bluuebunny/crossref_metadata_2025_split huggingface dataset:
Resting heart rate and arterial stiffness: a longitudinal prospective study in a population of hypertensive patients
Authors: Maloberti A , Fumagalli S , Garofani I , Ghidini S , Leidi F , Ruzzenenti G , Bombelli M , Giannattasio C 
Published: October 2022

Abstract

Background
The role of resting Heart Rate on the progression of arterial stiffness has not yet been extensively evaluated. The aim of this study is to investigate the relationship between resting HR and baseline arterial stiffness (evaluated by cfPWV) as well as its progression in a population of hypertensive patients over a 3.7 years follow-up period.

Methods
We enrolled 572 hypertensive outpatients 18–80 aged, followed by one hospital in Northern Italy. Anamnestic, clinical and laboratory data, BP and cfPWV were assessed at baseline and after a median follow-up time of 3.7±0.5 years

Results
At baseline the mean age was 53.9±12.7 years, SBP and DBP were 141.2±17.8 and 86.5±10.5 mmHg, HR was 65.6±10.9 bpm and PWV was 8.6±2.0 m/s. Despite an improvement in BP values (from 141.2/86.5 to 132.6/79.2 mmHg, p&lt;0.001), during follow-up, PWV increased (ΔPWV 0.5±2.2 m/s). In patients with a ΔHR above as compared to those under the median value (9 bpm), ΔPWV was significantly higher (0.82±2.22 vs. 0.27±2.25 m/s, p=0.003). At multivariate analysis, HR was among the significant determinants of both baseline PWV and its progression (β = 0.031, p&lt;0.001). Furthermore, ΔHR was a significant determinant of ΔPWV (β = 0.019; p=0.017).

Conclusions
in hypertensive patients there is a significant relationship between basal resting HR and basal PWV as well as between the increase of HR and the increase of PWV during the follow-up period. Beyond age and BP, resting HR must be considered as an independent determinant of arterial stiffness. This represents a possible mechanism through which HR contributes to the increase in CV risk.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Niguarda Hospital, Milan, Italy
How would we evaluate hypertension if we had hypertension norms created from population data same as we evaluate hypertension in children?
Authors: Smida J 
Published: October 2022

Abstract

When we evaluate blood pressure in adolescent children, at 18 years we look at adult hypertension classification. Some of limits in paediatrics can be slightly higher. In some cases, the limits for hypertension can be more than 10 mmHg lower than in adult population. We wanted to compare adult classification with percentile-based limits calculated from population data (Graph 1).
Tables for paediatric hypertension published by European society of hypertension, that are based on report published by US national health institute, were used for constructing paediatric part of the graph. To match general population limits for 50th height percentile were used. With data from Czech post-MONICA study, we have calculated percentiles to match algorithm in paediatric population.
Difference in normal blood pressure between young men and woman can be observed, corresponding with paediatrics norms. For 17 years old boy with height over 95th percentile limit for hypertension is 140 mmHg in contrast for 17 years old girl under 5th percentile limit for hypertension is 125 mmHg. To match general population, we are comparing data for 50th percentile of height for 17-year-old and percentile for age group 25–34 (Table 1). For boys limits for hypertension are 136 and 141,5 mmHg. For girls limits for hypertension are 125 and 127,9 mmHg. Average blood pressure rises with age and there is difference between blood pressure in young population for men and women.
The purpose is not to change limits in older population, but we believe that connection between blood pressure norms for paediatrics and adult population should be addressed in next guidelines. Big technological advances in personal devices for blood pressure monitoring will probably bring lot of data and technological companies will offer our patients comparison with others. Graphical comparison of blood pressure will be available for everyone on mobile phone, so we should focus on publishing population norms in format, which software developers can use for graphs. Graphical comparison especially for young population is easier to use than complex tables.

Funding Acknowledgement
Type of funding sources: Private company.
Determinants of left atrioventricular coupling index: the multi-ethnic study of atherosclerosis (MESA)
Authors: Pezel T , Ambale Venkatesh B , De Vasconcellos H , Kato Y , Post W P , Wu C , Heckbert S , Bluemke D , Cohen-Solal A , Logeart D , Henry P , Lima J 
Published: October 2022

Abstract

Background
Recent studies have described a novel left atrioventricular coupling index (LACI), which had a better prognostic value than individual left atrial (LA) or left ventricular (LV) parameters measured separately to predict cardiovascular events.

Purpose
To identify the determinants of the LACI and its 10-year annual change (ΔLACI), measured by cardiovascular magnetic resonance (CMR), and to better understand the parameters governing this left atrioventricular coupling.

Methods
In the Multi-Ethnic Study of Atherosclerosis (MESA), 2,112 study participants, free of cardiovascular disease at baseline, had LACI assessed by CMR imaging at baseline (LACIBaseline, 2000–2002) and 10 years later (2010–2012). The LACI was defined as the ratio of LA to LV end-diastolic volumes. Linear regression analyses were performed to identify independent determinants of LACIBaseline or ΔLACI.

Results
In the 2,112 participants (58.8±9.1 years, 46.6% male), after adjustment for all covariates, age was independently associated with both LACIBaseline (R2=0.10, slope=0.16) and ΔLACI (R2=0.15, slope=0.008, both p&lt;0.001). African Americans had the highest LACIBaseline value (18.0±7.7%). Although there was no difference in LACIBaseline between women and men (p=0.19), ΔLACI was higher in women than in men (1.0±1.1 vs. 0.8±1.0%/year, p&lt;0.001). Diabetes and a higher BMI were independently associated with LACIBaseline (both p&lt;0.001). LACIBaseline was independently associated with LV myocardial fibrosis markers (native T1: R2=0.11, slope = 0.09, p=0.038; and extra-cellular volume: R2=0.08, slope = 0.28, p=0.035) and NT-proBNP levels (R2=0.10, slope = −1.11, p&lt;0.001) but was not associated with IL-6 or hsCRP.

Conclusions
Age, sex, ethnicity, diabetes, and BMI were independent determinants of LACI. LACI was independently associated with LV myocardial fibrosis markers and NT-proBNP levels.

Funding Acknowledgement
Type of funding sources: None.
Additive predictive value of low testosterone level in hypertensive men with hypercholesterolemia
Authors: Ioakeimidis N , Terentes-Printzios D , Antonopoulos A , Dima I , Gourgouli I , Solomou E , Aznaouridis C , Chatzistamatiou E , Lazaros G , Kalfountzos D , Tsioufis C , Vlachopoulos C 
Published: October 2022

Abstract

Purpose
Hypercholesterolemia is common in hypertensive patients and its presence increases the risk of cardiovascular (CV) complications. Decreased concentration of testosterone appears commonly in men with hypertension, and is an independent predictor of CV events. We investigated the utility of testosterone concentration measurement as an aid in the risk prediction of CV events in men with arterial hypertension and high LDL levels.

Methods
A cohort of 321 men with arterial hypertension and without known diabetes or atherosclerotic CVD (mean age: 54±9 years) were followed for the occurrence of major adverse cardiovascular events (MACE), (CV death, coronary artery disease, stroke). Total testosterone (TT) and LDL levels were measured in all patients. We used Cox proportional hazards regression to analyze the associations between LDL, serum testosterone and CV outcomes.

Results
During a mean follow-up of 6 years (range: 1–11 years), 31 (9.5%) patients demonstrated a MACE. Patients in the CV-event group were older and they had higher LDL and lower baseline TT levels compared to subjects in the event-free survival group (all P&lt;0.01) while BMI, systolic blood pressure and smoking exposure (pack-years) were similar. Based on the observed distribution of baseline LDL levels the study cohort was divided in two groups: low LDL (&lt;130 mg/dl) and high LDL (≥130 mg/dl). According to baseline TT level distribution the study cohort was divided in two groups: normal TT (&gt;4.0 ng/mL) and low TT (≤4.0 ng/mL). Subjects in the high LDL group, had no increased risk of MACE compared to subjects in the low LDL group (HR 1.35; 95% CI 0.75–2.04) in the multivariable model. Moreover, there was no statistically significant association between low TT and risk of MACE. HR for low TT vs high TT was 1.48 (95% CI 0.85–2.16). We then subdivided the two LDL (high vs low) groups into subgroups according to presence of low or normal TT. Cox regression analysis revealed that the subgroup of men with both low TT and high LDL had an almost 2-fold higher risk of MACEs compared to the other three LDL/TT subgroups (adjusted hazard ratio: 2.07; 95% CI 0.94–3.56, P=0.035). Figure 1 shows the cardiac event-free survival curve of males with both baseline low TT and high LDL level with that of males in the other three LDL/TT subgroups (log rank: 11.3, P=0.008).

Conclusion
Low testosterone concentration is associated with a shorter event-free period in hypertensive patients with higher LDL levels. The measurement of testosterone concentration may be useful to further stratify the risk of middle-aged men with arterial hypertension and hypercholesterolemia.

Funding Acknowledgement
Type of funding sources: None.
Real-world data in the management of hypertension for patients with sleep disordered breathing after initiating continuous positive airway pressure treatment
Authors: Takama N , Kato T , Shiina T , Fujii T , Amanai S , Ishibashi Y , Ishii H 
Published: October 2022

Abstract

Introduction
There are many reports that patients with cardiovascular diseases including hypertension have already suffered from sleep disordered breathing (SDB). Furthermore, Continuous Positive Airway Pressure (CPAP) is effective for hypertension for improvement of sympathetic nervous activity reason. Previously, we reported that SDB is just as, if not more, important as common classical risk factors (hypertension, dyslipidemia, diabetes mellitus) for patients with cardiovascular diseases (Figure 1).

Purpose
Our aim in this study is to estimate the real-world data in the management of hypertension for patients with SDB after initiating CPAP treatment.

Methods
All patients were conducted full night polysomnography. One-hundred ninety-five patients showed obstructive SDB {apnea hypopnea index (AHI) &gt;20/hour}, and CPAP treatment were initiated. According to Japanese society of hypertension guidelines for the managements of hypertension 2019 (JSH2019), we estimated the blood pressure and presence of blood pressure-lowering agents to assess effectiveness of CPAP treatment after six-month follow up.

Results
The study group consisted of 195 SDB patients (166 males, 29 females). The mean age was 59±7 years. Figure 2 showed the blood pressure and presence of blood pressure-lowering agents after initiating CPAP treatment. Group A which showed systolic blood pressure (SBP) &lt;130 mmHg without intake of blood pressure-lowering agents was 20.9%. Group B which showed SBP &lt;130 mmHg with intake of blood pressure-lowering agents was 9.6%. Group C showed SBP≥130 mmHg without intake of blood pressure-lowering agents was 30.5%. Group D showed SBP≥130 mmHg with intake of blood pressure-lowering agents was 39.0%.

Conclusion
We could estimate that there were high prevalence of hypertension for patients with SDB after initiating CPAP treatment. It is true that CPAP treatment have a beneficial effect on hypertension, but 70% patients (Group C and D) still remain inadequately treated. We need the strict blood pressure follow up for patient with SDB before and after initiating CPAP treatment.

Funding Acknowledgement
Type of funding sources: None.
Relationship between systolic blood pressure and renal function on clinical outcomes in patients with atrial fibrillation: a report from the AF-GEN-UK registry
Authors: Shantsila A , Lip G Y H , Lane D A 
Published: October 2022

Abstract

Background
European guidelines on AF management recommend a systolic blood pressure (SBP) target of 120–129 mmHg as this level is associated with the lowest risk of poor outcomes. Elevated blood pressure and AF both negatively affect renal function, but the interactions between SBP and renal function in patients with AF remains unclear. In the UK extension of the EURObservational Research Programme (EORP) Long-term Registry of patients with atrial fibrillation (AF) [AF-GEN-UK study], we assessed the combined impact of BP levels and renal (dys)function on mortality, thromboembolic and haemorrhagic events.

Methods
1580 patients (60.1% males, mean (SD) age 70.6 (11.2) years) from the AF-GEN-UK registry had SBP available at baseline and were stratified into groups based on SBP: 120–129 mmHg (reference group, n=289), &lt;100 mmHg (n=165), 110–119 mmHg, (n=254), 130–139 mmHg (n=321), 140–159 mmHg (n=385), and ≥160 mmHg (n=166). Impact of SBP, renal function and their interaction on 1-year outcomes were assessed using Cox regression analysis, adjusted for age, oral anticoagulation (OAC) use and CHA2DS2-VASc score. SBP groups were compared by ANOVA (continuous data) and Chi-square test (categories) with two tailed p&lt;0.05 deemed significant (STATA Corp, version 13).

Results
Overall OAC use was 84% and was similar between all SBP groups. Renal function (eGFR), was preserved across SBP groups; those with SBP 110–119 mmHg had the lowest level. Prevalence of heart failure was highest in those with SBP &lt;110 mmHg. Patients with uncontrolled SBP (&gt;140 mmHg) were older, more likely female and higher rates of hypertension, with correspondingly higher CHA2DS2VASc scores. SBP &lt;100 mmHg (Hazard Ratio (HR) 2.36; 95% confidence intervals (CI) 1.20–4.64) and lower eGFR (HR 0.99; 95% CI 0.98–0.996) were associated with all cause-death in univariate analyses.
Adjusted Cox regression revealed that SBP &lt;100 mmHg and OAC use were independent predictors of all-cause death (Table). No interaction between BP groups and eGFR was evident. OAC use (aHR 0.31; 95% CI 0.11–0.92) was associated with a reduced risk of thromboembolic events.

Conclusion
In anticoagulated patients with AF, SBP &lt;110 mmHg was independently predicted of all-cause death, with no interaction with kidney function. No independent association of SBP groups with haemorrhagic and thromboembolic events was evident. OAC therapy was associated with a significant reduction in all-cause death and thromboembolic events.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This project was supported by the BMS/Pfizer European Thrombosis Investigator Initiated Research Program
Trends and risk factors of in-hospital mortality of patients with COVID-19 in Germany
Authors: Keller K , Sagoschen I , Barco S , Schmidtmann I , Espinola-Klein C , Konstantinides S , Munzel T , Hobohm L 
Published: October 2022

Abstract

Background
Unselected data of nationwide studies of hospitalized patients with COVID-19 is still sparse, but these data are of outstanding interest not to exceed hospital capacities and to avoid overloading of national health-care systems.

Purpose
Thus, we sought to analyze seasonal/regional trends, predictors of in-hospital case-fatality and mechanical ventilation (MV) in patients with COVID-19 in Germany.

Methods
We used the German nationwide inpatient sample to analyze all hospitalized patients with confirmed COVID-19 diagnosis in Germany between January 1st and December 31st in 2020 (source: RDC of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2020, own calculations). Covid-19-inpatients with MV vs. without MV and survivors vs. non-survivors were compared. Logistic regression models were calculated to investigate associations between patients' characteristics as well as adverse events and i) necessity of MV and ii) in-hospital death.

Results
We analyzed data of 176,137 hospitalizations of patients with confirmed COVID-19-infection. Among those, 31,607 (17.9%) died, whereby in-hospital case-fatality grew exponentially with age. Cardiovascular comorbidities were common in hospitalized patients with confirmed COVID-19-infections: Overall, almost half of the patients (46.8%; n=82,480) had arterial hypertension and 25,574 (14.4%) had a diagnosis of coronary artery disease. In 60.7% (n=106,913) of the hospitalizations, pneumonia was reported, 8.6% (n=15,061) had an acute infection of the upper or lower airways other than pneumonia, and 6.6% (n=11,594) suffered from an acute respiratory distress syndrome (ARDS) during hospitalization
Age ≥70 years (OR 5.91, 95% CI 5.70–6.13, P&lt;0.001), pneumonia (OR 4.58, 95% CI 4.42–4.74, P&lt;0.001) and acute respiratory distress syndrome (OR 8.51, 95% CI 8.12–8.92, P&lt;0.001) were strong predictors of in-hospital death. Most COVID-19-patients were treated in hospitals in urban areas (n=92,971) associated with lowest case-fatality (17.5%) as compared to hospitals in suburban (18.3%) or rural areas (18.8%). MV demand was highest in November/December 2020 (32.3%, 20.3%) in patients between 6th and 8th age-decade. In the first age-decade, 78 of 1861 children (4.2%) with COVID-19-infection were treated with MV and five of them died (0.3%).

Conclusion
The results of our study indicate seasonal and regional variations concerning number of COVID-19-patients, necessity of MV and case-fatality in Germany. These findings may help to ensure flexible allocation of intensive care (human) resources, which is essential for managing enormous societal challenges worldwide to avoid overloaded regional health-care systems.

Funding Acknowledgement
Type of funding sources: None.
Body adiposity estimated with CUN-BAE predicts atrial fibrillation: the SUN cohort
Authors: Diaz-Gutierrez J , Baron-Esquivias G , Martinez-Gonzalez M A , Sayon-Orea C , Bazal P , Almendral J , Barrio-Lopez M T , Amigo-Otero E , Fruhbeck G , Ruiz-Canela M A 
Published: October 2022

Abstract

Background
Obesity is widely recognised as a strong risk factor for atrial fibrillation and recent interest has focused on epicardial fat. Although body mass index is commonly used in the clinical practice, it doesn't precisely estimate adiposity. The Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE) is an equation developed for body fat calculation, that has been previously associated with cardiometabolic disease. Our objective was to assess the association between body fat, as captured by the CUN-BAE index, and the incidence of atrial fibrillation in a prospective cohort.

Methods
The SUN project is a dynamic, prospective cohort of Spanish university graduates. A total of 20.136 participants, free of atrial fibrillation at baseline, were followed-up for a median time of 12 years, with a retention proportion of 91%. CUN-BAE was calculated for each participant taking into account only sex, age and body mass index. Incident cases of atrial fibrillation were confirmed by a cardiologist according to a prespecified protocol. Multivariable Cox regression models were used to estimate hazard ratios (HR) of atrial fibrillation according to calculated body fat.

Results
During follow-up, we identified 128 incident cases of atrial fibrillation. There was a strong direct association between a higher CUN-BAE index at baseline and incident atrial fibrillation during follow-up. In comparison to participants with a lower body fat category (median 21.3%), those with a higher category of body fat (median 34.8%) exhibited a significant 118% higher relative risk of incident atrial fibrillation (adjusted HR=2.18; 95% CI: 1.22, 3.90). For each 2-unit increase in the CUN-BAE index, atrial fibrillation risk significantly increased by 10%. The risk of incident atrial fibrillation remained significantly associated with adiposity even after further adjustment for obesity (body mass index ≥30 kg/m2) and in repeated measures analysis of the CUN-BAE index every other year.

Conclusions
Increased body adiposity, as captured by CUN-BAE index, was strongly and independently associated with a higher risk of atrial fibrillation in a Spanish cohort. These findings support the hypothesis that adiposity is closely related with arrhythmogenic mechanisms that could lead to atrial fibrillation and may be predicted using an equation to estimate body fat.

Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Spanish Ministry of Health and European Regional Development Fund (FEDER)
Statins and influenza mortality: systematic review and meta-analysis
Authors: Lobo L M , Masson W , Masson G , Molinero G , Lavalle Cobo A , Huerin M , Delgado J , Benincasa F , Losada P 
Published: October 2022

Abstract

Background
Due to their anti-inflammatory properties, it has been suggested that the use of statins could influence the evolution of influenza virus infection.

Objective
To evaluate the effect of statin therapy on mortality from influenza.

Material and methods
A meta-analysis that included studies evaluating the use of statins in patients with influenza and reporting data on mortality, after searching the PubMed/MEDLINE, Embase, and Cochrane Controlled Trials databases, was performed. A random effects model was applied. The risk of bias was analyzed and a sensitivity analysis was performed.

Results
Eight studies (10 independent cohorts), which included a total of 2,390,730 patients, were identified and eligible for analysis. A total of 1,146,995 subjects analyzed received statins, while 1,243,735 subjects were part of the control group. Statin therapy was associated with lower mortality (OR: 0.66; 95% CI: 0.51–0.85). The sensitivity analysis showed that the results were robust.

Conclusions
Our data suggest that, in a population with influenza, the use of statins was associated with a significant reduction in mortality. These results must be confirmed in future clinical trials.

Funding Acknowledgement
Type of funding sources: None.