bluuebunny/crossref_metadata_2025_split huggingface dataset:
ANTIHYPERTENSIVE TREATMENT INITIATION IN FRANCE: WHAT DID GENERAL PRACTITIONERS PRESCRIBE IN 2021?
Authors: Mourad Jean Jacques , Jamet Philippine , Huguet Michael , Suhl Jaehyo , Voisin Olivier , Azria Philippe , Ferreira Emmanuel , Antakly Yara 
Published: June 2022

Objective:
Hypertension (HT) is the leading reason for visits to general practitioners (GPs). The diagnosis of HT and the decision to initiate drug treatment form an integral part of their natural field of practice. The recent national and international guidelines have made proposals that are specifically dedicated to this sequence of care. The objective of this study is to analyse the prescribing behaviours of GPs when initiating treatment for patients newly diagnosed with hypertension.

Design and method:
Data from the IQVIA Longitudinal Patient Database (LPD) France were used. LPD France is a permanent observatory to which a nationally representative panel of physicians – including GPs (n = 1200) – contribute anonymised electronic medical records (EMR). This analysis included all antihypertensive drug prescriptions made by the GPs from July 2020 to June 2021, which were then extrapolated to the entire population of mainland France. Initiation was defined by the establishment of an antihypertensive treatment for a patient already registered with the GP and who was receiving antihypertensive treatment for the first time in 24 months.

Results:
Over the 12-month period analysed, 869 283 patients had received an initial antihypertensive drug prescription following consultation with a GP. Monotherapy was prescribed in 71.5% of cases (versus 67.3% the previous year) and dual therapy in 21.5% of cases (versus 23.2% the previous year). Fixed-dose combinations accounted for 62% of the dual therapies.
The therapeu tic classes of the prescribed monotherapies were distributed as follows:

Conclusions:
These findings reveal prescriptions that appeared to be consistent with the latest guidelines in which the first-line use of renin-angiotensin system blockers and calcium channel blockers is preferred. It is also interesting to note that treatment initiation with dual therapies was much less common, with a use rate of fixed-dose combinations slightly higher than that of the free-dose combinations.
*IQVIA EMR LPD Médecins Généralistes / Cardiologues Libéraux’. EMR = Electronic Medical Records, LPD = Longitudinal Patient Data
PRESCRIPTIONS OF ANTIHYPERTENSIVE DRUGS ARE INFLUENCED BY THE CHARACTERISTICS OF GENERAL PRACTITIONERS AND THEIR PATIENTS: A CROSS-SECTIONAL STUDY IN NORMANDY (FRANCE)
Authors: Humbert Xavier , Rabiaza Andry 
Published: June 2022

Objective:
Hypertension is associated with significant cardio-vascular morbi-mortality. However, hypertension control is low, especially in France. The reasons influencing general practitioners’(GP) prescription of antihypertensive drugs (AD) remains unclear. This study aimed at assessing the influence of GP and patient characteristics on AD prescriptions.

Design and method:
A cross-sectional study based on a sample of 2,165 GPs working with French national health insurance was realized in Normandy (region of France) in 2019. Only GPs meeting the criteria for full-time GP practice were included. The ration of AD prescription to overall prescription volume, a relative measure of AD prescription level, was calculated for each GP and permited the “low-high AD prescriber’’ definition. Associations of this AD prescription ratio with GP’s age, gender, practice location, number of years of practice, number of home visits and consultations, number and age of registered patients, man patient income and number of patient with a chronic condition were assessed using univariate and multivariate analysis.

Results:
The low prescribers GPs were 51.3 ± 11.2 year-old and were mainly women (56%) and practiced in urban context (53%). They prescribed less antihypertensives drugs (4% vs 8%, p < 0.001) and had more low-income patients (6% vs 4%, p < 0.001). In the multivariate analysis, low prescribers were associated to urban practice (OR: 1.47, 95%CI: 1.14;1.88), GP’s younger age (OR: 1.87, 95%CI: 1.42;2.44), patients younger age (OR: 3.39, 95%CI: 2.77;4.15), more patients consultations (OR: 1.33, 95%CI: 1.11;1.61), more low-income patients (OR: 1.44, 95%CI: 1.17;1.76) and less diabetes mellitus patients (OR: 0.72, 95%CI: 0.59;0.88).

Conclusions:
Our study described a profile of the typical lower AD prescriber GP. In future work, a more detailed assessment of all components of the consultation (in particular home blood pressure monitoring use) is necessary to explain AD prescription in general practice.
ASSOCIATION OF BASELINE ALDOSTERONE/RENIN WITH MAGNITUDE OF BLOOD PRESSURE REDUCTION FROM FIRST-LINE TREATMENT IN TREATMENT-NAÏVE HYPERTENSIVE PATIENTS
Authors: Vischer Annina , Socrates Thenral , Glinz Delphine , Mayr Michael , Haschke Manuel , Burkard Thilo 
Published: June 2022

Objective:
Aldosterone and renin play an important role in the regulation of blood pressure. While it is well known that treatment causes distinct alterations in the concentrations of aldosterone/renin, less is understood regarding baseline hormone concentrations and its association with response to treatment.

Design and method:
Patients with newly diagnosed arterial hypertension according to 24h-BP measurements (ABPM) were randomized into four arms in a 1:1:1:1 fashion to either 5 mg perindopril (ACE), 20 mg olmesartan (ARB), 5 mg amlodipine (CCB), or 25 mg hydrochlorothiazide (HCT). Aldosterone, renin and its ratio (ARR) were measured before treatment initiation and after 4 weeks of treatment at 8 a.m. and 12 a.m. at both visits. All values were analyzed separately. ABPM was repeated after 4 weeks of treatment. Super-response was defined as a BP-reduction > = 10 mmHg of the 24 h mean ABPM values.

Results:
80 patients were randomized: 20 (25.0%) to ACE, 20 (25.0%) to ARB, 21 (26.3%) to CCB, and 19 (23.8%) to HCT. Mean age was 48 (±14) years, mean BMI 26.5 (±3.7) kg/m2. Systolic/diastolic super-responders was detected in the various groups: ACE-arm 14/6 patients (70%/30%), ARB-arm 12/6 patients (60%/30 %), CCB-arm12/1 patients (57%/5%), and HCT-arm 8/3 patients (42%/16%). ACE and HCT increased renin and reduced the ARR, ARB reduced aldosterone, increased renin and reduced the ARR; CCB did not uniformly alter the hormones (Figure, panel A). While there were no significant differences for systolic super-responders with any drug, diastolic super-responders with ACE had significantly higher aldosterone and renin values at 8 and 12 a.m. at baseline (p-value 0.015/0.051 and 0.033/0.072 for aldosterone and renin), whereas super-responders with ARB had significantly higher renin and lower ARR (p-value 0.105/0.029 and 0.089/0.015) compared to non-super-responders. There was no significant differences for patients treated with CCB or HCT (Figure, panels B - D).

Conclusions:
For ACE and ARB, there is an association of the baseline aldosterone, renin and ARR values with the magnitude of BP response to the drug after 4 weeks of treatment.
EXTREMELY HIGH DIRECT PLASMA RENIN IN A YOUNG WOMAN WITH NEGATIVE IMAGING FOR RENOVASCULAR HYPERTENSION
Authors: Kuzior Agnieszka , Hernandez-Lazaro Alba , De Leon-Durango Ricardo , Rios-Gomez Carlos , Arnas-Leon Claudia , Calero Carmen Acosta , Fernandeztrujillo-Comeng Paula Maria , Santana-Suarez Ana Delia , Gonzalez-Diaz Paula , Tocino-Hernandez Alba Lucia , Perdomo-Herrera Esperanza , Martin-Perez Marta , Del Pino Perez-Garcia Maria , Garcia-Alamo Debora , Martinez-Martin Francisco Javier 
Published: June 2022

Objective:
Direct plasma renin (DPR) has a much broader distribution than plasma renin activity (PRA). The finding in one patient of extremely high DPR values without apparent cause led us to the diagnosis and successful treatment of renovascular hypertension which had been initially ruled out by magnetic resonance angiography.

Design and method:
Review of the patient’s clinical records and the relevant literature.

Results:
A 39-year-old woman, long-term user of oral contraceptives was referred to our Hypertension Clinic. For the last two years she had presented severe hypertension, with BP often > 200/120 mmHg, poorly responding to antihypertensive drugs including ACEI or ARB plus calcium antagonists, diuretics, spironolactone, doxazosin and bisoprolol. She reported frequent holocranial non-pulsatile headaches without pallor, tachycardia, nausea or other vegetative symptoms. Laboratory testing was normal except for albuminuria (378 mg/g Cr) with normal plasma creatinine,eGFR, potassium, TSH and ACTH. Blood pressure remained high after contraceptive withdrawal. Physical examination showed only grade I overweight. ABPM showed diurnal 198/96 mmHg and nocturnal 186/89 mmHg, non-dipper without marked highs or lows. Echocardiography showed moderate LVH but ruled out heart failure. All drugs except diltiazem and doxazosin were withdrawn for a month, plasma metanephrines and cortisol suppression were normal, and plasma aldosterone was in the upper normal range (29.6 ng/dL) while DPR was extremely high (2196 mU/L, normal upper limit 39 mU/L). Renovascular hypertension (or reninoma) was suspected, but magnetic resonance renal angiography was informed as normal. However, the left kidney was significantly smaller and hypoperfused. A standard renal angiogram showed fibromuscular dysplasia with severe left stenosis. Angioplasty was performed, and after 3 months the patient’s blood pressure is well controlled with 120 mg slow-release diltiazem daily, and her plasma angiotensin and renin are normal.

Conclusions:
DPR can be raised by low-salt diet, hypovolemia, drugs such as diuretics, ACEIs and ARBs, hyperthyroidism, pheochromocytoma/paraganglioma and edematous states (heart or liver failure, nephrotic syndrome). However these conditions are unlikely to cause extremely high renin. Renovascular hypertension or reninoma should be suspected, even when the initial imaging seems negative. Fibromuscular dysplasia is likelier than atherosclerotic stenosis or reninoma in contraceptive users.
PRIMARY ALDOSTERONISM: INITIAL EXPERIENCE FROM A NEWLY ESTABLISHED ESH HYPERTENSION CENTER OF EXCELLENCE - WORK IN PROGRESS
Authors: Tabbalat Ramzi , Al-Hayek Tahani , Al Ani Hashim , Barghouthi Hiba 
Published: June 2022

Objective:
Primary aldosteronism is a common, yet underdiagnosed, cause of hypertension and resistant hypertension. It is estimated to be responsible for 6% of all cases of hypertension and 23% of all cases of resistant hypertension and is associated with disproportionately high rates of cardiovascular events and renal damage relative to the degree of hypertension. We sought to determine the prevalence of primary aldosteronism in patients referred to our center with the diagnosis of hypertension or resistant hypertension

Design and method:
From 08/03/2021 to 04/01/2022, 46 Patients (18 Females, 39.1%) were evaluated for primary aldosteronism. Thirty two patients (69.6%) were diagnosed with hypertension, of which 22 patients were newly diagnosed and were not on antihypertensive therapy. Fourteen patients (30.4%) were diagnosed with resistant hypertension and were on an average of 4 antihypertensive medications (range, 3 to 7). All were screened with Serum aldosterone (Ald) (pg/ml) and Plasma Renin activity (PRA) (mU/L) levels and ratio. To confirm the diagnosis, a seated saline suppression test (SSST) was performed when the Ald/PRA ratio was above 300. Adrenal computed tomography (CT) and adrenal vein sampling (AVS) were recommended or performed whenever the SSST was positive.

Results:
Of the 32 Patients with hypertension, 7 had an abnormal Ald/PRA ratio, 2 of which had a SSST which was positive in 1. Of the 14 patients with resistant hypertension, 7 (50%) had an abnormal Ald/PRA ratio, 4 of which underwent a SSST which was positive in all 4. Adrenal CT and AVS were done in 3 patients with resistant hypertension and positive SSST. AVS confirmed unilaterality in 2, both with adrenal adenomas. Adrenalectomy was recommended for the 2 patients and was performed in one with significant improvement in blood pressure control.

Conclusions:
Although this is a small number of evaluated patients, the data suggests that primary aldosteronism is not rare in hypertensive patients and is a common cause of resistant hypertension. All efforts should be made to improve physicians and patients’ awareness about its prevalence.
MRI POTENTIAL FOR PREDICTION OF THE ANTIHYPERTENSIVE EFFECT OF RFA IN PATIENTS WITH TREATMENT-RESISTANT HYPERTENSION
Authors: Sukhareva Anna , Falkovskaya Alla , Baev Andrey E. , Mochula Olga V. , Maksimova Alexandra S. , Ryumshina Nadezhda I. , Shelkovnikova Tatyana A. , Zyubanova Irina V. , Tsoi Ekaterina I. , Manukyan Musheg A. , Mordovin Viktor F. , Ussov Vladimir Yu 
Published: June 2022

Objective:
50% of the RFA procedures in patients with treatment-resistant hypertension (TRH) are ineffective or have ambiguous results. The most significant challenge is to find differential diagnostic predictors of the RFA efficacy in these patients.
Our purpose was to assess the MRI potential for efficacy prediction and real-world prospective control of the brain as a target organ in patients with RH during a course of treatment.

Design and method:
We studied 176 patients with RH (124 men and 51 women, aged 55.65 ± 8.99 years). All of them underwent an MRI brain scan before RFA, six months and one year after the procedure. The patients were divided into 2 groups: patients who had the average daytime BP drop by > 10 mmHg (Group 1) and patients whose BP decreased by < 10 mmHg or increased (Group 2). Using brain MRI, the CSF system measurements, including the linear measurements of the cerebral lateral ventricles and the external subarachnoid spaces in 6 regions (in the right and left frontal, parietal, and occipital lobes), sizes of the third and fourth ventricles, dimensions of intracerebral cisterns (quadrigeminal, prepontine, and chiasmatic), the presence of periventricular leukoaraiosis and focal changes in the brain were evaluated.

Results:
The methodology was based on a logistic regression model. fx180 If the p-value is< 0.5, the prognosis for the patient is “no effect’’; if the p-value is > 0.5, the prognosis is “a positive effect’’. The operating characteristics of the test on the training set amounted to 80.6% sensitivity, 85.4% specificity, and 83.3% diagnostic accuracy. The most significant brain MRI measures in hypertensive patients have been identified, which affect the RFA efficacy: the transverse dimensions of the quadrigeminal and prepontine cisterns and the fourth ventricle, the third ventricle width, the presence of lacunar infarcts, the presence of lacunae in II region—the area of the basal ganglia (thalamus, internal capsule), as well as age, DBP, and SBP.

Conclusions:
Quantitative indices are suitable for dynamic prospective assessment of the RFA efficacy in patients with TRH. Changes in MRI tomographic indices have prognostic significance.
DIFFERING EFFECTS OF RENAL DENERVATION ON BLOOD PRESSURE AND SYMPATHETIC NERVE TRAFFIC: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Seravalle Gino , Biffi Annalisa , Vanoli Jennifer , Quarti-Trevano Fosca , Dell’oro Raffaella , Corrao Giovanni , Mncia Giuseppe , Grassi Guido 
Published: June 2022

Objective:
Whether and to what extent the reported BP lowering effects of renal denervation (RD) are mediated by a sympathetic deactivation induced by the procedure is still largely undefined. We examined this issue by performing a meta-analysis of the microneurographic studies published so far based on the evaluation of the blood pressure (BP) and muscle sympathetic nerve traffic (MSNA) responses to RD.

Design and method:
The meta-analysis was based on 12 studies including a total of 394 patients with resistant hypertension underwent RD and followed up to 12 months. Evaluation was extended to the relationships of MSNA with heart rate (HR) and clinic or ambulatory blood pressure (BP) values (expressed such as mean and 95% confidence interval).

Results:
Baseline MSNA values amounted to 48.25 (43.86–52.64) bursts/minute, clinic HR to 66.35 (65.02–67.67) beats/minute and systo/diastolic clinic BP to 167.3 (157.6–177.01) and 90.54 (84.81–96.27) mmHg. RD caused a significant BP reduction at 3/6/12 months following the procedure amounting to 12.6 mmHg for systolic (range 20.9 to 4.39 mmhg, p = 0.003) and to 6.4 mmHg for diastolic BP (range -11.9 t0 0.9 mmHg, p = 0.02) respectively. No significant change in MSNA (-2.65, range -6.7 to 1.4 bursts/minute, P = NS) and HR (-0.58, range -3.98 to 2.81 b/min, P = NS) were concomitantly observed. No relationship was found between the number of renal ablations and the magnitude of the blood pressure or MSNA changes, this being the case also for HR.

Conclusions:
This meta-analysis, the first ever done on the MSNA responses to RD, shows that in a consistent number of patients underwent RD, the BP lowering effects of the procedure are not accompanied by any significant change in 2 adrenergic markers, i.e. MSNA and HR, and thus appear not to be mediated by any sympathetic deactivation.
PROGNOSTIC OF PATIENTS WITH REFRACTORY HYPERTENSION IN A COHORT OF RESISTANT HYPERTENSIVES
Authors: Chedier Bernardo , Souza Fabio de , Viegas Bianca , Carlos Fernanda Oliveira C. , Santos Taissa Lorena dos , Alves Hugo Farah Affonso , de Sá Kimura Lucca Hiroshi , de Carvalho Fortes Carolina , da Silva Marcus Vinicius Serejo Borges V. , Nemer Camila Bello , Lobo Sofia Luz Botelho , de Mello Barreto Bianca Zattar , de Melo Nolasco Vitor , da Silva João Gabriell Bezerra , Vallaperde João Gabriel Rega do N. , Muxfeldt Elizabeth Silaid 
Published: June 2022

Objective:
To determine prognostic value of true refractory hypertension diagnosis in a large cohort of resistant hypertensives

Design and method:
Prospective cohort study enrolled 835 patients of a large historical cohort of RHTN. After at least 6 months of follow-up, 147 (17.6%) patients remained refractory to treatment in ABPM despite the use of 5 or more drugs, including a thiazide-like diuretic and spironolactone. All of them were submitted to a standard protocol including laboratory tests, ABPM, echocardiography, and pulse wave velocity (PWV). Primary outcomes were total mortality, cardiovascular mortality, and fatal and non-fatal cardiovascular events. Secondary outcomes were major cardiovascular events separately (coronary artery disease, cerebrovascular disease, chronic kidney disease with substitutive therapy, peripheral arterial disease). Person-time rates for interest outcomes were calculated to find correlations of Kaplan-Meier survival curves using Cox regression multivariate models, after adjustments for several risk factors. Follow-up remained until December 2021

Results:
The median follow-up was 162 months [IQR 115–196]. When compared to resistant hypertensives, patients with RfHTN were younger and more obese. Regarding subclinical lesions, refractories presented less aortic stiffness (13 vs 21%, p = 0.02) and stage 3 chronic kidney diseases (26 vs 34%, p = 0.03) with albuminuria and LVMI similar to those of resistant hypertension despite uncontrolled ambulatory blood pressure. There were 232 all causes deaths (21.1 vs 29.2%), of which 122 from CV causes (12.9% vs 15%), and 253 total CV events (44.1% vs 49%). The diagnosis of RfHTN was associated with a significantly lower risk of all-cause mortality when adjusted by sex and age. It also presented a tendency to be a protective factor of cardiovascular death, chronic kidney disease with substitutive therapy and peripheral arterial disease, although without statistical significance. Risk ratio ranged from 0.62 to 0,94 for every analysis/adjustment, except incidence of stroke (IC95%:1.22(0.70–2.17) after every adjustment in RfHTN.

Conclusions:
Despite uncontrolled ABPM, refractory hypertensive patients presented lower overall and cardiovascular morbimortality at long-term when compared to non-refractory ones, except stroke, which seems to be at least partially influenced by spironolactone use.
A CLINICAL CASE OF SECONDARY HYPERTENSION IN A 20-YEAR-OLD FEMALE WITH COARCTATION OF THE AORTA
Authors: Manukyan Musheg , Falkovskaya Alla , Mordovin Victor , Zyubanova Irina , Tsoy Ekaterina , Saushkin Victor , Ryabova Tamara 
Published: June 2022

Objective:
Coarctation of the aorta (CoA) is a curable cause of secondary hypertension. Patients with CoA and associated heart disease typically are diagnosed in childhood, while isolated CoA may not be recognized until adulthood.

Design and method:
We report a case of diagnosis and treatment of CoA in a young female, previously observed with a diagnosis of essential hypertension.

Results:
A 20 years old female, diagnosed with hypertension at the age of 18, with difficult control of blood pressure (BP) values under treatment with angiotensin-converting enzyme inhibitors, beta-blockers and diuretics. The patient was referred to our clinic for evaluation. The clinical examination showed normal body development. BP on the left arm was 203/115 mm Hg, on the right arm - 206/115 mm Hg, normal heart sounds, 76 bpm. A systolic murmur was audible at the parasternal left area. BP on both legs was 140/90 mm Hg. There were no clinically significant abnormalities in other organs and systems. At transthoracic echocardiography we found the signs of a CoA, with a gradient of 80/32 mm Hg, and post-stenotic blood flow in the abdominal aorta. According to the computed tomography angiography signs of CoA in a typical place were confirmed as well as collateral blood flow through the dilated intercostal and mammary arteries. A week after admission to the hospital an operation of resecting the CoA, prosthetics of the arch and descending aorta, and transection of the aortopulmonary ligament was performed. The postoperative period was uneventful, the patient was discharged 10 days after the intervention with the recommendations of continuous administration of metoprolol 100 mg, torasemide 5 mg. At the 3–month follow–up visit the BP was stabilized at 130/80 mm Hg.

Conclusions:
This clinical case presented a rare isolated type of CoA and demonstrates the importance of qualitative examination of young patients with hypertension, including BP measurement on the lower extremities and transthoracic echocardiography with a compulsory examination of the aorta.