bluuebunny/crossref_metadata_2025_split huggingface dataset:
BLOOD PRESSURE RESPONSE TO STANDING IS A STRONG PREDICTOR OF MASKED HYPERTENSION
Authors: Rattazzi Marcello , Saladini Francesca , Mos Lucio , Fania Claudio , Garavelli Guido , Zanatta Nello , Spinella Paolo , Palatini Paolo 
Published: June 2022

Objective:
The pathophysiologic mechanisms of masked hypertension are still debated. The aim of this study was to clarify the role of the blood pressure (BP) response to the upright posture as a potential mechanism for the development of masked hypertension in young subjects screened for stage 1 hypertension.

Design and method:
We studied 1078 young-to-middle-age (mean age 33.2 ± 8.5 years) subjects with stage I untreated hypertension at baseline. The response to standing was defined as the difference between 6 systolic BP measurements in the orthostatic and supine posture (OrthoResp). People with OrthoResp > 6.5 mmHg (upper decile) were defined as Hyperreactors. After 3 months of follow-up, 24-hour ambulatory BP was measured and the participants were classified as Normotensives (N = 120), White-coat hypertensives (N = 168), Masked hypertensives (N = 166), and Sustained hypertensives (N = 624) using the 140/90 and 130/80 mmHg cutoffs for office BP and 24-hour BP, respectively. In 591 participants, 24 h urinary epinephrine was also measured and patients were divided into four groups according to BP reactivity (>6.5 mmHg or <  = 6.5 mmHg) and 24-hour urinary epinephrine/creatinine median level (>10.5 mcg/g or < = 10.5 mcg/g). The risk of developing masked hypertension was explored in a logistic regression model adjusting for confounders.

Results:
Mean ± SEM age-and-sex-adjusted OrthoResp was -3.8 ± 0.7 mmHg in the Normotensives, -3.1 ± 0.6 mmHg in the White-coat hypertensives, -0.9 ± 0.6 mmHg in the Masked hypertensives, and -2.6 ± 0.3 mmHg in the Sustained hypertensives. OrthoResp was an independent predictor of masked hypertension after 3 months (p = 0.001). The Odds ratio for the Hyperreactors was 2.5 (95%CI,1.5–4.0, p < 0.001). In the participants stratified by OrthoResp and urinary epinephrine, the risk of masked hypertension was 4.2 (95%CI,1.8–9.9, p = 0.001) in the hyperreactors with epinephrine above the median and was 2.6 (95%CI,0.9–7.3, p = 0.069) in those with epinephrine below the median.

Conclusions:
The present findings indicate that hyperreactivity to standing is a significant predictor of masked hypertension. The risk of masked hypertension was even quadrupled in people with an OrthoResp> 6.5 mmHg and high urinary epinephrine suggesting a role of sympathoadrenergic activity in the pathogenesis of masked hypertension which may be partly mediated by hyperreactivity to standing.
BLOOD PRESSURE IN ATRIAL FIBRILLATION AND IN SINUS RHYTHM DURING 24 HOUR AMBULATORY BLOOD PRESSURE MONITORING: DATA FROM THE TEMPLAR PROJECT
Authors: Lundwall Kristina , Kahan Thomas , Omboni Stefano 
Published: June 2022

Objective:
Hypertension is the most common risk factor for atrial fibrillation (AF), and accounts for a worse prognosis. Blood pressure (BP) control is accordingly essential in AF. However, the interpretation of BP levels is difficult in AF, since differences may be dependent on rhythm, particularly when using automated oscillometric devices. We used data from the TEMPLAR project to compare oscillometric ambulatory BP monitoring (ABPM) intra-individually in AF and sinus rhythm (SR).

Design and method:
Among the 4398 individuals in TEMPLAR > 65 years investigated with ABPM and Afib Microlife detector (rhythm indicated with each BP measurement), those with > 30% of readings indicating AF were selected (as previously recommended), and episodes > 30 mins for AF and SR were chosen. Systolic and diastolic BP, mean arterial pressure (MAP), pulse pressure (PP), averaged real variability (ARV), and its coefficient of variation (CV) were assessed for AF and SR, separated for 24 h, daytime, night-time, and for heart rate (HR) < = 90 and > = 90 bpm.

Results:
We included 430 individuals (mean age 78 ± 7 years, 57% females, 77% with hypertension and 72% on treatment, 4% with previous AF). Mean BP of all measurements included were 124.2/69.0, 126.3/71.1, and 119.5/64.0 mmHg, for 24 h, daytime, and night-time, respectively. There were no differences in MAP for AF vs SR (p = 0.47). Systolic BP tended to be lower in AF (24 h 123.6 ± 13.9 vs 124.7 ± 16.1 mmHg in SR, p = 0.05), and night-time diastolic BP was higher in AF (64.6 ± 10.9 vs 63.3 ± 10.4 mmHg in SR, p = 0.01). PP was lower in AF (24 h 54.6 ± 10.9 vs 55.7 ± 12.8 mmHg in SR, p = 0.002). Diastolic, but not systolic BP variability (ARV and CV) was higher in AF (24 h, p < 0.001). Results were similar with HR <  = 90 and > = 90 bpm.

Conclusions:
Using an oscillometric ABPM device, our results suggest that MAP is similar and reliable in both AF and SR. Lower systolic and higher diastolic BP in AF affects PP, which together with a high variability might impact arterial structure. However, differences in absolute numbers are small, and do not imply different BP strategies and target values in AF.
AMBULATORY BLOOD PRESSURE MONITORING: A NEW DIAGNOSTIC APPROACH FOR DETECTION OF HYPOTENSION IN REFLEX SYNCOPE (SYNABPM 1 STUDY)
Authors: Rivasi Giulia , Groppelli Antonella , Brignole Michele , Soranna Davide , Zambon Antonella , Bilo Grzegorz , Pengo Martino , Sharad Bashaaer , Hamrefors Viktor , Rafanelli Martina , Testa Giuseppe Dario , Rice Ciara , Kenny Rose Anne , Sutton Richard , Ungar Andrea , Fedorowski Artur , Parati Gianfranco 
Published: June 2022

Objective:
Diagnostic criteria for ambulatory blood pressure monitoring (ABPM) in patients with suspected reflex syncope are lacking. We hypothesized that patients with reflex syncope have a higher prevalence of systolic blood pressure (SBP) drops on ABPM.

Design and method:
We conducted a retrospective analysis comparing ABPM data from reflex syncope patients and controls, matched by average 24-hour SBP, age, sex and hypertension. Patients with constitutional hypotension, orthostatic hypotension, predominant cardioinhibition or competing causes of syncope were excluded. Daytime and night-time SBP drops (<110, 100, 90, 80 mmHg) were assessed. Hypotensive susceptibility was defined likely or possible for cut-offs achieving the highest sensitivity among those with specificity > 90% and 80–90%, respectively. Findings were validated in an independent sample.

Results:
In the Derivation cohort, daytime SBP drops were significantly more common in 158 syncope patients than 329 controls. One or more daytime drop < 90 mmHg provided the best diagnostic yield (91% specificity, 32% sensitivity, Odds Ratio [OR] = 4.6, p = 0.001). Two or more-daytime drops < 100 mmHg achieved 84% specificity and 40% sensitivity (OR = 3.5, p = 0.001). Results were confirmed in the Validation cohort: one or more daytime SBP drop < 90 mmHg provided 94% specificity and 29% sensitivity (OR = 6.2, p < 0.001), while two or more daytime SBP drops < 100 mmHg achieved 83% specificity and 35% sensitivity (OR = 3.5, p < 0.001)

Conclusions:
SBP drops during ABPM are more common in reflex syncope patients than in controls. Cut-off values that may be applied in clinical practice are defined. This study expands the current indications for ABPM to patients with reflex syncope.
PREVALENCE AND PREDICTORS OF NOCTURNAL BLOOD PRESSURE DIPPING IN CHRONIC KIDNEY DISEASE
Authors: Motiejunaite Justina , De Pinho Natalia Alencar , Arnoult Florence , Tabibzadeh Nahid , Vrtovsnik Francois , Flamant Martin , Vidal-Petiot Emmanuelle 
Published: June 2022

Objective:
Management of blood pressure (BP) in chronic kidney disease (CKD) is critical for preventing cardio-renal complications. Information on nocturnal BP decrease patterns (dipping) in CKD is still scarce. We aimed at describing nocturnal BP dipping patterns and its predictors in patients with CKD.

Design and method:
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. Factors associated with a less than 10% dipping were analysed with 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 (> = 20%), 37% dippers (10% to < 20%), 40% non-dippers (0% to < 10%), and 15% reverse-dippers (<0%). 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). Non or reverse dipping was independently associated with measured GFR (odds ratio [OR, 95% confidence interval] per 10 ml/min/1.73m2 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 24 h 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, African origin, ambulatory daytime SBP 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.
ORTHOSTATIC HYPERREACTIVITY AND THE CARDIOVASCULAR RISK IN JUVENILE AND MIDDLE-AGE HYPERTENSION
Authors: Palatini Paolo , Mos Lucio , Rattazzi Marcello , Vriz Olga , Saladini Francesca 
Published: June 2022

Objective:
The prognostic significance of orthostatic hypertension (BP) in young individuals is still controversial. This study aims to evaluate the association of hyperreactivity to standing with major adverse cardiovascular and renal events (MACE) in a cohort of young-to-middle-age subjects.

Design and method:
This investigation was performed in 1207 untreated stage 1 hypertensive subjects with a mean age of 33.1 ± 8.6 years. Supine and standing BPs were measured during two visits performed two weeks apart. At each visit, three supine BP measurements and three orthostatic measurements were taken at 1-minute intervals. The orthostatic BP response to standing was calculated as the average of the standing-lying BP differences obtained during the two visits. Hyperreactors to standing were defined people with a standing-supine systolic BP difference in the top decile (>6.5 mmHg). The mean difference in the whole group was -2.5 ± 7.3/4.6 ± 5.4 mmHg. In 630 participants 24 h urinary epinephrine was measured.

Results:
Hyperreactors to standing were more frequently smokers (p = 0.003) and coffee drinkers (p = 0.05), and had higher 24 h urinary epinephrine (118.4 ± 185.6 versus 77.0 ± 90.1 nmol/mol, p = 0.005). Hyperreactors also had a greater orthostatic response of diastolic BP (p < 0.001). Ambulatory hypertension evaluated with 24-hour recordings was more common in Hyperreactors than Normoreactors (90.8% versus 76.4%, p = 0.001). During a 17.2-year follow-up, 105 MACE were accrued. In multivariate Cox analysis adjusted for age, gender, parental history of cardiovascular disease, smoking, alcohol drinking, coffee use, physical activity habits, body mass index, office systolic and diastolic BP, postural diastolic BP change, office heart rate, serum glucose, and total cholesterol, Hyperreactors to standing had an almost doubled risk of MACE compared to Normoreactors with a hazard ratio of 1.97 (95%CI, 1.10–3.52). Hyperreactivity remained an independent predictor of MACE even when ambulatory BP data and incident hypertension during follow-up were included in the Cox model (hazard ratio: 1.94; 95%CI, 1.10–3.44).

Conclusions:
Our data indicate that in young-to-middle-age hypertensive subjects an exaggerated systolic BP response to standing is associated with sympatho-adrenergic hyperreactivity and is an independent predictor of MACE. Orthostatic BP assessment gives the advantage of simple acquisition and future guidelines should encourage measurement of BP on standing in young individuals.
PROGNOSTIC CUTOFF OF TRIGLYCERIDES PREDICTING CARDIOVASCULAR OUTCOME IN A LARGE REGIONAL-BASED ITALIAN DATABASE
Authors: Tikhonoff Valerie , Casiglia Edoardo , Virdis Agostino , Barbagallo Carlo , Cirillo Massimo , Desideri Giambattista , Ferri Claudio , Galletti Ferruccio , Grassi Guido , Giannattasio Cristina , Iaccarino Guido , Mazza Alberto , Muiesan Maria Lorenza , Palatini Paolo , Parati Gianfranco , Pontremoli Roberto , Verdecchia Paolo , Volpe Massimo , Ungar Andrea , Borghi Caludio 
Published: June 2022

Objective:
Searching for a prognostic cut-off value of triglycerides (TG) in predicting cardiovascular (CV) outcome in a large regional-based Italian database of men and women.

Design and method:
A nationwide multicentre database collects data on subjects aged 18 to 95 years recruited on a regional community basis from all the territory of Italy with at least 1 measure of TG and a mean follow-up of 110.1 ± 64.3 months. A total of 18,784 subjects were included in the analysis. CV outcome was defined on the basis of ICD10 codes and double-checked with general practitioners and hospital files. Multivariate dichotomic Cox regression models having CV outcome as dependent variable, adjusted for age, sex, serum uric acid, body mass index, total and HDL-cholesterol, arterial hypertension, diabetes, chronic renal disease, smoking habit, use of antihypertensive and lipid lowering drugs were preliminarily used to search for an association between TG log-transformed as a continuous variable and CV event. The conventional cut-off value of TG (150 mg/d) and the prognostic cut-off value of TG identified by means of receiver operating characteristics (ROC) curves, both able to discriminate between subjects developing a CV event, were used as independent predictors in further multivariate Cox models adjusted for the confounders listed above.

Results:
During 172,329 person-years of follow-up, 1910 participants experienced CV events (11.1 per 1000 age-adjusted person-years). In Cox analysis, TG as a continuous variable was a significant predictor of CV event [odds ratio, OR, 1.189 (1.060–1.334), p = 0.003]. ROC curve showed that > 105 mg/dl (95%CI 75.8–129.3, sensitivity 61.7, specificity 48.8, p < 0.0001) was the prognostic cut-off value for CV event. The conventional cut-off (150 mg/dl) and that identified by ROC curve (105 mg/dl) were both accepted as multivariate predictors in separate Cox analyses, the hazard ratios being 1.157 (95%CI 1.037–1.290, p = 0.009) and 1.137 (95%CI 1.023–1.263, p = 0.016), respectively. Nevertheless, we observed that cut-offs of TG between 89 and 105 mg/dl, when played in the multivariate Cox analyses, seems to be protective as well.

Conclusions:
In conclusion, lower than expected prognostic cut-off value of TG for CV event do exist.
ASSOCIATION OF CEREBRAL OXYGENATION DURING EXERCISE WITH TARGET ORGAN DAMAGE IN HYPERTENSIVE AND NORMOTENSIVE INDIVIDUALS
Authors: Triantafyllou Georgios , Triantafyllou Areti , Dipla Konstantina , Zafeiridis Alexandros , Koletsos Nikolaos , Zafeiridis Andreas , Gkaliagkousi Eugenia , Douma Stella 
Published: June 2022

Objective:
To investigate whether indices of cerebral oxygenation during exercise correlate with subclinical markers of target organ damage (TOD), namely carotid intima-media thickness (cIMT), arterial stiffness, and retinal vessel diameter in newly diagnosed hypertensives and healthy individuals.

Design and method:
Hypertension was diagnosed using 24-hour ambulatory blood pressure (BP) monitoring. Patients with white coat or masked hypertension were excluded. Cerebral oxygenation was measured continuously during a three-minute isometric hand grip exercise at 30% of maximal voluntary contraction using near infrared spectroscopy. The average response during exercise in oxygenated-hemoglobin (O2Hb), deoxygenated-hemoglobin (HHb), and total-hemoglobin (tHb, reflecting changes in regional blood volume) were examined. CIMT was measured using ultrasound, arterial stiffness was estimated with augmentation index and pulse wave velocity, and retinal vessel diameters were estimated by the central retinal arteriolar (CRAE) and vein (CRVE) equivalent and retinal arteriovenous ratio (AVR). Univariate analyses were performed and partial correlation was used to account for traditional cardiovascular risk factors to identify independent associations between cerebral oxygenation indices and TOD.

Results:
Fifty-two newly-diagnosed, never treated hypertensives and 41 healthy normotensive individuals with no known medical history of any other disease were included in our study. There were no differences in anthropometric and laboratory variables between groups except for their BP levels, as expected by study design. Mean cIMT was negatively correlated with the average exercise response in cerebral oxygenation (rhoO2Hb = -0.348, pO2Hb = 0.001; rhotHb = -0.253, ptHb = 0.02). Augmentation index was negatively correlated with cerebral-oxygenation during exercise (rhoO2Hb = -0.374, p < 0.001; rhotHb = -0.332, p = 0.02), whereas no significant correlation was observed between pulse wave velocity and cerebral oxygenation indices. In the adjusted analysis, cerebral oxygenation was correlated with central retinal arteriolar diameter (CRAE rO2Hb = 0.233, pO2Hb = 0.043).

Conclusions:
Our novel findings suggest that indices of cerebral oxygenation during a submaximal physical task are associated with markers of early, subclinical target organ damage, namely increased carotid intima-media thickness, arterial stiffness and retinal arteriolar narrowing in a population of newly diagnosed hypertensive individuals.
IMPACT OF SEX AND ANTIHYPERTENSIVE MEDICATION ON GLOBAL COGNITION IN PRIMARY CARE OLDER ADULTS
Authors: De La Colina Adrian Noriega , Vasiliadis Helen-Maria , Berbiche Djamal , Bherer Louis , Kaushal Navin , Girouard Hélène 
Published: June 2022

Objective:
The goal of this study is to determine the impact of sex on the effects of different antihypertensive drugs classes, whether in monotherapy or in combination therapy, on the global cognition scores of older adults to identify the most appropriate medication regime in men and women.

Design and method:
This study used the ESA - Services study, consisting of a sample of 1811 older adults (>65 years) recruited in primary care practices in Quebec-Canada. Participants were examined for the Mini-Mental State Examination (MMSE), at three-time points: baseline, + 3 years, and + 4 years. Participants granted access to their provincial health record to assess: hypertension status, time since diagnosis, list of medications, and ptimisesations. Antihypertensives consumed by participants were divided into six categories: Diuretics, angiotensin II receptor blockers, beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and others. We assessed the changes in MMSE scores during the 4-year follow-up on the six antihypertensive groups per sex. Results were adjusted for age, years of education, and the Carlson Comorbidity Index.

Results:
Women had higher mean MMSE scores than men regardless of their blood pressure status, even though men had more years of formal education (10.65 vs 11.74 years, p < .001). Compared to normotensive individuals, hypertensive women had the highest mean MMSE score at each time point (T1 28.591 (SE .064); T2 28.282 (SE .118); T3 28.524 (SE .119)), while hypertensive men had the worst (T1 28.038 (SE .070); T2 27.694 (SE .125); 27.809 (SE .128)). Women taking angiotensin II receptor antagonists showed the highest MMSE scores (p < .003), and men taking diuretics had the lowest MMSE scores (p < .001) after a 3-year follow-up. Combination therapy of two or three antihypertensives drugs was associated with higher scores in women at T1 and T2 (p < .001). In men, the use of three antihypertensives showed a sharp decrease in MMSE scores from T1 to T3 (p < .001).

Conclusions:
Sex differences in global cognition outcomes in older adults are related to the type and number of antihypertensive drugs used. Effective antihypertensive treatment should consider the impact of sex to ptimise the effect of pharmacological interventions on cognition.
EXCESSIVE PULSATILE POWER IN CAROTID ARTERIES IS ASSOCIATED REDUCED COGNITIVE FUNCTION: PULSATILE AND STEADY STATE ARTERIAL HEMODYNAMICS IN TWO COMMUNITY-BASED COHORTS
Authors: Chuang Shao-Yuan , Wang Jiun-Jr Wang , Lin Chen-Hua , Pan Wen-Harn , Chen Liang-Kung , Wang Pei-Ning , Chen Chen-Huan , Cheng Hao-Min 
Published: June 2022

Objective:
Increased pressure and/or flow pulsatility in the carotid arteries have been adversely associated with cerebral structure and function. We postulated that increased power(product of pressure and flow) pulsatility is even harmful to the microcirculation of high-flow organs. We aimed to investigate the associations of carotid pressure, flow, and power pulsatility with cognitive function and pulsatile and steady state hemodynamics in proximal aorta and carotid arteries.

Design and method:
A total 1855 adult aged > = 30 years old were recruited for measurements of echocardiography and carotid sonography. We obtained hemodynamic parameters including pressure, flows, and power at proximal aorta and both carotid arteries. Proximal aortic pressure was determined by the tonometry waveform measured at common carotid arteries, calibrated by mean and diastolic pressure of brachial pressure. Pulsatility indexes(PIs) of pressure, flow and power in the proximal aorta and carotid arteries were calculated as the pulsatile value divided by mean value. We modelled the aorta-carotid interface with a large parent vessel(proximal aorta) branching into small (carotid) and large(distal aorta) daughter vessels and calculated the reflection coefficient and transmitting coefficient from aortic and carotid characteristic impedances. Cognitive function was evaluated by the Montreal Cognitive Assessment (MoCA) score.

Results:
The pulsatile component was 10.3%(105/996mW) and 4.2%(11/268mW) of total aortic and carotid power, respectively. PIs of aortic pressure(r = -0.048,p = 0.0417), aortic flow(r = 0.060,p = 0.0101), aortic power(r = -0.080,p = 0.006), carotid flow(r = -0.085,p = 0.003), and carotid power(r = -0.097,p < 0.0001) were all significantly associated with cognitive function, independent of age, sex, and education. Carotid power PI was significantly better than other PIs in the association with cognitive function. In the multivariable model, MoCA score was positively and negatively associated with carotid mean power (beta = 0.005,p < .0001) and carotid pulsatile power(beta = -0.048,p < .0001), respectively. With increasing aortic characteristic impedance and transmitting coefficient, and decreasing reflection coefficient, there was a significantly increased transmitting aortic power into carotid arteries(all p value < 0.0001).

Conclusions:
Among all ascending aorta and carotid hemodynamics, carotid power PI was the hemodynamic parameter with the best correlation with cognitive function. Increased proximal aortic stiffness, and increased transmission and decreased reflection of the aortic power at the aorta-carotid interface were closely associated with increased carotid pulsatile power.