bluuebunny/crossref_metadata_2025_split huggingface dataset:
HIDDEN CENTRAL HYPERTENSION AND SPURIOUS HYPERTENSION IN ELDERLY PEOPLE
Authors: Miserque Leila , Boscaro Marcelo , Kotliar Carol , Obrego Sebastian 
Published: June 2022

Objective:
Determination of brachial systolic blood pressure (SBP-b) and central systolic blood pressure (SBP-c) in the elderly could contribute to their better management by the identification of hidden central hypertension (HCH) and spurious hypertension (SH).
Objectives: a) to analyse SBP-b and SBP-c relationship, b) to determine prevalence and phenotypes of HCH and SH, c) to evaluate antihypertensive treatment; d) to identify risk of orthostatic hypotension (OH).
Methods: We included patients older than 65 years old who consecutively consulted to the participating sites (2014–2019) retrospectively and accordingly to their previous hypertension diagnosis were classified as hypertensives or normotensives. Brachial and central blood pressure measurements allow us to identify four phenotypes: 1) normal SBP-b with high SBP-c, 2) high SBP-b with normal SBP-c, 3) both normal, 4) both high. Statistical: Student test, ANOVA, Chi2.

Design and method:
1595 subjects were recruited (female 47.8%, 70.9 ± 5.2 years); 66.6%(n:1063) hypertensive/33.3%(n:532) normotensives. We identified HCH in 7.9%(n:84), SH in 5.2%(n:55) in hypertensive group, compared with 10.7%(n:57) and 3.4%(n:18) respectively in normotensives. Elevated values of SBP-b were detected in 27.1% normotensives, although 10.7% had normal SBP-c. Table 1 shows the baseline and hemodynamic characteristics of general population according to phenotypes. No differences were found between different classes of antihypertensive drugs, but a higher number of medications was reported in SH. OH was identified in 35%, showing 48% of them SH.

Conclusion:
Hidden central hypertension was present in almost 5% of elderly people while spurious hypertension in 9%, similar in hypertensives and normotensives. Phenotypically HCH subjects were older, less active, with increase PWV and AIX, but with lower HR than those with SH, who showed higher CI, HR and SVR. As it was expected, our study results suggest that elderly people with HCH could be at risk of being sub-treated and inversely, those with SH could be over-treated. The OH prevalence in SH supports this latter issue. Finally, the measurement of SBP-c seems to be a useful clinical variable that could lead to a better management of blood pressure in the elderly.
ASSESSMENT OF STIFFNESS OF LARGE TO SMALL ARTERIES IN MULTI-STAGE RENAL DISEASE: A NUMERICAL STUDY
Authors: Obeid Hasan , Bikia Vasiliki , Fortier Catherine , Pare Mathilde , Segers Patrick , Stergiopulos Nikos , Agharazii Mohsen 
Published: June 2022

Objective:
Arterial stiffness, as assessed via pulse wave velocity (PWV), is a major biomarker for risk assessment in patients with chronic kidney disease. However, the mechanisms responsible for the changes in PWV in the presence of kidney disease are not yet fully elucidated. In the present study, we aimed to investigate the direct effects attributable to biomechanical alterations to the arterial tree caused by renal disease progression on arterial stiffness, independent of any biochemical or compensatory effects.

Design and method:
Particularly, we used a previously validated one-dimensional (1-D) model of the cardiovascular system to simulate arterial pressure and flow at control with two kidneys (2KDN) and in arterial tree configurations representative of different stages of kidney disease, namely subject with a single functional kidney (1KDN), without any functional kidney (0KDN) and a transplant recipient (TX) with a single functional kidney re-attached to the external iliac artery. We evaluated the respective variations in blood pressure (BP), as well as arterial stiffness of large, medium, and small-sized vessels via carotid-femoral PWV (cfPWV), carotid-radial PWV (crPWV), and radial-digital PWV (rdPWV), respectively.

Results:
Our results showed that BP was increased in 1KDN and 0KDN, and that systolic BP values were restored in the TX configuration. Furthermore, a rise was reported in all PWVs for all tested configurations. The relative difference in stiffness from control to 0KDN was higher in the case of crPWV (+20 %); approximately twice the difference observed for cfPWV and rdPWV (+11 %). In TX, we observed a restoration of the PWVs to values close to 1KDN. Globally, it was demonstrated that alterations of the outflow boundaries to the renal arteries as occurring in different stages of renal disease lead to changes in blood pressure and central and peripheral PWV in line with previously reported clinical data.

Conclusions:
Our findings suggest that the PWV variations observed in clinical practice with renal disease progression may be partially attributed to biomechanical alterations of the arterial tree, and their effect on blood pressure.
PREVALENCE OF HYPERTENSION AND DISTRIBUTION OF BODY MASS INDEX LEVELS AMONG OLDER ADULTS WITH TYPE 2 DIABETES MELLITUS IN VIETNAM: A MULTICENTRE STUDY
Authors: Thanh Huan Nguyen , Trong Khang Ha Pham , Huu An Nguyen , Xuan Giao Nguyen Thi , My Hang Lam , Thanh Thu Nguyen , My Phuong Le Thi 
Published: June 2022

Objective:
The coexistence of hypertension and diabetes can increase the risk of cardiovascular events. However, in Vietnam, little information is known about the clinical characteristics of older adults with type 2 diabetes mellitus (T2DM) and the prevalence of hypertension in these patients. This study aims to investigate the prevalence of hypertension and the distribution of body mass index (BMI) among older adults with T2DM in Vietnam.

Design and method:
This cross-sectional study was conducted among outpatients aged 60 years or over at five geriatric clinics from January 2019 to July 2020. The patients were diagnosed with T2DM and hypertension based on the recent clinical guidelines of the European Society of Cardiology. The BMI was stratified according to the guidelines set by the World Health Organization for the Asia-Pacific region.

Results:
The 1,296 patients with T2DM enrolled in this study had a mean age of 69.9 ± 7.3 years, an age range of 60–94 years, and a male predominance of 54.4%. The prevalence of hypertension was 82.5% (n = 1069). For the BMI, 4.5% (n = 58) were underweight, 39.4% (n = 510) were of normal weight, 24.2% (n = 314) were overweight, and 31.9% (n = 414) were obese. Obesity was more prevalent in men than in women (35.5% vs. 27.7%), and women presented a higher rate of having normal weight than men (45.0% vs. 34.6%). There was no statistically significant difference in the distribution of BMI between the hypertensive and non-hypertensive groups (Figure 1).

Conclusions:
The prevalence of hypertension among older adults with T2DM was high among the Vietnamese study participants (82.5%). The distribution of BMI levels was not different between the hypertensive and non-hypertensive groups but was significantly different between the males and females.
THE ACTION OF ANTIHYPERTENSIVES ON CENTRAL VESSEL STIFFNESS IN THE ELDERLY: A SUBSTUDY OF EVOUPIU (BRAZILIAN STUDY OF PULSE WAVE VELOCITY IN ELDERLY)
Authors: Ferreira Flávio , Freitas Erci , Souza Denis , Rodrigues Cléria , Rodrigues Cristiane , Prado Erick , Ferreira-Filho Sebastião 
Published: June 2022

Objective:
Central arterial stiffness (CAS) is increased in the elderly, and its acceleration may be induced by systemic hypertension. The increased pulsatile pressure may promote damage to vital organs. Antihypertensive drugs can act on the CAS and decrease these patients’ cardiovascular risk. The present study aimed to compare the CAS of hypertensive elderly patients with different therapeutic schemes, using only two antihypertensive drugs: hydrochlorothiazide (HCTZ) as monotherapy or HCTZ associated with another class of antihypertensive drugs

Design and method:
This study is a cross-sectional analysis of elderly patients included in the data bank of EVOPIU. The data were extracted from the first medical consultation of the study. A total of 293 elderly hypertensive patients were separated into seven groups: those taking no antihypertensive medication (NAM, n = 47); hydrochlorothiazide alone (HCTZ, n = 25), HCTZ, and beta-blockers (n = 51); HCTZ and calcium channel blockers (n = 24); HCTZ and AII receptor blockers (n = 59); HCTZ and AII-converting enzyme inhibitors (n = 61); and HCTZ and spironolactone (HCTZ +SPIRO, n = 27). CAS was measured by femoral-carotid wave velocity (c-fPWV).

Results:
When compared to NAM patients, only the HCTZ + SPYRO group showed significantly lower values in c-fPWV (12.1 ± 0.44 vs. 10.5 ± 0.56 ms; P < 0.05, respectively), central pulse pressure (PP) augmentation index (Alx) (52.0 ± 1.9 vs. 45.6 ± 2.5 mmHg, P < 0.05), brachial PP (68.6 ± 2.1 vs. 61.5 ± 2.7 mmHg, P < 0.05). This group did not show higher serum potassium levels than the other groups studied.

Conclusions:
The results suggest that arterial stiffness in elderly patients may be, at least in part, caused by an effect of aldosterone on the arterial wall. CAS may be partially reversible with spironolactone. Its effect seems independent of observed effects on systemic arterial blood pressure.
EARLY VASCULAR AGEING IN PATIENTS WITH HYPOPARATHYROIDISM
Authors: Fabbri Saverio , Boutouyrie Pierre , Khettab Hakim , Maruani Gérard , Houillier Pascal , Bruno Rosa Maria 
Published: June 2022

Objective:
Hypoparathyroidism may induce arterial damage, but underlying mechanisms are not well established. Few papers have addressed the topic, reporting an increase in central values and in carotid intima-media thickness [1][2]. The aim of this study was to determine the presence of early vascular ageing signs in large and small arteries.

Design and method:
17 patients affected by hypoparathyroidism and 17 healthy controls (matched for age, sex, blood pressure and risk factors) were studied to obtain carotid-femoral PWV, carotid and digital intima-media thickness and stiffness bystandard and ultta-high frequency ultrasound respectively. In the patients affected by hypoparathyroidism, complete calcium-phosphorus metabolism blood tests were taken.

Results:
carotid distensibility was significatively lower in the patients group (18,7 ± 6.0 vs 39,4 ± 10,5 (kPa at(-1)) p < 0.001), with a marked increase in carotid stiffness (7,6 ± 1,3 vs 5,3 ± 0,9 m/s, p < 0.001). No significant difference was reported in PWV and central pressure among the groups. A reduced digital artery diameter was present (mean diameter 0,8 ± 0,1 vs 1,0 ± 0,2 mm p = 0.005), with a reduced stiffness (5,6 ± 2,5 vs 9,2 ± 4,9 m/s p < 0.05). A positive correlation between carotid artery stiffness and Calcium – Phosphorus product was found in the patients group (r = 0.538 p = 0.031).

Conclusions:
Hypoparathyroidism is characterized by increased carotid artery stiffness. Digital stiffness (UFHS) is paradoxically reduced (possibly as compensatory mechanism), with hypotrophic emodelling. Our data support altered calcium-phosphorus metabolism as mechanism of arterial damage.
PREDICTING INDIVIDUAL RISK OF MUSCLE DISORDERS IN PATIENTS ELIGIBLE FOR STATIN TREATMENT: STRATIFY-STATINMD MODEL DERIVATION USING DATA FROM ELECTRONIC HEALTH RECORDS
Authors: Cai Ting , Koshiaris Constantinos , Hirst Jennifer A. , Hobbs F.D. Richard , McManus Richard J. , Sheppard James P. 
Published: June 2022

Objective:
Concerns about muscle-related adverse events have posed a dilemma when considering statin prescription for prevention of cardiovascular disease (CVD). This study aimed to develop a prediction model for an individual’s risk of muscle disorders to support clinical decision making in primary care.

Design and method:
A prospective cohort design was adopted, using electronic health records from the Clinical Practice Research Datalink in the UK. Males aged over 50 and females aged over 60, who were potentially eligible for statin treatment based on their underlying CVD risk, were followed-up for ten years. The primary outcome was hospitalisation or death in those with a diagnosis of muscle disorders. The Fine-Gray proportional sub-distribution hazards model was fitted to address competing risk of death from other causes. Statin prescriptions within the 12 months before follow up and other predictors were included in the model based on a literature review.

Results:
The cohort included 1,785,207 patients, with a mean age of 64 and 44% females. Patients prescribed statins were predicted to have a higher risk of muscle disorders (atorvastatin: hazard ratio = 1.77 [95% confidence interval: 1.58 - 1.97]; rosuvastatin: 2.04 [1.58 - 2.63]; simvastatin: 1.58 [1.45 - 1.71]; other statins (fluvastatin/pravastatin): 1.38 [1.14 - 1.68]). Female sex, deprivation, smoking, obesity, frailty, liver or kidney disease, rheumatic arthritis, previous muscle problems, degenerative joint disorders, hypothyroidism, vitamin D or B12 deficiency, and the use of drugs that are potentially myotoxic or interact with statins also increased an individual’s risk (Table). An automated risk calculator was developed based on the model (Figure).

Conclusions:
This model uses routinely available patient characteristics and medical history to predict an individual’s risk of muscle disorders. The calculator may help clinicians and patients communicate the safety concerns and make shared decisions or monitoring strategies on statin treatment. External validation of this model is ongoing to support general application of the risk calculator in clinical practice.
IMBALANCE IN BONE MORPHOGENIC PROTEINS 2 AND 7 IS ASSOCIATED WITH HYPERTENSION AND ARTERIAL STIFFNESS IN CHRONIC KIDNEY DISEASE
Authors: Manzano-Lista Francisco J. , Sanz-Gómez Marta , González-Moreno Daniel , Vega-Martín Elena , Gil-Ortega Marta , Aránguez Isabel , Schulz Angela , Rubio Miguel Ángel , Ruiz-Hurtado Gema , Ruilope Luis M. , Kreutz Reinhold , Fernández-Alfonso María S. 
Published: June 2022

Objective:
Patients with chronic kidney disease (CKD) exhibit an elevated cardiovascular risk from the early stages (I-III) with an exponentially increasing risk of cardiovascular death as kidney function worsens. The hypothesis of this study is that there is a imbalance in bone morphogenetic proteins BMP-2 (procalcifying) and BMP-7 (renoprotective) at early CKD stages associated with the development of hypertension, vascular stiffness and progressive kidney damage.

Design and method:
BMP-2 and BMP-7 levels were determined by ELISA in samples of CKD patients (stages I-III; n = 95) and of Munich Wistar Frömter (MWF) rats (22 weeks old; n = 6), a genetic model with spontaneous nondiabetic CKD, compared to age-matched Wistar rats.

Results:
Plasma BMP-2 levels were significantly higher in stage III CKD patients compared to controls. BMP-7 was, however, significantly lower at any stage of CKD compared to the control group with a significant further reduction in stage III patients. MWF rats presented significantly higher BMP-2 plasma levels compared to Wistar rats, whereas BMP-7 level was lower. The MWF strain showed an elevation of both systolic (SBP) and diastolic blood pressure (DBP), as well as pulse wave velocity (PWV) compared to the Wistar group. A positive correlation was observed between the BMP-2/BMP-7 ratio and SBP, DBP, and PWV, respectively. Plasma 25-OH cholecalciferol concentration was lower in MWF showing a negative correlation with the BMP-2/BMP-7 plasma ratio. Urinary albumin excretion (UAE), tubular damage markers, Kim-1 and Ngal, as well as renal BMP-2 were significantly higher in the MWF group compared to Wistar, whereas renal BMP-7 expression was significantly lower. A positive correlation was detected between the BMP-2/BMP-7 ratio and both the UAE and plasma creatinine level. Periaortic and mesenteric perivascular adipose tissue (PVAT) from MWF rats showed an altered expression of BMP-2, BMP-7, profibrotic and calcification markers.

Conclusions:
Our data show an imbalance in plasma, kidney and PVAT-derived BMP-2 and BMP-7 levels associated with hypertension and arterial stiffness. This might reflect a profibrotic/pro-calcifying propensity related with progressive CKD.
A SMART SENSING MODULE AIMS AT REDUCTION OF MOTION ARTIFACT FOR WEARABLE TONOMETRY BLOOD PRESSURE DEVICE
Authors: Liu Weiting , Zhu Tao , Xie Fuyuan , Zhan Binpeng , Xu Man 
Published: June 2022

Objective:
This work focuses on development a unique mini sensing module to alleviate muscle action induced rtefacts and in the meanwhile to enable the alignment free capability for radial BP measurement.

Design and method:
The coupling variations from motion rtefacts tremendously distorts the sensing signal thus leads the measuring results unreliable and limits the applications of wearable blood pressure monitoring in daily life. It is key to have capability of sensing and recognizing the muscle action induced stress at the measuring site and then have the opportunity to eliminate misleading coupling variation. The mini sensing module consists of two independent sensing channels, which are neighboring distributed in parallel (Fig. 1). The channels are arranged enough close with the spacing only 2 mm in order to guarantee them sensing the same induced stress. The two channels have identical dimension feature with10 mm length and 3 mm width. And a 3 mm × 3 mm hard block is integrated into the middle segment of one channel. The channels are filled with degassed silicon oil and a silicon die is embedded and serves as pressure sensor unit. TPU flexible film is used to seal the channels, which serves also as the mechanical stimulation interface. The smart module is fixed to wrist with channel direction transversal to the arterial path during radial BP measuring. The blocked channel isolates completely (partly at least) stimulating from the vascular and serves as skin stress sensing reference, and the other sensing channel gets combination of the skin stress together with fully stimulating of vascular BP. It is straightforward that the difference two signal can partly at least eliminate the stress induced error, which also is presented in Fig.2. Further rtefacts reduction can be achieved by exploiting specific adaptive filtering algorithm with the blocked signal as disturbance input and the other as source.

Results:
Experiments have proved the effectiveness of the scheme.

Conclusions:
By comparison with the BP signal under optimal condition, the sensing module can provide with accurate BP pulse waves in the presence of motion interference.
VALIDITY CHECKING OF OSCILLOMETRIC AND AUSCULTATORY BLOOD PRESSURE MONITORING IN CLINICAL PRACTICE
Authors: Zhemanyuk Svitlana , Syvolap Vitaliy 
Published: June 2022

Objective:
Ambulatory blood pressure monitoring (ABPM) is an out-of-office method of blood pressure (BP) measurement, that could detect pressure with oscillometric or auscultatory devices. According to the 2021 practice guideline, one of the principles of ABPM implementation in routine clinical practice is validity checking, which means result elimination in case of the insufficient number of readings. However, the prevalence of correct ABPM data is unclear in daily practice. The study aimed was to analyze the validation procedure of two algorithms of blood pressure detection (oscillometric and auscultatory).

Design and method:
We study ABPM patterns in sinus 242 patients (mean age, 62 [95% CI, 60–63] years, 57% men). The day-night period was determined as 24-hour clock-based definitions (nighttime: 01:00 to 05:59). Validity was verified by nalysing readings numbers in awake and night periods (not-valid: < 20 and < 7 readings, respectively). To compare groups, we used Mann-Whitney two-sample statistic (Stata 15).

Results:
The total number of non-valid readings was 19,8% (48/242) in oscillometric and 45,9% (111/242) auscultatory devices (p < 0,001).

Conclusions:
The oscillometric devices show better validity checking in daily practice compare to auscultatory. Approximately one-fifth of ABPM results in oscillometric devices have to be repeated due to non-valid readings in daily clinical practice.
PERIDIALYTIC AND INTRADIALYTIC BLOOD PRESSURE MEASUREMENTS ARE NOT VALID ESTIMATES OF 44-HOUR AMBULATORY BLOOD PRESSURE IN PATIENTS WITH INTRADIALYTIC HYPERTENSION
Authors: Theodorakopoulou Marieta , Alexandrou Maria-Eleni , Iatridi Fotini , Karpetas Antonios , Geladari Virginia , Pella Eva , Alexiou Sophia , Ziakka Stavroula , Papagianni Aikaterini , Sarafidis Pantelis 
Published: June 2022

Objective:
In contrast to pre- and post-dialysis blood pressure (BP), intradialytic and home BP measurements are accurate metrics of ambulatory BP load in hemodialysis patients. This study assessed the agreement of peridialytic, intradialytic and scheduled interdialytic recordings with 44-h interdialytic BP in a distinct hemodialysis population, patients with intradialytic-hypertension (IDH).

Design and method:
45 patients with IDH (defined as: SBP rise greater than or equal to 10 mmHg from pre- to post-dialysis and post-dialysis SBP greater than or equal to 150 mmHg) with valid 48-h ABPM and 197 without IDH were included in this analysis. With 44-h BP used as reference method, we tested the accuracy of the following BP metrics: Pre- and post-dialysis, intradialytic, intradialytic plus pre/post-dialysis readings and scheduled interdialytic BP (out-of-dialysis day: readings at 8:00 am, 8:00 pm or their average).

Results:
In patients with IDH, peri-dialytic and intradialytic BP metrics showed at best moderate correlations, while averaged-interdialytic-SBP/DBP exhibited strong correlation (r = 0.882/r = 0.855) with 44-h SBP/DBP. Bland-Altman plots showed large between-method difference for peri- and intradialytic BP, but only + 0.7 mmHg between-method difference and good 95% limits-of-agreement for averaged-interdialytic-SBP. The sensitivity/specificity and kappa-statistic for diagnosing 44-h SBP greater than or equal to 130 mmHg were low for pre-dialysis (72.5%/40.0%, kappa-statistic = 0.074) and post-dialysis (90.0%/0.0%, kappa-statistic = -0.110), intradialytic (85.0%/40.0%, kappa-statistic = 0.198) and intradialytic plus pre/post-dialysis SBP (85.0%/20.0%, kappa-statistic = 0.043). Averaged-interdialytic-SBP showed high values of sensitivity/specificity (97.5%/80.0%,) and strong agreement (kappa-statistic = 0.775). In ROC-analyses, the peri- and intradialytic BP metrics showed bad performance with low Area-Under-the-Curve values; scheduled interdialytic SBP/DBP had the largest AUC (0.967/0.951), along with the highest sensitivity(90.0%/88.0%) and specificity(100.0%/90.0%) for detecting elevated 44-h BP.

Conclusions:
In patients with IDH, averaged-scheduled-interdialytic but not pre- and post-dialysis, nor intradialytic BP recordings show reasonable agreement with ambulatory BP. Interdialytic BP recordings only could be used for hypertension diagnosis and management in these subjects.