bluuebunny/crossref_metadata_2025 huggingface dataset:
O18 UNCERTAINTY QUANTIFICATION OF WEARABLE CUFFLESS BLOOD PRESSURE MEASUREMENT
Authors: Ding Xiaorong , Shen Zhan
Published: September 2024

Background and Objective:

Due to aleatoric and epistemic uncertainty, most cuffless blood pressure (BP) estimation models struggle to provide reliable and accurate BP estimations. The purpose of this study is to quantify the uncertainty of wearable cuffless BP estimation so as to reduce the impact of uncertainty on the accuracy of model estimation, and in the meanwhile to provide an estimated uncertainty interval (UI) in addition to the point estimation.

Methods:

We developed a gradient boosting regression tree (GBRT) model to estimate ambulatory BP and the estimation UI with eight noninvasive features extracted from wearable photoplethysmogram (PPG) and electrocardiogram (ECG) signals. We validated the proposed method with the Microsoft Aurora dataset that was originally collected for the Aurora-BP study. We identified 483 subjects (247 males) with wearable watches collecting PPG, ECG, and other signals, while ambulatory BP was monitored hourly using an oscillometric BP device. We trained the model with quantile loss on 60% of subjects (2954 samples), then calibrated the estimated UI with conformal predication with 24% (2148 samples) of subjects and tested the model with 16% (1658 samples) of the subjects.

Results:

The mean absolute difference (MAD) in systolic BP (SBP) and diastolic BP (DBP) estimated by the GBRT model were 13.96 mmHg and 9.89 mmHg, respectively. Then, with implementation of conformal prediction with error rates of ϵ=0.05, for the test set samples, the percentage of the estimated UI covering the reference BP during the daytime and nighttime phases can reach 91.67% and 95.89%, respectively.

Conclusions:

The combination of the GBRT model with conformal predication can quantify the uncertainty in cuffless BP estimations. In addition, the estimated uncertainty quantification interval together with the point estimation is potentially more reliable than single-point estimation, which could benefit better diagnosis and treatment of hypertension.
O24 ACUTE KIDNEY INJURY IN PREGNANCY AND CARDIO-RENAL OUTCOMES: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Jeyaraman Deepthika , Peiris Telge Dimuth Priyankara , Alahmdi Haia , Fish Richard , Lambie Mark , Wu Pensee
Published: September 2024

Background and Objective:

Acute kidney injury (AKI) is a common problem in pregnancy but adverse cardio-renal outcomes following AKI in pregnancy has not been systematically evaluated. We aimed to quantify the risk of adverse cardio-renal outcomes of AKI in pregnancy.

Method:

A literature search was conducted on MEDLINE, Cochrane library and EMBASE from inception until January 2024. The titles, abstracts and full studies were separately screened by two reviewers. Studies were included if they considered pregnant women with AKI, compared them to pregnant women without AKI and included predetermined renal or cardiac outcomes. References from relevant systematic reviews were included if they met the inclusion criteria. Data was independently collected by two reviewers. Any discrepancy was addressed by a third author. The data was analysed using Revman 5. Newcastle-Ottawa Quality Assessment Scale was used for quality assessment.

Results:

We included 17 studies. There is a significantly increased risk of maternal mortality (OR 9.70, 95% CI 3.49, 26.97), ICU admission (OR 3.86, 95% CI 1.93, 7.71), stroke (OR 22.92, 95% CI 2.32, 226.65), thrombotic microangiopathy (OR 9.62, 95% CI 1.57, 57.67), heart failure (OR 22.55, 95% CI 4.39, 115.71) and need for dialysis (OR 408.99, 95% CI 1.23, 135716.45) in pregnant women with AKI compared to women without AKI. Furthermore, there is an increased risk of composite renal disease (chronic kidney disease, renal replacement therapy and end-stage renal failure (OR 52.37, 95% CI 4.67, 587.63) and composite cardiovascular disease (OR 20.6, 95% CI 14.7, 28.9) amongst pregnant patients with AKI compared to non-AKI patients. The composite outcomes are compiled using follow-up data over at least 1 year or more and reflect long-term outcomes.

Conclusions:

We show that AKI in pregnancy is associated with adverse cardio-renal outcomes. Therefore, careful monitoring and follow-up of patients with AKI in pregnancy are needed to improve the cardio-renal outcomes of this high-risk group of women.
O32 AVAILABILITY OF PROPERLY VALIDATED BLOOD PRESSURE MEASURING DEVICES FOR PREGNANT WOMEN: STRIDE BP SYSTEMATIC REVIEW
Authors: Menti Ariadni , Mariglis Dimitrios , Kyriakoulis Konstantinos , Kollias Anastasios , Palatini Paolo , Parati Gianfranco , Wang Jiguang , Schutte Aletta , Stergiou George
Published: September 2024

Background and Objective:

Validated automated upper-arm cuff blood pressure (BP) measuring devices are currently recommended for BP measurement. However, a validated BP device in the general population may be inaccurate in pregnant women. Thus, separate validation studies are required in pregnant women with normal BP, hypertension, and preeclampsia. This study assessed the published evidence on BP devices in pregnancy.

Methods:

STRIDE BP (www.stridebp.org) performs periodic systematic PubMed searches to identify validation studies of automated cuff BP monitors. Validation studies in pregnancy conducted using an established protocol, including the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018), ANSI/AAMI/ISO 2013/2009, ESH-IP 2010/2002, AAMI 2002/1992/1987, and BHS 1993/1990, were identified.

Results:

Of 569 validation studies included in the STRIDE BP database, 63 (35 devices) were identified including pregnant women. Among them, STRIDE BP rejected 45 studies, of which 25 were reported as “device pass” in the published validation paper. Among the studies rejected by STRIDE BP but published as “pass”, the main reasons for rejection were violations in the BP measurement protocol (44%), inadequate reference device or cuffs for reference and test device (36%), no data in women with hypertension and/or preeclampsia (36%), single observer for reference BP measurement (28%), and inappropriate data analysis (20%). Eventually 18 studies in pregnant women (28.6%) fulfilled the protocol requirements, and 16 devices (8 of them available on the market) can be recommended for clinical use in pregnancy. When additional ‘equivalent’ devices were considered (devices lacking validation studies but with differences from validated devices not affecting the BP measurement accuracy), 37 devices were found to be accurate in pregnancy, with 27 of them available on the market (Table).

Conclusions:

This analysis showed a shortage of properly validated BP devices for pregnant women available in the market, with published validation often having major methodological issues. There is an urgent need to develop and properly validate more BP devices in pregnancy.

TABLE. Validated devices for office, home, and ambulatory BP measurement in pregnant women.
O38 A SOCIAL DETERMINANT AND SIMPLE CLINICAL VARIABLES AS THE BEST PREDICTORS OF ESRD BY AN XGBOOST MACHINE LEARNING MODEL IN CKD
Authors: Giraldo-Castrillon Y , Giraldo E , Sánchez-Martínez Y , Hernández-Quiñonez D , Martínez-Bello D , Gómez-Montoya I , Castañeda A , García C. , López-López JP , López-Jaramillo P
Published: September 2024

Background and Objective:

Chronic Kidney Disease (CKD) is a complex disease that affects approximately 13% of the world's population and is growing rapidly due to the increase in aging and the prevalence of type 2 diabetes mellitus, obesity and hypertension. It is difficult to predict who will develop End-Stage Renal Disease (ESRD) and, so far, no prediction model is applied in clinical practice. Our aim was to develop and externally validate an ESRD prediction model with potential utility in clinical decision making.

Methods:

A longitudinal study was conducted with an 8-year follow-up of sociodemographic, biological, and clinical variables. Individuals with a diagnosis of CKD belonging to the cardiovascular risk program were recruited in two cohorts for derivation and external validation of the model. Classical and machine learning models on an imputed data matrix and sub-databases were explored by bootstrapping and cross-validation, as well as the change in GFR between measurements that predicted ESRD. Measures of calibration, discrimination, and overall predictive performance were presented. Models were trained and tested in sub cohorts and the best performing model was validated in an independent cohort and its uncertainty established.

Results:

A total of 2514 patients were included, 1650 in the derivation cohort, mean age of 74 years, 40.4% were women. A machine learning xgboost model identified previous GFR, creatinine, blood glucose, HbA1c, HDL cholesterol, BUN and income level as the main predictors of ESRD. Likewise, an inter-measurement GFR delta of 3.09 ml/kg/min was associated with a significant increase of ESRD. In the external validation cohort, with 864 patients, the model maintained an accuracy of 0.98, an AUC of 0.776, a recall of 1.00 and an F1-score of 0.99. The uncertainty of the AUC given by the 95%CI was 0.68-0.826.

Conclusions:

A machine learning xgboost model identified the most important predictors of ESRD, maintaining adequate predictive performance when cross-validated in an independent cohort of patients. The model could be applied in real clinical practice.
O42 USABILITY AND EFFECT OF A HYPERTENSION MOBILE APPLICATION IN KNOWLEDGE AND GUIDELINES ADHERENCE OF FAMILY AND COMMUNITY MEDICINE RESIDENTS
Authors: Salabi Sitti Khadija , Francisco Peter Julian , Marcelo Portia Grace , Trutna Timothy Francis
Published: September 2024

Background:

Mobile health (mHealth) applications have become integral in medical education and information access, yet effectiveness varies, and barriers to engagement persist.

OBJECTIVE: This study aimed to assess the usability and effectiveness of the mHealth application entitled Hypertension Now in increasing knowledge and guideline adherence among residents.

Methods:

A before-and-after educational intervention study was conducted among residents of the Department of Family and Community Medicine (DFCM), Philippines General Hospital from January to August 2023. The intervention was a newly developed medical reference app for managing hypertension based on the latest local and international hypertension guidelines. Usability, knowledge score, and adherence rate were measured using a questionnaire, pre- and post-intervention examinations, and medical chart audits.

Results:

All 32 DFCM residents participated in the study. The app was rated high on ease of use and usefulness for practice by the residents. It was also rated high on interface and overall satisfaction. It significantly increased the knowledge scores of the residents by 1.6 points (p=0.001). The proportion of those who passed the exam significantly increased post-intervention (37.5% vs. 59.4%, p=0.035). Moreover, the app increased the adherence of the residents to proper physical examination (82% vs. 91%, p=0.024), diagnosis (80% vs. 90%, p=0.012), and pharmacologic treatment (53% vs. 83%, p=0.001). There was no increase in adherence to proper risk assessment (83% vs. 78%, p=0.371), laboratory examination (35% vs. 40%, p=0.329), and non-pharmacologic treatment (77% vs. 81%, p=0.470).

Conclusion:

The mHealth app for hypertension management was usable and effective in increasing the knowledge of family and community medicine residents in managing hypertension. While the app increased guideline adherence to physical examinations, diagnostics, and pharmacological treatments for hypertension, it did not increase adherence to risk assessment, laboratory examination, and non-pharmacologic treatment.
O43 ADHERENCE OF CLINICIANS TO HYPERTENSION CLINICAL PRACTICE GUIDELINES: A MULTICENTER CROSS SECTIONAL STUDY
Authors: Villar Juan Carlos , Cuevas José D. Cruz , Moreno Angélica M.
Published: September 2024

Background:

Hypertension is the cardiovascular risk factor that accounts for most preventable deaths worldwide. Implementation of clinical practice guidelines (CPG) reduces variability in care and improves outcomes. In Colombia, clinicians’ adherence to recommendations is rarely reported. The aim of this study was to assess the adherence of clinicians to hypertension CPG in out-patient clinics from Bogotá.

Methods:

we performed a cross-sectional study as part of the baseline measurement of a cluster randomized trial. A panel of experts selected seven prioritized recommendations from the Colombian hypertension CPG. Clinicians from 5 health-care institutions in Bogotá, Colombia, who voluntarily accepted to participate were included. We consulted electronic health-records of a consecutive sample of patients with hypertension treated by the participating clinicians to evaluate the applicability of, and adherence to, selected recommendations.

Results:

The 37 clinicians included had a mean age of 36.9 years, 54.05% were male, most of them general physicians (83.7%) and the mean clinical experience was 10.5 years. Evaluation of 4872 recommendations by reviewing health-records from 696 patients (67% female, mean age 68.5 years, 51.5% less than 5 years since diagnosis) showed an overall applicability of 21.3% (CI95% 20.1-22.4%) and adherence was 29.1% (CI95% 26.3-37.9%). We identified a significant variation in adherence between recommendations, being highest for treating with combination of antihypertensive medications for stage 2 hypertension (58.7%) and lowest for proteinuria screening (7.8%) (figure 1). Adherence was better in male clinicians (25% vs 32%, p=0.008) and those with more clinical experience (35% for >10 years of experience vs 26% for <10 years of experience, p=0.014). Also, clinicians were more adherent to recommendations related to treatment with moderate certainty of evidence (39.5%), compared to those on screening with high certainty (15.2%).

Conclusions:

in a sample of physicians practicing in Bogotá, adherence to strong recommendations from the Colombian hypertension CPG varied greatly by clinicians’ sex, clinical experience and the type of recommendations, and was overall poor.
O44 LOW ADHERENCE TO HYPERTENSION MANAGEMENT IN THE COLOMBIAN COMMUNITY IMPLEMENTATION RE-HOPE STUDY
Authors: Giraldo-Castrillon Yessica M. , Gomez-Montoya Isabela , Sánchez-Martínez Yuri , Hernandez-Quiñones Daniela , Martinez-Bello Daniel , Otero Johanna , Castañeda Álvaro , Lopez-Lopez Jose Patricio , Lopez-Jaramillo Patricio
Published: September 2024

Background and objective:

Uncontrolled hypertension is a leading cause of death worldwide, and it's associated with a high socioeconomic burden. Demographic, social, behavioral, and health system-related factors contribute to low adherence to hypertension management. Recognizing adherence rates is a mainstay for improving hypertension control. This study examined the level of adherence to hypertension management and control in the participants belonging to the implementation, integration, and institutionalization of a community-based care strategy to reduce the risk of cardiovascular disease in Santander (ReHOPE) study.

Methods

This cross-sectional analysis was conducted in 12 municipalities of Santander, Colombia, from May to December 2023. Participants over 18 with hypertension, not in a cardiovascular risk program, were included. Data were collected door-to-door by trained community health providers using standardized questionnaires for socio-demographic information, medication use, lifestyle details, and hypertension knowledge. Physical exams provided anthropometric and blood pressure values. Medication adherence was assessed with the Morisky 4-item scale. Continuous variables are presented as central tendency measures, and categorical variables as frequencies and proportions. Analysis was performed using R software.

Results:

A total of 2,617 participants were included. The mean age was 65.09 (SD 12.09), and 64.3% were women. The mean systolic blood pressure was 133.94 mmHg (SD 16.53). The median waist-to-hip ratio (WHR) was 0.96 (IQR 0.92-1.00) in men and 0.91 (IQR 0.87-0.96) in women. Among participants, 33.9% had uncontrolled hypertension, 28.5% were not aware of their condition, and 69.2% reported no physical activity. High WHR was found in 84.8% of the participants. Antihypertensive monotherapy use was reported in half of the participants (53.8%). The most frequently used pharmacological group was angiotensin-converting enzyme inhibitors (81.8%). Hypertension control was observed in 66.1%, and 12.6% had high adherence.

Conclusions:

Low medication adherence was observed, only 12.6% of participants reported high adherence and nearly 40% had uncontrolled hypertension. Additionally, nearly 30% were undetected by the healthcare system. Thus, improving medication adherence and healthcare strategies is essential to enhance health outcomes.
O50 EFFECT OF LONG-TERM USE OF CONTINUOUS POSITIVE AIRWAY PRESSURE ON BLOOD PRESSURE PATIENTS WITH RESISTANT HYPERTENSION AND OBSTRUCTIVE SLEEP APNEA
Authors: Da Costa Fernandes Ana Cristina Tenorio , Oliveira De Carvalho Carlos Fernanda , de Azevedo João Carlos Moreno , Pimentel Chiara Donnangelo , da Silva de Sousa Vitória Mirian , Jardim Duarte Mr Carlos Henrique , Margallo Victor , Muxfeldt Elizabeth Silaid , de Souza Fabio
Published: September 2024

Background and Objective:

Obstructive Sleep Apnea (OSA) is strongly associated with Resistant Hypertension (RHT). Continuous positive airway pressure (CPAP) is the treatment of choice for moderate-severe OSA. Its benefit in terms of blood pressure (BP) control is still unclear. The objective of the study is to evaluate the effect of CPAP on BP in patients with RHT and moderate-severe OSA.

Methods:

This was a prospective intervention study that included 124 patients with RHT and moderate/severe OSA (AHI>15/hour) divided in 2 groups. Patients using CPAP uninterruptedly for a minimum period of 12 months (CPAP group) were compared with those who refused to use CPAP despite clinical indication (Control group). Office BP and 24-hour ABPM were obtained at baseline and after follow-up. Primary outcomes were changes in office and ambulatory BPs, and nocturnal BP reduction.

Results:

124 individuals were included (37.9% male with a mean age of 60.7 ± 7.8 years), 65 in the CPAP group and 59 in the control group with a median [interquartile range] follow-up time of 68 [49-81] months. There was a reduction in office systolic BP (SBP) of -7.5 mmHg ([CI95%: -16.3 to -1.1],p=0.089), in nocturnal SBP and diastolic BP (DBP) of – 6.1 mmHg ([CI95%: -12.4 to 0.3],p=0.06) and -3.5 mmHg ([CI95%: -7.4 to 0.6],p=0.092), respectively, without reaching statistical significance. Otherwise, after excluding 9 patients of CPAP group with low adherence, we found a reduction in office SBP of -10.3 mmHg ([CI95%: -19.7 to 0.9],p=0.031), in 24-hour SBP and DBP of – 4.8 mmHg ([CI95%: -10.5 to 0.8],p=0.095) and -3.4 mmHg ([CI95%: -6.8 to 0.1],p=0.045), and in nocturnal SBP and DBP of – 8.1 mmHg ([CI95%: -14.7 to -1.5],p=0.017) and -5.3 mmHg ([CI95%: -9.6 to -1.1],p=0.014), respectively.

Conclusion:

Long term use of CPAP reduced office, 24-hour and nighttime SBP specially in resistant hypertensives with good CPAP adherence.
O52 KIDNEY ARTERIOLAR RESPONSES TO LIVER-TARGETED SMALL INTERFERENCE RNA (SIRNA) TARGETING ANGIOTENSINOGEN IN DIABETIC RATS: COMPARISON WITH OTHER RENIN-ANGIOTENSIN SYSTEM BLOCKERS
Authors: Cruz-Lopez Edwyn , Martini Alexandre , Foster Don , Zlatev Ivan , Kasper Anne , Sequeira-Lopez Maria-Luisa , Gomez Ariel , Danser A.H. Jan
Published: September 2024

Objective:

Inhibition of the renin-angiotensin system (RAS) with ACE inhibitors (ACEi) or angiotensin receptor blockers (ARB) is associated with concentric thickening of renal arteries and arterioles and parenchymal disease. Here we evaluated to what degree this also occurs during RAS inhibition with siRNA targeting hepatic angiotensinogen (AGT).

Methods:

Male hypertensive heterozygous transgenic rats overexpressing mouse renin (TGR(mRen2)27 rats), made diabetic with streptozotocin, were treated with the ARB valsartan (4 mg/kg/day), the ACEi captopril (6 mg/kg/day), AGT siRNA (30 mg/kg every 2 weeks), AGT siRNA + valsartan, or captopril+valsartan for 3 weeks, starting at 15 weeks after induction of diabetes. After 3 weeks of treatment, kidneys were removed, and immunocytochemistry was performed on Bouin's fixed kidney sections using antibodies against renin or α-smooth muscle actin. Juxtaglomerular index and wall thickness were assessed using tiling pictures of both renin and α-smooth muscle actin sections from the slides. Tubular degeneration was scored by summing up scores for tubular atrophy, interstitial fibrosis, and tubulointerstitial inflammation. Concentric vascular hypertrophy was assessed in a blinded manner.

Results:

All treatments increased juxtaglomerular index, and the largest increases were observed in dual treatment groups, consistent with the highest degree of RAS blockade in these groups. Tubular scores increased after induction of diabetes, and the highest scores were seen in dual treatment groups, significance versus vehicle being reached in the valsartan+captopril group only (P<0.05). Afferent arteriole wall thickness increased in all treatment groups, and the greatest increases were observed during dual treatment. Finally, concentric vascular hypertrophy was observed in 1 of 7 diabetic Ren2 rats; this percentage increased during RAS blocker treatment of these rats, numerically reaching the highest values during dual treatment.

Conclusions:

Our data suggest that, in the hypertensive diabetic rat model, high levels of RAS blockade, irrespective of the type of blockade, may result in an increase in afferent arteriole thickness and concentric vascular hypertrophy. AGT siRNA in combination with RAS inhibitors should be further explored in clinical studies.
O58 CONTINUOUS MEASUREMENT OF BLOOD PRESSURE DURING NIGHT - INSIGHTS INTO THE GENESIS OF THE NOCTURNAL BLOOD PRESSURE FLUCTUATIONS
Authors: Patzak Andreas , Bothe Tomas Lucca , Küchler Gert
Published: September 2024

Background and Objective:

Nighttime blood pressure (BP) is a strongly predictive marker for overall cardiovascular risk. Traditional cuff-based BP measurements methods provide only discrete BP data. Short-term BP fluctuations are not detectable with such methods. Therefore, we applied two independent and continuously measuring methods with the aim to characterize systolic nocturnal blood pressure fluctuations (NBPF) related to sleep apnoea or periodic leg movements (PLM).

Methods:

BP fluctuations were analysed in patients with suspected sleep disturbances. The Portapres™ device (Penaz method) and a system based on the measurement of the pulse transit time (SOMNOscreen®) were used to measure the BP in addition to a polysomnography performed under the conditions of a clinical sleep laboratory. The calculation of the BP by the SOMNOscreen® was performed using a BP-pulse wave velocity (PWV) transfer function.

Results:

We saw BP fluctuations which occurred in connection with obstructive apnoeic events as well as in connection with PLM. Both methods recorded the same apnoea related NBPF. The amplitudes of these NBPF accounted for 24.7 mmHg and 22.8 mmHg (Portapres™ and SOMNOscreen®, respectively, 11 patients, number of events: n=695). PLM related PB fluctuations (in 5 of 11 patients, n=317) amounted to 18.4 mmHg (Portapres™ and 16.9 mmHg (SOMNOscreen®). Most of the patients did not show BP dipping when comparing awake with sleep time periods and they had a moderate to severe apnoea/hypopnoea index.

Conclusions:

The study demonstrates a strong relation between apnoeic events/PLM and NPBF. The NBPF were similarly detected by two different BP measuring methods suggesting that the more indirect method of BP determination using the PWV provides a reliable measurement of NBPF. The results suggest that OSA and PLM related NBPF strongly contribute to non- or reverse dipping of patients with these sleep disorders.
O61 HYPERTENSION IN COLOMBIA: ETHNIC GROUP COMPARISONS IN CHARACTERIZATION AND SURVIVAL
Authors: Quintero Martínez Juan Andrés , Herrera Parra Lina Johana , Urina Triana Miguel Alberto , Valbuena García Ana María , Ocampo Dagnovar Aristizábal , Moreno Cortes Javier Alfredo , Donado Rodrigo Oñate , Acuña Merchán Lizbeth Alexandra , Quintero Baiz Adalberto Elias
Published: September 2024

Background and objective:

Research has shown that ethnic minorities may be disproportionately affected by arterial hypertension. The aim of this study is to compare the overall survival (OS) HTN patients within the Colombian health system, by their ethnic group.

Methods:

Design: Longitudinal retrospective cohort study. Population: Adults diagnosed with HTN from June 1, 2014, to July 30, 2015, from the National Registry of Chronic Kidney Disease (NRCKD). The follow-up period was until July 30, 2023. Analysis: The probability of global survival from the date of diagnosis was estimated using Kaplan-Meier analysis. An unadjusted Royston Parmar flexible regression model was fitted. Right-censoring was defined as abandonment or completion of follow-up without death occurring.

Results:

5,634,812 cases were identified from june 1st 2022 to july 30th 2023, and 299,161 incident cases were included in the survival analysis. 95.29% had no ethnic group, 1.20% were indigenous, 3.47% were Afro-descendant and 0.03% were Gypsy (ROMA). ROMA group had a higher proportion of residents in Bogotá, D.C. compared to other groups (13.96% vs ∼3%). Afro-descendant group had a higher proportion of obesity (30.61% vs. 27.86%) and diagnosis of Chronic Kidney Disease (27.31% vs. 15.69%) compared to cases with no ethnic group, while ROMA group had a higher occurrence of DM cases (23.46% vs. 21.66%). 9 years OS was higher in ROMA group (OS = 0.85; CI 95% 0.71 – 0.93) compared to indigenous (OS = 0.83; CI 95% 0.81 – 0.84) and afro-descendants (OS = 0.83; CI 95% 0.83 – 0.84). The probability of all-cause mortality was approximately 20% higher among afro-descendants and indigenous people (HR = 1.20; 95% CI 1.14 – 1.25 and HR = 1.22; 95% CI 1.12 – 1.32, respectively) compared to the non-ethnic group. In contrast, the ROMA did not present differences (p = 0.712).

Conclusions:

In the Colombian health system, differences in OS among afro-descendant and indigenous groups are observed compared to non-ethnic population.
O35 THE SYNERGISM BETWEEN HIGH GLUCOSE AND INTERLEUKIN-1beta PROMOTES INFLAMMASOME ACTIVATION AND THE RELEASE OF SMALL EXTRACELLULAR VESICLES IN HUMAN AORTIC SMOOTH MUSCLE CELLS
Authors: Valencia Inés , Hipólito-Luengo Álvaro , Villacampa Alicia , Vidal-Gómez Xavier , Shamoon Licia , Cuadrado Ana , De la Cuesta Fernando , Martínez Mª Carmen , Andriantsitohaina Ramaroson , Peiró Concepción , Sánchez-Ferrer Carlos F.
Published: September 2024

Background and objective:

Hyperglycemia and inflammatory cytokines like interleukin (IL)-1beta play a key role in the vascular complications associated to diabetes melllitus (DM), such as atherosclerosis and hypertension. Understanding the pathophysiological mechanisms involved, including altered intercellular communication, is essential to identify potential therapeutical targets. We investigated the synergism of IL-1beta and high glucose on: (1) the activation of nucleotide-binding-oligomerization-domain, leucine-rich-repeat, and pyrin-domain-containing-3 (NLRP3)-inflammasome, an innate immunity component linked to vascular disease, and (2) the production and cargo of small extracellular vesicles (sEVs) as key players in vascular intercellular communication.

Methods:

Human aortic smooth muscle cells (HASMC) were challenged for 18 h with IL-1beta (10 ng/ml) in the presence of normal (5,5 mmol/L) or high glucose (22 mmol/L). Protein levels were quantified by Western blot, while the formation of ASC-like specks, reflecting NLRP3 activation, was assessed by indirect immunofluorescence. sEVs were determined by nanotracking analysis and endothelial senescence by the beta-galactosidase activity assay.

Results:

In HASMC cultures, IL-1beta favored NLRP3-inflammasome priming, as shown by NF-kappaB (phospho-p65) activation while NLRP3 and pro-IL-1beta levels were increased. The cytokine equally promoted NLRP3-inflammasome complex assembly, caspase-1 activation, and a subsequent release of mature IL-1beta in an auto-inflammatory loop. High glucose alone did not promote these effects, but it exacerbated some actions of IL-1beta and potentiated the release of HASMC-derived sEVs induced by IL-1beta, increasing their cargo content in NLRP3-inflammasome components. Moreover, these sEVs induce autocrine NLRP3-inflammasome activation in naïve HASMC and paracrine senescence in human endothelial cells. The IL-1 receptor blocker anakinra (1 mg/ml) blunted the IL-1beta effect, as well as their exacerbation by high glucose.

Conclusion:

High glucose exacerbates the activation of NLRP3-inflammasome by IL-1beta and alters intercellular communication by modifying the number and content of sEVs, which can expand inflammation in neighboring tissues. By preventing such synergy, biological drugs blocking IL-1beta receptors arise as potential pharmacological tools to attenuate DM associated vascular abnormalities.
O68 ATRIAL SEPTAL ANEURYSM IN IDENTICALS TWINS
Authors: López-Aldazoro Ysabel Cecilia , Tellez Mendez Ramon Dario
Published: September 2024

Introduction:

Interatrial septal aneurysm (ISA) is a dilatation of saccular tissue, generally located in the foramen ovale area, which moves freely and protrudes into the right or left atrium, or even both. Today it is estimated that 85% of children born with congenital heart disease survive to adulthood, however, we have not found cases of ISA reported in identical twins in adulthood.

Methods:

Two 55-year-old female patients, identical twins EAM and RAM, body surface area 1,899 and 1,826 m2 respectively, consulted for elevated blood pressure (160/90 and 160/95 mmHg respectively). One of them reported headache accompanied by joint pain and mild dyspnea, the other patient reported palpitations and mild dizziness. His parents are hypertensive. They were hospitalized at 5 months of age due to viral meningitis, with no further consequences. Antihypertensive treatment, laboratory, stress test, and echocardiogram/Doppler were prescribed.

Results:

Laboratory tests were found to be normal. The stress test (protocol: Bruce) was reported to be negative for induced myocardial ischemia. Echocardiography revealed ISA in both patients.

Conclusions:

Twins, particularly monochorionic twins, are at increased risk of congenital anomalies compared with singleton pregnancies, and the risk of cerebrovascular disease (CVD) or transient ischemic attack (TIA) in patients with ISA is 6.7% in adult patients. ISA has been associated with acquired cardiac diseases, such as valvular heart disease, cardiomyopathies, pulmonary and systemic hypertension, ischemic heart disease, arrhythmias, and thrombus formation. More recently, an association with embolic cerebrovascular pathology has been observed, both in TIA and CVD. For this reason, we consider that in adult patients who are identical twins when one of them is found with ISA, an evaluation should be carried out in their twin for its appropriate treatment and thus avoid future cardiovascular complications derived from this anomaly. According to our reviews, this is the first case of ISA in identical twins. New observations on ISA in twins are needed.
O69 THE REGULATORY ROLE OF CIRCULAR RNAS IN RESPONSE TO RAAS INHIBITORS
Authors: Atchison Benjamin
Published: September 2024

Circular RNAs (circRNAs) are a class of non-coding RNA that may play an important role in disease progression and diagnosis. This study aimed to investigate the role of renal circRNAs in hypertension and to identify circRNAs pathways explaining chronic reset in blood pressure. Two groups of young spontaneously hypertensive rats (SHR) were used: rats treated with or without losartan (RAAS inhibitor, n = 18 in each group). Through established circRNA identification and quantification tools, we identified five significant circular RNA candidates (P < 0.05), each aligning with differentially expressed and biologically significant miRNA. Furthermore, these candidate circRNAs aligned with expression pathways found in both treatment and control groups. In conclusion, this study identified several circRNAs which may play an important role in blood pressure regulation. It may advance our understanding of circRNAs in mediating losartan-induced blood pressure reduction. Future studies on validation, expression networking and methylome analysis may shed light on these circRNAs’ significance and identify potential therapeutic biomarkers.
O90 EFFICACY AND SAFETY OF DUAL COMBINATIONS OF ANTIHYPERTENSIVE DRUGS AS FIRST-LINE THERAPY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Authors: Dhurjati Rupasvi , Pant Rashmi , Kumar Amit , Rodgers Anthony , Haghdoost Faraidoon , Salam Abdul
Published: September 2024

Background:

Hypertension remains the primary cause of mortality worldwide, resulting in about 11 million deaths annually. Despite recent hypertension guidelines advocating for dual combination of antihypertensive drugs as the first-line therapy for most patients, many patients do not receive this therapy.

Objective:

To assess, among adults with hypertension, dual combinations of AHTDs compared to monotherapy as first-line treatment for blood pressure (BP)-lowering efficacy and safety.

Methods:

We systematically searched multiple electronic databases until December 2022 to identify relevant randomized, double-blind trials. We included trials involving adults with hypertension who were either treatment naive or untreated for at least 2 weeks, compared dual combinations of drugs with monotherapy from 5 major classes of AHTDs (angiotensin converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, and diuretics), for a duration of at least 4 weeks and reported data on BP reduction. AHTDs and their combinations were categorized based on standard daily doses. Outcomes were reduction in BP, treatment related adverse events (TRAE) and withdrawals from the treatment due to adverse events (WDAE). Meta-analyses were conducted using random-effects model.

Results:

We included 98 trials (636 comparisons and 25892 participants). Overall, baseline mean BP was 159/102 mmHg. Overall BP reduction with dual combination compared to monotherapy was 4.4 (CI: 3.8-5.1)/3.5 (CI:3.2-3.9) mmHg. Compared with standard-dose monotherapy, dual combinations of <1 + <1, 1 + <1 and 1 + 1 (i.e. low-to-standard dose), showed a dose-response relationship in reducing BP by 1.4 (CI: 0.01-2.7)/2.3 (CI: 1.4-3.1), 4.4 (CI: 3.6-5.2)/ 3.3 (CI: 2.9-3.8) and 7.8 (CI: 6.2-8.9)/5.2 (CI: 4.4-5.9) mmHg, respectively. TRAEs [4.8% vs 4.9%; RR 0.92 (0.80 to 1.06)] and WDAEs [0.8% vs 0.9%; RR 1.8 (1.5 to 2.1)] were uncommon with low-to-standard dose dual combinations, with no significant difference compared with standard-dose monotherapy.

Conclusion:

First-line treatment with low-to-standard dose dual combination therapy is more efficacious and equally safe compared to monotherapy to reduce BP.
O102 RELATIONSHIP BETWEEN AGTR1 (c.1166 A>C) POLYMORPHISMS AND KIDNEY INJURY IN HYPERTENSION
Authors: Zeng Yiyao , Jiang Yufeng , Huang Ziying , Zhou Yafeng
Published: September 2024

Background:

High blood pressure is the main cause of cardiovascular diseases. Kidney damage is one of the most common organ secondary damage to hypertension. The study of hypertension gene polymorphisms is an important means of precision treatment of primary hypertension. Objectives: The objective of this study was to explore the relationship between AGTR1 (c.1166 A>C) gene polymorphisms and hypertension combined with kidney damage, while exploring the relationship between codominant, dominant and recessive gene model and hypertension with kidney injury and the susceptibility of different genotypes to hypertension with kidney injury.

Methods:

The distribution of AGTR1 polymorphism in the AGTR1 in hypertensive patients (hypertension group, 292 patients) and hypertension with kidney injury patients (44 patients) were detected and compared by PCR-melting curve method.

Results:

The genotype distribution of hypertension and combined groups met Hardy-Weinberg equilibrium (p > 0.05); the distribution difference between the three genotypes was statistically significant (p < 0.05), the codominant, dominant and recessive distribution frequency of genotypes (p < 0.05), and no difference between A allele and C allele (p > 0.05).

Conclusions:

Our study identified the relationship of AGTRA (c.1166 A>C) with hypertension combined with renal injury, and compared the susceptibility of different genetic models, which may provide novel targets for precision gene therapy of hypertension.
O104 OPTIMAL NIGHTTIME BLOOD PRESSURE MONITORING SCHEDULE USING HOME MONITORS IN CHILDREN AND ADOLESCENTS: ASSOCIATION WITH AMBULATORY BLOOD PRESSURE AND PRECLINICAL TARGET-ORGAN DAMAGE
Authors: Stambolliu Emelina , Kollias Anastasios , Bountzona Ioanna , Ntineri Angeliki , Servos George , Vazeou Andriani , Kyriakoulis Konstantinos , Stergiou George
Published: September 2024

Background and Objective:

To evaluate the optimal schedule for nighttime blood pressure (BP) assessed using home monitors (HBP) in terms of agreement with nighttime ambulatory BP (ABP) and association with indices of preclinical organ damage in children and adolescents.

Methods:

Apparently healthy children and adolescents (6-18 years) referred for elevated BP were subjected to (i) 24-hour ABP monitoring using a validated upper-arm cuff oscillometric device (Microlife WatchBP O3), (ii) HBP monitoring during daytime (7 days, duplicate morning and evening measurements) and nighttime (automated measurements, 3 nights, 3 hourly measurements/night) using a validated upper-arm cuff oscillometric device (total of 9 nighttime readings, Microlife WatchBP HOME N), (iii) carotid intima-media thickness (cIMT) measurement (ultrasonography), (iv) carotid-femoral pulse wave velocity (cfPWV) (Complior device; duplicate measurements), and (v) echocardiographic determination of left ventricular mass index (LVMI).

Results:

Forty-nine individuals were included (mean age 13.4±2.7 years, 51% males). There were no differences in nighttime HBP among individual readings or the average of different nights (night 1: 109.7±10.9/60.8±7.3 mmHg, systolic/diastolic BP; night 2: 109.1±11.7/59.7±8.6 mmHg; night 3: 109.1±11.5/60.4±8.4 mmHg, p=NS for all comparisons). By averaging an increasing number of nighttime systolic HBP readings, there was a consistent trend towards a stronger association of nighttime HBP with nighttime ABP (correlation coefficients r increased from 0.65 to 0.81), and with indices of preclinical organ damage (LVMI: 0.21 to 0.30; cIMT: 0.38 to 0.57; cfPWV: 0.60 to 0.69). There was no further improvement in these associations by averaging >4 nighttime readings. The diagnostic agreement between the two methods in detecting nocturnal hypertension was progressively improved by averaging more nighttime HBP readings with near plateau at 4 measurements.

Conclusions:

A two-night HBP monitoring schedule (6 readings) appears to be the minimum requirement for a reliable assessment of nighttime HBP in children and adolescents, which provides reasonable agreement with nighttime ABP and association with preclinical organ damage.
P006 AGE-RELATED DIFFERENCES IN PULSE PRESSURE AND AMBULATORY ARTERIAL STIFFNESS INDEX MEASURED BY AMBULATORY BLOOD PRESSURE MONITORING
Authors: Córdoba Laura Fernanda Gilón , Gómez Valencia Aura Maria , Póveda Henao Claudia Marcela , Villegas Claudia Jaramillo , Beltrán Fernan Mendoza
Published: September 2024

Background:

Hypertension is a prevalent public health concern, particularly affecting older adults. Beyond optimal blood pressure (BP) control, ambulatory blood pressure monitoring (ABPM) offers valuable insights into additional cardiovascular parameters like pulse pressure (PP), arterial stiffness index (AASI), and heart rate (HR). Studies have shown that PP correlates with systolic blood pressure and predicts cardiovascular mortality in older adults (1). Furthermore, AASI, a readily measured indirect marker of arterial stiffness, has demonstrated predictive power for cardiovascular mortality (2).

Objective:

This study investigates the differences in PP, AASI, and HR measured through ABPM across age groups (younger than 50 years, 50-65 years, and over 65 years) and between genders.

Methods: This cross-sectional descriptive study analyzed ABPM data collected between 2018 and 2024 from a cardiovascular institution in Colombia. Mean systolic and diastolic BP, heart rate, AASI, and PP were evaluated based on age and sex. Normality testing was performed using the Kolmogorov-Smirnov test. For continuous variables, parametric ANOVA tests compared values across age groups. Categorical variables were analyzed using Chi-square tests.

Results:

A total of 150 patients participated in the study, with females comprising 76 (50.7%) of the group. The age distribution was: 23.3% younger than 50 years, 41.3% between 50-65 years, and 34.0% over 65 years old. Significant differences were found in diastolic BP, PP, AASI, and HR between the age groups. Importantly, no significant differences were observed in these measures based on gender, nor in systolic BP by age or sex.

Conclusions:

Our findings align with previous research, demonstrating an increase in PP and AASI with advancing age. Given its widespread availability, ABPM offers a valuable tool. Incorporating additional parameters like PP and AASI provides further information potentially linked to cardiovascular mortality risk.

1. Glynn RJ et al. Pulse Pressure and Mortality in Older People. Arch Intern Med. 2000;160(18):2765–2772.

2. Li, Y. et al. Ambulatory arterial stiffness index derived from 24-hour ambulatory blood pressure monitoring. Hypertension, 47(3), 359–364.
P007 HIGH PREVALENCE OF HYPOTENSION IN OLDER ADULTS ON AMBULATORY BLOOD PRESSURE MONITORING (ABPM)
Authors: Córdoba Laura Fernanda Gilón , Valencia Aura Maria Gómez , Villegas Claudia Jaramillo , Henao Claudia Marcela Póveda , Beltrán Fernan Mendoza
Published: September 2024

Background:

Hypertension, a prevalent public health concern, disproportionately affects older adults. Effective blood pressure (BP) control is crucial to preventing cardiovascular complications such as heart attack, stroke, and heart failure. In recent years, there has been a discussion about the optimal BP control strategies in older adults (1). While some studies advocate for intensive BP control, others emphasize the importance of considering individual patient characteristics, such as age and frailty (2,3).

Objective:

This study aims to describe the prevalence of hypotension in ambulatory blood pressure monitoring (ABPM) in older adult patients compared to younger patients.

Methods:

This cross-sectional descriptive study analyzed ABPM records from 2018 to 2024 at a cardiovascular institution in Colombia. The difference in systolic (SBP) and diastolic (DBP) blood pressure was evaluated according to the age group (younger or older than 80 years) to determine the presence of hypotension in older adults defined as pressure less than 90/60 mmHg. Normality was assessed using the Kolmogorov-Smirnov test. Comparisons of continuous variables across age categories were performed using the non-parametric Mann-Whitney U test. For categorical variables, the Chi-square test was employed.

Results:

Among the 653 participants, 57.3% (374) were women. The average age was 63 years, with 60 patients (9.18%) being over 80 years old. Table 1 shows a significant difference in systolic and diastolic blood pressure (SBP and DBP) between the age groups. Notably, 47.5% of patients over 80 had SBP less than 130 mmHg, and a high prevalence (84.7%) had DBP less than 90 mmHg. DBP below 60 mmHg was more common in this age group. Additionally, 20 older adults had SBP between 130-139 mmHg.

Conclusions:

This study demonstrates a high prevalence of hypotension, especially low DBP, in older adults. Considering these findings, re-evaluating current blood pressure control targets for older adults is crucial to avoid overtreatment and minimize the risk of complications like symptomatic hypotension and falls.
P008 COMPARISON OF CLINICAL OUTCOME OF ELDERLY (AGED >65 YEARS) VS NON-ELDERLY HYPERTENSIVE STEMI PATIENTS: RESULTS FROM NAMI REGISTRY
Authors: Kalimuddin Md , Malik Fazila Tun-Nesa , Ishraquzzaman Mir , Ahmed Nazir , Badiuzzaman Mohammad , Ahmed MN , Dutta Ashok , Banik Dhiman , Rahman MH , Huq TS , Kanungo Smita , Laila Nazmun , Ara Esmat , Choudhury SR , Mamun Mohammad Abdullah Al
Published: September 2024

Background and Objective:

Elderly hypertensive ST-segment elevation myocardial infarction (STEMI) patients had increased morbidity and mortality. Little is known regarding clinical outcome of elderly hypertensive STEMI patients worldwide. This study aimed to compare clinical outcome of elderly and non-elderly hypertensive STEMI Bangladeshi patients.

Methods:

This prospective observational study- National Heart Foundation Hospital Acute Myocardial Infarction (NAMI) Registry was carried out in our hospital over eight years (2015-2022). All hypertensive STEMI patients were included in this study. Clinical outcome of elderly (aged >65 years) and non-elderly (aged ≤65 years) patients were compared.

Results:

NAMI registry enrolled 10488 STEMI patients. Among them 6890 (65.69%) patients were hypertensive and included in this study. Of them 1127 (16.4%) patients were elderly, and 5763 (83.6%) patients were non-elderly. The mean age of the elderly patients was 72.93 ± 5.5 years and non-elderly patients 52.54 ± 8.69 years. Although male were predominant in both groups (79.3% vs 85.0%; p=0.001), significantly more female were in elderly group (20.7% vs 15.0%; p=0.001). Most of the elderly patients had chronic kidney disease (85.1% vs 41.3%; p=0.001). Most of the non-elderly patients were smokers (52.8% vs 41.3%; p=0.001), dyslipidemic (81.1% vs 76.0%; p=0.001), and obese (38.8% 31.4%; p=0.001). Elderly patients received less invasive therapy (thrombolytic therapy- 14.3% vs 19.0%, p=0.002; primary percutaneous coronary intervention- 10.6% vs 11.6%; pharmaco-invasive therapy-5.9% vs 11.4%, p=0.001; only percutaneous coronary intervention- 18.4% vs 20.0%) and more medical therapy (50.9% vs 38.1%; p=0.001). Elderly patients were more prone to complications (cardiogenic shock- 14.8% vs 10.8%, p=0.001; acute left ventricular failure- 33.9% vs 22.7%, p=0.001; conduction disturbance- 15.2% vs 9.7%, p=0.001; arrhythmias- 13.1% vs 8.2%, p=0.001; cardiac arrest-7.5% vs 4.7%, p=0.001; in-hospital death- 7.9% vs 4.2%, p=0.001).

Conclusions:

Most of the elderly hypertensive STEMI patients had chronic kidney disease, less risk factor, received less invasive therapy but more medical therapy and were more prone to complications in comparison to younger counterpart.