bluuebunny/crossref_metadata_2025 huggingface dataset:
PS-C23-6: THE ASSOCIATION OF ANTHROPOMETRY AND DIETARY PATTERNS WITH THE SEVERITY OF HYPERTENSION AT DIAGNOSIS IN HYPERTENSIVE PATIENTS IN SRI LANKA
Authors: Ralapanawa Udaya , Karunathilake Parackrama
Published: January 2023

Objective:

The association between hypertension with anthropometric measurements and dietary patterns has been studied globally, giving variable results. This study analyses the anthropometry and dietary patterns of hypertensive patients in Sri Lanka.

Methods:

A cross-sectional descriptive study was designed to include hypertensive patients admitted to Teaching Hospital Peradeniya, Sri Lanka, from June 2015 to June 2016. An interviewer-administered questionnaire was used to collect data, and the clinical parameters were measured. Analysis was performed using the SPSS 26.0 statistical package.

Results:

371 patients were included in the study with a mean age of 64.6 ± 11.4 years, 68.2% females. The mean weight, height, body mass index (BMI), and the waist circumference (WC) of the population were 58.0 ± 12.2 kg, 152.5 ± 8.0 cm, 24.9 ± 4.8 kg/m2, and 90.1 ± 12.8 cm, respectively. The sample composition according to systolic blood pressure (SBP) at diagnosis was, normal (< 130 mmHg) 2.5%, high normal (130–139 mmHg) 14.2%, Grade 1 (140–159 mmHg) 51.9%, and Grade 2 (> 160 mmHg) 31.5%, and according to diastolic blood pressure (DBP) at diagnosis was, normal (< 85 mmHg) 6.8%, high normal (85–89 mmHg) 0.6%, Grade 1 (90–99 mmHg) 43.8%, and Grade 2 (> 100 mmHg) 48.8%. The mean weight, height, BMI, and WC did not differ between these groups (p > 0.050). Simple linear regression analysis did not reveal any correlation between the systolic or diastolic blood pressure at diagnosis with the weight, height, BMI, or WC (p > 0.050). Considering the diet, out of 14 food components, the consumption of rice, vegetables, sweat, and dairy products was the highest (18.8, 18.0, 12.4, and 8.5 mean number of meals per week). Regarding the variation of food consumption between the SBP groups, only grains and pulses (p < 0.001), and dairy products (p = 0.034) showed a significant variation. For the SBP categories normal, high normal, Grade 1 and Grade 2, the mean consumption of grains and pulses and dairy products per week were (14.0, 4.7, 3.8, 3.5) and (14.0, 8.2, 7.1, 7.4) respectively. Regarding the DBP categories, consumption of fried food showed a significant variation (p = 0.044) in addition to grains and pulses (p = 0.009) and dairy products (0.007). For the DBP categories normal, high normal, Grade 1 and Grade 2, the mean consumption of fried foods, grains and pulses and dairy products per week are (2.7, 0.0, 1.2, 1.9), (7.8, 0.0, 4.3, 3.4) and (11.5, 7.0, 6.4, 8.0) respectively. Between the bloods pressure groups, there was no significant variation in the consumption of salty foods.

Conclusion:

There is no association between the anthropometric measurements and the severity of hypertensionat the diagnosis, however the dietary components grains and pulses and dairy products showed a negative correlation, and fried foods only showed an effect on DBP.
PS-C24-2: SYSTOLIC BLOOD PRESSURE AND MORTALITY IN ELDERLY PATIENTS WITH HEART FAILURE
Authors: Inoue Taku , Shinjo Tetsuji , Matsuoka Mitsuteru , Tamashiro Masahiro , Arasaki Osamu , Arima Hisatomi
Published: January 2023

Background:

Optimal blood pressure levels in elderly patients are controversial. Our previous results demonstrated that systolic blood pressure (SBP) lowering to less than 140 mmHg might not improve the prognosis in elderly hypertensive patients with frailty. Optimal blood pressure levels for elderly patients with heart failure (HF) have not yet been established.

Objective:

To examine the association between SBP level and mortality in elderly outpatients with or without HF.

Design and setting and participants: A prospective cohort study of older patients in an outpatient setting in Okinawa (Nambu Cohort Study) included 630 patients. Data were collected from 2017 to 2021. Patients were stratified into four categories according to SBP levels of more or less than 140mmHg and presence or absence of HF.

Results:

A total of 630 patients, with a median (IQR) age of 78 (71 - 84) years and 50% of whom were men, were followed for a median duration of 42 (34 - 43) months. 56% of them had SBP less than 140 mmHg, and 21% were diagnosed as HF. All-cause mortality occurred in 39 (11%) and 31 (11%) of patients with SBP less than 140 mmHg vs. SBP more than 140 mmHg, respectively (HR 1.02, 95%CI 0.64 - 1.65). Likewise, 32 (24%) and 38 (8%) of patients with HF vs. without HF were dead, respectively (HR 3.75, 95% CI 2.33 - 6.00). Adjusted HR (95%CI) for all-cause death of each category patients was as follows; SBP less than 140 mmHg / Non-HF (Reference), SBP more than 140mmHg / Non-HF 1.41 (0.74 - 2.71), SBP less than 140 mmHg / HF 2.71 (1.40 - 5.29), SBP more than 140mmHg / HF 3.75 (1.67 - 8.09) (Figure).

Conclusion:

In an elderly outpatient setting, an SBP level of more than 140mmHg was likely associated with an increased risk of all-cause mortality in HF and non-HF patients but not statistically significant. On the other hand, HF was associated with increased mortality risk.
PS-C24-10: HAEMODYNAMIC CHARACTERISTICS OF THE HEART BEFORE AND AFTER CRT IN PATIENTS WITH HEART FAILURE
Authors: Kuanyshbekova Roza Tokhtanalievna , Akhyt Bagdat , Mussagaliyeva Aisulu Tolekaevna , Koshumbaeva Kulzida Mukievna , Madaliev Kurmangazy Nurmaganbetovich
Published: January 2023

The aim of the study:

to evaluate the clinical and hemodynamic effects of resynchronization therapy in patients with congestive heart failure.

Materials and Methods:

seventy-six consecutive patients underwent echocardiography, NYHA classification, 6-minute walk test before and after cardiac resynchronization therapy. All had complete left bundle branch block, with a QRS complex duration greater than 130 ms. and left ventricular ejection fraction less than 35%. Also, all patients had received optimal medical therapy for at least 3 months before inclusion to the study.

Results:

we observed significant increase in left ventricular ejection fraction (on 35.4 ± 3.7%, p < 0.001, compared with baseline) and decrease in end-systolic volume of the left ventricle (on 20.2 ± 3.0%, p < 0.001 compared with baseline). Improvement in functional class of congestive heart failure by NYHA classification by more than 1 was observed in 68.4% of individuals, in 26.3% of participants demonstrated no change and 5.3% of patients had worsening of CHF symptoms.

Conclusions:

the response of patients with congestive heart failure to cardiac resynchronization therapy is heterogeneous. The relationship between left ventricular reverse remodeling and the functional class of the congestive heart failure was not significant.
PS-C24-11: CLINICAL COURSE OF ACUTE DECOMPENSATED HEART FAILURE IN PATIENTS WITH RENAL DYSFUNCTION
Authors: Bezrodnyi Andrii , Mostbauer Galina , Rudenko Julia , Karasevska Tetyana
Published: January 2023

The aim of the work:

To determine the influence of the presence of impaired renal function on the clinical course of the disease of acute decompensated heart failure.

Materials and methods:

The prospective study involved 72 patients with acute decompensated heart failure aged 48 to 82 years (mean age 68.4 ± 2.1), including 53 (73.6%) men, who were successively hospitalized in the cardiology department of the Oleksandrivska Clinical Hospital in Kyiv, Ukraine. Patients were divided into two groups depending on GFR at hospitalization: < 60 ml/h/1.73m2, i.e. significantly reduced, and < 60 ml/h/1.73m2, i.e. mildly to moderately decreased.

The results:

In the group with reduced GFR, patients were significantly older in age (63.7 ± 2.83 vs. 56.4 ± 2.48, p < 0.01) and differed in a higher frequency of hypertension (84.7% vs. 55.6%, p < 0.01), diabetes mellitus (30.6% vs. 15.3%, p < 0.05), a decrease in LVEF < 45% (88.9% vs. 69.4%, p < 0.01). The average time of hospital treatment was 14.7 ± 0.9 days in the GFR < 60 group, and 11.6 ± 0.5 days in the GFR < 60 ml/h/1.73m2 group, p < 0.01. A greater severity of HF according to NYHA classes with a predominance of IV FC in patients of this group was associated with a greater severity of clinical manifestations of congestion - shortness of breath according to the Borg scale, congestion index (all p < 0.05), as well as an increase in E/E‘ by 22.7% and NT-proBNP - by 24.2% (p < 0.01).

Conclusions:

In patients with acute decompensated heart failure, renal dysfunction is observed in 62,5% of cases and is associated with a more difficult clinical course of the inpatient treatment period, a higher frequency of arterial hypertension, more severe signs of congestion and the need for more aggressive decongestive treatment. An additional negative contribution is the development of acute kidney injury during the first 48 hours in a significant part of patients.
PS-C25-2: NOVEL AND SIMPLE INDEX USING BIOMARKERS FOR DETECTING SARCOPENIA IN PATIENTS WITH CARDIOVASCULAR DISEASE
Authors: Harada Haruhito , Nishiyama Yasuhiro , Niiyama Hiroshi , Katoh Atsushi , Kai Hisashi
Published: January 2023

Objectives:

Sarcopenia has been highlighted as a common comorbidity in patients with cardiovascular disease (CVD), which is related to poor prognosis. Sarcopenia is generally diagnosed based on the decrease in skeletal muscle index (SMI) and the reduction of either handgrip strength or gait speed. However, SMI is difficult to measure for general physicians or cardiologists, because special, expensive equipment (i.e. bioelectrical impedance assay (BIA) or dual-energy X-ray absorptiometry) is necessary. Therefore, the aim of this study was to investigate a new, simple index to detect sarcopenia in CVD patients.

Design and Methods:

We retrospectively investigated the association of sarcopenia with physical examination data and circulating biomarkers of nutrition, inflammation, skeletal muscle homeostasis in CVD patients who admitted in our hospital. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia (AWGS) guidelines using SMI measurements by BIA method. The age criterion was not adopted for sarcopenia diagnosis in this study.

Results:

This study included 132 consecutive inpatients (72 [27–93] years, 80 males) with CVD and/or undergoing cardiovascular surgery. According to the modified AWGS guidelines, 39 patients were diagnosed as having sarcopenia and 93 patients as not having sarcopenia. Sarcopenic patients were older and had lower estimated glomerular filtration rates (eGFR) and lower Barthel index, and included higher numbers of females and subjects with chronic kidney disease, as compared with non-sarcopenic patients. Among the screened biomarkers (e.g. hsCRP and IL-6), serum adiponectin and sialic acid was significantly higher in sarcopenic patients than non-sarcopenic patients. On stepwise multivariate regression analysis, adiponectin, sialic acid, sex, age, and body mass index were independent detecting factors for sarcopenia based on the modified AWGS criteria. Sarcopenia index was obtained from the diagnostic regression formula for sarcopenia detection including the five independent factors. Sarcopenia index indicated a high accuracy in ROC curve analysis (sensitivity 94.9%, specificity 69.9%) and the cutoff value for sarcopenia detection was -1.6134. Sarcopenia index had a significant correlation with the conventional diagnostic parameters of sarcopenia.

Conclusion:

Novel biomarker-based sarcopenia index would be a simple, useful tool for detecting sarcopenia in CVD patients.
PS-C25-4: VALIDATION OF ACTIVITY MONITORS IN AND OUT-OF-THE LABORATORY ENVIRONMENT
Authors: Dreisbach Scott B , Rhudy Matthew B , Henriquez Brandon , Veerabhadrappa Praveen
Published: January 2023

Objective:

Physical inactivity is an important risk factor for cardiovascular disease (CVD). Activity monitors track activity and health which can used to measure progress in CVD population. Fitness trackers may help motivate consumers towards a healthier lifestyle by providing feedback, tracking and accountability to maintain regular exercise. Before placing trust in these monitors, their validity and reliability must be determined both, within the laboratory and out-of-laboratory environment. The purpose of this study was to validate the step counts of Apple Watch and compare wrist-, hip- and ankle- worn Actigraphs, in and out-of-the-laboratory environment during treadmill and overground walking respectively, at different walking intensities using video monitoring of participants with manual counting of steps as a reference.

Design & method:

Apple Watch and wrist-, hip- and ankle- worn Actigraphs were used for this study. Participants walked on a set track on a flat, overground surface to mimic free-living conditions. Verbal instructions were provided to walk at three different stages (slow, moderate, fast). Subsequently, participants completed a 3-stage treadmill protocol using the calculated average velocity/stage from overground walking. Both conditions were recorded using a Canon VIXIA HF500 camcorder to observe the steps. All data was collected and analysed between 2017 and 2018.

Results:

Apple Watch, compared to Actigraphs, had the lowest errors (absolute: -2.32, -8.95, and -20.00steps; relative: -1%, -2% and -5%) during overground walking for all stages, and (absolute: -3.35 and -2.25 steps; relative: -1% and -1%) on the treadmill protocol for the moderate and fast stages.

Conclusions:

Apple Watch was an extremely accurate and credible consumer device that can be used by the general population for activity monitoring during overground and treadmill walking. Our study demonstrated the equivalence of step counts during overground and treadmill walking. Such simple, cost effective and precise monitoring could play a larger role to reduce the burden of CVD.
PS-C25-5: ASSOCIATIONS BETWEEN CARDIORESPIRATORY FITNESS AND CARDIOVASCULAR PARAMETERS DERIVED AT REST FROM FINGER PHOTOPLETHYSMOGRAM
Authors: Cox James R , Qasem Ahmad , Tan Isabella , Butlin Mark
Published: January 2023

Objective:

Cardiorespiratory fitness has been shown to be correlated with cardiovascular complications and comparable to other conventional health parameters. Consequently, it can be a useful preventative and a practical first line of information for cardiovascular diseases, such as hypertension. Wearable devices have the capacity to provide a convenient assessment of individuals cardiorespiratory fitness. Despite its clinical relevance measures of cardiorespiratory fitness remain limited to commercial devices for exercise training purposes. This study investigates whether there is potential for cardiorespiratory fitness to be derived from indices measured at rest from a finger photoplethysmogram waveform.

Design and method:

Participants (n = 8, 4 females, 39 ± 17 years) first completed two questionnaires to provide two separate estimates of cardiorespiratory fitness. The first questionnaire by Jackson et al. (1990) provides an estimated maximum rate of oxygen (VO2max, gold standard measure of cardiorespiratory fitness) based on height, weight, age, and a subjective physical activity rating score. The second questionnaire by Radim et al. (2005) provides a metabolic equivalent parameter (MET) that has previously been shown to correlate with measured VO2max. Following 10 minutes of seated rest, 30 seconds of finger photoplethysmography was recorded. A 10-second snippet with high quality signal was extracted, and a generalised transfer function was applied to the signal to generate an uncalibrated central aortic waveform. Pulse pressure amplification (PPAmp), ejection duration (ED), subendocardial viability ratio (SEVR), heart rate (HR) and augmentation index corrected to a HR of 75 bpm (AIx75bpm) were then calculated for each cardiac cycle and averaged over 10 seconds. Correlation plots and stepwise linear regression were then performed on the estimated VO2max and MET with the derived parameters.

Results:

Average baseline estimated VO2max was 44 ± 10 ml/kg/min and estimated MET was 11 ± 2 (1 MET = VO2/3.5). Stepwise linear regression revealed AIx75bpm, SEVR and HR were the strongest predictors of estimated VO2max (model R^2 = 0.929, F = 17.44, p = 0.009). Only AIx75bpm and SEVR were strongly associated with estimated MET (model R^2 = 0.942, F = 40.5, p < 0.001). For both estimated VO2max and estimated MET, individual correlation plots for PPAmp and ED showed poor correlation.

Conclusion:

A selection of non-exercise derived central aortic parameters from finger photoplethysmography were correlated with cardiorespiratory fitness. This demonstrates that a finger photoplethysmogram signal obtained at rest, such as can be easily measured in wearable devices, may be useful in management and monitoring of cardiorespiratory fitness, and by association health, without the burden of performing rigorous exercise tests.
PS-C26-1: USEFUL MARKERS FOR RENAL PROGNOSIS IN HYPERTENSIVE EMERGENCIES WITH SEVERE RENAL DYSFUNCTION
Authors: Nakazato Rei , Mii Akiko , Sakai Yukinao , Iwabu Masato
Published: January 2023

Background:

Hypertensive emergencies are poor prognosis conditions associated with rapid blood pressure (BP) elevation and various organ damage. The frequency of dialysis induction due to nephrosclerosis is high and early detection and appropriate therapeutic intervention are important.

Methods:

We selected 15 patients diagnosed as hypertensive emergencies with severe renal dysfunction (serum creatinine level > 2.5 mg/dL) admitted to our hospital between 2005 and 2019. These were divided into two groups: those who received a renal replacement therapy (RRT) after 3 years and those who were not received (non-RRT). The clinical features and laboratory data between the two groups were reviewed and compared retrospectively.

Results:

The median age was 48 years old and the male to female ratio was 3:1. All the patients lacked medical examination and regular checkups after diagnosis of hypertension. 33% of them were obese with body mass index > 25. Six patients resulted in end-stage renal disease and received RRT. On admission, about 80% had elevated plasma renin activity and serum aldosterone levels, while there were no cases of renal artery stenosis. Between two groups, there was no significant difference in serum creatinine levels. Serum LDH levels in the non-RRT group were higher than those in the RRT group. Serum potassium levels and platelet counts were lower, respectively. These data at post-antihypertensive treatment was improved significantly in the non-RRT group. Serum values of LDH, potassium, and platelet in the comparison of pre-and post-treatment data of the two groups showed significantly improved by two-way analysis of variance.

Discussion and Conclusion:

The mechanism of the onset of hypertensive emergencies is still unclear. Severe hypertension causes severe vascular injury and multiple organ damages. In our study, there were young or middle-aged adults and some of them were obese. Therefore, taking health-checkup is helpful for the prevention of the risk of hypertension and appropriate treatment. Higher LDH levels and decreased platelet counts in the non-RRT group suggested the development of severe endothelial damage with rapid BP elevation in the short term. Severe renal dysfunction in these cases can be improved to some extent by appropriate antihypertensive therapy. Furthermore, the lower potassium level suggested the aggravation of the renin-angiotensin-aldosterone system (RAAS) and early induction of RAS inhibitors would be beneficial for the maintenance of BP and renal protection. In conclusion, the value of serum LDH, platelet count, and serum potassium would be predictors of renal prognosis.
PS-C26-4: ASSOCIATIONS BETWEEN ARTERIAL STIFFNESS INDICES AND CHRONIC KIDNEY DISEASE CATEGORIES IN ESSENTIAL HYPERTENSIVE PATIENTS
Authors: Kusunoki Hiroshi , Iwashima Yoshio , Kawano Yuhei , Ohta Yuko , Hayashi Shin Ichiro , Horio Takeshi , Shimizu Hideo , Shinmura Ken , Ishimitsu Toshihiko , Yoshihara Fumiki
Published: January 2023

Background:

This study investigated the association between arterial stiffness indices and asymptomatic chronic kidney disease (CKD) risk categories in hypertensive patients by using oscillometric device.

Methods:

Arterial stiffness indices, including 24-hour brachial and aortic systolic blood pressure (SBP) and pulse wave velocity (PWV), were measured by an oscillometric Mobil-O-Graph device, brachial-ankle PWV (baPWV) by a volume-plethysmographic method, and renal resistive index (RI) by ultrasonography, in 184 essential hypertensive patients (66.0 ± 17.1 years, 47.3% male). CKD was categorized into 3 stages based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria, using a combination of estimated glomerular filtration and albuminuria.

Results:

The 24-hour aortic PWV (aPWV), baPWV, and RI increased with worsening severity of CKD risk category (all P < 0.01 for trend). Multivariate logistic regression analysis found that a 1 SD increase of nighttime aortic SBP (odds ratio [OR] 1.52), PWV (OR 4.80), or RI (OR 1.75) was an independent predictor of high or very-high CKD stage (all P < 0.05). After adjustment for potential confounders, day-to-night change in brachial SBP as well as in aPWV differed among groups (P < 0.05, respectively). In a multivariate regression model, day-to-night changes in aortic SBP and PWV, and RI were independently associated with day-to-night brachial SBP change.

Conclusions:

In hypertension, circadian hemodynamics in high CKD stage are characterized by higher nighttime values of aortic SBP and PWV and disturbed intrarenal hemodynamics. Further, the blunted nocturnal BP reduction in these patients might be mediated via disturbed intrarenal hemodynamics and circadian hemodynamic variation in aortic SBP and arterial stiffness.
PS-C26-6: HYPERTENSION DUE TO HYDRONEPHROSIS SECONDARY TO IGG4-RELATED DISEASE
Authors: Matsuoka Hiroki , Shimizu Hideaki , Kawada Kyogo , Naruse Yuki , Hayakawa Takuto , Goto Shuji , Kishima Yukari
Published: January 2023

Background:

Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory condition that is capable of affecting multiple organs. It can present as an inflammatory pseudotumor in various organs. Patients may present with normo- or hypertension (HT) and urinary tract obstruction (UTO). Hydronephrosis (HN) leads to HT by overloading vessels or activating the renin-angiotensin system.

Case presentation:

A 53-year-old man presented with a two week history of abdominal pain. At admission, his blood pressure (BP) was 208/112 mmHg. His physical examination was otherwise unremarkable. Laboratory data and imaging revealed post-renal azotemia. HN was identified due to a mass around the aorta causing bilateral ureteric compression. The right ureter was considered to be more recently compressed because the left kidney cortex was more extensively thinned compared to the right kidney, respectively. Insertion of a double J stent in the right ureter led to improve urinary output with an attendant reduction of weight of 7 kg. Renal function also improved substantially (serum creatinine 5.66 mg/dL at admission; 1.34 mg/dL post-stent insertion).

Initial treatment included intravenous nicardipine, followed oral nifedipine and telmisartan. With the above interventions, HT normalized to 132/71 mmHg in nine days. Finally, only telmisartan was required to maintain normal BP upon discharge.

Biopsies of a salivary gland, the lip, and a cervical lymph node were non-diagnostic. The abdominal mass was not biopsied. Urine cytology was negative for malignancy three times. Serum lactate dehydrogenase was within normal limits, whereas soluble interleukin-2 receptor was elevated at 1,730 U/mL. IgG4-RD was considered as the likely cause. In accordance with current international diagnostic criteria for IgG4-RD, there was: 1) no exclusion criteria, 2) elevated serum IgG4 level, 3) hypocomplementemia, and 4) circumferential soft tissue around the infrarenal aorta. Oral corticosteroid therapy was prescribed. At 40 days post-discharge, follow-up imaging showed a slight reduction in the size of the soft tissue mass. Hypocomplementemia also showed improvement.

Conclusion:

HT was induced by UTO secondary to suspected IgG4-RD. It is reported that HT due to IgG4-RD occur in over one third of cases. Pathophysiology of HT includes renal parenchymal disease and HN. Laboratory data at admission revealed that the plasma renin activity and plasma aldosterone concentration were normal. His BP was ameliorated after urinary output improved, despite using antihypertensive monotherapy. Thus, we suspected that volume overload due to UTO led to HT. We suggest that HN should be considered as a differential diagnosis for the cause of HT.
PS-C26-10: THE PROPKD SCORE IS ASSOCIATED WITH THE PROGRESSION OF RENAL INVOLVEMENT IN PATIENTS WITH POLYCYSTIC KIDNEY DISEASE TREATED WITH TOLVAPTAN
Authors: Moriyama Tomofumi , Taguchi Kensei , Kaida Yusuke , Ito Sakuya , Kodama Goh , Yokota Yunosuke , Nasu Makoto , Fukami Kei
Published: January 2023

Background:

The PROPKD score has been proposed to evaluate the risk of the progression to end stage renal failure in patients with autosomal dominant polycystic kidney disease (ADPKD), based on gender (male: 1point), hypertension under 35 years old (2 points), urological event under 35 years old (2 points), and gene mutation (PKD1 truncating mutation: 4 points, PKD1 non-truncating mutation: 2 points, PKD2: 0 point). Although tolvaptan has benefits for renal involvement, whether PROPKD score could predict future renal involvement in patients with ADPKD treated with tolvaptan is unknown. Thus, we explored the effects of tolvaptan on the annual changes in total kidney volume (%TKV) and estimated glomerular filtration rate (%eGFR) according to the PROPKD score in these patients.

Methods:

32 ADPKD patients treated tolvaptan for at least a year were retrospectively analyzed (the mean observation period: 3.6 years). We examined the decline in renal function, %TKV by computed tomography, and gene mutation. The association between %eGFR and %TKV change before and after tolvaptan treatment, annual TKV change (%TKV) and PROPKD score was analyzed.

Results:

We identified gene mutations in ADPKD patients: PKD1 truncating mutation (n = 15), PKD1 non-truncating mutation (n = 5), PKD2 mutation (n = 6), and mutation not found (n = 6). Mean %TKV and eGFR were 1843 ± 986 ml and 54.7 ± 21.0 ml/min/1.73 m2, respectively. The mean PROPKD score was 3.3 ± 2.4 points and showed a significant negative correlation with %eGFR before and after tolvaptan treatment (p = 0.044/0.016), and no significant correlation with %TKV before and after tolvaptan treatment.

Conclusion:

The higher PROPKD score, the faster the decrease in %eGFR during tolvaptan therapy, suggesting that the PROPKD score may be useful as a predictor of the risk of progression to renal failure after tolvaptan introduction.
PS-C27-9: THE IMPORTANCE OF BP CONTROL IN AKI: THE KEY TO AN ESCAPE FROM RRT - NEW OPPORTUNITIES OR VAIN HOPES?
Authors: Kwiatkowska Marlena , Kawalec Malgorzata Twardowska , Malyszko Jolanta
Published: January 2023

Objective:

Chronic kidney disease-CKD is associated with 18-fold increased cardiovascular risk, however data on acute kidney injury-AKI, in cardiovascular risk are limited. Hypertension (HT) is an overwhelming finding in CKD but again data on hypertension prevalence in AKI are very scarce. The etiology of HT AKI could be multifactorial thus BP control requires multidirectional, frequently aggressive, treatment and is one of the major challenge of nephrologists and hypertension specialists. The aim of the study was to assess blood pressure control in patients with AKI admitted to the nephrology department.

Design and method:

The retrospective analysis of 215 (mean age 58y) patients with AKI (N17) was made based on the medical documentation. The medical history, BP measurements body mass, diuresis, laboratory tests, the presence of peripheral edema and the echocardiography were taken. The kind of using hypotensive drugs and the connection between the number of them, the presence of volume overload and BP control, need for dialysis, were analyzed. Among patients with AKI 35% requires acute hemodialysis-HD, due to either clinical or biochemical indications.

Results:

AKI patients requiring HD were significantly older than patients treated conservatively group (Me = 67 vs. Me = 54y, p < 0,01) and had much higher both systolic and diastolic blood pressure values (p < 0.01 for both). The renal function was less present in AKI group requiring HD. The peripheral edema was observed significantly more often in HD group with uncontrolled BP (above 140/90 mmHg) (72,2% vs 35,7%, p < 0,05). The average amount of hypotensive drugs was 5 in HD and 3 in non-HD patients. The most used hypotensive drug was calcium channel blocker, diuretic and beta-blocker. Non-HD patients were treated with ACEi and ARB significantly wider (p < 0,05). There were no differences in echocardiographic parameters.

Conclusions:

There were the better BP and volume control in HD group. We confirmed the connection between BP control, volume status and the duration of dialysis, particularly in PD patients. Salt dietary restriction and the better volume control in PD patients are strongly recommended. ACEi should be used more widely, particularly in patients with the high risk of cardiovascular disease.
PS-C27-10: SHORT-TERM EFFICACY OF DAPAGLIFLOZIN FOR CHRONIC KIDNEY DISEASE PATIENTS
Authors: Nakai Kentaro , Hara Yuichiro , Inoue Megumi , Shukuri Tomoya , Hara Masatoshi , Nakagawa Kaneyasu , Tokumoto Masanori
Published: January 2023

Background:

Dapagliflozin, a SGLT-2 inhibitor, has been reported to prevent renal and cardiovascular events. Dapagliflozin has been approved for use in chronic kidney disease (CKD) without diabetes, so that it has been widely used in CKD patients.

Methods:

This study was a single-center, retrospective, and longitudinal study consisting of 102 patients (75% male, mean age 61.5 ± 15.7 years, 30.3% diabetes), who were started dapagliflozin prescription at our department between April 2021 and March 2022. The efficacy of treatment on proteinuria, blood pressure and blood sample findings (hemoglobin, uric acid, phosphorus and creatinine) in the short term (64.1 ± 46.7 days) between initiation of treatment and the first return visit were compared in two groups: advanced CKD (eGFR under 30 mL/min/1.73 m2) and moderate CKD (GFR more than 30 mL/min/1.73 m2).

Results:

Advanced CKD patients were older (mean age 65.1 ± 14.7 years vs. 58.2 ± 15.9 years) and had more diabetes (45.8% vs. 16.7%) compared with Moderate CKD patients, but the sex ratio was similar between the two groups. Proteinuria did not change in Advanced CKD, but decreased significantly from 2.1 ± 2.1 g/gCr to 1.8 ± 2.0 g/gCr in Moderate CKD. Systolic blood pressure significantly decreased from 144.1 ± 15.0 mmHg to 136.6 ± 26.1 mmHg in Advanced CKD and tended to decrease from 140.0 ± 17.4 mmHg to 135.4 ± 18.2 mmHg in Moderate CKD. Hemoglobin increased significantly in Moderate CKD (from 14.2 ± 1.8 g/dL to 14.7 ± 1.8 g/dL) and uric acid decreased significantly (from 6.4 ± 1.4 mg/dL to 5.4 ± 1.3 mg/dL), but no significant change was observed in Advanced CKD. On the other hand, Advanced CKD patients showed a significant increase in serum phosphorus (from 4.0 ± 1.3 mg/dL to 4.3 ± 1.5 mg/dL) and serum creatinine (from 3.2 ± 1.6 mg/dL to 3.3 ± 1.8 mg/dL). Serum creatinine elevation above 0.3 mg/dL was found in 29% of Advanced CKD patients, but not in any Moderate CKD patients.

Conclusions:

Dapagliflozin may reduce blood pressure and improve anemia, proteinuria, and hyperuricemia in short-term treatment of moderate CKD patients, while acute exacerbation of kidney function should be considered in short-term treatment of advanced CKD patients.
PS-P07-6: ACCESS TO ESSENTIAL MEDICINES AND DIAGNOSTIC TESTS FOR HYPERTENSION AND HEART FAILURE IN MAPUTO CITY, MOZAMBIQUE
Authors: Jessen Neusa , Sharma Abhishek , Jones Jennifer , Auala Tangeni , Boladuadua Sainimere , Jingi Ahmadou , Ferrer Jose , Mocumbi Ana
Published: January 2023

Objective:

To evaluate access (availability, price, affordability) to essential medicines (EMs) and diagnostic tests and technologies for management of hypertension and heart failure (HF) in Maputo City, Mozambique.

Design and method:

In a cross sectional survey, using a modified version of World Health Organization (WHO)/Health Action International methodology, data from a representative sample comprising 6 public and 6 private sector hospitals and 30 private sector retail pharmacies was collected. Upon reviewing WHO Model EM List (EML), Priority Medicines for Children and Women list, Mozambique National EML and guidelines, 50 EMs, including 14 WHO Core and 36 cardiovascular diseases (CVD) EMs were selected. Of those, data for 19 EMs (including different formulations and dosages) for management of hypertension and HF are presented here. Data on 19 diagnostic tests and 17 devices was collected from hospitals. Availability was calculated as percentage of surveyed facilities where a medicine or diagnostic tool was found on the day of survey. Median price ratio (MPR) refers to median consumer price of a medicine compared to respective international reference price (IRP). Medicines were considered unaffordable if to purchase a monthly supply, the lowest paid government worker had to spend more than one day wage.

Results:

Mean availability of anti hypertensive and HF medicines combined was far below WHO target (80%), both in private (retail: 35.0%, hospital pharmacies: 30.6%) and public sectors (hospital pharmacies: 27.8%). Only two surveyed medicines were available in over 80% of public-sector hospital pharmacies. Most (11/19) medicines were available in less than 50% of retail pharmacies.

Median MPR (range) of medicines was high [Lowest Priced Generic (LPG): 3.2 (0.98;19.84); Most Sold Generic (MSG): 4.8 (1.67;19.98)] compared to WHO recommendation (no one should pay greater than 4 times the IRP). LPG versions above that recommendation included amlodipine, enalapril, spironolactone.

The lowest paid worker, on average, would spend more than one day wage to purchase a monthly supply of most EMs.

Mean availability of CVD diagnostic tests and devices was lower in public (54.6% and 61.1%, respectively) compared to private (89.5% and 91.7%, respectively) sector.

Conclusion:

Access to EMs for management of hypertension and HF is very limited in Maputo City, characterized by high prices, low availability and affordability. Access to CVD diagnostic tests and devices is particularly low in public-sector. These data raise important concerns and may guide policies and interventions for improving access to cardiovascular care and serve as benchmark for future comparations.
PS-P07-8: TREATMENT STRATEGIES AND ADHERENCE TO THE TRIPLE COMBINATION OF AN ANGIOTENSIN-CONVERTING ENZYME INHIBITOR, A CALCIUM-CHANNEL BLOCKER, AND A DIURETIC
Authors: Rea Federico , Morabito Gabriella , Savare Laura , Corrao Giovanni , Mancia Giuseppe
Published: January 2023

Objective:

To compare adherence to antihypertensive treatment between patients prescribed the perindopril/amlodipine/indapamide single pill combination (SPC) vs the two pill combination of an angiotensin converting enzyme inhibitor (ACEI), a calcium channel blocker (CCB), and a diuretic (D).

Design and method:

Using the healthcare utilization database of the Lombardy Region (Italy), patients, aged 40 years or older, who received a prescription of perindopril/amlodipine/indapamide SPC during 2015 2018 were identified and the date of the first prescription was defined as the index date. For each patient prescribed the SPC, a subject who started ACEI/CCB/D treatment as a two drug SPC plus a third drug separately (i.e. 2 pills) at the index date was identified. Adherence to the triple combination was assessed over the year after the index date as the proportion of this year period in which prescription made the triple combination available, i.e. by the proportion of the follow up days covered (PDC) by prescription. The primary aim was to compare the odds of being highly adherent to the drug therapy (PDC> 75%) between groups. A secondary aim was to compare the odds of being poorly adherent (PDC < 25%).

Log binomial regression models were fitted to estimate the risk ratio, and its 95% confidence interval, of treatment adherence in relation to the drug treatment strategy, using the two pill combination as reference. Adjustments were made for several demographic and clinical covariates.

Results:

28,210 patients prescribed the perindopril/amlodipine/indapamide SPC were identified and matched to 28,210 patients prescribed ACEI/CCB/D in two pills. Compared with patients on the two pill combination, those treated with a SPC were slightly younger (68 vs 71 years) and more frequently men (54% vs 48%) with no between group difference in the clinical profile.

About 59% and 25% of patients prescribed the three drug treatment as SPC and two pill combination showed high adherence, respectively. Compared with patients under two pill combination, those who were treated with the SPC had a higher propensity to be highly adherent to the triple combination (risk ratio: 2.38, 95% confidence interval 2.32 2.44). This was the case regardless of the sex, age, patient clinical status, and number of co treatments. The odds of being poorly adherent to treatment was much lower in the SPC than in the two pill combination group (risk ratio: 0.33, 0.31 0.34).

Conclusions:

In a real life setting, patients who were prescribed the perindopril/amlodipine/indapamide SPC exhibited more frequently a good adherence to antihypertensive treatment than those prescribed a two pill combination of ACEI/CCB/D.
PS-P07-11: TRENDS OF ANTIHYPERTENSIVE DRUG PRESCRIPTION AND BLOOD PRESSURE CHANGES BY PREFECTURE USING NATIONAL DATABASE OF HEALTH INSURANCE CLAIMS OF JAPAN
Authors: Kuroda Shinnosuke , Sakuma Hirofumi , Matsuki Motoki , Hasebe Naoyuki , Nakagawa Naoki
Published: January 2023

Background:

Blood pressure control is an important issue in extending the healthy life expectancy of the population. The Ministry of Health, Labour and Welfare's “Reference Data on the Promotion of Healthy Japan 21 (Second Phase)” set a target of a mean reduction of 4.2 mmHg in systolic blood pressure, but this target was not achieved from 1998 to 2009.

Objective:

The purpose of this study was to detect prefectures that have effectively lowered systolic blood pressure, and to discuss and examine effective countermeasures for hypertension.

Methods:

We analyzed prescription trends of antihypertensive drugs and changes in systolic blood pressure from the 1st to 6th national database of health insurance claims and specific health checkups of Japan (NDB) open data (specified health examinations from 2013 to 2018 and drug receipts from 2014 to 2019).

Results:

The average change in systolic blood pressure was calculated for each prefecture, and the prefecture with the greatest decrease in systolic blood pressure was Kagoshima Prefecture. Conversely, Yamanashi Prefecture showed the highest increase in systolic blood pressure. Further analysis of antihypertensive drug use revealed that the use of antihypertensive drugs in Kagoshima prefecture was 30.4% for men and 23.9% for women, which was higher than the national average (23.5% for men and 17.3% for women). Furthermore, the prescription rate of Angiotensin receptor blocker/calcium channel blocker (ARB/CCB) combination drugs in Kagoshima prefecture was found to be the highest in Japan at 27.3% (national average: 20.9%). Therefore, we examined the correlation between the prescription ratio of various antihypertensive drugs and mean change in systolic blood pressure, and found a significant negative correlation (r = -0.37 for males, p < 0.01; r = -0.29 for females, p < 0.05) between the prescription ratio of and mean change in systolic blood pressure in 2019. p < 0.05) was observed. On the other hand, th ARB/CCB combos ere was no clear correlation between ARB or Ca antagonist alone and mean change in systolic blood pressure. Based on these results, the increase in the prescription rate of ARB/CCB combos may have improved adherence to medication and blood pressure control.

Conclusion:

In addition to lifestyle modification, prescribing combination drugs may improve adherence to medication and be effective in combating hypertension.
PS-P08-1: RELATIONSHIP BETWEEN EDUCATION LEVEL AND OBESITY AMONG HEALTHY JAPANESE PEOPLE
Authors: Furuki Hideaki , Sonoda Nao , Morimoto Akiko
Published: January 2023

Objective:

Obesity has been considered as one of the major causes of the onset of chronic diseases such as hypertension, diabetes, and dyslipidemia. Regarding the factors associated with obesity, many studies have focused on education level and investigated this relationship because of the possibility that a level of formal education being established at early adulthood influences their health throughout life. Previous studies conducted in the United States and European countries reported that low education level was associated with obesity risk. However, few studies have examined this relationship in Japan. Therefore, this study clarified the relationship between education level and obesity among healthy Japanese people.

Design and Method:

This cross-sectional mail survey was conducted in 2020 that involved all community residents with municipal National Health Insurance aged 40–64 years in five cities in three areas of A Prefecture, Japan. This survey included 33,902 community residents, and 12,446 (36.7%) agreed to participate in the survey. After exclusion of those with regular visits to medical institutions (n = 8,174) and those with missing data (n = 714), the analysis included 3,558 participants. Information on education level and obesity was obtained using a self-administered questionnaire. Body mass index (BMI) was calculated as self-reported weight (kg) divided by self-reported height squared (m2). According to the recommendation on Asia-Pacific criteria of obesity status given by the World Health Organization of the Western Pacific Region, we defined obesity as when an individual has a BMI of at least 25 kg/m2. The study protocol was approved by the Institutional Review Boards.

Results:

In this study, 23.6% were categorized as obesity. Additionally, 9.7% were categorized as low education level (< = 9 years of education), 43.2% as medium education level (> 9 years, <  = 12 years), and 47.1% as high education level (> 12 years). The proportions of those with obesity were 20.5% in those with high education level, 25.3% in those with medium education level, and 31.0% in those with low education level (p < 0.001). After adjusting for confounding factors, the multivariable-adjusted odds ratios and 95% confidence intervals for obesity were 1.33 (1.12–1.58) in those with medium education level and 1.61 (1.22–2.12) in those with low education level (p for trend < 0.001), compared with those with high education level.

Conclusions:

Education level was associated with being obesity among healthy Japanese people.
PS-P09-2: ASSESSMENT OF KNOWLEDGE, AWARENESS AND PRACTICES OF SALT INTAKE AMONG URBAN POPULATION
Authors: Patil Mansi , Patil Vishal
Published: January 2023

Objective:

The prevalence of hypertension has been rising drastically in all populations. The dietary habits which have become unhealthy in past few decades contribute to this global health threat. The rise in salt intake has been seen consistently in many populations, especially from hidden sources. The goal of this study was to investigate the knowledge, attitude, and practice of urban populations, regarding dietary salt intake.

Designs and Methods:

A standardised questionnaire was used to perform a cross sectional survey among a representative sample of 500 persons aged 18 to 69 years in 2021. The questionnaire used for assessing the salt intake is a closed questionnaire and has been previously used in a similar setting and has been validated. It is a likert scale questionnaire with maximum 48 points possible.

Results:

The majority of them ate processed foods, and only a few read food labels before buying groceries. Most participants (64%) despite consuming processed foods, felt that they consumed the right amount of salt. Most participants were not aware of all foods which are categorized as processed foods. Only 26% of participants felt that excess salt intake could result in deleterious effects on health. The majority of participants (60%) believe that reducing salt in the diet is unimportant. Most participants added salt (98.8%) while cooking meals.

Most participants (76%) ranked poorly on the salt intake scale and only 13% ranked well on it. The practices of salt intake showed the worst scores among awareness and attitudes.

Conclusion:

Overall awareness of dietary salt intake in their diet was quite low among urban residents. The practices of the participants reflected high salt intake with poor attitudes. There is a need for introducing awareness campaigns to sensitize people towards sources of sodium, calculating salt intake and recommended allowances for salt intake.
PS-P09-5: DIET QUALITY PARTIALLY MEDIATES THE ASSOCIATION BETWEEN ULTRA-PROCESSED FOOD CONSUMPTION AND OBESITY
Authors: Shim Jee Seon , Ha Kyung Hwa , Kim Dae Jung , Kim Hyeon Chang
Published: January 2023

Objective:

High consumption of ultra-processed food (UPF) is associated with an increased risk of obesity, which at least partly due to the poor nutritional profile of these foods. However, little is known about the magnitude of the direct and indirect effects of UPF consumption on obesity. Thus we evaluated whether the association between UPF consumption and obesity is mediated by overall diet quality.

Design and method:

This study is a cross-sectional analysis of the baseline data of adults aged 30–64 years (n = 6,894) which participated in the Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) cohort study. Dietary intake was assessed by a validated 112-items food frequency questionnaire. Using the NOVA food classification, 23 FFQ items were classified as UPF. Diet quality was assessed using the Korean Healthy Eating Index (KHEI) based on the 2015 Dietary Reference Intake for Koreans. Height, weight, and waist circumference (WC) were measured and body mass index (BMI, kg/m2) was calculated. Obesity was defined as ≧ 25.0 kg/m2. Abdominal obesity was defined as ≧ 90 cm for male and ≧ 85 cm for female. Single mediation models were used to estimate the mediating effect of UPF consumption (% kcal) on obesity, after adjusting for sex, age, research center, income, education, marital status, smoking, drinking, and sitting time. All analyses were performed using SAS version 9.4.

Results:

UPF accounted for 17.9% of total energy intake and the mean BMI and WC was 24.1 kg/m2 and 82.3 cm. The prevalence of obesity and abdominal obesity was 35.4% and 30.2%, respectively. UPF consumption (per 10% kcal increase) was associated with higher levels of BMI (0.13 kg/m2, P < 0.001) and WC (0.39 cm, P < 0.001), and also with higher odds of obesity (OR = 1.07, 10.1–1.13) and abdominal obesity (OR = 1.10, 1.04–1.17), after adjustment for confounders. The association of UPF consumption with BMI (14.3%, 95% CI: 1.9–26.8), WC (18.1%, 95% CI: 5.3–30.8), and abdominal obesity (20.9%, 95% CI: 6.0–35.8) were partially mediated by KHEI, but the association between UPF and overall obesity was not mediated by KHEI (17.2%, 95% CI: -1.1–35.4).

Conclusions:

Our findings suggest that the association between UPF consumption and obesity is partially, but not all, mediated by diet quality. Although our findings have a limitation on causal inference between UPF consumption and obesity, it may help understand the mediational structure between them and seek strategies for prevention of obesity.