bluuebunny/crossref_metadata_2025_split huggingface dataset:
EFFECTS OF LEFT VENTRICULAR MASS INDEX AND LEFT VENTRICULAR GEOMETRY ON 6 MINUTE STEPPER TEST RESULTS IN PATIENTS WITH HYPERTENSION
Authors: Sener Yusuf Ziya , Durukan Beyza Nur , Ozcan Emine Burcu , Kutukcu Ebru Calik , Saglam Melda , Yagli Naciye Vardar , Ince Deniz Inal , Tokgozoglu Lale 
Published: June 2022

Objective:
Exercise has effects on blood pressure (BP) and while systolic blood pressure increases with exercise, diastolic blood pressure is expected to remain in same values or decrease due to vasodilatation. Left ventricular concentric remodelling develop in patients with uncontrolled or undertreated hypertension and it results in deterioration in diastolic functions. Six-minute stepper test (6MST) is a simple test for evaluating performance status of patients. We aimed to evaulate effects of ventricular remodelling and left ventricular mass index (LVMI) on results of 6MST in patients with hypertension.

Design and method:
Adult patients with hypertension were enrolled after taking informed consent. Patients with significant valvular disease, coronary artery disease, malignancy, lung diseases and disabling orthopedic disorders that makes performing 6 MST difficult were excluded. Beta blockers were stopped 48 hours before the test. All patients underwent transthoracic echocardiography just before 6MST in order to assess LVMI and left ventricular geometry.

Results:
A total of 40 patients were included. Mean age of the population was 47.5 ± 6.5 years and 24 (60%) of them were female. Baselince characteristics were presented in Table-1. Left ventricular geometry was normal in 13 patients and left ventricular concentric remodelling was present in remaining cases. Number of steps during 6MST were similar between patients wih concentric remodelling and normal geometry. Difference between both systolic and diastolic BP values of at the end of test and beginning were recorded. Both systolic and diastolic BP differences were similar between patients with concentric remodelling and normal geometry. However, LVMI was significantly positively correlated with diastolic BP difference (r = 0.389,p = 0.03) while there was not any correlation with systolic BP difference.

Conclusions:
Left ventricular geometry has no relationship between change of blood pressure during exercise however, LVMI is correlated with change in diastolic BP. Large scale studies are required for evaluating effects of left ventricular geometry on changes of blood pressure during exercise.
STATINS, BUT NOT PCSK9 INHIBITORS, REDUCE THE ADIPOKINE CHEMERIN IN FAMILIAL HYPERCHOLESTEROLEMIA: FOCUS ON LIPOPROTEIN SUBFRACTIONS
Authors: Tan Lunbo , Wang Na , Van Vark Van Der Zee Leonie , Van Lennep Jeanine Roeters , Mulder Monique T. , Lu Xifeng , Jan Danser A.H. , Verdonk Koen 
Published: June 2022

Objective:
Familial hypercholesterolemia (FH) is characterized by severe elevations in circulating LDL-cholesterol, and an increase in the risk of dyslipidemia-related cardiovascular disease (CVD). Chemerin, as a newly identified adipokine, is considered as an additional risk factor for CVD. Here we investigated whether it can be modified by cholesterol-lowering therapy.

Design and method:
Lipoprotein subfractions were isolated by density gradient ultracentrifugation. Lipids and chemerin concentrations were determined both before and after cholesterol lowering with either a statin (atorvastatin, simvastatin, rosuvastatin, or fluvastatin) or a PCSK9 inhibitor (PCSK9i; alirocumab or evolocumab).

Results:
At baseline chemerin levels were 113 ± 46 (statin group) and 95 ± 44 (PCSK9i group) ng/ml, while triglyceride (TG) levels were 1.9 ± 1.6 and 2.6 ± 1.7 mmol/ml, high-density lipoprotein cholesterol (HDL-c) levels were 1.3 ± 0.4 and 1.2 ± 0.4 mmol/ml, and low-density lipoprotein cholesterol (LDL-c) levels were 5.7 ± 1.5 and 4.9 ± 1.4 mmol/ml (P = ns for difference between 2 groups). Chemerin correlated positively with triglycerides (r = 0.45, P < 0.005) and negatively with HDL-c (r = -0.33, P < 0.01). Both statins and PCSK9i reduced LDL-c (by 41 and 62%, P < 0.0001), triglycerides (by 13 and 19%, P < 0.01), and increased HDL-c (by 8 and 23%, P < 0.01), but only statins additionally reduced chemerin (by 35%, P < 0.005). The lipoprotein subfraction profile revealed that chemerin accumulated particularly in the HDL3 fraction (containing > 60% of all chemerin in lipoprotein subfractions), with approximately 30% being present in the HDL2 fraction, and approximately 3% in the LDL fraction. Statins reduced HDL3-c and HDL3-TG, and the level of chemerin bound to all subfractions. PCSK9i reduced HDL3-c but did not affect HDL3-TG or the level of chemerin bound to HDL3 and HDL2.

Conclusions:
Circulating chemerin occurs in different lipoprotein subfractions, accumulating particularly in the HDL3 fraction. Statins, but not PCSK9i, lowers chemerin, possibly by interfering with its levels across lipoprotein subfractions. This may represent a novel cardiovascular protective function of statins.
THE ASSOCIATION BETWEEN ANTIHYPERTENSIVE TREATMENT AND SERIOUS ADVERSE EVENTS BY AGE AND FRAILTY: AN OBSERVATIONAL COHORT STUDY OF 3.8 MILLION PATIENTS FOLLOWED UP FOR 10 YEARS
Authors: Sheppard James , Koshiaris Constantinos , Stevens Richard , McManus Richard 
Published: June 2022

Objective:
Antihypertensives are effective at reducing the risk of cardiovascular disease, but limited data exist quantifying their association with serious adverse events (SAEs), particularly in older people with frailty. This study examined this association using data from a large database of electronic health records.

Design and method:
This was a retrospective observational cohort study, utilising data from the Clinical Practice Research Datalink in England. Patients were eligible if they were aged 40 years or older, with a systolic blood pressure reading between 130–179 mmHg and not previously prescribed antihypertensive treatment. Outcomes were defined as hospitalisation or death within 10 years due to hypotension, syncope, falls, fractures, acute kidney injury (AKI), electrolyte abnormalities and gout. The association between antihypertensive treatment and SAEs was examined by cox regression, using propensity score adjustment to adjust for confounding. Subgroup analyses were undertaken by age and frailty.

Results:
A total of 3,834,056 patients, aged 57 ± 12 years, were eligible for the study. Of these, 484,187 (12.6%) were prescribed antihypertensive medication in the 12 months prior to the index date. Over a median follow-up of 7.1 years, antihypertensives were associated with an increased risk of hypotension (HR 1.32, 95%CI 1.29–1.35), syncope (HR 1.20, 95%CI 1.17–1.22), falls (HR 1.23, 95%CI 1.21–1.26), AKI (HR 1.44, 95%CI 1.41–1.47), electrolyte abnormalities (HR 1.42, 95%CI 1.43–1.48) and gout (HR 1.32, 95%CI 1.46–1.52). The absolute risk of SAEs with treatment was very low, ranging from four syncope events to twelve AKI events per 10,000 patients treated per year. In older patients and those with severe frailty, this risk was increased up to 116–120 events per 10,000 patients treated per year.

Conclusions:
Antihypertensive treatment is associated with an increased risk of SAEs, but the absolute risk of harm is very low. However, in older patients and those with severe frailty, this absolute risk is increased and physicians should take this risk into consideration when making prescribing decisions.
META-ANALYSIS OF THE EFFECT OF DUAL GIP AND GLP-1 RECEPTOR AGONISTS ON BLOOD PRESSURE LEVELS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
Authors: Patoulias Dimitrios , Katsimardou Alexandra , Boulmpou Aristi , Imprialos Konstantinos , Stavropoulos Konstantinos , Toumpourleka Maria , Papadopoulos Christodoulos , Karagiannis Asterios , Doumas Michael 
Published: June 2022

Objective:
Hypertension and type 2 diabetes mellitus (T2DM) are common co-morbidities, with hypertension being twice as frequent in patients with T2DM compared to those without. Blood pressure (BP) control is of utmost importance for subjects with T2DM, in order to minimize the risk for development of cardiovascular and chronic kidney disease. High on treatment BP levels also correlate with the incidence of major adverse cardiovascular outcomes and all-cause death. Recently, novel dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonists have been developed for patients with T2DM. Therefore, we sought to determine whether dual GIP and GLP-1 receptor agonists have a significant effect on BP in subjects with T2DM.

Design and method:
We searched PubMed and Cochrane Library databases for relevant published randomized controlled trials up to 13th November 2021. We assessed the change in office systolic BP (SBP) and diastolic BP (DBP) with dual GIP and GLP-1 receptor agonists compared to placebo or active comparator in subjects with T2DM.

Results:
We finally pooled data from 5 trials for a total of 5,060 patients with T2DM. We demonstrated that dual GIP/GLP-1 receptor agonists compared to control induced a significant decrease in SBP by 3.6 mm Hg (MD = -3.6, 95% CI; -5.54 to -1.65, I2 = 83%, p = 0.0003), along with a significant decrease in DBP by 1.29 mm Hg (MD = -1.29, 95% CI; -2.30 to -0.28, I2 = 74%, p = 0.01).

Conclusions:
Dual GIP/GLP-1 receptor agonists might provide a significant decrease, and thus a better control of BP in patients with T2DM. Whether this preliminary observation is translated into a significant cardiovascular benefit has to be further confirmed in well-designed trials, such as the forthcoming SURPASS-CVOT (NCT04255433). Moreover, the effects of dual agonists on out-of-office BP values need to be evaluated.
REASONS OF NON-COMPLIANCE TO OFFICE VISITS IN HYPERTENSIVE PATIENTS: RESULTS FROM THE REGISTRY OF SPECIALIZED HYPERTENSION CLINICS
Authors: Youssef Ghada , Mohamed Marwa , Remisy Dalia El , Hamid Magdy Abdel 
Published: June 2022

Objective:
Hypertensive patients’ compliance to the clinic’s follow up visits was found to be associated with a better blood pressure control and a better compliance to antihypertensive medications. The aim was to detect reasons of non-compliance to office visits in hypertensive patients included in the registry of the specialized hypertension clinics

Design and method:
Patients were enrolled from the registry of the specialized hypertension clinics of 9 university hospitals. Those who attended less than 3 office visits were considered non-compliant and were contacted through the phone. A simple questionnaire was prepared, and it included pre-specified questions about the reasons of dropping out the office visits. They were also asked about compliance to their antihypertensive medications and salt restriction, and whether they experienced any drug side effects.

Results:
There were 3014 patients eligible for inclusion in this study but only 689 patients (34.6%) completed the questionnaire. The reasons of non-compliance to the follow up visits in the specialized hypertension clinics were either that patients preferred to follow up elsewhere (n = 546, 79.2%) mostly in pharmacies, 129 patients (18.7%) claimed that the healthcare service was unsatisfactory, 118 patients (17.1%) were asymptomatic and they thought that absence of symptoms meant a well-controlled blood pressure, 136 patients (19.7%) said that the clinic was far from their homes, and 74 patients (10.7%) said that they were referred to the clinic for other comorbidities. Despite non-compliance to office visits, 455 patients (66.0%) were compliant to their antihypertensive medications and 264 (38.3%) patients were compliant to salt restriction. Patients’ reasons for non-compliance to medications were because of side effects (n = 14, 6.9%), financial restrains (n = 13, 6.4%), or because their BP was controlled (n = 20, 9.9%). About 42% of patients used herbs, mainly hibiscus, as adjuvant to their antihypertensive medications.

Conclusions:
Reasons for non-compliance to office visits were either patient-related or healthcare-related. To improve patients’ compliance, physicians need to allocate more time to educate their patients about hypertension, patients need to follow their doctors’ instructions as regard medications, salt restriction and scheduled office visits, and governments need to provide better and cheaper healthcare services.
ASSESSMENT OF ADHERENCE TO ANTIHYPERTENSIVE MEDICATION IN A POPULATION OF ARGENTINA DURING THE COVID-19 PANDEMIC
Authors: Renna Nicolas , Diez Emiliano , Vissani Sergio , Farez Beder , Sorasio Viviana , Camaño Belen , Alcorta Martha , Miatello Roberto , Ramirez Jesica 
Published: June 2022

Objective:
The objective was to assess the adherence to antihypertensive treatment and its determinants in patients during the pandemic by COVID-19

Design and method:
A multicenter, prospective, observational cohort study included outpatients from the Cuyo region of Argentina from March to July 2021 that met the following inclusion criteria: 1- patients over 16 years old under antihypertensive treatment; 2- informed consent signature 3- complete 35-dimensional questionnaire.

Results:
From 512 enrolled patients, 468 met the inclusion criteria. The average age was 50.1 ± 0.1 years, 56.8% were women. At least 39% had 1 CV risk factor. COVID-19 was documented in 35% and 3.6% presented a severe form. The most widely used vaccine was Sputnik V and 70% had at least 1 dose of vaccination for COVID-19. Average adherence was 69%. The average of systolic blood pressure was 139.3 ± 1.0 mmHg and diastolic blood pressure was 85.9 ± 0.6 mmHg. The average number of antihypertensive drugs was 1.26. Table 1 shows the results of multivariate analysis.

Conclusions:
In a population with intermediate cardiovascular risk, adherence was low, and blood pressure control was suboptimal. The most important predictive variables of low adherence were age, the number of antihypertensive drug tablets, level of education, and smoking.
MEDICATION NON-ADHERENCE IN UNCONTROLLED HYPERTENSION: SELECTIVE DETECTION AND EFFICIENCY AND EFFECTIVENESS OF A PROGRAM TO IMPROVE COMPLIANCE (ATHAN TRIAL)
Authors: Oliveras Anna , Galceran Isabel , Camps Carme , Faura Anna , Pascual Sergi , Fontdevila Laia , Vazquez Susana 
Published: June 2022

Objective:
To assess whether the implementation of a specific action plan to improve adherence for 3 months results in reduced peripheral 24h-systolic blood pressure (SBP) in patients with resistant hypertension (RH) or uncontrolled hypertension with at least 2 drugs.

Design and method:
Interventional, prospective, randomized, controlled, parallel groups, open study of patients consecutively attended in a specialized Hypertension Unit with ambulatory 24h-BP equal or more than 130 and/or 80mmHg although receiving at least 2 antihypertensive drugs. The partially or completely non-adherent patients (confirmed by determination of antihypertensive drugs in urine) were randomized (1: 1) to receive a specific program to improve adherence (intervention group) or routine follow-up (control group), with determination of antihypertensive drugs in urine, office-BP measurement and 24h-ambulatory BP monitoring at pre-randomization and 3 months.

Results:
Forty-three patients were randomized (mean age 59+/-14yr, 70% male). Mean+/-S.D. baseline SBP/DBP(mmHg) were 150.4+/-17.1 and 90.7+/-15.5, and the number of prescribed non-detected drugs in urine was 2+/-1.4. At 3 months, the variation of SBP-24 h for the intervention group and the control group was (mean[95%CI]) = -14.3 mmHg (-20.5 to -8.1), p < 0.001 and -3.3 mmHg (-10.2 to 3.7), p = 0.339, respectively. See table. At 3 months, the variation of the number of non-detected antihypertensive drugs in urine was (mean[95%CI]) = -1.29 mmHg (-2.06 to -0.53), p = 0.002 and -0.53 mmHg (-1.26 to 0.2), p = 0.144, respectively.

Conclusions:
A specific nursing intervention to improve therapeutic adherence results in an improvement of BP control in patients with difficult-to-control hypertension and inadequate therapeutic compliance.
HYPERTENSIVE CRISIS AT THE EMERGENCY DEPARTMENT OF A CENTRAL HOSPITAL
Authors: Leite Vanessa , Coelho Rita Passos , Abecasis Francisca , Beirão Pedro , Cunha Vitória 
Published: June 2022

Objective:
Hypertension is a well-established cardiovascular risk factor. Its low control can progress to a hypertensive crisis (HC) and the emergency department (ED) is the first point of contact of these patients. This study’s aim was analyzing the profile and management of the patients presenting with HC at the ED of a central hospital in Portugal.

Design and method:
This study is descriptive and retrospective in nature, encompassing three months of adult patients admittances to the ED with symptomatic or asymptomatic hypertension (337 in total). We defined hypertension as blood pressure (BP) greater than or equal to 140/90mmHg and HC as BP greater than or equal to 180/110mmHg.

Results:
Patients presenting to the ED with elevated blood pressure were predominantly women (65%) aged over 60 years. BP values compatible with HC were found in 40,4% of cases. Hypertension was unknown to 13,3% of patients. Despite having previously diagnosed hypertension, 8,5% were not receiving any medication. At admission, headache (45,1%), nausea and dizziness (19,3%), and chest pain (17,2%) were the most frequent symptoms. About 18% were asymptomatic. 71% of patients with elevated BP were receiving treatment with antihypertensive drugs. All off those presenting with HC received pharmacological treatment. Angiotensin-converting enzyme inhibitor was the most used class (75%), followed by benzodiazepines (~52%). Regarding the evolution of the blood pressure in the ED, the majority of patients had controlled or lower blood pressure at the time of discharge. The outpatient antihypertensive medication was adjusted in 25,8% of cases. Adding another drug was the most common strategy (23%), followed by initiating a fixed drug combination (18,4%) or starting therapy with a single drug (15%). At a one-year follow-up, most of patients (90,5%) were not readmitted to the ED due to hypertension.

Conclusions:
Hypertension is still a common cause of admission to the ED, despite only 40% of cases representing real HC. The lack of uniform management at the ED, or after discharge, further demonstrates a missed opportunity to prevent future cardiovascular morbidity/mortality.
ADHERENCE TO ANTIHYPERTENSIVE DRUG TREATMENT IN BRAZIL: SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Coelho Juliana , Guimaraes Mayra , Dos Santos Juliano , Vaz Ana , Higa Camila , Alvisi Joyce , Lee Renata , Drager Luciano , Pierin Angela 
Published: June 2022

Objective:
To assess the prevalence of adherence to antihypertensive drug treatment in Brazilian studies.

Design and method:
Systematic review and meta-analysis based on the recommendations of the PRISMA. The search period was from November 2020 to November 2021, in BDENF, SciELO, Cuiden, PsycINFO, CINAHL, Embase, LILACS, MEDLINE, AgeLine, Google Scholar and ScienceDirect academic search engines. Inclusion criteria were: studies carried out in Brazil, with adults, in Portuguese, English and Spanish, with no restriction on the year of publication and which indirectly assessed adherence to antihypertensive drug treatment with specific instruments. Exclusion criteria: studies with pregnant women that did not assess pharmacological adherence or did not consider the prevalence of pharmacological adherence exclusively for hypertension, studies that used the same database, review studies, theoretical and methodological articles, and gray literature were excluded. All steps were performed by two independent reviewers and a third reviewer was consulted in case of disagreement. The quality of the studies was assessed using an instrument adapted for cross-sectional studies and those with a high risk of bias were excluded from the meta-analysis. Descriptive analysis and meta-analysis were performed.

Results:
100 studies were included in the descriptive analysis and 98 in the meta-analysis of the prevalence. It was found that 89.00% were published in the last decade, in Nursing (37.00%) and Public Health (18.00%) journals. The most used instruments to assess adherence were the Morisky-Green Scale-4 item (59.00%) and the 8-item Morisky Medication Adherence Scale (15.00%). The adherence prevalence estimated according to the instruments were: Morisky-Green Scale-4 item 36.98% (95%CI: 32.11–42.13%); 8-item Morisky Medication Adherence Scale 38.88% (95%CI: 27.43–51.70%); Treatment Adherence Measure 74.11% (95%CI: 59.94–84.56%); Brief Medication Questionnaire 41.65% (95%CI: 29.33–55.11%); Drug Adherence Questionnaire-Qualiaids 49.43% (95%CI: 43.18–55.69%); Hypertension Treatment Adherence Questionnaire 88.38% (95%CI: 78.30–94.13%); Martín-Bayarre-Grade 30.55% (95%CI: 22.80–38.58%); and Primary Care Assessment Tool 89.12% (95%CI: 85.34–92.01%). The overall prevalence estimated by the meta-analysis was 43.47%, (95%CI: 38.47%-48.61%). There was great heterogeneity between studies, with prevalence values ranging from 5.7% to 94.7%.

Conclusions:
The prevalence of adherence found in Brazilian studies was low, demonstrating that this issue remains a global challenge.
ADHERENCE TO THE ANTIHYPERTENSIVE THERAPY – A VIEW FROM THE FAMILY MEDICINE PERSPECTIVE
Authors: Jug Juraj , Prkacin Ingrid 
Published: June 2022

Objective:
To check adherence to the antihypertensive medication in patients with arterial hypertension and a possible impact of fixed-dose drug combinations, cardiovascular event in history, and diabetes on it.

Design and method:
In this cross-sectional study, every fifth patient with arterial hypertension in two family medicine practices in Zagreb, Croatia (found by Medicus search engine) was analyzed during February 2022. We included medical records of 210 patients (116 males, 94 females) from which we checked the number and type of used antihypertensive medication (single pill or fixed-dose drug combinations), statin use, diabetes type 2 or cardiovascular event in history, and the date of the last lab test results. The patient was considered adherent if she/he regularly ordered hers/his prescribed medication from January to December 2021. Chi-square and Student t-test were used for statistical analysis in Statistica 12.

Results:
There were no differences between genders. Women were slightly more adherent to the prescribed therapy than men (72.34 vs. 68.11%, P = 0.5076). Statins were prescribed in 65 (30.95%), fixed-dose combination in 139 (66.19%), 39 had diabetes (18.57%), and 28 patients had cardiovascular events in their medical history (13.33%). The adherence was not dependent on the patient’s age (66.75 vs. 66.64 years in adherent patients, P = 0.9509), the existence of diabetes (Chi2 = 1.093, 2, P = 0.2958) or previous cardiovascular event in medical history (Chi2 = 0.384, 2, P = 0.5351). Adherence correlated with the number of prescribed antihypertensive medications (r = 0.263; P < 0.05; and average 2.56 in adherent vs. 1.97 medication per day in non-adherent group, P < 0.001), especially if the therapy was in fixed-dose combination (Chi2 = 11.60, 2, P < 0.001). The age of the lab test results was less in adherent patients (1.25 vs. 1.86 years, P = 0.108). 116 patients (55.24%) had them in 2021, while 16 did not have any result in five and more years (7.14%).

Conclusions:
The adherence to antihypertensive therapy was similar between genders and correlated with the number of prescribed medications with significantly better results in patients with fixed-dose combinations. The existence of the previous cardiovascular event and type 2 diabetes did not show any benefit on this type of adherence.