bluuebunny/crossref_metadata_2025_split huggingface dataset:
LONG TERM EFFECT OF RESISTANT ARTERIAL HYPERTENSION ON RENAL FUNCTION IN COMPARISON TO NON-RESISTANT ARTERIAL HYPERTENSION
Authors: Ramik Zdenek , Vaclavik Jan , Kvapil Tomas , Jelinek Libor , Kocianova Eva , Kamasova Monika 
Published: June 2022

Objective:
Arterial hypertension (AH) and its harmful effect on renal function is well known. Long term impact of resistant arterial hypertension (RAH) on renal function has not been evaluated yet. The aim of this study was to assess the long-term renal function decline in patients with RAH and non-resistant arterial hypertension.

Design and method:
We retrospectively reviewed records of 265 patients followed between May 2007 and January 2019 in an Hypertension Excellence Centre of a tertiary hospital. In all patients we assessed basic demographic characteristics, co-morbidities, laboratory findings, secondary causes of AH, medication, blood pressure including ambulatory blood pressure monitoring, studies and invasive procedures (CT, MRI, coronarography). We statistically evaluated differences in both groups and compared the decline of renal function.

Results:
137 patients had resistant and 128 patients non-resistant hypertension. Patients were followed for a mean of 6 years (minimum 2 years, maximum 10,6 years). Decline of renal function occurred more frequently in in patients with RAH (74.5%) than patients with non-resistant AH (65.6%). During the first 4 years of follow-up, patients with RAH had higher mean annual eGFR decline (-2.45 ml/s/1.73m2) compared to patients with AH (-1.825 ml/s/1.73m2) (Table 1). Patients with RAH were older (58.1 ± 10.8 years vs. 51 ± 13 years), more frequently diabetics (39.3 % vs. 8.7 %), had more frequent exposure to diagnostic studies and invasive procedures (86,5% vs. 64%), and more patients with RAH underwent renal denervation (15.3% vs. 1.3%), all with P < 0.001.

Conclusions:
Patients with resistant hypertension had faster decline of renal function in the course of first four years of follow-up in comparison to patients with non-resistant hypertension. The goal of the following studies will be to determine the key factors affecting renal function decline in both subgroups.
CARDIOVASCULAR AND KIDNEY OUTCOMES IN TREATED RESISTANT HYPERTENSIVE PATIENTS
Authors: Matova Olena , Mishchenko Larysa , Talaeva Tatyana 
Published: June 2022

Objective:
To evaluate the incidence of cardiovascular (CV) and kidney outcomes and its predictors in treated resistant hypertensive (rHTN) patients.

Design and method:
We studied 117 rHTN patients and 114 controlled hypertensives (cHTN) patients on a triple fixed-dose combination of RAAS blockers / CCB / thiazide or thiazide-like diuretic. Patients with rHTN treated with the same type of triple fixed-dose combination in maximally tolerated doses plus the individually defined most effective fourth-line agent (spironolactone/eplerenone 56.1%, torasemide 26.8%, nebivolol 14.6%, moxonidine 2.5%); the fifth class of antihypertensive drug was added for 35.2 % of patients. A composite CV (CV death, myocardial infarction and/or revascularization, stroke, atrial fibrillation, and peripheral arterial disease) and kidney outcome (dialysis or GFR decline by 40% or greater) were estimated after five years (a mean follow-up 5.1 ± 0.1). The combined endpoint was defined as total CV and renal outcome events.

Results:
The goal office and 24-h BP were achieved at 49.6 and 34.2 % rHTN patients by the end of 5-year follow-up. During follow-up the incidence of all outcomes were higher at rHTN patients compared to cHTN pts: composite CV events (26.5 % vs 7 %, P = 0.001), kidney outcomes (4.3 % vs 0.9 %, P = 0.01), and diabetes (3.4 % vs 0.9 %, P = 0.02). The independent predictors of combined end point identified by multivariant logistic regression analysis were initial 24-h systolic BP ( = 0.099; OR = 1.10; 95 % CI 1.03 – 1.18; P = 0.008), blood concentration of endothelial progenitor cells (CD45+/CD34+) ( = - 0.89; OR = 0.41; 95 % CI: 0.21 – 0.79), P = 0.007) and citrulline ( = - 0.89; OR = 1.13; 95 % CI: 1.07 – 1.20; P < 0.001).

Conclusions:
Despite significant improvement in BP control the incidence of CV and renal outcomes in rHTN patients were higher than in cHTN patients. The independent predictors of combined CV and renal events were higher baseline systolic blood pressure, citrulline plasma level, and low concentration of endothelial progenitor cells.
VASCULITIS AND RENOVASCULAR HYPERTENSION – A CASE REPORT
Authors: Ferrão Diana , Silva Clara , Matos Mariana , Ferreira Susana , Tavares Sofia , Nogueira-Silva Luís , Lima Maria João , Almeida Jorge 
Published: June 2022

Objective:
Vasculitides are a group of rare, systemic diseases that induce inflammatory reactions in blood vessels, causing a reduction of blood flow and ischemia. In the kidney, luminal narrowing reduces blood flow and activates the renin-angiotensin-aldosterone system, causing renovascular hypertension.

Design and method:
Clinical case report.

Results:
A 47-year-old male with previous intestinal tuberculosis and hypertension diagnosed two years prior (blood pressure around 220/110 mmHg) was referred to our Hypertension Clinic. He reported self-limited episodes of lumbar pain, tender erythematous nodules in the shins and arthralgias. His mean office blood pressure was 203/118 mmHg, confirmed in home blood pressure monitoring, without medication. He had left ventricular concentric hypertrophy and chronic kidney disease (eGFR 66 mL/min/1.73m2) with albuminuria (561 mg/24 h). Verapamil and clonidine were prescribed to search for secondary hypertension but he missed the following appointment. A few months later he was admitted to the Intensive Care Unit due to a hypertensive emergency, with acute kidney failure and a large peri-renal hematoma. A CT scan and an angiography showed bilateral renal scarring, intrarenal pseudoaneurysms and small irregularities in the renal arteries. The immunologic panel was negative. A PET scan showed a slight enhancement of the aorta walls and common carotid arteries and the diagnosis of large-vessel vasculitis was established. He was discharged with high-dose corticosteroids and lisinopril and returned to our Hypertension Clinic. His blood pressure remained uncontrolled despite full-dose amlodipine, chlorthalidone and nebivolol; lisinopril was stopped due to worsening kidney function. Due to doubts on the diagnosis, the CT scan was repeated, now showing also irregularities in the common hepatic artery and mesenteric artery, suggesting a medium-vessel vasculitis, namely polyarteritis nodosa, and cyclophosphamide was started. His blood pressure is now controlled with lisinopril 2.5 mg, amlodipine 10 mg bid, furosemide 40 mg bid, nebivolol 5 mg and clonidine 0,15 mg tid and his kidney function is stable.

Conclusions:
Renovascular hypertension is responsible for less than 1% of all cases of hypertension and, when present, it is usually caused by atherosclerotic disease or fibromuscular dysplasia. However, in more infrequent cases, an inflammatory systemic disease may be present and must be considered.
FACTORS ASSOCIATED WITH AN INCREASED RISK OF ADVERSE CARDIOVASCULAR EVENTS IN PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Denisova Anastasiya , Solntseva Tatyana , Sivakova Olga , Chazova Irina 
Published: June 2022

Objective:
To identify factors associated with an increased risk of adverse cardiovascular events in patients with arterial hypertension

Design and method:
We analyzed the results of 455 patient case files of patients with arterial hypertension included in the database in the period from January 2016 to May 2020. We made a phone call to all patients to identify new cases of adverse cardiovascular events (ischemic heart disease, stroke, transient ischemic attack, atrial fibrillation, chronic heart failure, death). 371 (81.5%) of 455 patients answered.

Results:
45 adverse cardiovascular events occurred in 371 patients with arterial hypertension. Such factors as the age of the onset of hypertension, the duration of hypertension, gender, obesity, dyslipidemia, hyperuricemia, left ventricular hypertrophy, and severe retinopathy were analyzed to assess the relationship with adverse cardiovascular events. According to the Kaplan-Meier survival analysis in the presence of severe retinopathy, the risk of complications after 36 months of follow-up was 50% (p = 0.018). The hazard ratio for complications in the presence of severe retinopathy was 7.88 (CI 1.05–58.98; p = 0.044). Besides only 8 (1.75%) of 455 studied patients with arterial hypertension had severe retinopathy (retinal hemorrhage, microaneurysm, cotton wool spot, hard exudates or optic disc swelling). All 8 patients had a resistant arterial hypertension. No other evidence of interaction was found between other factors and the risk of adverse cardiovascular events.

Conclusions:
Severe retinopathy is more common in patients with resistant hypertension. Severe retinopathy is associated with an increased risk of adverse cardiovascular events in patients with arterial hypertension
EFFECT OF LONG-TERM USE OF CONTINUOUS POSITIVE AIRWAY PRESSURE TREATMENT ON ARTERIAL STIFFNESS IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA AND RESISTANT HYPERTENSION
Authors: Roderjan Christian Nejm , de Souza Fabio , Chedier Bernardo , de Hollanda Cavalcanti Aline , Viegas Bianca , Carlos Fernanda Oliveira Carvalho , Santos Taissa Lorena dos , de Azevedo João Carlos Moreno , de Carvalho Fortes Carolina , de Jmello Barreto Bianca Zattar , de Melo Nolasco Vitor , do Nascimento Vallaperde João Gabriel , Silva João Gabriell Bezerra da , Muxfeldt Elizabeth Silaid 
Published: June 2022

Objective:
To evaluate the impact of a long-term use of CPAP on arterial stiffness (AS) measured by pulse wave velocity (PWV) in patients with resistant hypertension (RHT) and moderate-severe obstructive sleep apnea (OSA).

Design and method:
An observational prospective study was performed in 121 patients (38% male, mean age 60.7 ± 7.8 years) with RHT and moderate/severe OSA (AHI> 15/hour) divided in 2 groups using CPAP (CPAP group – n = 62) and not using CPAP (control group – n = 59) and followed for at least 12 months. Pulse wave velocity and ABPM were measured before and after follow-up. Primary outcomes were changes in aortic stiffness. Intergroup comparisons of differences in PWV were assessed by a general linear model with allocation group (CPAP or control) as a fixed factor and adjusted for their respective baseline PWV values in addition to gender, age, and 24-hour SBP values. Per-protocol analysis was performed excluding patients with poor CPAP adherence.

Results:
Patients were followed-up for a median of 68 [49–81] months. They used a median of 5 [3–8] anti-hypertensive drugs and had mean PWV of 8.41 ± 1.52 m/s. CPAP and control groups were similar in their baseline demographic, anthropometric, office and ambulatory BP, PWV, and laboratory characteristics.
Control group had a mean increase in PWV of 0.88m/s (95% CI: 0.52–1.25 m/s, p < 0.001), whereas CPAP group had an average increase in PWV of 1.20 m/s (95% CI: 0.84–1.55 m/s; p < 0.001). After adjustment for initial PWV, gender, age and 24-systolic BP, the mean difference between CPAP and control groups was + 0.32 (95%CI: 0.17–0.83; p = 0.20). In a subgroup analysis with patients with higher PWV (>10m/s) the mean difference adjusted was -0.20 (95%CI: -2.17–1.75, p = 0.83).

Conclusions:
Long-term treatment with CPAP did not reduce aortic stiffness in RHT with moderate/severe OSA, but it may prevent its worsening in relation to control group in those with baseline increased arterial stiffness.
EFFECTS OF ISOMETRIC EXERCISE ON THE SPECTROMETRIC PROFILE OF OLDER ADULTS WITH HIGH BLOOD PRESSURE
Authors: Teixeira Manuel , Pinto Diogo , Rato Nuno Dias , Garcia Catarina , Marques Maria J. , Amaral Teresa , Amaral Leonor , Ruivo Pedro , Abreu Ricardo , Oliveira Ana P. , Carneiro Cristiana , Figueiredo Daniela , Polónia Jorge , Mesquita-Bastos José , Viana João L. , Pescatello Linda S. , Nunes Alexandra , Alves Alberto J. , Ribeiro Fernando 
Published: June 2022

Objective:
A decline in protein homeostasis is associated with the development and progression of several cardiovascular diseases, including hypertension. Physical exercise is a promising intervention to counter defects in protein quality control. Isometric resistance training (IRT) promotes clinically relevant reductions in blood pressure (BP), however, its effects on protein homeostasis are not clearly defined. We determined the general proteomic profile in human plasma of older adults with high normal BP to hypertension and how it changes in response to IRT.

Design and method:
Older adults (n = 11, age: 73 ± 3 years) with high normal BP to hypertension participated in 8-weeks of IRT. IRT consisted of 4x45 sec contractions, alternatively with both hands, at an intensity of 50% of the maximum voluntary contraction, with a 1-min interval between sets, performed 3 times per week. Fourier-transform infrared (FTIR) spectroscopy assessed changes in the plasma after versus before IRT in the region of the spectra attributed to the secondary structure of proteins (1700–1600 cm-1).

Results:
Samples showed an excellent discrepancy before versus after IRT in the 1700–1600 cm-1 region. IRT induced a shift in the peak in the in the spectra region of 1622 cm-1; this region is attributed to intermolecular beta-sheets, which are common structures found in mature fibrils. Mature fibrils are prone to form toxic protein aggregates, especially amyloid aggregates. After IRT, participants appeared to have lower levels of intermolecular beta-sheets and samples were enriched with antiparallel beta-sheets (1696 cm-1) and beta-turns (1665 cm-1).

Conclusions:
The decrease in intermolecular beta-sheets may represent an improvement in the protein turnover and a better protein quality control in hypertension as a result of IRT. The differences in the antiparallel beta-sheets and beta-turns after IRT indicate IRT is modifying the protein profile. Further studies are needed to confirm these results and to address how exercise is influencing protein homeostasis.
TRENDS IN ANTIHYPERTENSIVE MEDICATION USE AFTER ISCHEMIC STROKE (1999–2020)
Authors: Castilla-Guerra Luis , Luque Linero Paula , Fernandez Moreno Maria Del Carmen , de la Serna Fito Macarena , Valenzuela Gonzalez Antonio , Alegre Albendea Maria , Ramirez Gurruchaga Pedro , Rico Corral Miguel Angel 
Published: June 2022

Objective:
Hypertension (HT) is a major risk factor for stroke. The guidelines for the management of HT in stroke patients have been updated periodically and changed. We aimed to examine trends in antihypertensive medications use after ischemic stroke

Design and method:
Retrospective study on ischemic stroke patients discharged from 3 tertiary general hospitals, during the periods: 1999–2001, 2014–16 and 2019–2020. Data analysis was performed using SPSS statistical software (IBM SPSS Statistics 24; Chicago, IL, USA).

Results:
We included 1,806 patients, 753 (41.6%) women, mean age 69.7 (± 10) years.
Comparing the periods, the patients are now older (68.7–69.9–71.3; p = 0.003) and have a higher frequency of HT (67.3% vs. 73.8% vs. 75.4%; p = 0.0001). HT was the most prevalent vascular risk factor in all periods.
At discharge, more antihypertensive drugs were used progressively (in 56.4% vs 69.1% vs 84.7% of patients; p = 0.0001). There was a clear increase in the number of antihypertensive drugs used (mean 0.94 ± 0.8 vs 1.6 ± 1.05 vs 2.1 ± 0.5 drugs; p = 0.0001). Use of diuretics (14%-41.1%-63.8%; p = 0.0001), angiotensin-converting enzyme inhibitors (37.1%-43.8%-54%; p = 0.0001), and angiotensin receptor blockers (12.3%-24.3%-31.1%; p = 0.0001) increased progressively. On the contrary, use of calcium antagonists decreased (25%-22.5%-15.1%; p = 0.0001)

Conclusions:
The last 20 years has seen a significant increase in antihypertension medication use after ischemic stroke. At present, antihypertensive drugs are one of the most important medications in these patients.
IS HEADACHE AT ADMISSION ASSOCIATED WITH HIGHER RATE OF RECENT BRAIN MRI INJURY DURING MALIGNANT HYPERTENSION CRISIS?
Authors: Boulestreau Romain , Tillement Jeremie , Lucas Ludovic , Cremer Antoine , Doublet Julien , Rubin Sebastien , Sibon Igor , Gosse Philippe 
Published: June 2022

Objective:
Reliable clinical signs associated with recent brain injuries in neurologically asymptomatic patients during malignant hypertension crisis are lacking. We aimed to compare the prevalence of brain MRI injuries between fully asymptomatic patients and those with isolated headache.

Design and method:
This single-center, cross-sectionnal observational study recruited patients with malignant Hypertension (MHT). MHT was defined by severe hypertension and severe hypertensive retinopathy OR subacute damage of three among the target organs: heart, kidney, brain, vessels (thrombotic microangiopathy). Patients under 18 years old, under chronic dialysis and not willing to participate were excluded. IBrain MRI was performed within 21 days following diagnosis and was reviewed by a stroke neurologist who recorded the following markers: acute ischemic stroke(DWI and FLAIR positive), acute intracerebral hemorrhage (T2* and FLAIR positive), acute brain edema with extensive posterior white matter hyperintensity suggesting a PRES, and small vessel disease including old lacunar infarct, white matter hyperintensities (WMH), presence of dilated perivascular spaces.
Primary endpoint was the prevalence of recent brain injury in both group.

Results:
92 patients were included. Among them, the average age was 47.8 years, 67 % were men, average admission systolic blood pressure and diastolic blood pressure were respectively 213 +/- 31 mmHg and 119 +/- 19 mmHg, 73 % had severe hypertensive retinopathy, median(IQR) creatininemia was 115 (92–180) mol/l and 11 % had systemic Hemolysis.
Patients with no clinical symptoms or isolated headache presented respectively 39.5 % and 40 % of recent brain MRI abnormalities (cerebral Hematoma, ischemic stroke or PRES, p = 0.96). Patients with neurological signs on admission tended to have a higher frequency of recent brain injury than patients with isolated headaches (64,5%, p = 0,06), and a higher prevalence of chronic lacunar infarct (70,5% vs 44%, p = 0,04). We found no difference regarding cerebral microangiopathy in the 3 groups.

Conclusions:
Prevalence of recent brain injuries among patients with isolated headache and fully asymptomatic patients at admission of malignant hypertensive patients are similar and high. This raises the question of systematically performing brain MRI in patients with malignant hypertensive crisis.
CONTROLLED-RELEASED ORAL MELATONIN SUPPLEMENTATION FOR HYPERTENSION: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Kam Eric , Lee Pui , Poon Paul , Yu Chun-Pong , Lee Vivian , Chung Vincent Ch , Wong Samuel Ys 
Published: June 2022

Objective:
Oral melatonin is a potential alternative treatment for hypertension, but high-quality and relevant meta-analyses have not yet been conducted. This meta-analysis aimed to investigate whether oral melatonin supplementation could reduce daytime/asleep blood pressure, reduce cardiovascular risks, improve sleep quality, and if it is well-tolerated compared with placebo.

Design and method:
Relevant articles were searched in multiple databases, including MEDLINE, EMBASE, CINAHL Complete, and Cochrane Library, from their inception to June 2021. The included studies were randomized controlled trials that recruited patients with hypertension, using oral melatonin as the sole intervention, and investigated its effect on blood pressure. The mean out-of-office (including 24-h, daytime, and asleep) systolic blood pressure and diastolic blood pressure, sleep quality, and side effects were compared between the melatonin and placebo arms using pairwise random-effect meta-analyses. The risk of bias assessment was conducted using the Cochrane risk-of-bias tool.

Results:
Four studies were included; only one study was considered to have a low risk of bias. No study reported cardiovascular risk or outcomes. Only controlled-release melatonin (but not immediate-release preparation) reduced asleep systolic blood pressure by 3.57 mm Hg (95% confidence interval: -7.88–0.73; I2 = 0%). It might also reduce asleep diastolic blood pressure and awake diastolic blood pressure, but these differences did not reach statistical significance. Melatonin may improve sleep efficacy and total sleep time and is safe and well-tolerated.

Conclusions:
Due to the limited number of high-quality trials, the quality of evidence was low to very low high-quality and adequately powered randomized controlled trials on melatonin are urgently needed.
A RANDOMIZED CONTROLLED TRIAL OF INDIVIDUALIZED HOMOEOPATHIC TREATMENT TO REDUCE ANGER & THEREBY REDUCING HYPERTENSION
Authors: Bagadia Leena 
Published: June 2022

Objective:
Despite improved detection and treatments, rates of hypertension (HT) are not decreasing. More and more people experience increased anger, anxiety, depression brought on by globalisation and stress leading to high-risk behaviours. There is the possibility that blood pressure (BP) may positively correlate with anger variables leading to essential hypertension (EHT). Homoeopathy works holistically, helping the patient to cope up with these changes. The study aims to demonstrate the efficacy of similimum on mild to moderate essential hypertension by modifying the underlying anger state, trait, and expressions, thus making the patient more capable of coping with the changing life situations than standard care treatment.

Design and method:
172 patients (108 males and 64 females) between 18–65 years were enrolled after consent. They were allocated to the placebo and intervention groups by simple randomisation. Thorough homoeopathic case-taking was done, and the STAXI-2 scale was applied at the beginning and after a 6-months study period to measure the change in anger. Regular follow up was done every two weeks to evaluate the subjective and objective parameters.

Results:
After six months, in the control arm 16%, had to be prescribed standard AHT. Whereas in the intervention arm, the BP of all patients were maintained on similimum. The patients on standard AHT, in the control arm 98%, continued with the same dose of their medicines. However, standard AHT stopped in 33% of patients in the intervention group, and in 28%, the dose was reduced. Reduction in blood pressure and anger variables at the end of the study period was statistically significant (p = 0.001) in both arms. However, the difference was significantly more in all variables in the intervention arm than in the control arm.

Conclusions:
Most hypertension patients, especially with a family history of HT, suppress their anger & hostile impulses.
Individualised homoeopathic treatment reduces anger & thereby have a reduction in elevated BP.
Also, it relieves associated ailments.