bluuebunny/crossref_metadata_2025 huggingface dataset:
PS-C18-4: HIGH BODY MASS INDEX IS A RISK FACTOR FOR TRANSITION TO HEMODIALYSIS OR HYBRID THERAPY AND PERITONEAL DIALYSIS-RELATED INFECTION
Authors: Hama Eriko Yoshida , Uchiyama Kiyotaka , Nagasaka Tomoki , Kusahana Ei , Nakayama Takashin , Yasuda Itaru , Morimoto Kohkichi , Washida Naoki , Hayashi Kaori , Itoh Hiroshi
Published: January 2023

Objective:

Obesity may negatively impact clinical outcomes of peritoneal dialysis (PD) patients. However, obesity is defined differently in Japan, and its impact on PD-related outcomes remains unclear. In current study, we aimed to examine the association of high body mass index (BMI) with the complete hemodialysis (HD) transfer, transition to HD and PD/HD hybrid therapy, peritonitis, catheter exit-site and tunnel infection (ESI/TI), and heart failure-related hospitalization.

Design and method:

This retrospective cohort study included 120 patients who underwent PD catheter insertion between January 2008 and June 2018. BMI ≧ 25 kg/m2, which was calculated from the height (m) and body weight (kg) at the time of PD catheter insertion, was defined as high BMI. Patients who develop solute retention or fluid overload with PD alone could choose to transfer first to PD/HD hybrid therapy, wherein patients usually undergo PD 5–6 days a week along with once-weekly HD, instead of directly transferring to HD alone. Association between high BMI and outcomes were analyzed by the log-rank test and the Cox proportional hazards models.

Results:

The follow-up duration was 46.2 (23.3–75.3) months. Time until transfer to HD and hybrid therapy was significantly shorter in the high BMI group than in the low one, whereas time until transfer to HD was not significantly different between both groups (P < 0.001 and 0.18, respectively). Peritonitis-free and ESI/TI-free survival were significantly shorter in the high BMI group than in the low one (P = 0.006 and 0.03, respectively). After adjusting for age, sex, diabetes mellitus, estimated glomerular filtration rate, BMI ≧ 25 kg/m2 remained as a significant risk factor for transferring to HD and PD/HD hybrid therapy, peritonitis, and ESI/TI (hazard ratio [HR] 2.60, P < 0.001; HR 2.08, P = 0.01; HR 2.64, P = 0.02, respectively).

Conclusions:

High BMI, defined as BMI ≧ 25 kg/m2, is a risk factor for transition to HD and PD/HD hybrid therapy, peritonitis, and ESI/TI. However, high BMI is not associated with early complete HD transfer in Japan, where PD/HD hybrid therapy is commonly used.
PS-C18-5: SEASONAL VARIATION IN PREDIALYSIS SYSTOLIC BLOOD PRESSURE AND CARDIOVASCULAR EVENTS IN JAPANESE MAINTENANCE HEMODIALYSIS PATIENTS
Authors: Uchiyama Kiyotaka , Washida Naoki , Shibagaki Keigo , Yanai Akane , Nakayama Takashin , Takahashi Rina , Morimoto Kohkichi , Itoh Hiroshi
Published: January 2023

Objective:

Predialysis systolic blood pressure (SBP) in hemodialysis (HD) patients follows a seasonal pattern, peaking during the winter and declining in summer due to changes in ambient temperatures. However, the relationship between seasonal variation in predialysis SBP and clinical outcomes has rarely been studied. We evaluate the association between the seasonal variation in predialysis SBP and clinical outcomes, such as major adverse cardiovascular events (MACEs), in Japanese HD patients.

Design and method:

In this retrospective cohort study, the standard deviation (SD) of each patient's monthly mean predialysis SBP was determined using the data from 47,219 HD sessions in 307 patients over a year (April 2019 to March 2020) at three dialysis clinics, which was defined as the seasonal variation in predialysis SBP. From April 2020 to March 2022, the relationship between seasonal variation in predialysis SBP and clinical outcomes, including MACEs, was investigated. Cardiovascular death, nonfatal myocardial infarction or unstable angina, stroke, heart failure, and other severe cardiovascular events requiring hospitalization were considered examples of MACEs.

Results:

The study included 105 women (34%), with an average age and a median HD vintage of 69.0 ± 12.4 years and 4.1 (2.0–7.7) years, respectively. The monthly mean SBP before dialysis was 8.9 ± 3.6 mmHg. There were 77 MACEs (25%) and 184 all-cause hospitalizations (60%) in this study. A Cox regression analysis adjusted for age, sex, HD duration, Charlson comorbidity index, mean annual predialysis SBP, intradialytic SBP decline, and ultrafiltration rate, revealed that a higher SD of the monthly mean predialysis SBP was significantly associated with an increased risk of MACEs (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.03–1.16). Furthermore, a higher monthly mean predialysis SBP SD was linked to a higher risk of all-cause hospitalization (HR, 1.05; 95% CI, 1.01–1.10). A greater seasonal variation in predialysis SBP was also significantly associated with increased risk of MACEs (HR, 1.08; 95% CI, 1.02–1.16) in the Fine-Gray subdistribution hazards model, considering death and semi-permanent hospitalization due to a decline in Activities of Daily Living as competing risks.

Conclusions:

A higher seasonal variation in predialysis SBP was linked to poorer clinical outcomes, including an increased risk of MACEs and all-cause hospitalization. More research is needed to confirm whether reducing seasonal variations in predialysis SBP improves this prognosis.
PS-C18-7: EFFECT OF TOLVAPTAN IN PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE G5 AND IMPACT OF CONCOMITANT USE OF THIAZIDE DIURETICS
Authors: Uchiyama Kiyotaka , Kojima Daiki , Hama Eriko Yoshida , Nagasaka Tomoki , Nakayama Takashin , Takahashi Rina , Tajima Takaya , Morimoto Kohkichi , Washida Naoki , Itoh Hiroshi
Published: January 2023

Objective:

Tolvaptan, a vasopressin V2 receptor antagonist, is used to treat congestive heart failure (CHF). Its diuretic effect in patients with severe renal dysfunction remains poorly characterized. Thiazide diuretics decrease urinary volume (UV) in patients with nephrogenic diabetes insipidus, in which V2 receptor function is absent. Likewise, thiazide diuretics may decrease UV in patients receiving tolvaptan.

Design and method:

This retrospective cohort study included inpatients with chronic kidney disease stage G5, in whom tolvaptan was administered for CHF. UVs at 24-h pre- and post-tolvaptan administration as well as 30-day dialysis initiation were compared between patients with and without thiazide diuretics.

Results:

Thiazide diuretics were used in 26 of 106 recruited patients (73.4 ± 13.0 years, estimated glomerular filtration rate: 8.07 ± 3.13 mL/min/1.73 m2). In contrast to those who received thiazide diuretics (1177.3 ± 686.5 vs. 1173.1 ± 629.1 mL/day, p = 0.93), patients without thiazide diuretics had significantly higher 24-h UV pre- and post-tolvaptan administration (1043.4 ± 645.6 vs. 1422.2 ± 774.0 mL/day, p < 0.001). In a multivariate regression model, the use of thiazide diuretics was significantly associated with decreased 24-h UV (beta coefficient, -486.7 [95% confidence interval (CI), -674.5 to -298.8]) and increased urine osmolality (beta coefficient, 37.7 [95% CI, 17.1–58.4]), bodyweight (beta coefficient, 0.62 [95% CI, 0.31–0.92]) and 30-day dialysis initiation (odds ratio 3.40 [95% CI, 1.18–9.82]) after tolvaptan administration.

Conclusions:

Tolvaptan had significant diuretic effects on patients with CHF, even in those with severe renal dysfunction. Concomitant use of thiazide diuretics diminished these effects.
PS-C18-12: STRESS AND COPING STRATEGY AMONG CAREGIVERS OF HYPERTENSIVE PATIENTS UNDERGOING HEMODIALYSIS- A PROSPECTIVE STUDY
Authors: Kaul Shaurya , Singh Narinder Pal , Gupta Anish Kumar , Sarkar Taposh
Published: January 2023

Objective:

To find out the level of burden/stress, and quality of life (QoL) among caregivers of hypertensive patients undergoing hemodialysis. And, to access the coping strategies used by caregivers.

Design and Methods:

This was a prospective observational study of caregivers of hypertensive patients undergoing hemodialysis having a history of caring for hemodialysis patient for at least 3 months and who had more than or equal to 18 years of age. A scheduled interview was arranged for each participant to complete the validated inventory questionnaire; Caregivers burden (CGB) Scale, WHO-QOL-BREF scale, and COPE inventory questionnaire to measure the level of stress, QoL and coping strategies used by the caregivers.

Results:

A total of 100 caregivers of hypertensive patients undergoing hemodialysis were enrolled in the study. Age varied from 20 to 76 years (mean 39.66 ± 12.74 years). The majority of the participants were male (62.9%) married (83.5%), employed (68%), and literate (95.8%). Around half (50.5%) of the patients had reimbursed the cost of dialysis from the Government schemes. Around half of the caregivers reported medium to high (medium, high; 40.21%, 10.31% respectively) levels of stress on utilizing the CGB scale. Using the WHOQOL-BREF questionnaire, it was found that participants had an overall good QoL (Table 1). Most of the caregivers adopted turning to religion, seeking social support, positive reinterpretation, planning, and acceptance as a coping strategy (Table 1).

Conclusion:

In view of moderate to high levels of stress among caregivers of hypertensive patients undergoing hemodialysis, there may be recommendations for developing a practicing guideline to address the caregiver assessment, education, and provision of referral to support services.
PS-C19-5: SAFETY PROFILES OF SACUBITRIL/VALSARTAN IN EARLY POST-MARKETING PHASE VIGILANCE FOR THE INDICATION OF CHRONIC HEART FAILURE AND HYPERTENSION
Authors: Araki Tsunenori , Mitani Hironobu , Eguchi Shunsuke , Yarimizu Daisuke , Mori Hiromasa , Nakamura Yumiko , Tasaki Junko , Iekushi Kazuma
Published: January 2023

Background:

The objective was to investigate and report the safety profile of Sacubitril Valsartan Sodium Hydrate (Sacubitril/Valsartan) (Entresto®) in Early Post-marketing Phase Vigilance (EPPV).

Methods:

In accordance with the regulation, the 6-month EPPV was conducted for the physicians or pharmacists at all medical institutions to which the drug was delivered. Safety information was collected and tabulated for the indication Chronic Heart Failure (CHF) (August 26, 2020 - February 25, 2021) and Hypertension (September 27, 2021 - March 26, 2022). The adverse drug reactions (ADRs) were classified using the basic terms of Medical Dictionary for Regulatory Activities (MedDRA). In addition, we focused on the five risks (hypotension, renal dysfunction/renal failure, hyperkalemia, angioedema, and dehydration) listed as Safety Specification in the Risk Management Plan (RMP).

Results:

The estimated number of patients treated with Sacubitril/Valsartan for the indication of CHF and hypertension was 24,898 and 165,000 during the data collection period. The number of ADRs were confirmed to be 850 (345 serious) for CHF and 455 (84 serious) for hypertension. No new safety findings were identified in both EPPVs. For both indications, the most common RMP-related ADRs were hypotension-related ADRs that occurred within 30 days after initiation were 87 (162 had, followed by renal dysfunction-related ADRs.

Furthermore, hypotension-related ADRs were 268 (75 serious) for CHF and 93 (three serious) for hypertension. Hypotension-related ADRs that occurred within 30 days after initiation were 87 (162 had an unavailable date of onset) for CHF and 19 (71 had an unavailable date) for hypertension.

Regarding renal dysfunction-related ADRs, the number of ADRs were 45 (45serious) for CHF and 19 (19serious) for hypertension. Renal dysfunction-related ADRs that occurred within 30 days after initiation were 17 (23 had an unavailable date of onset) for CHF and three (14 had an unavailable date) for hypertension.

The number of hyperkalemia-related ADRs, angioedema, and dehydration were 35 (including 19 serious), five (five serious), and 25 (two serious) for CHF, and nine (five serious), four (four serious), and four (sero serious) for hypertension, respectively.

Conclusion:

No new safety findings were identified during the 6-month EPPV. Furthermore, there were no differences in safety profile by indication.
PS-C19-9: CLINICAL EFFECTS OF ARNI (SACUBITRIL/VALSARTAN) IN PATIENTS WITH CHRONIC KIDNEY DISEASE WITH HYPERTENSION
Authors: Kobayashi Norihiro , Nakatani Yoshihisa , Shimizu Kazuyuki , Nakano Yukihito , Sakaguchi Mika , Arima Shuji
Published: January 2023

Purpose:

ARNI (Sacubitril / Valsartan) is known to have natriuretic effects in addition to vasodilatory effects, cardiac hypertrophy, and antifibrosis. Therefore, it is considered to have a great effect on blood pressure and is used as an antihypertensive drug. However, the details of improvement of blood pressure changes in CKD patients are clearly unknown. Here we examine the clinical effects of ARNI administration in CKD patients by stage of renal function.

Subject and Method:

41 CKD patients who started enresting for hypertension from September 27, 2021 to February 28, 2022, and 26 of them were able to follow up for a period of 3 months or more after oral administration. Patient profiles by renal function are 9 persons stage G3 (eGFR30–59), 4 persons stage G4 (eGFR15–29), 9 persons stage G5 (less than eGFR15), 3 persons stage G5D (during dialysis) PD, and 1 person HD + PD. Blood Pressure, eGFR, protein quantification, and NT-proBNP are measured before and after administration for a period of 3 months or more, and analysis was performed by two-way ANOVA with a mixed model using SPSS. In addition, ABPM was performed before and after ARNI administration in 9 of them (6 treatment-resistant hypertension), and the diurnal variation pattern, changes in proteinuria and renal function were also examined.

Result:

Before and after ARNI administration, blood pressure decreased and edema improved in most patients. There was no interaction with the rate of decrease in GFR (significance probability 0.972). In addition, urinary protein increased to 1.57 g/gCre (mean difference 95% confidence interval 0.175–2.966, significance probability 0.006 interaction). NT-proBNP decreased before and after administration.

In stage G3, the dipper type of ABPM did not change, and the non-dipper type improved slightly. In stage G5 it was improved the degree of descent at night, and a change in category. However, in the case of peritoneal dialysis, the mean blood pressure did not improve, and the effect of pattern improvement was not observed.

Discussion / Conclusion:

ARNI was found to exert a strong antihypertensive effect on CKD patients that has not been treated with dialysis. And ARNI did not affect the antihypertensive effect even if there is residual urine during the dialysis period. In addition, edema can be expected to have a reducing effect regardless of proteinuria, and if blood pressure can be lowered firmly, it can also be expected to have a reducing effect on proteinuria.
PS-C20-7: CARDIOVASCULAR SAFETY OF OLMESARTAN FOR MODERATE HYPERTENSIVE PATIENTS: A MULTICENTER COHORT STUDY USING A COMMON DATA MODEL
Authors: Kim Ju Hyeon , Lim Subin , Chung Se Hwa , Yum Yunjin , Joo Hyung Joon , Kim Yong Hyun , Kim Eung Ju
Published: January 2023

Objective:

Olmesartan has been linked to numerical imbalances of cardiovascular mortality compared to placebo group. There is a paucity of contemporary data on real world evidence of this agent in different study populations. We sought to investigate clinical outcomes between olmesartan and other anti-hypertensive medications in moderately hypertensive patients.

Design and method:

This multicenter, retrospective study used the Korea University Medical Center database built on electronic health records from 2017 to 2020. Patients prescribed with at least two antihypertensive drugs as combined therapy were followed up for 3 years. The primary endpoint was a composite of all cause mortality, myocardial infarction, stroke, and heart failure. Adjusted outcome was compared with the use of propensity score matching (PSM).

Results:

Among 20,835 patients, 3,508 (16.8%) were olmesartan initiators from Jan 2017 to Dec 2017. Average age was 64 years, 45% were men, and 41% had diabetes. Olmesartan group were younger, more often women, and less likely to have diabetes mellitus and chronic kidney disease. The 3 year cumulative incidence of the composite primary endpoint was similar in both groups (4.9% vs. 5.7%, log rank p = 0.06). After PSM, the adjusted 3 year rate of the primary endpoint was similar between two groups (7.4% vs. 7.1%, log rank p = 0.72). In multivariable analysis, olmesartan use was associated with an adjusted hazard for the primary outcome of 0.95 (95% confidence interval, 0.83 to 1.10).

Conclusions:

Olmesartan combination for moderately hypertensive patients showed similar cardiovascular outcomes in real world practice, and there is no robust signal for harm with olmesartan use.
PS-C21-5: EFFICACY OF SWITCHING FROM EPLERENONE TO ESAXERENONE FOR THE TREATMENT OF PRIMARY ALDOSTERONISM
Authors: Sugiyama Toru , Tomino Yuki , Chounabayashi Minami , Saeki Kousuke , Hayakawa Eri
Published: January 2023

Background:

Mineralocorticoid receptor (MR) antagonist is the first choice for medical therapy for primary aldosteronism (PA) due to bilateral adrenal disease. However, there are many cases of PA in which blood pressure control are inadequate and/or suppression of renin are insufficiently released even under the maximum dose of eplerenone (EPL) approved in Japan. In this study, we investigated the effect of switching to the novel MR antagonist Esaxerenone (ESX) in PA patients whose renin suppression was not released even under the maximum dose of EPL.

Methods:

Twenty-seven patients (age; 53 ± 10 years, male/female; 14/13) who were diagnosed with PA at our hospital and showed plasma renin activity (PRA) < 1.0 ng/mL/hr even under EPL 100 mg/day were switched to ESX. We investigated changes in blood pressure, PRA, plasma aldosterone concentration (PAC), blood biochemical findings, and concomitant antihypertensive agents in these patients for 12 months.

Results:

Systolic and diastolic blood pressure decreased significantly from 1 month (133 ± 12/84 ± 8 mmHg) to 12 months (127 ± 10/80 ± 9 mmHg) compared to before switching to ESX (140 ± 16/88 ± 11 mmHg), whereas the rate of concomitant use of other antihypertensive agents did not change (44.4% ¡ú 45.0%). PRA (0.5 ± 0.4 ng/mL/hr) increased significantly from 6 months (0.6 ± 0.4 ng/mL/hr) to 12 months (0.8 ± 0.6 ng/mL/hr). PAC (191 ± 83 ¡ú 188 ± 110 pg/mL), serum potassium (4.3 ± 0.3 ¡ú 4.4 ± 0.4 mEq/L), AST (20 ± 6 ¡ú 22 ± 4 U/L), ALT (21 ± 11 ¡ú 21 ± 5 U/L) and γGTP (34 ± 41 ¡ú 38 ± 34 U/L) did not change. Estimated GFR (78 ± 14 ¡ú 70 ± 15 mL/min/1.73m2) gradually decreased.

Conclusions:

These results suggest that ESX is a more potent antagonist of MR with equivalent safety to EPL in the management of PA.
PS-C22-4: ASSOCIATION OF ATRIAL NATRIURETIC PEPTIDE GENETIC POLYMORPHISMS WITH ARTERIAL HYPERTENSION IN MONGOLIAN POPULATION
Authors: Unurjargal Tsolmon , Byambatsogt Bolortuul , Sodovsuren Naranchimeg , Sukhbaatar Pagmadulam
Published: January 2023

Objective of the present study was to evaluate the association between polymorphisms of atrial natriuretic peptide(ANP) gene and arterial hypertension.

Design and method:

This study was conducted in Ulaanbaatar between October 2018 and November 2019 years. A case-control study was performed in 123 subjects including 82 hypertensives and 41 normotensive subjects, aged 20–60 years. The family history of cardiovascular disease and risk factors of hypertension were taken by questionnaires and body mass index, systolic and diastolic pressures were evaluated by physical examination. Hypertension was defined as systolic BP ≧ 130 mm Hg and/or diastolic BP ≧ 80 mm Hg. After isolation DNA from peripheral blood, specific primers were used for PCR to detect the mutations of gene by using ThermoFisher dream Tag DNA Polymerase. QIAGEN QIAquick PCR purification kit and QIAquick Gel extraction kit were used to establish nucleic acid sequence. The study was approved by the Ethics Committee of Mongolian National University of Medical Sciences and all subjects participated in the study after making signed informed consents.

Results:

The mean age of the participants was 40.2 years and 56.1% were men. The T2325C variant of ANP gene was identified in 4.9% of all participants. According to the genotype results, the frequencies of T2325C polymorphism of the ANP gene were 1.2% in hypertensive patients and 12.2% in normotensive subjects respectively. The partial DNA sequence in ANP gene was shown in Figure 1. DNA sequencing showed a thymine to serine substitution at nucleotide 2325. Compared with individuals without T2325C polymorphism, individuals with T2325C polymorphism had higher percentage of family history of cardiovascular disease.

Conclusion:

The genetic polymorphism in ANP gene identified for the first time in the Mongolia.

This case-control study indicated that the ANP T2325C gene polymorphism may have no relationship with arterial hypertension.
PS-C22-6: PERFORMANCE OF PREDICTION ALGORITHM FOR THE SUBTYPE DIAGNOSIS OF PRIMARY ALDOSTERONISM WHICH WAS ADVOCATED IN THE JAPAN PRIMARY ALDOSTERONISM STUDY
Authors: Kobayashi Sakiko , Kurihara Isao , Yokota Kenichi , Kinouchi Kenichiro , Nakamura Toshifumi , Miyashita Kazutoshi , Itoh Hiroshi
Published: January 2023

Objective:

In the part of the Japan Primary Aldosteronism Study (JPAS), the prediction algorithm for the subtype diagnosis of primary aldosteronism (PA) was advocated and published in 2018 (Umakoshi.H et.al, J Clin Endocrinol Metab, 2018, 103(3):900–908). In the algorithm, patients with PA with bilateral normal results on CT and normokalemia likely have a low prior probability of a lateral form of PA in AVS (6.2%) and could be treated medically, whereas those with unilateral visible mass on CT and presence of hypokalemia have a high probability of a lateralized form of PA in AVS (70.6%). To validate the efficacy of the algorithm, we applied the algorithm for recent PA cases in our institute, Keio University hospital.

Patients:

A total of 77 patients with PA who underwent adrenal venous sampling (AVS) between November 2018 and October 2019 were enrolled in this study. They were classified into four groups according to CT findings and potassium status. Subtype diagnosis of PA was determined by AVS.

Results:

In our case, the prevalence for unilateral hyperaldosteronism on AVS was as follows: CT-negative with normokalemia, 7.9%; CT-positive with normokalemia, 15.4%; CT-negative with hypokalemia 22.2%, and CT-positive, 71.4%. The results were quite similar to the results in the previous report. In the algorithm, it was stated that AVS could be spared in patients with unilateral lesion on CT and hypokalemia if they were younger than 35 years, however, in our cases, there was one patient whose age was 30 with unilateral lesion on CT and hypokalemia and the AVS result of whom indicated bilateral PA. In the algorithm, it was also stated that AVS could be spared in patients with bilateral lesions on CT and normokalemia if plasma aldosterone concentration was less than 8 ng/dl and it was consistent in our cases.

Conclusion:

Overall, the prediction algorithm for the subtype diagnosis of PA developed in JPAS could be applied well in our recent PA cases.
PS-C22-9: ANGIOTENSIN RECEPTOR-NEPRILYSIN INHIBITOR (ARNI) HAS MORE EFFECTS IN REDUCING ALDOSTERONE CONCENTRATIONS AND CARDIAC HYPERTROPHY IN WELL-CONTROLLED HYPERTENSIVE PATIENTS
Authors: Satoh Fumitoshi , Tezuka Yuta , Omata Kei , Ono Yoshikiyo , Morimoto Ryo , Ito Sadayoshi , Tanaka Tetsuhiro
Published: January 2023

In recent years, angiotensin receptor neprilysin inhibitor (ARNI), a new class of drugs, has shown good therapeutic effects on cardiovascular disease (CVD) patients in several clinical studies, reducing the morbidity and mortality of CVD patients. In this study, 301 well-controlled essential hypertensive patients with left ventricular dilatation disorder were enrolled and medicated with ARNI for six months replaced from angiotensin receptor blockers (ARB) from April 2021 till March 2022. There were no significant improvements in indices except blood pressure, aldosterone concentrations, left ventricular mass index (MD -3.15 g/m2, 95% CI -3.38, -2.62) and left atrial volume (MD -6.20 mL, 95% CI -11.11, -0.31). The systolic and diastolic blood pressures were significantly reduced from 120.5 ± 0.91 to 115.8 ± 0.86 (p = 0.002) mmHg and from 72.5 ± 0.57 to 69.9 ± 0.54 mmHg, respectively (means ± SEM). Of interest, plasma aldosterone concentrations were significantly reduced from 11.7 ± 1.15 to 6.54 ± 0.56. without significant change of renin concentrations. The patients with primary aldosteronism have increased risks of cardiovascular complications compared with essential hypertensives. ARNI distinctly improved hypertrophy compared with angiotensin receptor blockers, and such effects might be due to the reduced aldosterone concentrations.
PS-C27-2: RISK OF PSEUDO-MICROALBUMINURIA DURING MENSTRUAL SITUATION IN APPARENTLY HEALTHY WORKERS
Authors: Munakata Masanori , Hattori Tomomi , Nakayama Fumie , Konno Satoshi , Ioue Nobutaka , Nakamura Tomohiro , Hozawa Atsushi
Published: January 2023

Background:

Measurement of urinary albumin excretion (UAE) is useful for the prediction of future cardiovascular event and is now used not only in clinical but also in health-check up or industrial settings. Especially, microalbuminuria (MA) is an important category of early vascular marker to alert lifestyle modification and/or pharmacological treatment. In the working female population, however, examination of urine in above settings could encounter menstrual situation. Contamination of menstrual blood into urine could induce pseudo-microalbuminuria. However, it has never been studied in apparently healthy women how much of contamination of menstrual blood could increase the risk of pseudo-microalbuminuria. To address this issue, we examined the relationship between urine occult blood level and UAE or frequency of MA cases during menstrual and non-menstrual situation in apparently healthy workers.

Subjects and method:

We studied 735 female school workers who participated in the Miyagi Karoshi Prevention study. Urinary albumin excretion adjusted for creatinine (UAE) from morning spot urine sample was examined together with annual health check-up in 2019 and 2020. Menstrual situation was confirmed by a questionnaire at the time of examination. One hundred and forty-four non-diabetic, non-hypertensive women without chronic kidney disease (36.9 ± 9.2yrs) were studied either during menstrual or non-menstrual situation in the 2 consecutive years. We compared clinical data during menstrual and non-menstrual situation and then examined the dose-response relationship between urine occult blood category (negative to three plus) and UAE or frequency of MA cases at menstrual and non-menstrual situation.

Results:

Menstrual situation was associated with significantly higher UAE (4.6 vs. 3.4 mg/gCr, p < 0.001), systolic BP (113.6 ± 13.1 vs. 111.3 ± 12mmHg, p = 0.015) and uric acid level (4.3 ± 0.8 vs. 4.10.9 ± mg/dl, p = 0.004) and was associated with significantly lower high density lipoprotein cholesterol (70.0 ± 14.4 vs. 72.7 ± 16.3 mg/dl, p < 0.001) and eGFR(85.0 ± 14.6 vs, 87.7 ± 16.9 ml/min/1.73m2, p = 0.003) as compared with non-menstrual situation. In menstrual situation, UAE was dose-dependently increased with an increase in urine occult blood category (p < 0.001). Frequency of MA in each urine blood category was 0, 0, 4.5, 0 and 17% (p = 0.001), respectively. UAE was not correlated with systolic BP or other parameters during menstrual situation. In non-menstrual situation, there was no correlation with UAE and urine occult blood level.

Conclusion:

Risk of pseudo-microalbuminuria could abruptly rise if urine occult blood level reach three plus in menstruated women.
PS-C27-4: CONTROLLED RESISTANT HYPERTENSION FOLLOWING A SUCCESSFUL RENAL ARTERY STENTING: A RARE CASE REPORT IN A DEVELOPING COUNTRY
Authors: Munita Fatihatul Firdaus , Wahyudi Dendy Puji , Tiksnadi Badai Bhatara , Hadian Widi Nugraha
Published: January 2023

Introduction:

Renal artery stenosis is among the etiologies of secondary hypertension in which the diagnosis and therapy are difficult. We report a case of a patient suffered from uncontrollable hypertension with frequent episode of malignant hypertension, treated with renal artery stenting.

Case Description: A 36-year-old female visited cardiovascular policlinic on a routine control for her hypertension. Having diagnosed with hypertension for two years, he had several episodes of malignant hypertension. At the beginning of her treatment, she was prescribed an angiotensin-converting-enzyme inhibitor yet her pressure was not only uncontrolled but also worsen. By the visit, she was medicated using two alpha-2-adrenergic agonists, a loop diuretic, a beta-blocker, a calcium-channel blocker, an angiotensin-receptor blocker, and an aldosterone-receptor antagonist without any satisfactory outcome on her blood pressure status. She had a blood pressure of 196/130 mmHg with tachycardia of 112 times/minute. We found cardiomegaly on physical examination which proven by chest x-ray. Echocardiography indicated hypertensive heart disease. Screening for secondary hypertension, including laboratory tests (complete blood count, potassium, sodium, creatinine, fasting glucose, fasting lipid profile, urinalysis, thyroid stimulating hormone, 24H urinary free cortisol) suggested normal results. Renal ultrasound and doppler were also conducted and showed a suspicion of right renal artery stenosis. Therefore, angiography of the renal artery was conducted for diagnostic and therapy when indicated. The angiography suggested a normal left renal artery while the right artery had a 95% stenosis on the proximal part. An intravascular ultrasound-guided percutaneous transluminal angioplasty on her right renal artery was conducted and two vascular stents were implanted. The patient showed a remarkable development following her decreasing blood pressure on follow-up. After 1 week, her blood pressure is now controllable on a single antihypertensive and antiplatelet therapy.

Conclusion:

The diagnosis and management of a patient with resistant hypertension might be challenging, particularly in the setting of a developing country. Renal artery angiography, among other examination, might be crucial in the diagnosis sequence, yet was not always readily available. We present a case in which diagnosis of renal artery stenosis was made followed by a definite treatment resulting in a remarkable hypertension control. An identifiable etiology is the key to a proper and the best treatment option for the patient.
PS-C27-6: HIGH BRACHIAL-ANKLE PULSE WAVE VELOCITY IS ASSOCIATED WITH THE RENAL OUTCOME IN CHRONIC KIDNEY DISEASE PATIENTS WITH HYPERTENSION
Authors: Ko Ye Eun , Jhee Jong Hyun , Lee Chan Joo , Park Sungha , Yoo Tae Hyun
Published: January 2023

Background:

Increase in arterial stiffness is associated with increase in cardiovascular events and mortality. Although studies have shown an association between arterial stiffness and chronic kidney disease (CKD), the association between CKD progression and arterial stiffness has not been clearly defined. The aim of this study is to investigate the association between brachial-ankle pulse wave velocity and chronic kidney disease progression in CKD patients with hypertension.

Methods:

A total of 717 CKD (stage 3 to 5) patients with hypertension were enrolled from the prospective observational cohort of CMERC-HI (Cardiovascular and Metabolic Disease Etiology Research Center-High Risk). Patients were classified into tertile based on brachial-ankle PWV: low, intermediate, high. Primary outcome was progression of CKD, which was composite of at least 50% decrease in estimated glomerular filtration rate (eGFR) from baseline or end stage kidney disease requiring dialysis.

Results:

The mean age of study subjects was 60.7 ± 11.8 years and 404 (56.3%) were male. During a median follow-up of 42.5 months, CKD progression occurred in 213 (29.7%). There were statistically significant differences in age (54.0 ± 12.1, 61.0 ± 11.1, 67.1 ± 8.2 in low, intermediate, high group, respectively, P < 0.001) among brachial-ankle PWV tertile groups. In multivariate Cox analysis, brachial-ankle PWV above the median value was related to increased risk of CKD progression (HR, 2.29; 95% CI, 1.33–3.94, P = 0.003) compared to subjects with brachial-ankle PWV below the median. In addition, when the study population was divided into tertiles, the intermediate and high brachial-ankle PWV group were associated with progressively increased risk of CKD progression (HR, 2.03; 95% CI, 1.09–3.77, P = 0.03, HR, 2.51: 95% CI, 1.27–4.96, P = 0.008) compared to low brachial-ankle PWV group after adjusting for confounding factors. The Kaplan-Meier analysis also showed statistically significant association between brachial-ankle PWV and CKD progression. In contrast, there was no statistically significant association between CKD progression and femoral-ankle PWV, an index for peripheral arterial stiffness, which suggests that increase in central arterial stiffness is associated with CKD progression.

Conclusions:

High brachial-ankle pulse wave velocity may be an independent predictor of CKD progression in CKD patients with hypertension.
PS-C27-7: ELECTROCARDIOGRAPHIC LEFT VENTRICULAR HYPERTROPHY CAN PREDICT FUTURE DECLINE OF RENAL FUNCTION IN GENERAL POPULATION
Authors: Ikeda Shota , Shinohara Keisuke , Matsumoto Sho , Yoshida Daisuke , Nakashima Ryosuke , Ono Yoshiyasu , Toyama Kensuke , Tsutsui Hiroyuki
Published: January 2023

Objective:

Electrocardiographic left ventricular hypertrophy (LVH) has been shown to be associated with future renal function decline in patients with chronic kidney disease. However, this association remains unclear in general population. We aimed to elucidate the association between baseline LVH on electrocardiogram and future renal function decline using health checkup data.

Design and method:

We used a dataset derived from the annual health-screening program from 2010 to 2019. Patients with baseline estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2 were excluded. LVH was determined by the electrocardiographic voltage criteria at baseline. Association between LVH and renal function outcomes, specifically ≧ 30% decline in eGFR from baseline, eGFR decline less than 60 ml/min/1.73m2 and 45 ml/min/1.73m2, were analyzed using multivariate Cox proportional hazard models.

Results:

Among total of 19,825 participants, 1,263 had LVH and 18,562 no LVH. LVH group was older and more male and current smokers, and to complicated with more hypertension, and higher systolic (136.7 ± 20.9 vs 123.7 ± 19.1 mmHg, P < 0.001) and diastolic blood pressure (81.8 ± 12.6 vs 74.6 ± 12.0 mmHg, P < 0.001). Baseline eGFR and HbA1c were comparable between the groups. Incidence of ≧ 30% eGFR decline was significantly higher in LVH group (P < 0.001, log-rank test). LVH was associated with ≧ 30% eGFR decline (HR 1.92, 95% CI 1.26–2.91, P = 0.002) and eGFR < 45 ml/min/1.73m2 (HR 3.12, 95% CI 1.54–6.35, P = 0.002) after adjustment. LVH was not associated with eGFR < 60 ml/min/1.73m2 in the overall population. However, when analyzed this association in subpopulation stratified by baseline SBP (< 140 and ≧ 140 mmHg), LVH was associated with eGFR < 60 ml/min/1.73m2 in persons with SBP ≧ 140 mmHg (HR 1.40, 95% CI 1.10–1.79, P = 0.007) but not in those with SBP < 140 mmHg (HR 0.88, 95% CI 0.68–1.14, P = 0.32) (P for interaction between LVH and baseline SBP = 0.005). Similarly, LVH was significantly associated with ≧ 30% eGFR decline and eGFR < 45 ml/min/1.73m2 in persons with SBP ≧ 140 mmHg but not in those with SBP < 140 mmHg, although the interaction between LVH and baseline SBP was not significant in these renal outcomes.

Conclusion:

Electrocardiographic LVH was independently associated with the rate of renal function decline among general population. The association between LVH and future renal function decline might be stronger in people with SBP ≧140 mmHg.
PS-P07-5: PHARMACEUTICAL INFLUENCES ON IN-HOSPITAL DEATH IN PATIENTS WITH AND THOSE WITHOUT DIABETES AT A JAPANESE COMMUNITY GENERAL HOSPITAL
Authors: Hosoki Minae , Yamagami Hiroki , Hori Taiki , Yasui Saya , Hara Tomoyo , Kurahashi Kiyoe , Yoshida Sumiko , Nakamura Shingen , Otoda Toshiki , Yuasa Tomoyuki , Endo Itsuro , Abe Masahiro , Aihara Kennichi
Published: January 2023

Background:

Diabetes mellitus (DM) is associated with increased risks of cancers, cardiovascular disease (CVD), liver disease and death. In recent years, cardiovascular and metabolic medications have been developed for reducing cardiovascular events and mortality. We examined mortality statistics by cause of in-hospital death in patients with DM and patients without DM and we analyzed the effects of cardiovascular and metabolic medications on the lifespans of patients in a Japanese community general hospital during the past decade.

Methods:

We performed a retrospective analysis of cause of death in hospitalized patients at Anan Medical Center, a community general hospital in Tokushima, Japan, during the period from 2011 to 2020. Information on clinical characteristics of the patients including age at death, cause of death, complications and medications used was obtained from medical records. Statistical comparisons were performed in patients with DM and those without DM. Multivariate analysis was also carried out to determine the effects of medications on age at death.

Results:

A total of 2336 deaths were recorded during the 10-year period. The mean age at death was not significantly different between diabetic and nondiabetic patients for both sexes (78.9 (DM) vs. 79.6 (non DM) years in males and 82.5 (DM) vs. 83.6 (non DM) years in females). The rates of hepato-pancreatic cancer and cardio-renal failure as a cause of death were significantly higher in patients with DM than in patients without DM (p < 0.01 and p < 0.05, respectively). The incidences of hepato-renal failure, CVD, hypertension and dyslipidemia as comorbidities were significantly higher in diabetic patients than in nondiabetic patients (all p < 0.01). The percentages of patients taking antihypertensive, antiplatelet, diuretic and statin medications were higher in diabetic patients than in nondiabetic patients (all p < 0.01). Multivariate analysis of medications for determinants of age at death showed that insulin was a negative contributor in diabetic patients. On the other hand, the use of an angiotensin receptor blocker (ARB)/angiotensin-converting enzyme inhibitor (ACEi) or Ca antagonists was a positive correlator for longevity in all of the subjects including diabetic and nondiabetic patients.

Conclusions:

In our community general hospital, DM had no influence on age at death. It is possible that comprehensive treatment for DM and its complications eliminates the difference between lifespans of individuals with DM and those without DM. In addition, treatment of hypertension with ARB/ACEi or Ca antagonists was positively associated with the longevity of Japanese community subjects.
PS-P07-7: IMPACT OF INORGANIC NITRATE ON ENDOTHELIAL FUNCTION IN ADULTS A SYSTEMATIC REVIEW OF RANDOMISED CONTROLLED TRIALS AND META ANALYSIS
Authors: Celik Begum , Muriki Esther , Spencer Jeremy , Kuhnle Gunter , Mills Charlotte
Published: January 2023

Aim:

Inorganic nitrate which is found in green leafy vegetables and beetroot reduces blood pressure via the nitrate-nitrite-NO pathway and may have other benefits such as improved endothelial function. It is assumed that endothelial dysfunction is key risk factor for CVDs. Therefore, in this systematic review and meta-analysis, we evaluated the impact of inorganic nitrate supplementation on endothelial function.

Design and method:

MEDLINE, Web of Science, and Scopus databases were searched by two independent authors up to November 2021. We included randomised controlled trials that test oral administration of dietary/non-dietary inorganic nitrate versus a control, adult male and female subjects with/without health conditions, measuring endothelial function by flow mediated dilatation (FMD) as an outcome. Risk and quality assessments were performed using a Cochrane risk of bias score and standardised mean differences of the outcomes were pooled using a random-effects model.

Results:

3,521 studies were identified after a database search, of which 12 studies met the inclusion criteria. The pooled sample size was 362 and the number of participants per trial ranged from 10 to 65. Eight studies were acute, four studies were chronic and most of them included healthy participant arms (n = 12) with (n = 4) focusing on unhealthy populations. The mean difference in %FMD for nitrate versus the control was 1.57% (95% CI: 0.76–2.37), p = 0.01; high heterogeneity (I2 = 98.3%) was observed (Figure 1). Subgroup analyses were performed in terms of, nitrate amount (< more or less than 600 mg), type of intervention (dietary or non-dietary), participants health status (healthy and unhealthy), and study duration (acute or chronic). All sub-analysis still showed significant increases in %FMD. In acute studies, FMD response was higher (2.13% (95% CI: 0.87–3.40), p < 0.01, I2 = 98.5%) than chronic studies (0.90% (95% CI: 0.48–1.31), p < 0.01, I2 = 68.6%). Only one study showed low risk of bias; the other studies were classified as “some concern” due to a lack of information about randomisation and lack of pre-specified analysis plans.

Conclusions:

The meta-analysis provides evidence that inorganic nitrate improves FMD response and may be a useful strategy for preventing further CVD. Change in 1.5% of FMD as seen in this review could results in a reduction in CVD risk of ∼15%. However, due to the high heterogeneity of the results, further studies are needed to build a robust evidence base to inform dietary recommendations.
PS-P08-4: FOXO3 LONGEVITY GENOTYPE ATTENUATES THE IMPACT OF HYPERTENSION ON RISK OF INTRACEREBRAL HEMORRHAGE
Authors: Nakagawa Kazuma , Randi Chen , Greenberg Steven M , Ross G Webster , Willcox Bradley J , Donlon Timothy A , Allsopp Richard C , Willcox D Craig , Masaki Kamal H , Morris Brian J
Published: January 2023

Objective:

To determine the association between the longevity-associated G allele of FOXO3 SNP rs2802292 and risk of hypertension mediated intracerebral haemorrhage (ICH).

Design:

Prospective population-based longitudinal study.

Methods:

The cohort comprised Japanese American men living on Oahu, Hawaii, who were recruited from 1965 to 1968 for the Kuakini Honolulu Heart Program. Age adjusted incidence of ICH by hypertension status was assessed for the whole cohort after stratifying by FOXO3 genotype. Cox regression models, adjusted for age, cardiovascular risk factors, and FOXO3 and APOE genotypes, were utilized to determine the relative risk of effect of hypertension on ICH. All models were created for the whole cohort and stratified by FOXO3 G allele versus TT genotype.

Results:

Among 6,469 men free of baseline stroke, FOXO3 G allele was present in 3,009 (46.5%) participants. Overall, 183 subjects developed ICH over the 34 year follow-up period. Age adjusted ICH incidence rates were 0.90 and 1.32 per 1,000 person years followup in those without and with hypertension, respectively (p = 0.002). After stratifying by FOXO3 genotype, this association was no longer significant in G allele carriers. In the whole cohort, hypertension was an independent predictor of ICH (RR = 1.70, 95%CI 1.25, 2.32; p = 0.0007). In stratified analyses, hypertension remained an independent predictor of ICH among the FOXO3 TT genotype group (RR = 2.02, 95% CI 1.33, 3.07; p = 0.001), but not in those who were carriers of the protective (G) allele of FOXO3 (RR = 1.39, 95% CI 0.88, 2.19; p = 0.15).

Conclusions:

The longevity associated FOXO3 G allele mitigates the impact of hypertension on ICH risk. Our finding has implications for risk assessment of patients with hypertension.
PS-P08-5: METABOLIC SYNDROME RISK PREDICTION EQUATION AND A SIMPLE SCORE MODEL DERIVATION AND VALIDATION IN JAPANESE GENERAL POPULATION
Authors: Salim Anwar Ahmed , Kawasoe Shin , Kubozono Takuro , Ojima Satoko , Kawabata Takeko , Ikeda Yoshiyuki , Miyahara Hironori , Tokushige Koichi , Ohishi Mitsuru
Published: January 2023

Objective:

Predicting metabolic syndrome (MetS) is important for identifying high risk cardiovascular disease individuals and providing preventive interventions. We aimed to develop and validate an equation and a simple MetS score according to the Japanese MetS criteria using Japanese health checkup data.

Design and Methods:

In total, 54,198 participants (age, 54.5 ± 10.1 years; men, 46.0%), with baseline and five year follow up data were randomly assigned to Derivation and Validation cohorts (ratio: 2:1). Multivariable logistic regression analysis was performed in derivation cohort and scores were assigned to factors corresponding to beta coefficients. We evaluated predictive ability of the scores using area under the curve (AUC), then applied them to validation cohort to assess reproducibility. For equation model, all variables were treated as continuous except for sex, current smoking, and alcohol consumption, which were treated as binary variables.

Results:

The primary model (including blood tests) ranged 0 to 27 points had an AUC of 0.81 (sensitivity: 0.81, specificity: 0.81, cut-off score: 14), and consisted of age, sex, blood pressure (BP), body mass index (BMI), serum lipids, glucose measurements, current smoking, and alcohol consumption. The simplified model (excluding blood tests) ranged 0 to 17 points with an AUC of 0.78 (sensitivity: 0.83, specificity: 0.77, cut off score: 15) and included seven variables: age, men, systolic BP, diastolic BP, BMI, alcohol consumption, and current smoking. We classified individuals with a score < 15 as low-risk MetS and ≧ 15 points as high risk MetS, respectively. The incidence of MetS increased constantly as the score increased. Furthermore, the equation model to predict MetS incidence from derivation cohort generated an AUC of 0.85 (sensitivity: 0.86, specificity: 0.55). Analysis of the validation and derivation cohorts yielded similar results.

Conclusion:

We developed a primary score, an equation model, and a simple score. The simple score is convenient, well validated with acceptable discrimination, and could be used for early detection of MetS in high risk individuals.