bluuebunny/crossref_metadata_2025 huggingface dataset:
PS-BPC09-1: SKELETAL MUSCLE MASS REDUCTION ASSOCIATED WITH INCREASED ARTERIAL VELOCITY PULSE INDEX AND TISSUE DAMAGE MARKER IN PATIENTS WITH CARDIOVASCULAR DISEASE
Authors: Harada Haruhito , Nishiyama Yasuhiro , Niiyama Hiroshi , Katoh Atsushi , Kai Hisashi
Published: January 2023

Objectives:

Reduction of skeletal muscle mass is the most important component of sarcopenia. Aging and chronic diseases, including chronic heart failure, are the causes of reduced skeletal muscle mass. However, little is known about the mechanism of skeletal muscle mass reduction in patients with cardiovascular disease (CVD). The purpose of this study was to assess the association between skeletal muscle mass reduction and the indicators of early and advanced arterial damages in CVD patients.

Design and Methods:

This was a single-center, retrospective cross-sectional analysis including 310 inpatients with CVD. Bioelectrical impedance assay was used to measure skeletal muscle index (SMI) as well as bioelectrical phase angle (PA), a marker of tissue damage. Arterial velocity pulse index (AVI) was assessed for advanced vascular damages, such as arterial stiffening and increased peripheral resistance, using a commercially available instrument. Flow-mediated vasodilation (FMD) was performed to assess early vascular damages, i.e. endothelial dysfunction, using a commercially available, high-resolution, ultrasound device.

Results:

The mean age was 72 years (male, 57.7%). Symptomatic heart failure (AHA/ACC stage C and D) was observed in 19.4%. Sarcopenia was diagnosed in 25.5% of the whole group, according to the Asian Working Group for Sarcopenia criteria. Sarcopenic patients showed higher AVI and narrower PA than non-sarcopenic patients, suggesting as having severer arterial stiffness and tissue damage. Single regression analysis showed that SMI associated with AVI, FMD, PA, age, male sex, hypertension, diabetes mellitus, and dyslipidemia, but not with CKD and heart failure. Stepwise multivariate regression analysis revealed that age, male sex, AVI, PA, and hypertension were independent factors for SMI in CVD patients, whereas FMD, diabetes mellitus, and dyslipidemia were not.

Conclusion:

AVI was a significant marker for detecting sarcopenia in CVD patients independently of age and male sex. In addition, skeletal muscle mass reduction was correlated with a tissue damage marker, PA. Therefore, it is suggested that advanced vascular damages resulting arterio-/arteriolo-sclerosis, rather than early endothelial dysfunction, might be attributed to the reduction of skeletal muscle mass, possibly through damages of skeletal muscle tissue in CVD patients.
PS-BPC09-5: THE RELATIONSHIP BETWEEN CHANGES IN EXERCISE HABITS, PHYSICAL FUNCTION, AND PSYCHOLOGICAL STATUS IN OLDER PATIENTS WITH HYPERTENSION
Authors: Yasunobe Yukiko , Akasaka Hiroshi , Yamamoto Kouichi , Onishi Yuri , Minami Tomohiro , Yoshida Shino , Rakugi Hiromi
Published: January 2023

Objective:

Self-restraint from activities due to the COVID-19 pandemic has limited the range of activities and interpersonal relationships for older persons. Moreover, prolonged restraint has been reported to increase the risk of frailty and sarcopenia. Therefore, we examined the effects of changes in exercise habits on physical function and psychological status of older patients with hypertension throughout their self-restraint lifestyle from 2020 to 2022 in the 1-year follow-up study.

Design and Methods:

Participants were patients with hypertension aged 65 years or older attending outpatient clinics at our institution who could obtain information on exercise habits, history of falls, comprehensive geriatric assessment, and muscle strength. We conducted the same survey in the first year and one year later. The subjects were classified into four groups by combining their exercise habits in the first year with or without one year later. That is Group A: with exercise habits at both times of the survey; Group B: with exercise habits in the first year and without exercise habits one year later; Group C: without exercise habits in the first year and with exercise habits one year later; and Group D: without exercise habits at both times of the survey. Written consent forms were obtained from all participants. Our institutional review board approved the study protocol.

Results:

The study participants were 183 patients (Group A: 119, Group B: 26, Group C: 17, Group D: 21). The age of the participants was 76.1 ± 5.5 years, 82 (44.8%) were male, and the duration of hypertension was 18.4 ± 11.5 years. Changes in exercise habits were not associated with physical function, history of falls, and comprehensive geriatric assessment at one year. However, when the results were examined separately for men and women, the geriatric depression scale was significantly higher in women in Group B (Dunnett test, p = 0.0094) than in Group A, suggesting that the tendency toward depression had progressed. Group B women also had more falls one year later (chi-square 12.04, p = 0.0072).

Conclusions:

In a 1-year follow-up study during the COVID-19 pandemic, a relatively high proportion of older patients with hypertension attending our hospital maintained their exercise habits, but 14% of cases lost their exercise habits. Only women showed the development of depression and increased risk of falls when exercise habits were lost. Women were more susceptible to the effects of environmental changes than men in older patients with hypertension.
PS-BPC10-6: RELATIONSHIP BETWEEN CIRCULATING ANGIOPOIETIN-LIKE PROTEIN 2 LEVELS AND ARTERIAL STIFFNESS IN PATIENTS RECEIVING MAINTENANCE HEMODIALYSIS
Authors: Morinaga Jun , Fukami Hirotaka , Okadome Yusuke , Matsunaga Eiji , Kuwabara Takashige , Oike Yuichi , Mukoyama Masashi
Published: January 2023

Background and aims:

Chronic inflammation is receiving much attention as a critical pathology that induces various aging phenotypes, a concept known as “inflammaging’’. Uremic patients receiving hemodialysis show vascular aging phenotypes characterized by greater arterial stiffness and calcification compared to healthy controls. In this study, we investigated whether levels of inflammaging markers in the circulation were associated with vascular aging phenotypes in uremic patients, as estimated by the cardio-ankle vascular index (CAVI).

Methods:

We conducted a multicenter cross-sectional study of patients undergoing hemodialysis and evaluated the relationship between circulating high-sensitivity C-reactive protein (hs-CRP) or angiopoietin-like protein (ANGPTL) 2 levels, as markers of inflammaging, and CAVI.

Results:

Of 412 patients, 376 were statistically analyzed. While circulating hs-CRP levels had no significant association with CAVI, linear regression models revealed that high ANGPTL2 levels in circulation were significantly associated with increasing CAVI after adjustment for classical metabolic factors and hemodialysis-related parameters. Exploratory analysis revealed that high circulating ANGPTL2 levels were also strongly associated with increased CAVI, particularly in patients with elevated blood pressure, elevated pulse pressure, or excess body fluid.

Conclusions:

We conclude that circulating levels of ANGPTL2 rather than hs-CRP are positively associated with CAVI in the uremic patients and that ANGPTL2 could be a unique biomarker of progression of vascular aging in patients receiving hemodialysis.
PS-BPC11-9: ADMA/SDMA RATIO AND ITS RELATIONS TO URIC ACID AND ALBUMIN IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS PATIENTS IN INDONESIA
Authors: Praptini Mirna Nurasri , Hustrini Ni Made , Marbun Maruhum Bonar , Yaruntradhani Rizki
Published: January 2023

Background and Aims:

Asymmetric Dimethylarginine (ADMA) and Symmetric Dimethylarginine (SDMA), rarely reported together, are markers of endothel dysfunction and kidney function. ADMA was inversely related to albumin, while SDMA was positively correlated to albumin. Meanwhile, uric acid was positively correlated to both SDMA and ADMA. By using ADMA and SDMA as ratio, we postulated that their ratio can more precisely predict activity dimethylarginine dimethylaminohydrolase (DDAH), a key enzyme that metabolized ADMA, and not SDMA, and can be used as marker of NO activity. Low NO activity is related to high vascular tonus and peripheral resistance, hypertension and low Sodium excretion and cardiac output.

Method:

This was a cross-sectional study conducted in adults underwent chronic Continuous Ambulatory Peritoneal Dialysis (CAPD) in tertiary hospital in Jakarta, Indonesia. Uric acid, albumin, ADMA and SDMA levels were measured at the same time patients controlled to outpatient clinic after washout from hyperuricemia drug for 2 to 4 weeks. Analysis performed using Pearson for normal distribution data, Spearman for nonparametric analysis and linier regression test and ROC curve with SPSS v20.

Results and Discussion:

Total of 55 subjects (83%) were included, male 63.6%, mean age of 40.71 ± 14,4 year old. Median of CAPD use was 27 months. Causes of CKD were glomerulonephritis (47.3%), diabetes mellitus (25.5%), hypertension (25.5%) and polycystic kidney disease (1.8%). At the time of research, 90.9%, were uncontrolled hypertension patients. Median level of UA was 7.30 ± 1.59 mg/dl and 60% had UA levels of 7 mg/dl or higher. Albumin level lower than 3.5 g/dl (mean 3.55 ± 0.49 g/dl) were 24 patients (43.6%). Median ADMA level was 87.5 ± 16.64 ng/ml and SDMA level was 633.73 ± 231.54 ng/mL. Median ADMA/SDMA ratio was 0.13 + 0,08 ng/ml. ADMA, SDMA, ADMA/SDMA ratio were correlated with uric acid with p = 0.027 (95%CI 0.175–0.471), p < 0.001 (95%CI 0.688–0.928) and p < 0.001 (95%CI -14,96 to -5,03) with sensitivity and specificity 91% and 95%, 97% and 68% and 79% and 96%, respectively. ADMA, SDMA, ADMA/SDMA ratio were not statistically significantly correlated with albumin with p = 0.26, p = 0.14 and p = 0.23, respectively. Albumin level was caused by many factors that are not in the scope of this research, this might explain this result.

Conclusion:

ADMA/SDMA ratio had comparable sensitivity and specificity to ADMA or SDMA alone when correlated with uric acid in CAPD patients. Albumin might not correlated with ADMA, SDMA, or ADMA/SDMA ratio in CAPD patients.
PS-BPC12-1: AGE-RELATED DIFFERENCES IN LONGITUDINAL ASSOCIATIONS BETWEEN ALCOHOL INTAKE AND ARTERIAL STIFFNESS, PRESSURE WAVE REFLECTION, AND INFLAMMATION IN MALE EMPLOYEES
Authors: Takahashi Takamichi , Shiina Kazuki , Nakano Hiroki , Fujii Masatune , Iwasaki Yoichi , Matumoto Chisa , Yamashina Akira , Chikamori Taishiro , Tomiyama Hirofumi
Published: January 2023

Backgrounds:

The effect of alcohol intake on arterial stiffness related to macro-vascular damage, pressure wave reflection related to both macro- and micro- vascular damages and inflammation have not been fully concluded.

Aims:

In the present longitudinal observational study, which conducted in annually repeated measurements data, mixed model analyses were applied to examine the difference of longitudinal associations of amount of alcohol intake (i.e., non, mild, moderate and heavy) with arterial stiffness, pressure wave reflection and inflammation.

Methods:

In 4016 middle-aged (43 ± 9 years) healthy Japanese men without cardiovascular disease (CVD) at the study baseline, alcohol intake, which obtained by questionnaire, risk factors for CVD, brachial-ankle pulse wave velocity (brachial-ankle PWV), radial augmentation index (rAI), and serum C-reactive protein levels (CRP) were measured annually during a 9-year study period.

Results:

In this repeated measurements data, mix model linear regression analyses demonstrated that alcohol intake had a significant longitudinal association with brachial-ankle PWV and rAI in dose-dependent manner {i.e., non, Mild (1–10 g/day), Moderate (10–30 g/day) and heavy (Over 30 g/day) ethanol intake} (Figure). When baPWV was included as a covariate, the association of alcohol intake with rAI was significant. On the other hand, the serum CRP levels were significantly lower in mild to moderate alcohol intake groups as compared to other groups (i.e., U-shaped) (Figure).

Conclusion:

The amount of alcohol intake may have longitudinal linear association with increased arterial stiffness and abnormal pressure wave reflection, but it may have a U-shaped relationship with inflammation reflected by serum CRP levels. Thus, the alcohol intake may longitudinally affect both macro- and micro- vascular damages in a linear dose-dependent manner without mediating inflammation.
PS-BPC12-2: EFFICACY AND SAFETY OF SINGLE-PILL COMBINATION OF OLOMAX&ACIRC; (OLMESARTAN, AMLODIPINE, AND ROSUVASTATIN) IN HYPERTENSIVE PATIENTS WITH LOW-TO-MODERATE CARDIOVASCULAR RISK
Authors: Kim Byung Jin , Cha Kwang Soo , Cho Wook Hyun , Kim Eung Ju , Chae In Ho , Choi Seung Hyuk , Kim Moo Hyun , Kim Sang Hyun , Park Jun Bean , Park Seong Mi
Published: January 2023

Objective:

Of the ten hypertensive patients who have to take statins in Korea, about two are not actually prescribed. The use of polypills including lipid-lowering and blood pressure (BP)-lowering drug improves medication adherence, and consequently ameliorates in cardiovascular risk levels. This study was to evaluate the efficacy and safety of single-pill triple-combination of olmesartan/amlodipine/rosuvastatin (OLOMAX®) in comparison to single-pill dual-combination of olmesartan/amlodipine (SEVIKAR®) in hypertensive patients with low-to-moderate cardiovascular risk.

Design and method:

This multicenter, active-control, randomized study included 106 hypertensive patients with low-to-intermediate cardiovascular risk, who were randomly assigned to receive either OLOMAX®(20/5/5 mg, treatment 1), OLOMAX®(20/5/10 mg, treatment 2), or SEVIKAR®(20/5 mg, control) once daily for 8 weeks. The low and moderate cardiovascular risk groups were defined according to the definition of the 4th Korean dyslipidemia treatment guidelines. Primary endpoint was assessed as the difference of the percent change of LDL-C(low-density lipoprotein-cholesterol) level at 8 weeks from baseline among the three groups.

Results:

The difference in the least square mean % change of LDL-C in the treatment 1 and 2 groups compared to the control group at 8 weeks was -32.6 ± 3.7% and -45.9 ± 3.3%, respectively (all p < 0.001). There was significant difference in the achievement rate of LDL-C levels < 100 mg/dL at 8 weeks between the three groups (65.8% for the treatment 1 group, 86.7% for the treatment 2 group, and 6.25% for the control group, p < 0.001). The results of total cholesterol, triglycerides, high-density lipoprotein-cholesterol, apolipoprotein B, and apolipoprotein B/apolipoprotein A1 showed the superiority in the treatment 1 and 2 groups compared to the control group. Meanwhile, there was no significant difference in systolic and diastolic BPs and diabetes-related variables including fasting glucose, fructosamine, and hemoglobinA1c at 8 weeks between the three groups. Adverse drug reaction (ADR) developed only 1 case (constipation) in the treatment 1 group and serious ADR did not occur in the three groups. Medication adherence rates were highly excellent in the three groups (98.0% for the treatment 1 group, 99.7% for the treatment 2 group, and 96.3% for the control group, p > 0.05).

Conclusions:

Single-pill triple-combination of olmesartan/amlodipine/rosuvastatin were superior to single-pill dual-combination of olmesartan/amlodipine in LDL-C lowering effect, with similar BP reduction effects and excellent safety profiles in hypertensive patients with low to moderate cardiovascular risk.
PS-BPP01-2: ASSOCIATIONS OF ARTERIAL STIFFNESS AND ATHEROSCLEROTIC BURDEN WITH BRAIN STRUCTURAL CHANGES AMONG JAPANESE MEN
Authors: Azahar Nazar Mohd , Yano Yuichiro , Kadota Aya , Shiino Akihiko , Miyagawa Naoko , Kondo Keiko , Moniruzzaman Mohammad , Torii Sayuki , Segawa Hiroyoshi , Hisamatsu Takashi , Fujiyoshi Akira , Nozaki Kazuhiko , Tooyama Ikuo , Ueshima Hirotsugu , Miura Katsuyuki
Published: January 2023

Objective:

To assess whether arterial stiffness and atherosclerotic burden are each independently associated with brain structural changes (i.e., volume and vascular damage) among healthy Japanese men.

Design and method:

Healthy Japanese men (n = 853) aged 46–83 years participated in the examination of the Shiga Epidemiological Study of Subclinical Atherosclerosis II (SESSA II), and underwent assessments of arterial stiffness using brachial-ankle pulse wave velocity (baPWV) and of atherosclerotic burden using coronary artery calcification (CAC) between 2010–2014. Of 853 men, 740 underwent brain magnetic resonance imaging (MRI) between 2012 and 2015, and brain volumes (i.e., total brain volume, gray matter, Alzheimer disease [AD] signature and prefrontal) and white matter lesion volume (WMLV, reflecting cerebral small vessel disease) were assessed.

Results:

We excluded 54 participants with history of stroke and myocardial infarction at SESSA II, leaving a final sample size of 686 for analyses. After multivariable adjustment including age and blood pressure (see footnote in Table), higher baPWV was associated with lower volumes of AD signature and of hippocampus volume (see Table). Higher CAC score was associated with greater WMLV (ml). Both baPWV and CAC were entered into a same model, higher baPWV was associated with lower volumes of AD signature, and higher CAC score was associated with greater WMLV.

Conclusions:

Among general Japanese men, higher arterial stiffness was associated with lower brain volumes related to cognition. Higher CAC score was associated with greater vascular damage. Arterial stiffness and atherosclerotic burden may each independently link to brain structural changes among healthy Japanese men.

Keywords:

Arterial stiffness; coronary artery calcification; brain volume; Alzheimer disease; atherosclerosis
PS-BPP02-5: COMPARISON OF OPPORTUNISTIC VS SURVEY-BASED POPULATION ASSESSMENT OF HYPERTENSION IN 14 COUNTRIES
Authors: Razo Christian , Beaney Thomas , Poulter Neil R , Prabhakaran Dorairaj , Schutte Aletta E , Legrand Kate E , Johnson Catherine O , Roth Gregory A
Published: January 2023

Objective:

We sought to compare the proportion of individuals with hypertension obtained from the large-scale May Measurement Month (MMM) opportunistic screening program with those from the population-based household STEPwise Approach to Non-communicable Risk Factor Surveillance (STEPS) surveys in 14 countries.

Design:

The MMM program was first implemented in 20117 by the International Society of Hypertension in 92 countries to improve detection and awareness of elevated blood pressure (BP). The STEPS surveys are cross-sectional household surveys developed by the World Health Organization to track non-communicable risk factors in more than 115 countries.

Methods:

Up to three BP readings were obtained by MMM and STEPS. The average of the second and third BP readings was used to compare the proportion of individuals with hypertension (systolic BP > = 140 mmHg and/or diastolic BP > = 90 or on drug treatment for raised BP) from the MMM 2017–2019 with the prevalence estimates of hypertension from STEPS 2013–2019 by sex and age among adults (> 18 years) across 14 countries (Figure). Countries were selected if data with a maximum 5-year overlap among sources was available and if MMM sample size was > 10,000 observations. Prevalence estimates were paired based on age, sex, and year. Chi-squared tests with alpha of 0.05 were used to test comparisons.

Results:

In total, 211,852 individuals aged at least 30 years across 14 countries over 3 years (2017–2019) were screened by the MMM program. STEPS surveyed 48,300 adults in 14 countries over 7 years, representing 252,095,678 individuals.

Based on MMM, the proportion of females with hypertension across countries (all ages) ranged from 13.2% in United Arab Emirates to 34.9% in Algeria while in males ranged from 45% in Armenia to 22.8% in Ecuador. STEPS hypertension prevalence in females and males, ranged from 41.2% and 42.1%, in Kyrgyzstan to 10.5% and 17.1% in Ecuador, respectively. Countries where prevalence was most similar were Botswana and Kenya. Countries where MMM estimates were higher than STEPS were Mongolia and Malawi. STEPS reported higher estimates than MMM in Kyrgyzstan. Differences on the prevalence of hypertension across surveys showed heterogeneous variation by age, sex, and country (Figure).

Conclusion:

Hypertension prevalence varies between opportunistically screened MMM and systematically sampled STEPS populations. However, given the high prevalence of hypertension worldwide and the lack of routine health examination surveys in most countries, screening efforts, such as MMM, could be helpful in approximating the population prevalence of hypertension in specific subgroups and to raise hypertension awareness, treatment, and control.
PS-BPP03-6: HIGHER ARTERIAL STIFFNESS IS ASSOCIATED WITH SILENT CEREBRAL SMALL VESSEL DISEASE IRRESPECTIVE OF BLOOD PRESSURE
Authors: Miyagi Tomo , Ishida Akio , Ohya Yusuke
Published: January 2023

Objectives:

Arterial stiffness and hypertension are important risk factors for cerebral small vessel diseases (CSVD). Arterial stiffness assessed by pulse wave velocity (PWV) is closely related with hypertension. Higher PWV represents an organ damage from hypertension. However, there are hypertensive patients with lower PWV and non-hypertensive subjects with higher PWV in clinical practice. The aim of the study is to determine the impact of PWV on CSVD in non-hypertensive and hypertensive individuals.

Design and method:

An observational cross-sectional study was conducted in 1894 stroke-free participants who underwent a brain magnetic resonance imaging and brachial-ankle PWV (baPWV) at a health checkup between 2013 and 2020. baPWV were measured using an automatic oscillometric device. The presence of CSVD, including white matter hyperintensities, cerebral microbleeds, silent lacunar infarcts, and dilated periventricular spaces, were determined by brain magnetic resonance imaging. Participants were divided into 4 groups according to blood pressure (BP, 120/80 mmHg) and baPWV (14.63 m/s, a cutoff value that predicted the presence of CSVD).

Results:

The mean age was 57 years (41% women). The prevalence of CSVD was 718 (38%), and it was higher in low BP with high baPWV group (56%) and high BP with high baPWV group (55%) compared to high BP with low baPWV group (24%) and low BP with low baPWV group (22%). Both low BP with high baPWV group (odds ratio 1.89; 95% CI, 1.00–3.56) and high BP with high baPWV group (odds ratio 2.12; 95% CI, 1.41–3.21), but not high BP with low baPWV group (odds ratio 1.19, 95% CI 0.76–1.86), had significantly higher odds ratio for the presence of CSVD compared with low BP with low baPWV group, after adjustment for age, sex, and other conventional risk factors, and use of any agents for hypertension, dyslipidemia, and diabetes.

Conclusions:

Individuals with high baPWV had higher prevalence of CSVD, irrespective of BP status. It is likely that higher arterial stiffness is an important risk for CSVD in stroke-free healthy populations.
PS-BPP04-2: GEOSTATISTICAL ANALYSIS OF HYPERTENSION IN CANADIAN POPULATION
Authors: Leroux Denis , Cloutier Lyne
Published: January 2023

Objective:

A quarter of the population is affected by hypertension in Canada and, around the world, it is the second most common conditions for consultation in primary care. Substantial improvement has been achieved in HTN control in Canada over the past twenty-five years. However, as noted in many studies, disparities associated with factors like sex, ethnicity, home location and health care access remain. Reliable information about trends in hypertension is needed at national and regional scale for the development of health policies and programs. Health geography and geographic information systems can provide a better understanding of the distribution HTN and its risk factors by detecting clusters using spatial analysis and mapping rates of HTN. The objectives of the study were to identify health regions with significantly high or low HTN rate using geostatistics and compare evolution from 2005 to 2015 and 2015 to 2019. It also seeks out to identify their populations characteristics using conventional statistical analysis. Canadian Community Health Survey (2005, 2015 & 2019) data were used for the analysis.

Design and Method:

Canadian Community Health Survey CCHS (2005, 2015, 2019) data were used for the analysis. The 130,000 respondents representing the whole population are located according to health regions and data can be analyzed using a geographic information system. Using age and gender as subdividing criteria for subgroups creation, we applied Moran I spatial autocorrelation analysis and Getis-Ord hot spot/cold analysis to identify geographically contiguous health regions with high or low HBP rates. We then extracted the records in CCHS database for all respondents living in these regions for further statistical analysis.

Results and Conclusion:

HTN is still a major problem in Canadian population, especially for people aged 65 years and older although 72.9% considered themselves in good, very good or excellent health in 2015. Increase in HTN rate in health regions is spread all over Canada, although some regions showed a decrease in HTN rate. Getis-ord analysis located a cold spot region in western Canada while a hot spot was located in Ontario, central Canada. Cluster of health regions with high HTN rates shows more diabetes and more obese people even though 38.4% declared being in good, very good or excellent health. In final conclusion, this approach could also be used in other countries seeking a better understanding of socio-demographic and geographic factors affecting hypertension rate in the country.
PS-BPP04-3: ASSOCIATION BETWEEN URINARY NA/K RATIO AND CHANGES IN COGNITIVE FUNCTION AND ALBUMINURIA OVER 10 YEARS IN A GENERAL POPULATION
Authors: Fukami Ako , Adachi Hisashi , Enomoto Mika , Nohara Yume , Morikawa Nagisa , Sakaue Akiko , Yamamoto Maki , Sato Hiromi , Fukumoto Yoshihiro
Published: January 2023

Objective:

Preservation of cognitive function is an important issue in extending healthy life expectancy in an aging society. To elucidate factors associated with changes in cognitive function over a 10-year period in a general population.

Design and method:

A total of 984 subjects (381 males, 603 females, mean age 62.4 years) underwent a physical examination, blood test, urinalysis and the mini-mental state examination as an evaluation of cognitive function in 2009 and 2018. After excluding subjects with diabetes at baseline, the remaining subjects were followed-up 10 years later. Complete data sets were available from 890 subjects (330 males, 560 females, mean age 62.4 years) for prospective analysis. Logistic regression was performed to determine factors associated with changes in cognitive function and albuminuria after 10 years.

Results:

The logistic regression analysis revealed that the age (OR 1.11; 95%C.I: 1.08–1.14, p < 0.0001), sex (male, OR 0.59; 95%C.I: 0.38–0.91,P < 0.05), HbA1c (OR 2.18; 95%C.I: 1.13–4.23, P < 0.05), hs-CRP (OR 1.22; 95%C.I: 1.03–1.46, P < 0.05), and albuminuria(OR 1.48; 95%C.I: 1.19–1.83, p < 0.001) were associated with cognitive decline over 10 years. The age (OR 1.11; 95% C.I: 1.08–1.14, p < 0.0001) and albuminuria (OR 1.26; 95%C.I: 1.01–1.59, p < 0.05) were independently correlated to cognitive decline in stepwise logistic regression analysis. Furthermore, the age (OR 1.01; 95%C.I: 1.05–1.12, p < 0.0001), uric acid (OR 1.36; 95%C.I: 1.15–1.62, p < 0.001), insulin (OR 1.48; 95%C.I: 1.01–2.04, p < 0.05) and urinary Na/K ratio (OR 1.14; 95%C.I: 1.05–1.25, p < 0.01) were independently related to the progression of albuminuria over 10 years in stepwise logistic regression analysis.

Conclusions:

Urinary albuminuria and age were independently associated with 10-year cognitive decline, and urinary Na/K ratio was independently associated with progression of urinary albuminuria. The urinary Na/K ratio may have important significance in cognitive decline.
PS-BPP04-4: NOVEL ANTHROPOMETRIC MEASURES FOR SCREENING OF HYPERTENSION IN COMMUNITY
Authors: Patil Vishal , Patil Mansi
Published: January 2023

Aim:

To investigate the relationship between height, waist, hip, thigh, arm, and wrist circumference (cm) and hypertension, and to predict them as markers of hypertension development.

Materials and Methods:

In the present cross-sectional study, a total of 635 subjects were involved in the study. Study was conducted from June 2019 to July 2020. Height to Waist Ratio (HtWR), Arav Body Index (ABI), Waist to Thigh Ratio (WTR) and Wrist to Arm Ratio (WAR) was compared to common existing markers such as Waist to Height Ratio (WHtR), Waist to Hip Ratio (WHR) and Body Mass Index (BMI).

Results:

There were 750 people in all, with 38 percent (n = 285) males and 62 percent (n = 465) females. In this study, 44 percent (n = 330) of the participants were not hypertensive, but 52.1 percent (n = 420) were. In males, the Area Under Receiver Operating Curve (AUROC) of HtWR (0.677) and Inverse ABI (0.611) were superior to other anthropometric markers for predicting the development of hypertension, while in females, the Waist to Thigh Ratio (0.669) was superior. WTR cut-off values for females are 1.55, while HtWR and Inverse ABI cut-off values for males are 2.3 and 2.84, respectively.

Conclusion:

In males, the height to waist ratio and inverse ABI were more reliable markers for predicting the development of hypertension, but in females, the WTR was more trustworthy.
PS-BPP04-5: BURDEN AND TRENDS OF HYPERTENSIVE HEART DISEASES IN SOUTH ASIA, 1990 TO 2019: ANALYSIS FROM THE GLOBAL BURDEN OF DISEASES
Authors: Islam Sheikh Mohammed Shariful , Moreno Sebastian Vicente , Huxly Racheal , Maddison Ralph
Published: January 2023

Background:

There is lack of comprehensive population based studies on the burden of hypertensive heart diseases (HHD) in South Asia and its trends over time. We aimed to explore the burden of HHD, and how it changed over time from 1990 to 2019 in South Asia.

Methods:

We performed a systematic analysis of burden of hypertensive heart disease using the Global Burden of Disease (GBD) study data from South Asia, including Bangladesh, Bhutan, India, Pakistan, and Nepal. GBD data sources included surveillance and survey data, published, and unpublished research articles and reports, vital registration and hospital data. We assessed the prevalence, mortality, disability adjusted life years (DALY), years lived with disability (YLD) and years of life lost (YLL) attributable to HHD between 1990 and 2019 in South Asia. Data were presented as point estimates with their corresponding 95% uncertainty intervals (UI).

Results:

From 1990 to 2019 the age standardized prevalence for HHD in South Asia increased from 110.2 (95% UI, 77.4 - 156.8) to 111.8 (78.3 - 159.0) per 100,000 population, and from 8.7 (5.2 - 13.7) to 8.8 (5.2 - 13.9) for YLDs, in both genders, respectively. The prevalence increased with age and was higher among females. The age standardized rate decreased from 334.1 (206.3 - 452.4) to 229.2 (166.1 - 296.9) for DALYs, and from 19.0 (12.1 - 26.7) to 13.2 (9.3 - 17.4) for death, respectively. In 2019, HHD prevalence was highest in Pakistan (138.6, 95% UI, 96.2 to 196.9), and lowest in Nepal (69.9, 49.5 to 98.3). Countries with the biggest increase in YLDs were Bangladesh (8.3%, 95% UI, -3.9% to 22.8%), followed by India (5.0%, 2.4% to 7.7%), Bhutan (4.0%, -8.7% to 18.3%), Pakistan (3.4%, -3.5% to 10.8%), and Nepal (1.0%, -11.5% to 15.5%). The age standardized DALYs decreased from 334.1 (95% UI, 206.3 to 452.4) in 1990 to 229.2 (95% UI, 166.1 to 296.9) in 2019 with the highest significant percentage change in the India (-34.1%, 95% UI, -48.3% to -9.5%), followed by Bangladesh, Bhutan and Nepal. Deaths due to HHD significantly declined in all countries except Pakistan with a small increase (0.3%, -24.6% to 26.8%) and in Nepal with a decrease (-8.6, -38.8% to 36.8%), respectively.

Conclusion:

HHD remains a significant cause of disease burden in South Asian countries. The increased prevalence amongst older people and females warrants particular attention. Policies focusing on preventing modifiable risk factors and access to essential medicines is warranted.
PS-BPP05-2: TREATMENT STATUS OF HYPERTENSION DETECTED IN HEALTH CHECKUPS: AN OBSERVATIONAL STUDY OF JAPANESE EMPLOYEES
Authors: Shima Azusa , Tatsumi Yukako , Ohkubo Takayoshi , Arima Hisatomi , Miura Katsuyuki , Kiyohara Maiko , Kawatsu Yuichiro , Morino Ayumi , Godai Kayo , Miyamatsu Naomi
Published: January 2023

Objective:

Despite the clear evidence for lowering blood pressure in hypertensive patients, control rates are insufficient, especially among younger adults. The first step in improving control rates is patient behavior to visit an outpatient when hypertension is detected at annual health checkups. The present study aims to explore the demographic and lifestyle characteristics related to the outpatient visits among employees who had untreated grade II or grade III hypertension.

Design and method:

An observational study was conducted using the data of annual health checkups and medical claims from 2012 to 2020 in an employee's health insurance society in Japan. We included participants if they were 20–69 years of age and had untreated grade II or grade III hypertension (blood pressure (BP)> = 160/100 mmHg and no use of BP-lowering medications) at the time of health checkups (first measurement) and had BP > = 140/90 mmHg in the previous years, to exclude transient hypertension. If more than one year of data met the criteria, the data from the first year was used to remove duplicates of individuals. Multilevel logistic regression with random effects of health checkup years was used to estimate odds ratios (ORs) with 95% confidence intervals (95%CIs) of demographics and lifestyle characteristics for newly outpatient visits (completing a clinic visit within 6 months).

Results:

The number of employees who had annual health checkups was approximately 10,000, and the number of applicable individuals for the present study was approximately 6% each year. In 2013–2020, after duplicate removal, 993 individuals (mean age 51.5 years, 63% women) had untreated grade II or grade III hypertension. Of these, 200 (20%) had an outpatient visit within 6 months. Among the independent variables, diabetes (ORs and 95% CI: 1.97, 1.19–3.26), body mass index (per 1-BMI increment: 1.04, 1.00–1.08), age (per 1-year increment: 1.03, 1.00–1.05), and systolic BP (per 1- mmHg increment: 1.04, 1.03–1.06) had significantly positive ORs for outpatient visits. The results of a similar analysis for antihypertensive medication after outpatient visits, no other factors besides systolic BP were associated with medication.

Conclusion:

Only 20% of individuals who detected grade II or grade III hypertension in annual health checkups visited outpatients within 6 months. The present findings suggested the necessity for more aggressive promotion of outpatient visits to younger adults without chronic illnesses or obesity.
PS-BPP05-6: THE ASSOCIATION BETWEEN SLEEP AND BLOOD PRESSURE CONTROL AMONG THE COMMUNITY DWELLING OLDER ADULTS TAKING ANTIHYPERTENSIVE DRUGS: THE SONIC STUDY
Authors: Mizuno Toshiki , Godai Kayo , Kabayama Mai , Akasaka Hiroshi , Isaka Masaaki , Yamamoto Koichi , Gondo Yasuyuki , Ogawa Madoka , Ikebe Kazunori , Masui Yukie , Arai Yasumichi , Ishizaki Tatsuro , Rakugi Hiromi , Kamide Kei
Published: January 2023

Purpose:

Short sleep duration and poor sleep quality in middle age have been reported to affect blood pressure(BP) control. However, the association between sleep duration, sleep quality and BP control is controversial in older adults with hypertension taking antihypertensive drugs. The aim of this study was to investigate this association in 70–80-year-old participants in the Japanese study of Septuagenarians, Octogenarians and Nonagenarians Investigation with Centenarians (SONIC).

Method:

Of the participants in the SONIC study, we performed a cross-sectional analysis of participants with hypertension taking antihypertensive drugs aged 76 ± 1 (n = 242) and 86 ± 1 (n = 196) years who had cooperated in the sleep survey. Sleep duration and quality were evaluated by the Pittsburgh Sleep Quality Index(PSQI). The subjects were categorized as < 6(short) and > = 6 hours. A PSQI> = 6 defined poor sleepers and a PSQI< = 5 defined good sleepers. BP control was defined as average systolic BP < 140mmHg and diastolic BP < 90mmHg as controlled status. We performed the multivariable logistic regression to investigate the association between sleep duration, sleep quality and BP control adjusted for the following confounding factors: age, sex, body mass index, frail, smoking, alcohol consumption, medical history, depressive symptoms separately for each age group.

Results:

In the age 70 years, logistic regression analysis indicated that neither sleep duration nor sleep quality association BP control. On the other hand, in the age 80 years, sleep duration of < 6 hours was associated with poor BP control(OR = 4.87, 95% CI: 1.54–15.41,P = 0.007) when compared to sleep duration of > = 6 hours and sleep quality was not significantly associated with BP control.

Conclusion:

In the age 80 years, sleep duration of < 6 hour was associated with poor BP control. These results indicate that adequate sleep may be important for BP control in older adult, especially age around 80 years.
PS-BPR01-8: A CASE OF PHEOCHROMOCYTOMA WITH CONCOMITANT SPLENIC ARTERY ANEURYSM
Authors: Chonabayashi Minami , Tomino Yuki , Hayakawa Eri , Sugiyama Toru
Published: January 2023

A 62-year-old man with a 30-year history of headaches and a 20-year history of treatment-resistant hypertension and diabetes mellitus was referred to our hospital for evaluation of his 5 cm retroperitoneal tumor found by abdominal ultrasound examination at a medical checkup. A simple CT and MRI scan showed a heterogeneous tumor (diameter, 5 cm) in the left adrenal gland and a splenic artery aneurysm (diameter, 2 cm). Endocrine examinations revealed increased levels of plasma-free normetanephrine (NMN) (853 pg/mL), urinary noradrenaline (NA) (670 μg/day), and urinary NMN (2.6 mg/day). 123I-MIBG scintigraphy showed high accumulation in the left adrenal region. He was diagnosed with NA-dominant left pheochromocytoma. His blood pressure was controlled at around 140/90 mmHg with 16 mg of doxazosin and 10 mg of amlodipine. His insulin-dependent diabetes was treated with multiple daily insulin injections (63 units/day), metformin, and miglitol. First, he underwent splenic artery aneurysm embolization under general anesthesia, which was completed without developing a hypertensive crisis. Two months later, he underwent laparoscopic left adrenalectomy, and the resected tumor was pathologically diagnosed as pheochromocytoma with a GAPP score of 1. He did not develop postoperative hypotension. His blood pressure was well controlled with only 10 mg of amlodipine, and his insulin requirement was reduced to 23 units/day after surgery.

Since few cases of pheochromocytoma with concomitant splenic artery aneurysm have been reported, we discussed the treatment plan with much consideration. Splenic artery aneurysms have a high risk of rupture due to intraoperative blood pressure elevation in pheochromocytoma, which could be fatal. Although the first choice of treatment for a splenic artery aneurysm is endovascular therapy, the use of contrast media is generally contraindicated in pheochromocytoma in Japan due to the risk of hypertensive crisis. In the present case, systemic management with a sufficiently high dose of alpha-blocker allowed the embolization to be preceded avoiding a crisis, and subsequent surgery for pheochromocytoma could be performed safely. A long history of hypertension and diabetes exacerbated by the pheochromocytoma may have contributed to the arteriosclerosis leading to the splenic artery aneurysm. Here we report a rare case of pheochromocytoma with concomitant splenic artery aneurysm and will discuss the pathogenesis and management of this case with a review of the literature.
PS-BPR02-1: A CASE OF ADVANCED ENDOMETRIAL CANCER AFTER NEPHRECTOMY FOR RENAL CELL CANCER WITH HYPERTENSION AND PROTEINURIA INDUCED BY LENVATINIB
Authors: Tajima Takaya , Itoh Hiroshi
Published: January 2023

Background:

The combination of pembrolizumab plus lenvatinib is approved for advanced endometrial cancer that is not MSI-H or dMMR, is progressive on prior systemic therapy, and is not amenable to curative surgery or radiation. Lenvatinib is an oral, multi-targeted tyrosine kinase inhibitor (TKI) that exerts anti-malignant effects by inhibiting many tyrosine kinase receptors, such as VEGF receptors 1, 2, and 3, fibroblast growth factor receptors 1 through 4, platelet-derived growth factor receptor α, rearranged during transfection (RET), and stem cell factor receptor (KIT) signaling networks. Although lenvatinib's usefulness has been demonstrated, adverse effects such as hypertension and proteinuria often necessitate the discontinuation of administration. We encountered a patient with advanced endometrial cancer after nephrectomy for renal cell cancer who developed hypertension and proteinuria due to lenvatinib. We discussed TKI induced hypertension and proteinuria in patients on pre-existing eGFR decline.

Case presentation:

A 65-year-old Japanese female was diagnosed in 2011 with concurrent endometrial cancer and right renal cell cancer. She underwent total hysterectomy, bilateral salpingo oophorectomy, and right nephrectomy. She received 6 courses of CAP (cyclophosphamide, epirubicin and cisplatin) therapy as adjuvant chemotherapy for endometrial cancer. More than 7 years later, the patient presented with a vaginal cuff recurrence that was histologically confirmed and radiotherapy was indicated. In 2019, there was a recurrence in pelvic lymph nodes. Between 2019 and 2021, she underwent 9 cycles of chemotherapy with carboplatin plus paclitaxel, however the cancer progression was observed. In February 2021, the patient was started on pembrolizumab and Lenvatinib (20 mg/day) combination therapy. Her creatinine was 0.85 mg/dL, with an eGFR of 52 mL/min/1.73m2 before the administration of lenvatinib. The patient experienced continuous grade 3 hypertension (systolic blood pressure Hiragino Sans 160 mmHg or diastolic blood pressure ≧ 100 mmHg), and 2 antihypertensive agents(amlodipine and ormesartan) were required to control hypertension. Despite lenvatinib dose reduction and the aggressive use of antihypertensive agents, grade 3 hypertension had recurred several times, and then proteinuria gradually increased to 3.0 g/day. Lenvatinib was decreased to 10 mg/day (2 steps of dose reduction) within 2 months of treatment initiation, and finally, hypertention and proteinuria were ameliorated.

Conclusion:

A history of nephrectomy, pre-existing eGFR decline and hypertension are associated with developing TKI induced proteinuria. These patients should be monitored carefully, and appropriate measures for the early control of hypertension and proteinuria may result in higher-dose treatment with lenvatinib, thereby maximizing its therapeutic effect.
PS-BPR02-4: RENOVASCULAR HYPERTENSION FROM FIBROMUSCULAR DYSPLASIA WITHOUT ABNORMALITIES IN RENAL DOPPLER ULTRASOUND: A CASE REPORT.
Authors: Kato Kyosuke , Mizutani Yosuke , Nakamura Toshifumi , Kinouchi Kenichiro , Kobayashi Sakiko , Miyashita Kazutoshi , Itoh Hiroshi
Published: January 2023

Background:

Renovascular hypertension (RVH) is one of the most common forms of secondary hypertension, and accounts for nearly 1% of all hypertension cases. It is characterized by compromised renal perfusion pressure, resultant renin secretion, and hypokalemia due to secondary hyperaldosteronism. Arteriosclerosis is a common underlying pathogenesis in middle-aged and older adults, whilst fibromuscular dysplasia is occasionally seen in younger patients with RVH. Since cardiovascular complications are of grave concern in RVH, early detection and appropriate therapeutic intervention are particularly important. Here, we report a case of renovascular hypertension from fibromuscular dysplasia which was incidentally unveiled during close examination of an adrenal tumor.

Case report:

A 55-year-old woman was being treated for hypertension by her primary care physician. She was referred to our hospital for a thorough examination of her right ureteral stone, which necessitated a CT scan incidentally revealing an left adrenal nodule measuring 8 mm in size. Primary aldosteronism was unlikely based on the lack of renin suppression (active renin concentration, 36.5 pg/mL; plasma aldosterone levels, 263 pg/mL and aldosterone-renin ratio < 40 under treatment with nifedipine 40 mg/day. Ultrasound of the kidney demonstrated a notable difference in size between the right and left kidneys of 87 mm and 106 mm, respectively, albeit Renal Artery Doppler failed to suggest the renal artery stenosis. CT scan with contrast material revealed the remarkable irregularity and “string on beads” sign on the distal main trunk of the right renal artery. Renovascular hypertension from fibromyalgia dysplasia was suspected, and percutaneous renal artery angioplasty was performed. After the pressure gradient across the stenotic lesion (105/99 mmHg on the distal side and 125/67 mmHg on the proximal side of the renal artery) was verified, balloon dilation was applied. The procedure was successful as the pressure gradient virtually resolved (105/95 mmHg on the distal side and 109/101 mmHg on the proximal side of the renal artery). Digital subtraction angiography indeed reaffirmed improvement in blood flow.

Conclusion:

Renovascular hypertension can go unnoticed solely based on renal Doppler Ultrasound. This was a case in which renovascular hypertension from fibromuscular dysplasia was incidentally identified in CT scan designated as a work-up for an adrenal tumor.