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[Machine Learning Methods in Assessing the Risks of Target Organ Damage in Masked Hypertension].

[评估隐匿性高血压靶器官损害风险的机器学习方法]。

  • 影响因子:0
  • DOI:10.18087/cardio.2020.5.n883
  • 作者列表:"Geltser BI","Shakhgeldyan KI","Nazarov DA","Vetrova OО","Kotelnikov VN","Karpov RS
  • 发表时间:2020-06-03
Abstract

:Aim To develop models for predicting the risk of target organs damage (TOD) in different phenotypes of "masked" arterial hypertension (MAH) based on methods of machine learning (ML).Material and methods A retrospective cohort analysis was performed for 284 clinical records of patients (261 males, 23 females; median age, 38 years). Group 1 included 125 patients with grade 1-2 arterial hypertension (AH) and low or moderate risk; group 2 included 159 subjects with normal "office" blood pressure (BP) exposed to chronic professional stress. The 24-h BP monitoring (24-h BPM) and ultrasound examination of the heart and carotid arteries were performed; glomerular filtration rate (GFR) was estimated using the СКD-EPI formula. MAH was phenotyped by clustering 24-h BPM data, and the risk of TOD was predicted by analysis of odd ratios (OR) and with the ML methods, random forest (RF) and artificial neural networks (ANN). Data were analyzed using the R language in the RStudio environment.Results According to results of the 24-h BPM and cluster analysis, 121 (76.1 %) subjects of group 2 had MAH. The MAH phenotypes were identified as follows: systolic-diastolic (SDMAH) (43.8 %); isolated systolic (ISMAH) (35.5 %), and isolated diastolic (IDMAH) (20.7%). As compared to stable AH, subjects with different MAH phenotypes showed both increases and decreases in individual 24-h BPM indexes. Thus, in subjects with IDMAH, mean 24-h values of systolic and diastolic BP were significantly lower than with AH while in SDMAH, they were considerably higher. The OR analysis demonstrated that odds of differently located TOD were associated with definite MAH phenotypes. With that, ISMAH was associated with the highest risk of glomerular hyperfiltration; IDMAH was associated with reduced GFR and vascular remodeling; and SDMAH was associated with left ventricular myocardial hypertrophy. The developed models for predicting the risk of TOD based on the RF and ANN methods showed a high accuracy, which was provided by multistep procedures of selecting the predictors and cross-validation.Conclusion Modern ML technologies enhance the risk stratification of patients with different clinical variants of AH.

摘要

: 目的开发基于机器学习 (ML) 方法的 “掩蔽” 动脉高血压 (MAH) 不同表型的靶器官损伤 (TOD) 风险预测模型。材料和方法对284例患者的临床记录进行回顾性队列分析 (男性261例,女性23例; 中位年龄,38年)。组1包括125名1-2级动脉高血压 (AH) 和低或中度风险的患者; 组2包括159名暴露于慢性职业压力的 “办公室” 血压 (BP) 正常的受试者。对心脏和颈动脉进行24 h血压监测 (24 h BPM) 和超声检查; 使用 с к d-epi公式估计肾小球滤过率 (GFR)。MAH通过聚类24小时BPM数据进行表型分析,TOD的风险通过奇数比 (OR) 分析和ML方法,随机森林 (RF) 和人工神经网络 (ANN) 进行预测。在RStudio环境中使用R语言分析数据。结果根据24小时BPM和聚类分析的结果,组2的121 (76.1%) 受试者患有MAH。MAH表型鉴定如下: 收缩-舒张 (SDMAH) (43.8   %); 分离收缩 (ISMAH) (35.5   %) 和分离舒张 (IDMAH) (20.7%)。与稳定的AH相比,具有不同MAH表型的受试者显示个体的24小时BPM指数增加和减少。因此,在具有IDMAH的受试者中,收缩压和舒张压的平均24h值显著低于AH,而在SDMAH中,它们显著更高。OR分析表明,不同位置TOD的几率与明确的MAH表型相关。因此,ISMAH与肾小球高滤过的最高风险相关; IDMAH与GFR降低和血管重构相关; SDMAH与左室心肌肥厚相关。基于RF和ANN方法开发的预测TOD风险的模型显示出很高的准确性,这是由选择预测因子的多步骤程序提供的,并且cross-validation.Conclusion现代ML技术增强了具有不同临床变体AH的患者的风险分层。

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相关文献
影响因子:1.44
发表时间:2020-01-01
DOI:10.1080/10641963.2019.1601205
作者列表:["Meng L","Bai X","Zheng Y","Chen D","Zheng Y"]

METHODS::Aim: We explored the role of histone modification in the association of depression-hypertension by comparing norepinephrine transporter (NET) gene levels in different depression-hypertensive patients. Then, we analyzed the expression of NET correlation with inflammatory cytokines to provide a new direction for detecting the association mechanism between depression and hypertension.Methods: NE expression levels in serum of diverse groups were detected by enzyme-linked immunosorbent assay. Then histone acetyltransferase (HAT), histone deacetylase (HDAC), H3K27ac, NET, TNF-α, and interleukin-6 (IL-6) were detected by western blot in nine female subjects in different depression and hypertension groups, and Chromatin immunoprecipitation-polymerase chain reaction (Chip-PCR) were used to confirm the degree of acetylation affecting on the transcription level of NET gene. Meanwhile, correlation between NET with TNF/IL-6 was analyzed by SPSS19.0 software program. Finally, Quantitative real-time polymerase chain reaction (qPCR) and western blot were used to detect TNF-α and IL-6 expression levels after NET overexpression or interference treatment in human umbilical vein endothelial cells and Neuro-2a cells.Results: The expression of HAT and H3K27ac had lower levels in D-H and nonD-H group than nonD-nonH group. The results showed that higher acetylation could promote expression of NET genes. Meanwhile, the expression of NET had a significant negative correlation with IL-6 (R = -0.933, p < 0.01) and tumor necrosis factor (TNF) (R = -0.817, p < 0.01) in subjects. In addition, the results confirmed that TNF-α and IL-6 mRNA and protein partial expressions could be inhibited by NET in both HUVECs and Neuronal cells (p < 0.01).Conclusion: In conclusion, differential expression of NET gene might function as an important factor in interaction between depression and hypertension by partially targeting TNF-α and IL-6.

翻译标题与摘要 下载文献
影响因子:1.62
发表时间:2020-01-01
来源期刊:Angiology
DOI:10.1177/0003319719849737
作者列表:["Dugani SB","Murad W","Damilig K","Atos J","Mohamed E","Callachan E","Farukhi Z","Shaikh A","Elfatih A","Yusef S","Hydoub YM","Moorthy MV","Mora B","Alawadhi A","Issac R","Saleh A","Al-Mulla A","Mora S","Alsheikh-Ali AA"]

METHODS::The Middle East and North Africa (MENA) region has a high burden of morbidity and mortality due to premature (≤55 years in men; ≤65 years in women) myocardial infarction (MI) and acute coronary syndrome (ACS). Despite this, the prevalence of risk factors in patients presenting with premature MI or ACS is incompletely described. We compared lifestyle, clinical risk factors, and biomarkers associated with premature MI/ACS in the MENA region with selected non-MENA high-income countries. We identified English-language, peer-reviewed publications through PubMed (up to March 2018). We used the World Bank classification system to categorize countries. Patients with premature MI/ACS in the MENA region had a higher prevalence of smoking than older patients with MI/ACS but a lower prevalence of diabetes, hypertension, and dyslipidemia. Men with premature MI/ACS had a higher prevalence of smoking than women but a lower prevalence of diabetes and hypertension. The MENA region had sparse data on lifestyle, diet, psychological stress, and physical activity. To address these knowledge gaps, we initiated the ongoing Gulf Population Risks and Epidemiology of Vascular Events and Treatment (Gulf PREVENT) case-control study to improve primary and secondary prevention of premature MI in the United Arab Emirates, a high-income country in the MENA region.

影响因子:2.49
发表时间:2020-03-01
DOI:10.1136/archdischild-2019-317131
作者列表:["Göpel W","Müller M","Rabe H","Borgmann J","Rausch TK","Faust K","Kribs A","Dötsch J","Ellinghaus D","Härtel C","Roll C","Szabo M","Nürnberg P","Franke A","König IR","Turner MA","Herting E"]

METHODS:OBJECTIVE:The aim of our study was to determine if a genetic background of high blood pressure is a survival factor in preterm infants. DESIGN:Prospective cohort study. SETTING:Patients were enrolled in 53 neonatal intensive care units. PATIENTS:Preterm infants with a birth weight below 1500 g. EXPOSURES:Genetic score blood pressure estimates were calculated based on adult data. We compared infants with high genetic blood pressure estimates (>75th percentile of the genetic score) to infants with low genetic blood pressure estimates (<25th percentile of the genetic score). MAIN OUTCOME MEASURES:Lowest blood pressure on the first day of life and mortality. RESULTS:5580 preterm infants with a mean gestational age of 28.1±2.2 weeks and a mean birth weight of 1022±299 g were genotyped and analysed. Infants with low genetic blood pressure estimates had significantly lower blood pressure if compared with infants with high genetic blood pressure estimates (27.3±6.2vs 27.9±6.4, p=0.009, t-test). Other risk factors for low blood pressure included low gestational age (-1.26 mm Hg/week) and mechanical ventilation (-2.24 mm Hg, p<0.001 for both variables, linear regression analysis). Mortality was significantly reduced in infants with high genetic blood pressure estimates (28-day mortality: 21/1395, 1.5% vs 44/1395, 3.2%, p=0.005, Fisher's exact test). This survival advantage was independent of treatment with catecholamines. CONCLUSIONS:Our study provides first evidence that a genetic background of high blood pressure may be beneficial with regard to survival of preterm infants.

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高血压方向

高血压(hypertension)是指以体循环动脉血压(收缩压和/或舒张压)增高为主要特征(收缩压≥140毫米汞柱,舒张压≥90毫米汞柱),可伴有心、脑、肾等器官的功能或器质性损害的临床综合征。高血压是最常见的慢性病,也是心脑血管病最主要的危险因素。临床上高血压可分为两类:原发性高血压和继发性高血压。

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