bluuebunny/crossref_metadata_2025 huggingface dataset:
23. Association polymorphism of gene-related preeclampsia, Fms-related tyrosine kinase 1 (FLT1), with peripartum cardiomyopathy
Authors: Dewi Ivana Purnama , Wardhani Louisa Fadjri Kusuma , Maghfirah Irma , Dewi Kristin Purnama
Published: April 2023

Introduction: Preeclampsia (PE) is one of the most serious hypertension disorder during pregnancy. Several polymorphisms have been correlated with an increased risk of PE, one of them is FLT1 gene. FLT1 gene encodes soluble Fms like tyrosine Kinase 1 (sFlt-1), an anti-angiogenic factor that plays crucial role in PE pathogenesis. PE is often cited as a risk factor for peripartum cardiomyopathy (PPCM). However, until now, no study has evaluated FLT1 polymorphism in relation to PPCM incidence.

Aims: To screen whether the Fms-related tyrosine kinase 1 (FLT1) gene polymorphism contributes to genetic susceptibility to peripartum cardiomyopathy (PPCM).

Methods: An analytic observational study with a case-control design was conducted at Integrated Cardiac Service Center of Dr. Soetomo General Hospital, Surabaya, Indonesia. The PPCM cases and controls were enrolled. Baseline characteristic data were collected, and blood samples were analyzed for FLT1 gene (rs722503 and rs12584067) polymorphism by PCR amplification followed by restriction fragment length polymorphism (RFLP). Serum levels of sFlt-1 were measured by sandwich ELISA.

Results: A total of 134 patients, 67 PPCM cases and 67 control, were included in this study. Genotyping of FLT1 showed T/T (rs722503) and G/G (rs12584067) genotypes were more frequent in PPCM cases with significant differences (p = 0.020 and p = 0.042, respectively). However, FLT1 polymorphism in PPCM with PE groups had higher significant genotype differences for rs12584067 than other groups (p < 0.001). Evidence of PE was found in 45% of PPCM cases. FLT1 polymorphism in PPCM with PE groups had significantly increased serum levels than other groups (p < 0.001).

Conclusion: The study shows the possible association of FLT1 polymorphisms with gene expression leading to PPCM related to preeclampsia.
24. Visceral Fat is Linked to Higher Blood Pressure and Lower Kidney Function in Obese Office Workers in Jakarta
Authors: Lestari Lea Ratna , Wulandari Yohannessa , Hustrini Ni Made
Published: April 2023

Background: High prevalence of obesity, hypertension and chronic kidney disease (CKD) in office workers in Jakarta was reported. Higher visceral fat volume, particularly central obesity, has a greater clinical significance in predicting the incidence of hypertension and CKD.

Objective: This study aims to investigate the relationship between visceral fat volume with blood pressure (BP) and kidney function in obese office workers.

Methods: This is a cross-sectional study of 101 subjects at Dr. Cipto Mangunkusumo Hospital, Jakarta. Visceral fat volume was evaluated using a multi-frequency bioelectrical-impedance analysis SECA mBCA 525. BP was measured with a digital sphygmomanometer, and the estimated glomerular filtration rate (eGFR) CKD-EPI 2021 was calculated based on serum creatinine value.

Results: Subjects were predominantly female (63.4%), age 41 + 9.6 years, and body mass index of 29.8 (25 − 48.5) kg/m2. The average systolic BP was 131 + 15 mmHg and diastolic 84 (60 − 127) mmHg, with eGFR 106.6 (35.5–132) ml/minute/1.73 m2. A high visceral fat volume was observed (2.9 L; range 1.1−6.5). Among subjects with abnormal visceral fat (91%), 18.5% had eGFR <90 ml/min/1.73 m2, and 33.7% with BP $140/90 mmHg. Visceral fat showed a positive correlation with both systolic (r = 0.436, p < 0.001) and diastolic BP (r = 0.306, p = 0.002) and a negative correlation with eGFR (r = -0.284, p = 0.004).

Conclusion: Visceral fat is significantly correlated with higher BP and lower kidney function in obese office workers.
26. Comparison of Electrocardiographic Criteria for The Diagnosis of Left Ventricular Hypertrophy in Patient with Hypertension
Authors: Pradipta I.D. , Sianipar J.P. , Amany A.Y. , Alamsyaputra A. , Farissa I.P. , Ahnaf M.F.
Published: April 2023

Background: Left ventricular hypertrophy (LVH) is an early cardiac complication in patient with hypertension. Several electrocardiographic (EKG) criteria have been identified for the diagnosis of LVH, the criterion that has the most diagnostic value is still unknown at this time.

Objective: The objective was to analyse three electrocardiographic criteria for LVH compared with transthoracic echocardiography (TTE) finding.

Method: This study was a-single centre, retrospective study, included 55 consecutive patients with hypertension who had visited the cardiology clinic. EKG and TTE were performed. The Peguero Lo-Presti criteria was calculated by adding deepest S amplitude in any precordial lead to the S amplitude in V4 (SD + SV4). Patients with valvular abnormalities, myocardial infarction, LV dysfunction, pericardial disease, bundle branch blocks, atrial fibrillation or flutter, and pulmonary disease were excluded from this study.

Results: We found 31 hypertensive patients (56%) had LVH by TTE. Of the 55 patients, 18 patients had LVH based on Peguero Lo-Presti criteria with a sensitivity of 58.06%. Cornell Voltage criteria was positive in 8 out of 55 patients with a sensitivity of 25.81% and Sokolow-Lyon criteria was positive in 6 out of 55 with a sensitivity of 19.35%. The Peguero Lo-Presti EKG criteria had a higher sensitivity (58.06%) and specificity (91.67%) in the diagnosis of LVH than traditional criteria.

Conclusion: Peguero Lo-Presti criteria for diagnosing LVH is more sensitive and specific than Sokolow-Lyon and Cornell voltage criteria. Perhaps it is due to the latter component of the QRS complex, which corresponds to the S wave, better represents voltage variations in patients with LVH.
27. The Critical Warning of Hypertension Burden: Systematic Analysis of Socio-Demographic and Gender Factors in Indonesia 1990–2019
Authors: Rizky Farizal , Saputra Mahendra Eko , Izzati Nabila , Saputri Faradila Budi
Published: April 2023

Background: The highest record Year Life with Disease (YLD) rate of Hypertension was observed in Indonesia (249.2 per 100,000) compared to the global average (100 per 100,000). Indonesia will suffer a heavy and surging hypertension burden in the near future. Hypertension control and concomitant CVDs treatment could be a significant public health challenge for the Indonesian government and health department. The major reason for the difficulties in providing primary services in Indonesia is a lack of analytical studies on the requirement for more comprehensive treatment of specific populations. We will evaluate hypertension in all Indonesian islands from 1990 to 2019 by gender and socio-demographics.

Methods: We used IHME-GBD data to estimate the DALYs caused by hypertension. The data was taken from 1990 to 2019. We grouped the data based on the Socio-Demographic Index (SDI) and gender. We analyzed data in R 4.2.2.

Results: Systematic analysis revealed that SDI and Gender significantly impact the prevalence of hypertension. Major changes over the last three decades were found in Male-Middle Income, Male-High Income, and Male-Low Income with 79%, 71%, and 50% change respectively. The most significant change was found in the male-middle SDI with a change from 2,926 to 5,251 (+79%) making it the highest Hypertension DALYs number in the World. Middle SDI has the Highest average change.

Conclusion: SDI and gender are crucial to identifying the contributor of disease burden and improving strategies for policy intervention and health equity. hypertension promotive and curative strategies must be personalized to every subgroup.
32. Correlation between Body Mass Index and Waist Circumference with Hypertension in Elderly at Seroja Health Center, Bekasi City
Authors: Dewi Anggieta Kumala , Maulida Syifa Nur , Luthfiah Hasna
Published: April 2023

Background: In 2020, Indonesia is estimated to have around 80,000,000 individuals aged >65 years old. The types of diseases that often occur in the elderly are non-communicable diseases (NCD), chronic and degenerative diseases, especially cardiovascular diseases. Hypertension is one of the diseases with the highest mortality and morbidity rates in Indonesia. The risk factor that is closely related to this disease is obesity. Central obesity has played a significant role in the occurrence of hypertension.

Objective: This study aims to assess the relationship between Body Mass Index (BMI) and Waist Circumference (WC) with the incidence of hypertension in the elderly population at Seroja Public Health Center, Bekasi.

Method: This study is a cross-sectional study, conducted in December 2022 at Seroja Public Health Center, with a total of 65 residents aged $60 years enrolled in this study. A face-to-face questionnaire survey and physical examination were conducted.

Result: The overall prevalence rate of hypertension was 44,6% with 13,8% males and 30,8% females. 43,1% of the samples were obese and 76,9% of the total population had central obesity. There was a positive correlation between BMI and WC with hypertension (P < 0,001 and p = 0,007 respectively). The multivariate logistic analysis showed that age, history of dyslipidaemia, and waist circumference were a predictor of hypertension in the elderly (P 
< 0.001).

Conclusion: There is a significant relationship between BMI and WC with the incidence of hypertension, WC is found to be one of the predictors of hypertension in elderly
35. Sublingual Versus Oral Captopril for Blood Pressure Reduction in Hypertensive Urgency: A Systematic Review
Authors: Untari P. U , Daindes T.
Published: April 2023

Background: Hypertensive emergencies are distinguished from hypertensive urgencies by the presence of immediately escalating target organ damage. The treatment of emergency hypertension should focus on bringing the blood pressure down gradually in 24 hours. Well known Guidelines recommend intravenous antihypertensive in this clinical setting. However, in some cases such as rural areas, oral antihypertensives are the one and only available option.

Objective: To evaluate the which Captopril intake - the widely available oral anti-hypertensive agent in rural areas - that would have better outcome in Emergency Hypertension.

Method: This review was conducted in accordance with the requirements outlined in the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines. The search for studies to be included in the systematic review was carried out from December, 28nd 2022 using the PubMed and SagePub databases by inputting the words: “sublingual”, “oral”, “captopril”, “blood pressure reduction” and “hypertension urgency”.

Result: After identifying 1.254 PubMed and 897 SagePub articles, the total article that met publishing time criteria (2012 and after) are 190 articles. After performing tittle screening, 37 articles were chosen and when final exclusion criteria were applied, we have 4 articles left. The study showed that patients who received captopril subligual 25 mg experienced the greatest reduction in systolic blood pressure, while DBP and MAP were better in the oral group.

Conclusion: Since the MAP reduction is the main therapy target in emergency hypertension, oral captopril intake is better than sublingual to achieve this goal.
36. Clinical Outcome of Intensive Blood Pressure Lowering in Diabetic Patients: A Systematic Review and Meta-analysis
Authors: Sukmadja Daniel , Triatmaja Rizkan , Tarigan Tinanda , Hidayat Saiful
Published: April 2023

Background: It remains controversial in defining the optimal blood pressure (BP) targets for diabetes mellitus (DM) patients. There were various data on intensive BP lowering management in DM population, particularly in reducing cardiovascular outcomes.

Objective: This study was conducted to compare the clinical outcome of intensive and standard BP lowering management in DM patients.

Methods: Randomized Controlled Trials (RCTs) from Pubmed, Proquest, Google Scholar and Cochrane Library databases which compare the clinical outcome between intensive and standard BP lowering therapy were analyzed. Meta-analysis was conducted with random effects and Mantel-Haenszel method.

Results: 18723 patients with DM from 11 RCTs were included. Intensive BP lowering strategy gave less number of stroke events (RR: 0.55; 95%CI: 0.36 to 0.85; p: 0.007) compared with standard BP lowering management. Between the two groups, there was no significant difference in causing all-cause death (RR: 0.94; 95%CI: 0.83 to 1.08; p: 0.39), cardiovascular death (RR: 0.85; 95%CI: 0.52 to 1.39; p: 0.53), myocardial infarction (RR: 0.96; 95%CI: 0.85 to 1.09; p: 0.54), heart failure (RR: 0.96; 95%CI: 0.75 to 1.23; p: 0.73), microalbuminuria (RR: 0.96; 95%CI: 0.65 to 1.40; p: 0.82). In the subgroup analysis, SBP reduction to lower than 120 mmHg caused lower incidence of stroke events compared with BP target of lower than 130 mmHg (RR: 0.57; 95%CI: 0.35 to 0.93; p: 0.02).

Conclusion: Intensive BP lowering strategy gave a better outcome in reducing stroke events in DM patients. Targeting SBP to below 120 mmHg showed more benefit compared with below 130 mmHg.
43. The Association Between Triglyceride-Glucose Index and Incidence of Hypertension: A Systematic Review and Dose-Response Meta-analysis
Authors: Putra Iwan Cahyo Santosa , Pranata Raymond , Pramudyo Miftah , Iqbal Mohammad , Prameswari Hawani Sasmaya , Erwinanto  , Akbar Mohammad Rizki , Tiksnadi Badai Bhatara
Published: April 2023

Background: Theoretically, insulin resistance and hypertension were shown to be closely related. Therefore, as the triglyceride-Glucose (TyG) index is one of the surrogate markers of insulin resistance, this meta-analysis aims to evaluate the dose-response relationship between the TyG index and hypertension.

Methods: We performed a systematic literature search using PubMed, Scopus, Embase, and Science Direct until January 2023. The exposure was the TyG index, and the outcome of interest was the incidence of hypertension across the TyG index intervals. The effect estimate was reported as odds ratios (ORs) in unadjusted and adjusted model. Adjusted odds ratios were carried out from all included studies in order to eliminate the possibility of confounding factors being involved in the incidence of hypertension.

Results: A total of 205.835 participants (mean age: 48 years old, male sex: 46%, mean BMI: 24.6 kg/m2) from 11 observational studies were included in this meta-analysis. This meta-analysis showed that the highest category of TyG index was associated with increased risk for hypertension in unadjusted (OR = 3.01 [1.97, 4.61], p < 0.001; I2: 99.1%, p < 0.001) and adjusted model (OR = 1.63 [1.25, 2.13], p < 0.001; I2: 95.5%, p < 0.001). The linear association showed a statistically non-significant trend for every 0.5 increase in the TyG index (OR 1.40 [0.63, 3.13], p = 0.413). Dose-response meta-analysis showed that the relationship between the TyG index and hypertension was non-linear (p < 0.001). Furthermore, statistical significance was obtained when the TyG index reached around 8.3 and increased non-linearly.

Conclusion: TyG index was significantly associated with hypertension in a non-linear dose-response relationship.
44. Correlation of Short-term Blood Pressure Variability and Cardiovascular Outcomes
Authors: Fathoni M. Y. , Kuncoro A. S. , Widyantoro B.
Published: April 2023

Background: Short-term blood pressure variability (BPV) is defined as the average variation in blood pressure throughout the day as measured by the ambulatory blood pressure monitoring (ABPM). Excessive BPV has potential to trigger cardiovascular events, especially in high-risk cardiovascular patients. Short-term BPV has been used as risk stratification but it is still unclear which subset of BPV is more significant to predict cardiovascular (CV) outcomes, especially in hypertensive patients with cardiovascular disease.

Objective: We sought to investigate correlation between short-term BPV and cardiovascular outcomes in the hypertensive population with cardiovascular disease.

Methods: Retrospective cohort study was conducted in NCC Harapan Kita, involving hypertensive patient with cardiovascular disease underwent 24-hours ABPM. Inclusion criteria were hypertensive patient with left ventricular hyperthrophy (LVH), documented coronary artery disease (CAD), pre-existing heart failure and atrial fibrillation. Data of 197 eligible patient were collected from electronic medical record and followed up from the ABPM examination for at least 1 year or until an event occur. The event is defined as a composite of all-cause mortality, acute coronary syndrome, stroke, heart failure requiring hospitalization, or need of coronary revascularization.

Result: Out of 197 subjects who met the inclusion criteria, 139 (70.6%) had sustained hypertension. Subset of BPV identified as risers (30.5%), non-dippers (43.1%), dippers (23.9%) and extreme dippers (2%). The morning blood pressure surge (MBPS) was observed in 50.8%. During follow up with median duration of 25 months (1 to 85 months), 32 subjects (16.2%) had cardiovascular outcomes. Multivariate analysis using Cox regression shows that none of the subset of blood pressure variability have significant correlation with cardiovascular outcomes.

Conclusion: In this study short-term BPV is not correlated with cardiovascular outcomes at 1 year follow up. The result suggested that in hypertensive patient with CV disease, the time to secondary events may need longer period.
46. Relationship between P Wave Dispersion and Left Ventricular Hypertrophy in Hypertensive Heart Disease Patients
Authors: Sianipar JP , Amany AY , Pradipta L. D. , Ahnaf MF
Published: April 2023

Background: It is associated with target-organ damage in various organs and ECG changes. P-wave durations and P-wave dispersion (PWD) are considered to reflect the heterogeneous conduction in atria.

Objective: The aim of this study was to investigate relationship PWD and P-wave duration and left ventricular hypertrophy in hypertensive heart disease patients.

Method: This study was a-single centre, retrospective study, included 55 consecutive patients with hypertension who had visited the cardiology clinic. Elektrocardiography (ECG) and transthoracal echocardiography (TTE) were performed. Patient were divided into LVH group and control group baed on TTE findings. Patients with valvular regurgitation (moderate or severe), valvular stenosis, myocardial infarction, LV dysfunction, pericardial disease, chronic obstructive pulmonary disease (COPD), bundle branch blocks, atrial fibrillation or flutter were excluded from the study.

Results: We found 31 hypertensive patients (56%) had LVH by TTE. The mean age for the HHD was 57 ± 11 years while the control group was 56 ± 11. In the HHD group, maximum P-wave duration was significantly increased at 119.31 ± 13.60 ms, compared to 97.14 ± 18.20 ms in the control group (p < 0.001). There was also a significant increase in minimum P-wave duration in HHD group at 59.65 ± 15.56 ms, compared to control group with 53.33 ± 14.60 ms (p = 0.004). There was a significant increase in the PWD in the hypertensive group at 59.31 ± 19.62 ms, compared to controls with 43.80 ± 17.54 ms (p < 0.001).

Conclusion: PWD was significantly increased in hypertensive patient with left ventricular hypertrophy.
47. Controlling Obesity is Promising Strategy for Hypertension Prevention in Medical Students
Authors: Santi Bryany Titi , Friska Pricilia
Published: April 2023

Indonesia's obesity prevalence has increased significantly over the past decade. This trend resulted in an increase in the number of people suffering from hypertension, some of whom are adolescents. Uncontrolled hypertension at an early age will result in early complications that cause disability and morbidity in productive age. Medical students, as adolescents, should have more knowledge to prevent hypertension. Unfortunately, the study on the topic is limited. This study is aimed at determining the prevalence of hypertension in medical students and promising factors to control hypertension. This is a cross-sectional study using health screening medical records from the faculty's clinic. Medical students should be screened at least once during their study period. The screening is evaluating behavioral risks (smoking, consuming junk food, physical activity), obesity (waist circumference, body mass index), and blood pressure. The data were analyzed statistically using multivariate logistic regression to determine factors that influence rising blood pressure. A total of 815 data are collected. There are 392 students (48%) with increased blood pressure, consisting of 325 (39,8%) prehypertension and 67 (8,2%) hypertension. The highest systolic and diastolic pressures were 160 and 110 mmHg, respectively. Central obesity (OR:1,54; CI 95%: 1,03–2,29) and BMI overweight (OR: 2,18; CI 95%: 1,34–3,55) and obese (OR:2,78; CI 95:1,83–4,22). Obesity is a strong risk factor for increasing blood pressure among youth, even if they have better knowledge to prevent hypertension than others.
53. Clinical Uses of Cuffless Blood Pressure Monitoring Devices Using Photoplethysmography as A Promising Ambulatory Telemonitoring Tool: A Systematic Review and Meta-Analysis
Authors: Florencia Audrey , Milla Clonia , Julian Timothy
Published: April 2023

Introduction: As check-ups in healthcare facilities are much arduous during the pandemic including blood pressure (BP) control, an alternative is urgently needed to replace the use of disturbing cuff-based office and ambulatory BP monitoring (BPM) devices. With the advancement of telemedicine, real-time checking and reporting of blood pressure may be potentially achieved using photoplethysmography (PPG) technology in cuffless devices. Therefore, this study evaluated the accuracy of these devices compared to the cuff-based BPM devices.

Methods: This systematic review and meta-analysis was conducted based on the PRISMA 2020 guideline through multiple databases using Rayyan according to the prearranged inclusion and exclusion criteria, yielding six clinical studies to be included in the final review and analysis.

Results: Overall fixed-effect meta-analysis of all studies (total of 319 subjects) presented small differences between cuffless and cuff-based devices, showing promising accuracy according to the current medical instrumentation guideline both in measuring systolic BP (SMD: 0.23 mmHg [95% CI: 0.07–0.39], p = 0.004; I2 = 0%, p = 0.55) and diastolic BP (SMD: 0.27 mmHg [95% CI: 0.11–0.43], p = 0.0007; I2 = 39%, p = 0.14).

Discussion: PPG itself is a noninvasive technology, consisting of an infrared-emitting light source and a photodetector to measure the blood-reflected light intensity. Despite its ease in equipment, it measures BP accurately without being influenced by various positions and activities. Moreover, the data can be accessed real-time by both users and healthcare providers.

Conclusion: In summary, cuffless PPG BPM devices have the potential in becoming a telemonitoring device for ambulatory patients for its accuracy. Its presence may be the answer to current restriction towards healthcare access during the COVID-19 pandemic. Therefore, in order to further confirm our findings, more clinical studies with various settings are encouraged to be held.
56. Survival of COVID-19 Patients with Hypertension
Authors: Pramudya Dana , Hertanto Decsa Medika , Tjempakasari Artaria , Pranawa
Published: April 2023

Background: Coronavirus Disease-2019 (COVID-19) is an infectious disease caused by SARS-CoV-2 virus. Severity of this disease influenced by old age, sex, comorbidities, and other factors. Hypertension and type 2 diabetes mellitus are the most common comorbidities in COVID-19 patients that cause high morbidity and mortality.

Objective: To analyze the survival of COVID-19 patients with hypertension comorbidity and compare it between diabetes mellitus and non-diabetes mellitus group.

Method: This retrospective, descriptive study included COVID-19 patients with hypertension comorbidity at Internal Medicine ward Dr. Soetomo Hospital Surabaya from May 2020 to December 2021. Data on age, sex, hypertension, diabetes mellitus type 2, symptoms, vital signs, laboratory finding, length of stay, and outcome were taken from medical records and we carried out kaplan-meier method and log rank test by using SPSS.

Result: This study obtained 698 sample of confirmed COVID-19 patients and after applying exclusion criteria there were 174 patients with hypertension comorbidity. Most patient were female (60.3%) and age 51–60 years (38.5%). The most common symptoms were shortness of breath (62.1%) and cough (50.6%). There were 50 hypertension and 79 non-hypertension patients died and Survival analysis showed a significant statistical difference between both groups (p = 0.042). From 50 deceased hypertensive patients, there are 36 and 14 hypertensive patients with and without diabetes mellitus respectively but survival analysis showed a non-significant statistical difference between both groups (p = 0.081)

Conclusion: There is significant statistical difference in survival analysis in patients with hypertension. We should be aware about COVID-19 patients with hypertension.
58. Blood Pressure Reduction Effect of Dapagliflozin in Patients with Type 2 Diabetes Mellitus: a Systematic Review
Authors: Lee J.V. , Sabran M.Z. , Rubismo K.Y. , Zebua A. , Jhoputri C.F. , Lee J.B.
Published: April 2023

Hypertension is a common comorbidity in patients with Type 2 Diabetes Mellitus (T2DM). One of the new anti-diabetic classes is Sodium-Glucose Cotransporter-2 (SGLT2) inhibitor which is still widely tested in clinical trials for indications beyond T2DM. However, the effect on blood pressure in T2DM patients receiving SGLT2 inhibitors is still not well known. This study wants to find out the effect of Dapagliflozin on blood pressure in patients with T2DM. This study was conducted on 1–7 January 2023. Two independent researchers systematically extracted data from several databases, such as PubMed Central (PMC), Science Direct, and PUBMED by using MeSH terminology of keywords SGLT2 inhibitor and blood pressure. The extracted studies were then analyzed and selected according to our inclusion criteria such as studies in the last 5 years, T2DM patients receiving dapagliflozin, cohort studies, and case-control studies. We excluded systematic reviews, meta-analyses, case series, case reports, studies on pregnant women, children, and animals. Research quality was assessed using Newcastle-Ottawa (NOS). From 4 cohort studies (1664 subjects from various countries), all of them showed dapagliflozin administration resulted in reduction of systolic blood pressure. In some studies, the blood pressure-lowering effect of dapagliflozin administration was greater when combined with other classes of anti-diabetic drugs like Glucagon-Like Peptide-1 (GLP1) agonist; All studies have proven good quality based on NOS. In conclusion, dapagliflozin had a blood pressure-lowering effect in T2DM patients. However, further study is needed to confirm these findings.
60. Prevalence and Management of Hypertension in Regular Hemodialysis Patients at Sanjiwani Gianyar Hospital
Authors: Ni Wayan Sri Wardani
Published: April 2023

Background: Hypertension is a condition in which blood pressure is more than equal to 140/90 mmHg. Hypertension is often found in CKD patients undergoing regular hemodialysis (HD). The mechanism of hypertension in CKD is multifactorial, so it is difficult to control and is associated with cardiovascular complications.

Methods: This study is a cross-sectional study to determine the prevalence and management of hypertension in regular hemodialysis patients at Sanjiwani Gianyar Hospital in 2021. Patients included in the study were over 18 years of age, who underwent regular hemodialysis twice a week, and were willing to participate in the study by signing an informed consent.

Results: In this study, 108 regular HD patients consisted of 61.1% men with the mean age of 53.70 years, mean length of HD of 43.04 months. The mean of URR is 75.6% and KT/V is 1.73. Hypertension was found in 68.5%, in which 29.7% of them with comorbid DM. The mean systolic blood pressure was 130.37 ± 20.37 mmHg and the mean diastolic blood pressure was 79.17 ± 9.87 mmHg. Controlled hypertension <140/90 mmHg, was found in 51.4% of cases, where the majority of patients (65.8%) took 2 types of antihypertensive drugs, however 34.2% of patients used 3 types of antihypertensive drugs or more.

Conclusion: The prevalence of hypertension in regular HD patients is high, however most of them can be controlled with 2 types of antihypertensive drugs.

Reference: Unger T., Borghi C., Charchar F,. et al. International Society of Hypertension Global Hypertension Practice Guidelines 2020;75:1334-1357.
61. Older Age is the Strongest Risk Factors for Hypertension in Indonesia: Subgroup Analysis of The National Basic Health Survey 2018
Authors: Hustrini Ni Made , Susalit Endang , Rotmans Joris I
Published: April 2023

Introduction: Among the threat of non-communicable diseases, hypertension is one of the potential health problems causing significant cardiovascular morbidity and mortality. Our recent study observed the prevalence of hypertension is as high as 41%, but the exact risk factors for hypertension are unknown. In this study we analyze the risk factors for hypertension in the Indonesian population, based on data from the National Basic Health Survey (Riset Kesehatan Dasar – Riskesdas) 2018.

Methods: We included subjects age >18 years and analyzed a large set of risk factors for hypertension: age, gender, body mass index, occupation status, level of education, consumption of salty food, consumption of fruit and vegetables, smoking, alcohol consumption, physical activity, comorbid condition (heart disease, diabetes, stroke), and access to healthcare facility. Hypertension defined as measurement of blood pressure based on JNC VII criteria and previous diagnosis of hypertension made by a physician. The associations between hypertension and risk factors were examined using multiple logistic regression models.

Results: We included 389,093 subjects out of 713,783 subjects participated in Riskesdas 2018 survey. The majority of hypertensive subjects was female (62.6%) and within the age of 40–59 years (50.2%). Compared to normal-blood pressure group, hypertensive subjects were likely having lower education status (36.9% vs 54.8%), were more obese (19.2% vs 34.3%), physically less active (47.5% vs 53.3%), had more heart disease (1.7% vs 3.9%), more diabetes mellitus (1.8% vs 5.65%), and more stroke (0.4% vs 3.7%). Older age (>60 years) was identified as a robust independent risk factor for hypertension (OR 2.01; 95% CI 1.76–2.29; p < 0.001), beyond the influence of other risk factors such as obesity (OR 1.47; 95% CI 1.04–2.07; p = 0.02), low education status (OR 1.37; 95% CI 1.35–1.39; p < 0.001), and unemployed (OR 1.1; 95% CI 1.08–1.12; p < 0.001). While interactions within other traditional risk factors were necessary for the occurrence of hypertension (i.e., heart disease∗age, heart disease∗alcohol consumption, heart disease∗stroke, heart disease∗salty food consumption, heart disease∗diabetes, heart disease∗less physical activity, diabetes∗gender, diabetes∗salty food consumption, diabetes∗less physical activity).

Conclusion: This study confirmed traditional risk factors play an important role in the development of hypertension in Indonesian population, particularly older age.
Skin lesions in a man with end-stage renal disease
Authors: Makowicz Chelsea
Published: April 2023

Calciphylaxis is an uncommon condition most often seen in patients with end-stage renal disease. It is easily mistaken for other more common conditions and requires a high level of suspicion to make a timely diagnosis. Although various treatments such as IV sodium thiosulfate and bisphosphonates have been used for management, calciphylaxis remains a condition with a high mortality that requires an interdisciplinary approach for optimal management.
Stronger together
Authors: Swanson Rebecca K. , Diederich Theresa A. , Jordan-Schaulis Samantha , Reicks Brandon L. , Zimmerman Risa
Published: April 2023

Physician associates/assistants (PAs) and advanced practice RNs (APRNs) are a vital part of the healthcare team. As the PA and APRN workforce continues to grow, collaborations can move beyond the bedside. With organizational support, a shared APRN/PA Council allows these clinicians to raise a collective voice on issues that are unique to their practice and to implement meaningful solutions, thus improving the quality of their work environment and clinician satisfaction.
Racism
Authors: Anderson James , Devine Patricia J. , Greenlee Quanté , Najera Deanna Bridge , Dominguez Delilah
Published: April 2023

Even in the context of major advances in medicine, racial minorities continue to suffer worse medical outcomes. Although race is defined as a social, nonscientific construct, researchers have continued to use it as proxy to explain genetic and evolutionary differences among patients. Poorer health outcomes among Black Americans are known to be related to the psychosocial and physiological stress of racism. Black communities experience premature health deterioration because of the cumulative effects of social, economic, and political oppression and marginalization. Additionally, recent assertions that racism is best seen as a chronic disease has added value to understanding the effect of racism on the health of Black people. Using evidence-based information to assess the health of Black patients is a key step to assist clinicians in promptly addressing this chronic threat to the health of Black patients.
What is the analgesic ceiling dose of ketorolac for treating acute pain in the ED?
Authors: Jaglal Reynold , Nemec Eric C.
Published: April 2023

Recent research has suggested that ketorolac has an analgesic ceiling effect, meaning that despite increased dosages, the patient obtains no additional pain relief and is more likely to suffer adverse drug reactions. This article describes the outcomes of these studies and the recommendation to use the lowest possible dose for the shortest time when treating patients with acute pain.
Postexposure prophylaxis (PEP) of HIV among adults
Authors: El Hussein Mohamed Toufic , Malyshev Ivan
Published: April 2023

In the last several decades, postexposure prophylaxis (PEP) with antiretroviral therapy (ART) has become an effective tool for the prevention of HIV transmission. The continuous evolution of antiretrovirals and the associated update of clinical practice guidelines create a challenge for NPs caring for patients exposed to HIV. Understanding the life cycle of HIV is of paramount importance in streamlining treatment regimens in exposed individuals. ART is a complex combination of drugs targeting different stages of the virus's life cycle within the host. NPs play an essential role in managing treatment for people exposed to HIV and following up on these patients' response and adherence to the treatment protocol. This article provides a comprehensive overview of HIV and step-by-step guidance for NPs treating patients who have been exposed.
Therapeutic Drug Monitoring of Perampanel in Children With Refractory Epilepsy: Focus on Influencing Factors on the Free-Perampanel Concentration
Authors: Qu Rui , Dai Yuanyuan , Zhu Zengyan , Lu Xiaoyun , Zhou Rui , Qu Xiangju , Chen Xuqin
Published: April 2023

Background:

This study aimed to assess the effect of perampanel dose, age, sex, and antiseizure medication cotherapy on steady-state free-perampanel concentration in children with refractory epilepsy, as well as the relationship between inflammation and the pharmacokinetics of perampanel.

Methods:

This prospective study in China included 87 children with refractory epilepsy treated with adjunctive perampanel therapy. Free and total perampanel concentrations in plasma were determined using liquid chromatography–tandem mass spectrometry. Free-perampanel concentration was compared among patients with various potential influencing factors.

Results:

A total of 87 pediatric patients (44 female children) aged 2–14 years were enrolled. The mean free-perampanel concentration and free concentration-to-dose (CD) ratio in plasma were 5.7 ± 2.7 ng/mL (16.3 ± 7.7 nmol/L) and 45.3 ± 21.0 (ng/mL)/(mg/kg) [129.6 ± 60.1 (nmol/L)/(mg/kg)], respectively. The protein binding of perampanel in plasma was 97.98%. A linear relationship was observed between perampanel dose and free concentration in plasma, and a positive relationship was found between the total and free-perampanel concentrations. Concomitant use of oxcarbazepine reduced the free CD ratio by 37%. Concomitant use of valproic acid increased the free CD ratio by 52%. Five patients had a plasma high-sensitivity C-reactive protein (Hs-CRP) level of >5.0 mg/L (Hs-CRP positive). The total and free CD ratios of perampanel were increased in patients with inflammation. Two patients with inflammation developed adverse events, which disappeared as the Hs-CRP level returned to normal, and neither required perampanel dose reduction. Age and sex did not influence the free-perampanel concentration.

Conclusions:

This study found complex drug interactions between perampanel and other concomitant antiseizure medications, providing valuable information to enable clinicians to apply perampanel in the future reasonably. In addition, it may be important to quantify both the total and free concentrations of perampanel to assess complex pharmacokinetic interactions.
The menopause transition: a critical stage for cardiovascular disease risk acceleration in women
Authors: El Khoudary Samar R.
Published: April 2023

The menopause transition is a critical period for cardiovascular health. During this stage, women experience adverse changes in multiple components that are key for optimal cardiovascular health. Additionally, women struggle to maintain ideal health behaviors, which if adopted collectively, have been shown in observational studies to prevent more than 70% of coronary heart disease cases. Significant efforts should be directed toward increasing awareness among women and healthcare professionals about the menopause transition as a stage of cardiovascular disease risk acceleration that is amenable to reduction with positive lifestyle measures.
Stretching Promotes Wound Contraction Through Enhanced Expression of Endothelin Receptor B and TRPC3 in Fibroblasts
Authors: Kawai Kenichiro , Ishise Hisako , Kubo Tateki , Larson Barrett , Fujiwara Toshihiro , Nishimoto Soh , Kakibuchi Masao
Published: April 2023

Background:

One factor that can contribute to the development of hypertrophic scar contracture is mechanical stress. Mechanical cyclic stretch stimuli enhance the secretion of endothelin-1 (ET-1) from keratinocyte. Cyclical stretching of fibroblasts also increases the expression level of the transient receptor potential ion channel (TRPC3), which is known to couple with the endothelin receptor and induce intracellular Ca2+ signaling via the calcineurin/nuclear factor of activated T cells (NFAT) pathway. The aim of this study was to investigate the relationship between keratinocytes and fibroblasts when they are stretched.

Methods:

The conditioned medium from stretched keratinocyte was added to the fibroblast populated collagen lattice. Then, we analyzed the levels of endothelin receptor in the human hypertrophic scar tissue and stretched fibroblasts. To address the function of TRPC3, we have used an overexpression system with the collagen lattice. Finally, the TRPC3 overexpressing fibroblasts were transplanted to mouse dorsal skin, and the rate of skin wound contraction was assessed.

Results:

Conditioned medium from stretched keratinocytes increased the rate of contraction of fibroblast populated collagen lattice. In human hypertrophic scar and stretched fibroblasts, endothelin receptor type B was increased. Cyclic stretching of TRPC3 overexpressing fibroblasts activated NFATc4, and stretched human fibroblasts showed more activation of NFATc4 in response to ET-1. The wound treated with TRPC3 overexpressing fibroblasts showed more contraction than control wound.

Conclusion:

These findings suggest that cyclical stretching of wounds have an effect on both keratinocytes and fibroblasts, where keratinocytes secret more ET-1, and fibroblasts develop more sensitivity to ET-1 by expressing more endothelin receptors and TRPC3.
Assessment of Health Disparities and Barriers to Accessing Keratoconus and Crosslinking at a Tertiary Referral Center
Authors: Angelo Lize , Gokul Akilesh , Wadhwa Himanshu , McGhee Charles N. J. , Ziaei Mohammed
Published: April 2023

Purpose:

The aim of this study was to determine the barriers to accessing the crosslinking service in Auckland, New Zealand.

Methods:

This was a prospective 1-year study of patients at Auckland District Health Board. Studied parameters included age, sex, body mass index, ethnicity, New Zealand Deprivation (NZDep; an area-based measure of socioeconomic status, 1 = low deprivation–10 = high deprivation) score of residence, disease severity (maximum keratometry and thinnest corneal thickness), attendance, distance travelled, car ownership, employment status, and visual outcomes. Statistical analysis was performed using independent t tests, Pearson correlation, independent samples ANOVA, MANCOVA, and binomial logistic regression.

Results:

Four hundred fifty-four patients with keratoconus were analyzed and had a mean age of 24.1 ± 0.8 years, mean body mass index of 33.0 ± 9.7 kg/m2, and 43% were female. Pacific Peoples consisted 40.2% of the population; Māori 27.2%; Europeans 21.2%; Asian 9.9%; and Middle Eastern, Latin American, and African (MELAA) 1.3%. The mean distance travelled was 12.5 ± 9.5 km, NZDep score was 6.8 ± 2.6, and attendance was 69.0 ± 42.5%. The lowest attendance was observed in Pacific Peoples (58.9%) and the highest was in Asians (90%) (P = 0.019). The mean worst-eye visual acuity at attendance was 0.75 ± 0.47 logMAR (6/35). Unemployment was associated with worse best-eye visual acuity at FSA (P = 0.01) and follow-up (P < 0.05). Māori and Pacific Peoples had the highest NZDep (P < 0.001), were younger at presentation (P = 0.019), had higher disease severity (P < 0.001), and worse visual acuity (P < 0.001).

Conclusions:

Poor attendance was seen in this cohort. Pacific Peoples and Māori presented younger with worse disease severity and visual acuity but also had the highest nonattendance. These results suggest that deprivation, factors associated with ethnicity, and unemployment are potential barriers to attendance.
Late-Onset Traumatic Corneal Conjunctival Epithelial Disorders due to Granular Formation After Cosmetic Suture Blepharoplasty
Authors: Morishige Naoyuki , Kakizaki Hirohiko
Published: April 2023

Purpose:

The purpose of this study was to report conjunctival granular formation as one of the causative factors of a traumatic corneal conjunctival epithelial disorder after plastic suture blepharoplasty.

Methods:

Clinical charts of 7 patients who had visited Ohshima Eye Hospital with a symptomatic corneal epithelial disorder and history of suture blepharoplasty were reviewed. Clinical evidence of conjunctival granular formations was observed in all patients at the tarsal conjunctiva facing to corneal conjunctival traumatic epithelial disorders. The desired outcome was to alleviate the disorder. The assessment included tabulating results after the placement of a soft contact lens bandage and subsequent partial tarsal plate resection of the granular formation.

Result:

Seven women (mean age 45.0 ± 10.9 years) enrolled in this study had previously undergone suture blepharoplasty (mean 18.3 ± 6.9 years before). Soft contact lens bandages relieved all of the patients’ complaints immediately. After resecting the granular formation, the traumatic corneal conjunctival epithelial disorder disappeared, and no recurrence was observed after surgery.

Conclusions:

The conjunctival granular formation within the tarsal conjunctiva after suture blepharoplasty caused the late-onset traumatic corneal conjunctival epithelial disorder. A complete cure was obtained after resection of the granular formation at the tarsal conjunctiva. To the best of our knowledge, this is the first report to identify the removal of granular formations in 7 patients with late-onset traumatic corneal conjunctival disorders many years after blepharoplasty. The resection of these lesions is a promising procedure to treat late-onset ocular epithelial disorder after suture blepharoplasty.
Clinical performance of a hybrid presbyopia-correcting intraocular lens in patients undergoing cataract surgery in a multicenter trial
Authors: Chang Daniel H. , Hu Jerry G. , Lehmann Robert P. , Thompson Vance M. , Tsai Linda H. , Thomas Eugenia K.
Published: April 2023

Purpose:

To compare the clinical performance of TECNIS Synergy intraocular lens (IOL), model ZFR00V, vs TECNIS IOL, model ZCB00, in cataract patients.

Setting:

Multicenter clinical setting.

Design:

Prospective, randomized, subject/evaluator-masked clinical trial.

Methods:

Cataract patients aged ≥22 years were randomly assigned 1:1 to bilateral implantation with ZFR00V or ZCB00. Key end points at 6 months postsurgery included monocular and binocular visual acuities at 4 m, 66 cm, 33 cm, and/or 40 cm, binocular distance-corrected defocus testing, patient-reported outcomes, and safety.

Results:

272 patients were implanted with ZFR00V (135) or ZCB00 (137). At 6 months, 83/131 (63.4%) ZFR00V patients demonstrated 20/25 or better combined monocular distance-corrected vision at far, intermediate, or near, compared with 5/130 (3.8%) ZCB00 patients. ZFR00V demonstrated excellent binocular uncorrected vision at intermediate (0.022 logMAR) and distance-corrected vision at 40 cm (0.047 logMAR). Strong ZFR00V performance persisted under mesopic conditions (0.244 logMAR or ∼20/32 Snellen), where improvement over ZCB00 with distance-corrected vision at near was 3.5 lines. ZFR00V provided a broad range of functional vision (20/32 or better) through −3.5 diopters of defocus (29 cm). Most ZFR00V patients reported no spectacle wear overall (93.1%) or at all 4 viewing distances combined (87.8%), and 55.7% qualified as completely spectacle independent. Relatively low proportions of ZFR00V patients reported being very/extremely bothered by halos (13.7%), starbursts (11.5%), or night glare (8.4%). The safety profile was similar between IOL groups.

Conclusions:

TECNIS Synergy ZFR00V demonstrated improved intermediate and near vision, increased range of vision, and greater spectacle independence vs TECNIS monofocal ZCB00.