bluuebunny/crossref_metadata_2025 huggingface dataset:
PS-R04-9: REVERSIBLE ACUTE RENAL INJURY IN MALIGNANT HYPERTENSION DURING LONG-TERM FOLLOW-UP
Authors: Hishida Erika , Imai Toshimi , Nagata Daisuke
Published: January 2023

Background:

Malignant hypertension is a disease characterized by severe hypertension and multi-organ damage. Although mortality and renal prognosis have improved with antihypertensive therapy, progression to end-stage renal disease remains a leading cause of morbidity and mortality.

Case presentation:

A 37-year-old man with a history of untreated hypertension and proteinuria was referred to our hospital with complaints of right paralysis. He was diagnosed with left putaminal hemorrhage and treated with conservative blood pressure reduction management. He was also complicated with severe hypertension (blood pressure 231/146 mmHg), acute renal failure (BUN 39 mg/dl, serum creatinine 4.01 mg/dl, urinary protein 2.848 g/gCre), and heart failure with preserved ejection fraction (BNP 373 pg/ml). Initial evaluation demonstrated hyperreninemia (32.6 ng/ml/hr) with hyperaldosteronism (125 pg/ml), consistent with malignant hypertension. Secondary hypertension, such as primary aldosteronism, Cushing's syndrome, pheochromocytoma, and renal artery stenosis was excluded by further examination. His renal size was mildly atrophic assessed by CT scan, suggesting a history of chronic kidney disease. At first, we gradually decreased blood pressure with antihypertensive agents except for angiotensin-converting enzyme (ACE) inhibitor and angiotensin receptor blockade (ARB) so as not to induce exacerbation of renal function via glomerular ischemia. In the long-term, he was treated to achieve a tight blood pressure control to systolic blood pressure of 100–110 mmHg with the combination of ACE inhibitor, calcium channel blocker, and alpha/beta blocker. Although his clinical course showed gradual recovery of renal function, our conservative approach successfully induced renal function recovery over six months of follow-up (BUN 27 mg/dl, serum creatinine 2.26 mg/dl, urinary protein 0.154 g/gCre).

Discussion:

Previous reports suggest that malignant nephrosclerosis may recover slowly if the blood pressure is tightly controlled during the follow-up. From a long-term perspective, tight blood pressure control with inhibition of the renin-angiotensin-aldosterone system, which is a critical factor of the pathogenesis in malignant hypertension, may provide beneficial effects on the renal prognosis of malignant hypertension.
PS-R05-9: A CASE IN WHICH A MINERALOCORTICOID RECEPTOR ANTAGONIST COULD IMPROVE ARB-RESISTANT PROTEINURIA IN NON-DIABETIC HYPERTENSION
Authors: Fujita Megumi
Published: January 2023

The patient is a 53-year-old man with hyperetension, obesity (Body mass index 32–34), dyslipidemia and hyperuricemia, without diabetes mellitus, who has been received antihypertensive agents since age 40. At his initial visit to our hospital at age 40, he exhibited severe hypertension of 244/163 mmHg and proteinuria of about 1000 mg/gram creatinine. According to medical interview, he had been pointed out hypertension since age 32, but denied antihypertensive therapy. Accelerated cardiac and renal damage was not shown. In addition, secondary hypertension such as renovascular hypertension, primary aldosteronism and PPGL were ruled out. He was administered 50 mg losartan and 12.5 mg hydrochlotiazide, and his blood pressure was gradually downregulated, However, his proteinuria of about 700 mg/gram creatinine remained, and so entered a double-blind, randomized, placebo-controlled trial: the Eplerenone Combination versus Conventional Agents to Lower Blood Pressure on Urinary Antialbuminuric Treatment Effect (EVALUATE) study: (Ando K, et al. Lancet Diabetes Endocrinol. 2014; 2: 944). He was randomized to treatment with eplerenone (50 mg/day) or placebo for 52 weeks, and his assigned treatment turned out the eplerenone, associated with anti-alubuminuric effect at the end of EVALUATE study. After that, antihypertensive treatment with 25 or 50 mg eplerenone plus ARB: telmisartan or irbesartan has been continued on his agreement. He avoided excess intake of potassium-containing food, and his plasma potassium level was carefully checked every hospital visit. After 13 years, his proteinuria has not been increased (500–900 mg/gram creatinine). Nishimoto, et al. has reported that eplerenone plus renin-angiotensin system blockade may be effective for CKD in hypertensive patients, especially those with excessive salt intake by EVALUATE study (Hypertens Res 2019; 42: 514). Obesity is related to salt-sensitive hypertension (Nagae A, Fujita M, et al. Circulation 2009; 119: 978.). This obesity-related hypertensive case suggests that a mineralocorticoid receptor antagonist may improve ARB-resistant proteinuria in non-diabetic hypertension for more than 10 years, longer than EVALUATE study for about 1 year period.
PS-C32-10: EVALUATION OF ISH TREATMENT PROTOCOLS AMONG HYPERTENSIVE ADULTS
Authors: Arain Mudassar Iqbal , Fricovsky Eduardo
Published: January 2023

Objective:

To assess the international society of hypertension treatment protocol among those adults who had confirmed diagnosis of Hypertension at different clinical setups of Hyderabad, Sindh, Pakistan.

Methodology:

The prospective study was conducted for a period of one year during 2020. A total of 1000 prescription of hypertensive patients were collected in the study based on random sampling method. The study was conducted in six different clinical setup of Hyderabad territory. The data were transformed into pre-designed data sheet and assess based on ISH treatment protocols.

Results:

Among 1000 enrolled data maximum number were classified under grade 1 i.e. 548 followed by grade II i.e. 276. For grade 1 patients, data showed that only 26% prescribed medications according to ISH guidelines while remaining were not prescribed. For grade II patients, 37% of the prescriptions showed compliance with ISH guidelines while remaining did not followed the procedure.

Conclusion:

The study was clearly revealed that the treatment protocol of ISH guidelines in adults was not accordingly so proper CMEs must be conducted to aware the health care professionals.
PS-B10-4: AFFERENT RENAL NERVOUS SIGNALS CONTRIBUTE TO THE DEVELOPMENT OF HFPEF WITH SYMPATHOEXCITATION IN DAHL SALT-SENSITIVE HYPERTENSIVE RATS
Authors: Ryosuke Nakashima , Shinohara Keisuke , Ikeda Shota , Matsumoto Sho , Yoshida Daisuke , Ono Yoshiyasu , Tsutsui Hiroyuki
Published: January 2023

Objective:

Sympathetic activation is involved in the pathophysiology of heart failure with preserved ejection fraction (HFpEF). Renal nerves contain sympathetic efferent and sensory afferent fibers. Excitation of the renal efferent nerves increases renal renin release and sodium/water retention. On the other hand, the renal afferent nerves are activated by the renal injury associated with hypertension, and acute stimulation of the afferent nerves increases sympathetic output from the brain. In this study, we investigated whether the signals from the renal afferent nerves contribute to the development of hypertensive HFpEF using a novel method of selective afferent renal nerve denervation (ARDN) in Dahl salt-sensitive rats, a widely used animal model of HFpEF.

Design and method:

Male Dahl salt-sensitive rats were fed 0.3% low-salt diet (LS) or 8% high-salt diet (HS) from 7 weeks of age. At 9 weeks, LS-fed rats received sham operation (LS-Sham), and HS-fed rats were randomly divided into ARDN (HS-ARDN) or sham operation (HS-Sham). At 19 weeks, blood pressure, echocardiographic parameters, organ weights, and plasma norepinephrine levels were measured, and the histological and biochemical analysis of the heart were performed.

Results:

Systolic blood pressure was significantly increased in HS-Sham compared to LS-Sham, and this increase was not affected in HS-ARDN. By echocardiography, left ventricular (LV) fractional shortening did not differ between the three groups; however, E/e’ ratio was significantly increased in HS-Sham compared to LS-Sham and was attenuated in HS-ARDN. LV weight / body weight ratio and lung weight / body weigh ratio were significantly increased in HS-Sham compared to LS-Sham, and were decreased in HS-ARDN. Plasma norepinephrine levels were significantly higher in HS-Sham than LS-Sham, and this increase tended to be inhibited in HS-ARDN. LV fibrosis evaluated by Masson trichrome staining was significantly increased in HS-Sham compared to LS-Sham and was attenuated in HS-ARDN. ANP mRNA expression in LV tissue was extremely increased in HS-Sham compared to LS-Sham and was significantly attenuated in HS-ARDN.

Conclusion:

The signals from afferent renal nerves contribute to the development of HFpEF with sympathoexcitation in Dahl salt-sensitive hypertensive rats.
PS-B12-8: ANGIOTENSIN II TYPE I RECEPTOR SIGNAL REGULATES MITOCHONDRIAL DYNAMICS, CAUSING MUSCULAR MITOCHONDRIAL DYSFUNCTION AND SARCOPENIA UNDER METABOLIC STRESS
Authors: Uebo Shota , Ikeda Yoshiyuki , Uchikado Yoshihiro , Akasaki Yuichi , Ohishi Mitsuru
Published: January 2023

Introduction:

Metabolic stress, such as oxidized low density lipoprotein (ox-LDL) and advanced glycation end products (AGE) cause atherosclerotic cardiovascular diseases through dysfunction of mitochondria, which undergo quality control by mitochondrial dynamics, fission and fusion. Mitochondria also plays a crucial role in regulating muscular function, and its dysfunction leads to sarcopenia. This study aims to clarify whether and how mitochondrial dynamics are involved in the development of sarcopenia under metabolic stress.

Methods:

We used human skeletal muscle cells (HSMC) in in vitro experiments and C57BL6 (WT), apolipoprotein E (ApoE) deficient and the double knockout of ApoE and AT1R (DKO) mice in in vivo experiments.

Results:

Administration of either ox-LDL or AGE to HSMC induced mitochondrial fission through activation of fission factor, Drp1, decreased mitochondrial membrane potential assessed by JC-1 staining and increased reactive oxygen species assessed by Mito-sox Red staining and apoptosis, which were restored by Drp1-specific inhibitor, mdivi-1. Inhibition of angiotensin II type 1 receptor (AT1R) by AT1R blocker also ameliorated excessive mitochondrial fission, its function and oxidative stress induced by either ox-LDL or AGE in HSMC. These results suggest that metabolic stress induces mitochondrial fission and its dysfunction, which may cause sarcopenia. Muscular strength and the ratio of muscle weight to tibia length were lower in ApoE than those in WT. The number of fused mitochondria and mitochondrial function were lower and oxidative stress and the number of apoptotic cell were higher in ApoE KO than those of WT. Muscle strength, the ratio of muscle weight to tibia length, the number of fused mitochondria and its function were higher and the number of apoptotic cell were lower in DKO than those in ApoE KO mice. Taken together, these results suggest that either ox-LDL or AGE causes sarcopenia through AT1R signal-dependent mitochondrial fission and subsequent mitochondrial dysfunction.

Conclusion:

Either ox-LDL or AGE induces mitochondrial dysfunction through AT1R signal-regulating mitochondrial fission, which causes sarcopenia. Inhibition of AT1R signal may be a potential therapeutic strategy to avoid development of sarcopenia in patients with life style related diseases, such as dyslipidemia and diabetics.
PS-C28-2: STROKE RISK OF THE ELDERLY PATIENTS WITH NOCTURNAL HYPERTENSION DEFINED USING HOME BLOOD PRESSURE MONITORING IN JAPANESE GENERAL PRACTICE POPULATION
Authors: Fujiwara Takeshi , Hoshide Satoshi , Kario Kazuomi
Published: January 2023

Objective:

To investigate the association between nocturnal hypertension defined using home blood pressure (BP) monitoring (HBPM) and the prevalence, extent of cardiovascular target organ damage (TOD), and cardiovascular disease (CVD) event risks in participants with ≧ 65 years in general clinical practice.

Design and method:

We used the dataset of the Japan Morning Surge-Home BP (J-HOP) Study that recruited 4,310 participants with cardiovascular risk factors. Among them, we assessed the participants with ≧ 65 years who measured nocturnal home BP (n = 1,349, mean age 72.0 year, 48.6% men). We define nocturnal hypertension as nocturnal systolic (SBP) ≧ 120 mmHg or diastolic (DBP) ≧ 70 mmHg, using HBPM. Nocturnal home BP was automatically measured at least 1 day within the 14 days (2 AM, 3 AM, and 4 AM). We use the average of all nocturnal home BP values. N-terminal pro-brain natriuretic peptide (NT-proBNP) and urine albumin: creatinine ratio (UACR) were used as surrogate markers of TOD. The CVD outcomes were incident stroke and coronary heart disease (CHD) events.

Results:

The prevalence of nocturnal hypertension defined by HBPM was 61.7% of all study participants with ≧ 65 years. The participants with nocturnal hypertension defined by HBPM presented higher levels of log-transformed NT-proBNP and UACR at baseline compared to those with controlled nocturnal BP group. Over a median 4.0-year follow-up (5,453 person-years), 36 stroke events and 31 CHD events occurred, respectively. The nocturnal hypertension group had a higher incidence rate of stroke events compared with the controlled BP group. Concerning CHD, the incidence rate of CHD was similar between two groups (Figure). Cox model results suggested that the participants with nocturnal hypertension had a higher risk of stroke compared to those with controlled nocturnal BP group after adjustments for log-transformed NT-proBNP and UACR levels (adjusted hazard ratio 3.42; 95% confidence interval 1.15–10.19).

Conclusions:

In this Japanese population with ≧ 65 years, the participants with nocturnal hypertension defined by HBPM was significantly associated with stroke risk, independently of the extent of TOD.
PS-C29-10: WEIGHT GAIN IS ASSOCIATED WITH INCREASED ARTERIAL STIFFNESS IN HIGH-RISK PREGNANT WOMEN
Authors: Bourgeois Sophia , Phan Kim , Labos Christopher , Messidi Amira El , Abenhaim Haim , Gagnon Robert , Daskalopoulou Stella S
Published: January 2023

Objective:

There have been increasing efforts to establish effective screening tools for preeclampsia in early pregnancy. Arterial stiffness is a composite indicator of vascular health, reflects endothelial dysfunction, and has been shown to be predictive of cardiovascular events in the general population, while it has been noted to be increased at the time for preeclampsia. Pregnancy is characterized by acute weight gain. However, whether pregnancy weight gain can affect arterial stiffness is not known. Therefore, we aimed to investigate the impact of pregnancy weight gain on arterial stiffness in high-risk pregnant women.

Design and method:

In this prospective longitudinal cohort study, pregnant women (n = 177) in their first trimester (10–13 weeks gestation) who met established clinical criteria for high-risk of preeclampsia were recruited from obstetrics clinics. Arterial stiffness measurements and weight were recorded every 4 weeks throughout pregnancy. Arterial stiffness was measured non-invasively using the validated tonometry-based SphygmoCor System.

Results:

Continuous variables were analyzed using linear. Analysis adjusted for maternal age showed that an increase in total pregnancy weight gain was significantly associated with increased arterial stiffness during pregnancy (0.213 [95%CI: 0.007, 0.068], p < 0.02). More specifically, an increase in late pregnancy weight gain, from second to third trimester, was significantly associated with an increase in arterial stiffness during pregnancy (adjusted beta: 0.052 [CI: 0.002, 0.102], p < 0.05).

Conclusion:

An increase in total pregnancy weight gain and more specifically late pregnancy weight gain is associated with an increase in arterial stiffness. This is important as arterial stiffness could be a predictive tool for preeclampsia in clinical practice.
PS-C30-9: CHALLENGES IN MANAGING PERIPARTUM CARDIOMYOPATHY COMPLICATED WITH SEVERE PRE-ECLAMPSIA IN SUBURBAN AREA: A CASE REPORT
Authors: Sudirman Adrian Reynaldo , Surya Steven Philip , Sitompul Sanggap Indra
Published: January 2023

Background:

Peripartum cardiomyopathy (PPCM) is a life-threatening condition, refers to rare dilated cardiomyopathy causing heart failure in late pregnancy or early postpartum woman. The diagnosis was based on pregnant/peripartum woman who had sudden cardiac decompensation without any history of cardiac disease. Pre-eclampsia (PE) could be co-existed with PPCM because of similar pathophysiology mechanism, which leads to higher mortality. Hereby we present the challenges of managing PPCM complicated with severe PE in suburban areas.

Case Illustration:

A 36-year-old woman referred to hospital with shortness of breath. Her past medical history was remarkable for severe-PE and had undergone caesarean section two-day-ago. Upon arrival, her saturation-75%, HR-120x/min, BP-140/80 and RR exceeds-40x/min. She was in respiratory distress with JVP increased, coarse crackles at basal lungs, and leg swelling. Laboratory studies were unremarkable. The x-ray revealed cardiomegaly and ECG showing LVH. Initial echocardiography demonstrated left ventricular systolic dysfunction with ejection fraction-34%. The patient was suggestive for PPCM with previous history of PE. Continuous administration of IV-furosemide-5 mg/h, spironolactone-25 mg, bisoprolol-2.5 mg, and candesartan-8 mg were administered. Her condition improved rapidly with increased saturation from 75% to 95% and significant reduced in dyspnoea. She was transferred to intensive cardiovascular unit for further management and discharged after 7-days for outpatient control.

Discussion:

PPCM is a devastated diagnosis among pregnancy woman. The diagnosis should be distinguish from PE induced heart failure. In PPCM, the echocardiography findings is related with left ventricular systolic dysfunction and reduced EF, whereas diastolic dysfunction with preserved EF is identified in PE induced heart failure patient. PE is associated with PPCM based on the shared pathophysiology. It is related with the angiogenic imbalance and excess expression of antiangiogenic factor sFlt1 soluble fms-like tyrosine kinase-1, which have found increased in both of the diseases. This is explained why PE has been recorded to occur in 30% of PPCM cases and it contributes to the increasing maternal mortality when most of the causes of maternal death are preventable.
PS-C31-1: SIGNIFICANCE OF SCREENING AND DIAGNOSING PRIMARY ALDOSTERONISM (PA) IN GENERAL MEDICINE
Authors: Kusunoki Hiroshi , Nagasawa Yasuyuki , Motone Masaharu , Yoshihara Fumiki , Shimizu Hideo , Shinmura Ken
Published: January 2023

Background:

Primary aldosteronism (PA) is a frequent secondary hypertension that is more frequently associated with cerebrovascular disease than essential hypertension, and thus requires appropriate diagnosis and treatment. The Japan Endocrine Society has published the new guideline for the diagnosis and treatment of primary aldosteronism, following the change of aldosterone measurement system in 2021. In this presentation, we will discuss a case of PA experienced at a dental school hospital.

Case

75 years old male

Current medical history:

He had been diagnosed as hypertensive more than 10 years ago and had been prescribed antihypertensive medication, but he had stopped taking it. When he visited an oral surgeon for a tooth extraction, hypertension was noted and he was referred to internal medicine.

 Blood pressure: 208/120 mmHg, Pulse: 83/min,

 Cre 1.09 mg/dL, Na 139mEq/L, K 3.7mEq/L.

fT4 0.95ng/dL, TSH 2.58micro-IU/mL, Plasma renin activity: PRA (EIA method) 0.6ng/mL/hr, Plasma aldosterone concentration: PAC (CLEIA method) 130pg/mL.

 There was a nodule on the right adrenal gland.

The patient had a high aldosterone-renin ratio: ARR = PAC/PRA = 130/0.6 = 217 at the time of initial examination, and PA was suspected. CT showed a nodule in the right adrenal gland, raising suspicion of unilateral disease. Because of the high basal plasma aldosterone level and low K level, we referred the patient to a specialized facility because we thought that if PA was confirmed by functional confirmation testing, the case could be aggressively localized and typed by adrenal vein sampling (AVS). In this presentation, we would like to discuss the significance of screening and diagnosis of PA in primary care and general practice settings such as dental school hospitals, based on the results of functional confirmation testing at specialized facilities, and in light of current guidelines.
PS-C31-12: CHALLENGES IN MANAGING HYPERTENSION IN A SINGAPORE PRIMARY CARE SETTING: A QUALITATIVE STUDY
Authors: Ng Chirk Jenn , Tan Reuben , Moosa Shiwaza Aminath , Oka Prawira , Lee Cia Sin , Tan Ngiap Chuan
Published: January 2023

Objective:

The prevalence of hypertension among adults in Singapore has increased signifincantly from 24% (2017) to 35% (2020); half of those who have been diagnosed remained uncontrolled. Most of the patients with hypertension are managed in the primary care setting. Therefore, this study aimed to explore the experiences, challenges and needs of primary care providers in managing hypertension in Singapore

Design and method:

This qualitative study reported preliminary findings from 10 individual in-depth interviews with healthcare providers (5 doctors, 3 nurses and 2 pharmacists) in 2 primary care polyclinics in Singapore. The subjects were recruited purposively (based on experience and position) and recruitment continued till saturation was achieved. An experienced qualitative researcher conducted the interviews using an interview guide developed based on theories, literature review and expert discussion. All interviews were audio-recorded, transcribed verbatim, checked and managed using NVivo qualitative data management software. Thematic analysis was used for data analysis.

Results:

Four main challenges emerged from the preliminary analysis: (1) Lack of adequate blood pressure readings for decision making; (2) Lack of clarity of roles and responsibilities of healthcare team in hypertension care; and (3) Practice variations and lack of standardised training and (4) Usability and utility issues with the electronic medical record.

Conclusions:

Despite clear evidence on home blood pressure monitoring, team-based care, patient and clinician education, and technology in enhancing hypertension care, this study found a gap in implementing these clinical evidence. There is a clear need to find effective and sustainable strategies to overcome these barriers to improve hypertension care in primary care.
PS-C32-5: GENDER DIFFERENCE IN HYPERTENSIVE PATIENTS ASSOCIATED WITH PROBABLE OSA
Authors: Ching Siew Mooi , Loke Wen How , Ng Jun Ying
Published: January 2023

Objectives:

Obstructive Sleep Apnea (OSA) has high association with hypertension and cardiovascular disease. OSA has been widely proven to be more common in men than women possibly due to pathophysiological difference and clinical presentations. However, there are limited studies on assessing the gender difference in correlation between OSA and hypertensive patients. This study aimed to examine the determinants of probable OSA according to gender among hypertensive patients in primary care clinics.

Design and Methods:

A cross-sectional study was carried out using systematic random sampling method in hypertensive patients who attended two government primary care clinics in Sarawak, Malaysia. A validated STOP-Bang questionnaire was used in this study and socio-demographic data was captured with questionnaire. Probable OSA was defined as STOP BANG score of 3 and above. SPSS version 23 was used to do the analysis and multivariate logistic regressions were used to determine the determinants of probable OSA according to gender.

Results:

440 hypertensive patients were enrolled into this study, 60.7% of them were female. There was a higher proportion of male patients (92.5%) found to have probable OSA as compared to female patients (30%) (p < 0.001). Looking into criteria of STOP BANG, between female and male patients, there were significant differences in daytime symptoms (p = 0.020) and BMI categories (p = 0.001).

As for demographic data, the determinant of probable OSA in men were low income (<RM3,000) (AOR = 4.320, P = 0.022, 95% confidence interval [CI] 1.23,15.15), longer duration of hypertension (AOR = 1.269, P = 0.029, 95% CI 1.03,1.57) and being married (AOR = 5.612, P = 0.021, 95% CI 1.30,24.22). For female, the determinant of probable OSA were neck circumference (AOR = 1.613, P = 0.002, 95% CI 1.19,2.81) and Chinese ethnicity (AOR = 11.711, P = 0.013, 95% CI 1.67,81.95).

Conclusion:

In conclusion, this study reported that among hypertensive patients, OSA is more prevalent in men than women, and criteria of STOP BANG and clinical characteristics are significantly different between gender. Primary care clinicians should be aware of these difference and screen for probable OSA accordingly for further early intervention.
PS-C33-1: CIRCADIAN RHYTHM DISTURBANCES AND BLOOD PRESSURE LEVELS IN OBESE PATIENTS WITH TRUE AND PSEUDO-RESISTANT HYPERTENSION
Authors: Shalimova Anna
Published: January 2023

Background:

The aim was to conduct a comparative assessment of the circadian rhythm (CR) abnormalities and blood pressure (BP) levels between pseudo- and true resistant hypertension (RH) in obesity.

Methods:

The study included 302 patients with uncontrolled hypertension and obesity. Initial treatment efficacy was assessed 3 months after dual therapy was administered. Those patients who did not reach target BP in dual therapy were transferred to triple therapy. Among patients who received triple therapy, 69 people did not reach target BP. All patients were additionally examined 6 months after the therapy initiation.

Results:

In the absence of a difference in BP levels, patients who subsequently become resistant, already at the stage of inclusion, significantly more often had a violation of CR with a predominance of the non-dipper rhythm. After 3 months of follow-up, there was a significant difference in the indicators of both office and out-of-office BP in resistant and non-resistant patients; however, the distribution of CR remained the same as at the stage of inclusion in the study. Despite the achievement of target BP after 6 months of therapy, in the majority (91.42%) of patients without resistance, the circadian rhythm normalized, while resistant patients had a normal CR only in 60.87%. At the stage of enrolling patients into the study and 3 months after the start of therapy there was no significant difference in BP levels between true and pseudo-resistance, then after 6 months of therapy, patients with true resistance had significantly higher office SBP (p < 0.01) and 24 h average SBP according to ABPM data (p < 0.05) compared with pseudo-resistant patients. Already at the stage of inclusion in the study, the normal CR in patients with true resistance was significantly less common than in patients with pseudo-resistance, and during the prescribed therapy, a similar trend persisted: after 6 months of antihypertensive therapy, 71.05% of pseudo-resistant patients had a normal CR, while with true resistance only about half of the patients had a normal CR.

Conclusions:

Even when target BP levels in antihypertensive therapy are achieved, obese patients with resistant hypertension are characterized by more pronounced disturbances of CR (most often in the form of non-dipper) and higher levels of office and out-of-office BP, compared with non-resistant patients. Compared with pseudo-resistant patients, the presence of true resistance in obesity is associated with higher SBP levels and a higher incidence of CR disturbances.
PS-C33-11: FACTORS RELATED TO DETERIORATED KIDNEY FUNCTION IN RESISTANT HYPERTENSION PATIENTS
Authors: Bezrodna Larysa V , Mishchenko Larysa A , Bezrodny Volodymyr B , Matova Olena O , Kupchynska Olena G , Gulkevych Oxana V , Serbenyuk Kateryna I
Published: January 2023

Objectives:

To determine the factors associated with renal function deterioration in resistant hypertension (RH) patients

Methods:

The study included 152 patients aged 28 to 79 years with RH. They underwent measurement of office and ambulatory blood pressure monitoring (ABPM). Blood level of potassium, sodium, glucose, creatinine, uric acid, citrulline, C-reactive protein (CRP), matrix metalloproteinase-12 (MMP-12), aldosterone-renin ratio and 24-h excretion of metanephrine and 24-h urinary albumin excretion rate (AER) were determined. Glomerular filtration rate (GFR) was estimated by the CKD-EPI formula.

Results:

Chronic kidney disease (CKD) was diagnosed in 32.3% of patients with RH (gr.1 pts), gr.2 pts - those without CKD. Spearman's correlation analysis showed a negative relationship between GFR and office diastolic BP (DBP) and 24 hours mean DBP (r = -0.233; r = -0.373; P < 0.01, respectively). Significant negative correlation was revealed between GFR and daytime systolic BP variability (r = -0.275; P < 0.01). GFR was inversely related to AER (r = -0.412; P < 0.01), uric acid (r = -0.311; P < 0.05), CRP (r = -0.314; P < 0.05), MMP-12 (r = -0.385; P < 0.01), citrulline (r = -0.375; P < 0.01), sodium (r = -0.284; P < 0.05), aldosterone and urinary metanephrine level (r = -0.225; P < 0.05 and r = - 0.210; P < 0.05). In gr.1pts. level of CRP, MM-12 and citrulline was significantly (P < 0.01) higher than in the gr.2 pts.

Factors independently and most closely related to reduced GFR in RH patients are 24 hours mean DBP (β; = -0.449, P < 0.001), CRP (β; = -0.354, P < 0.01), MMP-12 (β; = -0.248; P < 0.01) and citrulline (β; = -0.232; P < 0.05).

Conclusions:

Revealed associations, in addition to elevated blood pressure, indicate the possible pathogenic role of low-grade systemic inflammation biomarkers in the renal function deterioration in RH patients. Targeting low-grade systemic inflammation may improve BP control in resistant hypertension patients with CKD.
PS-C34-3: EXPERIENCES AND INFLUENCES OF ONLINE HEALTH INFORMATION-SEEKING ABOUT STATIN USE IN PATIENTS WITH HIGH CARDIOVASCULAR RISK: A QUALITATIVE STUDY.
Authors: Lim Hooi Min , Ng Chirk Jenn , Dunn Adam G , Abdullah Adina
Published: January 2023

Objectives:

Online health information (OHI) about statin use has created debates among healthcare professionals and the public. As a result, online misinformation about statins has led to an increase in the discontinuation of statins. OHI has been shown to influence patients’ health decisions and behaviours. This study explores the views and experiences of OHI-seeking about statins in patients with high cardiovascular risk and how OHI influences patient decision-making and statin adherence.

Designs and method:

This is a qualitative study with semi-structured in-depth interviews of 20 patients with high cardiovascular risk from a primary care clinic in Malaysia. We included participants who were at least 18 years old and had high cardiovascular risk where statin use is indicated as per guideline (i.e. with pre-existing cardiovascular disease (CVD), diabetes mellitus, chronic kidney disease, a 10-year risk for CVD > 20% based on the Framingham General CVD risk score) and have sought OHI about statins. We used an interpretive description approach with thematic analysis.

Results:

The age of the participants ranged from 39–74 years, with 16 (80%) participants having hypertension. 12 (60%) participants took a statin for primary CVD prevention. The duration of statin use ranged from 2 weeks to 30 years. Six themes emerged from the interviews (Figure 1): (1) Participants sought different types of OHI throughout the disease trajectory depending on their information needs, (2) There is a changing paradigm of OHI-seeking behaviour, where passive exposure to OHI appears to have increased relative to active searching, (3) Participants sought a wide range of OHI from hypercholesterolemia, lifestyle modification and complementary alternative medicine, (4) Statin-related OHI was mainly negative and stressed the side effects of statins, (5) OHI triggered emotional reactions that may affect patients’ decision on statin adherence, (6) Doctors’ responses to participants’ OHI-seeking behaviour affected patient-doctor communication and patients’ decision in taking statins.

Conclusions:

This study highlights the changing information needs throughout patient journeys, suggesting the opportunity to provide needs-oriented OHI to patients with high cardiovascular risk. Passive OHI exposure appears to have an influence on patients’ adherence to statins. The quality of patient-doctor communication about OHI-seeking behaviour remains a critical factor in patient decision making. Doctors should discuss patients’ information needs and OHI-seeking behaviour throughout the disease trajectory and provide evidence-based health information to patients. Strategies are needed to address patients’ concerns about statins, acknowledge their emotional reactions toward OHI and support their need for evidence-based OHI.
PS-C36-1: CLINICAL INERTIA IN THE HYPERTENSIVE PATIENTS TREATED BY HYPERTENSION SPECIALISTS
Authors: Arakawa Kimika , Imazu Rina , Morinaga Yuki , Tominaga Mitsuhiro , Tsuchihashi Takuya
Published: January 2023

Background:

Only about 30% of hypertensive patients in Japan is reported to have properly controlled blood pressure (BP). The clinical inertia (Inertia) seems to be one of the factors behind the inadequate BP control.

Purpose:

We investigate the achievement rate of the BP lowering target in 2020 for outpatients in the division of hypertension, and confirm the prevalence of inertia as a possible factor for the failure to achieve their BP targets.

Methods:

Subjects were 517 outpatients (mean age 68.6 ± 13.2 years, 54% of women) who regularly visited the division of hypertension from March to September 2020 and took antihypertensive drugs prescribed by hypertension specialists. We calculated the average of office BP (OBP) in the two visits during the same period, and the average of home BP (HBP) for the three days before each two visits. In addition, we investigated the antihypertensive drugs taken during that period and complications such as diabetes and chronic kidney disease, and collected blood chemistry and urine test data. From these data, as of December 2021, the attending doctors determined whether each patient achieved the BP target according to the Japanese Society of Hypertension 2019 (JSH2019), and chose one reason from the options in the patients who failed to achieve target BP.

Results:

The target for OBP in all subjects was < 130/80 (48%), < 140/90 (140 group, 15%), < 140/90 mandatory, and < 130/80 if tolerable (37%). The percentage of those who achieved each OBP target was 48% (OBP achievers, N = 246). As a result of investigating the reason for the OBP non-achievement (N = 273) by the attending doctors, 20% answered “judged to be the optimal BP level (Optimal)”, 20% answered “due to the white coat effect ”, and then “Inertia” was the next highest at 14%. Regarding the achievement rate of HBP for OBP achievers, 36% did not measure HBP, 38% achieved < 135/85 or < 130/80 (HBP 135), and 26% (N = 65) did not achieve it. Among the HBP 135 other than the 140 group (N = 66), the unachieved rate of < 125/75 was 58% (N = 38). The reasons for non-achievement of HBP (N = 103 in total), “Optimal” was the most common answer (42%), followed by “Inertia” (27%).

Conclusion:

Inertia existed as a factor explaining insufficient BP control even in the patients treated by hypertension specialists. From now on, in order to increase the rate of achieving the BP target, we should make an effort to overcome inertia.
PS-C36-5: SUPEROXIDE DISMUTASE AS A PROTECTIVE FACTOR FOR EARLY RENAL DAMAGE IN HYPERTENSIVE PATIENTS
Authors: Yu Xiaoqian , Xu Rui
Published: January 2023

Background:

Hypertension is a primary risk factor for chronic kidney disease (CKD), which is a highly prevalent condition that contributes to a substantial proportion of disease burden globally. However, CKD can be reversed in the early stage of renal damage. As a result, for a better prognosis, early detection and treatment are crucial for a better prognosis. Oxidative stress had been linked to hypertensive renal impairment in previous investigations. Superoxide dismutase (SOD) was a clinically available oxidative stress biomarker that had yet to be linked to early kidney damage in hypertension. The association between SOD and the early renal damage (ERD) of hypertension has not been established. The aim of the study was to investigate the relationship between SOD and ERD, hoping to provide a new direction to prevent and treat hypertension with ERD.

Methods:

This was a retrospective observational study. Clinical data were collected from patients with essential hypertension (EH) in Shandong Provincial Qianfoshan Hospital from January 2017 to December 2018. ERD was defined as urine microablumin/ creatinine ratio (UACR) greater than 30 mg/g but less than 300 mg/g. Patients were divided into hypertension with ERD group and hypertension without early renal damage (NRD) group. Clinical data from patients were collected and compared between the two groups. Spearman and Pearson correlation analysis were used to analyze the correlation between UACR and SOD. Moreover, univariate and multivariate logistic regression analyses were used to screen for the risk factors for ERD.

Results:

According to our analysis, SOD was protective factors (P < 0.05). Multivariate logistic regression analysis showed that SOD was an independent protective factor for hypertension with ERD. Both Spearman and Pearson correlation analysis showed negative correlation between SOD and UACR (P < 0.05).

Conclusion:

SOD was an independent protective factor for early renal damage in hypertensive patients, providing a new direction for the treatment of early renal damage in hypertensive patients.
PS-P12-6: CADMIUM AND HYPERTENSION IN KINGSTON JAMAICA: ANY CORRELATION?
Authors: Hedge Tiffany , Rattray Vaughn , Coleman Novie Younger , Wilks Rainford , Nwokocha Chukwuemeka
Published: January 2023

Background:

The cadmium burden in Jamaican soil is exceptionally high. Cadmium has been found to induce hypertension in animal models but in humans, the results have been inconsistent.

Objectives:

We sought to Quantify associations of systolic and diastolic blood pressures with blood levels of cadmium in persons living in Kingston and St. Andrew. The distribution of hypertension by gender, age, BMI and other lifestyle categories and Determining the association of blood pressure with blood cadmium concentration.

Methodology: A cross- sectional study was conducted with 287 persons residing in the parishes of Kingston and St. Andrew. Demographic and lifestyle data were captured using closed ended questionnaires. Systolic and Diastolic blood pressure levels were measure using standardized protocol and blood cadmium concentration was measured by atomic absorption spectroscopy.

Results:

More than half of the respondents (58.5%) were hypertensive, with the majority being females (65.5%). There was a statistically significant relationship between hypertension status and age, X2 (3, N = 287) = 51.98, p = 0.001), and hypertension status and BMI (p = 0.008). There was a positive yet small correlation between blood cadmium concentration blood pressure measurements (systolic and diastolic). However, after multivariable adjustments, there was no association between blood cadmium concentration and blood pressure measures. Logistic regression analysis indicated that for every one unit increase in blood cadmium concentration the odds of respondents being hypertensive increase by a factor of 1.035 (95% CI 0.975–1.099) unadjusted and 1.014 (95% CI 0.951–1.808) adjusted. No association was found between dietary patterns and blood cadmium concentration.

Conclusion:

No association was found between blood cadmium concentration and blood pressure measurements (systolic and diastolic measurements) and blood cadmium concentration and dietary patterns. However a positive association was found between hypertension prevalence and blood cadmium concentration. Further studies with increased sample size will be required to improve the statistical significance among the variables of interest.
PS-P15-2: CHANGES IN HOME BLOOD PRESSURE VARIABILITY DURING DOWN-TITRATION OF ANTIHYPERTENSIVE DRUGS IN PATIENT WITH SYSTOLIC HOME BLOOD PRESSURE BELOW 120MMHG
Authors: Lee Yonggu , Shin Jinho , Pyun Wook Bum
Published: January 2023

Background:

In the guideline recommendation for intensive blood pressure (BP) control, there has been a concern for the J-curve phenomenon so European guidelines recommended down-titration if systolic BP (SBP) lowered below 120 mmHg. But there is no studies for the changes in BP and BP variability with down-titration. Aim of the study is to test the hypothesis that BP variability could be increased with down-titration.

Methods:

In a retrospective study, 82 patients undergone down-titration in whom home BP monitoring (HBPM) before and after were available were analyzed during 2020.09.01∼2022.05.31. During this period, the guideline directed medical therapy was to down-titrate when home SBP was below 120 mmHg. When preclinic SBP below 120 mmHg, down-titration was performed when home SBP was less than 120 mmHg in the next visit or incidental home SBP less than 120 mmHg regardless of clinic SBP level. Minimal and maximal required numbers of readings in HBPM were 8 and 40. Average and standard deviation (SD) were compared before after down-titration.

Results:

Mean age was 66.2(34∼95) years and female readings were 44 (53.7%). Preclinic SBP was 122.4  + /-17.5 mmHg and clinic SBP was 121.9 +/-14.2 mmHg at baseline (BL). Clinic SBP at follow up (FU) was 126.4 +/-15.5 mmHg. History of cardiovascular diseases, diabetes and hyperlipidemia were present in 17%, 32.9%, and 69.5%, respectively. Numbers of AHMS were 1 in 26.8%, 2 in 30.5%, 3 in 32.9%, and 4 in 9.7%. The uses of renin angiotensin blockade, beta blocker, calcium antagonist, and diuretics were 84.1%, 36.5%, 75.6% and 29.3%, respectively. Home SBP was increased significantly (111.6 mmHg BL, 118.8mmHg FU, p < 0.0001). SD of home SBP did not increased significantly (3.5 mmHg BL, 3.4 mmHg FU, p = 0.85). Home diastolic BP (DBP) was also increased significantly (68.7 mmHg BL, 72.8 mmHg FU, p < 0.0001). SD of home DBP did not changed (2.2 mmHg BL, 1.6 mmHg, p = 0.55).

Conclusion:

When antihypertensive drug was down-titrated due to excessive lowering of systolic BP less than 120 mmHg, mean BPs were increased modestly without increase in BP variability. Current guideline directed down-titration should be safe without increasing BP variability.
PS-P15-6: PERIPHERAL OSTEOPONTIN MIGHT BE A POTENTIAL BIO-MARKER FOR PREDICTING ARTERIAL STIFFNESS IN ELDERLY CHINESE
Authors: Fu Guoxiang , Pan Fengfeng , Xu Chanchan
Published: January 2023

Objective:

Compare the efficiency of pulse wave velocity (PWV) and ankle-brachial Index (ABI) in diabetes patients and healthy participants. Investigate novel bio-markers for aging related arterial stiffness.

JOURNAL/jhype/04.03/00004872-202301001-01307/figure1/v/2023-10-24T163949Z/r/image-jpeg

Design and method:

PWV, ABI, vascular cell adhesion molecule (VCAM), osteopontin (OPN) and glutathione peroxidase (GPX) were evaluated in elderly Chinese from March to June in 2019.

Results:

86 participants were included in the study. There were 69 male participants (80.2%), the mean age is 87.2 ± 0.5 years, the mean BMI is 23.3 ± 0.5. Of the 86 participants, 34 were diagnosed with diabetes mellitus. Compared with non- diabetes mellitus participants, ABI levels declined in left limbs of diabetes mellitus (DM) patients (0.94 ± 0.04 vs 1.02 ± 0.03, P < 0.05, separately). After adjusted by age, SBP, DBP, BMI, FPG, Cholesterol and HCT, serum OPN level was negatively correlated to both L- ABI and R- ABI (r = - 0.317, P = 0.028; r = - 0.362, P = 0.014, separately).

Conclusions:

Differential use of PWV and ABI should be considered in elderly with diabetes. Serum levels of OPN might be an independent bio-marker for predicting arterial stiffness in elderly Chinese.
Less use of rescue morphine when a combined PSP/IPP-block is used for postoperative analgesia in breast cancer surgery
Authors: Ahlberg Hans , Wallgren Daniel , Hultin Magnus , Myrberg Tomi , Johansson Joakim
Published: January 2023

BACKGROUND

Surgery for breast cancer is common, and intravenous opioids are often used to control postoperative pain. Recently, pectoralis-2 (PECS-2) block has emerged as a promising regional anaesthetic alternative. With nomenclature recently proposed, this block is termed combined PSP/IPP-block (pectoserratus plane block/interpectoral plane block).

OBJECTIVE

We aimed to compare the need for postoperative rescue morphine between the intervention group that received a pre-operative combined PSP/IPP-block and a control group that received peri-operative long-acting opioids for postoperative analgesia.

DESIGN

A randomised controlled study.

SETTING

Operating theatres of two Swedish hospitals. The patients were recruited between May 2017 and October 2020.

PATIENTS

Among the 199 women scheduled to undergo breast cancer surgery (sector resection or radical mastectomy) who were enrolled in the study, 185 were available for follow up.

INTERVENTION

All patients received general anaesthesia. The intervention group received a combined PSP/IPP-block before surgery. The control group received intravenous morphine 30 min before emergence from anaesthesia.

MAIN OUTCOME MEASURE

The primary endpoint was the cumulative need for intravenous rescue morphine to reach a predefined level of pain control (visual analogue scale score <40 mm) during the first 48 h after surgery.

RESULTS

Data from 92 and 93 patients in the intervention and control groups, respectively, were analysed. The amount of rescue morphine administered in the 48 h after surgery was significantly lower in the intervention group than in the control group (median: 2.25 vs 3.0 mg, P = 0.021). The first measured pain score was lower in the intervention group than in the control group (35 vs. 40 mm, P = 0.035). There was no significant difference in the incidence of nausea between the groups (8.7 vs. 12.9%, P = 0.357).

CONCLUSION

The use of a combined PSP/IPP-block block before breast cancer surgery reduces the need for postoperative rescue morphine, even when compared with the use of intra-operative morphine.

TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT03117894.