bluuebunny/crossref_metadata_2025 huggingface dataset:
PS-C01-4: ASSOCIATIONS OF ARTERIAL STIFFNESS ONSET AGE WITH TYPE 2 DIABETES RISK: A LARGE-SCALE CHINESE COHORT STUDY
Authors: Li Fei , Zhu Liyong , Yang Yiping , Wang Jie , Wu Jingjing , Miao Rujia , Cai Jingjing , Yuan Hong , Lu Yao
Published: January 2023

Objective:

To explore the associations between arterial stiffness (AS) onset age and type 2 diabetes (T2DM) risk.

Design and Method:

This study enrolled 22,588 participants free of T2DM at baseline. All participants take an annual physical examination from 2012 to 2016, with fasting blood glucose and brachial-ankle pulse wave velocity measurements. Cox proportional model was used to investigate the association between AS onset age and T2DM risk. Sex specific analysis was also performed, as well as examining the association between early vascular aging (EVA), normal vascular aging (NVA), supernormal vascular aging (SUPERNOVA) onset age, and diabetes risk.

Results:

Totalling 757 (3.4%) participants were diagnosed with T2DM. Compared with participants free of AS in each specific age group, the earlier AS onset age was more strongly associated with T2DM risk, especially for the middle age, with the fully adjusted hazard risk (HR) and 95% confidence interval (CI) of 4.63 (2.79, 7.67) for AS onset age at 50. Similar results were observed both in males and females, with the fully adjusted HR and 95% CI of 4.54 (2.60, 7.93) for males and 4.86 (1.48, 16.01) for females, with AS onset age at 50. Such association was also observed in the exploration of EVA, NVA, and SUPERNOVA onset age and incident T2DM risk.

Conclusions:

This study revealed that middle-aged onset of AS was more significantly associated with a higher risk of T2DM. Early screening of AS, especially in middle age, may assist in T2DM detection and postpone diabetic vascular complications developing.
PS-C02-4: QRS DURATION AS A PREDICTOR OF FUTURE ATRIAL FIBRILLATION IN END-STAGE RENAL DISEASE PATIENTS WITH PRESERVED LEFT VENTRICULAR SYSTOLIC FUNCTION
Authors: Chung Hyemoon , Lee Jung Myung , Woo Jong Shin , Kim Jin Bae , Kim Soo Joong , Ryu Sung Kee , Kim Weon , Kim Woo Shik
Published: January 2023

Objective:

We investigated the echocardiographic and electrocardiographic predictors for future development of AF in patients with ESRD and preserved LV EF who had never diagnosed AF.

Design and method:

Atrial fibrillation (AF) is a common cause which leads to adverse cardiovascular outcome in patients with end-stage renal disease (ESRD). AF is common arrhythmia in patients with reduced left ventricular (LV) ejection fraction (EF). It is unclear the predictor of new AF in patients with preserved LV EF. We enrolled 226 patients with ESRD who has performed transthoracic echocardiography. We excluded the 1) 16 patients who has been received a diagnosis of AF, and 2) 19 patients with LV EF < 50%, and 191 patients (121 males, mean 62 ± 14 years years).

Results:

During a mean follow-up period of 885 ± 720 days, AF occurred in 20 (10.5%) patients. The patients with AF development was older (69 ± 12 vs. 61 ± 14 years, p = 0.023). There were no differences in history of hypertension, diabetes, stroke and coronary artery disease between two groups. In univariate Cox regression analysis, left atrial volume index (LAVI), right ventricular systolic pressure, age and QRS duration were associated with future AF events. After multivariate Cox regression analysis, age (HR: 1.015, 95% CI: 1.008–1.105, p value: 0.022) and QRS duration (HR: 1.025, 95% CI: 1.001–1.049, p value: 0.043) significantly predicted the future development of AF.

Conclusions:

QRS duration is well known predictor of cardiovascular outcome in patients with reduced LV EF. In this study, we demonstrated QRS duration predicted new AF events in ESRD patients with preserved LV EF.
PS-C02-6: A PROTOCOL PAPER FOR THE NEW HEALTH GUIDANCE INITIATIVES OF HEART FAILURE AGGRAVATION PREVENTION PROJECTS FOR URBAN RESIDENTS IN JAPAN
Authors: Nosaka Saya , Sakai Yukie , Watanabe Emi , Yasui Yuka , Maeda Saori , Kashima Rena , Teramoto Masayuki , Kokubo Yoshihiro
Published: January 2023

Background:

At the end of 2021, Japan's ageing rate was 29.1%, the highest globally, and is steadily increasing. Heart failure is a terminal manifestation of various heart diseases, but there have been very few epidemiological studies of heart failure among residents in Japan. We have started a joint project with Suita city and its Medical Association to prevent heart failure, which implements the findings of the Suita study in urban area residents.

Objective:

The purpose of this project is to contribute to the prevention of heart failure as well as overall cardiovascular disease, cancer, and dementia by providing health guidance according to the level of heart failure.

Methods:

The examiners in this project agree to participate in the “Long-term Follow-up Study on Prognostic Factors for Heart Failure in Suita City Health Examination” at the time of their health examination in Suita from November 2020 to October 2022. Predict the onset of potential heart failure using a predictive tool that adds NT-proBNP to the risk score for coronary artery disease and atrial fibrillation. There are four groups of subjects: low, middle, and high risks. For high-risk people, we will provide medical cooperation as a treatment required. Subjects classified as middle risk will be given health guidance, and those classified as high risk will be recommended to consult a doctor. Those at middle risk are stratified into two categories: individual guidance and group guidance programs, according to their risk of potential heart failure. We developed the original textbook, “Lifelong Health Support 10.” Of the 26,267 participants in total (including 3,852 duplicates), 591 were given group guidance and 285 were given individual guidance (as of March 2022). Blood pressure and body composition are measured at the first interview in the individual guidance program, and lifestyle habits according to the lifelong health support 10 are checked. We set behavioral goals for each participant. At the time of 1 and 2 months later, a mail or letter support is provided, and after 3 months, blood pressure and body composition are measured and biochemical tests (HbA1c, LDL-c, NT-proBNP), and evaluation of lifestyle improvement. In the group guidance program, lifestyle checks and action goals are set at the time of initial guidance, and lifestyle improvement evaluations are conducted three months later. In both cases, the final review will be evaluated using the results of the health checkup items and risk scores for the following year.
PS-C02-8: ROLE OF STATIN THERAPY IN HYPERTENSION, PLEIOTROPIC EFFECT IN REDUCING NEW-ONSET AF AND ISCHEMIC STROKE
Authors: Pradnyana I Wayan Agus Surya , Antara I Made Putra Swi , Jagannatha Gusti Ngurah Prana , Kamardi Stanly
Published: January 2023

Introduction:

Hypertension is considered the most important risk factor for stroke in the general population, is the most common comorbidity in patients with atrial fibrillation (AF), and is prevalent in approximately 80 to 90% of subjects with AF enrolled in recent clinical trials. Statin drugs have potent anti inflammatory and antioxidant effects that have the potential to prevent AF. Patients who had ischemic stroke complications due to episodes of AF are usually asymptomatic, thus primary prevention of AF in hypertensive patients is very important.

Objectives:

To determine the effectiveness of statin in reducing the incidence of new onset AF and ischemic stroke complications in hypertensive patients.

Methods:

We included 180 subjects in this retrospective cohort study using medical records at Sanglah General Hospital from 2018 to 2020. Subjects were divided into hypertensive subjects who were treated with a statin and hypertensive subjects who were not given statins, and we tracked the incidence of new onset AF. Pearson chi square test was used to determine the association of baseline characteristics, comorbidities, and medications, including statin, on the outcome of new onset AF, ischemic stroke, and side effects of statin. The progression of new onset AF between groups was also compared with the Kaplan Meier curve.

Results:

Our subjects who used statin were 39.4%, the mean age for all was 51.51+12.31 with 28,3% new onset AF, 7,2% ischemic stroke, and 2.2% all cause death. Statin in hypertensive patients significantly reduced the incidence of new onset AF (PR 0.174; 95%CI 0.079–0.38; P < 0.001) with a longer AF free period (19.16 + 2.57 vs 13.68 + 0.67 months; 95%CI 5.01–5.84; P = 0.014) and ischemic stroke free period (23.72 + 0.71 vs 16.57 + 1.06 month; 95%CI 5.01–5.84; P = 0.003), without any significant relationship with the adverse effect of statin. The incidence of AF was significantly high in hypertensive subjects with comorbid heart failure (HF) however, the AF free period remains longer if hypertensive patients with HF are given statin (19.16 + 2.57 vs 13.68 + 0.67 month; 95%CI 5.01–5.84; P = 0.014).

Conclusion:

Statin administration has the potential to be an effective treatment for primary prevention of the incidence of new onset AF and ischemic stroke in hypertensive patients without significant side effects.
PS-C03-5: REAL-WORLD DATA OF BLOOD PRESSURE IN DIALYSIS PATIENTS WITH AND WITHOUT DIABETES IN JAPAN USING THE WEB-BASED DATABASE
Authors: Sakuma Hirofumi , Matsuki Motoki , Hasebe Naoyuki , Nakagawa Naoki
Published: January 2023

Objective:

Diabetic nephropathy was the most common primary disease among patients undergoing dialysis, and the number is growing each year. Despite advancements in dialysis technique, cardiovascular complications and mortality in dialysis patients with diabetes remain higher than in those without diabetes. Furthermore, hypertension is commonly known to contribute to the development of cardiovascular complications in dialysis patients, and we aimed to compare the systolic blood pressure (SBP) in dialysis patients with and without diabetes using the Web-based Analysis of Dialysis Data Archives (WADDA) system database.

Design and Methods:

From 2014 to 2020, we enrolled dialysis patients who had their predialysis SBP measured using the WADDA system 2.1. We classified SBP and evaluated its trends over time by gender, age, and presence of diabetes using the Japanese Society of Hypertension guidelines 2019 (JSH2019). Furthermore, we looked at the relationship between SBP and cardiovascular death in patients with and without diabetes.

Results:

Dialysis patients with diabetes (n = 168,227) had a mean age of 69.2 (11.7) years versus 69.4 (13.3) years, a mean predialysis history of 5.5 (5.3) years versus 9.4 (9.3 years), and a mean dialysis SBP of 156.6 (25.0) mmHg versus 147.9 (23.6) mmHg, respectively. Dialysis patients with diabetes had higher rates of cardiovascular complications than those without diabetes. From 2014 to 2020, the percentage and absolute values of hypertension were higher in dialysis patients with diabetes than across all age groups and in both men and women. Patients with cerebrovascular death had a higher rate of hypertension, but there was no difference in the rate of grade I and II hypertension between the two groups.

Conclusion:

We summarized the recent trends in SBP of Japanese dialysis patients with and without diabetes using the WADDA system. Dialysis patients with diabetes had higher SBP than those without diabetes in all age groups and in both men and women. As a result, optimal blood pressure management for dialysis patients with and without diabetes is important for the prevention of cerebrovascular death.
PS-C03-7: FUNDOSCOPIC EXAMINATION USING A SMARTPHONE CAMERA: A REVIEW OF EFFECTIVENESS AND FEASIBILITY IN DETECTING HYPERTENSIVE RETINOPATHY IN HYPERTENSIVE CRISIS PATIENTS
Authors: Chaichan Soramon , Laovirojjanakul Wipada , Kotruchin Praew
Published: January 2023

Introduction:

In patients presented with hypertensive crises, a fundoscopic assessment is necessary because once hypertensive retinopathy is discovered, a hypertensive emergency is diagnosed, and intravenous antihypertensive medication is recommended. However, direct ophthalmoscopy is relatively underutilized, especially under the social distance regulation, which may result in delayed diagnosis and treatment. The novel method, namely, smartphone-based fundoscopy offers longer working distance and shorter doctor-patient contact time, however, there is limited data regarding its feasibility and effectiveness.

Objective:

We aimed to gather scientific evidence on the smartphone-based fundoscopy in terms of its effectiveness, accessibility, and trainability in detecting hypertensive retinopathy among hypertensive crisis patients in emergency room settings.

Methods:

A literature search was conducted on PubMed, Google Scholar, and the Cochrane Library for papers published from January 2010 to November 2021. Keywords including hypertensive crisis, hypertensive retinopathy, target organ damage, fundoscopic optic examination, direct ophthalmoscope, fundus images, smartphone fundoscopy, digital fundus camera, and COVID-19 were used. Full papers published in English and abstracts of non-English publications were all reviewed.

Results:

Eight studies out of 34 fulfilled our search criteria. Five observational studies confirmed the effectiveness of smartphone-based fundoscopy in obtaining fundus images adequate for interpretation compared with those from commercially available fundus cameras. Also, smartphone-based fundoscopy offers time-saving properties as it allows fundus examination to be effectively completed within 74 seconds compared to 130 seconds with a traditional direct ophthalmoscope. Two studies investigated the accessibility of smartphone-based fundoscopy and discovered that fundus images can be obtained by using 20 diopter condensing lenses with the video mode of the smartphone camera, which can be easily provided even at a primary level hospital due to their low cost. Another study reviewed the trainability of the smartphone-based fundoscopy in 137 undergraduate medical students which concluded that 75% of these students can identify the optic nerve within 20–25 minutes of face-to-face demonstration.

Conclusion:

With a greater diagnostic capability, accessibility, and trainability of smartphone-based fundoscopy makes it a potentially game-changing technique for detecting hypertensive retinopathy in hypertensive emergency patients, especially during the current COVID-19 pandemic, in which longer working distance and shorter doctor-patient contact time are both required.
PS-C04-2: LONGITUDINAL CONSTANCY OF VASCULAR AGEING PHENOTYPES AND FACTORS ASSOCIATED WITH THE PHENOTYPE CONSTANCY OVER TIME
Authors: Shiina Kazuki , Takahashi Takamichi , Takada Yoichiro , Fujii Masatsune , Nakano Hiroki , Matsumoto Chisa , Chikamori Taishiro , Tomiyama Hirofumi
Published: January 2023

Background:

The concept of two phenotypes of vascular aging, healthy vascular aging (HVA) and early vascular aging (EVA) has been proposed.

Objectives:

To examine the: (1) constancy of these phenotypes over time; (2) validity of assuming that a constantly maintained phenotype reflects the rate of structural arterial stiffening; and (3) longitudinal associations between the vascular phenotypes and cardiovascular risk factors/heart rate (HR).

Methods:

The brachial-ankle pulse wave velocity (baPWV) was measured annually over a 16-year period in 4682 middle-aged Japanese subjects. The vascular phenotypes of 4682 middle-aged Japanese subjects were measured at the start and end of a 16-year study period, by measuring the arterial stiffness as a function of the age and blood pressure.

Results:

Of 4682 subjects, 158 (3.4%) showed constancy of the HVA phenotype, and 192 (4.1%) subjects showed constancy of the EVA phenotype throughout the study periods. The baPWV adjusted for the mean blood pressure differed significantly between the two groups. Elevated mean blood pressure, serum HbA1c levels and HR were significantly associated with constancy of the EVA phenotype, whereas only a low HR was significantly associated with constancy of the HVA phenotype.

Conclusions:

In middle-aged Japanese subjects with the HVA/EVA phenotype at the study baseline, while the phenotype changed during the study period in many subjects, phenotype constancy appeared to reflect the rate of structural arterial stiffening. Elevated blood pressure and abnormal glucose metabolism were associated with constancy of the EVA phenotype. On the other hand, HR was a robust marker of the presence/constancy of the HVA/EVA phenotype.
PS-C05-10: INDIVIDUALS WITH PRE-IMPAIRED GLUCOSE TOLERANCE (PRE-IGT) HAVE ALREADY ENDOTHELIAL DYSFUNCTION BUT WITH NO SIGNIFICANT IDENTIFIABLE CARDIOVASCULAR RISK FACTORS
Authors: Salmon Jeannine Ann Ong , Magbuhat Ann Lorraine , Sali Ruby Jane Guerrero , Purino Francis , Macindo John Rey , Asis Leilani Mercado
Published: January 2023

Objective:

Pre-impaired glucose tolerance (pre-IGT), characterized as normoglycemia with hyperinsulinemia, is the earliest stage of dysmetabolism in type 2 diabetes mellitus (DM). C-peptide, which is equimolar to insulin, has been shown to cause intima-media thickening when present in increased amounts. This study aims to determine the prevalence of endothelial dysfunction among individuals with pre-IGT and to determine the cardiovascular risk factors for developing endothelial dysfunction.

Design and method:

We employed a cross-sectional analytical study of adult patients with risk factors for developing diabetes [first-degree relative with type 2 DM, obesity, history of gestational diabetes (GDM), and polycystic ovary syndrome (PCOS)]. Brachial artery flow-mediated dilatation (FMD) was performed on pre-IGT patients to test for the presence of endothelial dysfunction. Cardiovascular risk factors evaluated were age, 2-hr insulin and glucose level after 75 gms OGTT, BMI, lipids, and systolic and diastolic blood pressure. Binary logistic regression was used to determine the significant risk factors affecting endothelial dysfunction,

Results:

Of the 67 subjects, 41 had pre-IGT with a prevalence of 61%. Among the pre-IGT who had FMD studies (31/41), seven had FMD (+) with a prevalence of 22.58%. Although statistically not significant, FMD (+) vs. FMD (-) subjects were respectively, older (mean 28.86 (SD 4.34) vs. 25.96 years (SD 25.96), p = 0.112), more obese (mean (SD) 26.87 (4.36) vs. 25.18 kg/m2 (4.83), p = 0.257), had higher 2nd hr glucose and HbA1c (mean (SD) 2-hr glucose; 106.34 (13.36) vs. 105 mg/dL (17.55), p = 0.620, mean (SD) HbA1c; 5.30 (0.37) vs. 5.23% (0.37), p = 0.669), and higher total cholesterol and LDL (mean (SD) cholesterol; 182.13 (21.51) vs.177.07 mg/dL (20.70), p = 0.620, mean (SD) LDL; 105.68 (3.77) vs. 98.58 mg/dL (19.25), p = 0.357). Conversely, FMD (+) vs. FMD (-) subjects had respectively, lower values of the following; 2nd hour insulin levels (mean (SD) 101.32 (76.10) vs. 122.44 uIU/mL (101.83), p = 0.450), mean (SD) systolic BP (109.71 (11.40) vs.110.67 mmHg (13.10), p = 0.886), and mean (SD) diastolic BP (71 (9.11) vs. 74.13 mmHg (10.60), p = 0.683). Similarly, the difference was not statistically significant. Comparative analyses also yielded no significant difference in the demographics (family history, GDM, PCOS) of the two groups.

Conclusion:

Endothelial dysfunction is already present among individuals with pre-IGT. The study did not demonstrate any significant difference in the previously reported cardiovascular risk factors contributing to endothelial function abnormality.
PS-C06-1: ELEVATED PULSE PRESSURE AND SERUM INSULIN ARE INDEPENDENTLY ASSOCIATED WITH DIABETIC RETINOPATHY IN DIABETIC WOMEN WITH OR WITHOUT SYSTEMIC HYPERTENSION
Authors: Olatunji Victoria Ayodeji , Olarinoye John Kola , Olatunji Lawrence Aderemi , Olorundare Olufunke Esan
Published: January 2023

Objective:

Diabetic retinopathy (DR) is a major cause of vision loss, creating a low quality of life in patients. High blood pressure and serum insulin levels are known to be associated with DR. Though incident diabetic eye disease is reportedly related to systolic blood pressure (SBP), the potential importance of pulse pressure (PP) is not clear. The present study aimed at determining the association between pulse pressure, serum insulin levels and diabetic retinopathy in type 2 diabetes (T2DM) with or without systemic hypertension.

Design and Method:

Cross-sectional hospital-based study involving type 2 DM female patients with (n = 70) or without systemic hypertension (n = 36). The groups were matched for age, sex and BMI. Anthropometric measurements were taken, fasting blood glucose, glycated hemoglobin, serum insulin, and lipid profile were determined.

Results:

The mean values for weight and BMI were comparable between the groups, however, DBP, SBP, PP and serum insulin were significantly higher in the hypertensive diabetics. Using multiple regression (stepwise) analysis, there was a strong relationship between PP and DR in hypertensive diabetics (β = 2.239, p < 0.000, R2 = 0.143) while serum insulin showed a strong relationship with DR in patients with only T2DM (β = 2.190, p < 0.000, R2 = 0.253). Receiver operating characteristics (ROC) curve showed that PP with area under the curve (AUC) of 0.746 in hypertensive diabetics and serum insulin with AUC of 0.784 in patients with only T2DM were the most efficient predictors of DR respectively.

Conclusions:

The findings in the present study indicate that elevated PP and serum insulin could be reliable independent predictors of DR in T2DM female patients with or without systemic hypertension respectively.
PS-C07-7: EFFECTS OF PSYCHOLOGICAL STRESS AND PHYSICAL ACTIVITY ON AMBULATORY BLOOD PRESSURE AND PULSE RATE VARIABILITY
Authors: Tomitani Naoko , Kanegae Hiroshi , Hoshide Satoshi , Kario Kazuomi
Published: January 2023

Objectives:

Physical activity and psychological stress during daily life contribute to ambulatory blood pressure (BP) variability. This study aims to investigate the effects of physical activity and psychological stress on daytime BPs measured by ABPM.

Methods:

This study is a post-hoc analysis using ABPM data from a comparison study of ambulatory BP measured by a wrist watch-type wearable BP monitoring device and an ABPM device. ABPM was performed at 30-min intervals for 24 h using a TM-2441 device (A&D Co., Tokyo), an oscillometric device with an upper-arm BP-cuff. This device is also equipped with a high-sensitivity actigraph that can detect fine-scale physical movements of the wearer in three directions. Physical activity was calculated as the sum of the actigraphically measured physical activity over the 5 min before each ABPM measurement. Study participants were asked to write a self-report diary of their general situation (i.e., location, emotion, and body position) corresponding to each BP measurement at least 10 times while awake.

Results:

From 50 outpatients (mean age 66.1 ± 10.8 years, 60.0% male, 98.0% hypertensive patients), 1580 daytime BP readings were taken by ABPM. Of these, 642 BP readings had corresponding diary information. In the mixed effect model analysis including physical activity, significant systolic BP (SBP) elevation associated with physical activity was observed in both a dataset of 1580 BP readings (2.9 ± 0.9 mmHg, P = 0.001 for light physical activity; and 2.9 ± 1.4 mmHg, P = 0.045 for moderate physical activity) and a dataset of 642 BP readings (2.5 ± 1.2 mmHg, P = 0.043 for light physical activity; and 4.2 ± 2.0 mmHg, P = 0.036 for moderate physical activity). In the analysis of 642 BP readings using the model including physical activity and situational factors from diary information, SBP was significantly higher during negative emotions than during positive emotions (7.4 ± 2.5 mmHg, p = 0.003), while the SBP change to physical activity decreased and was not statistically significant. On the other hand, pulse rate was unchanged by negative emotions, but was increased for physical activity.

Conclusions:

Daytime BP measured by ABPM was elevated to a greater extent by psychological stress than by physical activity. BP elevation without corresponding pulse rate increase might be influenced by psychological stress. Simultaneous monitoring of BP and physical activity might detect BP elevation caused by psychological stress.
PS-C07-10: DYNAMICS OF BLOOD PRESSURE ON SPIRONOLACTONE TREATMENT IN PATIENTS WITH RESISTANT HYPERTENSION AND RHEUMATOID ARTHRITIS DEPENDING ON THE ACTIVITY
Authors: Stakhova Alina , Kondratiuk Vitalii
Published: January 2023

Objective:

to determine the features of the dynamics of blood pressure (BP) in patients with resistant hypertension (RH) and rheumatoid arthritis (RA) depending on the decrease in laboratory activity of RA.

Design and methods:

60 patients with RH in combination with RA were included in the study. Outpatient BP measurement and ambulatory blood pressure monitoring (ABPM) were performed. Patients after 12 months of treatment with spironolactone were divided into two groups: A - reached the target value of low laboratory activity of RA - CRP < 5.0 mmol / l (n = 27), B - did not reach (n = 33). The average age of patients in group A was 62.7 ± 8.4 years (81.6% women), group B - 63.1 ± 7.4 years (78.4% women). RA activity was determined by the disease activity index (DAS 28-CRP) and was 5.7 ± 2.3 in group A, 5.8 ± 1.8 in group B before the treatment.

Results:

After reduction of RA activity, the improvement of BP control is more pronounced: in group A the levels of office systolic BP (SBP) were reduced by 15.0 mm Hg, diastolic (DBP) by 7.5 mm Hg and pulse (PBP) by 10.0 mm Hg (all p < 0.01) in comparison to reduction of SBP in group B by 10.0 mm Hg (p < 0.05). After ABPM performing identical results were obtained: in group A the average day-night (dn), day (d) and night (n) SBP, DBP and PBP were decreased (average SBPdn by 13.7 mm Hg, DBPdn by 9.7 mm Hg, PBPdn by 7.7 mm Hg; average SBPd by 10.5 mm Hg, DBPd by 5.8 mm Hg, PBPd by 6.6 mm Hg; average SBPn by 19.2 mm Hg, DBPn by 7.0 mm Hg, PBPn by 9.1 mm Hg (all p < 0.05)) against a less significant decrease in group B. Nocturnal SBP and DBP decrease were increased by 8.2% (from 4.5 (-2.8–13.8)% to 12.7 (7.4–25.4)%), p < 0.05) and 8.8% (9 .9 (4.2–18.7)% to 18.7 (10.4–25.4)%), p < 0.01) with the level of CRP < 5.0 mmol / l after 12 months of treatment.

Conclusions:

In patients with RA in combination with RH administration of spironolactone to existing triple therapy enhances the antihypertensive effect of drugs, which is manifested by more frequent achievement of target blood pressure levels.
PS-C08-2: WEARABLE CUFFLESS BLOOD PRESSURE MONITORING DEVICES: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Shariful Islam Sheikh Mohammed , Maddison Ralph
Published: January 2023

Background:

High blood pressure (BP) is the most common modifiable cardiovascular risk factor, yet its monitoring remains problematic. Wearable cuffless BP devices offer a potential solution for improved monitoring over time, however little is known about their validity and utility. We aimed to systematically review the validity, features, and clinical use of wearable cuffless BP devices.

Methods:

We searched MEDLINE, Embase, IEEE Xplore and the Cochrane Database till December 2019 for studies that reported validating cuffless BP devices. We extracted information about study characteristics, device features, validation processes, and clinical applications. Devices were classified according to their functions and features. We defined devices with a mean systolic BP (SBP) and diastolic BP (DBP) biases of < 5 mmHg as valid as a consensus. Our definition of validity did not include assessment of device measurement precision, which is assessed by standard deviation of the mean difference- a critical component of ISO protocol validation criteria. Study quality was assessed using the QUADAS-2 tool. A random-effects model meta-analysis was performed to summarise the mean biases for systolic and diastolic BP across studies.

Results:

Of the 430 studies identified, 16 studies (15 devices, N = 974) were selected. The majority of devices (81.3%) used photoplethysmography to estimate BP against a reference device; other technologies included tonometry, auscultation and electrocardiogram. In addition to BP and heart rate, some devices also measured night-time BP (n = 5), sleep monitoring (n = 3), oxygen saturation (n = 3), temperature (n = 2) and electrocardiogram (n = 3). Eight devices showed mean biases of < 5 mmHg for SBP and DBP compared to a reference device and three devices were commercially available. The meta-analysis showed no statistically significant differences between the wearable and reference devices for SBP (pooled mean difference = 3.42 mmHg, 95%CI −2.17, 9.01, I2 95.4%) and DBP (pooled mean = 1.16 mmHg, 95%CI -1.26, 3.58, I2 87.1%).

Conclusion:

Available cuffless BP devices utilise different sensing technologies, offering the potential for continuous BP monitoring. The variation in standards and validation protocols limited the comparability of findings across studies and the identification of the most accurate device. Challenges such as validation using standard protocols and in real-life settings must be overcome before they can be recommended for uptake into clinical practice.
PS-C08-4: TEC4HOMEBP: DEVELOPING A HOME BLOOD PRESSURE TELE-MONITORING PATHWAY TO SUPPORT PATIENTS DISCHARGED FROM THE EMERGENCY DEPARTMENT WITH ELEVATED BLOOD PRESSURE
Authors: Tran Karen C , Kuyper Laura , Bittman Jesse , Mangat Birinder , Sing Chad Kim , Lindsay Heather , Dawes Martin , Wong Hubert , Khan Nadia A , Mak Meagan Y , Corderio Jennifer , ho Kendall
Published: January 2023

Objectives:

Elevated blood pressure (BP) in the emergency department (ED) is common, but clinical uncertainty exists on how best to manage asymptomatic hypertension. Telehealth for Emergency-Community Continuity of Care Connectivity via Home Blood Pressure Telemonitoring (TEC4Home BP) evaluates how home blood pressure telemonitoring (HBPTM) can support patients with elevated BP manage their health at home after visiting the ED. The aim of this study is to assess the effect of HBPTM on BP control among those discharged home from the ED with severely elevated BP. We also examined adherence to HBPTM, medical therapy and patient satisfaction.

Methods:

We conducted a prospective, single-centre, observational study and recruited 50 participants from Vancouver General Hospital (VGH), ED with hypertensive urgency, asymptomatic severely uncontrolled BP (> 160/100 mm Hg averaged over 3 readings) or referred to the VGH Hypertension Clinic from the ED for high BP. All participants received a validated home BP monitor (A&D UA-651BLE) and App (Sphygmo App, Calgary, AB) to automatically teletransmit 2 readings in the morning and evening daily for 3 months. Proportion of patients diagnosed with hypertension with controlled home BP defined as less than 135/85 mmHg, adherence to HBPTM, and medication therapy using the Hill Bone medication adherence scale, at 1and 3 months following discharge from the ED.

Results:

From May to December 2021, 50 participants (60 years old, 61% females, average baseline BP (SD) in ED 191 +/−26/ 99 +/−15 mm Hg) were recruited. Our recruitment and enrollment rate were 41% and 88%, respectively. At 1 and 3 months, average home BP (SD) was 136 +/−15/80 +/−11 and 128 +/−10 /77 +/−10 mm Hg. At 3 months, there was a 66% improvement in proportion of those who achieved target BP control. Adherence to HBPTM at 1 and 3 months was 84 and 54%, respectively. There were no differences in medication adherence at baseline and 3 months of study. Participants were highly satisfied with the HBPTM program and 79% would highly recommend the program. More detailed data analysis is currently underway and will be presented.

Conclusions:

HBPTM is a feasible, effective, and acceptable strategy to triage and monitor patients with significantly elevated BP when discharged from the ED. Future studies are need to advise the integration of HBPTM pathway a key clinical strategy to improve patient flow in the ED, reduce length of stay in the ED, and improve BP control in patients with hypertension.
PS-C08-7: TIME IN THERAPEUTIC RANGE IS NOT A RISK FACTOR FOR CARDIOVASCULAR DISEASE WHEN ADJUSTED FOR MEAN SYSTOLIC BLOOD PRESSURE
Authors: Brunstrom Mattias , Rietz Helene , Ortendahl Lina
Published: January 2023

Background:

Time in therapeutic range (TTR) has been suggested as a novel metric to assess blood pressure (BP) control, the quality of antihypertensive therapy, and the risk of cardiovascular events in people with hypertension.

Methods:

We used a validated electronic health record dataset, including all BP recordings in primary care in two Swedish counties from 1993 to 2011. People were eligible if they were 18 years or older, had a diagnosis of hypertension, no previous cardiovascular events, and at least five BP recordings during the first five years from the date of hypertension diagnosis. TTR was defined as the percentage of BP readings with a systolic value less than 140 mmHg. Participants were followed until death, migration or the 31st of December 2019. The risk of myocardial infarction and stroke was assessed using Cox proportional hazards model with TTR as independent variable, with and without mean systolic BP as a covariate. All analyses were adjusted for age, sex, diabetes, county, income and educational level.

Results:

72 724 participants (56% female, mean age 62 years) were included in the analyses. The mean BP level during the first five years after diagnosis was 151/85 mmHg, with a median TTR of 17.7% (interquartile range 0–40%). During an average 7.7 years of follow-up, 6551 participants experienced a first-ever stroke and 5513 a first-ever myocardial infarction. In the unadjusted analyses, the risk of stroke decreased by 7% (HR 0.93, 95%CI 0.92–0.94) and the risk of myocardial infarction decreased by 6% (0.94, 0.93–0.95) for each 10 percentage points increase in TTR. When including mean systolic BP as a covariate, however, TTR was not associated with either stroke (0.99, 0.97–1.01) or myocardial infarction (1.00, 0.99–1.02).

Conclusion:

TTR for systolic BP is not an independent risk factor for stroke and myocardial infarction in clinical practice and does not add importantly to mean systolic BP as a measure of BP control.
PS-C09-9: AMBULATORY BLOOD PRESSURE CHARACTERISTICS IN CHINESE OBESE HYPERTENSIVE PATIENTS: A POPULATION-BASED AMBULATORY BLOOD PRESSURE MONITORING COHORT STUDY
Authors: Cai Qiujing , Zhao Xiaolei , Zeng Mingfa , Zhou Heng , Zhang Yuqing , Zhang Xuezhong , Liu Lisheng , Hu Aihua
Published: January 2023

Background:

Ambulatory blood pressure monitoring (ABPM) is increasingly recommended for clinical practice, but more knowledge about the characteristics of Chinese obese hypertensive patients ABPM remains to further explore. This study aimed to assess the features in Chinese obese and hypertensive patients from multi-regions ambulatory blood pressure database in China.

Methods:

In this cohort, 35,367 hypertensive patients who were eligible for this study including 19,380 men (54.8%) and 15,987 women (45.2%) aged from 19 to 99 were recruited. ABPM characteristics were defined according to European guidelines. Overweight was defined as BMI 18.5 kg/m2 or greater, and obesity BMI 25 kg/m2 or greater. Hypertension was defined as elevated mean ambulatory BP (135/85 mmHg greater in day-time, 120/70 mmHg greater in night-time, 130/80 mmHg greater over 24-h). There are four kinds of blood pressure circadian rhythm, dippers, non-dippers, reverse dippers and extreme dippers.

Results:

Based on the ABPM recordings, 70.5% of participants had 24-h hypertension, 26.1% had dippers rhythm. 2.6% of participants had normal weight, 51.0% were overweight, 38.2% were obesity, and 8.2% were in severe obesity state. Considering blood pressure circadian rhythm, 48% non-dippers rhythm, 23.6% reverse dippers rhythm and 2.3% extreme dippers rhythm. Among participants who were obesity and severe obesity, 48% and 45.1% of patients were non-dippers. Severe obesity patients had higher 24-h blood pressures, especially in independent nocturnal hypertension. The prevalence of reverse dippers rhythm hypertension increased with age and the obesity degree. A positive association between blood pressure level and variability was observed, and within-person and between-person SD and CV were of similar magnitude.

Conclusions:

In Chinese obese hypertensive population, circadian rhythm blood pressure variation is an underappreciated problem on the population level. Therefore, the ambulatory blood pressure monitoring in obese hypertensive population needs to be expanded.
PS-C09-12: RELIABILITY AND RELEVANCE OF 24 H AMBULATORY BLOOD PRESSURE MONITORING IN DAY-TO-DAY TREATMENT OF ARTERIAL HYPERTENSION TREATMENT
Authors: Neumann Claas Lennart , Wietoska Torsten , Schulz Egbert G
Published: January 2023

Introduction:

Blood pressure measurements are the basis of diagnosis, treatment and research of arterial hypertension and its sequelae. All decisions hinge on the validity of the measurement method. Here, the ABPM is considered best practice. Evaluation of ABPM, notwithstanding known issues like availability and economy, regarding its validity, accuracy and applicability to clinical practice was investigated.

Methods and materials:

We retrospectively consider 450 ABPMs executed using validated devices from Nephrology Center Göttingen (ESH-Excellence-Center). This work evaluates the measurements adherence to diagnostic guidelines (ESH) with respect to sources of error, count of valid measurements and cancellation by patient.

Criteria for validity are:

Cancellation by the patient is assumed if:

Results and conclusion:

23 % (n = 106) of 450 ABPM considered to meet all guideline criteria. Remaining 77 % of measurements failed at least one criterion. In 27 % (n = 120), measurement duration was below 24 hours and for 22 % (n = 98) it was below 22 hours. In 2.6 % (n = 12) minimum amount of daytime (n = 3) and night-time (n = 9) data points was not met. Requirement for at least 70 % of valid data points was failed by 23.5 % (n = 105). Here the source of error were motion artefacts in about 50 % of cases, pressurisation issues during the day in 17 % (n = 15) and 27 % (n = 11) at night and kinks in tubing in 14 % (n = 12) during daytime. About 20.6 % (n = 93) of ABPM were preliminary cancelled by the patient which amounts to approximately a quarter (25.4 %) of all measurements failing the guideline criteria. In total 16 % (n = 72) of ABPM were cancelled by patient without recording data of early morning blood pressure which strongly correlates with cardiovascular risk.

The value of ABPM hinges on guideline conforming execution of measurements and should therefore be explicitly discussed with the patient. Due to limitations of ABPM, we recommend introduction of additional methods, e.g. telemetric blood pressure measurements (idTM), with additional options for intervention. Quality of data obtained by an ABPM needs to be examined for every case to ensure its validity to justify a course of action.
PS-C09-13: NEW COMPREHENSIVE THERAPEUTIC STRATEGY FOR HYPERTENSION AND UREMIA USING INORGANIC SUBSTANCES WITH SPECIAL ADSORPTION PROPERTIES
Authors: Kobayashi Yusuke , Kimura Yuki , Kamijo Yuka , Shibata Kazuhiko , Morita Ryutaro , Azushima Kengo , Wakui Hiromichi , Tamura Kouichi
Published: January 2023

Background:

In order to remove uremic toxins accumulated in patients with chronic kidney disease (CKD), removal of uremic toxin-causing substances from the intestinal tract by administration of spherical adsorbed charcoal and removal of uremic toxins from the blood by hemodialysis are being performed. However, existing treatment methods are still inadequate for the removal of protein-bound uremic toxins (PBUT) and other medium- to large-sized uremic toxins, which leads to a decreased quality of life and worse prognosis in CKD patients. In order to solve this remaining problem, we are currently investigating the use of inorganic materials for the treatment of uremia.

Methods:

To evaluate the adsorption performance of our inorganic material, we compared the adsorption performance of various uremic substances in solution, healthy subjects’ plasma, and hemodialysis patients’ plasma, using Kremezin® as a control.

Results:

Kremezin® was able to adsorb small molecular weight substances in each solution and plasma, while medium to large molecules were poorly adsorbed. On the other hand, the inorganic material we are developing has high adsorption performance not only for small molecules but also for medium to large molecules including inflammatory cytokines and PBUT, and selectively adsorbs cations such as sodium, potassium, and inorganic phosphorus.

Conclusion:

Inorganic substances with special adsorption performance adsorbed not only uremic substances but also cations, whose accumulation is a problem in CKD patients. Therefore, the inorganic adsorbent may contribute not only to the treatment of uremia but also to the comprehensive treatment of hypertension, hyperkalemia, and CKD-MBD, which are common complications in CKD patients.
PS-C11-7: STUDY OF 24-HOUR CUFF-LESS, CONTINUOUS AND NON-INVASIVE BLOOD PRESSURE MEASUREMENT IN 100 CHILDREN AND ADOLESCENTS SHOWS CLINICAL VALIDITY
Authors: Bothe Tomas Lucca , Wette Martin Hulpke , Patzak Andreas , Pilz Niklas
Published: January 2023

Objective:

The reduction of discomfort caused by conventional, cuff-based blood pressure (BP) determination is a promising trend in ambulatory, cuff-less BP measurement devices. Mitigating these discomforts is especially desirable when performing measurement in children. In this study we want to assess the clinical validity of a cuff-less BP measurement device for 24-hour measurements in children and adolescents.

Methods:

We compared the simultaneously retrieved BP data of the cuff-less SOMNOtouch(TM) NIBP and the cuff-based Mobil-O-Graph® in 24-hour use in 100 children in the range from 5–17 years old.

Results:

A total of 1245 valid measurement pairs showed a mean deviation of 1.08 mmHg (limits of agreement: 24.10 / -21.93) for systolic and 3.32 mmHg (limits of agreement: 25.13 / -18.48) for diastolic BP values. Patient specific difference of means was within 15 mmHg in 95.6% (systolic BP) and 92.3% (diastolic BP) patients. 24.3% of nocturnal cuff inflations led to determinable, BP relevant arousal reactions.

Conclusion:

The SOMNOtouch(TM) NIBP showed desirable measurement accuracy over a broad spectrum 24-hour, ambulatory BP measurements in children and adolescents. Cuff-less blood pressure measurement relieves the issue of nocturnal arousal reactions which showed to be frequently induced by cuff-based measurements. We encourage the use of this cuff-less BP measurement device in everyday practice, driven by this clear indication of clinical validity and benefits in patient comfort.
PS-C12-6: ASSOCIATION BETWEEN DEFECATION STATUS AND BLOOD PRESSURE VARIABILITY
Authors: Kubozono Takuro , Akasaki Yuichi , Kawasoe Shin , Ojima Satoko , Kawabata Takeko , Salim Anwar Ahmed , Ikeda Yoshiyuki , Ohishi Mitsuru
Published: January 2023

Background:

Blood pressure variability (BPV) is an independent predictor for cardiovascular disease. Defecation status has also been linked to the risk of developing cardiovascular disease.

Aim:

To investigate the association between BPV and defecation status

Methods:

A total of 184 participants who were able to measure their home blood pressure at least 8 days per month at both baseline and 1 year later were included in the study. All participants measured home blood pressure (BP) using HEM-9700T (OMRON Healthcare). Day-to-day variability of systolic BP were evaluated by coefficient of variation (CV) of home systolic BP during one month. Data on defecation status was obtained by questionnaire survey and good defecation status was defined as having a bowel movement every day.

Results:

In multivariate regression analysis with the change of CV from baseline to 1 year later as the objective variable and age, gender, Good defecation status, taking medication including antihypertensive drugs, laxatives, intestinal preparations, and CV at baseline as independent variables, good defecation status is independently negatively associated with the elevated CV (β;: -0.669, P = 0.0019).

Conclusion:

Good defecation status is shown to be significantly associated with decreased BPV.
PS-C13-3: MORTALITY RATE AND REDUCTION OF HOSPITALIZATION FOR ACUTE MYOCARDIAL INFARCTION IN RESEARCH INSTITUTE OF CARDIOLOGY,BAKU IN COVID-19 PANDEMIC
Authors: Gasimov Zaur Ismayil , Dadashova Gulnaz , Javadova Tarana , Yusifov Tavakkul
Published: January 2023

Aims:

To study the impact of quarantine during COVID19 pandemic on admission of patients with myocardial infarction to the intensive cardiac care unit of Research Institute of Cardiology

Methods and Results:

We conducted a single-centre,observational survey to collect data on admissions for acute myocardial infarction(AMI) at ICCU RIC during strict quarantine in April-May 2020,in Baku,Azerbaijan,compared with April-May 2019. We observe 10% reduction in admission rate for AMII patients admitted at intensive cardiac care unit in April-May 2020 in comparison to April-May 2019. We observed significant 40% reduction in admissions for AMI in April 2020 compared with April 2019, it also turned out to be the lowest number of intensive cardiac care unit admissions for AMI among all months of the last 5 years.

Fatality cases of patients admitted in April-May 2020, was 70% higher than in the equivalent period of 2019.

The month of May, following the month of April 2020, had the mortality rate of 26.6% among acute myocardial infarction patients admitted to the intensive cardiac care unit, and it was the highest mortality rate among all months in the last 5 years. During the April 2020, the first month of strict quarantine, in 86,6% < 13 out of 15>of AMI patients admitted to ICCU used narcotic analgesics to relieve pain. In May, narcotic analgesics for pain relief were used in 36.6% or in 11 out of 30 patients.86,6%, the percentage of patients with AMI who received narcotic analgesics for pain relief in April 2020 was the highest among 15 months, from April 2019 to June 2020.
PS-C13-9: BLOOD PRESSURE CONTROL AND THE LEFT VENTRICULAR ECHOCARDIOGRAPHIC PROGRESSION IN HYPERTENSIVE PATIENTS: AN 18 MONTHS FOLLOW-UP STUDY
Authors: Yang Yan , Li Yan , Gao Pingjin
Published: January 2023

Objectives:

The impact of blood pressure control on left ventricular (LV) geometry and function remains unclear. The present study was to assess whether BP control associated with conventional LV geometry and function indexes or global longitudinal strain (GLS) progression, and when the echocardiographic changes would occur in hypertensive patients.

Methods and Results:

A total of 62 participants (mean age 55.2 ± 11.5, male 71.0%) with uncontrolled hypertension were included in the longitudinal study. The follow-up study was performed at 6 months and 18 months, when echocardiographic measurements were performed and BP control was evaluated during the follow up period. At the 6- and 18-months examination, patients were divided into two groups: BP controlled group and uncontrolled group. Patients with BP uncontrolled group (n = 33) had higher LV mass index(P = 0.02), higher left atrial volume index (P = 0.01), worse GLS (P = 0.005) and GLS changes (P = 0.003) compared with BP controlled group (n = 29) at the end of 6 months follow-up period. Patients with BP uncontrolled group (n = 25) had higher LV mass index(P = 0.001), higher LV mass index changes(p = 0.01), higher relative wall thickness (P = 0.01), higher E/e’ (p = 0.046), worse GLS (P = 0.02) and GLS changes (P = 0.02) compared with BP controlled group (n = 24) at the end of 18 months follow-up period. GLS changes was associated with BP control (beta = 0.370, P = 0.004 at 6 months and beta = 1.531, P = 0.02 at 18 months) in stepwise multivariate regression analysis. LV mass index changes was associated with BP control (beta = 0.426, P = 0.003) at the end of 18 months in stepwise multivariate regression analysis.

Conclusions:

Our findings offer a new piece of evidence on the association of BP control with echocardiographic changes in hypertensive patients, especially support the view that GLS progression was superior to conventional LV geometry and function parameters, GLS changes were significant between BP controlled and uncontrolled patients even in 6 months follow-up period.