bluuebunny/crossref_metadata_2025 huggingface dataset:
S-52-4: BLOOD PRESSURE CATEGORIES AND PROGRESSION OF COMMON CAROTID ARTERY STENOSIS DEGREE IN A JAPANESE URBAN POPULATION: THE SUITA STUDY
Authors: Teramoto Masayuki , Kokubo Yoshihiro , Kashima Rena , Arafa Ahmed , Shimamoto Keiko , Gao Qi , Kataoka Hiroharu , Iihara Koji
Published: January 2023

Objective:

Little is known about the impacts of systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels on the risk of a common carotid artery (CCA) stenosis degree progression in the general population. The objective of the present study was to examine the impact of blood pressure levels on the progression of CCA stenosis degree in the general population.

Design and method:

We studied 3,823 Japanese men and women without CCA stenosis at baseline whose CCA was measured by carotid ultrasonography on both sides (April 1994 to March 2005). We confirmed stenosis by Doppler and calculated the stenosis degree as a percentage of the stenotic area of the lumen in the cross-section perpendicular to the long axis. We measured BPs twice more than one min apart and used the average of two measurements of BPs for the analyses. The Cox proportional hazard model was used to calculate the multivariable-adjusted hazard ratios (HRs) with 95 % confidence intervals (CIs) of CCA stenosis degree progression according to the BP categories defined by the ESC/ESH 2018 guideline.

Results:

During 22,877 person-years of follow-up, we observed 74 cases of new progression of CCA stenosis (25 % or more). The high BP was associated with increased risks of CCA stenosis (25 % or more) progression; the multivariable-adjusted HRs with 95 % CIs were 1.34 (0.68-2.65) for participants with normal BP (120–139 and/or 80–89 mm Hg) and 2.13 (1.05–4.30) for those with hypertension (SBP ≧ 140 mm Hg and/or DBP ≧ 90 mm Hg), compared to those with optimal BP (SBP < 120 mm Hg and DBP < 80 mm Hg). Similar positive associations were observed between SBP and DBP and the risk of carotid stenosis incidence, but only statistically significant for SBP; the multivariable-adjusted HRs per 10 mm Hg increase were 1.15 (1.02–1.31) for SBP and 1.18 (0.94–1.49) for DBP.

Conclusions:

This is the first study to show that high BP was associated with increased risks of CCA stenosis degree progression in the general population, independent of cholesterol levels. A stronger association was found with SBP than DBP. In addition to managing dyslipidemia, adequate control of SBP can prevent the development of CCA stenosis.
S-52-6: HYPERTENSION AND ITS COMPLICATIONS ARE COMMON IN A LOW RESOURCE SPECIALTY CLINIC IN NIGERIA
Authors: Adamu Umar Gati , Musa Tanko , Abdullahi Aisha , Ibok Idogonsit Okon
Published: January 2023

Introduction (Background and Objective):

The cardiovascular disease spectrum in our environment is not well documented. This study aims to determine the spectrum of cardiovascular diseases in an out-patient specialty clinic in a low-resource tertiary center.

Methods:

This is a cross-sectional study of patients referred to with heart diseases in a hospital in North-central Nigeria. Consecutive patients that were consulted from June 1, to December 31, 2017, were included in the study. A pre-tested case report form was used to collect the data.

Results:

There were seven hundred and forty-eight patients with a mean age of 49.11 ± 14.47 years, (women, 61%). The females were younger than the men (46.21 ± 14.78 vs 53.64 ± 13.29). Hypertensive heart disease was the most common disorder (416 cases, 55.6%). Two hundred and five patients had heart failure (27.4%) and hypertension accounted for 67.8% while cardiomyopathies and peripartum cardiomyopathy occurred in 18.0% and 7.3% of the patients respectively. Valvular heart disease was found in 38 of the patients, 68.4% due to rheumatic valvular heart. There were 0.4% of the patients with symptoms suggestive of ischaemic heart disease.

Conclusion:

Our study shows that hypertensive heart disease was the most prevalent cardiovascular disease among patients seen in our clinic and is comparable to that reported in other parts of the country.

We, therefore, suggest that early screening, implementation of preventive strategies, and treatment be encouraged
S-54-4: DIETARY SALT INTAKE ASSESSED BY SPOT URINARY SODIUM EXCRETION FROM CHILD TO ADULTHOOD IN A JAPANESE TOWN
Authors: Nakagawa Naoki , Matsuo Yuka , Hasebe Naoyuki
Published: January 2023

In clinical practice, a high salt intake is strongly associated with elevation of blood pressure. To prevent and treat hypertension, it is important to restrict salt in one’s diet from child and adolescence. However, data are lacking regarding dietary salt intake from child to adulthood in general population. Therefore, we evaluated the dietary salt intake assessed by spot urinary sodium excretion from child to adulthood in a Japanese town. A total of 534 persons of both sexes, aged from 3 to 91 years were under study. The Tanaka formula was used to estimate 24-h urinary sodium excretion, which reflects salt intake. The average salt intake was 8.0 ± 2.7 g/day (n = 534); that of the men was 8.2 ± 2.8 g/day (n = 206), and that of the women was 7.8 ± 2.6 g/day (n = 249). When we assessed by age group, the average salt intake was 3.8 ± 2.2 g/day in 3 years old (n = 79), 6.8 ± 1.5 g/day in 11 years old (n = 36), 8.0 ± 1.5 g/day in 14 years old (n = 37), 8.6 ± 2.8 g/day in 20 s and 30 s (n = 37), 8.0 ± 1.7 g/day in 40 s (n = 24), 8.9 ± 2.2 g/day in 50 s (n = 32), 8.9 ± 2.1 g/day in 60 s (n = 108), 9.2 ± 1.9 g/day in 70 s (n = 182), and 9.0 ± 2.2 g/day in over 80 s (n = 22). Notably, dietary salt intake was over 6 g/day even in 11 years old. The salt intake was significantly higher in the older age group (P < 0.001 for trend) and was significantly associated with higher systolic and diastolic blood pressure. In conclusion, it is important to educate children, their parents, childcare professionals, and society about proper salt restriction and potassium supplementation, as well as to improve the food environment.
S-54-5: CHANGES IN ESTIMATED SALT AND POTASSIUM INTAKE AND SODIUM-TO-POTASSIUM RATIO USING SPOT URINE MEASUREMENTS: A 10-YEAR FOLLOW-UP OF NIPPON DATA2010
Authors: Kitaoka Kaori , Kadota Aya , Okami Yukiko , Kondo Keiko , Harada Akiko , Yoshita Katsushi , Yano Yuichiro , Ohkubo Takayoshi , Okamura Tomonori , Okayama Akira , Miura Kasuyuki
Published: January 2023

Background:

Reducing dietary salt (sodium) intake and increasing potassium intake and sodium to potassium ratio (Na/K) are crucial in preventing hypertension. However, these changes by aging have not yet been evaluated in Japanese general population.

Methods:

NIPPON DATA2010 is a cohort study in the participants of the National Health and Nutrition Survey of Japan in 2010, we assessed changes in dietary sodium and potassium intake from 2010 to 2020 using spot urine. Of 2,732 participants in the 2010 survey, 667 participants (mean age 54.8 ± 8.2 years, women 59.1%) underwent spot urine measurements in both 2010 and 2020 survey. Using Tanaka formula, we estimated 24-hour salt intake (g/day) and potassium excretion (mg/day), and calculated sodium to potassium (Na/K) ratio (mmol/mmol) in spot urine for each participant. We assessed these changes from 2010 to 2020 by sex and age groups.

Results:

Change in estimated 24-hour salt intake from 2010 to 2020 was not a statistically significant in all groups (see table). Only estimated 24-hour potassium excretion showed a statistically significant increase in women and men ≧60 years, and the change showed a tendency towards statistical significance in men < 60 years. Na/K ratio was significantly reduced in women and men ≧60 years, not in men < 60 years.

Conclusions:

Potassium intake increased and dietary Na/K ratio decreased by 10-year aging in Japanese men and women, except for relatively younger men.
S-55-3: MINERALOCORTICOID RECEPTOR ANTAGONISTS IMPROVE QUALITY OF LIFE IN PATIENTS WITH PRIMARY ALDOSTERONISM
Authors: Imaishi Nao , Yoshida Yuichi , Shibuta Kanako , Miyamoto Shotaro , Ozeki Yoshinori , Okamoto Mitsuhiro , Gotoh Koro , Masaki Takayuki , Shibata Hirotaka
Published: January 2023

Objective:

Although primary aldosteronism (PA) worsens quality of life (QOL), there have been no reports on whether treatment with a mineralocorticoid receptor antagonist (MRA) improves QOL in Japanese PA patients. Using the 36-Item Short-Form Health Survey (SF-36), we compared the QOL of PA patients before and after treatment and evaluated whether the effectiveness of MRAs differs by sex and serum potassium level.

Methods:

In 50 patients diagnosed with PA (with or without hypokalemia) and treated with an MRA, the SF-36 scores, blood pressure, and clinical features were assessed before, and 3 and 6 months after treatment. Separate analyses were also conducted for males and females, and for those with and without hypokalemia.

Results:

MRAs decreased systolic blood pressure (140.6 ± 2.4 mmHg and 125.1 ± 1.2 mmHg, p < 0.01) and increased serum potassium (3.8 ± 0.1 mEq/L and 4.2 ± 0.1 mEq/L, p < 0.01) and active renin levels (3.2 ± 0.4 pg/mL and 7.9 ± 1.2 pg/mL, p < 0.01) in PA patients. The normative mean SF-36 score of the healthy subjects was 50. The pre-treatment Role-Physical (RP) (46.7 ± 1.8, p = 0.019), General Health (47.1 ± 1.3, p = 0.042), and Role-Emotional (47.2 ± 1.7, p = 0.045) SF-36 subscale scores of all PA patients were significantly lower than those of healthy subjects but were improved by MRA treatment. Females with PA had a lower RP score (45.1 ± 2.2, p < 0.01), which was not improved by MRA treatment (46.1 ± 2.4, p = 0.036). In addition, PA patients with hypokalemia had a lower Mental Health SF-36 subscale score (43.2 ± 4.4, p = 0.041), which was improved by treatment with an MRA.

Conclusions:

MRAs improved the QOL of Japanese PA patients and were also effective for treating PA patients with hypokalemia, but female PA patients may be more resistant to MRAs.
S-56-4: ESTABLISHING A NEPHROLOGY-LED AMBULATORY BLOOD PRESSURE MONITORING SERVICE IN SINGAPORE
Authors: Khan Umer Farooq , DCosta Matthew Ross , Ngoh Clara Lee Ying
Published: January 2023

Objective:

The prevalence of hypertension in Singapore is increasing, and 64.3% of patients with hypertension are not able to meet treatment targets. Management of hypertension in patients with chronic kidney disease (CKD) and end stage kidney disease (ESKD) is challenging due to higher risk of resistant and masked hypertension, autonomic dysfunction, and blood pressure fluctuations related to intermittent haemodialysis (HD) treatment. Ambulatory blood pressure monitoring (ABPM) is the gold standard for diagnosis and management of hypertension and can provide better insight into patients blood pressure patterns and response to treatment.

ABPM for a 24-hour period is an established service with the Cardiology department at our hospital. However, access remains limited, and utilizing another departments resources increases costs and may be a burden for our patients. Our aim was to develop a nephrologist-led ABPM service to increase accessibility and utilization of ABPM in our department and provide the option of 48-hour ABPM for patients on haemodialysis to be able to track blood pressure trends on both dialysis and non-dialysis days.

Design & methods:

We procured a Schiller BR-102 ambulatory blood pressure monitor with battery compatibility ensured to be able to run for 48 hours. Other factors in machine selection were portability, and ease of use of machine interface and reporting software. Two cuff sizes were obtained to increase utility for patients of different body habitus. The device underwent a review by hospital operations management team for meeting standards for safety and patient data protection.

Scheduling and nursing workflows were established Nurses were trained in pre and post procedure checks with the aid of a nursing checklist, and a patient log was drafted for listing timing of medications, haemodialysis, and sleep and wake times. A patient information sheet was also created with a phone hotline to call during office hours in the event of complications. The service was then integrated into the electronic health reporting system. Reporting guidelines were adapted from the 2019 HOPE Asia Networks expert panel consensus guidelines for ABPM in Asia (2019).

Results:

Pilot studies were run on two healthy subjects to ensure the process flowed smoothly and that the machine was in working order., Recruiting of patients for ABPM service is ongoing.

Conclusions:

Establishing an ABPM service in our nephrology practice is feasible and will facilitate improved management of hypertension in our complex patient population.
S-57-4: THE ROLE OF ORAL L-TYROSINE, METABOLISED BY THE GUT MICROBIOTA INTO P-CRESOL DERIVED METABOLITES, IN BLOOD PRESSURE REGULATION
Authors: Xu Chudan , Donnell Joanne A O , Dinakis Evany , Xie Liang , Nakai Michael , Barlow Chris , Marques Francine Z
Published: January 2023

Objective:

Low fibre intake has emerged as an important risk factor for hypertension through changes in the gut microbiota, but the specific metabolites involved in this phenotype are unknown. We identified two novel secondary metabolites, p-Cresol glucuronide (PCG) and p-Cresol sulfate (PCS) that were elevated in plasma samples in mice on a low fibre diet. The precursor of PCG and PCS, p-Cresol, is a microbial metabolite derived from tyrosine fermentation by the gut microbiota. We hypothesized p-cresol-derived metabolites would trigger immune-activation to promote the development of hypertension. We aimed to assess whether oral L-tyrosine increases circulating PCG and PCS levels, leading to a worsened cardiovascular phenotype via immune-dependent mechanisms.

Design and method:

Male C57BL/6 mice (n = 8/group) were infused with saline or angiotensin II (Ang II, 0.5 mg/kg/day) for 4 weeks. Mice were treated with or without L-tyrosine in their drinking water accompanied by a normal chow diet for the duration of the experiment. Blood pressure (BP) was measured using tail-cuff and a targeted metabolomic approach was applied to identify the levels of PCG and PCS in the circulation. Additionally, liver enzymatic activities, immune cell activation and infiltration in the bone marrow, spleen and kidney were examined.

Results:

L-tyrosine treated hypertensive mice had significantly reduced systolic and diastolic BP compared to the control hypertensive mice (-16.4 and -14.2 mmHg, respectively, p < 0.01). Flow cytometric analysis revealed that L-tyrosine did not alter the numbers of the immune cells, including monocytes, neutrophils or T cells in bone marrow, spleen or kidneys in hypertensive or normotensive conditions. Furthermore, immune cell activation and production of cytokines, including TNF-alpha and IL17, did not change. Preliminary data suggests L-tyrosine increased the levels of PCS, but not PCG, in the circulation of both hypertensive and normotensive mice. The expression of the hepatic enzymes responsible for the biotransformation of p-Cresol to PCS and PCG were not differentially expressed, suggesting that conversion of p-Cresol to PCS occurs outside the liver.

Conclusions:

This study provides novel insights into the roles of L-tyrosine and PCS in hypertension. When delivered orally, L-tyrosine is digested by the gut microbiota, and leads to the production of PCS, lowering BP through immune-cell independent mechanisms. However, the role of PCG, a low-fibre driven-metabolite, in BP is still under investigation.
S-57-5: GUT MICROBIOME DIVERSITY AND BRAIN VOLUME AMONG GENERAL JAPANESE MEN
Authors: Ahmed Sabrina , Yano Yuichiro , Hexun Zhang , Okami Yukiko , Azahar Nazar Mohd , Kondo Keiko , Arima Hisatomi , Torii Sayuki , Moniruzzaman Mohammad , Kadota Aya , Andoh Akira , Shiino Akihiko , Ueshima Hirotsugu , Miura Katsuyuki
Published: January 2023

Objective:

Accumulative evidence links gut microbiome diversity to the central nervous system, cognition, and mental disorders. However, little is known regarding the associations of gut microbiome diversity with brain volumes in human. We assessed the association of within-person gut microbiome diversity and brain volumes in general Japanese men.

Methods:

Healthy Japanese men (n = 623) aged 40–79 years participated in the examination of the Shiga Epidemiological Study of Subclinical Atherosclerosis II (SESSA II) between 2010 and 2015. They underwent assessments of gut microbiota diversity (Shannon Diversity Index and Chao Index) through 16S rRNA sequencing using DNA extracted from stool samples and brain volumes in milliliters (i.e., total brain volume, white matter, gray matter, and hippocampus) and white matter lesion volumes (WMLV, reflecting cerebral small vessel disease) via brain magnetic resonance imaging (MRI). Multivariable linear regression tested the effect of indexes per SD on the outcomes.

Results:

In unadjusted models, higher Shannon Index and Chao Index were associated with lower volumes in hippocampus (see table). After adjustments for age and total intracranial volume, higher Shannon Index and Chao Index showed associations with higher volumes in gray matter but were attenuated after additional adjustments for body mass index, physical activity, smoking, drinking, and hypertension.

Conclusions:

Among general Japanese men, higher within-person gut microbiota diversity was not associated with volumes in total brain volume, white matter, gray matter, hippocampus, and WMLV. Further studies are warranted to identify specific gut microbiome signatures associated with brain volumes in human.
AW-NI-3: EFFECTS OF RENAL DENERVATION ON LEFT AND RIGHT VENTRICULAR FUNCTION IN HYPERTENSIVE RATS WITH HEART FAILURE INDUCED BY VOLUME OVERLOAD
Authors: Miklovic Matus , Gawrys Olga , Kala Peter , Honetschlagerova Zuzana , Jichova Sarka , Vanourkova Zdenka , Huskova Zuzana , Kikerlova Sona , Mracek Tomas , Sedmera David , Maxova Hana , Melenovsky Vojtech
Published: January 2023

Objective:

Clinical studies showed that renal denervation (RDN) is effective in blood pressure lowering in hypertension. Previously, we found that RDN prolongs survival in a hypertensive rodent model of heart failure due to volume overload from aorto-caval fistula (ACF). Whether it is due to afterload removal, or due to intrinsic effects of RDN on the right (RV) or left (LV) ventricular function, is currently unknown and was the focus of our investigation.

Design and method:

8-week-old Ren-2 transgenic male rats (model of angiotensin II-dependent hypertension) underwent ACF surgery to induce volume overload. After one week, animals underwent bilateral RDN (mechanical and chemical by topical phenol application) from laparotomy. Two weeks after RDN, the functions of both ventricles were measured by simultaneous biventricular pressure-volume analysis, and the animals were examined using echocardiography each week.

Results:

RDN in ACF rats only slightly reduced maximum pressure in RV but did not affect maximum pressure in LV. Yet, RDN in ACF animals significantly reduced hypertrophy and dilatation of both ventricles and decreased lung and liver congestion. RDN in ACF rats improved load-independent measures of contractility of both ventricles (end-systolic elastance and preload recruitable stroke work). RDN in ACF rats reduced renal levels of norepinephrine (NE) but restored depleted NE both in RV and LV. At the gene expression level, RDN in ACF led to favorable remodeling which was reflected as increased transcription of beta-1 adrenergic receptors in LV and beta-2 adrenergic receptors in RV and LV, decreased transcription of natriuretic peptide A gene (NPPA), collagen 1, and monoaminoxidase A (MAOA). These changes were relatively more pronounced in RV than LV. Interestingly, RDN in ACF rats also significantly inhibited the activity of neprilysin in the kidney.

Conclusions:

Besides the effects on pressure, RDN favorably affected load-independent measures of chamber function, markers of myocardial remodeling, and restored myocardial norepinephrine levels. These data indicate that RDN effects extend beyond pressure lowering and could be a promising method in the treatment of both right and left ventricular heart failure.
AW-APSH-1: TARGETING WINDOWS OF PLASTICITY TO PREVENT HYPERTENSION.
Authors: Denton Kate M
Published: January 2023

Failing lifestyle interventions, there are many classes of anti-hypertensive drugs that are highly effective in most patients if taken appropriately. But multiple agents taken daily may be required to achieve target blood pressure (BP). The problem is that the majority of patients are non-compliant: they do not take their drugs continuously, choose to only take some, or stop taking them completely. It is time to focus on interventions that do not require lifelong daily medications, and this requires understanding and treating the causative factors.

For decades, it has been understood that the kidney, under the influence of both the renin-angiotensin-aldosterone system and sympathetic nerves, has a dominant role in the long-term control of extracellular fluid volume and BP. The kidney is an important target for the treatment of hypertension. Early postnatal life is a period of remarkable plasticity and is a neglected window of opportunity to prevent disease onset.

Our aim is to preserve and protect function of existing nephrons. If born with reduced renal mass (less nephrons), the compensatory response is to increase the filtration rate of each individual nephron so that GFR is maintained. Clinically, the degree of nephron overload is linked to faster age and disease related reduction in renal functional reserve, glomerular damage, albuminuria and hypertension.

By targeting the postnatal period of maturation, our aim is to prevent maladaptive compensatory hypertrophy and hyperfiltration to preserve kidney health-span without the need for lifelong drug therapy. Our studies in a large animal model of congenital renal mass reduction demonstrate the long-term therapeutic potential of a brief period of angiotensin converting enzyme inhibition early in life to alter the trajectory of renal and cardiovascular disease.
ISH-PP-3: INTERNATIONAL SOCIETY OF HYPERTENSION POSITION PAPER: BEDTIME DOSING OF ANTIHYPERTENSIVE MEDICATIONS: SYSTEMATIC REVIEW AND CONSENSUS STATEMENT
Authors: Stergiou George S
Published: January 2023

Antihypertensive drug therapy is one of the most efficient medical interventions for preventing disability and death globally. Most of the evidence supporting its benefits has been derived from outcome trials with morning dosing of medications. Accumulating evidence suggests an adverse prognosis associated with night-ime hypertension, non-dipping blood pressure (BP) profile and morning BP surge, with increased incidence of cardiovascular events during the first few morning hours. These observations provide justification for complete 24-h BP control as being the primary goal of antihypertensive treatment. Bedtime administration of antihypertensive drugs has also been proposed as a potentially more effective treatment strategy than morning administration. This Position Paper by the International Society of Hypertension reviewed the published evidence on the clinical relevance of the diurnal variation in BP and the timing of antihypertensive drug treatment, aiming to provide consensus recommendations for clinical practice. Eight published outcome hypertension studies involved bedtime dosing of antihypertensive drugs, and all had major methodological and/or other flaws and a high risk of bias in testing the impact of bedtime compared to morning treatment. Three ongoing, well designed, prospective, randomized controlled outcome trials are expected to provide high-quality data on the efficacy and safety of evening or bedtime versus morning drug dosing.

In august 2022 The TIIME study announced results of its first analysis in 12,104 treated hypertensives in UK who were randomized to take their tablets in the morning or the evening for > 5 years. The study showed no difference in preventing heart attacks, strokes, or cardiovascular deaths. Thus, until more information is available, preferred use of bedtime drug dosing of antihypertensive drugs should not be routinely recommended in clinical practice. Complete 24-h control of BP should be targeted using readily available, long-acting antihypertensive medications as monotherapy or combinations administered in a single morning dose.
JS-CME-2: REDUCTION IN CARDIOVASCULAR MORBIDITY AND MORTALITY BY CARDIAC REHABILITATION: WHAT'S THE EVIDENCE?
Authors: Makita Shigeru
Published: January 2023

The Japanese Society of Cardiac Rehabilitation defines cardiac rehabilitation (CR) as follows. Cardiac rehabilitation refers to a long-term, multifaceted, comprehensive program designed to optimize a cardiac patients physical, psychological, social, and vocational status, in addition to stabilizing, slowing, or even reversing the progression of the underlying atherosclerotic or heart failure processes, thereby reducing recurrence, rehospitalization and mortality and enabling patients to live comfortably and actively. CR programs include medical assessment, prescribed exercise training, coronary risk factor modification, patient education, counseling and optimal medical therapy for individual patients, which are provided by a multi-disciplinary team in a coordinated manner.

Comprehensive CR consists of continuous multidisciplinary team medical care centered on exercise therapy and disease management. Comprehensive CR improves exercise tolerance and physical function in most heart diseases. Improvements in subjective symptoms and QOL are also observed in many heart diseases. Concerning long-term prognostic improvement effect, it is observed in coronary artery disease and heart failure. Reduced readmissions are also observed in heart failure patients.

Mechanisms for improving the long-term prognosis of patients with coronary artery disease and heart failure include: 1) improvement of coronary risk factors, 2) improvement of vascular endothelial function and systemic anti-arteriosclerosis/anti-inflammatory effects via suppression of oxidative stress, 3) improvement of autonomic nerve function, 4) increase in skeletal muscle mass and associated various myokine actions.

Based on the above-mentioned evidence, all clinical guidelines of the Japanese Circulation Society, AHA, and ESC strongly recommend participation in CR as class I (evidence and/or general agreement that a given procedure or treatment is effective and useful) for patients after acute myocardial infarction. In post-CABG patients, American and European guidelines recommend CR as Class I. As for chronic heart failure, exercise therapy is strongly recommended as class I in all heart failure clinical guidelines in Japan, Europe, and the United States.

However, a clinical problem is the low rate of CR participation in patients with heart disease. This tendency is particularly conspicuous in Japan. Furthermore, an increase in the number of elderly heart failure patients with frailty is also a major issue. There is a need to create a system that supports patients through a community network throughout the acute, recovery, and maintenance phases.
JS-ISH-ESH-1: DRUGS AND SUBSTANCES THAT INCREASE BLOOD PRESSURE
Authors: Khan Nadia A
Published: January 2023

The use of herbal medications and substances that have been touted to raise BP is increasing globally with estimates for example 6 to 48 percent of persons use herbal therapies in Europe. Other medications such as NSAIDs are among the most widely used treatments globally. Several of such medications and substances may raise blood pressure or antagonize the BP lowering effects of antihypertensive therapy in individuals. The individual effect of these substances on blood pressure can be highly variable with greater increases noted in the elderly, those with higher baseline blood pressure, use of antihypertensive therapy, and co-existing renal disease. In this discussion, we will review the evidence for the most commonly implicated substances that have been considered to raise blood pressure including NSAIDs, oral contraceptives, hormone replacement therapy, and antidepressants. We will also review the evidence for herbal therapies that may raise BP. Coxibs are associated with a 3.9 mm Hg mean increase in SBP and nonselective NSAIDs 2.8 mm Hg compared with placebo. In meta-analyses, aspirin was not associated with a significant blood pressure increase. High regular acetaminophen dosing is associated with an increased risk of new onset hypertension. Oral contraceptives were associated with new onset hypertension in approximately 5 percent of users of high dose compounds that contain at least 50 mg estrogen but these high estrogen doses are not commonly used in current formulations. SNRI antidepressants were found to have a small increase in systolic blood pressure relative to SSRI antidepressants 1.5 mmHg. Patients prescribed SSRIs showed no significant differences in blood pressure changes compared with placebo. Despite their widespread use, there are few studies on the effects of herbal substances on blood pressure apart from licorice and ephedra or ma huang. Licorice contains glycyrrhizic acid that acts as an 11 beta hydroxysteroid dehydrogenase type 2 inhibitor causing pseudohyperaldosteronism. Given the widespread use of these medications and substances, physicians will have to screen for these medications and substances when assessing patients at risk for and with hypertension.
JS-ISH-ESH-2: NOISE POLLUTION AND ARTERIAL HYPERTENSION
Authors: Wojciechowska Wiktoria
Published: January 2023

Environmental noise significantly impacts human health and well-being. It is a widespread problem in Europe, where at least one in five people are exposed to harmful levels of noise.

Hearing loss is the most known health effect related to noise exposure. There is, however, growing data that links noise exposure to hypertension, coronary artery disease, and stroke. According to some theories, this relationship may be explained by the indirect pathway of noise exposure, which can cause sympathetic and endocrine activation, as well as several cognitive and emotional responses, including annoyance. Noise exposure leads to stress reactions independent of cognitive involvement. There is a possibility that noise exerts its effects directly through synaptic interactions, as well as through cognitive and emotional effects.

Epidemiological studies indicate that nocturnal noise exposure has more profound health consequences. Nighttime noise exposure is associated with an increase in heart rate due to sympathetic activation or parasympathetic withdrawal, and with an increase in blood pressure as well as endothelial dysfunction.

Hypertension is a common condition and is an important risk indicator for other cardiovascular diseases. Previous studies showed an association between noise exposure, blood pressure and arterial hypertension. Meta-analysis of cross-sectional studies found an increase of hypertension prevalence per 10 dB increase in daytime average road traffic noise level. There is, however, some heterogeneity among these studies. Prospective studies have also found an association between aircraft noise exposure and hypertension, supporting the cross-sectional findings. The analyses, of data from the large Hypertension and Exposure to Noise near Airports (HYENA) study, showed that an increase in nocturnal aircraft noise exposure per 10 dB was associated with an increased incidence of hypertension. The meaningful effect of night-time aircraft noise on arterial hypertension was also observed in the prospective observation of the subset of individuals from that study. In a longitudinal observation of 420 participants, higher aircraft noise exposure during the night significantly associated with the incidence of hypertension.

Previous cross-sectional case-control study conducted in 2015, in 2 suburban areas of Krakow, Poland, revealed an increase in blood pressure and arterial stiffness as determined by carotid - femoral pulse wave velocity in individuals exposed to increased aircraft noise levels. However, even short-term noise reduction, as experienced during the COVID-19 lockdown, may reverse those unfavorable effects. As a result of these observations, noise mitigation strategies are important for cardiovascular health.
JS-NG-6: FRESH START: A LIFESTYLE INTERVENTION APPROACH IN REVERSING HYPERTENSION
Authors: Botabara Mary Jane Bercasio , Fernan Bysshe Mallorca , Racca Abraham Peralta
Published: January 2023

Objective:

Approximately 1.13 billion people worldwide are hypertensives, and they are mostly living in low- and middle-income countries. In the Philippines, one in five Filipinos are hypertensive and less than 20% of these hypertensives have controlled blood pressure of less than 140mmHg/90mmHg. Lifestyle intervention approaches in the primary level of prevention are not common. This study determined the effect of an eight-week, pure lifestyle intervention approach with the use of proper nutrition, physical activity, stress management, among others, in the blood pressure of hypertensive adults living in a rural community setting.

Design and method:

There were two phases of the study. The first phase was a needs assessment survey among 58 respondents to determine knowledge, attitude, preventive practices regarding hypertension and risks of high blood pressure. The second phase was an intervention program among those who qualified through purposive sampling with the following criteria: 1. Diagnosed as Stage 1 Hypertension according to the 2017 guideline, 2. willing to participate. A module entitled Fresh Start was created and was used as a guide in conducting the lifestyle intervention which lasted for eight weeks.

Results:

We utilized descriptive and repeated measures (week 1, 4 and 8, respectively) to analyse the result; 72% have good knowledge, good attitude (mean-3.47) and good hypertensive practices practice (3.44). Via Friedman test, there was a significant difference in systolic pressure across the given three periods of time, p < 0.001. Post hoc analysis with Wilcoxon signed-rank tests showed a significance level, p < 0.025. There is a significant difference from week 1 to week 4 (Z = -2.085, p = 0.005) and a significant difference from week 4 to week 8 (Z = -2.549, p = 0.001). Further, there was a statistically significant difference in diastolic pressure across the given three periods of time, p = 0.002. Post hoc analysis with Wilcoxon signed-rank tests resulted in a significance level set at p < 0.025. There is no significant difference from week 1 to week 4 (Z = -2.018, p = 0.044) but there is a significant difference from week 4 to week 8 (Z = -2.521, p = 0.012).

Conclusion:

This study revealed that lifestyle intervention approach to decrease blood pressure in a community setting is possible. As incidence of high blood pressure increase, especially among the poor socio-economic status spectrum, there is a need of new preventive measures that will address such needs.
JS-ECCR/HBPRCA-4: NEURAL CONTROL OF CARDIOVASCULAR FUNCTION AND ERYTHROPOIESIS BY THE BRAIN RAS
Authors: Rodrigues André Felipe , Todiras Mihail , Qadri Fatimunnisa , Alenina Natalia , Bader Michael
Published: January 2023

The renin-angiotensin system (RAS) strongly modulates not only cardiovascular homeostasis but also other non-cardiovascular physiological processes like erythropoiesis. The production of the peptide hormone angiotensin II (Ang II) in the circulatory system constitutes the main source of the RAS activity. However, Ang II has also been recognized to be generated locally by various tissues, because RAS components are either locally expressed and/or imported from the circulation. Contrary to peripheral organs, the blood-brain-barrier limits the traffic of all circulating RAS proteins into the brain, thus, brain Ang II formation relies exclusively on locally expressed RAS precursor and enzymes. Several brain cardiovascular centers contain neuronal populations responsive to Ang II that take part in sympathetic nerve outflow, vasopressin secretion, thirst and salt appetite. Angiotensinogen (Agt), the RAS precursor, is mostly produced by astrocytes in the brain. To investigate the role of the brain RAS in cardiovascular control and erythropoiesis, two transgenic rodent models with astrocyte-specific Agt gain- and loss-of-function were phenotyped. In both models, astrocyte-specific transgene expression was delivered using the human GFAP promoter. The gain-of-function model is a transgenic mouse overexpressing rat Agt, and the loss-of-function model is a rat expressing an antisense RNA against the endogenous Agt mRNA. The transgenic mouse line overexpresses the rat Agt mRNA distributed across the brain, including areas containing cardiovascular centers. Overexpression of Agt increased brain Ang II formation but reduced the peripheral Ang II levels. Rats expressing the antisense RNA exhibited a brain-specific decrease of Agt protein by ∼90%. The cardiovascular phenotyping of the two lines demonstrated opposing effects for the brain RAS. Increased brain RAS reactivity was associated with high BP, vascular sympathetic tone and vasopressin secretion, and downregulation of the brain RAS reduced BP and vasopressin secretion. Similarly, the brain RAS modulated erythropoiesis in contrary directions because capillary hematocrit experiments revealed that overproduction of Ang II in the brain correlates with increased erythropoiesis while reduced Ang II production with moderated erythropoiesis. These findings were further validated using detailed blood cell counting with an automated hematology analyzer. Submitting the transgenic mice with increased brain Ang II and respective controls to peripheral sympathectomy with 6-hydroxydopamine revealed that brain Ang II via sympathetic nerve activity increases erythropoiesis in transgenic mice. Altogether, these models confirmed the functionality of the brain RAS, and that baseline BP and erythropoiesis depends on its integrity and reactivity.
JS-HOPE ASIA-2: BLOOD PRESSURE VARIABILITY AND NEURODEGENERATIVE DISEASES
Authors: Turana Yuda
Published: January 2023

Alzheimer's disease (AD) and Parkinson's disease (PD) have become more prevalent as populations have aged. The treatment of many neurodegenerative disorders has not yet reached a point where it is possible to modify the disease's progression. Midlife hypertension is a significant predictor of cognitive impairment and neurodegenerative brain diseases in later life. These findings emphasize the importance of preventing and controlling hypertension as a neurodegenerative disease risk factor. In neurodegenerative diseases, autonomic dysfunction, neuropsychiatric, and sleep problems can lead to blood pressure variability (BPV). The BPV itself can exacerbate the disease's course. In light of this, it is crucial to regulate BPV in order to halt the progression of the degenerative process.
JS-WHL-ISH-LANCET-2: WHAT CONSTITUTES AN ACCEPTABLE TEST OF CLINICAL VALIDITY?
Authors: Sharman James E.
Published: January 2023

For the accurate clinical measurement of blood pressure (BP), hypertension guidelines recommend using an automated BP measuring device that has passed accuracy testing in accordance with an internationally-accepted validation protocol. Such a protocol is designed to rigorously determine the accuracy of an automated BP measuring device compared with a reference manual BP measurement method in a general, or special, population of people. The results of validation studies should be reported in full and made publicly available by such means as publication in the peer-reviewed literature. Since the 1980's, many validation protocols have been developed by Hypertension societies and organisations concerned with the safe and effective use of technology to improve health. An international initiative to harmonize different protocols and develop a single ‘universal’ accepted standard for BP device validation was recently completed by experts from the US Association for the Advancement of Medical Instrumentation, the European Society of Hypertension and the International Organization for Standardization. This standard (ISO 81060–2:2018) is now the recommended international validation protocol designed to replace all other previous standards and protocols. International hypertension organisation recommend convergence towards the global regulatory requirement for mandatory, independent clinical validation of automated BP measuring devices according to the universal standard. This will ensure that the accuracy of automated BP measuring devices is confirmed before being cleared for sale by regulatory authorities, and is an urgent international need.
JS-HR-4: PREECLAMPSIA UP TO DATE; WHAT WE SHOULD KNOW FOR MOTHER AND CHILD.
Authors: Bokuda Kanako , Ichihara Atsuhiro
Published: January 2023

Preeclampsia (PE) is a systemic hypertensive disorder of pregnancy thought to arise from placental maladaptation and subsequent systemic inflammatory processes. PE is associated with significant maternal and fetal mortality with hypertensive disorder of pregnancy accounting for -14% of maternal deaths globally and also with increased maternal risks for chronic diseases in later life.

In 2017, the American College of Cardiology/American Heart Association hypertension treatment guidelines identified hypertension as blood pressure (BP) 130/80 mmHg. The reference BP for hypertension during pregnancy as specified in international guidelines is still > 140/90 mmHg. Also, recommended target BP level differs between these guidelines. A large number of studies have been examining the incidence of PE and fetal outcomes according to BP levels to figure out the optimal level for pregnant women. Given only termination of pregnancy has been proved to initiate the resolution of PE once it has developed, prevention of PE is a health care priority. However, the predictive value of BP and other clinical characteristics for PE is relatively low, and therefore, improved method for the prediction of PE and associated adverse outcomes is required. Past history of PE is now widely known to link with major chronic diseases such as hypertension, type 2 diabetes mellitus, dyslipidemia, cardiovascular disease in later life. Since many cardiovascular risk factors are modifiable and related to lifestyle, all women with prior PE should be followed-up by physician even after resolution of PE (eg. hypertension, proteinuria). However, no long-term follow-up strategy for former-PE patient has yet been established.

The 2019 Maternal Mortality update from the WHO report indicated the major contribution of PE and eclampsia to worldwide maternal deaths. Further investigation is needed to decrease PE related maternal and fetal deaths and also to reduce maternal risks for chronic diseases in later life. Participation of physicians is necessary to offer appropriate medical care to women with prior PE.
JS-HR-7: BLOOD PRESSURE VARIABILITY; THERAPEUTIC TARGET FOR THE PREVENTION OF CARDIOVASCULAR DISEASE
Authors: Narita Keisuke
Published: January 2023

In the past three decades, there have been many reports on the associations of various parameters of blood pressure (BP) variability with increased risk of cardiovascular disease (CVD) events; these parameters include short term BP variability (BPV), i.e., beat-by-beat BPV and ambulatory BPV, abnormality of nocturnal BP dipping pattern, and mid- to long-term BPV, i.e., day-by-day BPV, visit-to-visit BPV, and seasonal variations in BP. Several factors that are associated with abnormal BPV, as well as environmental factors such as cold or warm temperatures and seasonal changes in climate, increase fluctuations in BP. Individual intrinsic factors such as sympathetic nervous tone, arterial stiffness, physical activity, and mental stress also contribute to elevated BPV. According to evaluations of BPV abnormalities, out-of-office BP measurements such as ambulatory and home BP monitoring are needed. Although there are issues regarding measurement accuracy, cuffless BP monitoring devices, for example, those using pulse transit time, may be used to estimate nighttime BP levels. Such cuffless BP devices can also evaluate beat-by-beat BPV. Moreover, by using the multisensor-equipped ambulatory BP monitoring device developed by our research group, it is possible to evaluate BPV associated with changes in temperature, physical activity, and/or atmospheric pressure. Based on the mechanism(s) behind a given patients BPV abnormality, several methods may be considered for the management of that abnormality (Figure). For example, improving excessive sympathetic nervous system activation may be useful in the management of BPV abnormality, and renal denervation has been reported to decrease ambulatory BPV. Abnormal nocturnal BP dipping may be treated by decreasing nighttime BP. Moreover, early adjustment of antihypertensive drugs has been reported to be useful in suppressing seasonal variations in BP, leading to a decreased risk of CVD events. Furthermore, housing conditions and room temperature are closely related to BP levels, and adaptive control of room temperature would be useful to suppress winter increases in BP. In clinical practice, we must not forget that BPV parameters are interrelated. For instance, frequent evaluation of BP levels and adjustment of antihypertensive drugs can suppress visit-to-visit BPV, which in turn leads to the suppression of seasonal variations in BP. Over the next decade, greater data on how to manage and control BPV need to be accumulated. Additionally, future studies should be conducted to verify whether the different types of BVP management are useful in preventing CVD events.