bluuebunny/crossref_metadata_2025 huggingface dataset:
PS-BPC03-7: ARE OSCILLOMETRIC WAVEFORMS DIFFERENT IN PREGNANCY?
Authors: Ringrose Jennifer , Araneta Patricia , Chan Lillian , Kassam Jalisa , Wirzba Mira , Greef Kate , Ramsay Gillian , Sia Winnie , Khurana Rshmi , Bader Erin , Sridar Sangita , Padwal Raj
Published: January 2023

Objective:

Hypertensive disorders of pregnancy are leading causes of maternal and perinatal morbidity and mortality. Automated blood pressure (BP) measurements are being used in clinical practice; however, understanding of how oscillometric waveform vary between pregnant and non-pregnant individuals remains low.

Design and Methods:

Pregnant individuals over 20 weeks gestational age and healthy, non-pregnant women were recruited. Healthy, non-pregnant women (HNP) were matched to healthy pregnant women (HP), and pregnant women with a hypertensive disorder of pregnancy (HDP) by age (± 10 years), arm circumference (± 6 cm), and BMI at the time of BP measurement (± 13 kg/m2). There were seven individuals in each group for a total of 21 participants. BP measurements were done per the International Organization for Standardization (ISO) protocol using a custom-built oscillometric device as the test device and 2-observer mercury auscultation as the reference measurement. Four pairs of auscultatory measurements and four oscillometric measurements were obtained for each participant. Baseline demographics, auscultatory BP and BP derived from slope-based and fixed ratio algorithms were determined. Oscillometric waveform and envelope features were compared among groups.

Results:

In HNP, HP, and HDP groups respectively: mean age was 31.3 ± 4.8; 32.1 ± 3.6; 32.0 ± 4.4 years; arm circumference 31.9 ± 3.3; 32.3 ± 4.9; 34.0 ± 3.3 cm; BMI 26.8 ± 3.8; 32.0 ± 7.2; 32.4 ± 3.7 kg/m2; mean auscultatory BP (systolic/diastolic) 103.3 ± 11.1/66.5 ± 7.4; 110.6 ± 4.0/56.9 ± 6.5; 132.6 ± 19.0/83.9 ± 13.3 mmHg. HDP had significantly higher auscultatory systolic (P < 0.05) and diastolic (p < 0.01) BP than the other groups. The pregnant groups (HP, HDP) had significantly higher heart rate (p < 0.01); higher pulses (p < 0.05) in the oscillometric waveform (OMV); lower average width in the pulses (p < 0.01); higher pressure amplitude at which the OMW peaks (p < 0.05) with longer time to reach this maximum pressure amplitude (p < 0.05); greater area under the curve (p < 0.01). Compared to HNP, the HDP showed significantly skewed OMW to the right (p < 0.01); greater spread in the OMW envelope (p < 0.05) and lesser random variation in the OMW envelope (p < 0.01). A typical OMV with the 3 groups superimposed is demonstrated in Figure 1.

Conclusion:

Significant differences in the oscillometric waveform morphology and parameters were found in pregnancy and in hypertensive disorders of pregnancy compared to healthy controls. These results suggest that pregnancy-specific algorithms may be required to optimize accuracy for oscillometric BP measurement.
PS-BPC03-8: MORNING BLOOD PRESSURE SURGE AND THE VASCULATURE: A COMPARISON BETWEEN YOUNG DIPPERS AND NON-DIPPERS FROM THE AFRICAN-PREDICT STUDY
Authors: Mokwatsi Gontse Gratitude , Schutte Aletta Elisabeth , Smith Wayne , Mels Catharina Martha Cornelia , Kruger Ruan
Published: January 2023

Background and aim:

Adverse changes in large arteries and retinal microvascular calibres are predictors for hypertension and stroke. These adverse changes were reported in response to the suppressed night-time dipping as well as in hypertensive individuals with exaggerated morning surge. However, it is unknown whether young healthy individuals with normal morning surge, but with non-dipping night-time blood pressure profile, will already present with early onset of micro and macrovascular changes. We investigated the relationship of morning surge with retinal vessel calibres and large artery stiffness in healthy young dippers and non-dippers.

Methods:

We included black and white participants (N = 323), aged 20–30 years, determined sleep-trough surge. We determined central retinal artery and vein equivalents from fundus images, as well as carotid-femoral pulse wave velocity.

Results:

Dippers had a greater morning surge (within normal range) (p < 0.001) and a greater proportion of individuals with exaggerated morning surge (p < 0.001). In dippers only, we found a positive relationship between central retinal artery equivalent and morning surge (p = 0.040). In sensitivity analysis, the association between central retinal artery equivalent and morning surge in dippers lost significance (p = 0.09) when 24-hour diastolic blood pressure was replaced with night-time diastolic blood pressure. However, an independent negative association between central retinal artery equivalent and night-time diastolic blood pressure (p < 0.001) emerged. Normal morning surge of dippers was positively associated with central retinal artery equivalent (dependent on night-time dipping).

Conclusion:

Normal night-time dipping may therefore be involved in preserving retinal arteriolar diameter of dippers, which may reflect a lower vascular resistance.
PS-BPC03-9: EFFECTIVENESS OF MAY MEASUREMENT MONTH EDUCATIONAL PROGRAM ON KNOWLEDGE AWARENESS AND LIFESTYLE PRACTICES OF PATIENT WITH HYPERTENSION
Authors: Kaur Amrit
Published: January 2023

Background:

Hypertension is not only an important risk factor for noncommunicable disease but also is a major cause of mortality and morbidity all over the world. Barriers to high blood pressure (BP) awareness and control are exacerbated by poor knowledge of the consequences and uncertainty regarding how to and who should direct care.

Aim:

To evaluates the effectiveness of educational program for improving knowledge awareness and health promoting lifestyle practices among patients with hypertension.

Objective:

1. to examine the knowledge and awareness about hypertension.in patient with hypertension.

2. To find out whether educational program is an effective tool for improving knowledge and promoting healthy lifestyle in patient with hypertension.

Methods:

This study was a case control intervention study on 100 patients with hypertension that were selected during may measurement month camp in our institute. Before the intervention both groups (50 subjects in each group) completed the HKLP questionnaire. (Hypertension knowledge and lifestyle practice scale).after completing the HKLP questionnaire case group an educational program was delivered through PPT and that group was provide one educational booklet. One month after the intervention both the group again completed the same questionnaire.

Results:

There was no significant difference in the mean age of both the groups. The mean of the total HKLP scores was significantly increased in the case group compared with the control group (p value is less than 0.05). Showed that mean score regarding hypertension knowledge and health promoting lifestyle behavior were significantly higher after than before program in case control group.

Conclusion:

In this study Hypertension educational program was effective in promoting knowledge and healthy lifestyle among patients with hypertension. Based on the relationship between lifestyle and hypertension it seems that implementing educational programs is essential to improve disease knowledge and lifestyle modification among patients with hypertension
PS-BPC04-4: PREVALENCE AND CLINICAL CHARACTERISTICS OF HYPERTENSION SUBTYPES ACCORDING TO HOME BLOOD PRESSURE CONTROL IN TREATED HYPERTENSIVE PATIENTS: A CROSS-SECTIONAL STUDY
Authors: Chotruangnapa Chavalit , Thammarux Tossaporn , Thongdang Piyawan
Published: January 2023

Objective:

To identify the prevalence and clinical characteristics of the different hypertension subtypes according to home blood pressure (BP) control in treated hypertensive patients.

Design and method:

This study was conducted in Siriraj hospital, Mahidol University, Thailand during 2019 to 2020. We included treated hypertensive patients with at least 1 antihypertensive medications and had self-home BP measurement. Hypertension subtypes were normotension (NT) (all home BPs were less than 135/85 mmHg), isolated morning hypertension (MHT)(morning BPs were only at least 135/85 mmHg), isolated evening hypertension (EHT)(evening BPs were only at least 135/85 mmHg) and sustained uncontrolled hypertension (SHT)(all home BPs were at least 135/85 mmHg). We analyzed the clinical data to evaluate blood pressure control rate and identify the associated clinical factors in the other groups.

Results:

Our study included 1,435 participants. The prevalence of home BP control was 55.82%, 12.61%, 7.32%, and 24.25% in NT, MHT, EHT, and SHT, respectively. Overall mean age was 63 years. There were 39.58% men. SHT group had significantly the highest body mass index, proportions of alcohol drinking and evening administration of antihypertensive medications. The participants in EHT group used the highest number of antihypertensive medication classes and chronic kidney disease was most found in this group. The multivariable analysis showed the significant association of history of CVD with MHT (OR 2.93, 95%CI (1.46 to 5.85)). The albuminuria of at least 300 mg/g was the significant associated factor of EHT (OR 3.05, 95%CI (1.23 to 7.57)) and SHT (OR 2.20, 95%CI (1.14 to 4.27)). Aging (OR 0.98, 95%CI (0.96 to 0.99)), use of thiazide diuretics (OR 3.38, 95%CI (1.03 to 11.11)), sprironolactone (OR 5.68, 95%CI (1.38 to 23.33)) and peripheral alpha1 blockers (OR 3.90, 95%CI (1.16 to 13.11)) were also strongly associated with SHT.

Conclusions:

BP control rate was fair. There were different clinical characteristics and independent associated factors in each subtypes.
PS-BPC04-6: INCREASED VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY IS ASSOCIATED WITH LEFT ATRIUM ENLARGEMENT AND HIGH RDW-CV IN HYPERTENSIVE PATIENTS
Authors: Tsujino Takeshi , Ito Satoyasu , Naito Yoshiro , Asakura Masanori , Ishihara Masaharu
Published: January 2023

Objective:

Visit-to-visit blood pressure variability (BPV) has been shown to be associated with incidence of atrial fibrillation and poor prognosis of heart failure with preserved ejection fraction (HFpEF). However, it is unknown why BPV induces AF or worsening of HFpEF. Objectives of this study are to investigate whether visit-to visit BPV affected cardiac remodeling and to explore the factors that associate with visit-to visit BPV.

Methods:

Out-patient with hypertension who received blood tests and echocardiography twice at an about 1-year interval in our hospital from 2014 to 2016 were included. Exclusion criteria were the number of blood pressure measurement less than 3, hospital admission between 2 tests, significant valvular heart disease, atrial fibrillation, hypertrophic cardiomyopathy, and hemodialysis. Visit-to visit BPV was evaluated with coefficient of variation of systolic blood pressure (SBP-CV) between 2 tests. Data were obtained from electronic health record of the hospital. Logarithmic transformations were used for values of red cell distribution width (RDW-CV) and left atrial volume index (LAVI) because they skewed to the left. Changing rate (Δ) of test value was calculated as follows: (2nd test value-1st test value)/[1st test value × test interval (years)]. This is a retrospective observational study and approved by the Institutional Ethics Committee.

Results:

One hundred and thirty-eight patients were included (median of age was 69, male 71%). In univariate analysis, SBP-CV was significantly correlated with age (P = 0.002), DBP-CV (P < 0.001), ΔlogLAVI (P = 0.001), logRDW-CV (P = 0.002), A wave (P = 0.011), and laxative use (P = 0.032). Multivariate analysis revealed that SBP-CV was significantly correlated with ΔlogLAVI (P = 0.009) and logRDW-CV (P = 0.022)

Conclusions:

Increase in visit-to-visit systolic BPV was associated with enlargement of left atrium and high red cell distribution width in patients with hypertension. Increased BPV was shown to be associated with impaired left ventricular (LV) diastolic dysfunction in cross sectional study. We found the association of increased visit-to visit BPV and enlargement of left atrium, the most sensitive marker of LV diastolic dysfunction, in longitudinal study for the first time. Experimental study using rats that received sinoaortic denervation showed that exaggerated BPV induced LV fibrosis and hypertrophy. BPV may cause LV diastolic dysfunction via LV fibrosis in patients with hypertension. We also found that SBP-CV was significantly correlated with RDW-CV. RDW-CV has been thought to be a marker of chronic inflammation. Chronic inflammation may causally relate to increased BPV.
PS-BPC04-9: IMPACT OF ATRIAL FIBRILLATION ON ACCURACY OF OSCILLOMETRIC BLOOD PRESSURE MONITORING IN CRITICALLY ILL PATIENTS FROM A LARGE REAL-WORLD DATABASE
Authors: Li Yuxi , Wang Beining , Fan Fangfang , Weng Haoyu , Zhang Long , Jiang Jie , Zheng Bo , Zhang Yan , Li Jianping
Published: January 2023

Objective:

It is controversial to use oscillometric blood pressure (BP) monitors for BP measurement in atrial fibrillation (AF) patients due to the variation in stroke volume. Several recent studies revealed no significant difference in oscillometric and intra-arterial BP bias between AF and sinus rhythm (SR) patients, but the population sizes were limited. We performed a cross-sectional study based on an extensive real-world database to further demonstrate the impact of AF on the accuracy of oscillometric blood pressure monitoring in the intensive care unit setting.

Design and method:

Adult patients with AF or SR records were enrolled from Medical Information Mart for Intensive Care-III (MIMIC-III) database. Concurrently-recorded non-invasive oscillometric BPs (NIBPs) and invasive intra-artery BPs (IBPs) were extracted and classified as AF or SR group according to the heart rhythm. Pairwise comparison was performed on NIBP/IBP bias between AF and SR circumstances. Bland-Altmann plots were used to assess bias and limits of agreement. A multivariable linear mixed-effect model was used to adjust confounders. Subgroup and interaction analyses were performed.

Results:

2335 patients (71.95 ± 11.23 years old, 60.90% of male) were included. The systolic (SBP), diastolic (DBP), and mean (MBP) NIBP/IBP biases were not clinically different between AF and SR circumstances (SBP: AF vs. SR, 0.66 ± 19.64 mmHg vs. 1.21 ± 21.96 mmHg, P = 0.002; DBP: -5.29 ± 12.03 vs. -5.17 ± 11.54, P = 0.124; MBP: -4.45 ± 12.31 vs. -4.19 ± 12.61, P = 0.014). After adjusting age, gender, heart rate, arterial BP, and vasopressor usage, the effect of heart rhythm on NIBP/IBP bias was still within ± 5 mmHg for SBP and DBP [adjusted effect on SBP bias: 3.32 mmHg (95% CI 2.89 to 3.74), P < 0.001; DBP: -0.89 (-1.17 to -0.60), P < 0.001], while the effect on MBP bias was not significant [adjusted effect 0.18 mmHg (-0.10 to 0.46), P = 0.200].

Conclusions:

Atrial fibrillation would not significantly influence the accuracy of oscillometric monitoring in critically ill patients compared with sinus rhythm circumstance.
PS-BPC05-4: DIASTOLIC FUNCTION AND STROKE VOLUME MEASURED BY ECHOCARDIOGRAPHY IS RELATED TO PROGRESSION OF FRAILTY IN ELDERLY HYPERTENSIVE OUTPATIENTS
Authors: Toba Ayumi , Ishikawa Joji , Harada Kazumasa
Published: January 2023

Objective:

In hypertensive patients, echocardiographic measures of cardiac structure and function were related to cognitive dysfunction and frailty in cross sectional studies; however, longitudinal relationship of these parameters has not been elucidated. We investigated whether stroke volume and diastolic function in echocardiography was predictive of worsening of cognitive function and frailty for 3 years.

Design and Methods:

Among 330 hypertensive patients who were registered in the frailty clinic and underwent echocardiography, 93 patients were followed up for 3 years. We evaluated stroke volume and diastolic function in echocardiography, frailty status evaluated as Kihon checklist (KCL), and cognitive function measured as mini mental state examination (MMSE) and Montreal cognitive assessment (MoCA).

Results:

Patients’ mean age was 78.8 ± 7.1 years old (58% male). KCL score remained or decreased in 50 (54 %) patients after 3 years of follow up (7.1 ± 4.7 points to 5.7 ± 4.7), and increased in 43 (46 %) patients (6.1 ± 4.1 to 8.9 ± 4.4). Between those whose KCL score increased and remained or decreased, there were no statistical difference in history of hypertension, heart failure, diabetes mellitus, stroke and type of antihypertensives; however, MMSE and MoCA score at follow up was higher in patients whose KCL score remained or decreased (MMSE: 27.8 ± 2.5 vs 26.7 ± 3.3, p = 0.24, MoCA: 22.2 ± 4.0 vs 20.7 ± 5.2, p¬ = 0.036). Ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e’) at baseline was lower in patients whose KCL score remained or decreased (E/e’ septal 11.8 ± 3.0 vs 14.4 ± 5.5 p = 0.01). Other value for diastolic function was not related to the change of KCL score. Logistic regression analysis revealed E/e’ septal was independently associated with an increased KCL score even after adjusting for age, sex, BMI, history of hypertension, diabetes mellitus, heart failure, and KCL score at baseline (p = 0.036, odds ratio = 0.89). On the other hand, E/e’ was not significantly different in the parallel analysis according to domains of physical function, nutritional state, cognitive function, and depressive mood in KCL. Systolic volume in echocardiography at baseline was related to change in physical function in KCL at follow up (r = -0.226, p = 0.028).

Conclusions:

E/e’ in echocardiography at baseline was predictive of worsening of frailty status, measured as KCL score, at 3 years later.
PS-BPC01-6: BRACHIAL-ANKLE PULSE WAVE VELOCITY IS USEFUL FOR CARDIOVASCULAR RISK ASSESSMENT IN WELL-TREATED HYPERTENSIVE PATIENTS WITH CORONARY HEART DISEASE
Authors: Maruhashi Tatsuya , Kajikawa Masato , Kishimoto Shinji , Harada Takahiro , Hashimoto Yu , Yusoff Farina Mohamad , Nakano Yukiko , Nakashima Ayumu , Takase Bonpei , Tomiyama Hirofumi , Yamashina Akira , Higashi Yukihito
Published: January 2023

Objective:

Measurement of brachial-ankle pulse wave velocity (baPWV) has been performed for the assessment of arterial stiffness. The purpose of this study was to determine whether baPWV is useful for cardiovascular risk assessment in treated hypertensive patients with a history of coronary heart disease (CHD).

Design and method:

This study was a post hoc analysis of Flow-mediated Dilation Japan Study A, which is a prospective multicenter observational cohort study. A total of 447 treated hypertensive patients with a history of CHD were enrolled to assess predictive value of baPWV for future cardiovascular events. The primary outcome was a composite of coronary events, stroke, heart failure, and sudden death.

Results:

The primary outcome occurred in 64 patients during a median follow-up period of 47.6 months. When using a blood pressure ≧ 130/80 mmHg as a reference, blood pressure < 130/80 mmHg was significantly associated with a lower risk of the primary outcome after adjustments for other cardiovascular risk factors in treated hypertensive patients with CHD (hazard ratio, 0.59; 95% confidence interval [CI], 0.35–0.99; P = 0.04). In well-treated patients with CHD who had a blood pressure < 130/80 mmHg, baPWV ≧ 1736 cm/s, that was derived from receiver-operator characteristic curve analysis, was significantly associated with a higher risk of the primary outcome after adjustments for traditional cardiovascular risk factors (hazard ratio, 2.83; 95% CI, 1.02–7.91; P = 0.04).

Conclusions:

The achievement of the target blood pressure is important to reduce the risk of cardiovascular events in treated hypertensive patients with a history of CHD. In well-treated hypertensive patients with CHD, baPWV is useful for cardiovascular risk assessment.
PS-BPC07-8: ARTERIAL HYPERTENSION AS PROGNOSTIC MARKER IN PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION AND EARLY PERCUTANEOUS CORONARY INTERVENTION
Authors: Reuter Hannes , Fassbender Patricia , Zander Wilhelm , Halbach Marcel , Hoffmann Fabian
Published: January 2023

Objective:

Strong evidence points to the prognostic value of renin angiotensin system (RAS)-inhibitors (ACE inhibitors or AT1-receptor blockers) and beta blockers (BB) in the secondary prevention after myocardial infarction (MI). However, adequate dosing of these drugs is often limited due to their blood pressure lowering effects, especially early after MI. The present study therefore sought to identify differences in rates of prescription, persistence and dosing of RAS-inhibitors and BB early after acute ST-elevation MI (STEMI) and its impact on survival in hypertensive and non-hypertensive patients.

Design and method:

1003 consecutive patients with adjudicated STEMI treated by early percutaneous coronary intervention (PCI) between 2007 and 2011 in a single centre as part of the Cologne Infarction Model (KIM) were retrospectively dichotomized according to their history of arterial hypertension at the time of hospital admission. Comparisons were made using students T-test. Qualitative analyses were done using Chi square-test or given as odds ratio (OR (95% KI).

Results:

Mean age was 63 ± 13 years, body mass index 27 ± 5 kg/m2, 24% were women. 749 patients were diagnosed with hypertension. Mortality was 11.3% at 30 days and 17.2% at 1 year follow up. History of hypertension at time of hospital admission was significantly associated with lower mortality on follow up (OR, at 30 days: 0.41 (0.27–0.64), at 1 year 0.37 (0.26–0.53)). Long term persistence to RAS-inhibitors was significantly higher in hypertensive patients compared to non-hypertensives (84% vs. 70%, p = 0.004). However, persistence to BB did not differ between groups (88% vs 86%, n.s.). At discharge the rate of prescription of RAS-inhibitors and BB was significantly higher in hypertensive patients (RAS-inhibitors: 87.3% vs. 69.8%, p < 0.001; BB: 92.8% vs. 84.3%, p < 0.001). In addition, the defined daily dose (DDD) among patients receiving RAS-inhibitors at discharge was higher in hypertensive versus non-hypertensive patients (DDD: RAS-inhibitors, 0.40 vs. 0.30, p < 0.001), whereas there was no difference for BB. At 30 days and at 1 year follow up survival was significantly associated with the prescription of RAS-inhibitors as well as BB at discharge.

Conclusion:

Patients with a history of hypertension show higher prescription rates at discharge, better long-term persistence as well as higher individual dosing of RAS-inhibitors after STEMI. This, as well as the higher prescription rates of BB, may contribute to the better survival that we observed in STEMI patients with history of hypertension compared to non-hypertensive controls.
PS-BPC08-3: CATHETER-BASED ADRENAL ABLATION: AN ALTERNATIVE THERAPY FOR PATIENTS WITH ALDOSTERONE-PRODUCING ADENOMA
Authors: Sun Fang , Liu Xiaoli , Zhang Hexuan Hexuan , Zhao Zhigang , He Hongbo , Yan Zhencheng , Li Yingsha , Li Qiang , Li Yaoming , Jiang Jun , Zhu Zhiming
Published: January 2023

Objective:

Unilateral adrenalectomy is the standard treatment for patients with aldosterone-producing adenoma (APA), but it lacks an option for patients with APA who refuse or are not suitable for surgery. In this study, we studied whether catheter-based adrenal ablation for APA is comparable to adrenalectomy.

Design and method:

A total of 1180 hypertensive patients were screened, and 112 patients with APA were recruited and counseled on the treatment options. Fifty-two patients opted for catheter-based adrenal ablation, and 60 opted for adrenalectomy. Clinical and biochemical outcomes were assessed at 6 months after treatment. Factors associated with hypertension remission, advantages and limitations of this approach were evaluated.

Results:

According to the primary aldosteronism surgical outcome (PASO) criteria, complete and partial clinical success was achieved in 21 (40.4%) and 23 (44.2%)patients in the ablation group vs. 33 (55.0%) and 23 (38.3%) patients in the adrenalectomy group. Complete and partial biochemical success was achieved in 30 (57.7%) and 17 (32.7%) patients in the ablation group vs. 51(85.0%)and 5 (8.3%) patients in the adrenalectomy group, respectively. The overall clinical (84.6% vs 93.3%) and biochemical (90.4% vs 93.3%) success rates were not significantly different between the two groups (P > 0.05). Factors associated with adrenal ablation-mediated hypertension remission were hypertension duration and serum potassium level at baseline. Compared with surgery, adrenal ablation requires a shorter operating time and time to resume physical activity.

Conclusions:

Catheter-based adrenal ablation may bean alternative and feasible option for APA patients unwilling surgical treatment.
PS-BPC08-4: IMPACT OF TESTOSTERONE REPLACEMENT THERAPY ON 24-HOUR AMBULATORY BLOOD PRESSUR E MEASUREMENTS IN MALES WITH OPIOID-INDUCED ANDROGEN DEFICIENCY. A PLACEBO-CONTROLLED RCT
Authors: Olesen Thomas Bastholm , Glintborg Dorte , Olsen Michael Hecht , Andersen Marianne Skovsager
Published: January 2023

Objective:

The primary aim was to investigate the effects of testosterone replacement therapy (TRT) on 24-hour ambulatory blood pressure (24hABPM) in opioid-treated men with relative hypogonadism. The secondary aim was to evaluate potential effect modification of baseline body composition and red blood cell measurements on the impact of TRT on 24hABPM.

Design and methods:

This was a double blinded and placebo controlled study. Men aged > 18 years, treated with an opioid dosage > 50 mg opioid/day were eligible for inclusion if total testosterone (TT) was < 12 nmol/L. Participants were randomized to TRT (1,000 mg testosterone undecanoate) or placebo at 0, 6 and 18 weeks. Participants were examined before and during 24 weeks of TRT/placebo.

Results:

The two groups (TRT, n = 15 and placebo, n = 20) were comparable at baseline. TRT was associated with numerical increase in 24hABPM. The difference in changes from baseline of daytime systolic blood pressure (SBP) was 5.2 mmHg (P = 0.134) between the TRT group and the placebo group. In subgroup analysis, baseline values of body mass index (BMI), hematocrit (Hct) and hemoglobin (Hgb) levels displayed significant positive interaction on the effect of TRT on change in SBP compared to placebo. In participants with BMI above the study median (30.7 m2/kg), daytime SBP change from baseline was 17.6 mmHg [10.6, 24.6] (P = 0.002) in the TRT group and 0.4 mmHg [-5.5, 4.7] (P = 0.864) in the placebo group. In participants with Hct levels above the study median (0.43%), daytime SBP increased 8.4 mmHg [-1.9, 18.8] (P = 0.09) in the TRT group and decreased -2.3 mmHg [-11.3, 6.8] (P = 0.564) in the placebo group. Similarly, in participants with Hgb> 8.7 mmol/L daytime, SBP change was 11.2mmHg [0.6–21.7] (P = 0.041) in the TRT group and -2.9 mmHg [-4.1, 9.9] (P = 0.367) in the placebo group. Baseline cIMT also increased the strength of association between TRT and change in SBP.

After adjusting for delta-BMI, delta-Hct remained significantly associated with increase in daytime SBP. An increase in 1 mmHg SBP was associated with an increase in Hct of 0.11% [0.10–0.22] (P = 0.032).

Conclusions:

Baseline levels of BMI, Hct, Hgb and cIMT, influence the effect of TRT on BP. The magnitude of BP increase is associated with increase in Hct levels.
PS-BPC08-8: SEX DIFFERENCES IN IN THE SCREENING CUTOFFS OF PRIMARY ALDOSTERONISM
Authors: Nozato Yoichi , Yamamoto Koichi , Akasaka Hiroshi , Takami Yoichi , Rakugi Hiromi
Published: January 2023

Title:

Sex differences in in the screening cutoffs of primary aldosteronism

Objective:

In screening for primary aldosteronism (PA), simultaneous measurements of plasma aldosterone concentration (PAC; pg/mL) and plasma renin activity (PRA; ng/mL/hr) and the resulting PAC/PRA ratio (ARR) > 200 have been actively employed. Because of the low stability and reproducibility of PRA, screening using active renin concentration (ARC; pg/mL), which can overcome these problems, is desirable but has not become a mainstream screening method in practice. This study will clarify the association between ARC and PRA and examine the impact of sex differences on PA screening.

Methods:

1631 consecutive patients (1018 inpatients (51.5%; male) and 613 outpatients (58.1%; male)) who had measured PRA and ARC simultaneously at Osaka University Hospital from February 2017 to December 2020 were analyzed retrospectively. In the inpatients, blood samples were taken in the supine position at rest in the early morning. In outpatients, blood was collected without specifying the blood collection conditions. PRA, ARC, and PAC if blood was collected at the same time were analyzed. PRA was measured by enzyme immunoassay. Each of PAC and ARC was measured by chemiluminescent immunoassay. All results are represented as median (25th to 75th percentile). For the analysis of variables association Mann Whitney`s U t test was used for comparison of each measurement between the two groups, with 5% significance level.

Results:

PRA and ARC were correlated in the overall population and by sex (overall; r = 0.78 p < 0.0001, male r = 0.90 p < 0.0001, female r = 0.71, P < 0.0001). Analysis of covariance showed a significant difference in the regression line between PRA and ARC by sex (p < 0.0001) and PRA/ARC was significantly lower in males (0.17 [0.13–0.22] vs 0.19 [0.14–0.26] p < 0.0001). In the inpatients, PRA, ARC and PAC was significantly higher in males (PRA; 1.1 [0.4–2.9] vs 0.7 [0.3–1.7] p < 0.0001, ARC; 6.6 [3.0–16.8] vs 4.4 [1.8–8.3] p < 0.0001, PAC; 137 [100–196] vs 130 [88–185], p = 0.003,). PAC/PRA, PAC/ARC were significantly lower in males (PAC/PRA; 120 [47–307] vs 179 [81–335] p = 0.0002, PAC/ARC; 20 [8–45] vs 32 [16–63] p < 0.0001). In the outpatients, both PRA and ARC, PAC were also significantly higher, and PAC/PRA and PAC/ARC were significantly lower in males(PRA; 1.3 [0.6–3.4] vs 0.8 [0.4–2.4] p < 0.0001, ARC; 6.8 [3.4–15.1] vs 4.4 [2.0–11.1] p < 0.0001, PAC; 137 [98–198] vs 158 [116–220] p = 0.003, PAC/PRA; 106 [44–226] vs 179 [70–380] p < 0.0001, PAC/ARC; 20 [10–40] vs 36 [15–72] p < 0.0001).

Conclusion:

Significant differences in PRA, ARC, PAC, PRA/ARC, PAC/PRA, and PAC/ARC were observed by the sex. Sex differences should be considered in screening for PA by ARR and PAC/ARC.
PS-BPC09-6: THE IMPACT OF LOW VERSUS HIGH INTENSITY ISOMETRIC HANDGRIP EXERCISE TRAINING ON REDUCTION OF BLOOD PRESSURE IN INDIVIDUALS WITH HYPERTENSION-A RANDOMIZED DOUBLE BLINDED CONTROLLED TRIAL
Authors: Kharva Dharmishtha J. , Thakar Vidhi V.
Published: January 2023

Title:

The Impact of Low Versus High Intensity Isometric Handgrip Exercise Training on Reduction of Blood Pressure in Individuals with Hypertension: A Randomized Double Blinded Controlled Trial

Objectives:

The primary objectives of the study are to investigate the effects of low and high-intensity isometric handgrip training in the reduction of blood pressure in individuals with hypertension and to identify which one out of three-intensity isometric handgrip training has a greater effect on blood pressure reduction. A secondary objective is to evaluate the extent of adherence to IHG exercise training among the three IHG training groups.

Design and Method:

Randomized controlled with parallel group, multiple arm trial. Participants and therapists were blinded to group allocations, with the allocation concealment handled by a Sequentially numbered, sealed opaque envelope method. Randomization with computer generated random number table was done into three IHG training groups. A total of 75 Individuals with hypertension were randomized into the following three isometric handgrip exercise groups: Group A 5% MVC (Control group) (n = 25), Group B 30% MVC (Intervention group) (n = 25), Group C 90% MVC (Intervention group) (n = 25). Participants were given 4-week of IHG exercise training at their homes by the therapist. At baseline and the end of 4 weeks, B/L blood pressure was measured and compared between groups. Adherence to the IHG exercise training was recorded in the exercise log after each exercise session. Trial Registration: CTRI/2022/01/039346 [Registered on: 12/01/2022] - Trial Registered Prospectively

Results:

A total of 60 participants completed the 4-weeks of IHG training and at baseline, they were similar (p > 0.05). From baseline to 4-weeks we have found statistical and clinically significant changes of > 7 mmHg in SBP and > 4 mmHg in DBP in all three groups. However, there was no significant difference was obtained between groups. For exercise adherence, 87% to 92% of participants completed the sessions.

Conclusion:

According to the findings of our study, Isometric handgrip exercise is effective in reducing blood pressure for individuals with hypertension but there is no significant difference in blood pressure for different intensities of IHG exercise training
PS-BPC10-4: THE CLINICOPATHOLOGICAL FINDINGS IN NON-DIABETIC CKD PATIENTS WITH CARDIOVASCULAR AUTONOMIC NEUROPATHY
Authors: Kuno Hideaki , Kanzaki Go , Oba Rina , Sasaki Takaya , Haruhara Kotaro , Koike Kentaro , Tsuboi Nobuo , Yokoo Takashi
Published: January 2023

Background:

Cardiovascular autonomic neuropathy (CAN) is common as the process of kidney injury. Coefficient of variation of R-R interval (CVR-R) is one of the most convenient, noninvasive tests of heart rate variability, and is widely used to assess cardiac autonomic nerve function. However, the clinical and pathological findings in non-diabetic CKD patients with CAN has not been fully elucidated. This current study investigated the characteristics of non-diabetic CKD patients with CAN diagnosed by CVR-R.

Method:

Subjects who underwent percutaneous kidney biopsy and performed CVR-R test at the Jikei University School of Medicine Hospital, Tokyo, Japan were retrospectively examined. Patients with arrhythmia, diabetes, and post transplantation were excluded. CAN was defined using the reference values of CVR-R based on age and sex. The proportion of glomerulosclerosis (GS) and interstitial fibrosis/tubular atrophy (IF/TA) were assessed. The severity of arteriosclerosis was determined by the extent of thickening of the intima: grade0 = intimal thickening< thickness of media grade1 = intimal thickening> thickness of media.

Results:

Ninety subjects were identified (Age 45.7 ± 14.9 (mean ± SD) years old; Male 56%; heart rate 69 ± 11 /min; eGFR 60.0 ± 29.5 mL/min/1.73m2; 24h-urinary protein excretion 0.55 [0.24–1.30] (median [IQR]) g/day; CVR-R rest 3.7 ± 1.7%; GS 11.6 [3.6–24.8] %, IFTA 20 [10–30] %.) Eleven patients were diagnosed as CAN, with nephrosclerosis [n = 4], acute tubulointerstitial nephritis [n = 2], IgA nephropathy [n = 1], IgA vasculitis [n = 1], membranous nephropathy [n = 1], lupus nephritis [n = 1], and focal segmental glomerular sclerosis [n = 1]. Patients with CAN had a higher triglyceride (P = 0.030) and higher IF/TA(P = 0.005) than those without CAN. The severity of arteriosclerosis increased in patients with CAN. (P = 0.017)

Conclusion:

These results indicated that that arteriosclerosis and IF/TA were associated with CAN in non-diabetic CKD patients.
PS-BPC10-7: EFFECT OF ORAL POTASSIUM CHLORIDE SUPPLEMENTATION ON THE THIAZIDE-SENSITIVE SODIUM CHLORIDE COTRANSPORTER (NCC) IN HEALTHY HUMANS: A RANDOMISED CROSSOVER TRIAL
Authors: Wu Aihua , Wolley Martin , Mayr Hannah , Cowley Diane , Li Bo , Welling Paul , Campbell Katrina , Fenton Robert , Stowasser Michael
Published: January 2023

Objective:

The putative “renal-K+ switch’’ mechanism links low K + intake with Na+-dependent Na+ retention and involves activation of NCC in the distal convoluted tubule in response to low K+ intake and suppression in response to high K+ intake. This study used urinary extracellular vesicles (uEVs) to examine NCC abundance and phosphorylation in healthy adults on a high Na+ diet to determine tubular responses to alterations in K+ (in the form of KCl) intake.

Design and method:

The study design was a double blind, randomised and placebo-controlled trial. Healthy adults maintained on a high Na+ (∼200mmol/day), low K+ (∼60mmol/day) diet underwent a run-in period of 1-week followed by a crossover study, with 5-day supplementary KCl (active phase, Span K, 24mmol thrice daily) or 5-day placebo administered in random order and separated by 2-day washout. After each phase, blood and 24-hour urine were collected for biochemistry, and spot urine for uEV analysis were collected for progressive ultracentrifugation. Participants who met dietary compliance (greater than 80%) and urinary response requirements were included in analyses.

Results:

Among the 23 (out of 28) participants who met inclusion criteria, supplementary KCl administration (verses placebo) in the active phase was associated with markedly higher levels of plasma K+ and 24-Hour urine levels of K+, Cl- and aldosterone, and lower levels of 24-Hour urinary Na+/K+ (Table 1). Among 18 participants who met inclusion criteria and whose uEV were successfully isolated, KCl intake was associated with less abundant NCC (fold change [FC](KCl/placebo) = 0.74 [0.30, 1.69], p < 0.01) and pNCC (FC = 0.81 [0.19, 1.75], p < 0.05) (Figure 1). Correlation analyses revealed an inverse correlation of plasma K+ with NCC (R2 = 0.11, p = 0.05) and delta urinary K+ with delta pNCC (R2 = 0.23, p = 0.04). Ambulatory systolic blood pressure positively correlated with timed urinary Na+/K+ (R2 = 0.08, p = 0.04) during interventions.

Conclusions:

In healthy adults on a high Na+ low K+ diet, supplementary KCl administration was associated with reductions in NCC and pNCC in uEVs, consistent with the “renal-K+ switch’’ mechanism, and offers a useful target for dietary intervention.
PS-BPC12-3: PLASMA XANTHINE OXIDASE ACTIVITY AND ITS RELATED FACTORS IN ESSENTIAL HYPERTENSIVE PATIENTS
Authors: Murai Sayama , Koike Tsutomu , Arisawa Yu , Fujioka Hayato , Kakeshita Kota , Yamazaki Hidenori , Kinugawa Koichiro
Published: January 2023

Objective:

Xanthine oxidase (XO) activity has a key role in the development of oxidative stress and progression of cardiovascular diseases. In resistant hypertension, plasma XO activity is related to increased urinary sodium excretion and left ventricular hypertrophy. In this study, plasma XO activity and its related factors were investigated in essential hypertensive patients.

Design and method:

In 53 essential hypertensive patients (30 men, 64 ± 13 years) without taking anti-hyperuricemic agents, plasma XO activity was measured by using a high-performance liquid chromatography method. 38 healthy volunteers without any specific comorbidities were included as a control cohort. Associations between plasma XO activity and other clinical variables were also investigated in essential hypertensive patients.

Results:

Plasma XO activity was increased in essential hypertensive patients compared with the healthy cohort (log10XO 1.33 ± 0.47 nmol/L/hr vs 0.98 ± 0.37, p < 0.001). In essential hypertensive patients, plasma XO activity did not associate with age, blood pressure, estimated glomerular filtration and urinary protein excretion. There were weak correlations between plasma XO activity and the levels of serum uric acid and blood glucose (r = 0.28, 0.32, p < 0.05, respectively). Plasma XO activity strongly correlated with body mass index (BMI) and alanine aminotransferase (ALT) (r = 0.46, 082, p < 0.001, respectively), and in multiple regression analysis, BMI and ALT were independent determinants for plasma XO activity (R2 0.57, p < 0.001).

Conclusions:

In essential hypertension, plasma XO activity was increased accompanying with obesity and liver disfunction, irrespective of blood pressure elevation and renal dysfunction.
PS-BPC12-7: ANTI-INFLAMMATORY AND PRO-INFLAMMATORY BIOMARKERS IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE AND HYPERTENSION
Authors: Rozhdestvenska Anastasiia , Zhelezniakova Natalia
Published: January 2023

Introduction:

Non-alcoholic fatty liver disease (NAFLD) affects up to 50% of patients with hypertension (HT). Research data indicate a decrease in the activity of anti-inflammatory biomarkers with a simultaneous increase in the levels of pro-inflammatory agents.

Objective:

To assess the changes in anti-inflammatory systems (using kallistatin, IL-10) and pro-inflammatory activity (using IL-1β; and high-sensitivity CRP (hsCRP)) in patients with NAFLD under the influence of concomitant HT.

Design and method:

63 patients with NASH and HT and 52 patients with isolated NASH were examined. Plasma kallistatin, IL-10, IL-1β; and hsCRP levels were evaluate using ELISA. The results were statistically processed using standard methods.

Results:

Kallistatin levels in patients with NAFLD and HT were on average 65.03 ng/ml (95% CI 61.38; 68.68), which was significantly lower than in the group with isolated NAFLD (83.42 ng/ml (95% CI 81.89; 84.94), p < 0.001) and control results (111.70 ng/ml (95% CI 106.14; 113.22), p < 0.001). The level of anti-inflammatory IL-10 in the group of NAFLD and HT also reached minimal values (12.69 pg/ml (95% CI 11.93; 12.95) against 14.34 pg/ml (95% CI 13.27; 14,34) in the group with isolated NAFLD (p < 0.001) and 16.19 pg/ml (95% CI 15.15; 17.74) in the control group (p < 0.001)). The opposite results were observed in the study of IL-1β; content, which was increased in the group with NAFLD and HT (17.55 pg/ml (95% CI 17.06; 19.73) versus 15.72 pg/ml (95% CI 15,25; 17.44) in the group with isolated NAFLD (p < 0.001) and 8.26 (95% CI 7.79; 8.46) in the control group (p < 0.001)).

In addition, patients with NAFLD and HT had an increase in CRP (7.90 mg/l (95% CI 7.96; 8.75) versus 6.55 mg/l (95% CI 6.47; 7.57) in the group with isolated NAFLD (p < 0.001) and 2.07 mg/l (95% CI 1.83; 2.85 mg/l) in the control group (p < 0.001)). It has been shown that with the progression of HT in patients with NAFLD, the level of kallistatin significantly decreases (p < 0.001, p = 0.011 for the HT stage and BP grade) and IL-10 (p < 0.001) with a simultaneous increase in IL-1β; (p < 0.001) and CRP levels (p < 0.001).

Conclusions:

Thus, patients with NAFLD and HT are likely to experience changes in biomarker status toward a pro-inflammatory profile and deepening of these deviations with the progression of concomitant hypertension.
PS-BPP01-4: THE RELATIONSHIP BETWEEN SERUM PROPROTEIN CONVERTASE SUBTILISIN/KEXIN TYPE 9 CONCENTRATION AND THE PREVALENCE OF CORONARY ARTERY CALCIUM
Authors: Kunimura Ayako , Miura Katsuyuki , Segawa Hiroyoshi , Torii Sayuki , Kondo Keiko , Hisamatsu Takashi , Yano Yuichiro , Kadota Aya , Fujiyoshi Akira , Nakagawa Yoshihisa , Okamura Tomonori , Ueshima Hirotsugu
Published: January 2023

Background and aims:

Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a promising new target for reducing low-density lipoprotein cholesterol (LDL-C) and cardiovascular events in high-risk patients. However, the influence of circulating PCSK9 concentration on atherosclerotic plaque formation in the younger, healthy population is not fully elucidated. We assessed the relationship between serum PCSK9 concentration and coronary artery calcium (CAC) prevalence in the general population with no history of cardiovascular disease in different age group.

Methods:

Community-dwelling Japanese men (n = 622) aged 46–82 years, without a history of cardiovascular disease or lipid-lowering medications, were included. Serum PCSK9 concentration and CAC score were measured using the Agatston method, and CAC was defined as an Agatston score of > 10. Multivariable Poisson regression with robust error variance were used to estimate the relative risk (RR) and 95% confidence interval (CI) per 1 SD of the serum PCSK9 concentration for the presence of CAC. We conducted further analysis stratified by age (< 60, 60–69, and 70 ≦ years).

Results:

The average age, LDL-C, and median serum PCSK9 concentration were 68 years, 122 mg/dL, and 240 ng/mL, respectively. After multivariable adjustment for traditional cardiovascular risk factors, no significant association was observed between serum PCSK9 concentration and CAC prevalence (adjusted relative risk [aRR] 1.05, 95% CI 0.97–1.13). With age stratification, serum PCSK9 concentration was significantly associated with CAC prevalence in men aged < 60 years (aRR 1.38, 95% CI 1.01–1.88), but not in men aged 60–69 years (aRR 0.96, 95% CI 0.85–1.10) or ≧ 70 years (aRR 1.08, 95% CI 0.99–1.19).

Conclusions:

A higher serum PCSK9 concentration was associated with a higher CAC prevalence in men aged < 60 years, which was independent of traditional cardiovascular risk factors. The results of our study suggest that serum PCSK9 concentration might be associated with earlier-stage atherosclerosis.
PS-BPP02-4: DIFFERENCES IN RISK FACTORS FOR DEVELOPING HYPERTENSION WHEN HYPERTENSION REFERENCE VALUES ARE CHANGED
Authors: Sakoda Takashi , Akasaki Yuichi , Kawasoe Shin , Kubozono Takuro , Sasaki Yuichi , Ikeda Yoshiyuki , Ohishi Mitsuru , Miyahara Hironori , Tokushige Koichi
Published: January 2023

Objective:

In 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) lowered the diagnostic reference value for hypertension to 130/80 mmHg. On the other hand, the Japan Society of Hypertension (JSH) Guidelines for the Treatment of Hypertension 2019 set the diagnostic reference value at 140/90 mmHg because there is insufficient evidence to set it at 130/80 mmHg in Japan. We sought to determine whether there were differences in risk factors predicting future development of hypertension if the diagnostic threshold were lowered in Japan.

Method:

Of 137,308 subjects who underwent health checkup between 2007 and 2015, 18,657 middle-aged men who were observable for 5 years were included in the study. First, we adapted the JSH2019 criteria and used nominal logistic regression analysis to explore factors involved in the development of hypertension in normotensive subjects who are judged to be normotensive at the first checkup and hypertensive 5 years later. Age, systolic blood pressure, diastolic blood pressure, BMI, uric acid, LDL, HDL, triglycerides, HbA1c (JDS), eGFR, smoking history, daily drinking habit were used as factors for adjustment. Next, the ACC/AHA2017 criteria were adapted and analyzed using the same method to examine the differences in relevant factors from the adaptation of the JSH2019.

Results:

12,296 subjects were considered normotensive at first checkup according to JSH2019 criteria. After 5 years, 2,568(20.8%) were diagnosed with hypertension. Age [OR = 1.04, CI = 1.03–1.05, p < 0.001], BMI [OR = 1.08, CI = 1.03–1.13, p < 0.001], uric acid [OR = 1.11, CI = 1.06–1.16, p < 0.001], HbA1c(JDS) [OR = 1.19, CI = 1.10–1.28, p < 0.001], and daily drinking habit [OR = 0.75, CI = 0.66–0.86, p < 0.001] were associated with development of hypertension at 5 years. On the other hands, 7,892 subjects were considered normotensive at first checkup when AHA/ACC2017 criteria were adapted. After 5 years, 5.549(45.1%) were diagnosed with hypertension. Age [OR = 1.03, CI = 1.01–1.04, p < 0.001], BMI [OR = 1.08, CI = 1.02–1.14, p = 0.006], uric acid [OR = 1.15, CI = 1.08–1.21, p < 0.001] and daily drinking habit [OR = 0.69, CI = 0.60–0.80, p < 0.001] were associated with development of hypertension at 5 years.

Conclusions:

Adapting the AHA/ACC2017 criteria will result in more people developing hypertension than the JSH2019 criteria. Aging, elevated uric acid, and daily drinking habits are risk factors that predict future hypertension, even according to the AHA/ACC2017 criteria.