bluuebunny/crossref_metadata_2025_split huggingface dataset:
TIME OF BLOOD PRESSURE IN TARGET RANGE IN ACUTE ISCHEMIC STROKE
Authors: Kakaletsis Nikolaos , Ntaios George , Milionis Haralampos , Protogerou Athanasios , Karagiannaki Anastasia , Chouvarda Ioanna , Dourliou Vasiliki , Ladakis Ioannis , Kaiafa Georgia , Daios Stylianos , Doumas Michael , Savopoulos Christos 
Published: June 2022

Objective:
The management and the prognostic role of blood pressure (BP) during the acute phase of acute ischemic stroke (AIS) still remain controversial. Time in target range (TTR) of BP was recently introduced and is suggested that reflects both patient’s mean BP levels and the magnitude of BP variability (BPV). The purpose of this study is to investigate the association of blood pressure TTR derived from 24-hour ambulatory BP monitoring (ABPM), during the acute phase of AIS, with the severity of stroke and its predictive value for the 3 months outcome.

Design and method:
A total of 228 AIS patients (175 without prior disability) underwent ABPM every 20 minutes within 48 hours from onset using an automated oscillometric device (TM 2430, A&D Company Ltd). Clinical and laboratory findings were recorded. Mean BP parameters, BPV (standard deviation) and TTR for systolic (SBP), diastolic (DBP) and mean arterial pressure (MAP) were calculated. Endpoints were death and disability/death at 3 months.

Results:
A total of 14,942 BP measurements were recorded (~66 per AIS patient) within 72 hours of stroke onset. Patient’s 24-hour blood pressure TTR was 34.7 ± 29.9%, 64.3 ± 24.2% and 55.3 ± 29.4% for SBP, DBP and MAP respectively. TTR of DBP and MAP differed according to stroke severity with a “J’’ association in all AIS patents. In patients without prior hypertension, TTR was lower as stroke severity increased for both DBP (p = 0.031) and MAP (p = 0.016). In 175 patients without prior disability, increase in TTR of DBP and MAP associated significantly with a decreased risk of disability/death in the unadjusted and fully adjusted models (HR: 0.96, 95% CI: 0.95–0.98, p = 0.001 and HR: 0.97, 95% CI: 0.95–0.98, p = 0.001). Increase in SBP TTR was associated significantly with an increased risk of disability/death in fully adjusted model with the addition of mean SBP (HR: 1.03, 95% CI: 1.00–1.07, p = 0.047).

Conclusions:
TTR can be included for a more detailed description of BP course, according to stroke severity, and for the evaluation of BP predictive role, in addition to mean BP values, derived from ABPM during the acute phase of AIS.
TRAJECTORY OF PATIENTS AFFECTED BY STROKE IN A UNIVERSITY HOSPITAL CENTER IN THE NORTH WEST OF ALGERIA
Authors: Abdrebbi Samira Benbekhti , Meguenni Kaouel 
Published: June 2022

Objective:
Describe the path of patients who have suffered a stroke, and have been cared for at the University Hospital of Tlemcen with the aim of proposing strategies allowing the involvement of the various health bodies in the implementation of these trajectories.

Design and method:
Descriptive observational study over 02 years on stroke patients admitted to TLEMCEN University Hospital. Data collection made using a data collection sheet. Entry and analysis by the EPI info6 software.

Results:
1. The alert and the acute phase: the patients who came to the university hospital center of Tlemcen came from 13 municipalities of the Wilaya of Tlemcen and 5.9% from the other wilayas.
Patient reception structure:
2. The medical emergency service represented the first reception service for 95.60% of our patients and it is at this level that they are initially taken care of by emergency general practitioners. 21 patients were referred by different health establishments in the Wilaya.
3. Hospitalization 82% of stroke patients were hospitalized directed to a specialized and adapted service, preferentially the neurology service (80.50%).
The orientation depends on the cause of the accident and the evolution of the pathology. The practice of brain scan was performed in the public sector in 80.5% of our patients. but 19.5% did so at the private sector level. 93.70% performed this examination the same day of their admission. The mean length of hospitalization was 10.17 ± 7.58 days.

Conclusions:
Stroke is a pathology that involves the entire healthcare chain. This pathology requires multidisciplinary care, it concerns the hospital sector but also liberal medicine with its medical and paramedical actors. Thus, the trajectory of the stroke patient has several phases and involves a wide variety of actors.
Areas for improvement:
-  Improve the organization of care and management of strokes by creating neurovascular units (UNV).
-  Multidisciplinary team coordinated and dedicated to pathology neurovascular both in acute and post-acute phase
DAPAGLIFLOZIN’S EFFECT ON SERUM HOMOCYSTEINE IN PATIENTS WITH HYPERTENSION COMPLIACTED WITH INSULIN RESISTANCE
Authors: Yu Xiaoqian , Xu Rui 
Published: June 2022

Objective:
Most patients with hypertension complicate with insulin resistance (IR), which is one of risk factors of hypertension and can increase the level of serum homocysteine (hcy) by affecting hcy metabolic enzyme and insulin. Investigations in recent years have shown that hcy is an independent risk factor of cardiovascular diseases. At present, folic acid is the main drug used to reduce hcy, but its effection for hcy has obvious individual difference, which is closely related to individual genes. Moreover, folic acid (FA) is mostly used in patients with hcy beyond 15 mol/l, but hcy beyond 10 mol/l has had an adverse effect for cardiovascular system. Animal studies have shown that dapagliflozin can improve insulin resistance. Therefore, whether it can reduce hcy has become a new direction.

Design and method:
This study is a retrospective case-control study. Patients with highly serum hcy and hypertension complicated with insulin resistance are divided into two groups: dapagliflozin group and FA group. Before and after 12 weeks of treatment, the changes in serum hcy and IR index are measured and compared.

Results:
(1) The IR index and serum hcy levels are clearly lower in the dapagliflozin group after therapy, and the changement of IR index and the level of serum hcy has a significant relativity. (2) The IR index reduction is more noticeable in the dapagliflozin group than in FA group. (3) In dapagliflozin group, the standard deviation (SD) of serum hcy is lower than in the FA group.

Conclusions:
Dapagliflozin can reduce the serum hcy level of patients with hypertension and insulin resistance in a certain extent, also having an important effection in reducing IR. The lowering of serum hcy in the dapagliflozin group is more balanced than in the FA group. Dapagliflozin could be a viable option for these patients.
TRIPLE ANTIHYPERTENSIVE THERAPY TYPE AND USE IN FRENCH GENERAL PRACTICE AND CARDIOLOGY IN 2021
Authors: Mourad Jean Jacques , Jamet Philippine , Huguet Michael , Loubiere Manon , Lorc’h Erwan Le , Azria Philippe , Ferreira Emmanuel , Antakly Yara 
Published: June 2022

Objective:
Blood pressure control in France leaves room for improvement. Analysis of the data from the 2015 ESTEBAN study found treatment to be insufficient, with disproportionate use of monotherapies. The 2016 French National Authority for Health (HAS) guidelines emphasise the importance of logical treatment titration giving preference in primary prevention to a triple therapy combining a renin-angiotensin system blocker, a thiazide diuretic and a dihydropyridine. The impact of these guidelines on the prescription of triple therapies has not been studied in France.

Design and method:
Data from the IQVIA Longitudinal Patient Database (LPD) France were used. LPD France is a permanent observatory to which a nationally representative panel of physicians – including general practitioners (GPs) (n = 1200) and community cardiologists (n = 100) – contribute anonymised electronic medical records (EMR). The analysis included all antihypertensive treatment prescriptions from July 2020 to June 2021, which were then extrapolated to the entire population of mainland France.

Results:
In 2021, a total of 2 455 065 patients had received a triple therapy. A figure that accounted for 17.4% of the patients seen by a GP (n = 2 016 689) and 19.0% of the hypertensive patients followed by a cardiologist (n = 438 376). The most common (>5%) triple therapy combinations are given in the table. The ‘standard’ triple therapy recommended by the guidelines accounted for only 24.7% of the prescriptions in general practice. The prescriptions made in the cardiology and general practice settings have more similarities than differences.

Conclusions:
These findings confirm not just the insufficient use of triple therapies, but also their misuse, with the overrepresentation of the beta-blockers class not always justified by preferential indications. These observations should call into question both the quality of the guidelines’ dissemination and the continuing education of the primary care practitioners for this disease.
ACUTE AEROBIC EXERCISE-INDUCED DECREASE IN BLOOD PRESSURE IS ASSOCIATED WITH CHRONIC BLOOD PRESSURE CHANGES IN PATIENTS WITH RESISTANT HYPERTENSION
Authors: Lopes Susana , Mesquita-Bastos José , Garcia Catarina , Oliveira José , Polónia Jorge , Alves Alberto , Ribeiro Fernando 
Published: June 2022

Objective:
The acute blood pressure (BP) decrease after an exercise training session seems to correlate with the chronic BP reductions following exercise training programs in participants with pre-hypertension; yet, among patients with resistant hypertension (RH) it is unknown. This study aims to investigate the association between the magnitude of BP decrease after acute exercise and the change in 24-hr ambulatory blood pressure (ABP) after an aerobic exercise intervention in patients with RH.

Design and method:
EnRicH trial was a randomized clinical trial assessing the effects of a 12-week moderate-intensity aerobic exercise program in participants with RH. In the present study, twenty-six patients (mean age 59.3 ± 8.2 years, 58.3% male) with RH that participated in the intervention arm of the EnRicH trial were included. Office and ABP measurements were obtained before and after the 12-week aerobic exercise training program. To assess the acute effect, resting BP measures were assessed before and 10 minutes after each exercise session of the third week of the exercise program. Exercise sessions were supervised, occurred three times per week, and included 40 min of aerobic exercise at 50% to 70% of VO2max and a 10-minute cooldown.

Results:
Resting systolic (-9.4 ± 7.0, p < 0.001) and diastolic BP (-1.9 ± 3.4, p = 0.10) were significantly reduced after acute exercise. 24hr systolic (-6.2 ± 12.1, p = 0.015) and diastolic BP (-4.42 ± 6.1, p = 0.001) an office systolic (-10.9 ± 15.2, p = 0.001) and diastolic BP (-5.9 ± 11.1, p = 0.013) were significantly decreased after the exercise program. The acute changes were correlated with the chronic decrease in 24hr ambulatory systolic (r = 0.556, p = 0.003) and diastolic (r = 0.484, p = 0.012) BP, and office systolic (r = 0.478, p = 0.014) and diastolic BP (r = 0.452, p = 0.020). Multiple regression analysis revealed that the acute effect of exercise was an independent predictor of the chronic effect on systolic BP (ß = 0.556, adjusted r2 = 0.280, p = 0.003) BP.

Conclusions:
The magnitude of the acute effect of exercise in BP correlates with the chronic decrease in both office and 24hr BP effects. These results suggest that it is possible to predict those patients that are less likely to improve BP with an exercise training program without the burden of a period of several months of intervention.
CARDIOVASCULAR OUTCOMES OF INITIAL BETA-BLOCKER + CALCIUM CHANNEL BLOCKER THERAPY VS OTHER DUAL THERAPIES IN CHINESE PATIENTS WITH NEWLY DIAGNOSED HYPERTENSION: A REAL-WORLD STUDY
Authors: Guo Qinghui , Lin Junxiong , Peng Feng , Chai Dajun , Lin Jinxiu 
Published: June 2022

Objective:
This study aimed to compare cardiovascular (CV) outcomes associated with initial beta-blocker (BB) + calcium channel blocker (CCB) dual therapy and other initial dual therapies in Chinese patients with newly diagnosed hypertension.

Design and method:
In this retrospective study, all patients in a regional electronic database with newly diagnosed hypertension from January 01, 2012 to December 31, 2016 who received initial dual therapy recommended by the 2018 Chinese Guidelines for Prevention and Treatment of Hypertension were included. The recommended dual therapies included BB+CCB (B+C), ARB/ACEI+C (A+C), A+Diuretic (A+D) and C+D. 1:2 PSM was used to balance baseline characteristics between patients receiving B+C and patients receiving other initial dual therapies (Others). Primary outcome was major adverse cardiovascular events (MACE) consisting of non-fatal stroke, non-fatal myocardial infarction (MI), non-fatal chronic heart failure (CHF) and all-cause death during a median follow-up of 2.02 years (IQR: 1.07–3.36 years). Cox proportional hazard models were used to compare these CV outcomes in the 2 matched cohorts.

Results:
After the PSM, 6,227 patients in the B+C group and 12,454 patients in the Others group were included. The B+C group and the Others group had comparable age (59.5 ± 12.7 years vs. 59.8 ± 12.3 years) and diastolic blood pressure (91.2 ± 6.7 mmHg vs. 91.2 ± 6.9 mmHg), although their heart rate (88.0 ± 6.8 vs. 88.4 ± 7.1) and systolic blood pressure (156.2 ± 7.0 mmHg vs. 155.9 ± 7.1 mmHg) still had differences. Compared to the Others group, the B+C group had significantly lower risks of MACE (HR 0.85; 95%CI 0.78–0.92; P < 0.001), non-fatal stroke (HR 0.89; 95% CI 0.81–0.98; P = 0.018) and non-fatal CHF (HR 0.74; 95% CI 0.63–0.86; P < 0.0001) (Figure 1). Differences in risks of non-fatal MI and all-cause death in the 2 groups were statistically insignificant. Additionally, A+D (HR 1.71; 95% CI 1.52–1.92) and C+D (HR 1.77; 95% CI 1.45–2.15) were associated with significantly higher risk of MACE than B+C, and the difference between A+C (HR 1.04; 95% CI 0.96–1.14) and B+C was small.

Conclusions:
BB+CCB initial dual therapy was associated with lower risks of MACE, stroke and CHF than other recommended initial dual therapies in Chinese patients with newly diagnosed hypertension.
BIOIMPEDANCE - BASED CLINICAL DECISION MAKING IN HEMODIALYSIS PATIENTS DECREASES EPISODES OF HYPOTENSION
Authors: Katzir Zeev , Petrohno Oksana , Leiba Adi , Sharipov Tatiana , Rubin Olga , Gaber Yahya , Hausman Michel 
Published: June 2022

Objective:
Intradialytic hypotension and exaggerated fluid removal during hemodialysis (HD) are related to organ ischemia and resultant increased morbidity and mortality. Fluid overload and congestion due to less than optimal fluid removal, are associated with adverse outcomes. Previous studies performed did not assess clinical decision making that is based mainly on hemodynamics. Thus, our aim was to recruit only new HD patients, and to examine the effect of bioimpedance based management within the first 90 days, a critical timeframe in dry weight determination and HD prescription.

Design and method:
The study incorporated 20 new HD patients in an established HD unit. Patients were randomized into standard clinical approach versus hemodynamic monitoring using a whole body bioimpedance device (NICaS, NI Medical, Petah Tikva, Israel). Intradialytic cardiac output, cardiac power, total body water and peripheral resistance were measured during the 1st dialysis session. Each measured session consisted of start, mid and end of dialysis recordings. Hemodynamic measurements during the pilot study interval (three months) were done also at the investigator discretion, whenever decisions on dry weight, diuretic or anti-hypertensive medications were needed. Control group patients were treated conservatively, without bioimpedance or any noninvasive hemodynamic monitoring. We recorded hypotensive episodes (<90/60 mmHg, while pre-dialysis blood pressure > = 90/60 mmHg) cardiovascular hospitalizations and cardiovascular related death.

Results:
Twenty patients completed the study (12 study, 8 control) thus far. Within a period of three months, there were 81 hypotensive episodes (6.75 episodes per patient per period) in the study group VS 93 (11.625 episodes per patient per period) in the control group (p < 0.05).
There were 3 hospitalizations due to cardiovascular events in the control group and one case of cardiovascular death, while study group had no deaths and one hospitalization due to CV complication.

Conclusions:
These preliminary results suggest that clinical decision making based on bio-impedance monitoring, when applied to new HD patients from the very beginning of their HD treatments, might confer a benefit in reducing hypotensive episodes and resultant hospitalizations. Our study is ongoing in order to further clarify these promising results.
EFFICACY OF SGLT2I IN ACUTE DECOMPENSATED HEART FAILURE WITH TYPE 2 DIABETES MELLITUS
Authors: Doan Long 
Published: June 2022

Objective:
We hypothesized that Sodium Glucose cotransporter 2 inhibitors (SGLT2i) exerts positive effects in patients admitted with ADHF and type 2 diabetes mellitus (T2DM).

Design and method:
Prospective case control study with 1-month follow up. All the patients who admitted to Cardiology center, Hue Central Hospital between 01/12/2020 and 01/06/2021. Inclusion criteria: Adults diagnosed with T2DM with hypervolemic ADHF reduce LVEF and planned treatment with IV loop diuretic therapy. Exclusion criterias: fasting blood glucose (FBG) < 4.4 mmol/L, Systolic blood pressure < 90mmHg, requires inotrope therapy, eGFR < 30 ml/min/1.73m2, severe anemia, breastfeeding or pregnant, severe AS or MS without repair, severe hepatic impairment, acute coronary syndrome or history of coronary artery stenting. The study primary end-point: Length of hospitalization, in-hospital death, death within 30 days after discharge and re-hospitalized within 30 days. The study safety end-point: Urinary tract infection, worsening renal function, ketonacidosis or hypovolemic shock.

Results:
The proportion of in-hospital mortality, 30-days mortality and the length of hospitalization by day tended to be higher in the group of patients not using SGLT2i but not significant. The proportion of re-hospitalized for 30 days was higher in group not using SGLT2i (p = 0.014). The patient group of non-SGLT2i using re-hospitalized sooner than the patient using SGLT2i (p = 0.029). The eGFR of the patient use the SGLT2i show significantly improvement after 30 days (p = 0.024) but in day 4, it’s shown no improvement. In patient who don’t use the agent, the eGFR get worst in day 4 with p = 0.01 then it improve in day 30 but not significant. The group of using SGLT2i seems much more effective in reduce NT-proBNP and FBG (p values: NT-proBNP:0.026 to 0.044; FBG: 0.021 to 0.038, respectively). Complications that should be considered in patients using SGLT2i were UTIs and discontinuation of treatment due to feeling lose weight too fast.

Conclusions:
The using of SGLT2i reduce the numbers of re-hospitalization in first 30-day after discharged, prolong the duration between re-hospitalization period and only the patient groups using SGLT2i could improve the eGFR after 30-days with no significant adverse effects.
EFFECT OF SINGLE PILL COMBINATIONS ON CENTRAL SYSTOLIC BLOOD PRESSURE
Authors: Brguljan Jana , Chazova Irina , Gaciong Zbigniew , Simic Dragan , Vajer Peter , Zelveian Parounak , Jelakovic Bojan 
Published: June 2022

Objective:
Central systolic blood pressure (cSBP) is considered an important haemodynamic parameter, and a relevant prognostic risk factor. Data about control of cSBP with single-pill combination (SPC) treatment are lacking. Therefore we assessed the effect of perindopril/amlodipine (P/A; dual SPC arm) and perindopril/amlodipine/indapamide (P/A/I; triple SPC arm) in naïve and uncontrolled hypertensive patients on 24-hour cSBP compared to office BP.

Design and method:
440 adults with essential hypertension were assessed in the 16-week interventional, open-label, prospective, international, multicentre trial PRECIOUS. ABPM was performed at the baseline and end of the trial (Mobilograph PWA). At inclusion, naïve or patients uncontrolled on previous mono or dual therapy other than P/A were assigned to dual SPC arm with initial dose of 4/5 mg P/A. Patients uncontrolled on previous dual or triple therapy were assigned to triple SPC arm with initial dose of 4/5/1.25 mg P/A/I. If not reaching office BP control, initial dose was up titrated in 4-week intervals to 8/5 mg, 8/10 mg P/A or 8/10/2.5 mg P/A/I in dual SPC arm and to 8/5/2.5 mg or 8/10/2.5 mg P/A/I in triple SPC arm.

Results:
In 16 weeks mean office BP decreased from 156.3 ± 10.9/98.6 ± 8 mmHg to 128.4 ± 9.4/81.7 ± 7.2 mmHg in dual SPC arm and from 157.9 ± 12.6/97.5 ± 9.5 mmHg to 127.7 ± 11.4/80.3 ± 7.5 mmHg in triple SPC arm. The average cSBP decreased from 132.1 ± 9.4 mmHg to 115.4 ± 8.9 mmHg in dual SPC and from 135.8 ± 11.1 mmHg to 114.7 ± 9.8 mmHg in triple SPC arm. All BP reductions were statistically significant (p < 0.001). 77.7% of patients achieved normal office BP values in dual SPC arm and 82.5% in triple SPC arm. A reduction of cSBP below 120 mmHg was reached by 68.9% of patients in dual SPC and by 71.5% in triple SPC arm.

Conclusions:
In triple SPC arm, higher proportion of patients reached target office BP which was reflected also in lower cSBP compared to dual SPC arm. This is important information showing the advantageous effect of triple SPC on cSBP. Usefulness of putting cSBP as additive information, reflecting effect of SPC treatment in clinical practice, will need to be proven with longer patients’ follow up.
DEPENDENCY RELATIONSHIP OF EXERCISE AND MEDICATION ADHERENCE IN HYPERTENSIVE PATIENTS
Authors: Fragoulis Christos , Prentakis Andreas G. , Kontogianni Evangelia , Polyzos Dimitrios , Leontsinis Ioannis , Mantzouranis Emmanouil , Kalos Theodoros , Politis Antonios , Tsioufis Konstantinos 
Published: June 2022

Objective:
Few studies have examined the relationship between exercise and adherence to antihypertensive medication, examining all possible factors contributing to blood pressure control. The purpose of our study was to access the possible dependence relationship among hypertensive patients visiting the Behavioral Cardiology Unit in a Tertiary Hospital.

Design and method:
The study population consisted of patients reporting to the Behavioral Cardiology Unit in a Tertiary Hospital during a period of 6 months in 2021. In terms of holistic approach, all patients underwent a thorough clinical in-depth interview, using the Morisky Medication Adherence Scale (MMAS8), the Frail Questionnaire Screening Tool (Frailty Score) and the Patient Health Questionnaire-4 (PHQ-4). All patients also provided full history of exercise (at least 150 minutes of physical activity or 75 minutes of intense activity per week), while completing the Duke Activity Status Index (DASI).

Results:
The population consisted of 42 hypertensive patients, 54.8% of them were females, with a mean age of all patients at 55.8 ± 15.2 years. Body Mass Index was averaging at 27.6 kg/m2. Salt consumption above the daily suggested amount (>5gr/day) was reported by 60% of patients, binge drinking by 43% of them, while 43% had a history of active smoking. High adherence was reported by 17 patients (46%), medium adherence by 14 (37.8%) and low adherence by 6 (16.2%). Results indicate a relationship between exercise and adherence to medication. More specifically, Chi-Square test showed statistical significance between exercise and medium medication adherence in MMAS8 (MMAS8: 6–7, p = 0.033). Moreover, statistical analysis showed significant relationship between exercise, frailty and PHQ-4 score. Particularly, patients with absence of exercise showed higher level of PHQ-4 score (F = 7.07, p = 0.011).

Conclusions:
Our study highlights the possible dependency relationship of exercise and adherence to medication. Results indicate that patients with good adherence to medication have better behavioral activation. There is need for further research in this domain, to confirm the findings.