bluuebunny/crossref_metadata_2025 huggingface dataset:
PS-C31-8: UNCONTROLLED HYPERTENSION AND ITS ASSOCIATED FACTORS AT PRIMARY HEALTH CARE FACILITIES IN MAPUTO CITY, MOZAMBIQUE
Authors: Tualufo Sheila Uamba , Tembe Esselina , Jessen Neusa , Govo Velario , Lunet Nuno , Damasceno Albertino Moura
Published: January 2023

Objective:

the main objective of this study was to estimate the prevalence of uncontrolled hypertension in patients being followed up at primary health care facilities of Maputo City, and to identify factors associated to poor blood pressure control.

Design and Methods:

a cross-sectional study was conducted from September to December 2021 in nine primary health care facilities randomly selected in Maputo City. Five hundred consecutive hypertensive patients aged 18 years or older, on medical therapy and being followed up for more than six months who consented to participate were enrolled. Data was collected through face-to-face interviews, review of medical records and anthropometric and blood pressure measurements to the participants. Three blood pressure measurements were taken in the same arm, with two minutes of interval. The mean of the last two readings was considered for analysis. Uncontrolled hypertension was defined as blood pressure ≧ 140/90 mmHg. Therapeutic inertia was defined as non-increase in antihypertensive therapy after two or more follow-up consultations in patients with a blood pressure ≧ 140/90 mmHg. Hill Bone scale was used to assess adherence to antihypertensive therapy. Data analysis was performed using SPSS 22. Logistic regression was performed to estimate age- and education-adjusted Odds Ratios (OR) and 95% confidence intervals (95%CI) for uncontrolled hypertension. A p-value less than 0.05 was considered significant.

Results:

among the 500 participants, 385 (77%) were female, the mean age was 59.7 years [standard deviation (SD) ± 10.4] and the mean duration of hypertension was 8.9 years (SD ± 8.2). Most participants had primary education 300 (60%).

The prevalence of uncontrolled hypertension was 73.2%. It was more common in patients 60 years or older compared to younger patients (adjusted OR 2.42; 95%CI: 1.30–4.52); among patients without formal education compared to those with higher levels (adjusted OR 0.45, 95%CI: 0.22–0.92, for secondary or higher education); in patients that referred difficulties in having access to the antihypertensive medication (adjusted OR 1.76, 95%CI 1.16 -2.69) and when therapeutic inertia was found (adjusted OR 2.53, 95%CI 1.10–5.86).

Conclusions:

uncontrolled hypertension is an important problem in primary health care in Maputo City and is associated to advanced age, lower levels of education, difficulty to access anti-hypertensive medication and therapeutic inertia. Training of health professionals and greater availability of anti-hypertensive medication in primary health care centers could improve blood pressure control.
PS-C33-3: THE EFFECT OF AGE AND HYPERTENSION ON PODOMETRICS IN DIFFERENT CORTICAL ZONES OF THE HUMAN KIDNEY
Authors: Haruhara Kotaro , Kanzaki Go , Sasaki Takaya , Hatanaka Saeko , Okabayashi Yusuke , Shimizu Akira , Tsuboi Nobuo , Yokoo Takashi
Published: January 2023

Objective:

Podocyte loss and resultant nephron loss are common processes in the progression of glomerulosclerosis and CKD. Aging and hypertension are the main causes of benign nephrosclerosis, which is histologically characterized by concomitant appearances of glomerular collapse and enlargement. Glomerular hypertrophy and glomerulosclerosis often preferentially occur in specific cortical zones of the kidney, possibly due to the difference in kidney artery perfusion. However, it is unknown if podometrics, such as podocyte number per glomerulus, podocyte density and podocyte volume, differ among different cortical zones in the human kidneys. The aim of the present study is to determine the effect of aging and hypertension on podometrics in different cortical zones of the human kidneys.

Design and method:

Autopsy kidneys from 50 Japanese adults without apparent glomerular disease were cross-sectionally analyzed. Podometrics in different cortical zones (superficial/middle/juxtamedullary) were estimated on a single section using a model-based stereology.

Results:

Median age was 68 years and median eGFR was 73.5 mL/min/1.73m2. Hypertension was identified in 21 (42%) subjects. While podocyte number per glomerulus was similar in the three zones, superficial glomeruli were the smallest and had the highest podocyte density and smallest podocytes. Increasing age and hypertension were associated with lower podocyte number, with age mostly affecting superficial glomeruli, and hypertension mostly affecting juxtamedullary glomeruli. There was no significant interaction between age and hypertension (Figure). Neither podocyte density, podocyte volume nor volume density of podocytes in glomeruli was associated with age or hypertension.

Conclusions:

Podometric changes, especially decreased podocyte number per glomerulus, may also contribute to the development and different distribution of glomerular morphological phenotypes in aging and hypertension-related benign nephrosclerosis.
PS-C33-6: ANALOGOUS ORGAN DAMAGE IN THE BRAIN, EYES, AND KIDNEYS IN MALIGNANT HYPERTENSION
Authors: Mishima Eikan , Abe Takaaki
Published: January 2023

Malignant hypertension, a form of hypertensive emergency, causes acute damage in vital organs such as the brain, eyes, and kidneys. We aimed to examine the concurrency of acute hypertensive damage across the target organs to elucidate the underlying analogous pathophysiology in malignant hypertension. This single-center retrospective study evaluated the characteristics of organ damage, short-term clinical course, and interorgan relationships in patients with malignant hypertension. Baseline characteristics of 20 patients who met our inclusion criteria were mean age 48 ± 13 years and blood pressure 222 ± 18/142 ± 16 mmHg; the median estimated glomerular filtration rate and urinary protein level were 49 mL/min/1.73m2 and 1.9 g/g creatinine, respectively. Posterior reversible encephalopathy syndrome (PRES) was found in 60% of patients with major involvement and a wide variety of distribution patterns in the brainstem. Serous retinal detachment was found in the fundus of 60% of patients. Patients with PRES and serous retinal detachment showed higher levels of urinary protein than those without the symptoms (P = 0.007 and 0.02, respectively), and proteinuria > 1 g/g creatinine highly complicated both PRES and serous retinal detachment (91%). Matrix analysis also showed that the three symptoms were highly associated with each other. These results demonstrate the close relationship and concurrency of hypertensive acute organ damage in the brain, eyes, and kidneys. A common analogous mechanism, such as hyperperfusion-induced capillary leakage in each organ, implies the underlying pathophysiology of PRES, serous retinal detachment, and proteinuria.
PS-C33-7: TRUE RESISTANT HYPERTENSION IN A TERTIARY HYPERTENSION CLINIC IN SAUDI ARABIA
Authors: Mahmud Azra , Alahaideb Ruba , Alhabdan Nawaf Abdul Aziz , Alkhdri Mohammad Hamad
Published: January 2023

Objective:

Resistant hypertension(RH), defined as office blood pressure (BP) above goal despite the use of more than three anti-hypertensives (one ideally being a diuretic) or BP that requires more than four agents to achieve control, has received more attention with increased efforts to improve BP control rates and the emergence of device-based therapies. Based on this definition of RH, the prevalence rates vary around 15–30% worldwide. However, there is paucity of data on RH, particularly true RH in the Middle-East.

The aim of this study was to explore the prevalence, clinical characteristics and choice of anti-hypertensives in a Saudi RH population.

Design & Methods:

We analysed retrospectively clinic and ambulatory BP monitory (ABPM) data in Saudi patients between January 2016 to June 2018. Office HTN was defined as greater than 140 systolic or greater than 90 diastolic, mm Hg. HTN was confirmed using one of the following ABPM cut-offs; 24-hr greater than 130/80 or daytime greater than 135/85, mm Hg. Results were analysed using JMP version 13, p less than 0.05 considered significant.

Results:

The mean age of the population(n = 540) was 54 ± 15 years, 40% female. The overall prevalence of RH was 47% in our cohort, of which 35% was true RH. The patients with RH were older; 62 ± 13 vs. 50.5 ± 14 years with no significant gender difference. RH was associated with diabetes (OR = 6.2, CI%, 3–12); CAD(OR = 3.3, CI%, 2–5); history of coronary revascularization(CABG/PCI) (OR = 3, CI%, 2–5); CKD(OR = 5.7, CI%, 3–12) and heart failure(OR = 1.9, CI%, 1–3). The average number of anti-hypertensives was 4.2 ± 1 in RH compared with 1.1 ± 1 in control group. Only a third of the patients were prescribed spironolactone in the RH group with some 10% on an alpha blocker.

Conclusions:

To the best of our knowledge, this is the first study in the Middle-East to establish the prevalence of true RH using ABPM. With a high prevalence rate, our cohort of RH is complex with high number of co-morbidities, sub optimal prescription rates of spironolactone or alpha-blockers, representing a therapeutic challenge.
PS-C34-13: LATE NIGHT EATING OR CIRCADIAN DISRUPTION COULD BE MORE DANGEROUS THAN OUR THINK FOR PATIENTS OF DIABETES WITH HYPERTENSION
Authors: Naz Qulsoom , Siddiqui Kauser Usman , Verma Narsingh , Mahdi Abbas Ali , Anjum Baby
Published: January 2023

Background:

Our bodies function optimally when we align our eating & sleeping patterns with our circadian rhythms, the innate 24-hour cycles that tell our bodies when to wake up, when to eat and when to fall asleep. Chronically disrupting this rhythm by eating late night meals & sleep could be a recipe for Hypertension, CVD, and metabolic trouble.

Aim & Objective:

The aim of this study is to investigate whether there was a relationship between morningness(MC) (110n) intermediate(IC) (100n) & eveningness chronotype(EC) (35n) in T2DM.

Methods:

A total of 245 subjects age 18 to 60 years were recruited in Clinical OPD of General Medicine, KGMU. We have tested FBG & PP level, lipid profile HbA1c, Insulin, Leptin and Cortisol level, 48 hours ABPM.

Result:

When we compared these 3 groups, Significant Different parameters found in FBG (P = 0.01) Postprandial (P = 0.03) HbA1c (P = 0.001) TG (P = 0.0001), Total Cholesterol (P = 0.01) & VLDL (P = 0.005). It also shows the complete inversion of the cortisol level (0.003). Insulin, IL-1 beta & IL-6 also show significant change in late night eating T2DM Patients. Systolic / Diastolic readings of ABPM shows significant change between MC and IC (0.005) but not b/w EC & IC (0.007). And for reliability of sleep by actigraphy shows MC (6:15 + 1:35) & EC (8:18 + 1:23) take complete sleep but IC total sleep hours (5:10 + 1:05) are very less. Disruption of Rev Erb & Ror alpha gene expression is also a risk factor for Cardio metabolic Diseases in T2DM Patients.

Conclusion:

Eveniningness & Intermediate Type Patients are more likely to have late night eaters & are associated with greater risk of Metabolic Disorders like Blood Pressure Variability, Dyslipidemia, T2DM & CVD.
PS-C35-3: EFFECT OF BMI REDUCTION ON BLOOD PRESSURE CHANGES IN OVERWEIGHT PATIENT: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Yang Shijie , Zhou Zhanyang , Miao Huanhuan , Zhang Yuqing
Published: January 2023

Objective:

To determine quantitative differences between weight loss and changes in clinic blood pressure (BP) in overweight patient, a systematic review and meta-analysis of randomised trials was performed.

Design and method:

A systematic literature search was conducted to identify relevant studies in the PubMed, Embase and Scopus databases up to April 2022. Only studies with English language were included. Studies were considered for inclusion if they met the following criteria: (1) included comparison clinical BP between weight loss; (2) the mean values and standard deviations (SD) of clinical BP and BMI were reported respectively; (3)all patients have a BMI ≧ 25 kg/m2. The certainty of evidence was used the GRADE approach. All statistical analyses were performed using Revman 5.

Results:

Twenty-four studies, for a total of 2614 patients were included in this meta-analysis. The clinic systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly reduced by 7.04 mmHg (95% CI, 5.04–9.03) and 4.40 mmHg (95% CI, 3.17–5.62) after a mean body mass index (BMI) reduction of 2.42 Kg/m2. The BP reductions were much larger in patients with a BMI decrease ≧ 3 kg/m2 than in patient with less BMI decrease, both for SBP [10.32 mmHg (95% CI, 6.15–14.49)] vs. [5.79 mmHg (95% CI, 3.19–8.39)] and DBP [7.48 mmHg (95% CI, 4.50–10.47)] vs [3.93 mmHg (95% CI, 2.15–5.70)]. The BP reductions were also much larger in patients with a baseline BMI ≧ 30 kg/m2 than in patients with a lower BMI, both for SBP [8.90 mmHg (95% CI, 5.97–11.83) vs. 5.25 mmHg (95% CI, 2.19–8.31)] and DBP [6.02 mmHg (95% CI, 3.89–8.14) vs. 3.82 mmHg (95% CI, 1.78–5.86)]. Furthermore, the SBP and DBP reductions in patients with medical interventions (ie drugs and surgeries) were 9.22 mmHg (95% CI, 6.36–12.08) and 6.11 mmHg (95% CI, 3.29–8.92) respectively, which were larger than patients with lifestyle interventions both for SBP [4.69 mmHg (95% CI, 2.81–6.57)] and DBP [3.82 mmHg (95% CI, 2.22–5.43)].

Conclusions:

The significant reduction of clinic BP followed the weight loss, and this phenomenon could be more notable after medical intervention and a larger weight loss.
PS-C35-7: THE TIME TREND OF INFORMATION SEEKING BEHAVIOR ABOUT SALT REDUCTION IN JAPAN
Authors: Suzuki Takahiro , Mizuno Atsushi
Published: January 2023

Objective:

When considering hypertension management, salt reduction is the most important lifestyle modification for cardiovascular prevention, especially in Japanese who still consume a significant amount of salt. For achieving a goal for salt reduction, the Japanese Society of Hypertension collaborated with stakeholders including business sectors and the government. However, the public awareness and interest about salt reduction has not been fully evaluated. In this study, by using Google trend, we retrospectively evaluated time trend of information seeking behavior about salt reduction in Japan.

Design and method:

We searched Google Trends for search terms relating to salt reduction. First, we searched “salt reduction” and filtered the top seven related searches to obtain relative search volumes (RSVs) for the period January 1, 2004, to December 31, 2021, in Japan. Correlation coefficient and regression coefficient were estimated to evaluate the time trend of seeking behavior about salt reduction. The contribution of related searches to the main search for “salt reduction” are also calculated in each month to evaluate the seasonal peak of the contribution to the “salt reduction”.

Results:

Both RSVs for salt reduction with ant without filtering top seven related searches significantly increased from 2004 to 2021 (13.8 ± 9.3 to 70.8 ± 10.9, r = 0.92, p-value < 0.001 and 8 ± 7.1 to 49.2 ± 3.5, r = 0.93, p-value < 0.01, respectively). Regression coefficients indicated that RSVs increased 0.0091 (95% CI, 0.0085–0.0097, p < 0.001) per year for salt reduction and 0.0065 (95% CI, 0.0061–0.0069, p < 0.001) per year for salt reduction filtered related searches (Figure A). Among related search results, search for “salt component”, “soy sauce” and “soy sauce” contributed to 9.9 ± 3.2%, 5.8 ± 2.0%, and 3.9 ± 5.5% of total RSVs for salt reduction. Of note, pickled plum explained all RSV for salt reduction in 18.0 ± 9.2% in June, which peaked in 41% in 2021 (Figure B).

Conclusion:

RSVs from Google trends apparently indicated increasing pattern of information seeking behaviors for salt reduction. Related searches might provide us insights when people search for salt reduction, which could be useful for future effective interventions for awareness of salt reduction.
PS-C36-3: ASSESS THE PHARMACOVIGILANCE REPORTING OF ANTIHYPERTENSIVE MEDICATIONS: NEED FOR OUR HEALTH CARE SOCIETY
Authors: Arain Mudassar Iqbal , Fricovsky Eduardo
Published: January 2023

The Current study was focused to identify the level of awareness regarding Pharmacovigilance and its reporting mechanism to the concerned authorities among Medical and Allied Graduates. In Pakistan, There is a gap between patients, Health care providers and Drug regulatory authorities for proper reporting that leads to unseen morbidities and mortalities. The thalidomide tragedy was the best example of Pharmacovigilance that leads to phocomelia. The cross-sectional, qualitative study was conducted for a period of 06 months from March to August 2017. The target population was pharmacy graduates who were working in marketing and medical graduates particularly house officers from district Hyderabad and Jamshoro. A total of 300 samples were recruited via purposive sampling technique and divide in two groups i.e. 150 each. A structured questionnaire was developed after validation that includes open and close ended questions. The finding of the this study revealed clear observation that the samples have little or no idea about how to report ADRs and where to report ADRs. Further both groups of samples have little or no awareness about the role of pharmaceutical companies for detection of adverse drug reactions. Moreover both groups of had denied any documentation/ form that was provided by any regulatory authority. Some Pharmaceutical companies have Pharmacovigilance system but both groups were unaware about the findings that also one of the barrier for proper ADRs reporting. So by this study, it was clear that the reforms will be taken by the government for proper reporting of adverse drug reactions.
PS-C36-4: ASSESSMENT OF AWARENESS TOWARDS PROPER MANAGEMENT FOR HYPERTENSIVE AND DIABETIC PATIENTS AT VARIOUS CLINICS OF HYDERABAD, SINDH, PAKISTAN
Authors: Arain Mudassar Iqbal , Shahnaz Saira
Published: January 2023

Objective:

Diabetes is a metabolic disorder characterized by a collection of other associated organ impairment i.e. Retinopathy, Cardiomyopathy and Nephropathy. While hypertension termed as silent killer. However, the cases of diabetes rise on daily basis throughout the world. Moreover, it is predicted that by year 2025, diabetes will prevail throughout the globe by 75–80% population if better steps would not be taken to curb it. Similarly as per USP, therapy based proper counseling is very important in management of Diabetes. At the other hand, Pakistan among those countries, which includes a huge number of diabetic and hypertensive patients and the figure, increases day by day.

Design and method:

For the purpose of study, 300 patients enrolled via random sampling technique from various clinical settings of Hyderabad a city of Sindh, Pakistan. Similarly, the samples were further classified into two groups, i.e. controlled group and test group respectively. However, 50% of total collected sample was placed in each group. Similarly, most of the patients with DM-2 were belonged to urban areas i.e. 68%. Subsequently 42% patients were among the age range 40 to 49 years. However, the malignant patients with certain cancer or tumors were not a part of this study.

Result and Conclusion:

Based on various collected data it was concluded that most of the patients were unaware about proper management of this fatal disorders. Therefore, it is the keen responsibility of the healthcare providers to properly educate the patient with such lethal disorder regarding the life style modification and medication therapy concomitantly in order to curtail disorder-induced mortality.
PS-C36-9: A REVIEW OF THE PHARMACOKINETIC PROFILES OF THE 40 MOST COMMONLY PRESCRIBED CARDIOMETABOLIC MEDICATIONS
Authors: Salim Farah , Osman Hanad , Alghamdi Randah , Lane Dan , Bernieh Dennis , Jones Donald , Gupta Pankaj
Published: January 2023

Objective:

To collate the pharmacokinetic (PK) parameters of the 40 most commonly prescribed cardiometabolic medications from published literature to provide a useful reference source for clinicians when interpreting results of chemical adherence testing.

Design and Methods:

Non-adherence to medication is a prime cause of treatment failure and costs the UK health system approximately £500 million annually. A recent meta-analysis on adherence to 7 cardiovascular drug classes revealed a non-adherence rate of 43%. Chemical adherence testing (CAT) by liquid chromatography tandem mass spectrometry (LC-MS/MS) is an objective method for testing patient adherence to medication and has been proven to be effective in managing disease progression. To improve result interpretation, factors including dose time, sample collection, and PK need to be better understood.

The list of the most commonly prescribed drugs was obtained using the NHS Prescription Cost Analysis 2020/2021. Data on the pharmacokinetic parameters was collected from original papers from the following sources:

Lexicomp: Medical Library

Goodmans & Gilmans: The pharmacological basis of therapeutics, 13th edition

Clarks analysis of drugs and poisons 4th edition

Martindale: The complete drug reference

All original manuscripts were reviewed, filtered and graded, following a robust criteria. The collected PK parameters focused on the bioavailability, volume of distribution, peak concentration, minimum plasma concentration, time to peak concentration, half-life, clearance and urine excretion.

Results:

A total of 3004 papers were initially screened for pharmacokinetic data, of which, 274 papers were relevant. These papers were further filtered, a total 84 papers adhered to the criteria for grading. Propranolol was one of the most prescribed cardiometabolic drugs with 6,124,180 prescriptions issued in the UK between 2020–2021. The half-life for Propranolol 80 mg (3.5 h), the peak time (1.5 h), the peak concentration (49 ± 8 ng/mL). Edoxaban was prescribed 1,584,638 times in the time period selected. Mean PK parameters for steady state levels of Edoxaban were: bioavailability (99.7%), urine excretion (44.7 ± 14.8%), clearance (535 ± 15.5 mL/min), volume of distribution (426 ± 30.7 L), half-life (9.2 ± 30.5 h), peak time (2 ± 1.03) and peak concentration (507 ± 17.3 ng/mL).

Conclusions:

This is one of the first studies to utilise a criteria for collecting and grading of PK parameters from published literature for common cardiometabolic medications. Medications have diverse pharmacokinetic profiles hence; systematic collection of these parameters will be a useful reference for clinicians when interpreting results of CAT for medication presence in patient samples.
PS-C36-12: PRESCRIPTION PATTERN OF ANTIHYPERTENSIVE MEDICATIONS, COMPLIANCE AND CONTROL OF BLOOD PRESSURE AMONG HYPERTENSIVE OUTPATIENTS AT TERTIARY CARDIAC HOSPITAL IN BANGLADESH
Authors: Ishraquzzaman Mir , Malik Fazila Tunnesa , Choudhury Sohel Reza , Mamun Abdullah al , Kalimuddin Md , Banik Dhiman , Ahmed Nazir , Badiuzzaman Mohammad , Dutta Ashok , Nesaruddin Mir , Haq Tawfiq Shahriar , Rahman Md Habibur
Published: January 2023

Objectives:

Blood pressure control in hypertensive patients depends not only on antihypertensive medications but drug compliance and lifestyle changes. The aim of the study is to look at the commonly used antihypertensive drugs and patients adherence to drug and lifestyle modification and their blood pressure control.

Method:

This is a cross sectional descriptive study among known hypertensive patients visited at hypertension clinic at National Heart Foundation Hospital and Research institute. Data was collected and entered according to structured questionnaire in software. Then data was analyzed using SPSS 20.

Result:

A total number of 920 patients were included in this study. Male and female were almost equal, 468 (50.9%) and 452 (49.1%) respectively. Mean age was 49.1 + 12.33 (min. 14 years and max. 90 years). Body mass index (BMI) is 26.57(+3.97) with 21% has obesity. 19% of patients were current smokers (male to female, 14.89% to 5.1%) and 8.1% are smokeless tobacco users. 14% of patient consume extra salt in main meal. Among other risk factors diabetes mellitus was 5.86% (54 patients), dyslipidemia was 2.3% (in 21 patients) and family history was positive in 78 patients (8.5%), chronic kidney disease was noted in < 1%. Mean duration of hypertension was 5.44 (+5.29) years. Single drug was prescribed in 246 (26.7%) patients where ARB prescribed in 119 (12.9%) patients followed by betablocker in 60 (6.5%) and CCB in 38 (4.1%) patients. ARB and CCB were used most (78 patients, 8.5%) as combination of dual drug (or single pill combination), followed by betablocker and CCB combination in 47 (5.1%) patients and ARB and betablocker in 38 (4.1%) patients. ARB, betablocker and CCB were used combinedly in 44 (4.8%) patients when three drugs were used. Overall, most commonly used antihypertensive drug was amlodipine in 188 (20.4%) patients followed by losartan potassium (15.2%), Olmesartan (13.3%) and Bisoprolol (10.9%). Out of 920 patients 171 (18.6%) were non-adherent to drug in whom control of blood pressure is poor (28.2% vs 7.3%, p. < 0.0001) and almost similar was seen in patients who were non-adherent to lifestyle changes (280 patients, 30.4%) (uncontrol vs control, 33.3% vs 27.1%, p < 0.04).

Conclusion:

Prescribing drugs is not enough to control hypertension. Drug compliance and adherence to lifestyle modification are important part of management plan that every physician should give emphasis to improve blood pressure control among hypertensive patients.
PS-C37-4: COMPARISON OF A SALT CHECK SHEET WITH ESTIMATED URINARY SALT EXCRETION MEASUREMENT IN HYPERTENSIVES OF AIZU REGION IN TOHOKU AREA
Authors: Inomata Rie , Hashimoto Shigeatsu
Published: January 2023

Objective:

We evaluated the salt check sheet developed by Tsuchihashi et al. for the patients with hypertension in Aizu region in Tohoku area of rural, high ageing population ratio and higher salt concentration within foods, because there have been very few such evaluation in this area.

Methods:

In outpatients with hypertension of our hospital of Aizu region, we analyzed the correlation between check-sheet scores and estimated 24-h urinary salt excretion levels to assess the appropriateness of the check sheet. We asked 150 patients to complete the salt check sheet and spot urine specimens; 24-h urinary salt excretion levels were estimated with the formula reported by Tanaka.

Result:

138 subjects completed the study (men/women: 89/49, mean ± s.d., age: 65.4 ± 12.3 years, blood pressure: 130.8 ± 13.9/75.4 ± 11.5 mm Hg), of whom all were treated antihypertensive drugs. Mean body mass index (BMI) was 25.5 ± 4.8 kg/m2, and 46.4% (64/138) of the subjects were obese (BMI> 25 kg/m2. The total salt check-sheet scores were distributed from 1 to 13 points (mean ± s.d.: 9.3 ± 2.88 points). The mean estimated 24-h urinary salt excretion level was 10.2 ± 3.1 g (3.6–19.6 g). The total salt check-sheet scores significantly correlated with the 24-h urinary salt excretion levels (r = 0.882; P < 0.01), also in both of 65 years old age or younger group (r = 0.848; P < 0.05; n = 63) and the > 65 years old age group (r = 0.924; P < 0.05; n = 75), both men (r = 0.869; P < 0.05, n = 89) and women (r = 0.924; P < 0.05, n = 48) and both in the obese group (r = 0.910; P < 0.05; n = 65), but not in the nonobese group (r = 0.851; P < 0.05; n = 73).

Conclusion:

The salt check sheet is applicable for the hypertensives of Aizu region of rural and high elderly population ratio.
PS-P11-4: ASSOCIATION OF HOME AND OFFICE SYSTOLIC AND DIASTOLIC HYPERTENSION WITH GLUCOSE METABOLISM IN A GENERAL POPULATION
Authors: Tatsumi Yukako , Satoh Michihiro , Asayama Kei , Murakami Takahisa , Hirose Takuo , Hara Azusa , Tsubota Megumi Utsugi , Inoue Ryusuke , Kikuya Masahiro , Nomura Kyoko , Metoki Hirohito , Hozawa Atsushi , Katagiri Hideki , Imai Yutaka , Ohkubo Takayoshi
Published: January 2023

Objective:

The aim of this study was to investigate the association of hypertension subtypes with glucose metabolism among the general population.

Methods:

The study involved 646 residents (mean age: 62.4 years) without treatment for hypertension or a history of diabetes from a rural community, who underwent an oral glucose tolerance test from 1997 to 2019. Hypertension subtypes [normotension (NT), isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic and diastolic hypertension (SDH)] were defined based on home and office systolic and diastolic blood pressure (HBP and OBP, respectively). The estimated means of blood glucose levels during OGTT, homeostasis model assessment (HOMA)-insulin resistance (IR), Matsuda-DeFronzo index, HOMA-beta and insulinogenic index among the groups were compared by analysis of covariance adjusted for possible confounding factors.

Results:

BG-related indices were not different among the morning HBP-defined hypertension subtypes. Participants with evening HBP-defined ISH had a significantly higher estimated mean BG at 120 min, higher homeostasis model assessment-insulin resistance (HOMA-IR), and lower Matsuda-DeFronzo index than participants with NT (the adjusted mean: 146 vs 127 mg/dl, 1.3 vs 1.0, and 6.6 vs 8.1, respectively) (all p < 0.021). Participants with OBP-defined SDH had a significantly higher estimated mean fasting BG; BG at 30, 60, and 120 min; and HOMA-IR and a lower Matsuda-DeFronzo index than participants with NT (the adjusted mean: 101 vs 94 mg/dl, 177 vs 158 mg/dl, 182 vs 157 mg/dl, 145 vs 125 mg/dl, 1.3 vs 1.0, and 6.3 vs 8.3, respectively) (all p < 0.0025).

Conclusion:

The BG-related indices were different among hypertension subtypes. Participants with evening HBP-defined ISH and OBP-defined SDH had higher BG levels and insulin resistance than participants with correspondingly defined NT, while those with morning HBP did not. These findings suggest the importance of measuring evening HBP and OBP for early detection of coexisting hypertension and diabetes.
PS-P11-6: ESTABLISHING A RELATINSHIP BETWEEN BMI AND HYPERTENSION IN UNIVERSITY STUDENTS
Authors: Deshmukh Akshada T , Patil Mansi , Patil Vishal
Published: January 2023

Introduction:

The Body Mass Index (BMI) has been identified as a key predictor of Blood Pressure (B.P).

Objective

The goal of the study is to discover the pattern of relationship between BMI and blood pressure in 1000 university students.

Materials and methods:

Blood pressure, weight, and height were all taken into account. The BMI was computed by dividing the weight in kilogrammes by the height in metres squared (kg/m).

Results:

Females were underweight in greater numbers than males (8.4% versus 4.7%). Males were more overweight than females (9% versus 5%). Males were more likely than females to be obese (7% versus 0.9%). Blood pressure parameters increased significantly with BMI (p0.0001), with higher values in males than females; (the mean systolic blood pressure 125.8 ± 8.3mmHg in males versus 117 ± 5.8mmhg in females and the mean diastolic blood pressure 94.6 ± 6.8mmhg in males versus 71 ± 7.7 in females) (p < 0.05).

Conclusion:

Among university students, a strong link between BMI and blood pressure was observed. Higher blood pressures were observed with higher BMI.
PS-P12-3: RELATIONSHIP BETWEEN SOCIOECONOMIC STATUS AND HEALTH LITERACY AMONG HEALTHY JAPANESE PEOPLE
Authors: Morimoto Akiko , Furuki Hideaki , Sonoda Nao
Published: January 2023

Objective:

In today's society, people are encouraged to take more active roles in their own health. For that purpose, a wide range of health information has become available to the public, and increased attention is being paid to health literacy worldwide. The World Health Organization defines health literacy as the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways which promote and maintain good health. On the other hand, low socioeconomic status is associated with higher blood pressure. Clarifying the relationship between socioeconomic status and health literacy could be useful to develop appropriate interventions to prevent hypertension in people with low socioeconomic status. This study clarified the relationship between socioeconomic status and health literacy among healthy Japanese people.

Design and Method:

This cross-sectional mail survey was conducted in 2020 that involved all community residents with municipal National Health Insurance aged 40–64 years in five cities in three areas of A Prefecture, Japan. This survey included 33,902 community residents, and 12,446 (36.7%) agreed to participate in the survey. After exclusion of those with regular visits to medical institutions (n = 8,174) and those with missing data (n = 690), the analysis included 3,582 participants. Socioeconomic status (education level, self-reported economic status, and occupation) and health literacy were obtained using the self-administered questionnaire. Health literacy was measured using the Communicative and Critical Health Literacy (CCHL) scale. Participants were classified into two groups, low and medium/high health literacy groups, by their CCHL scale scores. The study protocol was approved by the Institutional Review Boards.

Results:

In this study, 53.0% of those had < = 12 years of education, and 14.4% of those did not have an occupation. Regarding self-reported economic status, 18.3% were categorized as good, 22.3% as average, and 59.4% as poor. After adjusting for confounding factors, low education level [multivariable-adjusted odds ratio (OR) 1.61, 95% confidence interval (CI) 1.38–1.88, < = 12 years vs. > 12 years], poor economic status [multivariable-adjusted OR 1.75, 95% CI 1.39–2.19, poor vs. good], and no occupation [multivariable-adjusted OR 1.45, 95% CI 1.18–1.78, absence vs. presence] were positively associated with low health literacy.

Conclusions:

Low socioeconomic status was associated with low health literacy among healthy Japanese people. In order to prevent hypertension in people with low socioeconomic status, it may be useful to develop easy-to-understand materials.
PS-P12-4: AWARENESS OF HYPERTENSION AND DEMOGRAPHIC FACTORS INFLUENCING HYPERTENSION TREATMENT AMONG RURAL POPULATION OF KRISHNA DISTRICT IN SOUTH INDIA
Authors: Munganda Hariharan Ranga Satya , Ponnaganti Satyanarayana Chowdary , Shaikh Salma , Amle Dnyanesh
Published: January 2023

Introduction:

Being ascertained as single biggest risk factor for myocardial infarctions and stroke and cause of 10.8% of deaths in India, ICMR has already labelled HTN as silent killer. HTN is predicted to have higher prevalence than Diabetes mellitus and affect 1/3rd of our world population by year 2020. Prevalence of hypertension in India is predicted to be 200 million with only 40% being actually aware of the disease and only 20% of them being treated adequately. Thus, this study was aimed to assess awareness and demographic factors influencing treatment of HTN among rural population of Krishna district

Methods:

A cross sectional observational analytical study was carried out in out patient department setting of a tertiary level institute in Andhra Pradesh. Five hundred and eleven patients presenting with hypertension as per AHA guidelines were included in the study after informed written consent. Detailed clinical history was sought and thorough examination was performed. Treatment history was verified by reviewing prescriptions. Data regarding demographics, awareness of hypertension, awareness on hypertension therapy and compliance to therapy was collected using predesigned validated questionnaire. Data on compliance of treatment was also obtained.

Results:

Maximum subjects were noted to be in fifth and sixth decade of their age (60.4%). About a third of them were alcoholic while 3/4th were non vegetarian. Known hypertensive comprised 61.8% of these while 38.2% were diagnosed for first time. DM was observed as co-morbidity in 237 (46.4%) subjects and events of MI/CVA/CAD/AF was found in 33 (6.5%) subjects

Commonest factor in undiagnosed hypertension was not visiting the clinic followed by absence of health clinic in vicinity. Significantly higher frequency of incorrect drug combinations, incorrect dosage and poor adherence to drug therapy was noted in newly diagnosed hypertensive subjects.

Conclusion:

Undiagnosed hypertensive comprised of 38.2% of subjects visiting our health facility. Lack of assess and visit to clinic were the most common factors in undiagnosed cases. Significant inadequacy and non-compliance to treatment was also noted in newly diagnosed case.
PS-P12-7: IDENTIFYING THE EVIDENCE-POLICY GAP IN TASK-SHARING WITH COMMUNITY HEALTH WORKERS FOR MANAGEMENT OF HYPERTENSION: A MIXED-METHOD STUDY
Authors: Inagaki Yoko , Matsushita Kunihiro , Appel Lawrence John , Perry Henry B , Neupane Dinesh
Published: January 2023

Objective:

Few studies are addressing the evidence-policy gap in task-sharing with community health workers (CHWs) to manage hypertension. We aimed to identify the gap by 1) performing a scoping review of peer-reviewed journals and 2) conducting in-depth interviews with key informants who have been involved in national CHW programs.

Design and Methods:

We searched PubMed for studies published from 2010–2021 following the PRISMA extension for scooping review guideline. We included all type of studies on task-sharing with CHWs for hypertension management. We extracted data on types, places, and the frequency of CHWs’ activities and other relevant indicators. The primary outcomes were changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), BP control, and medication adherence. In the corresponding countries, key informants with policy and implementation experience in national CHW programs were identified and interviewed.

Result:

A single reviewer screened 2,316 records, of which 166 were assessed for eligibility, and 85 were included in the final review. There were 29 randomized controlled trials, 2 quasi-experimental trials, 11 pre-post studies, 2 prospective cohorts, 19 cross-sectional studies, and 22 qualitative studies. CHWs performed health education and BP measurement in 80% (60/75) and 63% (47/75) of studies, respectively. 89% (33/37) used digital BP device. Patients’ home (64%, 47/71) was used the most with a median of one visit per month, followed by public space (11%, 8/71) and home/clinic (6%, 4/71). One CHW was responsible for an average of 116 participant with the range from 3 to 612. Significant reduction in SBP was seen in 56% (9/16) of the included trials. Eight informants from six countries (Brazil, India, Iran, Liberia, Thailand, Zimbabwe) participated in in-depth interviews. Brazil, India, Iran, Thailand, and Zimbabwe involved CHWs in health education, whereas only Thailand and Iran involved in BP measurement and both use manual BP devices. In these five countries, one CHW was responsible for an average of 1,250 people with the range from 250 to 3,000 in a national program.

Conclusion:

Despite clinically relevant BP reduction in CHW programs, there was suboptimal translation of this evidence into policy. The size of the population served per CHW and the type of BP device differed between research studies and national programs. Global health partners (i.e. those who generate evidence) and local governments need to work together to bridge the gap between evidence and policy.

Figure 1: Forest plot of difference in systolic and diastolic blood pressure change in included studies.
PS-P13-6: DEFINING THE RELATIONSHIP BETWEEN IMMUNE TRAITS AND LIPIDS IN TWINSUK
Authors: Christofidou Paraskevi , Liechti Thomas , Menni Cristina , Spector Tim , Roederer Mario , Mangino Massimo
Published: January 2023

Objective:

The primary aim of this work was to evaluate associations of distinct immune cell subtypes and circulating lipids in a general population setting.

Methods:

The associations between 3,855 immune traits and lipids (HDL-C, LDL-C, TC, TG, non-HDL-C) were examined in 1,491 individuals from the TwinsUK cohort. Immune traits were defined by high-dimensional flow-cytometry which enabled in-depth assessment of all major lymphocyte and myeloid subsets in peripheral blood. Information on immune cell subset frequency (FREQ) and mean fluorescence intensity (MFI) was available. A linear mixed model regression analysis adjusted for family structure, gender, age, BMI and batch effect was used to examine the associations between immune traits and lipids. A sub-analysis in 441 individuals and 122 lipid metabolites quantified using nuclear magnetic resonance spectroscopy was undertaken to investigate the associations of 40 significant immune traits and lipoprotein particles. Secondary analyses explored the associations of lipids and immune traits with pulse wave velocity (PWV). A mediation model was constructed to test mediation effects of an immune marker on the total effect of lipids on PWV.

Results:

Significant associations were observed between 46 MFI and 6 FREQ immune traits and lipids (Bonferroni P < 2.45x10–5). These included associations between circulating lipids and different myeloid or lymphoid subsets including monocytes, NK cells and T cells. The top associations involved the expression of transmembrane activator and calcium modulator and cyclophilin ligand interactor (TACI) cytokine on classical (cM) and intermediate (iM) monocyte subsets. Decreased levels of non-HDL-C [cMP = 6.98x10–10, iMP = 3.72x10–7], LDL-C (cMP = 3.28x10–7, iMP = 1.75x10–5) and TG [cMP = 1.18x10–9, iMP = 2.97x10–6], and increased levels of HDL-C (cMP = 3.64x10–12, iMP = 1.44x10–10) were associated with higher TACI expression on both cM and iM subsets. Significant associations were identified between TACI expression and 13 lipid metabolites (Bonferroni P < 1.36x10–4). All linked metabolites referred to HDL related measures. Increased apolipoprotein A1 levels, total cholesterol in HDL and HDL2 and large and medium HDL related particles were associated with increased TACI expression on cM and iM subsets. The strongest association found between total cholesterol in HDL2-C and TACI expression levels on cM (P = 3.57x10–6). Mediation analysis showed that TACI expression on monocytes partially mediates the effect (∼10%) of TG on PWV.

Conclusions:

This study provides the first comprehensive picture of lipid-immune cell associations in the circulatory system. Interesting novel immune cell subset alterations and insights into the relationship between lipids, PWV and immunity have extended our knowledge. Further work is required to dissect the role of immune responses in cardiovascular disease.
PS-P13-7: O.N.E. (ONWARD NONCOMMUNICABLE DISEASE EDUCATION) CAVITE INITIATIVE: A COLLABORATIVE PROJECT TO IMPLEMENT PHILPEN AMONG PRIVATE PRACTITIONERS
Authors: Ona Deborah Ignacia David , Asis Leilanie Mercado , Bonzon Dolores D , Vilela Gilbert A , Diaz Alejandro F , Balmores Benjamin A , Garcia Rey an Nino L , Tejida Glenn M , Garcia Eileen Feliz Cortes , Tan Ardith Dominguez , Salvador David Raymond K , Mendoza Victor L , Dacayo Queenie G , Atilano Alberto A
Published: January 2023

Objective:

Cardiovascular diseases account for most noncommunicable disease (NCD) deaths about 17.9 million people annually. The Philippine Department of Health (DOH) began implementing the PhilPEN (Philippine Package of Essential Noncommunicable Disease interventions) nationwide in 2014. The protocol screens adult Filipinos seen in the public health facilities for major cardiovascular disease risk factors and includes interventions such as lifestyle advice and medications to achieve target goals. ONE Cavite Project is a collaboration between DOH, the Philippine Society of Hypertension (PSH), and private practitioners in Cavite- a densely populated semi-urbanized province in the Philippines. The primary objective of the One Cavite Project is to engage private medical practitioners in Cavite in screening, diagnosing, and managing adult patients (20 years old and above) for the following significant cardiovascular risk (CV) factors: hypertension, type 2 diabetes mellitus, dyslipidemia, smoking and to complement the PhilPEN implementation by the DOH in all its public health facilities in Cavite by private general physicians.

Design and Methods:

The first phase of the project is to organize a series of seminars to gather, enroll, and engage private doctors to ensure proper screening, monitoring, and follow up of patients with hypertension, diabetes, dyslipidemia, and other CV risk factors. The second phase is to enroll the patients of these private doctors, where patient data was collected, collated, and submitted to PSH for descriptive analysis by a third party.

Results:

A total of 680 doctors were engaged with a total of 41,477 patients screened. Preliminary data showed that out of the 41,477 patients, 61% have hypertension, 17% have diabetes, 22% have dyslipidemia, and 16% are smokers. Moreover, 21% have both hypertension and diabetes, 19% have hypertension and dyslipidemia, while 7% have hypertension, diabetes, and dyslipidemia. On follow-up after six months, out of 18,348 patients with hypertension, 88% of patients with hypertension had their blood pressure under control. For the 5,024 patients with diabetes, 15% had a fasting blood sugar < 110 mg/dL, and 32% had an HBA1c< 6.5 mg/dl. Out of 7,146 patients with dyslipidemia, 14% had an LDL < 130 mg/dl, while for the 3,510 smokers, 56% quit smoking on follow-up.

Conclusion:

The One Cavite Project has shown that engagement of private medical practitioners in screening, diagnosing, and managing adult patients for significant cardiovascular risk (CV) factors have complemented the implementation of PhilPEN by the DOH and this led to active prevention and control of these risk factors.
PS-P13-9: A MULTI-DISCIPLINARY LIPID ADVOCATE INTERVENTION ACHIEVES A SUSTAINED INCREASE IN LIPID AND HBA1C SCREENING WITHIN AN ACS POPULATION
Authors: Phillips Richard , Khan Ahsan , Belasco Marcus , Zathar Zafraan , Khan Aimen , Pressler Nikki , Sharma Vinoda
Published: January 2023

Objective:

Cholesterol is a key risk factor for atheroma and coronary heart disease. European Society of Cardiology (ESC) and National Institute for Clinical Excellence (NICE) guidelines both recommend that a full lipid profile is obtained for all patients presenting with an acute coronary syndrome (ACS) on admission. Here, we present an intervention study that aimed to improve lipid and HbA1c assessment in patients presenting with ACS at single UK NHS trust. The primary intervention included the creation of a multi-disciplinary lipid advocate team.

Design and method:

Data from 194 patients admitted with the diagnostic code acute coronary syndrome was collected over 4 discrete time intervals between August 2020 and January 2022 using electronic healthcare records. Data on whether total cholesterol, high-density lipoprotein (HDL), triglycerides and HbA1c tests were requested was collected as a baseline and after implementation of each quality improvement (QI) intervention. Interventions included establishing a lipid advocate team comprised of doctors and ward nursing colleagues to ensure that patients arriving on the ward with missing test results had further bloods sent. The final cohort of ACS patients was chosen 12 months after any QI intervention to assess sustainability of the interventions.

Results:

Analysis of the total cholesterol, HDL, triglycerides and HbA1c results across the 4 cohorts of patients presenting with ACS revealed a significant improvement in test compliance from the baseline cohort to the final cohort across all 4 parameters. After implementation of the lipid advocate team, compliance with test requesting rose significantly for total cholesterol (69.1% to 89.5%) and remained high after 12 months (94.3% compliance). Similar improvements were also shown with triglyceride, HDL and HbA1c measurements, with final compliance measurements at 92.4%, 79.2% and 90.6% respectively (compared to respective baselines of 65.4%, 60% and 67.3%).

Conclusion:

This longitudinal QI study of patients with ACS from a single cardiology centre demonstrated a significant and sustained improvement in compliance of lipid and HbA1c assessment. The implementation of a multi-disciplinary lipid advocate team led to significant improvements in compliance with lipid and HbA1c assessment. Utility of a combined nursing and medical-led service requires further exploration for in-hospital management of patients with ACS.