bluuebunny/crossref_metadata_2025 huggingface dataset:
P122 EXPLORING CARDIOVASCULAR RISK ENHANCERS IN WOMEN: EYE-OPENING FINDINGS TO RETHINK ASSESSMENT
Authors: Ghelfi Albertina M , Staffieri Gustavo , Sueldo Mildren Del , Miranda Gonzalo , Quintana Rosana , Lassus Melisa , Renna Nicolas , D’Andrea Ruben Mamprin , Passarino Flavia , Nieto Romina , Berbotto Leonel , Kisluk Boris , Kilstein Jorge , Berbotto Guillermo , Galindez Jorge
Published: September 2024

Background and Objectives.

Traditional cardiovascular risk (CVR) stratification does not consider CVR enhancers (CVRE). Women present under-recognized CVR factors that may lead to developing subclinical vascular lesions such as arterial stiffness (AS). AS is associated with long-term cardiovascular events and can be determined by carotid-femoral pulse wave velocity (cf-PWV). Our objective was to determine cf-PWV in women with low 10-years CVR (10yCVR) with a CVRE and to compare them with a control group.

Methods.

Multicentric cross-sectional study, carried out in 2023 in Argentina. Group-1: women, 18-59 years-old, office-BP <140/90 mmHg, low (<5%) 10-yCVR using WHO's Calculator for Argentina, with a CVRE: history of gestational hypertension/preeclampsia; previous oncological treatment in current complete remission; autoimmune hematological or rheumatic disease in clinical remission; history of abortions/preterm births; early menopause/menarche; anxiety/depression disorder. Patients with cardiovascular event, chronic renal disease, diabetes, chronic hypertension, target organ lesion, 10-yCVR≥5%, and those on antihypertensive, statins, or aspirin treatment were excluded. Group-2: healthy women who attended routine control. Consecutive sampling. Office-BP were obtained with Omron-M3. cf-PWV was measured non-invasively through Aortic. AS was defined if cf-PWV exceeded 95% confidence interval (95%CI) upper limit for healthy Argentine population. Institutional Research Committee's approval and informed consent were obtained. Data was analyzed using SPSS for Windows.

Results.

Included 199 women: Group-1 (N=119); Group-2 (N=80). No differences were found between groups concerning age, weight, height, body mass index and heart rate. Group-1 showed higher cf-PWV: 6.89±1.08 vs. 5.56±0.65 (p<0.0001) and higher AS frequency: 57.1% vs. 2.5% (p<0.0001). In multivariate analysis only CVRE maintain related with AS (p<0.0001).

A sub-analysis was performed excluding subjects with high-normal office-BP (27.6% of sample): 144 women remained, 77 (53.5%) in Group-1 and 67 (46.5%) in Group-2. Central (aortic) systolic-BP was <121 mmHg in all cases. Group-1 showed higher cf-PWV: 6.62±0.88 vs. 5.59±0.62 (p<0.0001) and AS: 51.9% vs. 1.4% (p<0.0001).

Conclusions.

Women with CVRE showed greater cf-PWV and higher proportion of AS.
P130 TO ASSESS THE SENSITIVITY OF ANKLE BRACHIAL INDEX, WAIST TO THIGH RATIO AND HEIGHT TO WAIST RATIO AS A PREDICTOR OF HYPERTENSION
Authors: Patil Vishal , Patil Mansi
Published: September 2024

Materials and Methods:

This cross-sectional study included 1000 subjects and spanned from August 2021 to December 2023. It compared Height to Waist Ratio (HtWR), Ankle Brachial Index (ABI), Waist to Thigh Ratio (WTR), and Wrist to Arm Ratio (WAR) against established markers like Waist to Height Ratio (WHtR), Waist to Hip Ratio (WHR), and Body Mass Index (BMI) to assess their effectiveness in measuring body composition.

Results:

Out of 750 participants, 40% (n=400) were males and 60% (n=600) were females. Among them, 44% (n=440) were non-hypertensive, while 56% (n=560) were hypertensive. For males, HtWR (AUROC: 0.677) and Inverse ABI (AUROC: 0.611) showed superior predictive capability for hypertension compared to other measures. Conversely, among females, Waist to Thigh Ratio (AUROC: 0.669) was the most effective predictor. Cut-off values for WTR in females were 1.55, while for males, HtWR and Inverse ABI were 2.3 and 2.84, respectively.

Conclusion:

Among males, height to waist ratio and inverse ABI proved more reliable for predicting hypertension, while in females, waist to thigh ratio was more sensitive. Among males, HtWR (AUROC: 0.677) and Inverse ABI (AUROC: 0.611) were superior predictors of hypertension, while females showed a higher predictive capability with Waist to Thigh Ratio (AUROC: 0.669). Specific cut-off values were established: 1.55 for WTR in females, and 2.3 for HtWR and 2.84 for Inverse ABI in males. These gender-specific findings inform tailored hypertension risk assessment strategies. This study suggests incorporating inverse ABI into both clinical and community-based hypertension screenings to enable earlier detection.
P131 URBAN-RURAL PATTERNING OF BEHAVIORAL AND ANTHROPOMETRIC CORRELATES OF HYPERTENSION AMONG THE AO NAGAS OF NAGALAND, INDIA
Authors: Pongen Imkongtenla , Doley Likhan Chandra , Dzuvichu Keviphruotsu , Kapoor Satwanti
Published: September 2024

Background and objectives:

In the context of an epidemiological and nutrition transition among the ethnic groups in India, leading to an increase in prevalence of hypertension, this study aims to explore the urban-rural pattern of behavioral and anthropometric correlates of hypertension among the Ao Nagas of Nagaland, India.

Materials and Methods:

A total sample of 1250 Ao Nagas, aged 20-49 years, residing in city, town and village areas were examined for blood pressure, body weight, height and waist circumference. Interview was taken using the WHO stepwise tool for the surveillance of NCDs. The behavioral and anthropometric correlates of hypertension were determined using multinomial logistic regression in SPSS 17.0. The presence of hypertension was considered as the outcome variable.

Results:

In the city, the male residents in the older age group (35-49 yr) had 3.53 times higher risk of been hypertensive than those in the younger age group (20-35 yr). Overweight males had 3.23 times higher risk of been hypertensive than those who had normal weight. Females in the older age group had 5.48 times higher risk of been hypertensive than the females who were in the younger age group. In the town, males who were abdominally obese had 2.93 times higher risk of been hypertensive as compared to those who were not abdominally obese. In the village, males who were overweight had 5.66 times higher risk of been hypertensive as compared to those who had normal weight. Females in the older age group had 1.89 times higher risk of been hypertensive as compared to those in the younger age group. Abdominally obese females had 3.45 times and those who consume alcohol had 6.22 times risk of been hypertensive as compared to females who were not abdominally obese and who doesn’t drink alcohol.

Conclusion:

Age, abdominal obesity, overweight and alcohol consumption were significantly associated with hypertension.
P142 ADHERENCE TO PHYSICAL ACTIVITY GUIDELINES IN MAY MEASUREMENT MONTH 2021 AND 2022 PARTICIPANTS
Authors: Mafara Lilia , Kerr Gabriele , Beaney Thomas , Schlaich Markus , Schutte Aletta E , Stergiou George , Poulter Neil
Published: September 2024

Background and Objective:

Physical activity (PA) lowers blood pressure (BP) and improves other cardiovascular risk factors, but many adults fail to achieve recommended PA levels. We aimed to evaluate adherence to the World Health Organisation's (WHO) PA guidelines and associations with BP treatment and control rates amongst adults screened in May Measurement Month (MMM) 2021 and 2022.

Methods:

Adults (≥18 years) were surveyed opportunistically from 74 countries. Each participant had three seated BP readings, using multiple imputation for any missing values. Participants who self-reported (yes/no) adherence to the WHO PA guidelines (75 minutes of vigorous exercise or 150 minutes of moderate exercise per week) were included. Hypertension was defined as a BP ≥140/90mmHg and/or taking BP-lowering medication.

Results:

Of 1,357,575 participants screened, 1,098,038 (80.9%) provided information on PA adherence. The mean (standard deviation) age was 46.8 (16.8) years and 52.9% were female. 333,214 (30.3%) participants adhered to PA guidelines. Of 394,444 (35.9%) participants with hypertension, PA adherence was higher in the 211,900 (53.7%) treated with BP-lowering medication (33.2% vs 27.4%, p<0.0001) than those untreated. Amongst treated hypertensives, adherence was higher in those with controlled BP (Table) and increased with age (p<0.0001). Of participants not taking BP-lowering medication, higher adherence was reported by the 703,594 (79.4%) normotensive participants (p<0.0001) and adherence was highest in the 18–29 age group.

The absolute rates of PA adherence were 40.3%, 37.3% and 36.2% in those with a history of diabetes, stroke and myocardial infarction, respectively, compared to 29.7, 30.3, 30.2% in those without these respective conditions (all p<0.0001).

Conclusions:

Only 30% of MMM 2021 and 2022 participants worldwide adhered to WHO PA guidelines. Compared with untreated hypertensive participants, adherence was higher amongst those taking BP-lowering medication. PA adherence was significantly higher in those with diabetes. Those adhering to PA guidelines were more likely to have BP <140/90 mmHg, regardless of taking BP-lowering medication, emphasising the importance of PA for BP control.
P147 EFFICACY AND SAFETY OF SACUBITRIL/VALSARTAN VERSUS AMLODIPINE IN JAPANESE PATIENTS WITH ESSENTIAL HYPERTENSION: A RANDOMIZED, OPEN-LABEL, MULTICENTER STUDY (PARASOL STUDY)
Authors: Yamamoto Koichi , Yarimizu Daisuke , Shimanishi Ayano , Eguchi Shunsuke , Iekushi Kazuma , Kario Kazuomi , Rakugi Hiromi
Published: September 2024

Background and Objective:

Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor, is shown to be superior to renin-angiotensin system inhibitors in terms of blood pressure (BP) lowering effect in several clinical trials. However, there is limited evidence on the BP-lowering effect of sacubitril/valsartan in comparison with amlodipine, a widely used calcium channel blocker (CCB), and potent BP-lowering effect. This study is to investigate the efficacy and safety of sacubitril/valsartan monotherapy compared with amlodipine monotherapy in Japanese patients with essential hypertension. (jRCTs051220165)

Methods:

This was a multicenter, randomized, open-label, parallel-group, and active-controlled study conducted in Japan. Male or female Japanese patients aged 18 to 79 with either treated or untreated mild to moderate essential hypertension were eligible for this study and randomly assigned to the sacubitril/valsartan 200 mg group or amlodipine 5 mg group. Each study drugs were administered once daily for eight weeks. The primary endpoint was to demonstrate the non-inferiority of sacubitril/valsartan versus amlodipine in mean change from baseline for 24-h systolic blood pressure (SBP) after eight weeks of treatment.

Results:

A total of 359 patients were randomized in this study (sacubitril/valsartan group n=182, amlodipine group n=177; mean age was 58.3 and 58.1 years, 75.3% and 74.0% were male, baseline BPs were described in Table). At week 8, mean reductions from baseline for mean 24-h SBP in sacubitril/valsartan were non-inferior to that in amlodipine (between-treatment difference: −0.6 mmHg [95% CI: −3.2 to 2.0; P=0.003 for non-inferiority, independent t-test]). In addition, other BP parameters in sacubitril/valsartan were comparable to those in amlodipine (Table). For the investigator-reported adverse events, seven hypotension-related events (3.8%) were observed in sacubitril/valsartan and three events (1.7%) in amlodipine.

Conclusions:

In Japanese patients with essential hypertension, the BP-lowering effect of sacubitril/valsartan was non-inferior to that of amlodipine, and no marked differences in tolerability were observed. Early initiation of sacubitril/valsartan in hypertensive patients is expected to achieve good BP control, similar to the widely used CCB.
P159 USING WHATSAPP AS A MEDIUM FOR HEALTH EDUCATION ON SELECTED LIFESTYLE MODIFICATIONS IN HYPERTENSION MANAGEMENT
Authors: Posiano Aaron , Kalimbira Alexander , Gondwe Tapiwa
Published: September 2024

Background and Objective:

Lack of hypertension knowledge negatively affects adherence to lifestyle modifications among hypertensive individuals. Recommended health education for on-going support and self-management can prove difficult to organise for frequent face-to-face sessions. This study aimed at determining the efficacy of using WhatsApp Instant Messaging (WIM) as a health education medium of selected lifestyle medications among hypertensive individuals.

Methods:

The study used a quasi-experimental design with 24 and 17 subjects in treatment and comparison groups respectively at Queen Elizabeth Central Hospital and run for 6 weeks. Treatment group was supplied with selected health education regarding lifestyle modifications related to hypertension management; physical activity (PA), dietary patterns (DP) and weight management (WM) on a WhatsApp group while the comparison group received none. Data was collected before and after intervention. Data were analysed using Pearson's Chi Square and T-Tests in IBM SPSS Statistics version 23 at 5% significance.

Results:

At baseline there were no significant differences (p=0.270) in PA between treatment and comparison groups while at endline the differences became significant (p=0.020) meaning that the intervention increased the chances of an individual being physically active. Changes were observed in WM, as weight dropped, on average, by 0.14 kg in the treatment group and increased by 1.6 kg in the comparison group. Mean differences between baseline and endline of the weights were not significant in both groups. Consequentially, the body mass indices decreased in the treatment group (mean decrease=0.12kgm-2) and increased in comparison group (mean=0.82kgm-2). Change in the comparison group was significant (p=0.045). Changes in food frequency of selected food groups were not significantly different.

Conclusions:

WIM has the potential of being an excellent medium of health education to enhance lifestyle modifications in the management of hypertension.
P161 INVESTIGATION OF BIOACTIVE FLAVONOID SOURCED FROM CITRUS FRUITS ON ITS EFFECT UPON CARDIAC HYPERTROPHY: AN EXPERIMENTAL STUDY
Authors: Sharma Jatin , Bhatia Jagriti , Arya Dharamvir SIngh
Published: September 2024

Objectives:

Cardiac hypertrophy is an adaptive process of the heart. It is a leading cause for heart failure, which in turn has a high mortality rate. Hesperidin (HES) is a bioactive flavanone glycoside with agonistic activity on Peroxisome Proliferator-Activated Receptor gamma (PPAR-γ), reported to be an inhibitor of cardiac hypertrophy signalling pathways. Therefore, we investigated the cardio-protective effect of this bioactive flavonoid in isoproterenol induced cardiac hypertrophy.

Methods:

The work was started after getting approval from the institutional animal ethics committee (IAEC). Male albino Wistar rats were divided into 6 groups (n=6) and administered isoproterenol (3 mg/kg/day s.c.) or hesperidin (200 mg/kg/day, p.o.) and isoproterenol or enalapril (30 mg/kg/day p.o.) and isoproterenol or a combination of hesperidin and enalapril for 28 days. On the 29 th day, rats were anaesthetized followed by cannulation of coronary artery to record hemodynamic parameters. Blood sample was collected and heart was excised to evaluate for parameters like biochemical, histopathological, ultrastructural and immunohistochemical studies.

Results:

Hesperidin significantly normalized heart weight/body weight ratio and cardiomyocyte area in the treated rats. Moreover, hesperidin improved cardiac function and attenuated pathological changes as seen in the heart tissue sections. A decline in the levels of cardiac injury markers (CK-MB, LDH) and inflammatory markers TNF-α, IL-6) was observed.

Additionally, hesperidin suppressed oxidative stress and apoptosis along with an increased PPAR-γ expression.

Conclusion:

Hesperidin has a good potential for attenuation of cardiac hypertrophy and acts by virtue of its PPAR-γ agonistic, anti-inflammatory, anti-apoptotic and anti-oxidant properties.
P165 HEMODYNAMIC PROFILES OF ISOLATED DIASTOLIC HYPERTENSION IN AMBULATORY BLOOD PRESSURE MONITORING
Authors: Álvarez-Montoya Diego , Gallo-Villegas Jaime , Aristizábal-Ocampo Dagnovar
Published: September 2024

Background and Objective:

Isolated diastolic hypertension (IDH) is a prevalent form of high blood pressure (BP), especially among young individuals. Yet, its association with cardiovascular disease risk and the necessity of treatment remain subjects of ongoing debate. Our research endeavors to elucidate hemodynamic profiles using a non-invasive method applied to 24-hour ambulatory blood pressure monitoring (24-h ABPM). However, uncertainty persists regarding whether distinct hemodynamic profiles exist within IDH patients, considering they are characterized by normal total arterial compliance (Ct). This study aims to shed light on potential variations in hemodynamics within the IDH population, providing valuable insights for personalized treatment.

Methods:

A cross-sectional study was conducted, involving 7,202 patients referred to an outpatient cardiology center for suspected arterial hypertension. These patients underwent 24-h ABPM. The study included individuals over 18 years old without a prior diagnosis of hypertension and not taking antihypertensive medication. Two groups were included: those with IDH, defined as diastolic blood pressure >80 mmHg (24-h ABPM), and those with normotension. Hemodynamic parameters were estimated using a published method to estimate Ct. Silhouette analysis determined the number of underlying groups within the IDH cohort, while cluster analysis classified these subgroups.

Results:

Among the participants, 59.0% were female, with an average age of 49.0±14.0 years. Of the total patients included, 3,424 (47.5%) had isolated diastolic hypertension (IDH). Silhouette analysis effectively distinguished two groups. Group IDH-1 exhibited normal Ct and systemic vascular resistance (SVR), elevated heart rate (HR), and higher cardiac index (CI) (P value <0.001). Conversely, group IDH-2 demonstrated high Ct and SVR, lower HR, and CI (P value <0.001) (Table).

Conclusions:

The delineation of two distinct hemodynamic profiles within IDH is significant. The first group demonstrates a cardiogenic hypertension profile, indicated by elevated CI, whereas the second group presents a profile characterized by heightened SVR. These contrasting hemodynamic patterns offer valuable insights for tailoring treatment strategies to individual patient needs.

Table. Comparison of hemodynamic variables between normotensives (NT) and two isolated diastolic hypertension (IDH) profile, utilizing ANOVA for statistical analysis.
P178 CENTRAL OR PERIPHERAL INJECTION OF A FORMULATION CONTAINING THE ANGIOTENSINERGIC DIPEPTIDE ASP-ARG REDUCES ARTERIAL PRESSURE AND CARDIAC INOTROPY IN HYPERTENSIVE RATS
Authors: Mendonça Michelle , Silva Sarah , Brasil Maria , Pedrino Gustavo , Castro Carlos , Menani José , Colombari Débora , Cilli Eduardo , Xavier Carlos , Colombari Eduardo
Published: September 2024

Background and objective:

Acute injection of Angiotensin 1-2 [Ang-(1-2)] reduced arterial pressure and heart rate, and improved coronary perfusion in normotensive and hypertensive rats. Formulations that confer stability and protection against proteolysis are requisites to the feasibility peptides. Next, we evaluated in rats the cardiovascular effects of peripheral or central injections of a complex containing Ang-(1-2) surrounded by a cyclodextrin.

Methods:

Ethics committee approval by CEUA-FOAr/UNESP 15/2022. We used male Holtzman rats that underwent 2 kidneys, 1 clip (2K1C) hypertension or sham surgery. Six weeks later, rats were separated in different experimental sets (n=4-6 per group) and were instrumented for intracerebroventricular (i.c.v.) and intravenous (i.v.) injections while recording arterial and cardiac left ventricular pressures. The dipeptide was injected i.c.v. (1, 25, 50 and 250pmol/2 μL) or i.v. (25mmol/0.1 mL).

Results:

dipeptide i.c.v. (25, 50 or 250pmol) reduced arterial pressure of normotensive rats (Δ=-20±3, -20±1 and -18±7mmHg respectively, P<0.05 vs. baseline). In 2K1C, the antihypertensive effect was observed at all doses (Δ=-19±4, -26±5, -19±3 and -17±1mmHg respectively, P<0.05 vs. baseline). I.v. injection of the dipeptide evoked slight increase in arterial pressure (Δ=7±3mmHg; P<0.05 vs. baseline) that was accompanied by a positive inotropic effect (Δ=524±159mmHg/s; P<0.05 vs. baseline). In 2K1C, this same injection reduced arterial and ventricular pressures (Δ=-14±4 and -20±1mmHg respectively, P<0.05 vs. baseline), and caused negative inotropy (ΔLVdP/dtmax=-1140±170mmHg/s; P<0.05 vs. baseline). I.c.v. injection of dipeptide in anesthetized normotensive rats discretely increased arterial and ventricular pressures, while in 2K1C group it reduced arterial and ventricular pressures (Δ=-17±3 and -18±4mmHg respectively, P<0.05 vs. baseline). The ratio between the variations in contractility and mean arterial pressure revealed afterload-independent inotropic effects, i.e, the dipeptide directly affects heart performance of 2K1C.

Conclusions:

The formulation containing Asp1-Arg2 reduces arterial pressure and modulates cardiac function during hypertension. Whether Ang-(1-2) acts through some antagonism on Angiotensin II receptors or other paths remain to be investigated.

Support: CONFAP-FAPESP/FAPEG 2019/24154-3, PROPe-UNESP 13/2022, CNPq-404079/2021-0 and FAPEG-202310267000206.
P182 AORTIC VASCULAR BIOMARKERS FOR THE EARLY DETECTION OF PLACENTAL SYNDROMES DURING PREGNANCY: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Bentley Gisele J. , Cox James R. , Liao Catherine , Avolio Alberto , Qasem Ahmad , Butlin Mark
Published: September 2024

Background:

Placental syndromes (PS) cause over 14 million complications and the death of more than 350,000 women each year. Women with preeclampsia (PE) or gestational hypertension (GH) typically exhibit late gestational acute brachial hypertension, making early intervention difficult. Non-invasive aortic waveform assessments provide nuanced insight to global cardiovascular function. Our objective is to delineate cardiovascular differences between complicated and normotensive pregnancies (NP), to identify early vascular markers of at-risk women.

Methods:

A systematic search (March 2024) for studies reporting both NP and PS pregnancies was performed across five databases: PubMed; Medline; CINAHL Complete; Web of Science; and Scopus. Inclusion criteria required reporting before, during (trimester: T1; T2; T3), or after pregnancy (< 1 year post-delivery) of at least one of the following vascular biomarkers from aortic pulse pressure waveform: aortic systolic blood pressure (aSBP); aortic pulse pressure (aPP); augmentation index normalised to a heart rate of 75 bpm (AIx@75); or arterial stiffness measured by carotid femoral pulse wave velocity (cfPWV). A meta-analysis of continuous random-effects model calculated Hedges’ g with 95% confidence intervals.

Results:

The systematic search yielded 19 studies. Analysis depicted PS having significantly higher aggregated measures than NP throughout pregnancy (p <0.001) and a stronger effect size of AIx@75, aSBP, cfPWV in each trimester [T1, Hedges g 1.4(CI .64 - 2.0); T2, 1.1(CI .64 - 1.5); T3, 3.4(CI 2.1 – 4.6) p<0.001]. Overall, cfPWV had the highest effect size particularly during T1 and T3 [T1, 2.8(CI 2.5 – 3.1); T2, 1.7(CI 1.2 – 2.1); T3, 5.3(CI 4.6 – 5.9)]. Low aPP reporting allowed only analysis of T3 which showed similar effect sizes to other markers [3.14(CI 1.23 – 5.05)].

Conclusions:

Early indication of PS was quantifiable from vascular biomarkers, along with each trimester of pregnancy being elevated compared to NP. Pulse wave analysis and arterial stiffness assessment could enhance risk assessment from as early as the first trimester, improving and informing prenatal care.
P186 ASSESSMENT OF ECHOCARDIOGRAPHY INDICATORS AND ENDOTHELIAL DYSFUNCTION IN PREGNANT WOMEN WITH GESTATIONAL ARTERIAL HYPERTENSION
Authors: Sadulloeva Mokhinur , Zakirova Feruza
Published: September 2024

Background and Objective:

Hypertensive disorders during pregnancy occur in 5–10% of pregnant women worldwide. In Central Asia, hypertension accounts for 14.5% of all maternal deaths. To identify the features of hemodynamic parameters in pregnant women with gestational arterial hypertension (GHTN).

Methods:

Study included 74 women, who were divided into 2 groups: Group I healthy pregnant women (n=44) and Group II pregnant women with HAG (n=30) according to 2018 ESC/ESH. All pregnant women underwent medical history collection, blood pressure measurement, ECG, B-mode echocardiography, 24-hour blood pressure monitoring, and endothelial function was determined based on an ultrasound cuff test. Statistical analysis of the obtained data was carried out using the STATISTICA 13 program. P <0.05 was considered statistically significant

Results:

The compared groups were comparable in age (27.24±5.79 years vs. 29.07±6.51 years, P = 0.2085), number of pregnancies (2.55±1.63 vs. 2.5±1.35 P = 0.8901), childbirth (2.11±1.13 vs. 2.13±1.02 P = 0.9378) and gestational age (28.4±3.89 vs. 29.6±4.86 P = 0.2632). The average BP level in II group corresponded to moderately elevated BP, amounting to SBP of 153.17±8.14 mmHg vs 102.72±10.42 mmHg (P<0.0001), according to DBP 96±4.62 mmHg. vs 64.77±5.9 mmHg. in group 1 (P <0.0001). Body mass index was normal in 37 women (84%) with normotension, while all pregnant women (100%) with GAG were overweight (n=14; 46.6%) and obese (n=16; 53.4%) respectively. Analysis of central hemodynamic parameters did not reveal any signs of cardiac remodeling (LVH, LVDD). Echocardiography did not reveal any statistically significant deviations. But in pregnant women with GHTN, signs of endothelial dysfunction were revealed according to the results of the cuff test ^D (%) was 7.93 ± 2.03 versus 10.97 ± 2.73 (P < 0.0001).

Conclusion:

According to the results of this study, initial manifestations of diastolic dysfunction were identified among pregnant women with GHTN who are overweight.
P206 ANALYZING ATTRITION POINTS IN INDONESIA'S HYPERTENSION CARE CASCADE: STUDY OF 200,000 POPULATION FROM 2013-2018
Authors: Muharram Farizal Rizky
Published: September 2024

Background:

According to NCDRisC, Indonesia ranks as the worst performer globally in hypertension control, with control rates of 5.1% for females and 3.6% for males, despite having an income level with better potential outcomes. Hypertension is a leading risk factor for cardiovascular disease (CVD), and its management is critical for reducing major CVD risks. This study aims to identify the significant attrition points in the hypertension care cascade in Indonesia, focusing on identifying where the most significant drop-offs occur at each stage.

Methods:

The study utilizes data from the 2018 Indonesian Basic Health Research (RISKESDAS), a nationally representative health survey sample of ∼1 million individuals. The hypertension care cascade was divided into stages: prevalence, diagnosis, treatment, and control. Descriptive statistics and attrition analysis were used to analyze the data.

Results:

Indonesia managed to diagnose 29.6% of its hypertensive population and treat 23.4%, yet only 4.4% achieved control over their condition. Between 2013 and 2018, diagnosis rates slightly decreased from 33.5% to 29.6%, while treatment rates significantly improved, doubling from 10.7% to 23.4%. Control rates modestly improved by ∼60% from 2013 to 2018, from 2.6% to 4.4%. The diagnostic phase showed the highest attrition, with over 70% of the hypertensive population undiagnosed. Improvement in diagnosed-to-treated performance was observed, with conversion rates increasing from 32% in 2013 to 79% in 2018. However, the treatment-to-control conversion remained low at 18%, indicating that 19% of the treated hypertensive population did not achieve control. Huge care gaps are shown in males vs females (Figure 1). Overall, more than 95% of the hypertensive population remains uncontrolled.

Conclusion:

The most significant drop in the hypertension care cascade occurs at the diagnostic phase, where over 70% of the hypertensive population remains undiagnosed. Despite improvements in treatment rates, the conversion from treatment to control remains low. Addressing the diagnostic gap is critical for enhancing hypertension control and reducing CVD risks in Indonesia.
P207 MAY MEASURE MONTH 2022 AND 2019: AN ANALYSIS OF BLOOD PRESSURE SCREENING RESULTS PRE COVID-19 AND POST COVID-19 FROM ULAANBAATAR, MONGOLIA
Authors: Myanganbayar Maral , Davaadamdin Orkhonselenge , Badamsambuu Tuyajargal , Erdenebat Solongo , Beaney Thomas , Poulter Neil R , Dashtseren Myagmarsuren , Dashdorj Naranjargal
Published: September 2024

Background:

Mongolia has experienced high mortality rates from ischaemic heart disease and haemorrhagic stroke, with hypertension as a major risk factor. Two separate hypertension screening campaigns were conducted: the May Measurement Month (MMM) campaign in May 2019 and a follow-up campaign after the COVID-19 pandemic between July and September 2022.

Methods:

The 2019 MMM campaign involved screening at 80 sites, primarily workplaces, using trained health volunteers. Blood pressure was measured using clinically verified digital devices. In contrast, the 2022 campaign was conducted at five primary healthcare centers in Ulaanbaatar, with participants voluntarily attending the screening, where blood pressure was measured over three sessions.

Results:

In 2019, 6522 individuals were screened, with a hypertension prevalence of 32.5%, where 62.2% were aware of their condition and 50.1% were on medication. The control rate among those treated was 27.1%. In 2022, 1774 individuals were screened, showing a higher prevalence of 56.1%, with 95.4% awareness and 52.7% receiving treatment. The control rate for treated individuals was significantly higher at 48.5%.

Conclusion:

Both campaigns highlight the critical public health issue of hypertension in Mongolia. The increase in hypertension awareness and control rates in 2022 may be due to smaller sample size and participants are already patients who came to visit primary healthcare centers.However, the persistent high prevalence of hypertension underscores the need for continued prioritization and enhanced strategies in hypertension management.
P216 STUDY OF BLOOD PRESSURE VARIABILITY DURING DIFFERENT PHASES OF MENSTRUAL CYCLE IN APPARENTLY HEALTHY FEMALES
Authors: Bajpai Manish , Singh Shweta
Published: September 2024

Background and Objective:

Variability is an intrinsic property of blood pressure and is essential for physiological adaptability, blood pressure variability can be spontaneous and especially striking during physical activity and emotional and hormonal challenges like menstruation.

Methods

30 Females in the age group 18 to 35 years having regular ovulatory cycles, not undergoing any medication were included in the study.

Blood pressure variability was measured by Ambulatory blood pressure monitoring using ABPM machine (A&D Japan). for 24 hours at midpoint of menstrual, proliferative and luteal phases of menstrual cycle considering ovulation on (X-14) where X is the last day of menstrual cycle.

Observation:

In the menstrual phase, mean systolic B.P.is 103.8 mm of Hg SD +/- 15.25, proliferative phase mean is 105.41 mm Hg, SD +/- 7.33 luteal phase mean is 124.13 mm Hg, SD +/- 10.6.(P < 0.001).

Comparison of mean changes in diastolic blood pressure between menstrual, proliferative and luteal phase shows mean of 63.6 mm Hg SD +/- 15.75, 68.4 mm Hg SD+/- 5.66 and 76.32 mm Hg SD +/- 6.7. (P < 0.001) respectively.

Mean arterial pressure (MAP) in the menstrual phase of 78.03 mm Hg, SD +/- 10.95 proliferative phase 79.91 mm Hg SD +/- 6.34 and luteal phase mean is 89.58 mm Hg +/- 5.49(P < 0.001).

Results-: This study shows that the systolic B.P. tends to rise in the luteal phase, also the diastolic B.P. rises significantly in the luteal phase.

There is marked dipping in the night time blood pressure in all phases when compared to day time blood pressure and the daytime blood pressure is elevated in the luteal phase compared to menstrual and proliferative phases.

Conclusion

Therefore, we can conclude that in luteal phase, the systolic, diastolic blood pressure and mean arterial pressure was significantly higher than the other two phases. The daytime BP was also high in luteal phase compared to other two phases.
P218 MAY MEASUREMENT MONTH 2019: BLOOD PRESSURE VARIABILITY AND ITS RELATIONSHIP WITH HYPERTENSION AND COMORBIDITIES
Authors: Kerr Gabriele , Beaney Thomas , Schlaich Markus , Schutte Aletta , Stergiou George , Poulter Neil
Published: September 2024

Background and Objective:

Within-visit blood pressure variability (BPV) is a predictor of cardiovascular events, independent of mean blood pressure (BP) levels. This study explored the associations of BPV with hypertension status and comorbidities in May Measurement Month (MMM) 2019 global survey participants.

Methods:

Adults (≥18 years) were surveyed via convenience sampling from 92 countries in May 2019. Each participant had up to three standardized seated BP readings. Participants with incomplete data on age or sex, or any missing BP readings were excluded. Hypertension was defined as having a BP ≥140 and/or 90 mmHg or being treated with BP-lowering medication. Participants were stratified into three groups: normotensive, untreated hypertensives, treated hypertensives, and normotensives. BPV was calculated as the variation independent of the mean (VIM) of the three BP readings. Associations between BPV and each of three conditions (previous stroke, previous myocardial infarction, or diabetes) were modelled using linear regression. Each model was adjusted for mean BP, age, sex, and an interaction term between age and sex.

Results:

Data from 1,128,889 participants were included. The mean age was 45.2 (SD 16.6) years and 51.4% were female. A third (33.6%) of participants were hypertensive, of whom 200,370 (53.2%) were treated. Of non-hypertensive and untreated hypertensive participants, those with a history of stroke, myocardial infarction, or diabetes had lower BPV relative to those without a history of these conditions (Figure). A stronger association was observed for diabetes within untreated hypertensive than non-hypertensive participants. However, amongst treated hypertensive participants, differences in BPV between those with comorbid conditions and those without were smaller than in the other two groups.

Conclusions:

Contrary to expectation, BPV was significantly lower in those with diabetes, or a history of stroke or myocardial infarction, amongst both untreated hypertensives and normotensives. However, among treated hypertensives, BPV was similar between those with or without each comorbidity, suggesting a modifying effect of BP-lowering medication.
P223 BENEFICIAL EFFECT OF ACEI/ARB, BETABLOCKER AND MINERALOCORTICOID RECEPTOR ANTAGONIST IN PATIENTS WITH RECURRENT FLASH PULMONARY EDEMA INITIATED ON HEMODIALYSIS FOR END STAGE RENAL FAILURE
Authors: Rajaratnam Krishnan
Published: September 2024

Background and Objectives:

Recurrent flash pulmonary edema is a rare manifestation of ESRF commencing hemodialysis, necessitating more frequent dialysis. Recurrent flash pulmonary edema is seen in renal artery stenosis and rarely in chronic kidney disease. Objective of the study is look for any possible contributory factors for recurrent flash pulmonary edema in patients with ESRF initiated on hemodialysis; and the potential role of ACEI/ARB, β blockers and MRA in controlling episodes of flash pulmonary edema.

Methods:

All patients initiated on hemodialysis from January 2020 to December 2023 were studied in detail; including ECHO cardiography and renal ultrasound doppler. Patient were divided in to 2 groups based on absence or presence of recurrent flash pulmonary edema (Group A and Group B).Group B further divided in to Group C and D. Group C were treated with ACEI/ARB, β blocker and MRA in addition to nitroglycerine infusion and hemodialysis. Group D were given usual anti hypertensives nitroglycerine infusion and hemodialysis as per requirement. Group C and D were followed up for 2 months and evaluated for the final out come.

Results:

238 patients were initiated on hemodialysis during the period of 3 years. 18 patients (7.56%) presented with recurrent flash pulmonary edema (Group B) and 220 patients (92.44%) comprised Group A. Patients in Group B had more severe LVH, left ventricular diastolic dysfunction (LVDD) PAH and accelerated hypertension. None of the patients had renal artery stenosis. At the end of 2 months patients in Group C (9 patients) were free from recurrent flash pulmonary edema compared to Group D (9 patients)

Conclusions:

Recurrent flash pulmonary edema is a rare manifestation of ESRF. Renal artery stenosis was not seen in our patients. LVH, LVDD due to uremic cardiomyopathy and accelerated hypertension due to RAAS activation may be the contributory factors. Treatment with ACEI/ARB, β blockers and MRA may help in controlling episodes of flash pulmonary edema.
A Scalable Advising Model for Part-Time, Distant Learners in Graduate Health Professions Education Programs
Authors: Meyer Holly , Wildermuth Annie , Melton John , Durning Steven J. , Martin Paolo C.
Published: September 2024

Problem

There is a need within graduate health professions education (HPE) programs to align advising practices to support an increasing number of working adult learners, especially those studying part-time and from remote locations. Despite the recognized importance of the advisor–advisee relationship in graduate learner success, many advisors lack formal training and have to manage multiple completing priorities. Furthermore, a lack of established evidence-based practices for graduate HPE advising has left each program navigating advising independently.

Approach

The Department of Health Professions Education, Uniformed Services University, established a small cadre of faculty to serve as academic advisors (n = 7) in August 2018. This cadre uses an advising model based on 5 advising practices, called TOTAL Advising—train the advisors, onboard the learners, touch base frequently, annually review learners, and learner review. These advising practices are meant to provide a wrap-around support system to ensure learners feel empowered to fully engage in the program while managing the demands of their personal and professional lives. TOTAL Advising provides the framework needed to achieve 3 guiding beliefs: each learner is capable of completing the program, fostering community, and providing clear communication.

Outcomes

Between May 2020–May 2024, learners who completed a degree (n = 21) were interviewed about their advising experiences by a program evaluator after they graduated. The themes observed from these reflect the program’s 3 guiding beliefs. Additionally, from May 2018–May 2024, of the 574 learners who enrolled in the program, 568 (99%) graduated with a certificate or degree, only 6 (1%) were disenrolled.

Next Steps

The next steps for TOTAL Advising involve a comprehensive evaluation of the effectiveness of the training program for advisors and collaborating with other graduate HPE programs to share best practices in advising, discuss emerging challenges, and shape advising practices in the broader HPE community.
Mortality Risks and Causes in Previous Carbon Monoxide Poisoning: A Nationwide Population-Based Cohort Study*
Authors: Ahn Gyo J. , Lee Solam , Heo Yeon-Woo , Cha Yong S.
Published: September 2024

OBJECTIVES:

Carbon monoxide (CO) poisoning can cause brain, heart, and kidney injuries. We aimed to determine the association of risks of all-cause and cause-specific mortality in patients with previous CO poisoning.

DESIGN, SETTING, AND PATIENTS:

This population-based cohort study used data from the National Health Insurance Service database and the National Death Registry of Korea. Adult patients diagnosed with CO poisoning and controls between 2002 and 2020 were included. Patients were matched with controls on a 1:1 ratio, considering age, sex, insurance type, income level, residential location, smoking status, alcohol consumption, obesity status, medical and psychiatric illness history, and Charlson Comorbidity Index at the index date. The cohort was monitored from 2002 to 2022 or until death or emigration in terms of all-cause and cause-specific mortality.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

A total of 48,600 patients with CO poisoning and matched controls were included. The cohort included 41.30% females, and the mean age was 48.05 years. Patients with CO poisoning exhibited a substantially elevated risk of all-cause mortality compared with those in the control group, with an adjusted hazard ratio (aHR) of 15.67 (95% CI, 12.58–19.51). The mortality associated with infectious (aHR, 6.71; 95% CI, 1.51–29.72), neoplasm/oncologic (aHR, 5.20; 95% CI, 3.39–7.99), endocrine (aHR, 13.44; 95% CI, 1.76–102.70), neurologic (aHR, 7.42; 95% CI, 2.91–18.90), cardiovascular (aHR, 8.97; 95% CI, 5.05–15.93), respiratory (aHR, 17.54; 95% CI, 5.48–56.17), and gastrointestinal (aHR, 24.72; 95% CI, 3.34–182.69) disorders was significantly greater in the former. Deaths due to external causes, including suicide, were significantly higher in the CO poisoning group (aHR, 50.07; 95% CI, 30.98–80.90).

CONCLUSIONS:

Patients with CO poisoning exhibited a heightened risk of all-cause mortality compared with the matched controls. Additionally, the cause-specific mortality risk differed between the groups.
High-resolution RNA-sequencing reveals TRIM33::CSDE1 gene fusion in metastasizing vulvar melanoma
Authors: Stawiarz Magdalena , Hoang Mai P. , Kowalik Artur
Published: September 2024

Although mucosal melanomas are rare and constitute approximately 1.4% of all melanomas, the prognosis of patients with mucosal melanoma is poorer in comparison to cutaneous melanomas. Despite their poor prognosis, limited treatment options are currently available for patients with advanced disease. These noncutaneous subtypes of melanomas are not responding to treatment used for cutaneous melanomas. We performed RNA sequencing on four mucosal melanoma samples comprising of two primary tumors and two corresponding metastases. A TRIM33::CSDE1 fusion was detected in both the primary tumor and metastasis of a vulvar melanoma, supporting the fusion to be a driver in oncogenesis. Vulvar melanoma is the third tumor to have been reported to harbor TRIM33::CSDE1 fusion. Detecting fusions may have a clinically significant impact in patients with advanced mucosal melanoma who have failed front-line immunotherapy.
Epineurectomy of extracranial facial nerve trunk for non-flaccid sequelae following Bell’s palsy: a single-arm trial
Authors: Zhao Hua , Cai Xiaomin , Zhang Zhongding , Ying Tingting , Tang Yinda , Wang Haopeng , Wang Baimiao , Li Shiting
Published: September 2024

Background:

Non-flaccid facial palsy sequelae manifest as sequelae following Bell’s palsy. Currently, there are no effective remedies for addressing this issue. In this study, the authors proposed a new surgical solution, epineurectomy of the extracranial facial nerve trunk, and assessed its safety and efficacy as a potential remedy.

Methods:

In this single-arm trial, adult patients with non-flaccid facial palsy sequelae were enrolled and subjected to epineurectomy of the extracranial facial nerve trunk. The primary efficacy endpoint was the Sunnybrook scores at months 12 postoperatively. The secondary endpoints included non-flaccid facial palsy sequelae symptom scores, such as facial tightness or facial stiffness, facial synkinesis, eye fissures narrowing or difficulty in opening the eyes, House-Brackmann grade scale, and Facial Disability Index.

Results:

A total of 22 patients were enrolled between July 2020 and January 2021. One patient was lost to follow-up. One year after surgery, the Sunnybrook score was 72.0 (63.0–75.0) at 12 months versus 68.0 (58.0–70.8) at baseline. The mean difference was −5.4 (−7.2 to −3.6). The scores of facial tightness or facial stiffness, synkinesis, eye fissures narrowing or difficulty in opening eyes were 0.0 (0.0–1.0), 1.0 (1.0–1.0), 1.0 (1.0–2.0) at 12 months versus 3.0 (1.3–3.0), 2.0 (1.0–2.8), 2.0 (2.0–3.0) at baseline, respectively. The median (IQR) values of the Facial Disability Index physical function were 92.0 (90.0–95.0) at months 12, and the mean difference (95% CI) was −32 (−38 to −26) compared to baseline. The mean difference (95% CI) in the Facial Disability Index social/well-being function between month 12 and baseline was −38 (−46 to −31).

Conclusions:

Epineurectomy of the extracranial facial nerve trunk can effectively and safely alleviate the sequelae of non-flaccid facial palsy.
Parametric imaging in salivary gland scintigraphy
Authors: Anton Faria Rogério , Chagas Jaguar Graziella , Nóbrega Pereira Lima Eduardo
Published: September 2024

Salivary gland scintigraphy (SGS) is an imaging technique to evaluate functional aspects of the salivary glands. First described in 1965, visual analyses of summed images and of time–activity curves generated through regions of interest (ROI) are still the main evaluation tools used in clinical practice. An alternative to ROI-based analysis is the use of parametric images, which are images generated through pixel-by-pixel calculation of parameters from the original frames. In this article, we would like to present some parametric images for SGS studies and how to create and use them. Two images, vascular flow and uptake velocity, were created using the intercept and slope of a linear model of the frames from after the first to fifth minute of acquisition. And two others, excretion fraction and absolute excretion, by subtraction and division methods of the frames before and after sialogogue stimulation. These images allow the visualization of the spatial distribution and heterogeneity of these quantitative parameters, favoring different forms of analysis and helping with image segmentation. After more than a year of using these images in daily routine, our general impression is that they have been very helpful. This article, however, still represents only our early experiences with this technique, and clinical studies are yet needed to better evaluate this method.
Point-of-Care Ultrasound for Diagnosis of Mandibular Fracture in a Pediatric Patient
Authors: Venn April M.R. , Rizvi Munaza Batool , Rabiner Joni E.
Published: September 2024

Point-of-care ultrasound has been shown to be effective in diagnosing many types of fractures, including nasal fractures, but it is not commonly used in pediatrics to diagnose mandibular fractures. We describe a case of a mandibular fracture diagnosed by point-of-care ultrasound in the pediatric emergency department. Additional studies are needed in the pediatric population to determine if point-of-care ultrasound can diagnose mandibular fracture rapidly and accurately, expediting diagnosis and potentially minimizing exposure to ionizing radiation in patients with no point-of-care ultrasound evidence of mandibular fracture.