bluuebunny/crossref_metadata_2025 huggingface dataset:
P143 IMPACT OF THE NUMBERS OF COMPONENTS OF CARDIO-RENO-METABOLIC SYNDROME PLUS OBESITY ON PATIENTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION: A SUB-ANALYSIS OF THE ARFEY-PRESER REGISTRY
Authors: Renna Nicolás Federico , Cursack Guillermo , Morris Cecilia , Echazarreta Diego , Coronel Maria Lorena , Castiello G , Hernandez D , Picchio D , Brasca Daniela García , Dagun V Botelli , Canella JP Cimbaro , Escalante Juan Pablo , Franchi V , Mandredi C , Perna Eduardo
Published: September 2024

Background and Objectives:

The primary objective was to evaluate whether the presence of combined cardio-reno-metabolic syndrome and obesity (CRM+O) in patients with heart failure with preserve ejection fraction (HFpEF) had a greater impact on cardiovascular disease (CVD).

Materials and Methods:

This prospective, multicentre observational registry enrolled outpatients or those discharged from hospitals, with prior informed consent. The study spanned from December 2022 to February 2024. Inclusion criteria were: 1) presence of current signs and symptoms of heart failure and LVEF ≥50%, 2) structural heart disease, 3) elevated natriuretic peptides. CRM+O was defined according with the number of components defined as: coronary artery disease (myocardial infarction, revascularization or ≥ 50% in one coronary artery), chronic renal disease (TFG ≤60 ml/min/1.72m2), diabetes mellitus and obesity (BMI ≥30 kg/m2)

Results:

This sub study included 388 patients, and at least one component of CRM+O was identified in 333 (86.9%), with 1, 2, 3 and 4 components in 23.8%, 30.8%, 27.7% and 4.7%. Demographics and clinical profile comparison is presented in Table 1. With the increasing number of components of CRM+O there was a higher proportion of women, sedentarism (p=0.001), smoking (p<0.001), OSA (p<0.001), hypothyroidism (p=0.010), coronary artery disease on angiography (p<0.001) and peripheral artery disease (p=0.010).

Conclusions

In patients with HFpEF, a high prevalence of combined components of CRM+O was observed, and 1 out of 3 presented at least three of them. A positive correlation between increasing in the severity and comorbidities was observed, except by inverse relationship with atrial fibrillation. These findings support the interaction among HFpEF and CRM+O syndrome and suggest the need of comprehensive, multidisciplinary management.
P145 EFFICACY AND SAFETY OF PERINDOPRIL/INDAPAMIDE/AMLODIPINE/BISOPROLOL SINGLE PILL COMBINATION IN PATIENTS WITH ESSENTIAL HYPERTENSION UNCONTROLLED ON TRIPLE THERAPY: AN INTERNATIONAL, RANDOMIZED, DOUBLE-BLIND, PHASE III TRIAL
Authors: Taddei Stefano , Bricout-Hennel Stéphanie , Asmar Roland , Petrova Parvoleta
Published: September 2024

Background and objectives:

In hypertensive patients uncontrolled on triple therapy, guidelines recommend the addition of a fourth drug such as mineral corticoid receptor antagonists, or alternatively, a betablocker. They also support the use of SPCs at any step of the treatment to increase treatment adherence and BP control. Currently, no SPC of 4 drugs is available. This 4-month phase III trial aimed to demonstrate the superiority in BP reduction, ofperindopril/indapamide/amlodipine/bisoprolol (Per/Ind/Aml/Biso) SPC versus a free combination of Per/Ind/Aml in hypertensive patients uncontrolled on triple therapy at optimal doses.

Methods:

After a 2-month run-in period on the combination of Per/Ind/Aml at optimal doses (10/2.5/5 or 10/2.5/10 mg), patients with sustained uncontrolled essential hypertension with office SBP≥140mmHg and SBP at 24h-ambulatory blood pressure monitoring (ABPM)≥130mmHg received the quadruple SPC of Per/Ind/Aml/Biso (10/2.5/5/5 or 10/2.5/10/5 mg) or continued the same triple therapy for two additional months. Efficacy was assessed on office-SBP (primary endpoint), DBP, BP control, 24h-ABPM and home-BPM (HBPM).

Results:

183 patients were randomized: 53.0% were men, mean age was 57.4±10.6 years, mean BMI was 28.2±2.6 kg/m2, and mean office SBP/DBP was 150.35±8.49/90.09±8.23mmHg. After two months, significantly greater decrease in office-SBP (-8.0mmHg, 95%CI [-11.9; -4.0]; p<0.0001) was observed in the quadruple SPC group (n=80) versus the triple therapy group (n=83). Greater decrease in the 24h-systolic ABPM was achieved with the quadruple SPC therapy (-7.5mmHg, 95%CI [-10.9;-4.1]; p<0.0001). Higher percentage of patients achieved 24h-ABPM and HBPM control in the SPC group 51.2% vs 20.7% (p<0.0001) and 60.7% vs 25.4%, (p<0.0001) respectively. After intentional 1-day SPC omission in patient volunteers (n=28), mean 24h-ABPM remained below the 130/80mmHg target, supporting the sustained efficacy of the SPC. Both treatments were well tolerated.

Conclusion:

The first quadruple SPC of Per/Ind/Aml/Biso demonstrated its superiority to the free combination of Per/Ind/Aml, offering a new alternative to treat effectively and safely patients with hypertension uncontrolled with a combination of Per/Ind/Aml at optimal doses.
P149 HYPERTENSION AS A SILENT KILLER: DOES OUR MANAGEMENT REACH THE RECOMMENDED TARGETS: SUDAN MMM 2022?
Authors: Ahmed Amjad M. , Beheiry Hind , Abukaraig Egbal , Ahmed Medical Practitioner Omer , AbdelFatah Microbiologist Deena , Ali Internal Medicine specialist Walleed , Mahmoud Medical Practitioner Mohamed , Hago Cardiologist specialist Maha
Published: September 2024

Introduction:

Several explanations might address the failure of antihypertensive medications: poor compliance, excessive salt ingestion, drug interactions, or an unsuspected secondary cause for hypertension. Resistant hypertension, as an additional failure cause, is relatively rare, but all patients should be considered medically treatable until proven otherwise. Therefore, we aim to explore the blood pressure readings and the current control status in hypertensive Sudanese patients.

Methods:

Utilizing the MMM 2022 Sudan screening data, participants’ BP >18 years was measured using a standard device by trained physicians for three consecutive measures, and a single mean value was calculated excluding the first reading. Participants with a history of hypertension were included in the analysis. Continuous data was presented in mean and standard deviation, and categorical data was presented in frequencies and percentages. According to current guidelines, several antihypertensive medications used were counted for each patient. All participants completed a structured questionnaire after obtaining their approval.

Results:

The study included 2,292 participants with an established diagnosis of hypertension. The mean age at diagnosis was 46±13 years, around 60% were females, and the median duration of hypertension was 5 (2, 10) years. Of these, 936 (40.9%), 790 (34.5%), and 543 (23.7%) had blood pressure exceeding SBP≥140 mmHg, DBP≥90 mmHg, and BP≥140/90 mmHg, respectively. Table 1 shows the baseline characteristics for each group. Despite the guideline recommendations to control hypertension, 78 (14.4%) were not adherent to medications, and 56 (10.3%) were taking three or more antihypertensive drugs.

Conclusions:

BP screening enables future decisions to control hypertension-related burden. Adherence to the internationally recommended guidelines will lead to achieving BP targets and prevent undesired outcomes. The subgroup of resistant hypertensive patients needs close monitoring and appropriate medical evaluation.
P150 HYPERTENSION URGENCY: GUIDELINES INDICATIONS AND IMPLEMENTATION IN CLINICAL PRACTICE
Authors: Roytberg Grigory , Bulanova Natalia , Sharkhun Olga
Published: September 2024

Background and objective:

Unreasonable admissions to hospital increase costs of the health care system. The maximum transfer of medical care to outpatient setting is a trend in modern medicine. Hypertension urgency (HU) is not accompanied by acute hypertension-mediated target organ damage and is not an indication for hospitalization of the patient. In 2018-2020 ISH/ESH Guidelines have revised the term “HU” for “uncontrolled hypertension”, approaches to its diagnosis and treatment. The purpose of the study is to evaluate the implementation of the Guidelines in real clinical practice.

Methods:

A single-center retrospective study was conducted in a private family medicine clinic, which has been observing a large number of patients of different age and gender for more than 30 years. The clinic has an emergency department, a hospital with 60 beds. Medical records of consecutive patients aged ≥18 years admitted to hospital in 2018 and 2023 with systolic blood pressure at admission ≥180 mmHg and/or diastolic blood pressure ≥110 mmHg were collected and analyzed.

Results:

The prevalence of patients admitted according to the chosen criteria was 0.8% (n=25) in 2018 and 0.9% (n=26) in 2023. According to the clinical characteristics and signs of acute damage to target organs (acute coronary syndrome, acute stroke, pulmonary embolism), 4% and 7.7% of cases in 2018 and 2023, respectively, were considered as hypertension emergencies. HU was diagnosed in other cases — 96% and 92.3%. HU was the direct cause of admission in 23.1% of cases in 2018 and in 28% of cases in 2023, in other cases - 69.2% (2018) and 64% (2023) hospitalization was due to another disease (pneumonia, neurological diseases, etc.). The probable causes of HU were patient non-compliance with antihypertensive drug therapy- 50% (2018) and 57% (2023), resistant hypertension, stress.

Conclusions:

The prevalence of patients admitted due to HU has not significantly changed. The most probable cause of HU is non-compliance with antihypertensive treatment, self-termination of treatment.
P153 NATIONAL SURVEY OF ARGENTINE DOCTORS ON HYPERTENSION
Authors: Sabio Rodrigo , Renna Nicolas , Valdez Pascual , Pablo Rodriguez , Camera Luis , Delucchi Alejandro , Mirofsky Matias , Diego Fernandez , Diego Marquez , Barochiner Jesica , Marin Marcos
Published: September 2024

Background and Objective:

Hypertension (HTN) is the leading cardiovascular risk factor, yet its control remains low. Identifying factors influencing diagnosis, potential clinical inertia, and the measuring devices used is crucial.

Objective:

This study aims to understand factors in medical practice affecting HTN knowledge and control, and to assess the availability and use of blood pressure (BP) measurement devices.

Methods:

This observational, cross-sectional study is based on a 25-question self-administered survey by the Argentine Society of Hypertension (SAHA) and the Argentine Society of Medicine (SAM), targeting doctors treating HTN patients in Argentina. This report focuses on BP measurement.

Results:

A total of 1,042 responses were received, with women comprising 45.8% (n:471). Responses came from 430 cardiologists (41.7%), 380 internists (36.8%), 68 HTN specialists (6.6%), 54 primary care physicians (5.2%), and 100 from other specialties (9.7%). An own validated automatic arm BP monitor was used by 44.5%, a manual aneroid by 36.5%, an institution's validated automatic arm monitor by 10.9%, and a fixed wall aneroid by 8.2%. BP was measured in all patients by 89% of respondents, sometimes by 8.5%, and only if the patient was hypertensive by 1.7%. Ambulatory blood pressure monitoring (ABPM) was always requested before treatment by 25.2%, sporadically by 34%, never by 4.1%, and only for BP between 130/85 mmHg and 159/99 mmHg by 36.7%. The 24-hour ABPM values for initiating pharmacological treatment were >140/90 mmHg (40.9%), >135/85 mmHg (39%), and >130/80 mmHg (20.1%).

Conclusions:

Discrepancies exist in HTN patient care. Only 20% of doctors start pharmacological treatment at 24-hour ABPM values above 130/80 mmHg. Enhancing education and information could improve HTN control strategies.
P155 WHAT ARE THE SEX DIFFERENCES IN THE USE OF SINGLE-PILL COMBINATIONS IN THE TREATMENT OF ARTERIAL HYPERTENSION? RESULTS FROM HOME BLOOD PRESSURE MONITORING IN SLOVAKIA IN 2022
Authors: Vachulova Anna , Simkova Adriana , Sidlo Rastislav
Published: September 2024

Arterial hypertension (AH) is the leading risk factor for cardiovascular morbidity and mortality for both, men and women.

Aim of the trial:

To evaluate the share of single-pill combinations (SPC) according to the gender of doctors and their patients. To evaluate the efficacy of the AH treatment with HBPM and education.

Patients and Methods:

This project was conducted from April to June 2022 at 178 general physician practices. We have enrolled consecutive adult patients willing to complete a questionnaire and take office BP and HBPM measurements.

Results:

4375 pts with AH were enrolled (2089 women, 51,8%), mean age 61,1 ± 19,1 years. The mean office BP was higher in male (136,7 ± 10,9/ 81,9 ± 7,2 mmHg), vs female patients (135±7,2/ 80,2 ± 6,2 mmHg). Mean blood pressure at home (HBP) was also higher in males (134,1± 7,2/ 81,1± 6,3 mmHg). There were 72% (129) of female doctors, participating in the trial.

The widest use of SPC was when male doctors treated male patients (70,7%). The lowest use of SPC was when female doctors treated female patients (52,1%). 44,6% of patients were treated with double SPC and 14,3% with triple. Dual SPC was the most preferred treatment when male patients were treated by male doctors (52,3%). Triple SPC strategy was used mostly when female doctors were giving care to male patients (16,8%). More patients reached optimal BP at home when treated by a male doctor (68%).

Conclusion:

Appropriate education of patients and their engagement via HBPM, led to 67% BP control. The preference for SPC by male doctors led to significantly better BP control at home, regardless of the gender of patients. By systematic rationalization of pharmacotherapy according to the 2023 ESH Guidelines, using SPC has the potential to improve adherence and increase the BP control rate in Slovakia to fulfill the initiative Charter 70/2023.
P157 THE USE OF PARTICIPATORY ACTION RESEARCH TO PROMOTE INCREASED CONSUMPTION OF VEGETABLES AMONG AFRICAN WOMEN WITH/AT RISK OF HYPERTENSION IN GQEBERHA, SOUTH AFRICA
Authors: Mfono Zitandile
Published: September 2024

Background and objectives:

Poor vegetable and fruit intake are reported in multiple studies of the South African population, especially among people with less income and lower educational status and it is a known risk factor for non-communicable diseases such as hypertension. “South Africa has one of the highest levels of hypertension globally, coupled with poor rates of diagnosis, treatment and control” Ware et al., (2019). It has been suggested that indigenous vegetables may aid in increasing vegetable intake, a recommendation of the South African Food Based Dietary Guidelines. As urbanisation and the nutrition transition increases in South Africa, the loss of indigenous knowledge and utilisation of indigenous vegetables is significant and is worse compared to countries such as Kenya and Tanzania. The aim of this study was to collaboratively promote the use of indigenous vegetables by African women in a peri-urban area with/at risk of hypertension with the goal of improving agency to increase vegetable intake.

Methods:

A qualitative participatory action research (PAR) methodology was utilised. African adult women with hypertension or at risk of hypertension were recruited from a local healthcare facility for a one year long project, with a total enrolment of 12-24 participants. Data collection included observations, focus groups, key informant interviews and the research journal of the researcher.

Results:

Participants worked collaboratively to co-construct relevant nutrition education materials, recipe development using local indigenous vegetables, clinic open day and a seminar for other community members. There was greater uptake of vegetable gardening at home and at the local community centre.

Conclusions:

using PAR methodologies to address inadequate vegetable intake and promote the use of indigenous vegetable crops may benefit personal agency which includes an individual's perceptions about how much control they have over themselves and their environment, in order to carry out a certain behaviour; self-confidence or efficacy; the ability to self-regulate and monitor behaviour and the ability to identify and use good coping skills.
P158 EDUCATION AS A PARAMETER FOR MANAGEMENT IN HYPERTENSION
Authors: Moya Luis , Lombo Ricardo , Escobar Hugo , Cely Leidy , Santoyo Ana , Saenz Ludy , Castro Mauricio , Jiménez Oscar , Chamié Katya
Published: September 2024

Objective:

Despite advancements, hypertension and its associated factors remain the leading cause of global death with concerning increases. This study aimed to estimate whether the impact of mass education in adults and subsequently in adolescents and children in Tunja, Boyacá, Colombia S.A influenced their knowledge of these factors.

Methods:

Cross-sectional and prospective community study in individuals > 18 years, with open invitation to various points of care collecting information with Framingham surveys, blood pressure measurement, anthropometric variables, educational level, history, associated factors, and cardiovascular diseases knowledge of causes (CDKC). Conducting four sessions: (1) December 2018, without prior educational intervention (PEI), (2) March 2019, PEI adults, (3) July 2019, PEI in adolescents and children‘s schools, (4) March 2024 long-term evaluation. PEI for adults included in-person lectures, media, and printed materials, for schools (13) lectures, printed materials, and educational video games.

Results:

3,025 people were surveyed, with a mean age of 49.9 years (SD ± 14.3); men 46%. Of the total, 52% were sedentary, 47% overweight, and 8% obese, smoking 11%, alcohol consumption 31%, diabetes 7.3%, cholesterol 56.4%, hypertension 32.1%, and CDKC 37%. Comparatively among the records, hypertension: (1) 37.4%, (2) 32.1%, (3) 32.6%, (4) 26.6%. CDKC: (1) 22.1%, (2) 38.6%, (3) 43.4%, and (4) 47%, its correlation with other variables and other risk factors are part of another report.

Conclusions:

We highlight the positive impact of educational intervention more in schools, evidenced by the increase in knowledge from 22.1% to 43.4% (p<0.001), and the decrease in hypertension from 37.4% to 32.6% (p<0.001). This knowledge increased to 47% in the long-term evaluation, reflected in the lower prevalence of hypertension 26.6%. These two parameters were not as significant with education only in adults, where we usually direct our campaigns, forgetting adolescents and children as the family guiding axis to change the course not only of cardiovascular diseases but also of chronic pathologies.
P166 EXPLORING AGE-ASSOCIATED CHANGES IN HEMODYNAMICS: INSIGHTS FROM 24-HOUR BLOOD PRESSURE MONITORING
Authors: Aristizabal-Ocampo Dagnovar , Alvarez-Montoya Diego , Gallo-Villegas Jaime
Published: September 2024

Background and Objective:

Aging is associated with progressive alterations in the structure and function of the heart and arteries, which can occur independently. This study aims to investigate the hemodynamic changes occurring in aging normotensive subjects concerning heart and arterial function. We employed a novel method based on blood pressure values obtained during 24-hour ambulatory blood pressure monitoring (24-h ABPM).

Methods:

A cross-sectional study was conducted involving 3,220 non-obese patients referred for 24-h ABPM, who did not have hypertension and were not taking any medications. 24-hour mean hemodynamics was obtained using a non-invasive method based on Ct. Ct was estimated as: Ct/BSA= 38/PPth+ 4/5 × Td/T - 3/7, where BSA: body surface area, Td: diastolic time, T: cardiac period, and PPth: theoretical pulse pressure. The stroke volume (SV) was estimation as: SV= Ct (PP+MSP ×Ts/τ), where PP: pulse pressure, MSP: mean systolic pressure, Ts: systolic time, τ: diastolic pressure decay time constant. Cardiac output (CO) and SVR were obtained using conventional formulas.

Results:

Among the participants, 64.6% were female, with an average age of 51.0±15.3 years, Ct of 0.96±0.21 mL/mmHg, CO of 5.2±0.68 L/min, and SRV of 1394±178 dyn.s/cm5. An age-related reduction in stroke index and cardiac index are noteworthy, stabilizing from the sixth decade of life onward (41.1±2.0 mL/m2 and 3.0±0.23 L/min/m2, respectively). Conversely, Ct exhibits an early increase from the third to fifth decades of life (1.04±0.18 mL/mmHg), followed by a continuous and gradual decline until the ninth decade (0.71±0.16 mL/mmHg). Meanwhile, SVR demonstrates an upward trend until reaching and maintaining high values from the sixth decade of life (1426±167 dyn.s/cm5) onward with a clear shift in arterial hemodynamics (Analysis of variance [ANOVA]; P value <0.001) (Figure).

Conclusions:

The current method based on 24-hour ABPM effectively portrays the cardiac and arterial hemodynamics that mirror age-related circulatory alterations. This method offers a valuable pathophysiological basis for understanding the aging blood pressure profile.
P170 OXIDIZED LOW-DENSITY LIPOPROTEIN POTENTIATES ANGIOTENSIN II-INDUCED GQ ACTIVATION THROUGH THE AT1 - LOX1 RECEPTOR COMPLEX
Authors: Nozato Yoichi , Ihara Jittoku , Huang Yibin , Takami Yoichi , Kakino Akemi , Sakai Shinsuke , Isaka Yoshitaka , Rakugi Hiromi , Sawamura Tatsuya , Yamamoto Koichi
Published: September 2024

Background and Objective:

Chronic kidney disease (CKD) and atherosclerotic heart disease, often associated with dyslipidemia and hypertension, represent significant health concerns. This study investigates the interplay among these conditions, focusing on the role of oxidized low-density lipoprotein (oxLDL) and angiotensin II (Ang II) in renal injury via G protein αq subunit (Gq) signaling. The hypothesis is that oxLDL enhances Ang II-induced Gq signaling via the AT1-LOX1 receptor complex.

Methods

Experiments were conducted using CHO cells and renal cell models. The effects of oxLDL and Ang II on Gq-mediated inositol phosphate 1 production and calcium influx were examined in cells expressing both lectin-like oxLDL receptor (LOX-1) and Ang II receptor type 1 (AT1), and in cells expressing only AT1. Additionally, conformational studies using AT1 biosensors were performed. In vivo studies involved wild-type mice and LOX-1 knockout mice fed a high-fat diet with Ang II infusion.

Results:

OxLDL alone did not activate Gq signaling. However, when combined with Ang II, it significantly potentiated Gq-mediated inositol phosphate 1 production and calcium influx in cells expressing both LOX-1 and AT1, but not in AT1-expressing cells. AT1 biosensors indicated a unique receptor conformational change due to the oxLDL-Ang II combination. In vivo, wild-type mice fed a high-fat diet with Ang II infusion showed exacerbated renal injury, whereas LOX-1 knockout mice did not.

Conclusions:

The findings suggest a critical synergistic interaction between oxLDL and Ang II in the AT1-LOX1 receptor complex, driving renal injury in CKD. This study highlights a novel mechanism of renal injury in CKD driven by dyslipidemia and hypertension and suggests the therapeutic potential of targeting the AT1-LOX1 receptor complex in patients with these comorbidities.
P171 WATER DEPRIVATION REDUCES WATER INTAKE AND INCREASES SUCROSE INTAKE IN SPONTANEOUSLY HYPERTENSIVE RATS: POSSIBLE MECHANISMS
Authors: Paes Milede , Pereira Emilson , Colombari Eduardo , Menani José , Colombari Débora
Published: September 2024

Background and Objective:

Water deprivation (WD), a common situation in wild and human lives, can induce an increase in sucrose palatability in SHR. However, it is not known if SHR also has an increase in sucrose intake after WD and if this intake is related to energy intake, as WD reduces food intake, or to the change in sucrose palatability.

Methods:

Adult (∼12 weeks) male Holtzman (normotensive, NT) or SHR rats (n = 20/strain) were used. In protocol 1, all rats were first subjected to 24-h WD. Food consumption was measured during WD and was used for the non-water deprived (ND)/food restricted (FD) group to equal energy consumption. Three days after the WD, rats were randomly assigned to the 24-hour WD or the ND/FR group. In protocol 2, animals were implanted with an intraoral cannula and were randomly assigned as above.

Results:

In the WD condition, water intake was greater in NT (15.9 ± 1.1, vs. SHR: 8.6 ± 0.2 mL/120 min, p < 0.05), whereas sucrose intake was greater in SHR (8.8 ± 0.7, vs. NT: 2.1 ± 1 mL/120 min, p< 0.05). In the ND/FR condition, water intake was very low in both strains, however, SHR had a higher sucrose intake compared to NT (11.5 ± 2.0, vs. NT: 3.3 ± 1.8 mL/120 min; p < 0.05). In NT rats, in the WD condition, there was a decrease in sucrose palatability compared to the ND/FR condition, whereas in SHR palatability was similar in the WD or ND/FR condition. SHR have a greater mean arterial pressure than NT (167 ± 3 vs, NT: 105 ± 2 mmHg).

Conclusions:

Our results suggest that SHR favours energy intake during WD, since during ND/FR they drank equivalent amount of sucrose. This suggestion is supported by the absence of a greater palatability to sucrose in SHR when food is restricted.

Support:

CAPES PrINT, FAPESP, CNPq
P173 ASSESSMENT OF URINARY SODIUM EXCRETION AND IT'S ASSOCIATION WITH BLOOD PRESSURE IN RURAL COMMUNITY OF BANGLADESH
Authors: Iqbal Md Masud , Banerjee S K , Chowdhury M AA , Hassan M Z , Hassan M S , Adhikary D K , Arslan M I
Published: September 2024

Background and Objectives:

Amount of salt intake has been shown to relate with level of blood pressure. Measuring urinary sodium (Na) is one of the ways to assess that indirectly. This study was carried out to identify the urinary sodium excretion pattern, as a surrogate of salt intake, and its association with blood pressure in a rural community of Bangladesh.

Method: In this survey adult subjects were selected randomly from a rural area. Systolic BP ≥140 and/or diastolic BP ≥90mmHg or subjects taking antihypertensive medications were considered for hypertension. The 24 hour urinary sodium excretion (24hUrNa) from spot urine samples was calculated according to formula of Kawasaki et al.

Results:

Around 1095 subjects participated in this study. Hypertension was present in 23% subjects. Comparison of normotensive vs. hypertensive subjects showed age 40±12 vs. 46±14 years, (p<0.001) without any difference in 24hUrNa excretion as 4.4±1.6 vs. 4.5±1.9 g/day (P=NS) and UrNa/UrCr ratio as 135±96 vs. 147±145 mEq/g (P=NS) in two groups. Further comparisons of four different 24hr urinary Na excretion groups (<2.3, 2.3-3.6, 3.6-4.8 and >4.8 g/day) showed that their distribution is similar in both normotensive and hypertensive groups (7.9 vs. 8.4%, 23.0 vs. 25.3%, 27.9 vs. 23.2% and 41.3% vs. 43.0%, respectively, P=NS). Another analysis of hypertensive subjects with only systolic HTN, diastolic HTN and both BP raised subjects showed similar 24hUrNa excretion among all (4.4±1.8, 4.4±1.5 and 4.8±1.2 g/day, P=NS, respectively). Bivariate correlations showed no relation of blood pressure with urinary Na excretion. The logistic regression analysis showed a strong influence of age, blood sugar, HbA1c, TG, Cholesterol and eGFR on blood pressure.

Conclusion:

In this study, based on urinary Na excretion, it is found that nearly 90% of the rural population is taking salt above the recommended limit. Higher urinary sodium excretion, an indicator of high salt intakes, has no apparent association with blood pressure among them.
P175 ESTIMATION OF SODIUM INTAKE CAN BE IMPROVED BY CORRECTION OF 24H SODIUM EXCRETION FOR 24H URINE VOLUME
Authors: Van Vliet Anne Myrthe , Rauh Manfred , Titze Jens , Engberink Rik Olde
Published: September 2024

Background and Objective:

Long-term sodium (Na) balance studies demonstrated that 24 h sodium excretion does not reflect 24 h sodium intake, which complicates the use of 24 h urine sodium measurements for sodium intake estimation. This discrepancy has been linked to infradian rhythms of aldosterone and cortisol, which are responsible for adaptive responses targeted to (renal) water conservation. We hypothesize that correction for these parameters will improve the accuracy of sodium intake estimates.

Methods:

We used data from two sodium balance studies that controlled dietary salt intake for 105 (4 men) and 205 days (6 men) at levels of 6, 9 and 12 g/day. We tested whether correction of 24 h urine sodium for 24 h urine volume, 24 h urine potassium, 24 h urine urea, 24 h urine aldosterone, 24 h urine cortisol, 24 h urine cortisol/cortisone and/or urine osmolality, increased the accuracy of 24 h sodium intake estimates using forward selection linear mixed-effects analysis with a random intercept per participant.

Results:

The median difference between 24 h sodium intake and excretion was 26 mmol (IQR 13 - 45 mmol). 24 h urine sodium explained only 49% of the variance in 24 h sodium intake. In 7 out of 10 subjects, 24 h urine volume was of most added value to the model, after 24 h urine sodium, increasing R2 with 0.08±0.03. Including 24 h urine volume in the model significantly improved the model fit (P<0.001, marginal R2 0.55). The addition of urine urea, urine aldosterone and urine osmolality also contributed significantly but the marginal R2 only further increased to 0.56. After correction of 24 h urine sodium for 24 h urine volume, sodium intake could be estimated more accurately: the 50-mmol discrepancy between 24 h sodium intake and excretion was reduced from 18% to 10% and the 25-mmol discrepancy from 52% to 43% (P<0.001, Figure 1).

Conclusions:

In healthy young males, estimation of sodium intake can be improved by correcting 24 h urine sodium for 24 h urine volume.
P176 SPOT URINE FORMULAS OVERESTIMATE DIETARY SODIUM INTAKE DURING LOW SODIUM CONSUMPTION
Authors: Engberink Rik Olde , van Vliet Myrthe , Vogt Liffert , Frings-Meuthen Petra , Heer Martina
Published: September 2024

Background and objective:

Long-term sodium balance studies have revealed a phenomenon of temporary storage of sodium in tissues. Consequently, relying on an individual's single 24-hour urine collections may lead to an unreliable estimation of sodium intake. Our recent research has shown that the accuracy of repeated spot urine collections is equal to that of a single 24-hour urine collection at a sodium intake level of 5 gram/day. Since no data is available about the performance at recommended sodium intake (i.e., <2 grams/day), we determined their accuracy during low sodium consumption.

Methods:

We performed a post-hoc analysis on data from a metabolic ward study in which 16 healthy male adults consumed a diet with a fixed sodium content of 50 or 200 mmol/day for 7 days. Each day, urine was collected in 4 intervals (7:00-13:00 h, 13:00-19:00 h, 19:00-23:00 h, 23:00-07:00 h). We estimated sodium intake by the European Toft formula using urines of the same interval on 3 consecutive days during steady state (day 5-7). In sensitivity analyses we applied the Tanaka and Kawasaki formulas.

Results:

During a 200-mmol sodium intake, the Toft formula estimates appeared the most accurate, deviating 10 [IQR 3-14], 8 [6-19], 36 [16-49] and 20 [10-43] mmol from the intake for intervals 7:00-13:00 h, 13:00-19:00 h, 19:00-23:00 h, 23:00-07:00 h, respectively (Figure 1A). This accuracy did not significantly differ from a single 24-hour urine (20 [12-55] mmol). However, at a 50-mmol sodium intake, the Toft formula estimates deviated 62 [IQR 45-69], 75 [67-97], 99 [90-109] and 51 [45-61] mmol from the intake for similar intervals (Figure 1B). These estimates were significantly less accurate than a single 24-hour urine (9 [6-23] mmol). Although the Tanaka equation outperformed the Toft equation, this formula was also significantly inferior to a 24-hour urine collection.

Conclusions:

Repeated spot urine collection substantially overestimates sodium intake when sodium intake is low, whereas it performs similarly to a 24-hour urine collection at an average sodium intake.
P179 CARDIOMETABOLIC DYSFUNCTIONS IN THE OFFSPRING OF FRUCTOSE-OVERLOADED RATS: EVIDENCE FOR THE CHOLINERGIC ANTI-INFLAMMATORY REFLEX
Authors: de Miranda Victor Hugo Martins , dos Santos Camila Paixão , Neves Pietra Petrica , Nascimento-Filho Antonio Viana , Dutra Marina R. H. , Bernardes Nathalia , de Souza Leandro Ezequiel , Guitierre Robson Campos , Irigoyen Maria Cláudia , De Angelis Katia
Published: September 2024

Background:

Studies have reported an increase in the consumption of processed foods high in fructose (F), which has been associated with the development of metabolic syndrome. The cholinergic anti-inflammatory reflex (CAT) pathway appears to play an important role in this condition. This study investigated the role of the CAT pathway by splenic and vagal denervation (D) and treatment with galantamine (GAL) on cardiometabolic and autonomic parameters in the offspring of rats subjected to chronic fructose consumption.

Methods:

Wistar rats (parents) were given fructose (10% drinking water) or water for 60 days. The rats were then mated and the fructose overload was maintained for females until the end of lactation. The offspring were randomized into 4 groups (n=10/5 per sex): Control (C), F, F+GAL, and F+D+GAL. GAL (5 mg/kg), an acetylcholinesterase inhibitor, was administered 30 days by gavage. D was performed at 21 days. The offspring were evaluated at 51 days.

Results:

Compared with the C group (3.63±0.24 mg/dl/%/min), the F and F+D+GAL groups (2.8±0.20 and 2.9±0.14 mg/dl/%/min) had a worsening of insulin sensitivity. The F+GAL (370±79 mg) and F+D+GAL groups (310±75 mg) had reduced adipose tissue compared to the C (708±121 mg) and F (980±160 mg) groups. The F and F+D+GAL groups (vs. C group) had increased mean arterial pressure (AP) (114±1.9 and 115±1.4 vs. 101±2.2mmHg), heart rate (381±5 and 369±5 vs. 343±10bpm), and low frequency component of systolic AP (4.95±0.49 and 3.33±0.23 vs. 1.62±0.2mmHg2). The F+GAL group had an increase in cardiac vagal modulation (HF-PI and RMSSD). F and F+D+GAL groups (vs. C) had impairment of baroreflex (-3.24±0.26 and -3.48±0.1 vs. -3.93±0.1bpm/mmHg), and F+GAL group improved this parameter.

Conclusion:

Our data provide evidence for the involvement of CAT in cardiometabolic dysfunction in the offspring of parents exposed to chronic fructose consumption. Such findings highlight the importance of therapeutic strategies that improve autonomic modulation to prevent early changes in offspring of metabolically overburdened parents.

Financial support:

FAPESP(2022/04050-1), CNPq, CAPES-PROSUP.
P180 CONTRIBUTION OF AFFERENT RENAL NERVES TO HYPERTENSION AND HYPERTENSIVE HEART FAILURE
Authors: Shinohara Keisuke , Ikeda Shota , Nakashima Ryosuke , Matsumoto Sho , Abe Kohtaro
Published: September 2024

Background and Objective:

Renal nerves contain efferent and afferent fibers. This study aimed to investigate the contribution of afferent renal nerves to the development of hypertension and hypertensive heart failure in several rat models of hypertension.

Methods:

Selective afferent renal nerve denervation (ARDN) or sham operation was performed in the following models: (1) SHRSP at 9 weeks; (2) 4% high-salt diet (HS)-fed SHRSP at 8 weeks (HS from 8 weeks); and (3) 8% HS-fed Dahl salt-sensitive rats at 9 weeks (HS from 6 weeks). Dahl rats fed 0.3% low-salt diet were controls for (3). Blood pressure (BP) was measured by telemetry in (1) and (2), and by tail-cuff method in (3).

Results:

(1) Mean BP was elevated from 9 weeks to 11 weeks in sham-SHRSP (155.2±2.0 vs 144.0±1.9 mmHg, n=10, p<0.05). Mean BP in ARDN-SHRSP (157.8±2.7 mmHg, n=10) did not differ from sham-SHRSP at 11 weeks. (2) Mean BP increased from 8 weeks to 11 weeks in HS-sham-SHRSP (191.5±8.1 vs 126.5±4.0 mmHg, n=6, p<0.05). Mean BP in HS-ARDN-SHRSP (186.0±7.1 mmHg, n=6) did not differ from HS-sham-SHRSP at 11 weeks. (3) Systolic BP increased (243.6±7.0 vs 140.0±2.7 mmHg, n=9 each, p<0.05) and echocardiographic left ventricular (LV) fractional shortening decreased (25.9±1.7 vs 48.8±0.4%, p<0.05) in HS-sham-Dahl rats compared to low-salt controls at 16 weeks (“HFrEF” phase). LV weight, lung weight, and LV fibrosis were significantly increased in HS-sham-Dahl rats compared to controls. ARDN attenuated these changes except for BP. At 12 weeks (pre-HFrEF phase), plasma norepinephrine levels increased in HS-sham-Dahl rats compared to controls and were attenuated by ARDN (controls 188.7±16.5, HS-sham 563.8±82.7, HS-ARDN 327.4±50.2 pg/ml; n=15, 12, 14; p<0.05).

Conclusions:

Signals from afferent renal nerves contribute to sympathoexcitation and the development of HFrEF without affecting BP in Dahl salt-sensitive hypertensive rats, but not to the development of hypertension in SHRSP and HS-fed SHRSP.
P184 CURRENT CONCEPTS IN THE MANAGEMENT OF HYPERTENSION IN HYPERTENSIVE DISORDERS OF PREGNANCY - A REVIEW OF GUIDANCE FROM DIFFERENT INTERNATIONAL GUIDELINES
Authors: Danielli Marianna , Moothathamby Thurkga , Gupta Ajay
Published: September 2024

Background and Objective:

Hypertensive disorders of pregnancy (HDP) are a leading cause of adverse maternal and perinatal outcomes internationally. This review aims to critically analyse international guidelines pertaining specifically to the management of HDP in cases of gestational hypertension and pre-eclampsia. By highlighting best practices and addressing discrepancies in the classification, diagnosis and management of treatment approaches, this review seeks to equip healthcare professionals with the necessary knowledge to improve the quality of care of pregnancy hypertension.

Methods:

We searched for published guidelines spanning from January 2010 to April 2024, utilising databases such as MEDLINE and EMBASE; guidelines were only included if they were not primarily or entirely derived from other guidelines and if written in English. All guidelines meeting the criteria were extracted for a full-text review. Additional databases were explored, including the Emergency Care Research Institute (ECRI) Guidelines Trust, and the Guidelines International Network's website (GIN). Twelve international HDP guidelines were reviewed, and their recommendations compared.

Results:

All guidelines were consistent in their definition of gestational hypertension and pre-eclampsia but differed in the diagnostic criteria for pre-eclampsia. Despite agreement on which antihypertensives to avoid, the recommended blood pressure thresholds for initiation of antihypertensive medication and treatment targets varied. The use of aspirin and calcium were universally recommended as prophylactic treatment for pre-eclampsia. The guidance on non-pharmacological interventions such as obesity, exercise and the role of salt restriction in diet lacked evidence of benefit and showed discrepancies among guidelines.

Conclusion:

All guidelines acknowledge the significant morbidity associated with HDP and advocate for timely diagnosis and management. We highlight areas of consensus that may be of practical value to healthcare professionals aiding in decision-making. More research is needed to understand optimal BP thresholds at which to initiate antihypertensive medication regimens, the choice of antihypertensive in pregnancy, and the efficacy and benefits of non-pharmacological interventions in HDP. These findings exhibit knowledge gaps, and call for new guideline development.
P185 CHARACTERISTICS OF CENTRAL HEMODYNAMIC CHANGES IN PREGNANT WOMEN WITH PRE-EXISTING ARTERIAL HYPERTENSION II UZBEK POPULATION DEPENDING BODY MASS INDEX
Authors: Sadulloeva Mokhinur , Zakirova Feruza , Hazratkulov Rustam , Yenaliyeva Diana
Published: September 2024

Background and Objective:

In Central Asia, hypertension accounts for 14.5% of all maternal deaths. In Uzbekistan for 2022-2023, pre-existing/chronic hypertension (CHTN) accounts for 3.6% of all maternal deaths. So, the aim was to identify the features of hemodynamic parameters in pregnant women with CHTN

Methods:

Study included 75 pregnant women of the 2nd-3rd gestation period, divided into 2 groups. Group 1 (n=44) included women without any cardiovascular or somatic pathology (healthy group). Group 2 (n=31) included pregnant women with CHTN (2018 ESC/ESH). HR was assessed, BP was measured, body mass index (BMI) was calculated. Central hemodynamic parameters were assessed using echocardiography. Statistical processing was carried out using Statistica 13.0 program. p < 0.05 was considered statistically significant.

Results:

Analysis showed, the mean age of 2 gr women was older than in 1 gr, 32.67±4.75 years vs 27.24±5.79(p < 0.0001). The mean level of BP corresponded to mild AH (2018 ESC/ESH), amounting to SBP 153.83±16.43 mmHg in 2 gr vs 102.72±10.42 mmHg in 1 group (p< 0.0001) and to DBP 96.16±7.62 mmHg vs 64.77±5.9 mmHg (p<0.0001). According to BMI 23 women (74.2%) with CHTN were overweight, 15 (48%) were with I and II obesity degree. In healthy group, were only 7 overweight women (16%) and no obese women. Analysis of hemodynamics did not reveal signs of cardiac remodeling (LVH, LVDD), but size of the LV walls, the LV mass were greater in 2 gr. Thus, LVEDD in group 2 was 4.79±0.44 cm versus 4.51±0.42 cm in group 1 (p= 0.0068); IVST was 0.976±0.14 cm versus 0.81±0.07 (p< 0.0001); LVEDV was 108.45 ± 23.72 ml versus 94.25 ± 19.48 (p = 0.0058); LV ind.mass was 90.96 ± 22.94 g/m2 versus 65.11 ± 15.28 g/m2 (p < 0.0001). Moreover, in group 2, E/A ratio was 1.52±0.34 versus 1.28±0.24 in group 1 (p = 0.0012).

Conclusion:

It was shown that CHTN in pregnancy, in more than 70% of cases, associated with overweight and initial manifestations of cardiac remodeling.
P187 CO-DESIGNING AN INTERVENTION FOR CARDIOVASCULAR DISEASE RISK ASSESSMENT AND MANAGEMENT AFTER HYPERTENSIVE DISORDERS OF PREGNANCY
Authors: Slater Kaylee , Taylor Rachael , McLaughlin Karen , Pennell Craig , Forbes Karyn , Marcetic Milena , Collins Clare , Hutchesson Melinda
Published: September 2024

Background and objective:

Women with a history of hypertensive disorders of pregnancy (HDP) are at two-to-fourfold increased risk of developing cardiovascular disease (CVD) within 10 years post-pregnancy. Despite clinical practice guidelines recommending general practitioners (GPs) for ongoing CVD preventative care, no intervention strategies exist within primary care aimed at improving risk assessment or management for women after HDP. This study aimed to co-design an intervention to enhance the implementation of CVD risk assessment and management following HDP for primary care settings in Australia.

Methods:

Researchers used the Integrated Knowledge Translation (IKT) framework and conducted five co-design meetings with the investigative team and end-users. Meetings were informed by the Behaviour Change Wheel (BCW) framework for intervention development and incorporated research findings from a systematic review and meta-analysis, surveys, and an online discussion. Data from activities and audio recordings following each meeting were analysed iteratively to inform ongoing intervention development.

Results:

The 18 end-users included women with lived HDP experience (n=8), obstetricians (n=2), midwives (n=5), and GPs (n=3). The target priorities were to improve communication between hospital staff and GPs following HDP occurrence and increase knowledge of GPs and women regarding CVD prevention post-HDP. Part 1 of the intervention is delivered within the hospital setting via physical resources to address communication gaps between hospital and primary care providers for women after post-HDP. Part 2 is delivered via an update to existing GP education platforms and resources for use within GP consultations to provide education for women and GPs on CVD prevention post-HDP.

Conclusions:

The IKT and BCW frameworks played a crucial role in development of a tailored intervention aimed at bridging gaps in current primary care practice and enhancing implementation of CVD risk assessment and management for women following HDP. This an important step in addressing CVD risk in women of childbearing age.
P190 POST-COVID INFECTION AS AN INDEPENDENT PREDICTOR OF DIASTOLIC HYPERTENSION IN AFRICAN POPULATION: SUDAN MMM 2022
Authors: Beheiry Hind , Ahmed of Cardiology Amjad , Abukaraig Fel Egbal , Ahmed Omer , AbdelFatah Deena , Homidh Eman , Abdellah Walleed , Hamid Abubaker , Abdoalkrem Mohamedalmontser , Hago Maha , Ali Ibtisam , Shaheen Mahasin , Mohamed Yasir
Published: September 2024

Introduction:

Several clinical studies reported a mutual relationship between coronavirus disease 2019 (COVID-19) and high blood pressure (BP) readings. It was established that hypertension is associated with increased COVID-19 severity, morbidity, and mortality; however, its effect on the future blood pressure reading and development of hypertension is not apparent.

Methods:

This is a cross-sectional analytic study based on MMM 2022, Sudan data. The targeted population was >18 years old. Blood pressure was measured on 3 consecutive measures. Participants who had a history of hypertension were excluded. Systolic hypertension was defined if systolic blood pressure (SBP) ≥ 140 mmHg, and diastolic hypertension was defined if diastolic blood pressure (DBP) ≥ 90 mmHg. Continuous data was presented in mean and standard deviation, and categorical data was presented in frequency and percentages. Logistic regression models (unadjusted and adjusted) were used to predict high blood pressure readings.

Results:

A total of 14,402, (42.92%) were male and the mean age was (35.1±14.7 years) patients were included in this study. The prevalence of associated medical conditions, diabetes, heart attack, heart failure, arrhythmia, and stroke were 6.3%, 1.12%, 1.5%, 0.8%, 4.8%, and 1.1% respectively. The mean SBP was (118.88±17.42) mmHg, and the mean DBP was (78.89±11.0) mmHg. Furthermore, the COVID-19 infection affected (4.48%) of this study population. They were older (36.8±12.2 vs. 35.0±14.8, p=0.003), more frequently males (56.1% vs. 42.3%, p <0.001), and diabetic (8.8% vs. 6.2%, p=0.006). The incidence of systolic hypertension and diastolic hypertension, in the population, was (10.98%) and (14.57%) respectively. The post-COVID patients had a significantly higher mean DBP (80.0±10.7 vs. 78.8±11.0, p=0.008) but not the SBP. Using unadjusted and adjusted logistic regression, the odd ratio is significant for predicting high DBP post-COVID infection (table 1).

Conclusions:

Post-COVID infection carries a huge burden on healthy individuals. After adjusting for the possible confounders, post-COVID-19 infection was an independent predictor of diastolic hypertension in the African population.