bluuebunny/crossref_metadata_2025_split huggingface dataset:
Microcirculation and blood pressure/heart rate response during exercise stress testing in hypertensive patients
Authors: Liatakis I , Konstantinidis D , Tatakis F , Drogkaris S , Zamanis I , Kariori M , Polyzos D , Siafi E , Thomopoulos C , Kakouri N , Andrikou I , Dimitriadis K , Tsioufis K 
Published: October 2022

Abstract

Background/Purpose
A hypertensive response during exercise has been associated with adverse cardiovascular outcomes in general population and hypertensive patients. On the other hand, microcirculation is the major site of control of vascular resistance and thus has a key role in the etiopathogenesis of hypertension. The aim of our study was to investigate the presence of a possible correlation between blood pressure and heart rate response during exercise with a microcirculation index (capillary rarefaction) in a cohort of hypertensive patients.

Methods
We studied 105 untreated patients with stage I-II essential hypertension (70% men, mean age: 59.5 years, mean office blood pressure: 150/92mmHg). Patients with diabetes mellitus, secondary hypertension, atherosclerotic cardiovascular disease, heart failure, significant chronic renal or pulmonary disease and any other systemic illness or orthopedic problems that would not allow maximal effort on a treadmill were excluded. All participants underwent maximal exercise testing, using the Bruce protocol, as well as nail-fold videocapillaroscopy assessment by using VideoCap 3.0 videomicroscope.

Results
A significant negative correlation between diastolic BP at minute-1 of the recovery phase and capillary density expressed in capillaries/mm was revealed (Pearson's r=−0.365, p=0.043). A significant negative correlation was also observed between capillary density and peak heart rate (Pearson's r=−0.364, p=0.024) as well as between heart rate increase from stage 1 to 2 and capillary density (Pearson's r=−0.746, p=0.013).

Conclusions
Our study shows that in a small cohort of hypertensive patients, capillary rarefaction was associated with a steeper increase in heart rate during exercise, as well as with a higher peak heart rate and higher diastolic blood pressure values during the recovery phase. These findings suggest that new indices such as capillary rarefaction may provide insights into possible autonomic dysfunction and could also be taken into account in the assessment of hypertensive patients.

Funding Acknowledgement
Type of funding sources: None.
Association between nocturnal blood pressure dipping and chronic kidney disease
Authors: Motiejunaite J , Alencar De Pinho N , Arnoult F , Vrtovsnik F , Tabibzadeh N , Flamant M , Vidal-Petiot E 
Published: October 2022

Abstract

Introduction
Management of blood pressure (BP) in chronic kidney disease (CKD) is critical for preventing cardio-renal complications. While increasing attention has been given to discrepancies between office and ambulatory BP control in this population, information on nocturnal BP decrease patterns (dipping) in CKD is still scarce.

Purpose
We aimed at describing nocturnal BP dipping patterns and its predictors in patients with CKD.

Methods
We analysed data from patients with CKD stages 1 to 5 referred for kidney function testing from September 2006 to January 2022, including 24-hour urine collection, gold-standard measurement of glomerular filtration rate (GFR) using clearance of a radioisotopic tracer, as well as ambulatory BP measurement (ABPM) in a single tertiary hospital in Paris, France. A total of 1177 ABPM were available in 642 participants. The magnitude of dipping was calculated as the difference between day- and night-time systolic BP (SBP), in percentage of daytime SBP. Participants were then categorized as extreme-dippers (≥20%), dippers (10% to &lt;20%), non-dippers (0% to &lt;10%), or reverse-dippers (&lt;0%). Factors associated with a less than 10% dipping were analysed with crude and adjusted logistic regression models including a random intercept to deal with clustering of measurements within patients.

Results
Participants (mean age 56±15 years; 35% female, mean GFR 49±21 mL/min per 1.73 m2) consisted of 8% extreme-dippers, 37% dippers, 40% non-dippers, and 15% reverse-dippers. The prevalence of non- or reverse-dipping increased with CKD severity, from 36% in CKD stage 1 to 65% in CKD stages 4–5 (Figure). In crude analyses, African origin, a lower measured GFR, a higher daytime SBP, diabetes, a higher number of antihypertensive medications and a higher 24-hour urinary sodium to potassium ratio (24h Na/K) were associated with abnormal dipping status. In the multivariable adjusted regression, non or reverse dipping was independently associated with measured GFR (odds ratio [OR, 95% confidence interval] per 10 ml/min/1.73 m2 decrease = 1.16 [1.06–1.26], p=0.001), daytime ambulatory SBP (OR per 10 mmHg decrease = 1.17 [1.06–1.28], p=0.001), African origin (OR= 1.56 [1.04–2.34], p=0.03) and 24h Na/K (OR per 1-unit increase = 1.20 [1.06–1.37], p=0.006).

Conclusions
The prevalence of nocturnal non-or reverse dipping BP profiles increases substantially across the spectrum of CKD. Measured GFR, ambulatory daytime SBP, African origin and 24-hour urinary sodium to potassium ratio are independent predictors of abnormal nocturnal BP decrease and thus may help in cardiovascular risk stratification in this population. More research is needed on whether nocturnal dipping may be a treatment target to reduce cardiorenal complications.

Funding Acknowledgement
Type of funding sources: None.
Angiotensin receptor blockers are equally effective in women and men; a systematic review and meta-analysis
Authors: Laven S , Mohseni-Alsalhi Z , Meijs D , Vaes E , Wilmes N , Van Luik E , Vesseur M , De Haas S , Spaanderman M , Ghossein-Doha C 
Published: October 2022

Abstract

Background
Hypertension is the leading risk factor for cardiovascular disease (CVD) and is the most substantial and neglected health burden in women. While treatment of high blood pressure is essential in the global prevention strategies of CVD it is assumed that effectiveness of pharmacological treatment may be hampered by sex differences. However, it is still not known whether sex differences exist in the effect of the antihypertensive medications.

Purpose
To evaluate sex-stratified effects for angiotensin receptor blockers (ARBs) on blood pressure (BP) and cardiac function in female compared to male hypertensive participants.

Methods
A series of systematic reviews and meta-analysis was performed. PubMed and EMBASE were systematically searched for studies evaluating the effects of the five major groups of antihypertensive medication from 1945 to May 2020. Randomized control trials and observational studies in humans (≥18 years) were included investigating beta-blockers (BB), angiotensin converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARB), calcium channel blockers (CCB), and diuretics. In this study data on ARB's was analyzed. Studies had to present both baseline and follow-up measurements of at least one of the outcome variables of interest and present their data in a sex-stratified manner. Data on BPand cardiac function where retrieved from studies. Risk of bias was assessed using the Cochrane risk of bias tool.

Results
The search strategy resulted in 73,867 hits. After first screening based on title and abstract, 15,130 articles where suitable for full test screening. After excluding all studies that matched the exclusion criteria, 205 studies with 15,570 participants where eligible for analysis for the five antihypertensive drugs. Studies investigating ARB's (n=17) where used in this review. Seven trials (41%) had a low risk of bias. ARB decreased BP significantly and comparably in both women and men. Systolic BP −18.2 mmHg (95% CI, −24.8 to −11.5) vs −20.1 mmHg (95% CI, −26.7 to −13.6) and diastolic BP −11.6 mmHg (95% CI, −14.7 to −8.4) vs −12.3 mmHg (95% CI, −16.4 to −8.1). LVEF did not change significantly in either group. LV mass was only reported in males and did not change significantly −11.8 g (95% CI, −25.6 to 1.9).

Conclusion
Our meta-analysis shows that based on the current studies, no sex differences exists in the effect of ARB on blood pressure or cardiac function.

Funding Acknowledgement
Type of funding sources: None.
Intensive reduction of high normal blood pressures: PRINT-TAHA9 randomized clinical trial
Authors: Attar A , Sayadi M , Borazjani R 
Published: October 2022

Abstract

Background
Currently, the best treatment strategy for patients with (Prehypertension) a high normal blood pressure (130 mmHg &lt; systolic blood pressure [SBP]&lt;140 mmHg) is controversial. While the ESC guideline does not recommend treating high normal blood pressure, the ACC/AHA recommends pharmacological treatments in these patients if the 10-year ASCVD risk is above 10%.

Purpose
We aimed to determine whether pharmacological reduction of SBP to a normal level (&lt;120mmHg) would prevent cardiac morbidity and mortality in patients with high normal blood pressure levels.

Methods
We randomly assigned 466 persons with high normal blood pressure (130 mmHg &lt; SBP&lt;140 mmHg and a DBP&lt;90 mm Hg) and an increased cardiovascular risk (10-year ASCVD risk ≥7.5%), but without diabetes, and apparent clinical cardiovascular diseases to standard treatment (n=235) which consisted of clinical follow up till SBP goes above 140 mmHg and then staring medications to keep SBP&lt;140 mmHg or to the intensive treatment (n=231) receiving pharmacological SBP reduction to &lt;120 mmHg upon enrollment. The primary composite outcome was myocardial infarction, stroke, heart failure, or death.

Results
Throughout the 1.66 years of follow-up, a primary outcome event was confirmed in 5 participants (0.13% per year) in the intensive-treatment group and 16 (0.39% per year) in the standard-treatment group (hazard ratio (HR), 0.31; 95% confidence interval [CI], 0.11 to 0.85; P=0.024). Rates of serious adverse events were not increased by intensive-treatment (HR, 1.78; 95% CI, 0.68 to 2.03; P=0.57).

Conclusion
Based on this clinical trial, intensive SBP reduction may probably be beneficial for primary prevention of cardiovascular morbidity and mortality in patients with high normal blood pressure level.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Shiraz University of Medical Sciences
Effect of blood pressure reduction on cardiovascular outcomes in patients with different baseline cardiovascular risk: systematic review and meta-analysis of randomized trials
Authors: Manta E , Thomopoulos C , Drogkaris S , Dimitriadis K , Polyzos D , Kariori M , Filippou C , Siafi E , Tatakis F , Konstantinidis D , Tsioufis K 
Published: October 2022

Abstract

Background/Introduction
Blood pressure (BP) lowering is accompanied by a reduction on cardiovascular (CV) outcomes and death in hypertensive patients. There is no data on the effect of lowering BP in patients stratified according to their baseline CV risk as indicated by SCORE 2.

Purpose
The aim of this meta-analysis was to demonstrate the impact of BP-lowering treatment on the occurrence of CV events in these previously reported patients.

Methods
A systematic review in electronic databases (Pubmed and CENTRAL, years: 1966 to 9/2021) was conducted to identify randomized trials that study 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, baseline cardiovascular risk was estimated using SCORE-2. Risk ratios (RR) were calculated together with their 95% confidence interval (CI) under the random-effects model.

Results
The analysis was composed of 54 studies, of which 12 trials included patients with low-to-moderate CV risk, (n=21,192 patients), 13 trials with high CV risk patients (n=66,886) and 29 trials with very high CV risk patients (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. This reduction was significantly greater (p=0.02) compared to high-risk trials (0.90 [95% CI, 0.77–1.04]). CV death showed a significant reduction in the high-risk group of patients 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
With the present meta-analysis, we observed that the greatest benefit from BP lowering in primary prevention in the occurrence of CV events and mortality is observed in patients at higher baseline cardiovascular risk, as calculated by the SCORE-2.

Funding Acknowledgement
Type of funding sources: None.
The differential effects of antihypertensive drugs on central blood pressure: nebivolol versus telmisartan (ATD-CBP)
Authors: Lim S , Yu C W , Kim J H , Cha J J , Kook H D , Joo H J , Park J H , Choi C U , Hong S J , Lim D S 
Published: October 2022

Abstract

Background
Central blood pressure and central pulse pressure have a better correlation with the risk of cardiovascular disease compared to those of peripheral measurement. In a previous study, a second-generation beta-blocker showed poor CBP-lowering effects. However, the effect on CBP by third-generation beta-blockers is not fully elucidated. Thus, this randomised study investigated whether nebivolol-based hypertension treatment may confer advantages over telmisartan, an angiotensin II receptor-blocker, in reducing CBP.

Methods
This was a prospective, randomised, multicentre, open-label, controlled trial that evaluated 98 hypertensive patients. Patients received either nebivolol- (N=49) or telmisartan-based (N=49) treatment for hypertension for 12 weeks with a target BP of ≤140/80. The primary outcome was the difference in change from baseline central systolic BP (cSBP) after 12 weeks.

Results
There were no significant differences between the two groups in baseline central and peripheral SBP. The mean change in cSBP from baseline (ΔcSBP) was −17.2±3 mmHg for nebivolol group (P&lt;0.001) and −29.9±3 mmHg for telmisartan group (P&lt;0.001). The difference in ΔcSBP between the two groups was significant (12.7mmHg, 95% confidence interval [CI], 4.13 to 21.2; P=0.004). Peripheral SBP (pSBP) decreased less in nebivolol group compared to telmisartan group (−18.0±3 in nebivolol group vs. −26.3±3 in telmisartan group, P=0.032). After adjusting for reduction in pSBP, reduction in cSBP was higher in telmisartan group compared to nebivolol group, as shown by the ratio of changes in cSBP and pSBP (ΔcSBP/ΔpSBP; 0.67 for nebivolol group vs. 1.11 for telmisartan group, P=0.080), albeit without statistical significance.

Conclusions
Nebivolol-based hypertension treatment may have less potent CBP-lowering effects compared to telmisartan. However, larger-scale studies are warranted to further elaborate our findings.

Funding Acknowledgement
Type of funding sources: None.
Age-related differences in longitudinal associations between alcohol intake and arterial stiffness, pressure wave reflection, and inflammation in male employees
Authors: Takahashi T , Shina K , Nakno H , Fujii M , Iwasaki Y , Matsumoto C , Yamshina A , Tomiyama H , Chikamori T 
Published: October 2022

Abstract

Backgrounds
While arterial stiffness and abnormal pressure wave reflection are independent cardiovascular risk, the difference of their association with alcohol intake have not been fully clarified.

Aim
This prospective observational study, which utilized repeated annual measurements performed over a 9-year period, applied mixed model analyses to examine age-related differences in longitudinal associations between alcohol intake and arterial stiffness, pressure wave reflection, and inflammation.

Methods
In 4016 middle-aged (43±9 years) healthy Japanese male employees, alcohol intake, brachial-ankle pulse wave velocity (baPWV), radial augmentation index (rAI), and serum C-reactive protein (CRP) levels were measured annually during a 9-year study period. Based on the questionnaire, alcohol intake was classified as non-drinker, mild-moderate drinker (ethanol 1–20 g/day) and heavy drinker (&gt;20 g/day).

Results
The estimated marginal mean baPWV (non-drinkers = 1306 cm/s, mild-moderate drinkers = 1311 cm/s, and heavy drinkers = 1337 cm/s, P&lt;0.01) and that of rAI showed significant stepped increases in an alcohol dose-dependent manner in the entire cohort, but an increase in rAI was not observed in subjects aged ≥50 years. The estimated slope of the annual increase in baPWV, but not rAI, was higher for heavy drinkers than for non-drinkers (slope difference, 2.73; P&lt;0.01), especially for subjects aged &lt;50 years. The estimated marginal mean of the serum CRP levels was lower for drinkers than for non-drinkers.

Conclusion
In middle-aged male Japanese employees, alcohol intake may attenuate inflammatory activity. While alcohol intake may exacerbate the progression of arterial stiffening in a dose-dependent manner without mediating inflammation, especially in subjects under 50 years of age, it may promote pressure wave reflection abnormalities with aging at earlier ages without further exacerbation at older ages.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Omroncarpis
Value of blood pressure measurement earlier versus later in life to predict cardiovascular mortality
Authors: Leiherer A , Ulmer H , Muendlein A , Saely C H , Fraunberger P , Mader A , Sprenger L , Maechler M , Vonbank A , Larcher B , Brozek W , Nagel G , Zitt E , Concin H , Drexel H 
Published: October 2022

Abstract

Hypertension is a potent risk factor for cardiovascular morbidity and mortality. High blood pressure (BP) correlates closely with all-cause and cardiovascular mortality.
The purpose of this study was to compare the value of systolic blood pressure earlier versus later in life to predict cardiovascular mortality.
In a cardiovascular observation study (OS) we prospectively recorded fatal cardiovascular events over up to 19 years in 1282 patients of whom 570 had the Metabolic Syndrome (MetS) at baseline. These patients had participated in a health survey (HS) 15 years prior to the OS baseline. BP was measured both at the HS and at the baseline of the OS.
We found that the increase in cardiovascular mortality matched the increase of BP in the HS in a linear way but this is not the case for BP assessed at the OS (figure). A cox regression analysis revealed that each millimeter of mercury (mm Hg) increased the risk for cardiovascular death by 2% (HR = 1.02 [1.01–1.03], p&lt;0.001). Applying a stratification for the presence of MetS, we found that in both groups BP was a significant predictor of cardiovascular mortality (HRMetS = 1.02 [1.01–1.02], p&lt;0.001 and HRnoMetS = 1.02 [1.01–1.03], p&lt;0.001). In contrast, BP as measured at the baseline of the OS was not significantly associated with cardiovascular death during follow-up neither in the total population nor in any subgroup (HR = 1.00 [0.99–1.01], p=0.652; HRMetS = 1.00 [0.99–1.01], p=0.468 and HRnoMetS = 1.00 [0.99–1.01], p=4.66).
We thus conclude that BP assessed earlier in life is a better predictor of cardiovascular mortality than BP assessed later in life.

Funding Acknowledgement
Type of funding sources: None.
Totum-854 reduction of blood pressure is associated with tissue remodeling in aorta and heart of SHR rat
Authors: Ripoche D , Michaux A , Pialoux V , Vallier M , Langhi C , Chavanelle V , Otero Y F , Peltier S , Sirvent P 
Published: October 2022

Abstract

Introduction and purpose
Arterial Hypertension (AHT) is a major cause of premature death worldwide. We have developed Totum-854 (T-854), a polyphenol-rich botanical composition to reduce the risk of developing AHT. We assessed the acute and chronic effects on blood pressure in spontaneous hypertensive rats (SHR).

Method
Acute protocol: 12-week-old SHR rats received randomly in a cross-over design, a dose of vehicle (VEH, 1% Tween 20), Captopril (50mg/kg) and T-854 (1250mg/kg) per os with at least 48h-wash-out interval between two gavages. Arterial pressure was recorded during 24h post-gavage, thanks to a radio-telemetry device (HD-S10, DSI) directly into the abdominal aorta. Baseline arterial pressure was measured before oral gavage during 90 min.

Chronic study
18-week-old SHR rats received vehicle (VEH, 1% Tween 20) or T-854 (1000mg/kg) per os once a day for 8 weeks. Arterial pressure was recorded before the oral gavage for 90 min once a week with a radio-telemetry device (HD-S10, DSI). Delta (Δ) SBP and ΔDBP were calculated by subtracting baseline blood pressure (before the start of oral gavage) to measured blood pressure every week. At the end of supplementation, rats were euthanized, and aorta and heart were sampled. Aorta was embedded in paraffin and Masson's trichrome staining was performed in slides obtained by a microtome. Media thickness was measured with ImageJ. For the heart, mRNA was extracted using Trizol and cardiac hypertrophy/fibrosis gene expression was evaluated by RT-qPCR.

Results
Acute supplementation with T-854 exhibited an intermediate profile between VEH and Captopril response for change in SBP and DBP curves. SBP and DBP were reduced in comparison to VEH with 24h-AUC decreased by 93.6±67.8 mmHg h and 70.8±54.6 mmHg h for captopril and T-854, respectively.
When T-854 was administered chronically during 8 weeks, ΔSBP and ΔDBP evolution were significantly different in comparison to VEH group (p&lt;0.05). These curves were maintained under vehicle curves from the 2nd week of supplementation and until the end of the study. After 8 weeks of T-854 supplementation, tissue analysis showed a decrease of 10% on the aorta media thickness in T-854 supplemented rats (p&lt;0.05). Cardiac MMP-2 gene expression was also lower in T-854 group compared to VEH (p=0.059).

Conclusion
T-854 24h-post-gavage acute effect on blood pressure in hypertensive SHR rats suggests a rapid effect, with a decrease in blood pressure few hours after oral administration. Moreover, chronic T-854 supplementation prevents AHT development in SHR. In conclusion, T-854 appears as an efficient strategy to prevent HTA suggesting also a protective role of T-854 on vascular and heart structure and function.

Funding Acknowledgement
Type of funding sources: None.