Kaufmann Christoph , Boutouyrie Pierre , Bruno Rosa Maria , Mayer Christopher , Hartl Sylvia , Burghuber Otto C. 
Published: June 2023

Objective:
Vascular aging (VA) is an important and prognostically relevant aspect of biological aging. Its determinants are incompletely understood, and a holistic view is missing.

Design and method:
The LEAD (Lung, Heart, Social, Body) study is an ongoing, longitudinal, population-based observational study, which started in 2011 in Vienna and six villages from Lower Austria. As part of the study, carotid-femoral pulse wave velocity (cfPWV) was measured non-invasively using applanation tonometry. In a predefined healthy normal population (non-smokers without known hypertension, diabetes, hyperlipidemia or cardiovascular disease, free from antihypertensive and lipid-lowering medication, blood pressure below 130/85 mmHg), age-specific Z-scores for cfPWV were calculated. Healthy (HVA), normal (NVA) and early (EVA) VA was defined as cfPWV value < 10th, 10th-90th, and >90th percentile, respectively.

Results:
In the overall population (n = 7924, 54.2% women, age 6-82 years), the prevalence of HVA/NVA/EVA was 7.3/70.3/22.4%, respectively, with EVA prevalence increasing in older age. NVA and EVA, as compared to HVA, were independently associated with age, hemodynamic parameters (blood pressure, heart rate), metabolic factors (diabetes), body composition (lean mass index), psychosocial (marital status), and socio-economic (socioeconomic status score, income, educational level) factors.

Conclusions:
In this large population-based study we observed a high percentage of early vascular aging in Austria. Besides age itself, hemodynamic factors and diabetes, body composition, psychosocial and socio-economic factors play an independent role in vascular aging. Cardiovascular prevention clearly needs to be improved and should be targeted towards high blood pressure on the one hand, but be holistically oriented on the other side.
PSYCHOSOCIAL STRESSORS AT WORK AND ATRIAL FIBRILLATION INCIDENCE: A 18-YEAR PROSPECTIVE STUDY
Authors: Trudel Xavier , Tiwa-Diffo Edwige , Milot Alain , Brisson Chantal , Lavigne-Robichaud Mathilde , Gilbert-Ouimet Mahée , Vézina Michel , Talbot Denis , Trudel Xavier 
Published: June 2023

Objective:
Psychosocial stressors at work are generally defined according to the job strain and the effort-reward imbalance at work (ERI) models. These work stressors were shown to increase coronary heart disease risk, with a higher risk among workers exposed to both stressors. The effect of combined exposure to both work stressors on atrial fibrillation (AF) incidence is not known. The aim of the present study was to examine the separate and combined effect of job strain and effort-reward imbalance at work on atrial fibrillation incidence.

Design and method:
The study design was a prospective cohort study. A total of 5,926 white-collar workers (3,021 women and 2,905 men) free of cardiovascular disease at baseline were followed for 18 years. Psychosocial stressors at work were measured according to the job strain and ERI models using validated instruments. AF events were identified in medical databases with universal coverage. Hazard ratios (HR) with 95% confidence intervals were estimated using Cox regression models, adjusting for socioeconomic characteristics, lifestyle-related factors and clinical factors.

Results:
During the follow-up, 186 AF events were identified. Workers exposed to job strain (HR = 1.8; 95% CI 1.1-2.9) or effort-reward imbalance at work (HR = 1.4; 95% CI 1.1-2.0) had a higher risk of AF, following adjustment for socioeconomic characteristics, lifestyle and clinical risk factors. Combined exposure to job strain and ERI was associated with a two-fold AF risk increase (HR = 2.0; 95% CI 1.3-3.1) in fully adjusted models.

Conclusions:
Workers exposed to job strain or effort-reward imbalance at work, separately and in combination, were at increased AF risk. Prevention strategies targeting psychosocial stressors at work should be considered to decrease the burden associated with AF.
THE IMPACT OF HYPERTENSION IN PATIENTS PRESENTING HEART FAILURE WITH AND WITHOUT ATRIAL FIBRILLATION
Authors: (Pogacean) Manuela -Claudia Lacatusu , German-Sallo Marta , Tatar Maria Cristina 
Published: June 2023

Objective:
Both atrial fibrillation and heart failure represent etiological factors for each other, while hypertension does the same for them.
Our aim consisted in identifying the degree of which the presence of hypertension contributed as a risk factor for developing atrial fibrillation in patients suffering from heart failure.

Design and method:
We analysed 129 patients with heart failure in sinus rhythm and 158 patients with heart failure and atrial fibrillation, both group patients being randomly selected from year 2019 to 2021. The study included patients admitted to a chronic patient care unit.

Results:
We performed a Fisher's exact test based on a contingency table including N = 132 patients with heart failure and atrial fibrillation exposed to the presence of hypertension, as well as N = 105 patients with heart failure in sinus rhythm without hypertension (nominal values of the groups are shown in Fig. 1). With the risk for the exposed (R1) being 0.557 and the risk for the unexposed (R0) 0.52, we obtained an RR of 1.071, meaning that patients with hypertension have a 1.071-fold increased risk of developing atrial fibrillation in patients with heart failure. Also, there is an association between atrial fibrillation and hypertension (RR>1).

Conclusions:
The link between atrial fibrillation, heart failure and hypertension is a well-debated topic in the medical world. In this study, we illustrated that although hypertension represents a frequent comorbidity, in patients with heart failure it encounters more often in association with atrial fibrillation, rather than in patients with sinus rhythm. This finding has led us to believe that our aim as medical practitioners would consist in a better blood pressure control, as well as improved treatment adherence, in order to prevent the development of atrial fibrillation and heart failure pathogenesis.
MACHINE LEARNING IN HYPERTENSION DETECTION: A STUDY ON WORLD HYPERTENSION DAY DATA
Authors: Pengo Martino , Montagna Sara , Ferretti Stefano , Bilo Grzegorz , Borghi Claudio , Ferri Claudio , Grassi Guido , Muiesan Maria Lorenza , Parati Gianfranco 
Published: June 2023

Objective:
Many modifiable and non-modifiable risk factors have been associated with hypertension. However, current screening programs are still failing in identifying individuals at higher risk of hypertension. Given the major impact of high blood pressure on cardiovascular events and mortality, there is an urgent need to find new strategies to improve hypertension detection.
We aimed to explore whether a machine learning (ML) algorithm can help identifying individual predictors of hypertension.

Design and method:
We analysed the data set generated by the questionnaires administered during the World Hypertension Day from 2015 to 2019. Demographic information (age, sex, BMI), self-reported information on cardio- vascular risk factors (hypertension, diabetes, smoking, high cholesterol, kidney disease, family history of cardiovascular diseases), sleep complaints (snoring, witnessed apneas, daytime sleepiness) and prior cardiovascular diseases (previous cardio and cerebrovascular events, previous myocardial infarction) as well as information about the awareness of hypertension and its health consequences were collected through the questionnaire. We computed the performance (sensitivity and specificity) of standard screening programmes as recommended by World Health Organisation and of five different ML algorithms, exploiting different balancing techniques (oversampling and undersampling).

Results:
A total of 20206 individuals (mean age 50.89 years, 51.65% females) have been included for analysis. Results show that a gain of sensitivity reflects in a loss of specificity, bringing to a scenario where there is not an algorithm and a configuration which properly outperforms against the others (Table 1). However, Random Forest provides the most interesting balance between sensitivity and specificity with a greater Area Under the Curve compared to the standard screening programs (Table 1).

Conclusions:
Detection of hypertension at a population level still remains challenging and a machine learning approach could help in making screening programs more precise and cost effective, when based on accurate data collection. More studies are needed to identify new features to be acquired and to further improve the performances of ML models.
Table 1: Performance in the test set of the three experimented schemes, original, oversampling and undersampling the training set, and of the medical protocol evaluation.
COMPARISON OF CLINICAL BENEFITS BETWEEN TELMISARTAN AND OTHER ANGIOTENSIN RECEPTOR BLOCKERS IN HYPERTENSION PATIENTS WITH COMBINATION THERAPY: MULTICENTER REAL-WORLD STUDY
Authors: Joo Hyung Joon , Yum Yunjin , Kim Yong Hyun , Kim Eung Ju 
Published: June 2023

Objective:
Background Telmisartan have potent blood pressure lowering effect as well as the other pleiotrophic effects including PPAR-??/?? dual activation. In large clinical studies, telmisartan demonstrated the comparable clinical benefits with angiotensin converting enzyme inhibitor. However, there were few studies of direct comparison between telmisartan and the other angiotensin receptor blockers (ARBs). This study aimed to compare the cardiovascular and renal protective effect between telmisartan and the other ARBs in patients with the advanced hypertension who required two or more anti-hypertensive drugs.

Design and method:
This study used the Observation Medical Outcomes Partnership-Common Data Model database of three tertiary hospitals in Korea. 19,247 Patients were prescribed at least two antihypertensive drugs including ARBs, were selected from January 1, 2017 to December 31, 2019. 3,437 patients in the telmisartan group and 15,810 patients in the other ARB group were matched 1:1 through propensity score matching. Major adverse cardiovascular event (MACE), heart failure (HF) hospitalization and new-onset dialysis were compared for 3,386 patients in each group.
Result: Before the matching, there was a higher proportion of patients with a history of myocardial infarction (MI) in the telmisartan group compared to the other ARB group. After the matching, average on-treatment blood pressure was similar between two groups. Over a three-year period, the incidence of MACE and HF hospitalization did not differ significantly between the two groups. Compared to the other ARB group, the telmisartan group had a lower incidence of new-onset dialysis (1.3% vs 1.9%, p-value = 0.04). However, this difference was not statistically significant in the multivariable Cox regression model.

Conclusions:
Telmisartan has similar cardiovascular and renal protective effects to other ARBs in patients with advanced hypertension who are taking at least two anti-hypertensive medications.
Figure. Kaplan-Meier curves showing the incidence of MACE and dialysis in the telmisartan group and the other ARB group.
INCREASED IONIZED CALCIUM-MAGNESIUM RATIO IN ELDERLY HYPERTENSIVES
Authors: Kisters Klaus , Groeber Uwe , Kisters Lukas 
Published: June 2023

Objective:
Alterations in the metabolism of calcium and the biofactor magnesium can be involved in the pathogenesis of essential hypertension. Serum magnesium concentrations only insufficiently reflect disorders in magnesium handling in humans, as only about 1% of total body magnesium stores are in blood. The calcium and magnesium flux across the external membrane is regulated by a calcium pump (calcium-magnesium-ATPase), calcium and magnesium (TRPM 6 and 7) channels and a sodium magnesium antiport. An increased calcium-magnesium ratio is known to be involved in the development of atherosclerosis. Early onset of this disorders are known in hypertension.

Design and method:
We present a study in 18 hypertensive elderly concerning ionized magnesium concentrations and ionized calcium-magnesium ratio in blood measured by a Prime Plus apparatus by NOVA Medical, Andover, USA.

Results:
In 18 elderly hypertensives (9 male/9 female with normal renal function) ionized magnesium was measured 0.55 +/- 0.04 mmol/l (normal range: 0.54 - 0.80 mmol/l).
The ionized calcium-magnesium ratio was 2.33 +/- 0.18 (normal range below 2.40)(p< 0.05). Data are means +/- SD. ANOVA was used for statistical evaluation.
About 40% of elderly hypertensives showed an significantly increased ratio of ionized calcium and magnesium, which is well known to be a marker for the development of arteriosclerosis.

Conclusions:
As described earlier, a deficiency in the biofactor magnesium can be involved in the pathogenesis of essential hypertension. Ionized magnesium data, as presented here, are rare, but ionized magnesium is the active magnesium in the body regulating about 600 enzymatic reactions.
The significantly increased ratio of ionized calcium and magnesium is important in the development of arteriosclerosis often resulting in stroke or heart insufficiency in hypertension.
AGE AND ANDROGENS IN POLYCYSTIC OVARY SYNDROME
Authors: Chaabouni Khansa , Jallouli Dana , Khanfir Fatma , Makhlouf Rihab , Chaari Asma , Baccouch Hanene , Moalla Chokri , Frikha Madiha , Chaabene Kais , Elleuch Aida , Ayadi Fatma 
Published: June 2023

Objective:
Hyperandrogenemia is a feature of polycystic ovary syndrome (PCOS). It was always linked to PCOS comorbidities and cardiovascular risk.

Objective:
analyze androgen levels across age groups in PCOS and controls.

Design and method:
age-matched PCOS and controls were recruited. PCOS diagnosis was made according to Rotterdam criteria. An age above 30 years was considered old reproductive age. Testosterone and estradiol were dertemined by cobas 6000-Roche. Androstenedione and dehydroepiandrosterone sulfate were assessed using ELSA-DRG kits.

Results:
A total of 80 participants were included: 40 PCOS and 40 controls. No difference was noted in body mass index between PCOS patients vs controls and young PCOS patients vs old ones. All sex steroid hormone levels were increased in PCOS patients compared to controls. Negative correlations were observed between age and androgens in all participants. One-quarter of PCOS patients were at old reproductive age. Their androgens levels were significantly lower compared to younger PCOS patients.

Conclusions:
as women grow older hyperandrogenemia would be less pronounced. An age-specific androgen cut-off would be considered for the diagnosis of hyperandrogenemia and help in the assessment of cardiovascular risk.