bluuebunny/crossref_metadata_2025_split huggingface dataset:
MICRO- AND MACROVASCULAR ALTERATIONS IN RHEUMATOID ARTHRITIS COMPARED TO TYPE 2 DIABETES MELLITUS: EVIDENCE OF SIMILAR DEGREE OF ORGAN DAMAGE
Authors: Anyfanti Panagiota , Nikolaidou Barbara , Gavriilaki Eleni , Triantafyllou Areti , Lazaridis Antonios , Dolgyras Panagiotis , Dimitriadou Antonia , Douma Stella , Gkaliagkousi Eugenia 
Published: June 2022

Objective:
Rheumatoid arthritis (RA) is characterized by excess cardiovascular risk attributed to the chronic inflammatory load in combination with the accumulation of traditional cardiovascular risk factors. RA is being currently perceived as a cardiovascular risk factor equivalent to type 2 diabetes mellitus (DM2), although recent relevant studies have provided conflicting results. The aim of the present study was to compare markers of micro- and macrovascular dysfunction between patients with relatively well-controlled RA and patients with DM2.

Design and method:
Patients with RA who presented low levels of systemic inflammation and patients with DM2, who were free from cardiovascular comorbidities including hypertension, were studied. A control group that comprised of healthy volunteers was additionally included. All participants underwent applanation tonometry (Sphygmocor device) to assess a) carotid-femoral pulse wave velocity (PWV), b) augmentation index corrected for 75 bpm (AIx@75), c) central systolic/diastolic blood pressure (cSBP/cDBP) as markers of large artery stiffening. Subendocardial viability ratio (SEVR) or Buckberg index was measured with the same device as a functional marker of microvascular myocardial perfusion. In addition, carotid ultrasound was applied to evaluate a) carotid intima-media thickness (cIMT), as a marker of systemic atherosclerosis, and b) beta-stiffness index, as a marker of local stiffness in the carotid arteries.

Results:
We studied 31 patients with RA at remission or low disease activity, 32 patients with DM2 and 69 controls matched for age and office blood pressure. Significant differences were observed in several outcomes of the study between patients and controls; by contrast, none of the studied parameters (PWV, AIx@75, cSBP/cDBP, cIMT, beta-stiffness index, and SEVR) significantly differed between patients with RA and patients with DM2 (Table 1).

Conclusions:
Patients with RA present impaired markers of micro- and macrovascular dysfunction, even in the absence of cardiovascular comorbidities including hypertension and whilst at remission or low disease activity. Moreover, the degree of divergent micro- and macrovascular alterations in this well-characterized group of RA patients appears comparable to that associated with DM2. These findings are line with the widely held perception that RA should be regarded as a novel cardiovascular risk factor equivalent to DM2.
HERA3 STUDY: CAN PRESSURE-FLOW MEASUREMENTS AND COMPUTATIONAL FLOW SIMULATIONS GUIDE US WHEN TO TREAT RENAL ARTERY STENOSIS?
Authors: Van De Velde Lennart , Collard Didier , Verberne Hein , Lamers Armand , Zijlstra Ijsbrand , Vogt Liffert , van den Born Bert-Jan 
Published: June 2022

Objective:
To stent or not to stent remains a difficult decision in patients with renal artery stenosis (RAS). Up to date, no diagnostic test that reliably identifies patients that will benefit from endovascular intervention has been established. Our goal is to develop and validate an image-based flow simulation method for predicting blood pressure improvement after renal arterial revascularization.

Design and method:
In total 30 patients scheduled for percutaneous renal transluminal angioplasty (PTRA) for atherosclerotic RAS or fibromuscular dysplasia RAS will be included in the HERA-3 study. Baseline imaging consists of computed tomography angiography (CTA). Before and after PTRA duplex ultrasound, renography and 24-h ambulatory blood pressure (ABPM) measurements are obtained. Based on the pre-operative CTA and duplex-imaging, personalized flow simulations are performed using computational fluid dynamics (CFD). During PTRA, pressure-flow measurements are obtained with a 0.014” Combowire (Philips-Volcano) before and after intrarenal dopamine administration. A non-invasive renal fractional flow reserve (rFFR) –the pressure gradient during vasodilation- is derived from the CFD simulation and compared to the invasively measured rFFR for validation. In addition, the renal flow reserve (RFR) -the relative increase in flow during vasodilation relative to resting condition- is obtained.

Results:
Twelve patients have been included in the study so far. Preliminary results show an encouraging agreement between the CFD-based and invasively measured rFFR. Second, in select cases with an anatomically moderate RAS (65% diameter reduction), a low RFR was found before PTRA, which markedly increased after PTRA. This suggests that a subset of RAS lesions cause a stronger flow impediment than can be expected on anatomic lesion grading.

Conclusions:
In patients with RAS, it is feasible to obtain the functional flow metrics rFFR and RFR during angiography. Second, preliminary data suggest that the rFFR can be non-invasively estimated using computational flow analysis based on CTA and ultrasound imaging. Future analysis can establish the predictive value of these metrics for predicting blood pressure improvement after PTRAS.
RENAL MICROPERFUSION RESPONSE TO A COLD PRESSURE TEST IS DECREASED IN HYPERTENSIVE PATIENTS
Authors: Hendriks-Balk Mariëlle , Damianaki Aikaterini , Polychronopoulou Erietta , Brito Wendy , Pruijm Menno , Wuerzner Grégoire 
Published: June 2022

Objective:
Microcirculation is essential to supply oxygen and nutriments to tissue. Alteration in the microcirculation is often proposed as a mechanistic link between hypertension and target organ damage. The recent developments in contrast-enhanced ultrasonography (CEUS) have enable the quantification of renal microcirculation. The objective of this study was to compare the microcirculatory response during a cold pressure test (CPT) in hypertensive (HT) patients with those in healthy normotensive (NT) participants.

Design and method:
This was a prospective case-control study. Hypertensive (HT) and normotensive (NT) participants underwent two separate CPT of 2 minutes. Doppler ultrasound was used to measure renal resistive index (RRI) and CEUS to measure the perfusion index (PI) as a proxy of renal tissue microcirculation. Renal Doppler and CEUS were performed before and during the CPT. We compared baseline measures and responses to CPT of HT and NT groups using a Wilcoxon test.

Results:
Sixteen hypertensive and nineteen normotensive male participants were included. HT participants were older and had higher blood pressure and body mass index. Baseline RRI was similar in both group, but HT had lower PI (median with interquartile range): 1083 U(447–1476) vs 1772 U(1295–2557), p = 0.016. The CPT decreased the RRI in NT and increased the RRI in HT, resulting in a different CPT response -0.026 [CI -0.045; -0.008, p = 0.006]. The CPT increased the PI in both groups but the response was blunted in HT patients - 755U ± 518, (p = 0.01).

Conclusions:
Compared to healthy participants, hypertensive patients show a paradoxal RRI response and a lower increase in perfusion index during CPT suggesting that microcirculation and possibly renal autoregulation is altered. This is the first demonstration showing that CEUS enables the detection of microcirculatory differences between healthy participants and hypertensive patients.
CAROTID ELASTICITY IS IMPAIRED IN STAGE 1 HYPERTENSIVE PATIENTS EVEN IF BLOOD PRESSURE IS WELL CONTROLLED BY TREATMENT
Authors: Saladini Francesca , Rattazzi Marcello , Faggin Elisabetta , Palatini Paolo , Puato Massimo 
Published: June 2022

Objective:
Whether impaired arterial elasticity in stage 1 hypertension can be brought back to normal by antihypertensive treatment is unknown. Aim of this study was to evaluate the impact of long-term well-controlled blood pressure (BP) on carotid artery elasticity and endothelial function in stage 1 hypertensive patients at low cardiovascular risk.

Design and method:
We studied 40 middle-age hypertensives whose BP had been kept at target by pharmacological treatment and/or lifestyle modifications for a mean of 7.5 years. Carotid compliance coefficient (CC) and distensibility coefficient (DC) were measured by B-mode ultrasound system. Measurement of carotid intima-media thickness (IMT) was performed in each carotid artery segment, bilaterally. Endothelial function was evaluated by post-occlusion flow mediated dilation (FMD). hs-CRP and osteoprotegerin were measured as markers of inflammation. Forty normotensive subjects matched for age and sex served as controls.

Results:
In the hypertensive subjects, BP levels were well controlled throughout the study period (mean office BP 133.7 ± 9.0/81.2 ± 7.0 mmHg; mean 24 hours BP was 124.2 ± 10.4/78.2 ± 7.5 mmHg). However, compared to controls, significantly higher office BP levels and waist circumference were present. Compared to normotensives, carotid elasticity (DC 24.5 ± 9.0 vs 37.0 ± 8.5 10–3/kPa, and CC 0.92 ± 0.34 vs 1.28 ± 0.36 mm2/kPa, p < 0.0005 for both) as well as endothelial function (FMD 5.7 ± 2.4% vs 9.2 ± 2.9%, p < 0.0005) were significantly impaired in hypertensives. Moreover, hs-CRP and osteoprotegerin were higher in HT than in NT (1.41 ± 1.07 vs 0.97 ± 0.65 mg/L, p = 0.030; 1246 ± 560 vs 936 ± 148 pg/ml p = 0.001). In a logistic regression, hypertensive status was a significant predictor of local carotid vascular stiffness (DC < 30 10–3/kPa) with an odds ratio of 14.98 (95%CI, 2.60–18.55) p < 0.0005 for crude data; when data were adjusted for age, FMD, OPG, and BMI, the odds ratio only slightly decreased (13.04 (2.27–74.96), p = 0.004). Hypertensive status remained a significant predictor also after the adjustment for systolic, diastolic, mean BP.

Conclusions:
Despite the “pseudo-normalization’’ of BP levels, hypertensive patients with long term well-controlled BP according to current standards exhibited increased local arterial stiffness, endothelial dysfunction and increased markers of inflammation. Whether an earlier and more aggressive intervention could be useful to reduce arterial stiffening and improve endothelial function in hypertension should be explored.
OUTCOME-BASED THRESHOLD FOR CAROTID-FEMORAL PULSE WAVE VELOCITY: THE IDCARS STUDY
Authors: An Dewei , Cheng Yi-Bang , Aparicio Lucas S. , Thijs Lutgarde , Huang Qi-Fang , Wei Fang-Fei , Barochiner Jessica , Sheng Chang-Sheng , Yang Wen-Yi , Niiranen Teemu J. , Boggia José , Stolarz-Skrzypek Katarzyna , Gilis-Malinowska Natasza , Tikhonoff Valérie , Wojciechowska Wiktoria , Casiglia Edoardo , Narkiewicz Krzysztof , Filipovský Jan , Kawecka-Jaszcz Kalina , Wang Ji-Guang , Li Yan , Staessen Jan A. 
Published: June 2022

Objective:
Guidelines recommend a > 10m/s threshold of carotid-femoral pulse wave velocity (cf-PWV) to detect hypertension mediated organ damage. However, the > 10m/s threshold was derived from the cf-PWV distribution across cross-sectional studies with limited contribution of prospective cohort studies. Using data from the International Database of Central Arterial Properties for Risk Stratification (IDCARS), we aimed to determine an outcome-based threshold for cf-PWV.

Design and method:
Adults (> = 18 years) recruited by eight IDCARS centres and followed up for 6 months or longer qualified for inclusion in the current subject-level meta-analysis. Cf PWV was measured using the Sphygmocor device (Itasca, IL). Pulse transit distance was determined by subtracting the distance between the carotid sampling site and the suprasternal notch from the distance between the carotid and femoral sample sites. The primary endpoint consisted of fatal and nonfatal cardiovascular events. Total and cardiovascular mortality and fatal and nonfatal coronary events were secondary endpoints. The cf-PWV threshold was determined by multivariable Cox regression with average risk based on established risk factors in the whole cohort as reference.

Results:
After 5.0 years of follow-up (median), of 3494 participants (mean age: 52.2 years; women: 55.3%; mean cf-PWV: 7.8 m/s), 156 (4.5%) experienced the primary endpoint, and 104 (3.0%) died, 25 (0.7%) of cardiovascular disease and 77 (2.2%) had a coronary event. After whole adjusting for sex, age, systolic blood pressure, heart rate and other cardiovascular risk factors, the outcome-driven cf-PWV thresholds were 8.6, 9.1, 8.7 and 8.6 m/s for a composite cardiovascular endpoint, all-cause and cardiovascular mortality and a coronary event, respectively. A cf-PWV > = 9 m/s (n = 752, 21.5%), compared with slower velocities, had an increased risk of a composite cardiovascular endpoint (HR: 1.75; 95% CI: 1.20–2.54, P = 0.004).

Conclusions:
The outcome-based threshold of > = 9 m/s for cf-PWV, which was present in 20% of the IDCARS participants, is close to the cut-off limit proposed by guidelines based on other approaches.
ARTERIAL HAEMODYNAMIC PARAMETERS LINKED TO ARTERIAL PULSATILITY, EXCESS WAVE PROPAGATION AND COGNITIVE FUNCTION
Authors: Jordan Andrew N. , Aizawa Kunihiko , Gooding Kim M. , Llewellyn David , Casanova Francesco , Mawson David M. , Gates Phillip E. , Adingupu Damilora D. , Elyas Salim , Hope Suzy V. , Strain W. David , Clark Chris E. , Bellenger Nicholas G. , Sharp Andrew S.P. , Parker Kim H. , Hughes Alun D. , Shore Angela C. 
Published: June 2022

Objective:
Hypertension is associated with the development of cognitive impairment and dementia in an ageing population. Aortic stiffness and alterations in central artery haemodynamics could intensify the penetration of excess wave energy into the cerebral circulation, damaging the microvasculature in addition to age-associated vascular changes. We aimed to determine whether haemodynamic parameters linked to arterial pulsatility and excess wave propagation was associated with cognitive function in a sample of normotensive and hypertensive individuals.

Design and method:
We studied 35 treatment-naïve patients with stage II/III hypertension (HT: 63.8 ± 7.4yrs, 19F, SBP 175.6 ± 16.8 mmHg) and 35 age-, sex- and body mass index-matched normotensive individuals (NT: SBP 127.2 ± 8.2 mmHg). Indices of excess pressure including excess pressure integral (INTXSP) and peak excess pressure (MAXXSP) were obtained by radial artery tonometry. Aortic forward compression wave intensity (FCWI) and aortic pulse wave velocity (aPWV) were estimated as proposed by Hughes et al (Front Physiol. 2020). A battery of cognitive examination tests was administered including Addenbrooke’s Cognitive Examination-III (ACE), Mini-Mental State Examination (MMSE), Trail making test part A (TMT-A) and B (TMT-B).

Results:
Both INTXSP (9.2 ± 2.7 vs 5.4 ± 1.2 mmHg s) and MAXXSP (54.1 ± 12.8 vs 33.4 ± 5.9 mmHg) were significantly higher in HT compared to NT (p < 0.001). Additionally, FCWI [14.9 (12.0–20.0) vs 8.0 (6.8–9.3) x105 W/m2] and aPWV (7.2 ± 1.7 vs 4.5 ± 0.8 m/s) were significantly greater in HT compared with NT (p < 0.001). Higher INTXSP was associated with poorer ACE (rs = -0.310, p = 0.009), longer TMT-A (r = 0.409, p < 0.001) and TMT-B (r = 0.380, p = 0.001). Similarly, higher MAXXSP was associated with poorer ACE (rs = -0.343, p = 0.004), longer TMT-A (r = 0.397, p = 0.001) and TMT-B (r = 0.330, p = 0.006), and greater aPWV was associated with poorer ACE (rs = -0.331, p = 0.005), longer TMT-A (r = 0.397, p = 0.001) and TMT-B (r = 0.324, p = 0.007). Higher FCWI was associated with longer TMT-A (rs = 0.378, p = 0.002) and TMT-B (rs = 0.260, p = 0.038), and showed a trend to be associated with poorer ACE (rs = -0.238, p = 0.054). None of the haemodynamic indices was associated with MMSE.

Conclusions:
Haemodynamic parameters linked to excess arterial wave propagation are associated with poorer cognitive function. These observations reveal a potential mechanism linking hypertension and cognitive impairment, and reinforce the importance of blood pressure control to reduce cognitive impairment risk.
SALT-SENSITIVITY IN HEALTHY NORMOTENSIVE MEN IS ASSOCIATED WITH IMPAIRED BAROREFLEX SENSITIVITY
Authors: Oppelaar Jetta J. , Bouwmeester Thomas A. , Silova Anastasia A. , Collard Didier , Wouda Rosa D. , Rorije Nienke M.G. , Engberink Rik H.G. Olde , Van Den Born Bert-Jan H. , Vogt Liffert 
Published: June 2022

Objective:
Blood pressure (BP) responses to Na+ intake show great variability, discriminating sodium sensitive (SS) from salt resistant (SR) individuals. The pathophysiology behind salt-sensitivity is still not fully elucidated. A pivotal role for the sympathetic nervous system to BP increase after sodium loading is suggested. Therefore, we aimed to investigate the effect of the sympathovagal balance on Na+-induced BP effects and if Na+-induced effects on sympathetic activation contribute to salt-sensitivity.

Design and method:
We performed a randomized cross-over study in 31 young healthy men with normal BMI and eGFR. Subjects followed both an 8-day low Na+ diet (LSD, < 50mmol/d) and high Na+ diet (HSD, > 200mmol/d), in 18 subjects the diets were extended to 14-days. SS was defined as an increase of three or more mmHg standardized measured office MAP after HSD. Cardiac-output (CO) and cross correlation baroreflex sensitivity (xBRS) were measured with continuous non-invasive finger photoplethysmography. Systemic vascular resistance (SVR) was calculated as the ratio of MAP by CO.

Results:
After HSD, SS men (19%) showed a mean 6.2 (±2.1 SD) mmHg increase in MAP. No absolute differences in Na+-induced effects on CO and SVR could be observed between groups. After HSD, xBRS was 34% lower in SS men compared to SR men (Fig1A). Sodium loading resulted in a mean xBRS decrease of 3.4 (±6.5 SD) ms/mmHg in SS men, whilst xBRS increased with 2.3 (±6.3 SD) ms/mmHg in SR men (p = 0.06). HSD xBRS values were significantly correlated with Na+-induced BP changes in the complete group when corrected for age and BMI (Fig1B).

Conclusions:
Salt-sensitivity of BP in young normotensive men seems to be predominantly driven by changes in sympathovagal balance. The significant correlation between xBRS and delta BP further suggests a continuous relation between sympathetovagal balance and salt exposure. Further studies are needed to unravel pathophysiological mechanisms underlying Na+-effects on sympathetic regulation.
EXERCISE AND AMBULATORY BLOOD PRESSURE: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS WITH META-ANALYSIS
Authors: Decorte Elise , Dewilde Camille , Michielsen Matthijs , Smart Neil , Cornelissen Veronique 
Published: June 2022

Objective:
Hypertension remains the biggest single contributor to the global burden of disease and to the global mortality rate. Lifestyle changes, including exercise therapy, are recommended in the prevention and treatment of high blood pressure (BP). To date, most randomized controlled trials (RCT’s) have evaluated the effect of exercise therapy on resting office blood pressure (BP). Data on the efficacy of exercise on ambulatory BP (AMBP), nowadays considered the gold standard measurement, remain scant. The current systematic review and meta-analysis aimed to summarize the effect of different exercise modalities on AMBP in individuals with a normal, high normal BP or hypertension.

Design and method:
This systematic review was conducted and reported according to the PRISMA-guidelines. A systematic literature search was conducted in three databases including only RTC’s involving exercise of at least 4 weeks in adults with a normal, high-normal BP or hypertension without concomitant diseases and published as a full-text in a peer-reviewed journal up to October 2021. Random effects models were used for analyses, with data reported as weighted means and 95% CI. We included 30 trials, including 36 study groups (n = 31 aerobic endurance exercise interventions, n = 4 resistance exercise interventions; n = 1 combined exercise intervention) randomizing a total of 1919 participants.

Results:
Analyses were performed with Comprehensive Meta-Analysis software (CMA 2.0). Aerobic endurance exercise significantly decreased 24 h AMBP (-2.8/-1.7 mmHg; p < 0.05); daytime AMBP (-3.6/-2.8mmHg; p < 0.001), nighttime ABMP (-1.6/-1.1; p < 0.05). Following resistance training, only a decrease in daytime systolic BP (-5.3 mmHg; p> 0.05) was observed without a statistically significant effect on daytime diastolic BP or nighttime BP (p > 0.05 for both).

Conclusions:
This meta-analysis confirms the BP lowering potential of exercise therapy in the management of BP. Daytime, nighttime and 24 h AMBP were significantly lower following an aerobic exercise intervention. The limited data available on resistance exercise warrants more research to confirm the resistance exercise as a sole exercise therapy to lower AMBP.
POSITIVE PULMONARY ARTERY REMODELING AFTER A SERIES OF BALLOON PULMONARY ANGIOPLASTIES IN A PATIENT WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION
Authors: Yarovoy Sergey , Chazova Irina , Danilov Nikolay , Matchin Yuri 
Published: June 2022

Objective:
To demonstrate positive pulmonary artery remodeling after balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH).

Design and method:
A 68-year old female was admitted to pulmonary hypertension department with swelling of the feet and legs, low level of arterial blood saturation (92%). She passed two episodes of pulmonary embolism – 7 and 5 years before the hospitalization. The patient was treated with anticoagulants (warfarin), diuretics (furosemide, spironolactone). Invasive pulmonary angiography confirmed thromboembolic lesions of pulmonary artery. Another types of pulmonary hypertension, except CTEPH, were excluded. Multidisciplinary commission considered her as inoperable due to obesity and anemia of unknown origin. But it was technically possible to perform BPA.
The patient underwent 5 sessions of BPA. Before and just after the first BPA and 3 months after the last BPA intravascular ultrasound (IVUS) of pulmonary arteries was performed.

Results:
According to the results of treatment the functional class improved in the patient (from 4 to 3), the distance in 6-minute walking test slightly increased (from 290 to 303 m), and the mean preassure in pulmonary artery decreased from 40 to 35 mm Hg. When assessing the size of the pulmonary arteries, underwent angioplasty, there were determined signs of positive remodeling (Table 1). According to invasive angiography the diameter of branches of the subsegmental arteries increased up to 14.3%. According to the results of IVUS, comparable results were obtained: 10% increase of the lumen diameter.

Conclusions:
successful series of BPA in patients with CTEPH can lead to the significant positive remodeling of pulmonary arteries.