{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T19:49:08Z","timestamp":1788896948032,"version":"build-2803163510"},"reference-count":60,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2024,11,13]],"date-time":"2024-11-13T00:00:00Z","timestamp":1731456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Thrombotic adverse events and disease progression are crucial in Polycythemia Vera (PV), as it stands as the leading cause of mortality. The pulse wave velocity (PWV) is a valuable indicator of arterial aging and often plays a significant independent role in contributing to cardiovascular adverse events (CV-AEs). The aim of this study was to examine the relationship between PWV and critical vascular function parameters, with the goal of identifying new predictive factors of vascular damage and exploring a potential connection with disease progression. Methods: Non-invasive aortic stiffness was assessed through carotid\u2013femoral PWV measurement. PWV was measured using the SphygmoCor device. History of arterial or venous thrombosis (TAEs) or other CV-AEs was collected at baseline. PWV measurements were repeated at baseline, at 6 and at 12 months. Results: The study involved 28 PV patients aged 27 to 77 years, with 57.1% being male. Fourteen patients (50%) reported a high-risk thrombotic score at diagnosis, and 60.7% had at least one comorbidity. Multivariable regression models showed that hemoglobin levels were independently associated with PWV (\u03b2: 0.68, SE 0.24, p &lt; 0.01). During the follow-up period (median duration 21.3 months, range 6\u201333), a total of 13 events were documented. Specifically, two patients exhibited a loss of response to treatment, four patients presented an increase in spleen diameters, three patients displayed an escalation of systemic symptoms, and three patients had a clear progression to secondary myelofibrosis. PWV (per 1 m\/s: OR 1.70, 95% CI 1.00\u20132.91, p = 0.047) and leukocyte count (per 1 \u00d7 103\/\u03bcL: OR 1.47, 95% CI: 1.04\u20132.09, p = 0.043) were significant predictors of events, independently of waist circumference, blood pressure, treatment, and hematocrit. Conclusions: PWV has demonstrated its potential as an effective tool for monitoring PV patients. It stands as a clinical parameter that can predict the risk of progression in PV patients. Further investigation is essential to fully explore this potential. If successful, it could offer clinicians a valuable resource for effectively managing PV patients.<\/jats:p>","DOI":"10.3390\/jcm13226811","type":"journal-article","created":{"date-parts":[[2024,11,13]],"date-time":"2024-11-13T06:10:48Z","timestamp":1731478248000},"page":"6811","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Arterial Stiffness as a New Predictor of Clinical Outcome in Patients with Polycythemia Vera"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7487-3328","authenticated-orcid":false,"given":"Olga","family":"Mulas","sequence":"first","affiliation":[{"name":"Hematology Unit, Businco Hospital, ARNAS Brotzu, 09134 Cagliari, Italy"},{"name":"Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Sestu","sequence":"additional","affiliation":[{"name":"Post Graduate Medical School of Internal Medicine, University of Cagliari, 09121 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7726-2936","authenticated-orcid":false,"given":"Alessandro","family":"Costa","sequence":"additional","affiliation":[{"name":"Hematology Unit, Businco Hospital, ARNAS Brotzu, 09134 Cagliari, Italy"},{"name":"Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6073-0388","authenticated-orcid":false,"given":"Salvatore","family":"Chessa","sequence":"additional","affiliation":[{"name":"Post Graduate Medical School of Internal Medicine, University of Cagliari, 09121 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Vargiu","sequence":"additional","affiliation":[{"name":"Post Graduate Medical School of Internal Medicine, University of Cagliari, 09121 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludovica","family":"Corda","sequence":"additional","affiliation":[{"name":"Post Graduate Medical School of Internal Medicine, University of Cagliari, 09121 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Pittau","sequence":"additional","affiliation":[{"name":"Hematology Unit, Businco Hospital, ARNAS Brotzu, 09134 Cagliari, Italy"},{"name":"Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"La Nasa","sequence":"additional","affiliation":[{"name":"Hematology Unit, Businco Hospital, ARNAS Brotzu, 09134 Cagliari, Italy"},{"name":"Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6585-5187","authenticated-orcid":false,"given":"Giovanni","family":"Caocci","sequence":"additional","affiliation":[{"name":"Hematology Unit, Businco Hospital, ARNAS Brotzu, 09134 Cagliari, Italy"},{"name":"Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4784-5441","authenticated-orcid":false,"given":"Angelo","family":"Scuteri","sequence":"additional","affiliation":[{"name":"Internal Medicine Unit, University Hospital \u201cDuilio Casula\u201d, AOU Cagliari, 09123 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1038\/s41408-018-0054-y","article-title":"The 2016 WHO classification and diagnostic criteria for myeloproliferative neoplasms: Document summary and in-depth discussion","volume":"8","author":"Barbui","year":"2018","journal-title":"Blood Cancer J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2507","DOI":"10.1182\/blood-2014-05-579136","article-title":"Long-term survival and blast transformation in molecularly annotated essential thrombocythemia, polycythemia vera, and myelofibrosis","volume":"124","author":"Tefferi","year":"2014","journal-title":"Blood"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/S0140-6736(05)71142-9","article-title":"Acquired mutation of the tyrosine kinase JAK2 in human myeloproliferative disorders","volume":"365","author":"Baxter","year":"2005","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1960","DOI":"10.1038\/sj.leu.2404810","article-title":"Prevalence and clinicopathologic correlates of JAK2 exon 12 mutations in JAK2V617F-negative polycythemia vera","volume":"21","author":"Pardanani","year":"2007","journal-title":"Leukemia"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3339","DOI":"10.1038\/s41375-021-01401-3","article-title":"Polycythemia vera: Historical oversights, diagnostic details, and therapeutic views","volume":"35","author":"Tefferi","year":"2021","journal-title":"Leukemia"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/j.leukres.2006.12.002","article-title":"International Working Group for Myelofibrosis Research and Treatment (IWG-MRT). Primary myelofibrosis (PMF), post polycythemia vera myelofibrosis (post-PV MF), post essential thrombocythemia myelofibrosis (post-ET MF), blast phase PMF (PMF-BP): Consensus on terminology by the international working group for myelofibrosis research and treatment (IWG-MRT)","volume":"31","author":"Mesa","year":"2007","journal-title":"Leuk. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2224","DOI":"10.1200\/JCO.2005.07.062","article-title":"Vascular and neoplastic risk in a large cohort of patients with polycythemia vera","volume":"23","author":"Marchioli","year":"2005","journal-title":"J. Clin. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1874","DOI":"10.1038\/leu.2013.163","article-title":"Survival and prognosis among 1545 patients with contemporary polycythemia vera: An international study","volume":"27","author":"Tefferi","year":"2013","journal-title":"Leukemia"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1200\/JCO.1990.8.3.556","article-title":"Incidence and risk factors for thrombotic complications in a historical cohort of 100 patients with essential thrombocythemia","volume":"8","author":"Cortelazzo","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1038\/leu.2008.72","article-title":"Life expectancy and prognostic factors in the classic BCR\/ABL-negative myeloproliferative disorders","volume":"22","author":"Cervantes","year":"2008","journal-title":"Leukemia"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1200\/JCO.2010.31.8436","article-title":"Philadelphia-Negative Classical Myeloproliferative Neoplasms: Critical Concepts and Management Recommendations from European LeukemiaNet","volume":"29","author":"Barbui","year":"2011","journal-title":"J. Clin. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1002\/ajh.27002","article-title":"Polycythemia vera: 2024 update on diagnosis, risk-stratification, and management","volume":"98","author":"Tefferi","year":"2023","journal-title":"Am. J. Hematol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1161\/01.HYP.0000177474.06749.98","article-title":"Arterial aging: Is it an immutable cardiovascular risk factor?","volume":"46","author":"Najjar","year":"2005","journal-title":"Hypertension"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2340","DOI":"10.1097\/HJH.0000000000001824","article-title":"Characteristics of healthy vascular ageing in pooled population-based cohort studies: The global Metabolic syndrome and Artery REsearch Consortium","volume":"36","author":"Nilsson","year":"2018","journal-title":"J. Hypertens."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1093\/eurheartj\/ehp491","article-title":"The central arterial burden of the metabolic syndrome is similar in men and women: The SardiNIA Study","volume":"31","author":"Scuteri","year":"2010","journal-title":"Eur. Heart J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1093\/eurheartj\/ehp133","article-title":"Left ventricular mass increase is associated with cognitive decline and dementia in the elderly independently of blood pressure","volume":"30","author":"Scuteri","year":"2009","journal-title":"Eur. Heart J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.pcad.2019.11.002","article-title":"Systemic hemodynamic atherothrombotic syndrome (SHATS)-Coupling vascular disease and blood pressure variability: Proposed concept from pulse of Asia","volume":"63","author":"Kario","year":"2020","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1016\/j.jacc.2009.10.061","article-title":"Prediction of cardiovascular events and all-cause mortality with arterial stiffness: A systematic review and meta-analysis","volume":"55","author":"Vlachopoulos","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1097\/00004872-200307000-00023","article-title":"Nitric oxide inhibition as a mechanism for blood pressure increase during salt loading in normotensive postmenopausal women","volume":"21","author":"Scuteri","year":"2003","journal-title":"J. Hypertens."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1007\/s11357-022-00699-w","article-title":"Dilated hypertrophic phenotype of the carotid artery is associated with accelerated age-associated central arterial stiffening","volume":"45","author":"AlGhatrif","year":"2023","journal-title":"Geroscience"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1161\/hy1201.099291","article-title":"Functional correlates of central arterial geometric phenotypes","volume":"38","author":"Scuteri","year":"2001","journal-title":"Hypertension"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.1097\/HJH.0b013e328347cc17","article-title":"Microvascular brain damage with aging and hypertension: Pathophysiological consideration and clinical implications","volume":"29","author":"Scuteri","year":"2011","journal-title":"J. Hypertens."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1111\/jgh.12368","article-title":"Increased whole blood viscosity associated with arterial stiffness in patients with non-alcoholic fatty liver disease","volume":"29","author":"Yu","year":"2014","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.atherosclerosis.2020.01.001","article-title":"Progression of coronary calcium burden and carotid stiffness in patients with essential thrombocythemia associated with JAK2 V617F mutation","volume":"296","author":"Vrtovec","year":"2020","journal-title":"Atherosclerosis"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"An\u017ei\u010d Drofenik, A., Blinc, A., Bozic Mijovski, A., Paji\u010d, M., Vrtovec, T., and Sever, M. (2024). Relation of JAK2 V617F allele burden and coronary calcium score in patients with essential thrombocythemia. Radiol. Oncol.","DOI":"10.2478\/raon-2024-0036"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1182\/blood-2016-03-643544","article-title":"The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia","volume":"127","author":"Arber","year":"2016","journal-title":"Blood"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1161\/01.HYP.0000154229.97341.d2","article-title":"Evaluation of carotid-femoral pulse wave velocity: Influence of timing algorithm and heart rate","volume":"45","author":"Millasseau","year":"2005","journal-title":"Hypertension"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Asefa, N.G., Meirelles, O., Lakatta, E., Fiorillo, E., Scuteri, A., Cucca, F., Marongiu, M., Delitala, A., Schlessinger, D., and Launer, L.J. (2024). Genetic and biomarker modulation of arterial stiffness change in the SardiNIA population cohort. Front. Epidemiol., 3.","DOI":"10.3389\/fepid.2023.1295209"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1161\/01.STR.0000065428.03209.64","article-title":"Aortic stiffness is an independent predictor of fatal stroke in essential hypertension","volume":"34","author":"Laurent","year":"2003","journal-title":"Stroke"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1161\/01.ATV.0000160548.78317.29","article-title":"Mechanisms, pathophysiology, and therapy of arterial stiffness","volume":"25","author":"Zieman","year":"2005","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1574","DOI":"10.1038\/leu.2010.148","article-title":"A prospective study of 338 patients with polycythemia vera: The impact of JAK2 (V617F) allele burden and leukocytosis on fibrotic or leukemic disease transformation and vascular complications","volume":"24","author":"Passamonti","year":"2010","journal-title":"Leukemia"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3021","DOI":"10.1182\/blood-2014-07-591610","article-title":"In contemporary patients with polycythemia vera, rates of thrombosis and risk factors delineate a new clinical epidemiology","volume":"124","author":"Barbui","year":"2014","journal-title":"Blood"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1136\/heartjnl-2017-312610","article-title":"Arterial stiffness association with chronic inflammatory disorders in the UK Biobank study","volume":"104","author":"Dregan","year":"2018","journal-title":"Heart"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1161\/ATVBAHA.119.313880","article-title":"Total White Blood Cell Count Mediated the Association Between Increased Arterial Stiffness and Risk of Type 2 Diabetes Mellitus in Chinese Adults","volume":"40","author":"Liu","year":"2020","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.ypmed.2009.04.015","article-title":"Hematocrit and the risk of coronary heart disease mortality in the TAMRISK study, a 28-year follow-up","volume":"49","author":"Kunnas","year":"2009","journal-title":"Prev. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/s13410-019-00794-3","article-title":"Hematocrit levels and arterial stiffness: The Cardiometabolic Risk in Chinese (CRC) Study","volume":"40","author":"Zou","year":"2020","journal-title":"Int. J. Diabetes Dev. Ctries."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Arnold, N., Gori, T., Schnabel, R.B., Schulz, A., Prochaska, J.H., Zeller, T., Binder, H., Pfeiffer, N., Beutel, M., and Espinola-Klein, C. (2017). Relation between Arterial Stiffness and Markers of Inflammation and Hemostasis\u2013Data from the Population-based Gutenberg Health Study. Sci. Rep., 7.","DOI":"10.1038\/s41598-017-06175-2"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e301","DOI":"10.1016\/S2352-3026(22)00046-1","article-title":"Appropriate management of polycythaemia vera with cytoreductive drug therapy: European LeukemiaNet 2021 recommendations","volume":"9","author":"Marchetti","year":"2022","journal-title":"Lancet Haematol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1182\/blood-2005-11-4454","article-title":"Hydroxyurea induces the eNOS-cGMP pathway in endothelial cells","volume":"108","author":"Cokic","year":"2006","journal-title":"Blood"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/j.niox.2007.01.001","article-title":"Hydroxyurea increases eNOS protein levels through inhibition of proteasome activity","volume":"16","author":"Cokic","year":"2007","journal-title":"Nitric Oxide."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2879","DOI":"10.1182\/blood-2012-02-409524","article-title":"Hydroxyurea and a cGMP-amplifying agent have immediate benefits on acute vaso-occlusive events in sickle cell disease mice","volume":"120","author":"Almeida","year":"2012","journal-title":"Blood"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1182\/blood-2016-10-695940","article-title":"Genetic basis and molecular pathophysiology of classical myeloproliferative neoplasms","volume":"129","author":"Vainchenker","year":"2017","journal-title":"Blood"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"100711","DOI":"10.1016\/j.blre.2020.100711","article-title":"Role of inflammation in the biology of myeloproliferative neoplasms","volume":"42","author":"Koschmieder","year":"2020","journal-title":"Blood Rev."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/j.mayocp.2018.08.022","article-title":"3023 Mayo Clinic Patients with Myeloproliferative Neoplasms: Risk-Stratified Comparison of Survival and Outcomes Data Among Disease Subgroups","volume":"94","author":"Szuber","year":"2019","journal-title":"Mayo Clin. Proc."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e366","DOI":"10.1038\/bcj.2015.95","article-title":"Blast transformation and fibrotic progression in polycythemia vera and essential thrombocythemia: A literature review of incidence and risk factors","volume":"5","author":"Cerquozzi","year":"2015","journal-title":"Blood Cancer J."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1038\/s41408-023-00960-1","article-title":"The impact of thrombosis on probabilities of death and disease progression in polycythemia vera: A multistate transition analysis of 1545 patients","volume":"13","author":"Barbui","year":"2023","journal-title":"Blood Cancer J."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1182\/blood-2023-180215","article-title":"A Real-World Evaluation of Risk Factors for Disease Progression in Patients with Polycythemia Vera (PV) Enrolled in REVEAL","volume":"142","author":"Grunwald","year":"2023","journal-title":"Blood."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"258","DOI":"10.3349\/ymj.2012.53.2.258","article-title":"Role of inflammation in the pathogenesis of arterial stiffness","volume":"53","author":"Park","year":"2012","journal-title":"Yonsei Med. J."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/j.bcp.2009.04.029","article-title":"Inflammatory cytokines in vascular dysfunction and vascular disease","volume":"78","author":"Sprague","year":"2009","journal-title":"Biochem. Pharmacol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1769","DOI":"10.1016\/j.hlc.2021.06.524","article-title":"Transforming Growth Factor-\u03b21, Arterial Stiffness and Vascular Age in Patients with Uncontrolled Arterial Hypertension","volume":"30","author":"Podzolkov","year":"2021","journal-title":"Heart Lung Circ."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e154092","DOI":"10.1172\/JCI154092","article-title":"TGF-\u03b2 signaling in myeloproliferative neoplasms contributes to myelofibrosis without disrupting the hematopoietic niche","volume":"132","author":"Yao","year":"2022","journal-title":"J. Clin. Investig."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1161\/HYPERTENSIONAHA.107.089409","article-title":"Proinflammatory profile within the grossly normal aged human aortic wall","volume":"50","author":"Wang","year":"2007","journal-title":"Hypertension"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Gallo, G., Volpe, M., and Savoia, C. (2022). Endothelial Dysfunction in Hypertension: Current Concepts and Clinical Implications. Front. Med., 8.","DOI":"10.3389\/fmed.2021.798958"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1038\/s41569-023-00964-1","article-title":"Immune and inflammatory mechanisms in hypertension","volume":"21","author":"Guzik","year":"2024","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Portes ESilva, K.R., Nogueira, E.M., Jesus Mendes, A.L., Pena, A.L.B., and Sim\u00f5es ESilva, A.C. (2024). The potential role of renin angiotensin system in acute leukemia: A narrative review. Mol. Biol. Rep., 51.","DOI":"10.1007\/s11033-024-09659-3"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.4161\/cbt.6.9.4568","article-title":"Bone marrow renin-angiotensin system expression in polycythemia vera and essential thrombocythemia depends on JAK2 mutational status","volume":"6","author":"Vrsalovic","year":"2007","journal-title":"Cancer Biol. Ther."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2717","DOI":"10.1007\/s00277-023-05417-w","article-title":"Renin-angiotensin inhibitors reduce thrombotic complications in Essential Thrombocythemia and Polycythemia Vera patients with arterial hypertension","volume":"102","author":"Mulas","year":"2023","journal-title":"Ann. Hematol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1016\/j.amjhyper.2004.06.028","article-title":"Effects of valsartan and nifedipine coat-core on systemic arterial stiffness in hypertensive patients","volume":"17","author":"Munakata","year":"2004","journal-title":"Am. J. Hypertens."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Laurent, S., and Boutouyrie, P. (2020). Arterial Stiffness and Hypertension in the Elderly. Front. Cardiovasc. Med., 7.","DOI":"10.3389\/fcvm.2020.544302"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"3179","DOI":"10.1200\/JCO.2010.34.5298","article-title":"Survival and disease progression in essential thrombocythemia are significantly influenced by accurate morphologic diagnosis: An international study","volume":"29","author":"Barbui","year":"2011","journal-title":"J. Clin. Oncol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/22\/6811\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:31:11Z","timestamp":1760113871000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/22\/6811"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,13]]},"references-count":60,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["jcm13226811"],"URL":"https:\/\/doi.org\/10.3390\/jcm13226811","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,13]]}}}