bluuebunny/crossref_metadata_2025_split huggingface dataset:
BLOOD PRESSURE REDUCTION AND OUTCOMES IN PATIENTS WITH DIFFERENT BASELINE CARDIOVASCULAR RISK: SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED TRIALS
Authors: Manta Eleni , Thomopoulos Costas , Konstantinidis Dimitris , Tatakis Fotis , Polyzos Dimitris , Drogkaris Sotiris , Tsioufis Konstantinos 
Published: June 2022

Objective:
Blood pressure (BP) lowering is accompanied by reducing cardiovascular (CV) outcomes and death in hypertensive patients. No data are available for the effect of BP lowering in trials stratified according to baseline CV risk that was assessed according to SCORE-2.

Design and method:
A systematic review was conducted to identify randomized trials in electronic databases (Pubmed and CENTRAL, years: 1966 to 9/2021) for the effect of BP-lowering treatment against placebo or less aggressive BP reduction on 6 fatal or non-fatal CV outcomes and all-cause death. Selected studies reported outcomes in patients without a history of previous CV disease. In each study, we calculated baseline cardiovascular risk using SCORE-2. Risk ratios (RR) were calculated together with their 95% confidence interval (CI) under the random-effects model.

Results:
We included 54 studies (i.e., 12 trials with low-to-moderate CV risk, n = 21,192 patients; 13 trials with high risk, n = 66,886; and 29 trials with very high risk, n = 79,061). For a standard SBP/DBP reduction of 10/5 mmHg, the relative risk of the combined outcome of major CV events (i.e., myocardial infarction, stroke, and heart failure) was decreased by 27% (95% CI, 22–35%) in the category of very high-risk patients, and this reduction was significantly greater (P = 0.02) compared to high-risk trials (0.90 [95% CI, 0.77–1.04]). Moreover, CV death showed a significant reduction in the high-risk group compared to the low-moderate risk group (p = 0.005), as well as in the very high-risk group compared to the low-moderate risk group (p = 0.001). The same pattern was observed for all-cause death in the very high-risk group compared to the high-risk group (p = 0.045).

Conclusions:
The greatest outcome benefit from BP lowering in primary prevention is observed in patients at higher baseline cardiovascular risk as calculated by the SCORE-2.
ESTIMATES ON MEDICATION COST OF DRUG DOSE SPECIFIC TREATMENT PROTOCOL FOR HYPERTENSION MANAGEMENT IN PUBLIC AND PRIVATE HEALTHCARE SECTORS IN INDIA
Authors: Sahoo Swagata Kumar , Pathni Anupam Khungar , Krishna Ashish , Sharma Bhawna , Cazabon Danielle , Moran Andrew E. , Hering Dagmara 
Published: June 2022

Objective:
Hypertension is a major public health challenge in most low- and middle-income countries and calls for prioritization of large-scale hypertension control programs. Adoption of drug and dose specific treatment protocols as recommended by the WHO-HEARTS is crucial for scaling up effective hypertension treatment in resource-limited settings. This study estimated the annual cost of medication per patient using three such protocols in India.

Design and method:
The medication requirement was simulated with a range of hypertension control assumptions for the selected protocols based on preliminary observations from sentinel sites of a large-scale hypertension control program in the public sector. Two five-step single molecule and a single pill combination (SPC) based antihypertensive treatment protocols were selected for this study and the approximate medication costs was calculated based on Indian prices in the public and private sectors.

Result:
The approximate annual cost of antihypertensive medication per patient ranged from $33.88–58.44 in the private sector when using a single molecule drug protocol and from $51.57–68.83 when using a SPC drugs protocol. The cost of medication was lower in the generic stores ranging between $5.78–9.57 for single molecule protocols and $7.35–9.89 for protocol with SPC. The cost of medication for patients covered by the public sector was the lowest at $2.05–3.89 for single molecule protocols and $2.94–3.98 for SPC.

Conclusion:
At less than $4 per patient per annum, scaling up hypertension control program with drug and dose specific treatment protocols is a potentially cost-effective public health intervention to save lives and reduce expenses associated with cardiovascular complications in India. Generic drug prescription enforcement and the development of low-cost generic retail networks would increase affordability in the private sector. The cost of treatment with SPCs is comparable to the single molecule protocol, and therefore SPC based treatment protocol can be adopted in a public health program considering the advantage of simplified logistics, reduced pill burden, improved treatment adherence and blood pressure control.
RIGHT HEART PULMONARY CIRCULATION UNIT RESPONSE TO EXERCISE IN PATIENTS WITH SYSTEMIC ARTERIAL HYPERTENSION. INSIGHTS FROM THE RIGHT-NET STUDY
Authors: Vriz Olga , Rudski Lawrence , Frumento Paolo , Limongelli Giuseppe , D’Andrea Antonello , Cittadini Antonio , Ekkehard Grunig , Guazzi Marco , Bossone Eduardo , Palatini Paolo 
Published: June 2022

Objective:
Systemic arterial hypertension is the main risk factor for the development of heart failure with preserved ejection fraction (HFpEF). The aim of this study was to assess the right heart-pulmonary circulation unit response to exercise doppler echocardiography (EDE) in patients with hypertension in order to evaluate the capacity of EDE to unmask a pre-HFpEF state.

Design and method:
EDE was performed in 155 hypertensive patients and in 145 healthy normotensive subjects on a semi-recumbent cycle ergometer with load increments of 25 watts every 2 minutes. Left ventricular (LV) and right ventricular (RV) dimensions, function and hemodynamics were evaluated. Linear mixed models were used to test the interaction between hypertension and age group on the echocardiographic parameters at peak exercise, adjusting for baseline values.

Results:
Impaired echo-Doppler LV and RV function was observed both at rest and peak exercise in hypertensives compared to healthy subjects. Pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance were higher in the former. The entire population was then divided into tertiles of age: at rest no significant differences were recorded for each age group between hypertensives and normotensives except for E/E’ that was higher in the hypertensives of the middle age tertile. At peak exercise, hypertensives had higher pulmonary artery systolic pressure (PASP) and E/E’ but lower tricuspid annular plane systolic excursion (TAPSE) as age increased, compared to normotensives. Differences in E/E’ and TAPSE between the 2 groups at peak exercise were explained by the interaction between hypertension and age even after adjustment for baseline values (p < 0.001 for E/E’, p = 0.011 for TAPSE). At peak exercise, the oldest group of hypertensive patients had a mean E/E’ of 13.0, suggesting a significant increase in LV diastolic pressure combined with increased PASP.

Conclusions:
Age and hypertension have a synergistic effect on E/E’ and TAPSE at peak exercise indicating that the detrimental effect of aging on cardiac function is amplified in hypertension. EDE appears a useful tool for unmasking a pre-HFpEF state in hypertension even in patients with controlled resting blood pressure.
RIGHT VENTRICULAR LONGITUDINAL SYSTOLIC STRAIN AS A PREDICTION MARKER OF NEW ONSET HEART FAILURE WITH PRESERVED EJECTION FRACTION IN ESSENTIAL HYPERTENSION
Authors: Zervakis Stylianos , Marketou Maria , Danelatos Christos , Maragkoudakis Spyros , Pateromichelakis Themistoklis , Plevritaki Anthoula , Savva Eirini , Fragkiadakis Kostas , Kladou Eleni , Kampanieris Emmanouil , Kassotakis Spyros , Kalomoirakis Petros , Peponaki Eirini , Kochiadakis George 
Published: June 2022

Objective:
Accurate assessment of right ventricular (RV) systolic function is important, as it is an established prognostic marker in cardiac diseases. Speckle-tracking echocardiography is a sensitive tool for detection of subclinical left ventricular impairment in essential hypertension. We associated RV function using longitudinal peak systolic strain (GLS) in patients with essential hypertension with the risk of future development of heart failure with preserved ejection fraction (HFpEF).

Design and method:
We performed a retrospective observational study that included 458 patients with essential hypertension (266 males, aged 63 ± 18 years) and 179 normotensives (100 males, aged 66 ± 15 years). Standard echocardiography was performed at the initial visit. 2D speckle tracking echocardiography with evaluation of longitudinal strain in each segment of the RV (basal: RVLS-B; mid: RVLS-M, apical: RVLS-A) and global RV free-wall strain (RVLS-G) were also performed. We studied the cases of new onset HFpEF in hypertensive patients.

Results:
The median follow up was 85 months (22–122). RVLS-G, RVLS-B and RVLS-M were significantly impaired in hypertensives compared to controls (RVLS-G: -16.1 ± 9.7 vs -20.0 ± 5.1, RVLS-B: -11.7 ± 3.7 vs -20.6 ± 3.3, RVLS-M:-16.3 ± 5.4 vs -20.7 ± 4.9, p < 0.05 for all). No significant difference was detected for the RVLS-A (-20.1 ± 3.8 for hypertensives vs -21.31 ± 6.5 for controls, p = NS). Thirty two hypertensive patients developed HFpEF (7 %). A cut-off RVLS-G worse than -17 % was significantly associated with new onset HFpEF (p < 0.001) in those patients. A multivariate Cox regression analysis showed that RVLS-G had independent significant prognostic value for the risk of HFpEF (HR: 10.5, 95% confidence interval (CI): 7.3–25.4).

Conclusions:
Essential hypertension leads to a decrease of RVLS which is strong predictor of a new onset HFpEF. Future studies are needed to assess the significance of these findings and the effects of treatment.
INTRAVASCULAR ULTRASOUND SUBTYPES OF UNIFOCAL RENAL ARTERY FIBROMUSCULAR DYSPLASIA
Authors: Xu Jianzhong , Wu Qihong , Kang Yuanyuan , Hong Mona , Gao Pingjin , Wang Jiguang 
Published: June 2022

Objective:
A binary angiographic classification of renal artery FMD lesions into multifocal or unifocal is well established. The multifocal type, with the ‘string-of-beads’ appearance, is related to medial FMD. While the unifocal type (focal or tubular type), is not clearly related to specific histological lesions. IVUS is a useful tool, in addition to the angiography for evaluation of the anatomical changes of structures of the vessel wall.
The purpose of this study was to reveal the different subtypes of unifocal renal artery fibromuscular dysplasia (FMD) based on intravascular ultrasound (IVUS) and assess the clinical characteristics.

Design and method:
Thirty-six hypertensive patients (mean age 24 ± 7 years, 13–39 years) with computer tomography angiography (CTA) scan suggestive of unifocal renal artery FMD underwent renal angiography, IVUS and angioplasty, with both immediate and long-term blood pressure (BP) response assessment.

Results:
Of the total 36 patients, renal angiography revealed focal type in 22 (66.1%) and tubular stenoses in 14 (38.9%) patients. On IVUS, two subtypes of unifocal renal artery FMD were identified include intima-media thickening (IMT, n = 21, 58.3%) and negative remodeling of the whole vessel (NR, n = 15, 41.7%). In the 22 patients with focal type on angiography, 18 (81.8%) showed IMT and 4 (18.2%) showed NR on IVUS. 14 patients with tubular type on angiography, IVUS showed IMT in 3 (21.4%) and NR in 11 (78.6%) patients. No difference in age of onset, gender, BMI, initial BP levels were found between two IVUS subtypes. However, the proportion of BP returning to normal in the immediate term (48 hours after angioplasty procedure) (76.2% vs 26.7%, p = 0.004) and the long-term (1–5years) cure rate of hypertension (90.5% vs 20.0%, p < 0.001) were much higher in the IMT subtype than those in the NR subtype.

Conclusions:
In this study, we describe a new classification into IMT or NR of unifocal renal artery FMD based on IVUS. Patients with IMT renal FMD were more likely to achieve cure of hypertension.
HYPERTENSIVE HEART DISEASE, WHAT ARE THE FACTORS PRECIPITATING ITS EARLY ONSET?
Authors: Bendiab Nabila Taleb , Henaoui Latifa , Benkhedda Salim 
Published: June 2022

Objective:
Hypertension is a well-established risk factor for cardiovascular disease. It causes left ventricular pressure overload, and changes in cardiac geometry and LV hypertrophy.
This study is intended to assess the clinical and echocardiographic factors associated with and predictive for early impairment of left ventricular function as assessed using global longitudinal strain evaluation in hypertensive patients.

Design and method:
Cross-sectional descriptive study, with a total number of 130 hypertensive and with the objective of evaluating the study of longitudinal function by 2D strain in patients with systemic hypertension with preserved LVEF and the determination of predictors the decrease GLS in this population. This work is to make a complete study echo cardiographic, including LVEF biplane Simpson method, calculation of left ventricular mass indexed and relative parietal thickness, analysis diastolic function and the study of longitudinal strain of the LV by the speckle tracking technique (calculation of GLS)

Results:
The prevalence of left ventricular hypertrophy (LVH) was found in (66%). half of the patients (49%) presented a concentric hypertrophy, It was clearly noted that 73%of the patients had a relative wall thickness (RWT)> 0.42. Alterations in diastolic function were detected in 89% of the group, 18% had severe diastolic dysfunction with elevation in filling pressure. Analysis of the longitudinal systolic function of the left ventricle took the average GLS as a reference value. The mean GLS was found to be -16.9 ± 3.2%, within a range between -25% and-11.6%.
Low GLS values (>-17%) were found in 45.5%. In particular, 34.4% of the patients had no left ventricular hypertrophy (LVH) and 50.7% of them presented LVH.
The average systolic and diastolic blood pressures, taken at the time of echocardiographic analysis, were found higher in the subgroup of hypertensive patients with low GLS.
Statistical analysis revealed significant correlation between the decrease in GLS and diabetes the values of blood pressure and elevated filling pressures.

Conclusions:
The evaluation of longitudinal systolic function by 2D strain provides new insight of myocardial function in hypertension that could improve the pathophysiological understanding and identify high-risk heart failure patients eligible for preventive strategies.
SEMI-AUTOMATIC MEASUREMENT OF INTIMA-MEDIA THICKNESS OF BRACHIAL ARTERY IN PATIENTS WITH CONGESTIVE HEART FAILURE
Authors: Kannenkeril Dennis , Kolwelter Julie , Pietschner Robert , Striepe Kristina , Bosch Agnes , Achenbach Stephan , Schmieder Roland E. 
Published: June 2022

Objective:
Cardiovascular diseases are associated with an increase in intima-media thickness (IMT). However, the techniques used to measure IMT have limitations. A semi-automatic device called UNEX has been developed, which overcomes the limitation of classic systems (in particular the investigator-dependency of conventional, “hand-held’’ measurements). The purpose of this study was to measure the intima-media thickness of the brachial artery (bIMT) with the UNEX device in patients with and without congestive heart failure.

Design and method:
The UNEX device is comprised of a 7.5-MHz, H-shaped linear array transducer and a novel stereotactic probe-holding device (UNEX EF 18G; UNEX Co., Nagoya, Japan). Another advantage of this device is the continuous recording of B-mode images and A-mode waves of the brachial artery. Measurement of bIMT was automatically performed on A-mode images of the far wall of the brachial artery. The analysis system automatically detects the measurement point where an image was clearly obtained. The average of mean measurement values obtained from 10 cardiac cycles was defined as bIMT. In a first set of clinical studies, we measured bIMT in patients with reduced left ventricular ejection fraction (HFrEF) and in patients without heart failure.

Results:
Patients with HFrEF (n = 85, ejection fraction: 38.3 ± 8.4 %, NT-pro-BNP: 713 ± 714.7 pg/ml) compared to patients without heart failure (n = 63) were older (66.4 ± 9.2 vs. 53.8 ± 12.6 years, p < 0.001), with more male subjects (67 vs. 40, p = 0.039). bIMT was higher in patients with HFrEF compared to the other group (0.295 ± 0.083 vs. 0.249 ± 0.083 mm, p < 0.001). After adjustment for age, gender and other cardiovascular risk factors, the result remained significant (p = 0.032).

Conclusions:
Our study demonstrate that IMT of large muscular arteries can be automatically (investigator independently) measured. Our data indicate an increased vascular remodeling in patients with HFrEF independent of other confounders.
INFLAMMATORY MARKERS AND HYPERTENSION-MEDIATED ORGAN DAMAGE IN COMMUNITY-DWELLING ELDERLY INDIVIDUALS: THE NORTHERN SHANGHAI STUDY
Authors: Zhao Song , Yu Shikai , Tang Jiamin , Maimaitiaili Rusitanmujiang , Teliewubai Jiadela , Li Jiaxin , Chi Chen , Xu Yawei , Zhang Yi 
Published: June 2022

Objective:
Inflammation plays a role in pathogenesis of atherosclerosis. Many inflammatory makers have proven to can predict cardiovascular events. This study is investigating the association between inflammatory makers and hypertension-mediated organ damage.

Design and method:
2451 participants who had available blood routine examination from the Northern Shanghai Study were included in this analysis. Inflammatory makers include white blood cell (WBC), neutrophile, monocyte and monocyte to high-density lipoprotein cholesterol ratio (MHR). Hypertension-mediated organ damage (HMOD), including left ventricular hypertrophy (LVH), arterial stiffness (AS), lower extremity atherosclerotic (LEA), carotid hypertrophy (CH), micro-albuminuria (MAU) and chronic kidney disease (CKD), were measured by standard methods. Logistic regression model was used to explore the relationship between the quartiles of inflammatory makers and HOMD.

Results:
In multivariable logistic regression analysis, set quartile 1 (Q1) as reference, quartile 4 (Q4) of WBC (odds ratio (OR) = 1.72, 95% confidence interval (CI): 1.31–2.24, Pfor trend < 0.001), neutrophile (OR = 1.48, 95%CI:1.14–1.94, Pfor trend = 0.005), monocyte (OR = 1.37, 95%CI:1.05–1.77, Pfor trend = 0.026) and MHR (OR = 1.41, 95%CI:1.05–1.88, Pfor trend = 0.036) were associated with AS; Q4 of WBC (OR = 1.78, 95%CI:1.24–2.58, Pfor trend = 0.001), neutrophile (OR = 2.06, 95%CI:1.40–3.02, Pfor trend < 0.001), monocyte (OR = 1.64, 95%CI:1.11–2.38, Pfor trend = 0.013) and MHR (OR = 2.23, 95%CI:1.49–3.35, Pfor trend < 0.001) were associated with LEA; Q4 of WBC (OR = 1.60, 95%CI:1.13–2.27, Pfor trend = 0.012), neutrophile (OR = 1.74, 95%CI:1.21–2.51, Pfor trend = 0.002), monocyte (OR = 1.71, 95%CI:1.18–2.46, Pfor trend = 0.013) and MHR (OR = 2.46, 95%CI:1.60–3.77, Pfor trend < 0.001) were associated with CKD; Q4 of monocyte (OR = 0.69, 95%CI:0.54–0.87, Pfor trend < 0.001) and MHR (OR = 0.61, 95%CI:0.47–0.79, Pfor trend < 0.001) were inversely associated with MAU; but no inflammatory markers associated with LVH or CH.

Conclusions:
In Chinese community-dwelling elderly individuals, WBC, neutrophile, monocyte and MHR are significantly and independently associated with an increased risk of AS, LEA and CKD; monocyte and MHR inversely associated an increased risk of MAU.
7-DAYS HIGH SALT DIET AFFECTS THE PRODUCTION OF PRO- AND ANTI-INFLAMMATORY CYTOKINES IN YOUNG HEALTHY INDIVIDUALS
Authors: Knezovic Ana , Kolobaric Nikolina , Drenjancevic Ines , Mihaljevic Zrinka , Susnjara Petar , Jukic Ivana , Mihalj Martina , Stupin Ana 
Published: June 2022

Objective:
This study aimed to investigate the earliest immunomodulatory effects of NaCl during pre-hypertensive phase of acute salt loading in humans. Thus we have investigated serum levels of systemic pro- and anti-inflammatory cytokines in relation to peripheral Th17 and regulatory T cell abundance following 7-day high-salt (HS) loading in young salt-resistant healthy individuals.

Design and method:
30 young healthy individuals adhered to a 7-day low-salt (LS) diet (3.5 g salt/day) followed by a 7-day high-salt (HS) diet (~14.7 g salt/day) protocol. Serum pro- and anti-inflammatory cytokines (INF-gamma, TNF-alpha, IL-6, IL-9, IL-17A, IL-23, IL-10, IL-21, IL-22, TGF-beta1), complement component C3a, as well as frequencies of peripheral blood Th17 and regulatory T cells (Treg), Th17/Treg ratio and the level of enzymes involved in their activation and differentiation (SGK1 and p38/MAP kinase) were measured before and after 7-day HS diet protocol.

Results:
Short-term HS diet significantly increased serum level of pro-inflammatory cytokines INF-gamma, TNF-alpha, IL-9 and IL-17A level, but also serum concentration of anti-inflammatory cytokines IL-10 and TGF-beta1. In addition, serum INF-gamma and IL-9 levels positively correlated to 24-h urine natriuresis. Relative amount of total and phosphorylated p38/MA kinase remained unchanged, while relative amount of total SGK1 significantly increased following 7-day HS diet compared to LS values.

Conclusions:
Result of the present study provided evidence of acute salt-loading induced changes in the immune status of young healthy individuals. The increase in relative amount of total SGK1 in peripheral mononuclear cells suggests lymphocyte (re)activation in response to hyperosmotic stress resulting in enhanced production of proinflammatory (IL-17, INF-gamma), but also anti-inflammatory cytokines (IL-10 and TGF-beta1). Still, which effect is prevailing remains elusive and warrants further studies.
INFLAMMATION MARKERS IN SUBJECTS WITH DIPPER AND NON-DIPPER BLOOD PRESSURE PATTERNS
Authors: Isayeva Anna , Matiashova Lolita 
Published: June 2022

Objective:
Elevated inflammation markers play important role in vessels damage and remodeling in patients with hypertension. However, the data are limited concerning the association between blood pressure circadian rhythm and inflammation status, especially in early changes of a pattern of blood pressure circadian rhythm in normotensive subjects.
The aim of the work was to study the connection between dipper and non-dipper patterns of blood pressure circadian variation and inflammatory markers in normotensive and hypertensive subjects.

Design and method:
The cross-sectional study included 125 hypertensive patients (54 men) with an age median of 56,5 [45.0 ÷ 63.7] years old and 41 normotensive subjects 52,1 [41.5 ÷ 61.2] years old. All hypertensive patients had been on stable antihypertensive therapy during the last three months and had target blood pressure at the moment of inclusion to the study. Ambulatory blood pressure monitoring was done to all patients with Heaco ABPM50 monitoring. Fasting glucose, blood lipids, creatinine, uric acid, high sensitive C-reactive protein (hCRP), and interleukin 1 beta (IL-1B) were measured. Physical activity was assessed using the International Physical Activity Questionnaire. Data were analyzed with SPSS IBM 19.0.

Results:
Parameters of ambulatory blood pressure monitoring are presented in the table1 1. Normotensive subjects had lower BMI than hypertensive patients (26,1 [23,5–28,4] vs 35,3 [31,0–37,9]), p = 0.03, Mann-Whitney). It was found out that hCRP was significantly higher in a non-dipper subgroup of hypertensive patients (7.43[3.26–11.45] vs 9.50[7.70–15.87], p = 0.01, Mann-Whitney) as well as in the non-dipper subgroup of normotensive patients (2.37[0.97–4.75] vs 2.87[1.84–523], p = 0,03, Mann-Whitney). There was no significant difference in interleukin-1b level in dipper and non-dipper normotensive patients (2.10 [1.63–2.65] vs 1.8 [1.55–2.10], p = 4.13, Mann-Whitney). However, in hypertensive patients with non-dipper patterns, interleukin-1b was significantly higher, than in dipper patients (2.21 [1.62–2.77] vs 2.26 [2.0–3.11], p = 0.03, Mann-Whitney).

Conclusions:
Non-dipper pattern of blood pressure circadian rhythm is associated with increased inflammatory markers in hypertensive patients as well as in normotensive subjects.