bluuebunny/crossref_metadata_2025 huggingface dataset:
AW-AD-3: ATRIAL FIBRILLATION AS PREDICTOR OF MORTALITY IN HEMODIALYSIS PATIENTS WITH CARDIOVASCULAR DISEASE
Authors: Febrianora Mega , Akbar Mohammad Rizki , Iqbal Mohammad
Published: January 2023

Background:

The predictors of mortality in hemodialysis patients remain unknown, especially in patients with cardiovascular disease.

Aim:

To find the predictor of mortality in hemodialysis patients with cardiovascular disease.

Methods:

A number of 444 hemodialysis patients with cardiovascular disease in 2018 participated in the study. We performed history taking to determine comorbid (history and duration of hypertension, history of diabetes, coronary artery disease, congestive heart failure, stroke, vascular disease, liver disease, and alcohol consumption) and electrocardiography as baseline data. The patients then were followed up to assess the death event. Cox proportional hazards models were used to estimate hazard ratios (HR) and their 95% CI for various covariates.

Results:

Among 444 hemodialysis patients, 266 patients matched the inclusion and exclusion criteria, 166 patients were completely followed up in December 2019. The mean age was 50.8 ± 14.68 years, 52.4% female, mean duration of follow-up duration was 11.2 ± 10.08 months. History of hypertension was found in 149 (89.8%) patients. We observed all-cause death in 109 patients (65.7%) patients. Hypertension, diabetes, coronary artery disease, congestive heart failure, stroke, and vascular disease were not associated to death. We found out that atrial fibrillation was associated as a predictor of death (HR 2.540; 95% CI, 1.558–4.140, p = <0.001).

Conclusions:

Atrial fibrillation was associated with a higher incidence of death in hemodialysis patients with cardiovascular disease.
AW-APSH-2: “MINERALOCORTICOID RECEPTOR (MR)-ASSOCIATED HYPERTENSION” IN “GREEDY ORGAN HYPOTHESIS”
Authors: Itoh Hiroshi
Published: January 2023

Spironolactone has been used for more than 60 years. Eplerenone is MR-specific MRB and esaxerenone possesses non-steroidal structure with high affinity and specificity to MR and exhibits long half-life. We conducted a double-blind phase III study of esaxerenone compared with eplerenone in patients with essential hypertension in 2020. Esaxerenone 2.5 mg elicited comparable hypotensive effect to eplerenone 50 mg and 5 mg exhibited significantly stronger effect than 2.5 mg. We also investigated the efficacy of dosage-escalation of esaxerenone added to a RAS inhibitor in hypertensive patients with type 2 diabetes (DM) (HbA1c:6.8%) and albuminuria (212 mg/gCr). 5 mg esaxerenone induced 20/8mmHg blood pressure reduction and reduced albumin excretion significantly. Interestingly, in these studies, esaxerenone exerted similar hypotensive action in the patients with RAS inhibitors, compared to the groups without them. This observation indicates that MR can be activated being independent of renin-angiotensin-aldosterone system. In 2012, we proposed the concept of “MR-associated hypertension”, hypertension caused by over-activation of MR with wide range of plasma aldosterone level. Primary aldosteronism is the typical example of MR-associated hypertension, but even in low plasma aldosterone concentration state, such as obesity, DM, CKD, MR can be over-activated. There are several postulated mechanisms of over-activation of MR. Increased expression of MR, increased sensitivity of MR and MR protein stabilization. We are interested in the activation of MR by salt and sugar themselves. We focus on MR expressed in the intestine for sodium absorption. Administration of DOCA and high salt induced up-regulation of epithelial sodium channel, ENaC, the target molecule of MR. And intestine specific knock-out of MR mice exhibited blunted increase of blood pressure by DOCA and high salt loading. We also demonstrated that high sugar induces MR protein stabilization by PKC activation, O-GlcNac modification or EGFR-ERK activation. More recently, in relation to excessive salt and sugar intake and occurrence of non-communicable diseases (NCDs), including hypertension, we have proposed “Greedy Organ Hypothesis”. Excessive intake of salt and sugar are sensed by the kidney and the intestines, and these organs up-regulate SGLT, sodium-glucose co-transporters and come to absorb salt and sugar greedily. Excessive salt intake through SGLT2 makes the kidney greedy to induce hypertension/CKD. Excessive food intake through SGLT1 make the intestines greedy to induce obesity/DM. Furthermore, there is “crossing” relationships between “greedy organs” and NCDs. Greedy kidney and intestines over-activate MR and induce MR-associated hypertension. Therefore, MRB are effective to alleviate Greedy Organs and to suppress NCDs.
ISH-PP-2: VIRTUAL MANAGEMENT OF HYPERTENSION: ISH POSITION PAPER
Authors: Khan Nadia A
Published: January 2023

The COVID-19 pandemic caused an unprecedented shift from in-person care to delivering health care remotely. To limit the infectious spread, patients and providers rapidly adopted distant evaluation with online or telephone-based diagnosis and management of hypertension. However, many patients and care providers were unprepared for this rapid shift and may not be delivering optimal hypertension assessment and management. Given that it is likely that virtual care of chronic diseases including hypertension will continue into the future, the International Society of Hypertension developed a position paper to provide practical guidance on the virtual management of hypertension to improve its diagnosis and blood pressure control. This position paper is based on the currently available evidence, hypertension guidelines, and international expert opinion. Virtual care is defined as the delivery of healthcare remotely between patients, their carers, and healthcare providers. As different regions and patients have varying degrees of virtual care resources, skills, and preferences, we conceptualize the basic, advanced and complete virtual care models representing advancing degrees of virtual care.

This presentation will review the position statements in these three levels of virtual care and discuss the position statements and rationale for selecting blood pressure monitoring devices, cuffless devices, accurate home blood pressure assessments, optimizing patient education, health behavior change, medication adjustment, and long-term monitoring in a virtual care environment.
JS-ISH-ESH-3: POST-TRAUMATIC STRESS DISORDER AND HYPERTENSION
Authors: Persu Alexandre
Published: January 2023

Post-traumatic stress disorder (PTSD) is a psychiatric condition that may affect people who have experienced or witnessed a traumatic event, which causes intense, disturbing thoughts and feelings related to this experience, that last long after the traumatic event and cause significant distress and/or impairment in social, occupational, or other important areas of functioning It affects approximately 3.5% of U.S. adults every year and an estimated 6.8% subjects will be diagnosed with PTSD in their lifetime, with a prevalence more than doubled in women compared to men. Several studies have reported a relation between PTSD diagnosis, hypertension and cardiovascular diseases. The association was initially reported in veterans cohorts and later described also in general population. In particular, in wounded US military servants, the incidence of hypertension was independently associated with the injury severity score and the chronicity of PTSD. More recently, in a series of patients from Bukavu, man-made trauma and PTSD were strongly associated with hypertension, over and above classical environmental and lifestyle factors. PTSD has also been involved in the pathogenesis of resistant hypertension and poor drug adherence, either directly or through mediation of altered expression of emotions and somatization. PTSD should be considered among the mechanisms involved in onset and maintenance of hypertension, particularly in military servants and war veterans, subjects living in countries exposed to war and chronic violence, migrants, refugees and patients with resistant and difficult-to-control hypertension. Further research is required to unravel the mechanisms underlying the association of PTSD and hypertension, and to define the optimal therapeutic strategy and psychological interventions required to improve blood pressure control, psychological well-being and to decrease cardiovascular risk in patient suffering from both conditions.
JS-NG-3: UNIQUE IMAGING FINDINGS IN RENAL ARTERY FIBROMUSCULAR DYSPLASIA
Authors: Kang Yuanyuan , Xu Jianzhong , Wang Jiguang
Published: January 2023

A 35-year-old female patient with fluctuating blood pressure was referred to hypertension department for investigation of possible secondary hypertension. Computed tomographic angiography (CTA) of the renal arteries was performed, demonstrating abnormal right renal artery at the medial portion of the vessel with complete tubular narrowing and right kidney atrophy (right 79*35 mm, left 109*45 mm) (Panel A). Subsequent renal arteriography confirmed the long tubular narrowed right renal artery (Panel C) and the established severe tortuosity collateral vessel from the abdominal aorta (Panel B). The etiological diagnosis of the renal artery stenosis in this young woman was challenging and was supposed to be congenital renal dysplasia. Catheter-based angioplasty was not recommended. However, intravascular ultrasound (IVUS) revealed that it was not congenital narrowed artery, but concentric intimal-medial thickening caused stenosis of the vessel (Panel E). Therefore, renal artery fibromuscular dysplasia (FMD) was diagnosed and considered to be intimal type. Balloon angioplasty was performed, and IVUS showed that the lesion lumen was dilated successfully (Panel F). However, a bailout stent had to be placed because of intimal dissection during angioplasty, and renal blood flow was restored after procedure (Panel D). One month after the procedure, the patient was normotensive without any antihypertensive medication. At 1 year follow-up, the 99mTc-glomerular filtration rate of the right kidney increased from 19.7 to 40.4 ml/min.

FMD is a nonatherosclerotic, noninflammatory vascular disease that most commonly affects renal arteries and is recommended to be classified according to angiographic finding as multifocal FMD or focal FMD. Compared with multifocal FMD, focal FMD is less often seen, and the diagnosis of some cases is challenging. In the present case, such a long tubular stenosis of renal artery is rare, and the diagnosis was confirmed by IVUS. IVUS may be a useful tool for the diagnosis of focal FMD.
JS-HOPE ASIA-3: HOME BLOOD PRESSURE MONITORING: EVIDENCE BEHIND THE 722 PROTOCOL
Authors: Wang Tzung-Dau
Published: January 2023

Home blood pressure (HBP) has been recognized as a prognostic predictor for cardiovascular events, and integrated into the diagnosis and management of hypertension. With increasing accessibility of oscillometric blood pressure devices, HBP monitoring is easy to perform, more likely to obtain reliable estimation of blood pressures, and feasible to document long-term blood pressure variations, compared to office and ambulatory blood pressures. To obtain reliable HBP estimates, a standardized HBP monitoring protocol is essential. A consensus regarding the optimal duration and frequency of HBP monitoring is yet to be established. Based on the current evidence, the “722” protocol, which stands for 2 measurements on one occasion, 2 occasions a day (morning and evening), and over a consecutive of 7 days, is most commonly used in clinical studies and recommended in relevant guidelines and consensus documents. HBP monitoring based on the “722” protocol fulfills the minimal requirement of blood pressure measurements to achieve agreement of blood pressure classifications defined by office blood pressures and to predict cardiovascular risks. In the Taiwan HBP consensus, the frequency of repeating the “722” protocol of HBP monitoring according to different scenarios of hypertension management, from every 2 weeks to 3 months, is recommended. It is reasonable to conclude that the “722” protocol for HBP monitoring is clinically justified and can serve as a basis for standardized HBP monitoring.
JS-MT-5: MAINTAINING AN ACTIVE RESEARCH CAREER DURING PARENTHOOD: AN EXPERIENCED PARENT PERSPECTIVE
Authors: Khan Nadia A
Published: January 2023

Almost 80% of faculty in sciences and medicine are parents. This poses a challenge for early and mid-career faculty when trying to establish independent research and continue productivity as a researcher. In this discussion, we outline the challenges faced by faculty, the “parent penalty”, work to life and life to work conflict, and the differential effect of parenting by gender on maintaining an active research career. Through a long view lens of personal experiences, I will discuss potential strategies to try to maintain an active research career during parenthood in academia.
JS-HR-11: HOT TOPICS IN URIC ACID RESEARCH
Authors: Kuwabara Masanari , Kodama Takahide
Published: January 2023

The mechanism between hyperuricemia, arteriosclerosis, hypertension, chronic kidney disease, and cardiovascular disease is becoming clearer (Figure cited from the article ‘Update on Hypertension Research in 2021’, Hypertension Research. 2022;45(8):1276 to 1297). However, it remains unclear whether treatment of hyperuricemia improves these diseases. In this session, we will introduce some recent topics of uric acid research.

The PERL (Preventing Early Renal Loss in Diabetes) trial and the CKD-FIX (Controlled Trial of Slowing of Kidney Disease Progression from the Inhibition of Xanthine Oxidase) showed that urate-lowering treatment with allopurinol, one of xanthine oxidase (XO) inhibitors, did not slow the decline in eGFR as compared with placebo. These results were similar with the results of FEATHER (Febuxostat Versus Placebo Randomized Controlled Trial Regarding Reduced Renal Function in Patients with Hyperuricemia Complicated by Chronic Kidney Disease Stage 3) from Japan. Furthermore, the PRIZE (Program of Vascular Evaluation Under Uric Acid Control by the Xanthine Oxidase Inhibitor Febuxostat: Multicenter, Randomized, Controlled) study showed that febuxostat did not delay progression of carotid atherosclerosis in patients with asymptomatic hyperuricemia. These results suggest that treatment of hyperuricemia could not directly prevent chronic kidney disease (CKD) and/or arteriosclerosis. In contrast, there are many studies that showed the positive relationship between uric acid and hypertension. Lowering serum uric acid levels could reduce blood pressure, but it is unclear that lowering serum uric aclid levels might be directly causing the results in preventing CKD progression, arteriosclerosis, and cardiovascular events. These results suggest that we should carefully choose the treatable patients with hyperuricemia and hypertension.
PS-B02-3: FGF23 EXACERBATES CARDIAC FIBROSIS IN DOCA-SALT HYPERTENSIVE MICE THROUGH LOCALLY ABNORMAL VITAMIN D METABOLISM
Authors: Saito Tomohiro , Mizobuchi Masahide , Kato Tadashi , Shikida Yasuto , Ogata Hiroaki , Koiwa Fumihiko , Honda Hirokazu
Published: January 2023

Backgrounds:

Fibroblast growth factor 23 (FGF23) is associated with cardiovascular disease in patients with chronic kidney disease (CKD), but the mechanisms underlying the effect of FGF23 on cardiac function remain to be investigated. Herein, we studied the effect of continuous intravenous (CIV) FGF23 loading in a deoxycorticosterone acetate (DOCA)-salt mouse model that has mild CKD and hypertension, and heart failure with a preserved ejection fraction (HFpEF).

Design and method:

Wild type male mice (n = 16) were allocated randomly to four groups: normal control (NC), vehicle-treated DOCA-salt mice (V), FGF23-treated DOCA-salt mice (F), and FGF23 and calcitriol-treated DOCA-salt mice (C). The DOCA-salt mice received agents by CIV for ten days via an infusion mini-pump, uninephrectomized, and cardiac changes were evaluated in these mice.

Results:

DOCA-salt mice that received FGF23 showed a marked increase in serum FGF23 (249 pg/mL in V, 1416 pg/mL in F, and 1261 pg/mL in C) than NC (51 pg/mL). Echocardiography in these DOCA-salt mice revealed HFpEF. These mice also showed exacerbation of myocardial fibrosis area (7.0% in V, 13.2% in F, and 3.8% in C) concomitant with an inverse and significant correlation with Cyp27b1 expression (r = -0.79, P < 0.01). Calcitriol treatment attenuated the FGF23-induced cardiac fibrosis (F vs. C, P < 0.01) and improved diastolic function (early-to-atrial wave ratio in doppler echocardiography, 0.7 in F vs. 2.0 in C; P < 0.01) via inhibition of transforming growth factor (TGF)-beta signaling. Protein expression levels of TGF-beta was significantly higher in F (1.32-fold to NC; P < 0.01) than in NC, and significantly lower in C (0.96-fold to NC; P < 0.05) than in F. This effect was independent of systemic and local FGF23 levels.

Conclusions:

These results suggest that CIV FGF23 loading induced cardiac fibrosis concomitantly with locally abnormal vitamin D metabolism, and this might have contributed to HFpEF progression in the DOCA-salt mice model. Thus, cardiac toxicity of FGF23 may be partly due to vitamin D inactivation in cardiac tissue. Calcitriol has cardioprotective effects by mediating TGF-beta signaling, independently of local and systemic FGF23 levels.
PS-B02-6: CHANGES OF THE EXTRACELLULAR MATRIX AND INTERCELLULAR COMMUNICATION IN THE RAT HEARTS WITH VOLUME-PRESSURE OVERLOAD AND MODULATION BY CARDIOPROTECTIVE DRUGS
Authors: Sykora Matus , Kratky Vojtech , Tribulova Narcis , Kopkan Libor , Bacova Barbara Szeiffova
Published: January 2023

Objective:

Pathogenesis of heart failure (HF) and hypertension with a focus on extracellular matrix (ECM) and communication in the heart is still a current scientific topic that calls for new findings.

Design and method:

We used as experimental model normotensive (HSD) and hypertensive (TGR) rats with aortocaval fistula (ACF) supplemented with an ACE inhibitor (ACEi)(15weeks, 6 mg/L) and an AT1 receptor blocker (ARB)(15weeks, 200 mg/L). At the end of the experiments, serum and myocardial tissue samples of the right and left ventricles were taken for biometric, biochemical, gene, protein and microscopic analyzes.

Results:

We observed an increase in the cardiac weight index after ACF, left and right ventricles in HSD and TGR rats. ACEi and ARB have normalized this condition to a greater extent. Due to ACF, serum concentrations of ANP and TBARS were increased in the blood serum of both strains. ACF increased hydroxyproline levels in right ventricular levels in HSD and TGR rats and left ventricular TBARS in TGR rats. In addition, ACF increased mRNA collagenI, and collagenI protein expression in the left and right ventricles of HSD rats. In contrast, ACF reduced Cx43 and pCx43 protein levels in the left and right ventricles of both strains, SMAD2 expression in the right ventricle in HSD and TGR rats. ACF also suppressed MMP-2 protein expression in both cardiac ventricles in HSD rats and PKCepsilon protein expression in both heart chambers of both strains. Hypertension caused a slight decrease in the protein expression of Cx43, pCx43 and PKCepsilon and an increase in the expression of PKCdelta in cardiac ventricles of both rat strain. Hypertension further increased and collagenI in TGR rats in the left and right ventricles of the heart. Microscopic analyzes showed that ACF induced cardiomyocyte hypertrophy as well as decreased activity of enzymes involved in ACF energy metabolism. An interesting finding was that the signaling pathways involved in cardiac remodeling were more normalized by the ARB, while proteins involved in intercellular communication by ACEi.

Conclusions:

Based on the results obtained from the experiment, it can be stated that the right ventricle is more significantly affected by ACF and the results of analyzes in TGR indicate adaptation, attenuated responses to the parameters we observed. Supported by: APVV-21-410, VEGA-2/0158/19.
PS-C02-1: BENEFIT OF RANOLAZINE ADDED TO ANGIOTENSIN RECEPTOR BLOCKERS PLUS MINERALOCORTICOID RECEPTOR ANTAGONISTS THERAPY FOR VENTRICULAR EXTRASYSTOLES TREATMENT IN HYPERTENSIVE PATIENTS
Authors: Paterno Carlos Alberto
Published: January 2023

Objective:

Ranolazine is an anti-ischaemic agent with additional electrophysiological properties by inhibiting the cardiac late Na+ current and reducing the Ca2+ overload; it does not produce a change in heart rate or blood pressure. This study aimed to know if Ranolazine was added to Angiotensin Receptor Blockers plus Mineralocorticoid Receptor Antagonists (ARB+MRA) therapy in hypertensive with normal kidney function can reduce or avoid ventricular extrasystoles without the use of antiarrhythmics drugs such as flecainide or propafenone.

Design & Methods:

For developing this study, one first group of 45 hypertensive patients was entered, females 17 with an average age of 64.8 (SD 14.0) and males 28 with an average age of 68.4 (SD 12.8) in a regime of ARB+MRA therapy. All patients were assessed with a 24hs-monitoring Holter, pre and post Ranolazine (375/500 mg, 2xd), with an average therapy time-length on females-males by 12.4 (SD 10.0) - 12.8 (SD 12.0) months. Also, the second group of 73 patients was registered, females-males (43–30) with an average age (SD) 67.1 (12.2) - 66.8 (13.5) assessed with a 24hs-monitoring Holter only once at 12.2–16.7 months after ARB+MRA+Ranolazine therapy. All patients achieved normal levels of the central hemodynamic parameters, principally augmentation index (surrogate value of arterial stiffness) and end-systolic pressure measured with applanation tonometry (SphygmoCor System-PVX AtCor-Australia) used according to standard methods.

Results:

In the pre-and post-treatment group of females-males were observed ventricular extrasystoles a mean of 2610–5004 which were reduced to a mean of 12.5–1464, respectively, with a highly statistically significant difference (p > 0.001).

In the post-treatment group, the average of ventricular extrasystoles on females-males was found 15.0–37.4. Interestingly, during ARB+MRA+Ranolazine therapy patients which had not registered anyone ventricular extrasystoles, in the first group were found females-males 8/17 (47%) - 7/28 (25%), and in the second group 14/43 (33%) - 6/30 (20%), respectively.

Conclusion:

The combination of ARB+MRA therapy normalized the augmentation index and the end-systolic pressure, stabilized the curve volume/pressure reduce the stress of ventricular-arterial coupling, and can avoid the onset of atrial fibrillation, also so it would allow added Ranolazine to perform a beneficial antiarrhythmic action avoiding or reducing the appearance of the ventricular extrasystoles.
PS-C02-2: THE USE OF HYDROCHLOROTHIAZIDE FOR THE TREATMENT OF HYPERTENSION INCREASES THE CARDIOVASCULAR RISK ACCORDING TO THE CENTRAL HAEMODYNAMIC PARAMETERS
Authors: Paterno Carlos Alberto
Published: January 2023

Objective:

The chronic use of the diuretic hydrochlorothiazide (Hct) can activate the neurohormonal system, increasing metabolic risk factors it is potentially arrhythmogenic; and can stimulate the escape of aldosterone, even during Angiotensin Receptor Blockers (ARB) treatment. Aldosterone is a hormone with dangerous effects on the cardiovascular system, from arterial/myocardium stiffness to sodium and water retention; also, is involved in the production of reactive oxygen species and endothelial dysfunction. Psoriasis is a systemic disease that exemplifies the intersection of inflammation, immune dysregulation; and accelerating cardiovascular disease. This study aimed to know if the hydrochlorothiazide added to ARB therapy for the treatment of hypertension can produce a deleterious effect on the cardiovascular system similar to psoriasis, and compare the different responses of ARB therapy alone, according to the measuring of the Central Hemodynamic Parameters (CHP).

Design & Methods:

For this cross-sectional retrospective study data were collected from 994 patients divided into three groups, both sexes. One group of patients with psoriasis female-male (F-M) (65–57) average age (SD) 55.7 (14.7) - 52.1 (12.5). A second group, in the regime of ARB therapy, F-M (237–217) average age (SD), 62.6 (12.8) - 58.5 (13.6). In the third group, during ARB+Hct therapy, F-M (253–165) average age (SD) was 65.2 (11.2) - 61.9 (12.6). For this study were entered anthropomorphic measures, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Heart Rate, CHP, and the Difference between observed values and normal levels of Augmentation Index (Diff-AIx), the surrogate value of arterial stiffness, assessing with a validated device employing the high-fidelity technique of applanation tonometry according to standard methods (SphygmoCor-PVX). All patients had a therapy time length of more than 6 months. The presence in brief phases of atrial fibrillation was in 24hs-Holter monitoring in the 3 groups were registered.

Results:

Data of SBP, DBP, Central Aortic Pressure, End-Systolic Pressure, Mean Arterial Pressure and Diff-AIx were highest among the groups with ARB+Hct and psoriasis, and ARB therapy with a statistically significant difference, while between the group psoriasis and ARB+Hct was not found a statistically significant. The highest percentage of patients with phases of atrial fibrillation during 24hs-Holter monitoring were found in the group ARB+Hct (13.6%) than ARB therapy (7.5%) with a statistically significant (p < 0.001).

Conclusions:

The chronic use of Hydrochlorothiazide for hypertension treatment produces deleterious action on hemodynamics and cardiovascular parameters and can increase the development of atrial fibrillation.
PS-C03-9: A COMPARATIVE STUDY OF SELF-VITAL MEASUREMENTS AND TELEMEDICINE IN THE TREATMENT OF HYPERTENSION: RATIONALE AND PROTOCOL
Authors: Yatabe Junichi , Yatabe Midori Sasaki , Ishida Kazuya , Yano Yuichiro , Nishiyama Akira , Node Koichi , Goto Rei , Yabuki Takashi , Hashimoto Shigeatsu
Published: January 2023

Background:

There has been a series of reports on the effectiveness of ICT-based telemedicine in the treatment of hypertension. However, sufficient evidence has not been obtained in Japan. In this study, we will clarify how push-type communication through the combination of vital data measurements including home blood pressure (HBP) obtained by IoT devices and online visits (telemedicine) affects blood pressure management.

Setting:

Multicenter, open-label, randomized, prospective intervention study

Methods:

This study (Fukushima Medical University Ethics Committee Permission no. 2021–292, now registering in jRCT) is an investigator-initiated 6-month clinical trial, which will recruit 234 patients to be randomized in Aizuwakamatsu area, Fukushima, Japan. During the whole study, HBP, body weight and physical activity data will be collected through the internet using smartphone App (OMRON CONNECT and TELEMEDEASE). This study includes 3 arms; 1: Vital data measurement without any feedback (control), 2: Vital data measurement with telemonitoring and feedback from health care professionals such as registered nurse, 3: In addition to telemonitoring and feedback, patients can engage in consulting physicians through telemedicine and receive prescription via mail when needed. Eligible patients are asymptomatic patients with hypertension who are aged 40–75 years old and can measure HBP and use smartphone App. The primary endpoint is percentage of patients achieving antihypertensive goal (mean morning and night systolic HBP < 125 mmHg). Examples of secondary endpoints include medical economics and safety of telemedicine for treatment of hypertension.

Anticipated Medical Contributions:

The expected outcome is that application of telemedicine on self-measurement of vital data including HBP will be superior to vital data monitoring alone in the treatment of hypertension to improve cardiovascular outcome.
PS-C03-10: PRACTICE OF TELEMEDICINE CONCERNING ATRIAL FIBRILLATION DETECTED BY APPLE WATCH
Authors: Takai Kohichi , Yoneyama Akio , Hammarlund Hampus , Miyake Yoshinori , Nakanishi Takeshi , Sawada Ryousuke , Yatabe Junichi , Taguchi Kenta
Published: January 2023

Background:

Atrial fibrillation affects nearly 60 million adults worldwide. Atrial fibrillation is associated with a high risk of cardiovascular morbidity, therefore early detection of atrial fibrillation is important for improving patient outcomes. Apple Watch has an ECG which can detect atrial fibrillation but users do not always contact a doctor. We report in-depth interviews with users who detected atrial fibrillation with Apple Watch.

Methods:

In this research, participants wearing an Apple Watch received real-time electrocardiograms via their smartphone, and received telemedicine guidance from our smartphone application. This research was a single arm study with 489 participants conducted with the goal of evaluating the effectiveness of telemedicine by using Apple Watch. In a three-month experiment, 412 participants measured more than once and 89 participants measured once a day on average. 20 participants experienced atrial fibrillation which was detected by their Apple Watch. Finally, five participants connected to a Telehealth doctor, who based on the data from the Apple Watch and the patient's symptoms was able to give appropriate medical guidance.

Results:

We carried out in-depth interviews with four participants who detected atrial fibrillation. Two participants did not understand the detection. Afterwards they received an explanation of atrial fibrillation from the person in charge of the experiment via email, after which the participants applied for telemedicine. The other two participants were familiar with atrial fibrillation and did not apply because they had existing medical history and subjective symptoms.

In addition, we conducted a questionnaire survey about telemedicine from the 20 participants who detected their atrial fibrillation. 95% of questionnaire respondents were aware of telemedicine, which was free in this experiment. However, 53% of questionnaire respondents did not understand the risks and basic information about atrial fibrillation. Moreover, 47% of questionnaire respondents selected that they were not going to contact a doctor if they do not have subjective symptoms.

Conclusions:

Early detection of atrial fibrillation is important for patients, but people do not always get in connect with an online doctor. We confirmed that one of the reasons is lack of knowledge about atrial fibrillation and another is lack of subjective symptoms.
PS-C04-5: ASSOCIATIONS BETWEEN INTERARM SYSTOLIC BLOOD PRESSURE DIFFERENCE AND HYPERTENSIVE ORGAN DAMAGES IN PATIENTS WITH ESSENTIAL HYPERTENSION
Authors: Ohara Maiko , Koike Tsutomu , Yamazaki Hidenori , Kinugawa Koichiro , Tomoda Fumihiro
Published: January 2023

Objective:

Several studies and meta-analyses have reported that interarm systolic blood pressure difference (IAD) in the upper limbs is associated with risks such as all-cause mortality and cardiovascular diseases. However, few results have examined the usefulness of IAD as an index of arteriosclerosis in patients with essential hypertension (EHT). We investigated the relationship between IAD and vascular structures and evaluated the usefulness of IAD as an index of hypertensive organ damages in EHT patients.

Design and method:

In 71 untreated EHT patients (48 males, average age 56 ± 13 years) without chronic kidney disease (urinary albumin excretion less than 300 mg / g of creatinine and estimated glomerular filtration rate 60 mL / min / 1.73m2 or more), blood sampling, 24-hour urine collection, and 24-hour blood pressure monitoring were performed. Next, as cardiovascular structural indices, Next, as indicators of vascular structure, the intima media thickness of carotid artery (IMT) was measured by ultrasonography, and the cardio ankle vascular index (CAVI) and ankle brachial index (ABI) were measured by using the Vascular Screening System VaSera VS-1000 (Fukuda Denshi, Tokyo, Japan) device. The absolute value of the difference between the left and right blood pressure measured at the same time was defined as IAD.

Results:

IAD was not associated with age, BMI, or systolic and diastolic blood pressure in 24-hour blood pressure monitoring. IAD increased accompanying with a decrease in creatinine clearance (r = -0.25, p < 0.05). IAD correlated positively with IMT (r = 0.24, p < 0.05) and negatively with ABI (r = -0.45, p < 0.01), whereas it did not associate with CAVI. Furthermore, in multiple regression analysis using any of IMT, ABI and creatinine clearance as objective variables, and conventional risk factors for atherosclerosis and IAD as explanatory variables, IAD became an independent determinant factor for IMT, ABI and creatinine clearance.

Conclusions:

In EHT patients, IAD was associated with decreased renal function and vascular abnormalities. IAD was considered to be a useful index as an initial screening for latent hypertensive organ damages in EHT patients.
PS-C05-7: ASSOCIATION OF VENTRICULAR-ARTERIAL COUPLING WITH LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
Authors: Kang Bomin , Yoon Homin , An Soyeon , Beom Jongwook , Boo Kiyoung , Lee Jaegeun , Choi Joonhyouk , Kim Songyi , Joo Seungjae
Published: January 2023

Objective:

Ventricular-arterial coupling (VAC) has an important role in the pathophysiology of coronary artery disease and heart failure. The association of VAC with left ventricular (LV) function in patients with acute myocardial infarction (AMI) was investigated in this study.

Design and Method:

Echocardiographic indexes of LV volumes, systolic function, and diastolic function were measured in the usual way. Effective arterial elastance (Ea) was calculated from stroke volume measured using LV outflow waveform. Effective LV end-systolic elastance (Elv) was obtained using the single-beat method. Central aortic pressure waveform was recorded using the applanation tonometry. Characteristic impedance (Zc) of aortic root was calculated after Fourier transformation of both aortic pressure and flow waveforms.

Results:

Eight-five patients (age 58.5 ± 10.6 years) with AMI were enrolled. They were grouped as patients with reduced EF (rEF, < 50%; n = 27) and preserved ejection fraction (pEF, ≧ 50%; n = 58). In patients with rEF, Ea (2.14 ± 0.55 vs. 1.84 ± 0.51 mmHg/mL; P = 0.017) and VAC (1.18 ± 0.22 vs. 1.02 ± 0.22; P = 0.002) were increased, but peripheral and central systolic blood pressure, Elv and Zc were not different. In multiple linear regression analysis, VAC was significantly associated with E” velocity (beta -0.36, P = 0.001) and Zc (beta 0.33, P = 0.019), but neither with EF nor left ventricular longitudinal strain. The association between VAC and E” velocity was significant in patients with pEF (beta -2.64, P = 0.011), but not in patients with rEF.

Conclusions:

VAC was associated with LV diastolic dysfunction in AMI patients with pEF, but not with rEF.
PS-C06-8: CONCOMITANT HYPERTENSION INFLUENCES CASPASE-8 LEVELS IN COPD PATIENTS
Authors: Tverezovskyi Volodymyr , Kapustnyk Valeriy , Shelest Borys
Published: January 2023

Introduction:

Cardiovascular diseases are common in chronic obstructive pulmonary disease (COPD) patients with hypertension (HTN) having leading places, contributing to higher hospitalization and mortality rates. Oxidative stress, chronic hypoxia and hypoxemia induce systemic inflammation, leading to apoptosis development. Active apoptosis processes lead to forced violations in respiratory tract and influence the course of COPD. To the best of our knowledge, little data is available on assessment of caspase-8 (Cas-8) activity in hypertensive COPD patients.

Aim:

To investigate association of Cas-8 levels in COPD patients depending on presence of concomitant hypertension.

Methods:

93 COPD matched by gender and age patients were enrolled to the study: 47 non-hypertensive (62.0 [52.3; 65.8] years; 29.8% females) in main group and 46 hypertensive (60.0 [58.0; 62.8] years; 37.0% females) in comparison group. COPD and HTD diagnosis was made according to respective GOLD and ESC guidelines. Spirometry was used to assess FEV1/FVC ratio. Cas-8 was assessed by ELISA.

Results:

Systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the main group was 142.5 [140.0; 150.0] mm Hg. and 85.0 [80.0; 90.0] mm. Hg respectively; and 120.0 [115.0; 120.0] mm Hg. and 80.0 [75.0; 80.0] mm Hg.

Hypertensive COPD patients showed significantly (p < 0.001) higher Cas-8 levels than non-hypertensive: respectively: 3.7 [3.5; 3.8] ng/ml vs. 3.3 [2.8; 3.7] ng/ml. While FEV1/FVC ratio was significantly higher in the COPD only group than in COPD+HTN patients: 73.0 [71.0; 77.0] % vs. 72.0 [69.0; 75.0] %, p = 0.014.

Increase in Cas-8 levels was significantly (p < 0,001) associated with presence of HTN in univariate analysis: 0.406 [95.0% CI 0.225–0.578] ng/ml. In adjusted (for age, gender and FEV1/FVC ratio) model presence of concomitant HTN was significantly (p < 0.001) associated with increase in Cas-8 levels for 0.306 [95.0% CI 0.128–0,484] ng/ml.

Conclusion:

Concomitant hypertension can aggravate apoptosis in COPD patients, which leads to worsening of the course of the diseases. Our study showed significant association of increased Cas-8 levels with the presence of hypertension in both non-adjusted and adjusted linear models.
PS-C07-3: PREVALENCE AND DEMOGRAPHIC PROFILE OF WHITE-COAT HYPERTENSION IN THE PATIENTS PRESENTING A TERTIARY CARE CENTER IN EASTERN NEPAL
Authors: Karki Prahlad , Ghimire Jeet P , Karki Biplave , Pandey Naveen K , Shah Prashant
Published: January 2023

Background:

There is unequivocal evidence showing that at hospital environment BP levels are usually different from measures found at other settings. Therefore, ambulatory BP is expected to be more dependable, as well as allow the identification of a relevant subgroup of white-coat hypertension patient.

Methods:

This was a single center descriptive cross-sectional study conducted to assess the prevalence of white-coat hypertension among 50 participants consisting of 31 males and 19 females referred for 24 hour Ambulatory BP monitoring in B .P. Koirala Institute of Health Sciences, Dharan, Nepal, between October 2021 to December 2021.

Results:

The prevalence of white-coat hypertension was 19 (32%) among 50 participants, while 31(62%) of them had sustained hypertension. Prevalence of WCHTN and sustained hypertension in young age equal or less then 35 years was 4 (21.1%) and 10 (32.3%) respectively, similarly middle age 36–54 years was 13(68.4%) and 16(51.6%) and elderly equal or more then 55 years was 2(10.5%) and 5(16.1%) respectively. Most participants were of middle age group 36–54 years age. While of sex distribution pattern of WCHTN and sustained hypertension, male was 11(57.9%) and 20 (64.5%) respectively and female was 8(36.8%) and 15(48.4%) respectively. The association between the demographic variables age, sex and BMI and white-coat HTN was not statistically significant.

Conclusion:

The study showed that White-coat hypertension was more common in male patients and in middle age group 36–54 years, but was not statistically significant. Prevalence of white-coat hypertension was 19(38%). There was no significant association between white-coat hypertension and demographic variables.
PS-C09-1: CORRELATION OF SYMPATHETIC NERVOUS SYSTEM ACTIVITY AND BLOOD PRESSURE IN HYPERTENSIVE PATIENTS WITH NONALCOHOLIC FATTY LIVER DISEASE
Authors: Kakouri Niki , Andrikou Ioannis , Konstantinidis Dimitrios , Siafi Eirini , Manta Eleni , Polyzos Dimitrios , Drogkaris Sotirios , Tatakis Fotis , Kariori Maria , Zamanis Ioannis , Iliakis Panagiotis , Papakonstantinou Pantelis , Grigoriou Kalliopi , Thomopoulos Costas , Tsioufis Konstantinos
Published: January 2023

Objective:

Nonalcoholic fatty liver disease (NAFLD) is associated with hypertension and predicts future cardiovascular events. The purpose of this study was to investigate the effect of sympathetic nervous system (SNS) overactivity on blood pressure levels in hypertensive patients with and without NAFLD.

Design and method:

111 newly diagnosed untreated hypertensive patients (mean age 55 ± 10 years, 48 males, mean office systolic/diastolic BP 140 ± 14.8/88 ± 9.9 mmHg) without history of cardiovascular disease underwent office blood pressure (BP) measurements. NAFLD was diagnosed by liver ultrasound to separate patients into those with and without NAFLD. SNS activity was assessed by muscle sympathetic nerve activity (MSNA) based on established methodology (microneurography).

Results:

Hypertensive patients with NAFLD (n = 71) compared to those without NAFLD (n = 40) were younger (53 ± 10 vs 58 ± 9 years, respectively, p = 0.01) with greater body mass index (33 ± 10 vs 26 ± 3 kg/m2, p < 0.001). Also, male gender was more prevalent in the NAFLD group compared to the non-NAFLD group (52% vs 29%, respectively, p = 0.03), whereas there were no differences in glucose, low density lipoprotein levels and glomerular filtration rate. In NAFLD patients, MSNA was correlated with office diastolic BP (r = 0.24, p = 0.02) and in linear multiple regression analysis MSNA levels were an independent determinant of office diastolic BP levels (beta = 0.185, p = 0.05), while in the non NAFLD group, MSNA was not related to office BP levels (p = ns). MSNA levels were greater in hypertensives with NALFD compared to those without NAFLD (44.3 ± 9.5 vs 40 ± 7.5 bursts per minute, respectively, p < 0.04). Moreover, in multiple logistic regression analysis, MSNA was proven as an independent determinant of the presence of NAFLD (OR 1.2, 95% CI 1.01–1.5), p = 0.04).

Conclusions:

In conclusion, higher sympathetic nervous system activity, as assessed by MSNA, is associated with greater diastolic BP in NAFLD patients compared to their non-NAFLD counterparts. These findings suggest that SNS may contribute importantly to the regulation of BP in NAFLD patients.
PS-C09-3: DETECTION OF NOCTURNAL HYPERTENSION BY SELF-MEASUREMENT OF BLOOD PRESSURE MEASUREMENT
Authors: Ozono Ryoji
Published: January 2023

Outside-office BP measurements are recommended for the diagnosis of hypertension because of its better prediction for the cardiovascular (CV) risks compared to that of office BP. Nocturnal hypertension (NH), detectable only by outside-office measurement, is a strong CV risk predictor. However, in the real-world clinical setting, ambulatory blood pressure monitoring is not routinely conducted at least in part because of its annoyance (clinical inertia). In the present study, usefulness of home BP self-measurement, much easier to practice, upon detecting NH was sought.

Subjects were patients with hypertension being treated in Ozono Clinc, Internal Medicine and Cardiology (n = 45, mean age72.8 +/-13, M26:F19). BP was self-measured by a sphygmomanometers provided by the clinic (OMRON HEM-7080 IC), which is equipped with timer-triggered BP measuring system at preset times. Patients were asked to record their morning BP (within one hour after getting-up) and evening BP (just before going to the bed). For detection of nocturnal BP, patients were informed to sleep with the cuffs set around their arms, then the recordings were obtained at 2:00. 3:00, 4:00 and 5:00. NH was defined as having the average of the four systolic BPs (SBPs) during sleep exceed 120 mmHg.

Among the 45 patients 23 (51%) had NH. Relations between the existence of morning hypertension (SBP > 130 mmHg) or evening hypertension (SBP > 130 mmHg) and the existence of NH was shown in the table. When morning or evening hypertension exist, the prevalence of NH was around 60%. On the other hand, if morning hypertension does not exist, the rate of NH is very low. Interestingly, some patients without evening hypertension develop NH during night. Home blood pressure measurement is a convenient and useful clinical tool to estimate NH.
PS-C09-5: AUSCULTATORY AND OSCILLOMETRIC AMBULATORY BLOOD PRESSURE MONITORING: METHODS COMPARISON IN ADULT PATIENTS
Authors: Zhemanyuk Svitlana Pavlina , Syvolap Vitaliy Victorovich
Published: January 2023

Background/Introduction:

Ambulatory blood pressure monitoring (ABPM) is an out-of-office method of blood pressure (BP) detection in usual patients activities via oscillometric or auscultatory recording devices. Correct measurement is crucial as for diagnosis, as treatment purpose. There are different rules for each method exist, however, they are not respected much for ABPM.

The aim of the study was to compare a combined (oscillometric and auscultatory) ABPM device in adult individuals.

Methods:

One-hundred twenty-two patients had 24-hour clock-based definitions (nighttime: 01:00 to 05:59) ABPM patterns (mean age, 62 [95% CI, 60–63] years, 44% men) performed with a combined (oscillometric and AUSCULTATORY) device. Analyzing reading numbers in awake and night periods (not-valid: < 20 and < 7 readings, respectively) the validity was verified. Arterial hypertension was evaluated according to diurnal ABPM.

Results:

Twenty-four-hour systolic and diastolic BP were equal using auscultatory and oscillometric monitoring (140.3 and 139.6 mmHg, 77.2 and 79.0, respectively, NS). In hypertensions, 9.5% systolic and 4.0% diastolic BP patterns were outside the limits of agreements according to Bland-Altman analysis. Meanwhile, in normotensive individuals, 6.4% both for systolic and diastolic (for the population, 7.4% systolic and 5.0% diastolic BP).

Conclusion:

Using the oscillometric and auscultatory methods for ABPM show the same level of diurnal systolic and diastolic BP, but with the hypertension misclassification along with systolic BP rises in adults.
PS-C09-8: FEATURES OF DAILY BLOOD PRESSURE PROFILE IN PATIENTS WITH ARTERIAL HYPERTENSION AND OBESITY
Authors: Duysenbaeva Aziza , Mirakbarova Kamola , Srojidinova Nigora
Published: January 2023

Purpose of the study:

To study the daily profile of blood pressure in patients with arterial hypertension (AH) with obesity.

Materials and methods of the study:

The study included 71 patients with AH I-III degree (ESH, 2018) who received inpatient treatment. Obesity was defined according to the WHO classification (1997). The daily blood pressure profile was assessed using the Medicom-Combi device (Russia). Blood pressure was measured at intervals: day - 30 minutes, night - 60 minutes.

Results of the study:

Patients were divided into 3 groups depending on the degree of obesity: group 1 BMI 30–34.9 kg/m2 (43 patients), group 2 BMI 35–39.9 kg/m2 (19 patients) and group 3 BMI > 40 kg/m2 (9 patients). The compared groups had similar office SBP and DBP: 144.88 ± 21.84/88.14 ± 10.75 mm Hg. vs 143.42 ± 21.86/87.89 ± 9.76 mmHg vs 145.56 ± 17.40/87.78 ± 14.81 mmHg. Analysis of ambulatory blood pressure monitoring (ABPM) revealed that 3 grade obese patients with AH had significantly higher mean daily SBP values (124.98 ± 11.16 vs 120.00 ± 7.18 vs 132.22 ± 12.85 mm Hg, p < 0.018) and DBP (73.93 ± 8.86 vs 68.21 ± 4.71 vs 74.00 ± 7.68 mm Hg, p < 0.02), mean daily SBP (127.14 ± 10 .82 vs 120.95 ± 6.88 vs 134.11 ± 11.59 mmHg, p < 0.005), mean daily DBP (75.79 ± 9.41 vs 69.42 ± 4.98 vs 77.44 ± 7 .80 mm Hg, p < 0.012) compared with AH patients with 1–2 grade obesity. Variability in SBP and DBP did not differ significantly between the groups. The load index of SBP in the daytime was high in AH patients with 3rd grade obesity. Index of SBP daytime were 37.26 ± 29.31 (group 3 patients) vs 7.04 ± 9.78 (group 2) vs 16.35 ± 19.41% (group 1) p < 0.0009. A normal daily profile of SBP/DBP had 30.23%/37.21% of patients of the 1st group vs 21.05%/42.10% of patients of the 2nd group vs 33.33%/33.33% of patients of the 3rd group had, p < 0.145. The number of non-dippers in SBP was slightly higher in the group of patients with grade 1 obesity: night reduction speed (NRS) SBP/DBP 53.48%/ 46.51% in group 1 vs 52.63%/36.84% in group 2 vs 44.44%/ 33.33% in the third, p < 0.113. In the group of patients with grade 3 obesity, persons with daily SBP/DBP ‘night-picker’ profile significantly prevailed: 22.22%/22.22% vs 21.25%/21.05% vs 16.27% /13.95%, (in groups 3, 2, 1, respectively) p < 0.001. There were no patients with an excessive decrease in SBP and DBP at night.

Conclusion:

Patients with hypertension and obesity have more pronounced pronounced disturbances in the daily blood pressure profile, which contribute to an increased risk of developing complications of arterial hypertension.