bluuebunny/crossref_metadata_2025 huggingface dataset:
S-46-5: THE INTRA-WEEK VARIABILITY ON HOME BLOOD PRESSURE WITH OR WITHOUT ANTIHYPERTENSIVE MEDICATION: NOSE STUDY
Authors: Kubo Mio , Godai Kayo , Kabayama Mai , Wada Arisa , Kido Michiko , Hashimoto Sumiyo , Higashi Makiko , Hatanaka Hiromi , Kikuchi Takeshi , Dodo Takayuki , Tabara Yasuharu , Asayama Kei , Ohkubo Takayoshi , Rakugi Hiromi , Kamide Kei
Published: January 2023

Objective:

Few studies have investigated weekly variations in long-term home blood pressure (BP) measurement. The aim of this study was to examine the intra-week variability and the difference in the day of the week on long-term home BP with or without antihypertensive medication.

Design and method:

This study was based on an ongoing community-based intervention study in Nose, Osaka, which was designed to assess the effect of home BP measurement on prolonging healthy life expectancy. The study included 510 participants aged 40–91 years. Participants measured their BP with an electronic oscillometric device (HEM-7281; Omron Healthcare CO., Ltd) and wrote the value on the recording book twice in morning and evening for about six months to a year. The intra-week variability in home BP were calculated as maximum minus minimum BP (MMD: maximum-minimum difference). Home BP recording for 62916 days were obtained by extracting weeks in which BP were measured on 7 consecutive days. The participants were divided into 2 groups according to with or without antihypertensive medication. The mean BP values according to the day of the week of home BP measurement were compared by one-way analysis of variance. MMD means were compared with the t-test. To identify the factors influencing on the intra-week variability in home BP, Multiple linear regression models were applied to examine.

Results:

Among participants without antihypertensive medication, morning systolic BP(SBP) was lowest on Saturday (p < 0.001) as compared with all other days of the week and evening SBP tends to be highest on Sunday. Among participants with antihypertensive medication, morning SBP tends to be lowest on Saturday and evening SBP was highest on Sunday (p < 0.001). The characteristics of the day of the week were similar for the two groups. Antihypertensive medication was not significantly associated with MMD in morning SBP in the multiple linear regression model. MMD in morning SBP had significant positive relationships with female(β = 0.05) and age(β = 0.07), measurement in winter(β = 0.04), morning SBP means(β = 0.25), respectively by p < 0.001.

Conclusions:

Evening SBP was highest on Sunday regardless of antihypertensive medication. This may be related with clinical evidence that cardiovascular events occur more frequently in the morning on Monday. Considering a variety of factors associated with the intra-week variability in home BP with or without antihypertensive medication, this observation suggested that treatment decisions against hypertension may be based on long-term home BP measurements.
S-48-3: PHYSICAL ACTIVITY AND HEALTHY AGING
Authors: Shimada Hiroyuki
Published: January 2023

Hypertension is a risk factor for dementia, and physical activity has been reported to be effective in reducing the risk of hypertension and dementia. Several technical devices are available to monitor and promote changes in behavior toward higher activity. In particular, smartphones are becoming the primary platform for recognizing human activity. However, the effects of behavior change techniques that promote physical, cognitive, and social activities on incident dementia in older adults remain unknown. We are conducting a randomized controlled trial aims to examine the effects of behavior change techniques on the prevention of dementia among community-dwelling older adults using a smartphone as a behavior change tool. The study cohort comprises 3,498 individuals, aged 60 years and over, randomized into two groups: the smartphone group (n = 1,749) and the control group (n = 1,749). Intervention. The smartphone group will be asked to use smartphone applications for at least 30 minutes daily to self-manage and improve their physical, cognitive, and social activities. The smartphone group will perform 60-minute group walking sessions using application-linked Nordic walking poles with cognitive stimulation twice a week during the intervention period. The walking poles are a dual-task exercise tool that works with a smartphone to perform cognitive tasks while walking, and the poles are equipped with switches to answer questions for simple calculation and memory tasks. The smartphone and control groups will receive lectures about general health that will be provided during the baseline and follow-up assessments. Incident dementia as primary outcome will be detected using cognitive tests (at baseline, after 15 months, and after 30 months) and by preparing diagnostic monthly reports based on data from the Japanese Health Insurance System. Participants without dementia at baseline who will be diagnosed with dementia over the 30-month follow-up period will be considered to have incident dementia. This study has the potential to provide the first evidence of the effectiveness of information communication technology and Internet of Things in incident dementia. If our trial results show a delayed dementia onset for self-determination interventions, the study protocol will provide a cost-effective and safe method for maintaining healthy cognitive aging.
S-49-4: URINARY BIOMARKER ANALYSES ON JAPANESE, MEDITERRANEAN AND EURO-WESTERN POPULATIONS: WHICH IS BETTER FOR POST-PANDEMIC LONGEVITY?
Authors: Yamori Yukio , Sagara Miki , Mori Hideki , Mori Mari
Published: January 2023

Objective:

Since nutrition could extend lifespan even in stroke-prone rats developing stroke genetically, our WHO-Collaborating Center for Primary Prevention of Cardio-vascular Diseases (CVD) started world-wide hearth examination to investigate nutrition good for healthy longevity by collecting 24-hour urine (24U) samples.

Design:

Urinary biomarkers of nutritions, sodium for salt, potassium (K) for vegetables and fruits, isoflavones(Is) for soy, taurine(Ta) for fish and magnesium (Mg) for beans and nuts were analyzed in 24U among 4211 participants (49.7% females(F)), aged 48–56 years in 50 populations from 22 countries according to WHO-CARDIAC(Cardiovascular Diseases and Alimentary Compression) Study Protocol, and studied comparatively in 6 Japanese(J), 6 Mediterranean(M) populations from Greece, Italy(2), Spain(2), Portugal and 6 Euro-Western(EW) populations from Sweden, Ireland, Scotland, Canada, Australia, New Zealand.

Results with Discussion:

The quintile analyses of Ta and Mg/creatine ratio in the world were inversely associated with CVD risks. The Odds ratios of obesity, hypercholesterolemia and hypertension in the lowest quintile of both Ta and Mg were 6.3, 4.6 and 1.8, respectively. J and M populations had significantly higher Ta and Mg therefore, lower CVD risks than EW, but J and M took more salt increasing the risk of stroke (Table 1). Despite the high salt intake, M had the merit of significantly high K intake to attenuate the adverse salt effect. J had a merit to take Is from soy containing Mg. Since Is intake was inversely associated with lower BMI in the world populations, high Japanese Mg intake was related to high Is intake which was inversely associated with obesity in Japan. In fact, the Japanese populations who took significantly higher T and Mg had lower BMI as well as higher HDL and folic acid in the blood, expected to prevent atherosclerosis and dementia. In contrast to M and EW, particularly severe obesity over BMI 30 was obviously less in J, ranking 182nd among 190 populations (WHO). The mortality rates of COVID-19 were significantly positively related to the ratio of severe obesity among 20 major countries in the world and this mortality was obviously lower in J, suggestive of the potential of J diet for post-pandemic longevity.

Conclusion:

24U biomarker analyses indicated low-salted J and M diets are recommendable for CVD prevention. J diet is so far better than M diet because of lower CVD risks such as obesity and lipidemia, which were proven by urinary biomarkers to be related with traditional fish and soy intakes.
S-49-5: PRACTICAL AND PERSONAL EDUCATION OF DIETARY THERAPY IN HYPERTENSIVE PATIENTS
Authors: Tsuchihashi Takuya
Published: January 2023

Hypertension is the most important risk factor of cardiovascular death in Japan. The annual number of deaths due to hypertension is estimated to be 100,000 persons. The number of hypertensives in Japan is estimated to be 43 million. Of these individuals, 33% are estimated to be unaware of hypertension, 11 % are aware but untreated, and 29% are poorly controlled despite ongoing treatment. Thus, measures to reduce the number of untreated and poorly controlled hypertensive patients are needed.

Lifestyle modifications including dietary therapy are quite important regardless of the use of antihypertensive drugs. Especially, salt reduction is most important because Japanese individuals still consume a significant amount of salt. The Dietary Reference Intakes for Japanese 2020, issued by the Ministry of Health, Labour and Welfare, propose a salt intake goal of < 7.5 g/day for men and < 6.5 g/day for women. Regarding the goal of salt reduction in hypertensive patients, the hypertension guideline by the Japanese Society of Hypertension 2019 (JSH2019) proposes a goal of < 6 g/day. Although salt intake in Japan gradually decreased in the early 2000 s, the declining trend has not been seen in recent years, and thus it seems difficult to achieve these target salt intake levels. To overcome this challenge, the JSH announced the JSH Tokyo Declaration and pledged to create a specific action plan to achieve the target salt intake level of < 6 g/day.

Since the awareness of salt reduction may not necessarily lead to actual salt reduction, the assessment of salt intake of the individuals is essential when the medical stuffs provide the guidance of salt reduction. In the practical clinical settings, the combination of the assessment of dietary contents using simple questionnaires and the estimation of salt intake using spot urine specimen is recommended. Repeated assessment of salt intake and the practical guidance by the medical stuffs is useful for the long-term adherence of salt reduction. Nevertheless, it is difficult to achieve the target salt intake levels. To support individuals’ efforts to reduce salt intake, the JSH Salt Reduction Committee certifies 124 delicious low-salt foods as of April, 2022. Annual sales of these products are about 45 billion yen and the reduction in salt consumption is estimated to be about 1,000 tons. Through the utilization of these products and the efforts to improve the food environment, a society with low-salt and healthy diet will be expected to come.
S-51-4: RENAL DENERVATION IMPROVES FLUID RETENTION BY MODULATING RENAL SGLT2 FUNCTION IN RATS WITH HEART FAILURE
Authors: Katsurada Kenichi , Nandi Shyam S , Patel Kaushik P , Kario Kazuomi
Published: January 2023

Objective:

Renal denervation (RDN) has been developed as a neuromodulation therapy for patients with treatment-resistant hypertension. RDN is expected to prevent not only hypertension but also heart failure (HF). Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to ameliorate HF and widely used for HF patients. The present study was conducted to assess the effect of RDN on HF and the interaction between renal sympathetic nerves and SGLT2 function in HF.

Design and method:

HF was induced by coronary artery ligation in rats. Four weeks after coronary artery ligation surgery, surgical bilateral RDN was performed. Western blot analysis was performed to assess the expression levels of SGLT2. One week after RDN surgery, as a functional test for SGLT2 activation, natriuretic response to intravenous injection of SGLT2 inhibitor dapagliflozin (0.5 mg/kg, i.v.) was investigated. Furthermore, the changes in expression and localization of SGLT2 were assessed in human embryonic kidney cells treated with norepinephrine directly, in vitro.

Results:

Western blot analysis indicated that renal SGLT2 expression is increased in rats with HF. RDN significantly reduced enhanced renal SGLT2 expression in HF. Natriuretic response to dapagliflozin were greater in HF than Sham (Cumulative sodium excretion at 120 min, 227 ± 35 vs. 133 ± 13 μEq/gkw, P < 0.05, n = 6). RDN significantly attenuated natriuretic response to dapagliflozin in HF (Cumulative sodium excretion at 120 min, 138 ± 19 vs. 227 ± 35 μEq/gkw, P < 0.05, n = 6). Direct application of norepinephrine on human embryonic kidney cells, in vitro, resulted in an increased expression of SGLT2 and specifically promoted the translocation of SGLT2 from the cytosol to the cell surface (Cytosolic SGLT2/GAPDH 0.51 ± 0.05 vs. 0.86 ± 0.08, Membranous SGLT2/Na-K-ATPase 1.06 ± 0.10 vs. 0.54 ± 0.03, P < 0.01, n = 6). Moreover, RDN increased the cytosolic SGLT2 while decreasing membranous SGLT2 in the kidneys of rats with HF (Cytosolic SGLT2/GAPDH 1.30 ± 0.11 vs. 0.58 ± 0.09, Membranous SGLT2/Na-K-ATPase 0.51 ± 0.10 vs. 2.08 ± 0.08, P < 0.01, n = 6).

Conclusions:

These findings suggest that the excessive activation of renal sympathetic nerves in HF increases the expression of SGLT2 protein trafficked by norepinephrine to cell membrane in proximal tubules resulting in greater sodium retention associated with HF condition. RDN mitigates the enhanced expression and activity of SGLT2 and ameliorates the subsequent sodium and water retention associated with HF, suggesting the potential therapeutic use of RDN for HF.
S-52-5: MEASURING DRUG LEVELS USING A DRIED BLOOD SPOT COMBINED WITH PERSONALIZED FEEDBACK TO IMPROVE RESISTANT HYPERTENSION: A RANDOMIZED CONTROLLED TRIAL
Authors: Peeters Laura EJ , Kappers Mariette HW , Hesselink Dennis A , Gelder Teun van , Koch Birgit CP , Versmissen Jorie
Published: January 2023

Introduction:

Identification of non-adherence to antihypertensive drugs is crucial to improve resistant hypertension (RH). For this therapeutic drug monitoring is the most reliable method.

Objectives:

The primary objective of this study is to determine whether drug levels measured with a dried blood spot (DBS) method combined with personalized feedback leads to a decrease in prevalence of RH after 12 months due to an increase in adherence.

Design and method:

This is a multi-center single-blinded randomized controlled trial (RHYME-RCT, NL6736). Eligible patients based on previous blood pressure readings underwent DBS sampling and a 24-hour ambulatory blood pressure measurement (ABPM) simultaneously. Patients with a daytime systolic blood pressure (SBP) > 135 and/or diastolic blood pressure (DBP) > 85 mmHg were randomized to a standard treatment (control) arm or intervention arm. The intervention was performed by the treating physician and included information on drug levels and a personalized feedback conversation based on a feedback tool. The follow-up period was one year and included visits at 3, 6 and 12 (T = 12) months inclusion. At each visit an 24h-ABPM and DBS were performed.

Results:

A total of 141 patients were measured at baseline, of which 100 patients had blood pressures > 135/85 mmHg and were randomized to the intervention (n = 49) or control arm (n = 51). The adherence rate in the excluded population (n = 41) was 78.0%. The randomized patients had a mean age of 59.4 ± 11 years and were predominantly male (70.0%). The prevalence of RH decreased from 100% in both arms to 73.2% at T = 12 in the intervention arm (p = 0.002, n = 37) and 59.1% at T = 12 in the control arm (p < 0.001, n = 41). Adherence rates improved from 67.3% to 92.1% in the intervention arm (p = 0.021) and 68.6% to 71.4% in the control arm (p = 1.000). This increase in adherence was significantly higher in the intervention arm compared to the control arm (p = 0.018). No statistically significant difference was found after 12 months between the two arms in the degree of RH (p = 0.171), SBP (p = 0.297) or DBP (p = 0.655).

Conclusions:

Measuring blood pressure and drug levels led to a decrease in the prevalence of RH in both arms and improved non-adherence in the intervention arm. However, the improvements in adherence did not lead to a lower blood pressure and degree of having RH. The fact that one third was excluded at baseline because of normotension suggests that participation in a study already leads to improvement of adherence and thus blood pressure control.
S-53-3: DEVELOPMENT OF RISK SCORES TO PREVENT CARDIOVASCULAR DISEASES
Authors: Kokubo Yoshihiro , Kashima Rena , Teramoto Masayuki , Arafa Ahmed , Shimamoto Keiko , Nosaka Saya , Maeda Saori , Kawachi Haruna , Yasui Yuka , Matsumoto Chisa , Watanabe Emi , Sakai Yukie
Published: January 2023

There are still many places where medical care does not reach. In this abstract, from the perspective of the SDGs, we can see that we should tackle the world through the problems that Japan has.

Social inequality faces many challenges that must be resolved in the future. First of all, as for income disparity, while absolute difficulties are declining worldwide, the number of relatively poor people in poverty compared to their standard of living is still increasing. Although Japan is the world’s third-largest economy, it is the worst in eight of the 41 OECD member countries.

Regional disparities and their associated population disparities are also major issues. When the population flows out, it becomes depopulated, and the town’s infrastructure deteriorates. The medical system in depopulated areas is a serious problem.

Educational disparities are caused by poverty, creating a chain of poverty. The digital divide is associated with educational inequality and can lead to health problems due to difficulty obtaining correct health and preventive information. The need for a nutritionally balanced diet to improve health is learned through education.

Gender inequality is also a serious problem that causes employment inequality, income inequality, and education inequality. Japan’s Gender Gap Index in 2019 was the lowest in the G7 and 121st among the 153 countries in the world. Japan needs to improve the gender gap radically.

As for the intergenerational disparity, Japan’s aging rate is about 30%, which is the largest in the world. Although it will continue to increase, the population will decrease sharply. As a result, the medical services received will become increasingly difficult for the elderly. Medical staff will be available when they really need it.

We have created a model for predicting incident cardiovascular disease and its subtypes. The results are returned to the participants as a joint project between Suita City and its Medical Association to prevent the aggravation of heart failure, and the results are returned on a paper basis as a personal health record. As for health guidance, we developed Lifelong Health Support 10 (LHS10) so that the examinee can objectively understand where to improve in their daily lives. We are considering creating a mechanism that allows multi-worker intervention, such as incorporating such tools on smartphones. By utilizing LHS10, it is possible to contribute to reducing social disparity as health information that is objectively simple and easy for anyone to understand.
S-53-4: HYPERTENSION AND ITS ASSOCIATIONS WITH MULTIMORBIDITY: AN ANALYSIS OF 4 MILLION PARTICIPANTS FROM MAY MEASUREMENT MONTH 2017–2019
Authors: Janssen Carolina , Wang Wei , Schlaich Markus , Schutte Aletta E , Stergiou George , Poulter Neil R , Beaney Thomas
Published: January 2023

Objective:

Hypertension is a leading cause of global morbidity and mortality and is a principal risk factor for cardiometabolic multimorbidity. Evidence regarding the prevalence of hypertension, hypertension treatment and blood pressure (BP) control is scarce in people with cardiometabolic long-term conditions (LTCs). May Measurement Month is the largest annual, global BP screening campaign providing one of the largest datasets on BP and cardiometabolic status. This study explores the association between cardiometabolic LTCs and hypertension, hypertension treatment, BP control, and mean BP.

Design and methods:

A total of 3,397,746 participants (≧18 years) from the three MMM campaigns in 2017–2019 arising from 103 countries were included. Data on three LTCs were collected: diabetes, myocardial infarction and stroke. Participants were subdivided based on number of LTCs. Hypertension was defined as having a systolic BP≧140mmHg and/or diastolic BP≧90mmHg, using the average of the second and third of three readings and/or taking antihypertensive medication. Multiple imputation was used to estimate BP readings if any readings were missing. Controlled hypertension was defined as a BP< 140/90mmHg on treatment.

Results:

Amongst all participants, 316940 (9.3%), 62731 (1.8%), and 28491 (0.8%) reported having one, two or three LTCs, respectively. There was a graded effect of increasing number of LTCs on rates of hypertension: 29.6% in those with no LTCs, and 63.0%, 68.6% and 71.2% in those with one, two or three LTCs, respectively. A similar graded effect was seen for the percentage of hypertensive participants on antihypertensive medication: 44.0% in those with no LTCs, and 79.6%, 87.1% and 89.8% in those with one, two or three LTCs, respectively. Despite higher treatment rates, BP control rates (<140/90mmHg) were similar in those with no LTCs, one or two LTCs (57.6%, 56.4% and 56.0%, respectively) but higher in those with three LTCs (67.9%). This was reflected in the average BPs of participants on treatment, with similar average BPs in those with no LTCs, one, or two LTCs (134/82mmHg, 135/81mmHg and 135/81mmHg, respectively) compared with lower BP (129/78mmHg) in those with three LTCs.

Conclusions:

With an increasing number of cardiometabolic LTCs, there was a graded increase in the likelihood of having hypertension, and amongst hypertensives, of being treated. Control rates were similar in those with two or fewer LTCs but higher in those with three LTCs, although BP control was suboptimal in all groups. Focused efforts in the higher-risk population with cardiometabolic LTCs are needed to reduce the global burden of hypertension.
S-54-7: URINARY NA/K RATIO AS THE RISK MARKER FOR ESSENTIAL HYPERTENSION
Authors: Tabara Yasuharu
Published: January 2023

Excessive sodium intake is a cause of hypertension. Further sodium restriction is needed in developed countries, but it is difficult to achieve sodium reduction to the levels indicated in the guideline. A major reason for the difficulty may be the lack of tools to easily measure daily sodium intake. Although 24-hour urine collection is an objective standard method to measure sodium intake, it is burdensome to perform in daily life. In addition, it is also important to assess potassium intake because potassium exhibits a blood pressure lowering effect. Given these backgrounds, we propose the urinary sodium to potassium ratio (Na/K) as a useful index that can represent the effect of both sodium and potassium on blood pressure. By analyzing data from cohort studies of the general population, we previously reported that spot urine Na/K was strongly associated with blood pressure measured on the same day than Na alone or salt intake estimated from the Na and creatinine values. It is important to consider that spot urine Na/K values vary greatly depending on the timing of the measurement (fasting time). The spot-urine Na/K is also affected by the meal eaten several hours before the measurement. However, because the mean 7-day spot urine Na/K measured at any given time of the day correlates closely with measurements from 24-hour urine collection over a 7-day period, repeated measurement of spot urine Na/K may be a way to accurately estimate one’s average Na/K. Another advantage of Na/K measurement is that it does not require creatinine values and can be easily measured with a small device. This advantage make daily measurement at home possible. In the near future, it may become common practice to measure Na/K along with home blood pressure. Furthermore, spot-urine Na/K is useful in hypertension prevention practice in the community. It is suitable for use in opportunities to instruct dietary behavior change, because the Na/K value represents the amount of sodium in the meal consumed immediately before the measurement. In my talk, I would like to present the current status and future prospects of spot-urine Na/K as a new risk marker for blood pressure.
S-56-3: RESPONSE OF COMMUNITY RESIDENTS TO PROMOTION OF RECOMMENDING HOME BLOOD PRESSURE MEASUREMENT AND FACTORS ASSOCIATED WITH EVERYDAY-MEASUREMENT:NOSE STUDY
Authors: Wada Arisa , Kabayama Mai , Godai Kayo , Kido Michiko , Hashimoto Sumiyo , Higashi Makiko , Hatanaka Hiromi , Kikuchi Takeshi , Dodo Takayuki , Asayama Kei , Ohkubo Takayoshi , Rakugi Hiromi , Tabara Yasuharu , Kamide Kei
Published: January 2023

Objective:

We clarify the status of home blood pressure (HBP) measurement during the first 90 days after recommendation of self-measurement and recording among community residents and factors associated with everyday-measurement.

Methods:

The study subjects were 677 participants from the intervention group of NOSE study, a intervention study of HBP measurement in community residents.NOSE study began fiscal 2020 as health and longevity project in local administration. We distributed HBP machine (Omron Healthcare HEM-7281) and recommended self-measurement and recording between August 2020 and August 2021. HBP records in the recording book were collected on March, October and December 2021. The background information included age, sex, on-site blood pressure, use of antihypertensive medications, present illness such as diabetes and dyslipidemia, smoke, drinking, exercise and employment. From HBP records, we obtained the percentage of measurement and morning HBP during the first 90 days. We divided the participants into two groups as following; Group including participants who measured HBP 6 or 7 days a week was defined as everyday-measurement group, the other participants were in not-everyday-measurement group. Each item was compared among the two group.

Results:

HBP records were obtained from 641 participants (response rate, 94.7%), of which 637 without missing data for relevant items were analyzed. Everyday-measurement group was present in 572 (89.8%) participants. About proportion of participants with treated hypertension 190 (93.6%) and 382 (88.0%) with non-treated hypertension were in everyday-measurement group. Participants in everyday-measurement group indicated significantly higher age, on-site systolic BP, and morning HBP than those in not-everyday-measurement group. There was also significantly more likely to be the proportion of hypertension treatment, no drinking habit, exercise habit, and rate of no employment.

Conclusion:

The study clarified that about 90% of the residents was able to measure their HBP almost every day, regardless of whether they are treated for hypertension or not, when recommended self-measuring and recording HBP by distributing HBP machine. Based on these results, it may be effective to reduce CVD by improving the environment for the promotion of self-measuring HBP measurement.
S-57-2: THE GUT MICROBIOME AND CARDIOVASCULAR RISK FACTORS IN HUMANS
Authors: Valdes Ana Maria
Published: January 2023

Animal studies to date have demonstrated the functional link between gut microbiota composition and cardiovascular outcomes, with specific microbial metabolites being involved. Examples of this include trimethylamine oxide (TMAO) involved atherosclerosis and more recently, studies proving that short chain fatty acids (SCFAs) acetate, butyrate and propionate are involved in blood pressure regulation and cardiovascular outcomes in animal models.

At the same time, a number of epidemiological studies have highlighted the links in humans between gut microbiome composition and both hypertension and arterial stiffness. Additional factors involved in cardiovascular disease (CVD) risk that have come from human observational studies show that circulating levels of ceramides, GlycA (a marker of glycosylated acute phase proteins) and indole propionic acid (an antioxidant predictive of insulin resistance and arterial stiffness) are all modulated by the gut microbiome and alter cardiovascular risk in general. Dietary fiber supplementation results in reduced circulating levels of both GlycA and ceramides, both of which have been proven to be predictors of major acute cardiovascular events (MACE). Changes in gut microbiome composition induced by dietary interventions accompany decreases these markers of MACE. Formal mediation analyses of such data show that the effect of gut microbiome composition on the markers of MACE is mediated by increases in circulating levels of SCFAs.

Butyrate, propionate and acetate activate the short fatty acid receptors FFAR2 and FFAR3 with different affinities, which might explain the different roles that these compounds play in blood pressure regulation and CVD outcomes. Furthermore, some SCFAs but not others are involved in modulation of the endocannabinoid system. Specifically, butyrate, but not propionate or acetate, affects endocannabinoid circulating levels and is involved in the gene expression levels of enzymes that modulate degradation of endocannbinoids. Importantly, butyrate levels can be modulated by diet but also by exercise. In addition, circulating levels of different SCFAs have different bacterial and host contributions, with serum levels of acetate being negligibly determined by gut microbiota composition (Figure 1).

Joining together the evidence from human observational and interventional studies and the data from animal model data helps us delineate a complex series of interconnected pathways from bacterially produced SCFAs to blood pressure regulation and other cardiovascular outcomes, which are modifiable by both diet and exercise.
S-58-3: HOW COULD CONTINUOUS CUFFLESS AUTOMATED BLOOD PRESSURE MEASUREMENT DEVICES CONTRIBUTE TO HYPERTENSION MANAGEMENT?
Authors: Parati Gianfranco
Published: January 2023

Evidence that hypertension is the most importat global risk factor for cardiovascular morbidity and mortality, and demonstration of the cardiovascular protection offered by antihypertensive treatment, have been based on upper-arm cuff blood pressure (BP) measurements. This approach is recommended by current hypertension guidelines for BP measurement in clinical practice, as well as for validation of novel BP measuring devices. However, the spot or intermittent BP measurements in static conditions allowed by arm-cuff devices are unable to identify and track the continuous and rapid BP changes characterizing daily life. Moreover, cuff-based BP measurements are exposed to errors related to cuff size, shape and positioning, and cuff inflation may itself induce an alerting response and produce discomfort in the users during daily activities and in particular during sleep, which may modify the measured BP levels. To face these issues, use of continuous recordings techniques, not based on arm-cuff inflation, would be required. This is possible through intra-arterial recordings, which however are not feasible in daily practice because of their invasiveness. An alternative solution is represented by photoplethysmographic volume-clamp method for finger BP monitoring which, however, is difficult to implement in clinical practice because of its cost and complexity. Technological progress is now offering an increasingly large and heterogeneous series of cuffless BP monitors, which estimate BP based on sensors, signal processing and algorithms embedded in wearable devices, smartphones or pocket devices. These cuffless devices might allow for comfortable and continuous BP recordings, detecting rapid BP changes during day and night sleep, thus offering information on both short, mid and long term BP variability. Cuffless devices might also be useful for continuous non invasive BP monitoring in different clinical settings, including ICUs, during anaesthesia, in patients with arrhythmias, hypotension/syncope, and other transient conditions affecting BP levels and variability. Moreover, cuffless BP measurement devices connected to telemonitoring facilities or smartphones apps may improve patients empowerment, adherence to treatment and long-term BP control. In spite of all these potential advantages, however, cuffless BP devices have to face specific accuracy issues, which would need refinement of specific validation protocols aimed at testing the need of individual calibration, the stability of measurements after calibration and the device actual ability to track BP changes before they might be recommended for clinical use.
AW-AD-5: HEAVY METAL EXPOSURES, BRAIN GRAY MATTER THICKNESS, AND WHITE MATTER HYPERINTENSITIES
Authors: Woo Shinyoung , Bae Munjoo , Gwak Eun Sun , Yang Sung Hee , Jeong Da Hui , Kim Bo Ram , Cho Jaelim , Kim Changsoo
Published: January 2023

Objective:

Exposure to heavy metals may affect various organs including the brain. Previous studies so far have reported mixed findings on the neurotoxicity of heavy metals. This study examined the associations of heavy metals with brain cortical thickness and subcortical volume. Additionally, check white matter hyperintensity to examine the effect of heavy metals on brain vascular.

Methods:

We included 50 year-old or older people dwelling in Seoul, Incheon, Wonju, and Pyeongchang. Airborne manganese concentration was estimated using universal kriging modelling of values from measurement at each participant's residential address. Blood heavy metals (manganese, aluminum, mercury, and lead) were also collected. Regional cortical thicknesses (frontal, parietal, temporal, occipital, insula, and cingulate) and subcortical volumes (thalamus, putamen, pallidum, caudate, hippocampus, amygdala, and nucleus accumbens) on brain magnetic resonance imaging were estimated (n = 936). White matter hyperintensity volume was additionally calculated from brain imaging data of part of the participants (n = 397). We constructed generalized linear models, adjusting for age, sex, years of education, intracranial volume, smoking history, drinking history, fasting blood glucose, systolic blood pressure, and diastolic blood pressure.

Results:

An 10 μm/m3 increase in airborne manganese concentration was significantly associated with thinner parietal (β = -0.02 mm; 95% CI, -0.04 to -0.01 mm; p = 0.012) and occipital lobes (β = -0.02 mm; 95% CI, -0.04 to -0.01 mm; p = 0.007), but with a greater volume of the nucleus accumbens (β = 18.17 mm3; 95% CI, 5.27 to 31.08 mm3; p = 0.006). An increase in log transformed blood manganese was associated with a smaller volume of the nucleus accumbens (β = -24.10 mm3; 95% CI, -39.98 to -8.23 mm3; p = 0.003).

None of the associations between airborne and blood manganese and white matter hyperintensity volume was statistically significant. Blood aluminum, mercury, and lead also did not exhibit significant associations.

Conclusion:

These findings suggest that exposure to manganese may affect the parietal lobe, occipital lobe, and nucleus accumbens. Further studies are needed on the neurotoxicity of manganese.
JS-CC: CONTROVERSIES IN ACADEMIA MINI-DEBATES
Authors: Mihailidou Anastasia S , Jones Erika , Burger Dylan , Hiremath Swapnil
Published: January 2023

Organized by the ISH Communications Committee, this session will feature two mini-debates focused on emerging controversies in academic/biomedical research. Our first debate will focus on the role of social media in an academic career and how this should be assessed in performance reviews. Dr. Anastasia Mihailidou (Australia) will argue the Pro perspective and Dr. Erika Jones (South Africa) will argue the Con. The second debate will focus on the increasing use of pre-prints in dissemination of research. Dr. Dylan Burger (Canada) will argue the Pro perspective while Dr. Swapnil Hiremath (Canada) will argue the Con. The session will emphasize effective communication in discussing these controversies and will feature a TED-style format and a more relaxed atmosphere than conventional debates. It will also include members of the Communications Committee as Panel discussants
JS-HOPE ASIA-4: TELEMEDICINE IN HYPERTENSION
Authors: Teo Boon Wee
Published: January 2023

The COVID19 pandemic resulted in lock-downs and reduction of social interactions to reduce the risks of disease transmission. Routine medical services were affected and telemedicine was rapidly adopted for the diagnosis, monitoring, and treatment of many chronic diseases including hypertension. We look at the considerations for the design and set-up of telemedicine for the management of hypertension. Many aspects need attention in order to ensure a safe, reliable, and effective program. Many regulatory agencies developed guidelines, advisories, regulations, and legislation to manage telemedicine. We examine some of these guidelines and their differences in South East Asian countries. Often, the professional clinical service standards in telemedicine are maintained by the state medical boards or councils. Additional training or certification and licensure is needed prior to providing telemedicine services. In-person visits are required when remote consultations cannot meet the professional clinical standards. Because telemedicine can traverse national boundaries, different regulators differ in their approach to the provision of telemedicine services to overseas patients. Nonetheless, the doctor must meet the same standard of care for overseas patients. Also, practice insurance will need to explicitly cover the practice of telemedicine especially for overseas patients. Besides the professional clinical standards, telemedicine differs by technology platforms, communication devices, software, and blood pressure monitoring devices. These varied devices and software require further evaluation of technical standards for safety, reliability, data privacy, storage, transmission, and licensure. Some of the guidelines also cover the need for quality improvements and technology upgrades. Regardless, there have been many studies of telemedicine in hypertension covering many aspects of care. Some can be simpler telemonitoring of blood pressure to highly sophisticated ones with devices linked to personal communicators (usually cellphone) with feedback to healthcare professionals (doctors, nurses, dietitians, pharmacists) and tagged to clinical interventions to improve the control of hypertension. Reviews of these studies show that hypertension telemedicine programs are effective but the evidence may be available in different practice settings and patient types, thus, complicating the design and recommendations. Therefore, it is important to review the type of practice and patients, determine which aspects are lacking to be targeted, and designing a good program. A good program will lead to better clinical outcomes, patient satisfaction, lower cost, reduced manpower for delivery of care, and convenience all round. Clinical practice guidelines and undergraduate and postgraduate medical training need to encompass telemedicine for the future.
JS-FMD: FIBROMUSCULAR DYSPLASIA IN ASIA: A DISEASE TO (RE)DISCOVER
Authors: Zen Kan , Fanelli Elvira , Kawarada Osami , Matsubara Kentaro , Xu Jianzhong , Persu Alexandre
Published: January 2023

The International Consensus on Fibromuscular Dysplasia (FMD) (Gornik, Persu et al. J Hypertens. 2019;37:229–252; Vasc Med. 2019;24:164–189) provided a comprehensive summary of the clinical history, diagnosis and management of FMD. However, the authors admitted that most of current knowledge on FMD has been acquired in patients of Caucasian descent. Accordingly, they expressed their commitment to include a higher proportion of patients of non-white ethnicities in existing registries. Along these lines, the European International FMD Registry and Initiative (FEIRI, coord. A. Persu, Brussels) has established collaborations with centres from Japan and China and begun to enrol patients from these countries. The 2022 meeting of the International Society of Hypertension in Kyoto is a unique opportunity to further develop the Japanese FMD initiative (coord. Kan Zen, Kyoto), the Chinese FMD initiative (coord. Jiguang Wang, Shanghai) and potentially initiatives in other Asian countries. This implies also raising awareness of Asian experts on FMD and identifying the specificities of FMD in Asia.

The objectives of the current session are: (1) to summarize the key messages of the international FMD Consensus; (2) to present preliminary data obtained in patients from Asian vs. Caucasian descent enrolled in the FEIRI registry; (3) to present current experience on the characteristics, diagnosis and management of FMD in centres from Japan (Kyoto, Osaka and Tokyo) and China (Shanghai); (4) to emphasize the specific challenges raised by FMD in Asia, particularly the differential diagnosis with Takayasu disease; (5) to open a debate with specialists of FMD in Japan and abroad, to expand the Japanese FMD initiative and to initiate new national initiatives on FMD in Asia, in collaboration with FEIRI.
RAG-SACA-2: EPIDEMIOLOGY OF HYPERTENSION IN SOUTH ASIA
Authors: Ralapanawa Udaya
Published: January 2023

Hypertension is the one of major risk factor contributes to the burden of heart disease, stroke, kidney failure, disability and premature death. According to 2019 WHO fact sheet, an estimated 1.13 billion people worldwide have hypertension while only 21% of people have it under control. Further, more than one million deaths are related to hypertension. It is projected that 1.56 billion adults (29.2%) have hypertension globally by 2025 and 75% of them will be Asians and Africans.Hypertension is the most prevalent risk factor of stroke among Asians and cardiovascular complications associated with hypertension is steeper in Asians compared to west.

Asia is a diverse region with differences in prevalence, awareness, treatment and control of hypertension. The trend of prevalence of hypertension has been vividly increased over the past two decades in South East Asian countries and numerous factors contribute to the current hypertension burden including modernization, urbanization, lifestyle changes and socioeconomic status.

Hypertension prevalence in south East Asia is 25% and is slightly higher than the global prevalence (22%). According to the data from May-Measurement-Month 2018, the prevalence of hypertension in South Asia was 29.3% and only 46% of them aware about their hypertension while 43% was on medication. However, only 23.9% of them had controlled blood pressure either with medication, life style modification or both. East Asia had the lowest blood pressure average (117.0/75.4 mm Hg). In contrast, South Asia had the highest average (124.6/78.1 mm Hg).

According to a recent meta-analysis, the prevalence of hypertension was 17.9% in Bangladesh, 20.9% in Sri Lanka,23.9% in Bhutan,25% in Pakistan,31.4% in India,31.5% in Maldives and 33.8% in Nepal. As per WHO data in 2020 among South Asians, Pakistan had highest hypertensive related death whereas Sri Lanka had the lowest (nearly 20 vs 4 per 100,000).

Overweight and obesity in women and higher waist circumference in men are significantly associated with uncontrolled hypertension. Excess salt intake (average daily intake is higher than 12 g) associated with elevated blood pressure is also considered as a specific characteristic of hypertension in Asia.

A vital issue in Asia is not just the high prevalence of hypertension, especially in some countries, but also the low level of awareness and treatment rates in many regions. Future research are necessary to implement strategies for prevention and control of hypertension, especially in low-income populations and to precisely assess the prevalence and financial burden of hypertension in the region.
PS-B02-4: GLYCINE BETAINE ALLEVIATES MYOCARDIAL HYPERTROPHY IN SPONTANEOUS HYPERTENSION RATS BY REGULATING AMPK/NF-KAPPAB/STIM1/ORAI1 SIGNALING PATHWAY
Authors: Xiao Bing , Zhao Yan , Yang Xiuchun , LU Jingchao
Published: January 2023

Background:

Spontaneous hypertension is one of the common cardiovascular diseases. Glycine betaine (GB) is a natural vitamin that has the potential to lower blood pressure. This work attempted to investigate the precise mechanism of action of GB in spontaneous hypertension.

Methods:

Spontaneous hypertension rats (SHRs) were administrated with 100, 200 or 400 mg/kg of GB by gavage, or followed by injection of lentivirus-mediated STIM1 overexpression vector. The heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart weight/body weight (HW/BW) of rats were monitored. The pathological changes of myocardium were examined by hematoxylin and eosin staining and Masson staining. The expression of gene and protein was detected by quantitative real-time PCR and western blotting.

Results:

GB at 200 and 400 mg/kg reduced the levels of HR, SBP, DBP and HW/BW in SHRs. GB decreased the cross-sectional area and fibrotic area in the myocardium, and down-regulated the expression of ANP and beta-MHC in the myocardium of SHRs. It indicated that GB treatment effectively alleviated myocardial hypertrophy in SHRs. Additionally, GB treatment enhanced p-AMPK expression and repressed the expression of p-NF-kappaB, STIM1 and Orai1 in the myocardium of SHRs. STIM1 overexpression reversed GB treatment-mediated inhibition of myocardial hypertrophy in SHRs.

Conclusion:

This study demonstrated that GB activated AMPK and repressed NF-kappaB/STIM1/Orai1 signaling pathway, which contributed to alleviate myocardial hypertrophy in SHRs. Thus, this work provides a theoretical basis for GB as an antihypertensive drug.
PS-C01-5: RELATIONSHIP BETWEEN MICROANGIOPATHY AND MACROANGIOPATHY IN DIABETIC PATIENTS
Authors: Obeid Hasan , Eveilleau Kornelia , Hallab Magid , Wessels Hester , Nasr Imad Abi , Marre Michel , Segal David
Published: January 2023

Background:

Diabetes patients are known to produce diabetic retinopathy. Pulse wave velocity (PWV) provides arterial stiffness and hemodynamic parameters. We studied the effect of diabetic retinopathy in different stages on arterial stiffness in diabetics. We measured vascular aging with a new system (pOpmètre) that measures PWV, Ankle-Brachial Index (ABI) and Central Blood pressure

Methods:

83 type 1 diabetes patients attending the clinic (59% male) aged (42 ± 1.54 years). Insulin dependent diabetic patients with retinopathy (N = 61) or without retinopathy (N = 22) with abnormal albuminuria ratio (17%), mean diabetes duration 26 years. All patients underwent vascular assessment with pOpmètre (Axelife - France). The following parameters were measured in each patient, PWV, ABI and central Blood Pressure, non-invasively and without cuff compression.

Results:

PWV correlated with the degree of retinopathy (F = 13.80; p < 10^(-4)) and with aging (r2 = 0.25; p < 10^(-4)), and with diabetes duration (r2 = 0.12; p < 0.002) independently of gender, HbA1c, smoking, BMI, diabetes duration or lipid profile. Aging and diabetes duration were not associated (ANOVA, p = 0.5) to the degree of retinopathy unlike PWV.

Conclusions:

there is a high interdependence between microvascular and macrovascular lesions in this population of well treated type I diabetic patients with or without retinopathy.