bluuebunny/crossref_metadata_2025 huggingface dataset:
PS-C15-8: SUPER HYPERTENSION OR VERY SEVERE HYPERTENSION IN A SUB-SAHARAN COUNTRY: EPIDEMIOLOGICAL, CLINICAL, THERAPEUTICAL AND EVOLUTIVE PATTERNS
Authors: Christian Ngongang Ouankou , Oriane Chendjou Kapi Leana , Liliane Mfeukeu Kuate , Raoul Simeni Njonnou Sylvain , Yannick Fogang Fogoum , Jerome KAZE Francois , Pierre CHOUKEM Simeon
Published: January 2023

Backgroung:

To describe the epidemiological, clinical, therapeutical and evolutive patterns of super hypertension in Yaounde University Teaching Hospital.

Methodology:

This study is an observation cohort over a period of 9 months (January 2016 to September 2016). We recruited from members of the public who accepted voluntary blood pressure screening offered in various localities in Yaounde, and were aged 18 years or over.

Results:

Of a total of 6.519 people, 1.875 (28.8%) presented a high blood presure. Amongst them, 37 presented a super hypertension (a systolic blood pressure 250 mmHg and/or diastolic blood pressure 150 mmHg in presence or not of complications), corresponding to a prevalence of 2% of all hypertensive patients. Our cohort comprised 33 of these individuals who accepted the invitation to participate in the study. The mean age was 49.3 years, with a sex- ratio of 0.7. Twenty-three (70%) of the patients were known hypertensive for a mean time of 10 years, out of 9% were regularly rewieved, but none on medications. The mean of cardiovascular risk factors was 7, with 91% who had an excess salt intake. Dyspnea and headache were the main symptoms. The means systolic blood pressure and diastolic blood pressure were respectively 244.9 mmHg and 144.8 mmHg. Twenty-six (78.8) patients were either overweight or obese. We noticed a fundoscopy stage II or III in 21.1% of the cases. Seventy percent of the cases had left ventricular hypertrophy on electrocardiogram and 18.2 on echography. Complications were noticed on admission in 60.6% of all cases, mainly signs of renal failure. Acute kidney injury occurred in 15.15% of the cases during follow-up. The average rate of blood pressure control over 6 months was 3%. The main cause of poor blood pressure control was lack of therapeutic compliance. We noticed refractory high blood pressure in 4 (12.1%) cases and registered one death at the 3rd month of follow up due to acute kidney injury.

Conclusion:

Super hypertension is a yout s pathology. The early detection reduces significantly the high morbi-mortality. However, its efficient management needs minimal additional resources.
PS-C16-6: POSTAL MEDICINE DELIVERY FOR STAGE-2 HYPERTENSIVE PATIENTS IN COVID-19 SITUATION: TURNING CRISIS TO OPPORTUNITY
Authors: Mitsungnern Thapanawong , Ponpong Sathorn , Udonjarut Nipa , Imoun Supap , Kotruchin Praew
Published: January 2023

Introduction:

The COVID-19 pandemic has influenced healthcare systems, particularly in the areas of non-communicable diseases, such as hypertension, where the majority of patients require medication therapy and frequent visits. The postal medicine delivery (PMD) approach was an innovative solution to keep antihypertensive drugs accessible under the social distance regulation.

Objective:

We aimed to investigate the effectiveness of the PMD in terms of blood pressure (BP) control (< 140/90 mmHg), and target organ damage (TOD) including myocardial infarction, heart failure, acute stroke, and progression of chronic kidney disease) during the use of PMD.

Design and method:

This was a cross-sectional study in a university hospital, conducted between 11th March to 27th May 2020 when the hospital policy stated that outpatient departments’ service would be reduced, and physicians were encouraged to use PMD. Patients without a history of TOD and who had a history of well BP control (< 140/90 mmHg) for the last 2 weeks, were enrolled. All of the patients used smartphones and LINE® applications for contacting the nurse coordinator every 3 months to report their home BP. After 6 months of PMD, patients were assigned to have a follow-up visit at the hospital for office BP measurement and having metabolic panel checked.

Results:

Thirty-eight patients met the inclusion criteria, and 68% were women. Most of the patients (97.4%) had used home BP monitoring (HPBM). The rate of BP control in goal was 64.2%. There was no TOD during the PMD approach. The medication boxes were sent successfully via postal service within 5–10 days, with no loss or damage recorded. All of the patients reported that they had been taking their antihypertensive medications. More than two-thirds (68.4%) continued to follow a low-sodium diet, while 76.3 percent continued to exercise regularly.

Conclusions:

In the COVID-19 epidemic, the PMD method could be another effective and safe strategy to enhance medicine access, if suitable enrolment criteria and communication between healthcare practitioners and patients are maintained.

Keywords:

COVID-19 pandemic, antihypertensive drugs, postal medicine delivery, efficacy, safety
PS-P01-2: ARTERIAL STIFFNESS IN PATIENTS WITH ARTERIAL HYPERTENSION INFLUENCED BY AGTR2 GENE G1675A POLYMORPHISM IN UZBEK POPULATION
Authors: Zakirova Darya , Abdullaeva Guzal , Abdullaev Alisher , Sadulloeva Mokhinur , Khamidullaeva Gulnoza , Masharipov Shukhrat , Safarov Jamshid , Atoeva Munisa
Published: January 2023

Material and Methods:

109 Uzbek male and female with I / III AH (ESH / ESC, 2018), mean age 54.1 ± 11.3 years, average duration of AH was 9.1 ± 5.9 years. Applanation tonometry was performed using SphygmoCor device (AtCor Medical, Australia) to measure the carotidfemoral pulse wave velocity (PWV). The genotyping of G1675A polymorphism of AGTR2 gene in 109 patients was carried out. Results are presented as M ± SD. For all types of analysis, P values less 0.05 were considered statistically significant.

Results:

109 patients were examined and divided into two groups: 1st group with increased arterial stiffness: patients with pulse wave velocity (PWV) more 10 m/s (cases, n = 62) and 2nd group: patients with PWV less 10 m/s (controls, n = 47). 1st group, following distribution of G1675A polymorphism of AGTR2 gene was revealed: GG genotype determined in 54.8% of patients, GA genotype in 12.9%, AA genotype 32.3%, x2 = 18.21, P = 2.0. The allelic distribution showed the predominance of G allele carriers: G allele 61.3%, A allele 38.7%, x2 = 11.758, P = 0.000. 2nd group, the allelic distribution was uniform: A allele in 56.4% and G allele in 43.6%, respectively, x2 = 2.574, P = 0.109. The ratio of GG:GA:AA genotypes was as follows: 27.7%: 31.9%: 40.4%, x2 = 2.88, P = 0.09. An association of G allele with the development of arterial stiffness in patients with AH was found: among 62 patients of 1st group, G allele was common than in patients of 2nd group (61.3%; x2 = 6.72; p = 0.01; OR = 2.05, 95% CI 1.19–3.53) and only 38.7% of patients had A allele. That demonstrated an accumulation of GG genotype among patients of 1st group (54.8%; x2 = 9.66; P = 0.008; OR = 3.18, 95% CI 1.41), while GA genotype occurred in 12.9% of cases and AA genotype in 32.3% of cases. Whereas in the 2nd group, the GG genotype was less common in 27.7% of cases than the GA genotype (31.9%) and AA genotype (40.4%) cases.

Conclusion:

The study indicates greater accumulation of the G allele of the AGTR2 gene G1675A polymorphism among patients, where G allele and GG genotype are associated with the development of arterial stiffness in patients with AH of the Uzbek population.
PS-P01-10: MASKED HYPERTENSIVE EFFECT AND GROWTH DIFFERENTIATION FACTOR 15
Authors: Ishikawa Joji , Fujita Yasunori , Tamura Yoshiaki , Toba Ayumi , Ito Masafumi , Fujiwara Yoshinori , Tanaka Masashi , Araki Atsushi , Harada Kazumasa
Published: January 2023

Background:

Growth differentiation factor 15 [GDF15], a possible biomarker of mitochondrial function related to ageing was reported to be associated an increased risk of cardiovascular events. However, there were no previous data that investigated the relationship between masked hypertensive effect and serum GDF15 level.

Methods:

In outpatients clinic in which evaluated frailty in elderly patients, we evaluated clinic, home and 24-hr ambulatory BP, and serum GDF15 level in 116 hypertensive patients. Clinic BP was automatically measured twice in a sitting position [HBP-9035, Fukuda-Colin, Japan]; home BP [HBP], 3 times in the morning and evening for 5 days [HEM-7080IC, Omron, Japan]; and ambulatory BP [ABP], at 30-minute intervals for 24 hours [TM-2441, A&D, Japan].

Results:

Mean age was 77.6 ± 7.3 years [male 37.1 percent]. Clinic BP was 132.9 ± 18.7 / 73.9 ± 12.7 mmHg, and pulse rate 77.2 ± 14.4 bpm. GDF15 had a skewed deviation, and median GDF15 was 1.53 [25–75 percentile, 1.25–2.08] ng/ml. Natural log-transformed GDF15 [LnGDF15] was negatively related to clinic BP [systolic BP, r = -0.338, P < 0.001; diastolic BP, r = -0.335, P < 0.001], but not to home systolic BP [r = -0.112, P = 0.252] or awake ambulatory systolic BP [r = -0.080, P = 0.426]. LnGDF15 was significantly related to masked hypertensive effect assessed by ABP [SBP r = 0.273, P = 0.006] and that by home BP [SBP r = 0.382, P < 0.001]. In tertile analysis of GDF15, masked hypertensive effect assessed by ABP and HBP were significantly increased across tertile of GDF15. Masked hypertensive effect was significantly greater across tertile of GDF15 even after adjustment for age, sex, BMI, antihypertensive medication use, diabetes, dyslipidemia, smoking habit, alcohol drinking habit.

Conclusion:

An increased GDF15 can be associated with an increased masked hypertensive effect in elderly hypertensive patients.
PS-P02-1: MACHINE LEARNING PREDICTS MELATONIN TARGETS ON THE PSYCHOSOCIAL STRESS-SLEEP/CIRCADIAN-CARDIOMETABOLIC DISORDERS TRIAD
Authors: Campos Luciana A , Baltatu Ovidiu C , Senar Sergio , Ghimouz Rym , Alefishat Eman , Neto Jose Cipolla
Published: January 2023

Objective:

Melatonin may have a role in the pathophysiology of a set of three diseases categories that interact with each other, namely psychosocial stress disorders, sleep/circadian rhythm disturbances, and cardiometabolic diseases, forming a therapeutic target triad for melatonin (stress-sleep/circadian- cardiometabolic disorders triad). Establishing a relationship between the pharmacological target and disease has become a fundamental goal for scientists, as it is crucial for developing novel medicines or repurposing existing ones. We investigated the target prediction of melatonin for the stress-sleep/circadian- cardiometabolic disorders triad using machine learning predictive models.

Design and Methods:

The Open Targets Genetics, ChEMBL, PhenoDigm, PheWAS Catalog and Europe PMC databases were utilized to examine melatonin target tractability and prediction of the stress-sleep-cardiovascular triad. Diseases with association records for melatonin MT1, MT2 and MT3 receptors have been categorized into sleep, cardiovascular, diabetic pathology and psychosocial disorders discarding other pathologies. The collections of direct and indirect relationships were queried to generate tables containing the names of diseases, supporting data sources, and the number of evidences for each association and data source. Graphs were built by applying igraph library-based scripts and have been depicted applying the Gephi ForceAtlas algorithm.

Results:

To date, 144 phase I to IV trials for melatonin or agonists have been completed, and 78 phase 4 trials are ongoing or completed, for drugs with investigational or approved indications targeting melatonin receptors based on their proposed mode of action on stress-sleep/circadian- cardiometabolic disorders triad. The scientific evidence on the pathogenic linkages for melatonin within the stress-sleep- cardiometabolic disorders triad is identified. This study not only identified novel biologically plausible relationships that may justify further translational research for melatonin, but it also demonstrated an effective usage of data from several databases.

Conclusion:

Molecular biomarkers, 24-hour blood pressure, nocturnal blood pressure and heart rate, psychosocial markers, cardiometabolic risk scores, and multiple biomarker modeling are all referenced for this triad. Based on these findings, we propose combining outcome measures with biomarkers from different triad diseases when designing clinical trials for melatonin or agonists for a triad disorder.
PS-P02-7: GENOME WIDE ASSOCIATION STUDY IDENTIFIES NOVEL SNPS ASSOCIATED WITH ALBUMINURIA IN GENERAL POPULATION
Authors: Okuda Hiroshi
Published: January 2023

Objective:

Urine protein is one of the important indicators of renal failure. Generally, In high blood pressure, diabetes, urinary protein excretion tends to increase with poor control and renal dysfunction, but the difference between individuals is very large. This suggests that there are some genetic factors for urinary protein excretion. We performed a genome-wide association study (GWAS) on urinary protein excretion using data from 10,000 Japanese people and reported 18 SNPs related to urinary albumin excretion. (Clin Exp Nephrol. 2020 Aug; 24 (8)). This time, we increased the number of samples and analyzed using the data of 67,000 Japanese people.

Design and method:

GWAS was performed using approximately 680,000 single nucleotide polymorphism (SNP) data obtained from 67,000 TMM health survey participants collected from 2013 to 2020. As covariates, age, gender, BMI, blood pressure, renal function (calculated by blood CysC), and HbA1c were used. Imputation was performed using a haplotype panel consisting of whole-genome sequence data of 2000 people, and further analysis was performed on the data, and allele frequency and INFO value after imputation were adjusted.

Results:

The analysis results were examined with p < 5 × 10 −8 as the significance level, and novel SNPs related in urine protein excretion were identified on chromosome 6. The identified SNPs were found in regions associated with potassium metabolism.

Conclusions:

The identified SNPs are considered to have some effect on urinary protein excretion. It is necessary to consider the mechanism and further verify it.
PS-P03-4: LOW LEVELS OF HYPERTENSION AWARENESS AND HIGH PROPORTIONS OF UNCONTROLLED BLOOD PRESSURE IN THE UNITED KINGDOM AND IRELAND
Authors: McDonnell Barry J , Beaney Thomas , Shezawi Mahfoudha Al , Cockcroft John , Keitley James , Bhullar Dilraj S , Heagerty Anthony , Brady Adrian AJB , Padmanabhan Sandosh , Dolan Eamon , Brien Eoin O , Thomaszewski Maciej , Schutte Aletta E , Poulter Neil R , Cappuccio Francesco P
Published: January 2023

Objective:

Globally, it is estimated that 10.4 million people die each year due to raised blood pressure (BP). Unfortunately, at least 40% of those with high BP globally are unaware of their condition. In the most recent UK and Ireland community-based data, 66.5% of people were unaware of their high BP(1). The UK and Ireland have taken part in the global May Measurement Month (MMM) campaign, in a bid to increase awareness of BP and to evidence the proportion of those in the community with undiagnosed high BP. The aim of this study was to investigate the large and combined 2017, 2018 and 2019 MMM dataset, to evidence the proportion of people with raised BP, undiagnosed hypertension and levels of hypertension not treated to target in the UK and Ireland.

Design and method:

As part of the MMM protocol, community-based opportunistic BP screening sites were set up across the UK and Ireland in places of worship, supermarkets, pharmacies, GP surgeries, workplaces, gyms and other public spaces in 2017, 2018 and 2019. A questionnaire recording medical history, lifestyle and demographics was used to collate participant information. BP was measured three times and the average of 2nd and 3rd readings used for analyses. Multiple imputations were performed to impute the mean BP, where data were missing. The term Hypertension was used for those with systolic BP >/ = 140 or diastolic BP >/ = 90 mmHg, or the participant was on BP medication. Controlled BP was considered as < 140 and < 90 mmHg.

Results:

Data on 22,910 individuals were analysed as part of the combined MMM dataset. Mean age of participants was 52 ± 18 years, with 60% reporting as female gender. See Table 1 below for the proportion of those considered hypertensive, levels of awareness and the proportion of hypertensives treated to target.

Conclusion:

In the largest community-based BP dataset to date in the UK and Ireland, our data highlight the concerning levels of people with high BP unaware of their condition and poor levels of controlled BP in hypertensive patients. Better community based and primary care screening initiatives are required to improve awareness and early identification of those at high risk of cardiovascular disease.

REFERENCES:

(1) McDonnell BJ, Rees E, Cockcroft JR, et al. May Measurement Month 2019: an analysis of blood pressure screening results from the UK and the Republic of Ireland. Eur Heart J Suppl. 2021 May;23 Suppl_B. 147–150.
PS-P03-11: EFFECT OF CLEANER COOKING FUEL (LPG) ON CARDIOPULMONARY HEALTH IN WOMEN FROM RURAL MAHARASHTRA
Authors: Shah Rohan , Bhalerao Aboli , Agarwal Dhiraj , Juvekar Sanjay
Published: January 2023

Background and Objective:

Air pollution generated due to the use of solid fuels is recognized to be an environmental and health risk globally, especially in developing countries. Exposure to household air pollution is estimated to kill 3.8 million people worldwide. Major victims are women who are the immediate users. In an attempt to address this issue, the Indian government launched the Pradhan Mantri Ujjwala Yojana (PMUY) which provides clean LPG cooking gas to first-time users. However, it is majorly being promoted as a scheme about providing cooking gas to those who don’t have it but the health benefits of the scheme are not being focused. Accordingly, this study aimed to evaluate the effect of LPG on cardiopulmonary health in women.

Design and method:

A total of 997 healthy women participants (808 primary cooks and 189 secondary cooks) who cooked either with biomass or with LPG were enrolled. Systolic (SBP) and diastolic blood pressure (DBP), blood glucose was measured in all study participants and data on 24-hour personal exposure to fine particulate matter < 2.5 μm (PM2.5) and lung function (by spirometry) were measured on a subset using a standard protocol. Socio-demographic data, cooking practices and other information were collected using a validated questionnaire. Descriptive analysis was done in SPSS v26.

Results:

Results highlighted that SBP, DBP, mean arterial pressure, pulse pressure and glucose level were significantly higher in the biomass group compared to the LPG group in both primary and secondary cooks. The prevalence of hypertension in primary and secondary cooks was 29.5 and 33.6 respectively in biomass users compared to 21.1 and 13.4 in LPG users. Higher number of obstructive airway pattern (n = 10; 6.4% vs n = 2 1.3%), restrictive airway pattern (n = 31; 19.7 % vs n = 19; 12.5 %) and small airway obstruction (n = 55; 35.0 % vs n = 22; 14.4 %) was observed in biomass group compared to LPG group respectively. After adjusting for age, BMI and study group, it was seen that biomass exposure index (odds ratio [OR] 2.288; 95% confidence interval [CI] 1.169, 4.479, P = 0.016) and PM2.5 levels (OR 1.065; 95% CI 1.035, 1.096, P < 0.001) significantly increased the odds of having hypertension.

Conclusions:

Based on preliminary analysis, it can be concluded that the use of biomass is significantly associated with an increased risk of hypertension and impaired lung function. Thus, adoption of cleaner cooking fuels like LPG will have meaningful clinical and public health benefits.
PS-P04-2: 24 HOUR AMBULATORY BLOOD PRESSURE PROFILE OF HYPERTENSIVE AND PRE-HYPERTENSIVE HEALTHCARE WORKERS IN A PHILIPPINE TERTIARY HOSPITAL
Authors: Abarquez Anna , Llanes Elmer Jasper , Santos Lourdes Ella , Bongcawil Roxanne
Published: January 2023

Objectives:

To determine the blood pressure profile and phenotypes of hypertensive health care workers and its association to BP control dipping status.

Design and Methods:

This is a cross-sectional study of hypertensive employees who underwent 24 hr ambulatory blood pressure monitoring (ABPM). Clinical profile, and ABPM data were also evaluated

Results:

181 patients were included with majority from 50–59 years old age group (33.3%), female (70.17%), non-shift workers (61.88%) with the most common comorbidity of obesity (60.22%) and suspected obstructive sleep apnea (60.22%). All the known hypertensives (100%) had uncontrolled blood pressure despite being on antihypertensive medication. The most frequent anti-hypertensive drug was an angiotensin receptor blocker (ARB, most cited was Losartan), comprising 62% among those on antihypertensive medication followed by calcium channel blockers (CCB- 23%). Majority or 73% were on mono therapy. The following hypertension phenotypes were identified: Sustained hypertension (64.7%), masked hypertension (13.26%), white coat hypertension (7.18%), and non-dippers (66%). Healthcare workers who work > 9 hours were 2.05 times more likely to be non-dippers compared to healthcare workers who works up to 9 hours.

Conclusion:

Among health care workers, 24 hour blood pressure were uncontrolled more in females 50–59years old, with association on working hours> 8 hours, without association to shift work, and job classification. There is a significant association of longer work hours and nocturnal dipping pattern.

This study highlights the importance of 24-hour ABPM to detect 24-hr pattern and identify ABPM parameters at high risk for cardiovascular outcomes and finally determine blood pressure control among known hypertensive patients on maintenance medications.
PS-P04-4: BLOOD PRESSURE VARIABILITY IN PRESCHOOL CHILDREN
Authors: Hu Zhe , Qin Li , Chen Xin
Published: January 2023

Objective:

To investigate the blood pressure variability (BPV) and its relevant factors in preschool children.

Design and method:

A total of 497 preschool children from two public kindergartens in Shanghai were enrolled. Blood pressure (BP) was standardized measured three times consecutively in a sitting position. Demographic information was collected. The measures used for BPV were the difference between the third and the first systolic blood pressure (SBP) (Delta-SBP), the difference between the third and the first diastolic blood pressure (DBP) (Delta-DBP), standard deviation of SBP (SBPSD) and DBP (DBPSD), and coefficient of variation of SBP (SBPCV) and DBP (DBPCV). Statistical analysis was performed by SAS9.4.

Results:

The subjects were on average 4.5 ± 0.8 years and 49.7% male. Mean blood pressure was 96/56mmHg. BPV was not significantly different between sex, however, it was significantly different among different SBP grade groups. According to the quartile of the first SBP, the subjects were divided into four groups. SBPSD and SBPCV were greater with the increase in SBP level. DBPSD and DBPCV were not significantly different among groups. Multiple linear regression showed that Delta-SBP was negatively correlated with the first SBP (Fig. 1), that was, the higher the first SBP, the magnitude of decrease from the third SBP to the first SBP was greater. After adjustment for sex, age, height, and weight, the first SBP was positively correlated with SBPCV.

Conclusions:

This study revealed that the higher the first SBP in preschool children, the greater the blood pressure variability may be.
PS-P04-8: COMPARISON OF INDICES OF WITHIN-VISIT BLOOD PRESSURE VARIABILITY IN MAY MEASUREMENT MONTH 2019
Authors: Kerr Gabriele Keziah , Schlaich Markus , Schutte Aletta E , Stergiou George , Poulter Neil , Beaney Thomas
Published: January 2023

Objective:

There is a lack of consensus on the optimal mathematical indices for quantifying blood pressure variability (BPV). We sought to compare four established indices of BPV across six age strata among the substantial international population screened during May Measurement Month (MMM) 2019.

Design and method:

Within visit BPV of readings taken at 1 minute intervals was calculated for each of the 1,133,008 participants with three readings on a single occasion. Indices of BPV were the standard deviation (SD), absolute difference in BP from the first to the second reading (AR), coefficient of variation (CV), and variation independent of the mean (VIM). Mixed effects regression models were fit with a random intercept for country of screening site to account for clustering. Three models were created for each systolic (sbp) and diastolic (dbp) BPV metric: (1) unadjusted, (2) adjusted for average BP, and (3) adjusted for average BP, sex, and use of antihypertensive medication (multifactor).

Results:

Unadjusted models of sbpSD and sbpAR showed increased BPV with age from 40 to 49 years onwards. In average BP and multifactor adjusted models of all indices and unadjusted models of sbpVIM and sbpCV, systolic BPV decreased with age from 18 to 49 years but was similar across the remaining age categories (Fig.1A). Diastolic BPV displayed a “U shaped” association with age such that it was lowest in the 40 to 49 year group and relatively higher in the youngest and oldest age categories (Fig.1B).

Adjustment for average BP significantly altered coefficient estimates for SD and AR (Fig.1). Compared to unadjusted models, adjustment for average BP modestly affected effect estimates for sbpCV, dbpCV, sbpVIM, and dbpVIM (Fig.1). Compared to models only adjusted for average BP, multifactor adjusted models resulted in increases in the relative differences in systolic within visit BPV across age categories but estimates for diastolic BPV across age categories were slightly attenuated on multifactor adjustment.

Conclusions:

Unlike AR and SD, CV and VIM were largely independent of average BP levels. Unlike VIM, to calculate CV for an individual solely requires parameters derived from their own BP readings. Models of CV produced similar outputs those produced by models of VIM, which suggests CV may have utility in clinical practice settings as an index of within visit BPV that is relatively independent of average BP while simple to calculate. The relative clinical utility and prognostic implications of these metrics of BPV remain to be assessed.
PS-P05-4: GLOBAL BURDEN OF ATRIAL FIBRILLATION/ATRIAL FLUTTER DUE TO HYPERTENSION DURING 1990–2019
Authors: Wang Keke , Jin Yaqiong , Wamg Mengxiao , Gao Xueying , Zhang Jie , Lu Jingchao
Published: January 2023

Objective:

High systolic blood pressure (HSBP) remains the leading risk factor for atrial fibrillation/atrial flutter (AF/AFL) worldwide. However, limited quantitative research has revealed the specific AF/AFL burdens due to HSBP. This study aimed to estimate the global burden of AF/AFL attributable to HSBP by region, sex, and age.

Design and method:

Data on HSBP-related AF/AFL burden was extracted from the 2019 Global Burden of Disease (GBD) study. Numbers and age-standardized rates of deaths, disability-adjusted life years (DALYs) and corresponding estimated annual percentage change (EAPC) were discussed by age, sex, socio-demographic index (SDI) and locations.

Results:

Globally, HSBP-related AF/AFL caused 107,091 deaths and 3,337,876 DALYs in 2019, an increase of 142.5% and 105.9% from 1990, respectively. The corresponding mortality and DALYs rates dropped by 5.8% and 7.7%, respectively. Almost half of the HSBP-related AF/AFL burden was bore by high and high-middle SDI regions and it was experiencing a shift from high and high-middle SDI regions to lower SDI regions. In general, females and elderly people tended to have a higher HSBP attributable AF/AFL burden. In addition, young adults (30–49 years old) experienced an annual increase in global deaths and DALYs rates. V-shaped correlation was detected between SDI and HSBP-related AF/AFL burden.

Conclusions:

HSBP attributable AF/AFL burden has been an incremental public health concern worldwide, with heterogeneities across regions, sexes and ages. Geographically and sexually tailored strategies were required to reduce the burden of hypertension-related AF/AFL.
PS-P05-9: A PROTOCOL OF DIGITAL PROSPECTIVE COHORT STUDY ON HEART FAILURE AND COGNITIVE DECLINE IN URBAN RESIDENTS: THE SUITA STUDY NEXT
Authors: Kokubo Yoshihiro , Kashima Rena , Teramoto Masayuki , Arafa Ahmed , Gao Qi , Sakai Yukie , Nosaka Saya , Maeda Saori , Wada Akane , Yasui Yuka , Kawachi Haruna , Dohi Tomoharu , Matsumoto Chisa , Sheerah Haytham A , Izumi Chisato
Published: January 2023

Background:

The aging rate in Japan is about 30%, which is the highest worldwide and will continue to increase. The prevalence of heart failure and dementia in Japan increases much more than the nationally known values. There is an urgent need for a drastic solution to this. Multi-employers’ community intervention prevents heart failure and dementia in Western countries, but Japan mainly relies on family care to prevent them. Although heart failure and dementia worsen each other, there are few cohort studies aimed at both at the same time. Also, there are few cohort studies of Japanese heart failure.

Objective:

This study aims to show the evidence of risk factors for heart failure and dementia in urban residents and to build evidence to create a town where multi- employers’ community intervention is possible

Methods:

We recommend that all people aged 65 or older who live in two predetermined (elementary school) districts of Suita City receive a medical examination (6,340 people). We will conduct the following tests accompanying the medical check-up: echocardiography, carotid artery echo, limb blood pressure, Holter electrocardiography, ophthalmic examination (visual acuity, fundus examination, color vision examination, tonometry, optical interference tomography), otolaryngology examination (auditory examination, olfactory test), physical fitness test (grip power, walking test), oral examination (dental prescale, masticatory ability measurement, and repeated saliva swallowing test), cognitive function test, depression test, and health and semi-quantitative food frequency questionnaires. Blood collection will be carried out collectively for research and biobank projects (only for consenters). In addition, we will receive prognosis data (annual medical examination data, medical expenses, long-term care, transfer information, and cause of death) of cohort subjects. We encourage and follow up every three years for people aged 65 and over who live in the same two specific districts. The Institutional Review Board approved this protocol. Informed consent is obtained from all subjects.

Discussion:

We started this cohort study in September 2021. After a three-year baseline survey, a follow-up survey will begin. In a cross-sectional study of the baseline survey, we prepare profile papers on the relationship between the prevalence of heart failure and cognitive decline and prognosis. We are studying multi-layered omics analysis using blood sampling and AI research using a lot of digital data. We will first provide evidence on the prevention of heart failure and dementia among the urban residents in Japan and present materials that contribute to policymaking that can extend healthy life expectancy.
PS-P06-1: REDUCED HEALTHCARE UTILIZATION AMONG PATIENTS WITH CHRONIC DISEASES DURING THE PANDEMIC
Authors: Gamage Anuji Upekshika , Gunasekera Therani , de Silva Amala
Published: January 2023

Objective:

Public-health strategies resorted to world-wide, to reduce the transmission of COVID-19 impacted the healthcare-utilization of people with pre-existing chronic diseases. We aimed to assess the healthcare utilization, patient-experiences and economic impacts among people with chronic diseases due to COVID-19 pandemic.

Design and Methods:

An online survey was conducted in 2021 involving 449 adults living in the Western-Province of Sri Lanka. Data on participants socio-demographic and economic status, co-morbidities, healthcare utilization, and healthcare-seeking behaviours were collected using a pre-tested questionnaire. The questionnaire link was distributed through social media and by emails. Categorical data were expressed as proportions/percentages with 95% confidence intervals where relevant. Quantitative data, normally distributed, were summarized in terms of mean and standard deviation (SD) and non-normally distributed as the median and interquartile-range (IQR).

Results:

449 respondents completed the survey. Majority (55%) responded that they experienced a negative impact on their main income. 26%(n = 115) mentioned that they had a doctor-diagnosed chronic disease or a disability and of them 72% (n = 83) were on regular medication. Nearly half (n = 55;48%) mentioned that there was a delay in seeking healthcare during the pandemic and 27% (n = 30)reported not having sought treatment during the lockdown period. Of the people with delayed healthcare seeking 25% had hypertension, 16% diabetes, and 12.2% asthma. Considering care seeking pattern among people with chronic illness, it declined in all institutions during the lockdown period. However careseeking in the private sector, only margially declined during the pandemic. Considering care seeking at a government hospital, a drastic drop was observed during the lockdown period (n = 13; = 11.3%). Of the respondents who sought healthcare for chronic illness during the pandemic in lockdown (n = 85; 74%) and no-lock down (n = 107; 93%), a considerable proportion mentioned that clinics were either not functioning on time or not functioning at all. Although the majority agreed that their perceived health despite the chronic illness was good, very good, or excellent, around 38% reported it as fair or poor.

Conclusion:

Health-care utilization among people with a chronic disease reduced due to supply and demand driven factors in healthcare. Efforts are necessary to ensure continuity of care for people with chronic disease to prevent complications. The government needs to invest in resilient health systems to be better equipped to provide uninterrupted care for NCDs in any circumstances. To support this, primary healthcare strengthening and tele-health options should be explored.
PS-R01-5: SACUBITRIL/VALSARTAN IMPROVES HYPERTENSION, NIGHTTIME BLOOD PRESSURE AND HEART FAILURE: A CASE-REPORT
Authors: Takami Takeshi
Published: January 2023

Objective:

Sacubitril/valsartan, angiotensin receptor blocker (ARB)/neprilysin inhibitor, has been shown to effectively reduce ambulatory 24-h blood pressure in patients with hypertension. Improvements in heart failure have also been reported. This case report highlights the validity of sacubitril/valsartan for the treatment of hypertension, nocturnal blood pressure, and heart failure.

Methods:

A 75-year-old hypertensive male patient with heart failure was prescribed an ARB and a β;-blocker, along with a mineralocorticoid receptor antagonist (MRA) for diuresis. However, his nighttime blood pressure and central blood pressure remained high, and left ventricular ejection fraction (LVEF) remained low, along with persistent elevation of serum N-terminal pro-brain natriuretic peptide (NT-pro BNP) levels.

Hence, we switched the ARB to sacubitril/valsartan. The other drugs were left unchanged. We measured his daytime and nighttime blood pressure by ambulatory blood pressure monitoring (ABPM) before and 6 months after the change of medication. In addition, central systolic blood pressure (cSBP) was measured using an automated tonometry system, LVEF, left ventricular mass index (LVMI), left atrial (LA) diameter and septal ratios of transmitral flow velocity to annular velocity (septal E/e’ ratio) were measured using a Vivid S6 ultrasound system with 3-MHz transducer and serum sample was obtained for NT-pro BNP assessment before and 6 months after the change of medication.

Results:

Brachial blood pressure (154/71 to 132/72 mmHg), nocturnal blood pressure (average value: 136/65 to 121/67 mmHg), and cSBP (154 to 135 mmHg) improved by changing the treatment. Additionally, the riser pattern was improved to the dipper blood pressure pattern by changing the prescription, along with improvements in EF (39.5 to 51.2%), LVMI (127.3 to 119.6 g/m2), LA diameter (40.1 to 37.8 mm) and septal E/e’ ratio (15.1 to 14.5). Further, although serum levels of NT-pro BNP improved with the change of treatment (656 to 325 pg/mL).

Symptoms of heart failure were also reduced from New York Heart Association (NYHA) class 3 to NYHA class 2. There were no noticeable adverse effects after the change.

Conclusion:

In our patient, changing from an ARB to sacubitril/valsartan resulted in an improvement in nighttime and central blood pressure, and left ventricular hypertrophy and diastolic function, and to recovery of EF, with a change from heart failure with reduced ejection fraction (HFrEF) to heart failure with preserved ejection fraction (HFpEF). His NT-proBNP levels and heart failure symptoms also improved.

Our experience suggests that sacubitril/valsartan might be useful in patients with heart failure who have nocturnal hypertension.
PS-R02-2: HEART FAILURE AS A PRESENTING FEATURE OF CUSHING'S DISEASE: A CASE REPORT
Authors: Xiao Bing , Geng Lu , Yang Xiuchun , Liu Fan , LU Jingchao
Published: January 2023

Cushing's disease is an endocrine disorder in which the pituitary gland releases too much adrenocorticotropic hormone, resulting in excess synthesis and secretion of cortisol by the adrenal glands. Cushing's disease associated heart failure is rare in clinic and can be misdiagnosed with initial presentation of heart failure. Symptoms of heart failure are caused by structural and functional alterations in the heart. The disturbances of cardiac structure and function may be recovered by eucortisolaemia. A 30-year-old man with a medical past of hypertension and history of smoking presented to the outpatient department with global heart failure. The left ventricular ejection fraction (LVEF) was estimated as 31% and the blood pressure (BP) was above 180/100 mmHg. After 1 months of optimal pharmacological treatment for systolic heart failure, there was obvious improvement of LVEF of 42%. Clinical features were suspicious for Cushing's disease. Initially, the patient could not have an MRI because of metal sheet in the body. After removal of metal sheet, the pituitary imaging were suggestive of Cushing's disease. The patient was referred to the neurosurgical department and the adenoma was successfully removed. Approximately one year after his initial hospitalization, his cardiac structure and function had nearly returned to normal and there were no high BP and signs of Cushing's syndrome.
PS-R02-4: MANAGEMENT OF BLEEDING IN SEVERE TR AND MR WITH CAD UNDERGOING OPEN HEART SUGERY
Authors: Jain Rajesh , Hosseini JS , Shogli Reza
Published: January 2023

Raising ACT may be led to active bleeding. There are two scenarios

On the other hand, after major causes, use the best treatment in the patient with a history of coagulopathy, and using anticoagulant drugs can typically prevent the same events. Raising ACT may be led to active bleeding. There are 2senarios 1. active bleeding similar to our case.

2. delayed tamponade because this bleeding summed and gathered and cause clotting formation and led to tamponade.

On the other hand, after major causes, use the best treatment in the patient with a history of coagulopathy, and anticoagulant drugs can prevent the same events.

Summary of the report

This is about a specific 68 years old woman diagnosed with severe TR (tricuspid valve disease) and severe MR mitral valve regurgitation. After that, she underwent open-heart surgery, and subsequently, after three hours of needed surgery, she experienced drainage. Alternatively, she had transferred to the operations room, and the very first problem was that she had no dominant surgical site, while her ACT Active Clotting Time was 900. On the other hand, because the case had been treated with aspirin, after the operation, she received protamine; however, protamine, in these cases, shows the rebound feedback, and the complex interaction with the platelet is not successful and robust. For this apparent reason, when the ACT is about 130, one hour after the operation, ACT elevates to 900, and the patient experiences bleeding. Her sternum was kept open out of lacking any operation site. Standard treatment with FFP and Fibrinogen started, and after that, the patient general condition improved, and her sternum was closed the following day. It should be noted that the patient had a pandesal surgery history and also raised ACT history 16 years before the mentioned surgery.
PS-BPB01-2: VASCULAR ENDOTHELIAL NAMPT-MEDIATED NAD+ BIOSYNTHESIS REGULATES WHOLE-BODY BLOOD PRESSURE AND INSULIN RESISTANCE
Authors: Kosugi Shotaro , Yamaguchi Shintaro , Homma Koichiro , Nagahisa Taichi , Nishioka Ken , Watanabe Yasuhiro , Kinouchi Kenichiro , Hayashi Kaori , Miyasita Kazutoshi , Kanda Takeshi , Irie Junichiro , Yoshino Jun , Ito Hiroshi
Published: January 2023

Obesity is associated with dysregulation in blood pressure control and whole-body glucose metabolism, but the precise underlying mechanism(s) remain unclear. Here, we generated and characterized mice with vascular endothelial-cell specific deletion of nicotinamide phosphoribosyltransferase (NAMPT), which mediates the biosynthesis of nicotinamide adenine dinucleotide (NAD+), a key regulator of cellular energy metabolism. We found that vascular endothelial cell-specific Nampt knockout (VeNKO) mice exhibited 1) higher blood pressure (systolic blood pressure; flox/flox mice: 111 ± 2.6 mmHg, VeNKO mice: 134 ± 4.0 mmHg, p < 0.05) with cardiac hypertrophy (flox/flox mice: 5.0 mg/g-body weight, VeNKO mice: 6.1 mg/g-body weight, p < 0.05) and 2) insulin resistance with abnormal fat distribution, under high-fat diet feeding. These deleterious alterations were partially rescued by administering nicotinamide mononucleotide (NMN), a key NAD+ intermediate. Taken together, our findings demonstrate that vascular endothelial NAMPT-mediated NAD+ biosynthesis is involved in the regulation of blood pressure and whole-body glucose metabolism. Our study provides mechanistic and therapeutic insights into vascular endothelia NAD+ biology related to obesity-associated hypertension and insulin resistance.
PS-BPB01-6: PROTECTIVE NOX4 EFFECT IN ENDOTHELIAL CELLS INVOLVES ACTIVATION OF TRANSIENT RECEPTOR POTENTIAL MELASTATIN 2 (TRPM2) CATION CHANNEL
Authors: Lopes Rheure Alves , Neves Karla , Harvey Adam , Montezano Augusto , Touyz Rhian M
Published: January 2023

Objective:

In endothelial cells, Nox4 is the most prevalent isoform and, in contrast to other Noxes, which generate superoxide O2, Nox4 produces mainly H2O2. Low H2O2 levels have been described to lower blood pressure, which suggests that a certain level of reactive oxygen species (ROS) can have protective effects on the cardiovascular system. We demonstrated that TRPM2 is a target of H2O2 in vascular cells. TRPM2 is a redox-sensitive Ca2+ channel and once activated leads to Ca2 influx. Endothelial dysfunction involves a reduction in eNOS activation by Ca2+ and is potentiated in the absence of Nox4. As TRPM2 channel is a H2O2 sensor and regulates Ca2+ entry, we questioned whether protective Nox4 effect in endothelial cells involves the H2O2-TRPM2-Ca2+ axis, with consequent regulation of NO signalling.

Design and Methods:

WT and TTRhRen hypertensive mice were crossed with Nox4 KO mice. Vascular function was measured by wire myograph in resistance arteries. ROS and H2O2 generation were assessed by lucigenin and amplex red, and Ca2+ influx by fluorescence microscopy in rat aortic endothelial cells (RAEC). eNOS activation was assessed by immunoblotting.

Results:

Blood pressure was significantly increased in TTRhRen (130.3 ± 7.0 mmHg) and TTRhRen/Nox4 KO mice (141.3 ± 18 mmHg) versus control mice (98.1 ± 8.0 mmHg). TTRhRen mice had reduced endothelium-dependent relaxation (Emax: WT 83.5 ± 4.03 vs TTRhRen 59.1 ± 3.5); an effect worsened by Nox4 KO (37.9 ± 5.4), p < 0.05. The TRPM2 activator, ADPR, improved vascular relaxation in TTRhRen/Nox4 KO mice (75.9 ± 7.7); an effect recapitulated by H2O2 (74.2 ± 15.4), p < 0.05. Ang II-induced ROS and H2O2 generation in RAEC, effect reversed by Nox4 siRNA and followed by increased Ca2+ influx (AUC - Ca2+: 20440.3333 ± 1870.9), important in eNOS activation. Ang II-induced Ca2+ influx in endothelial cells was reduced by TRPM2 siRNA, TRPM2 inhibitors (AUC - Ca2+: 8-br-cADPR 15232.2 ± 1052.1; Olaparib 14952.6 ± 843.2 and 2-APB 13270.8333 ± 277.4, p < 0.05) and by Nox4 siRNA and Nox4 inhibitor GKT137831 (AUC - Ca2+: GKT 15067.5 ± 255.6). Ang II-induced eNOS activation (Ser1177) (%: 72.3 ± 24.7) and NO release were blocked by Nox4 and TRPM2 sirNA, GKT137831, PEG-catalase and the TRPM2 inhibitor 8-br-cADPR (p < 0.05).

Conclusions:

We defined a novel molecular pathway in endothelial cells, where Nox4-induced H2O2 production activates PARP/TRPM2 signalling followed by Ca2+ influx, eNOS activation and NO release. The absence of Nox4 impairs Ca2+ homeostasis leading to endothelial dysfunction, an effect exacerbated in hypertension. The protective role of Nox4 corroborates the idea that the use of antioxidants based on the sole evidence that decreased oxidative stress is cardioprotective, it is not effective.
PS-BPB02-7: THE ROLE OF NEUTROPHIL TO LYMPHOCYTE RATIO AS PREDICTIVE BIOMARKER IN ACUTE CORONARY SYNDROME: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Greca Elona , Spicer Alexander James , Gomez Sabas , Marzban Sima , Michel Jack
Published: January 2023

Introduction:

Current evidence suggests that the the neutrophil/lymphocyte ratio (NLR) is growing as a prognostic marker in patient with cardiovascular disease. It has been reported expanding evidence that involves innate and adaptive immune cell in the pathogenesis of Acute Coronary syndrome (ACS) which indicate the pivotal role of NLR as valuable diagnostic parameter in ACS patient. Purpose: The objective of our meta-analysis is to investigate the association of neutrophil lymphocyte ratio (NLR) for ACS risk and the prognostic utility of NLR in ACS patients.

Method:

We conducted a systematic literature search on various databases such as PubMed, Cochrane and Scopus to identify the relevant articles published until October 2021. Data extracted were pooled using odds ratios (OR) for incidence of ACS and non- ACS patients between high and low NLR. For studies that did not provide these estimates, data were extracted using weighted mean difference (WMD) of NLR for ACS and non-ACS patients. A random effects model was used to conduct this MA. The receiver operating characteristic (ROC) curve was utilized to analyze the prognostic ability of NLR in the ACS patients. Heterogeneity was evaluate using Cochran's Q- and the I 2 − test. GRADE was used to assess the study's quality. The presence of publication bias was evaluated by Egger's test and by visual inspection of the symmetry in funnel plots. Data analysis was conducted using Stata.

Results:

Nine studies met the inclusion criteria with more than 5215 participants. The MA that used OR as effect size was 1.44 (95% CI:1.082–1.92) with low heterogeneity (Chi- square = 6.2; P-value = 0,0012 I2 = 12.8%). The analyze that used WMD as effect size was 1.24 (95% CI: 1.04- 1.43) with high heterogeneity (Chi-square = 102.7; P-value < 0.001 I2 = 95.1%). There was no evidence of publication bias from Egger's test for OR effect size MA and for WMD MA (coefficient = 0.58; P-value = 0.558) and (coefficient = 3.06; P-value = 0.361). The ROC curve shows that AUC (ACS) = 88.8% (95% CI:0.73 – 1). The best cut- off point of the N/L was 4, with a sensitivity of 82.8 % and a specificity of 77.7 %

Conclusion:

The MA that used OR as effect size indicated high NLR was significantly associated with increased risk of ACS. The analyze that used WMD as effect size indicated mean NLR was significantly higher in ACS patients than in non-ACS patients. ROC curve analysis was significant for NLR in diagnosing ACS. Therefore, our results conclude that the NLR effect was strongest on ACS outcome and might also help in early diagnosis of ACS and all this make NLR a predictive biomarker in ACS patient .