bluuebunny/crossref_metadata_2025 huggingface dataset:
S-24-2: IMPACT OF FEBUXOSTAT ON VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY: INSIGHTS FROM THE RANDOMIZED PRIZE STUDY
Authors: Saito Yuichi , Tanaka Atsushi , Kobayashi Yoshio , Node Koichi
Published: January 2023

Objective:

Although uric acid lowering therapies, including xanthine oxidase (XO) inhibition, may reduce the absolute level of blood pressure (BP), the effect of XO inhibition on BP variability is largely unknown. The objective of the present analysis was to evaluate the impact of febuxostat, an XO inhibitor, on BP variability in a randomized trial setting.

Design and method:

This was a sub-analysis of the PRIZE study, a randomized trial to evaluate the potential effect of febuxostat on carotid intima-media thickness progression. Patients with hyperuricemia and carotid plaques were randomly assigned to the febuxostat or control group. During a 24-month period, office BP and pulse rate (PR) were measured 3 times or more. BP and PR variabilities were assessed with standard deviation (SD) and coefficient of variation (CV). The effect of febuxostat on BP and PR variabilities were adjusted with age, sex, and baseline BP or PR, expressed with 95% confidence intervals.

Results:

A total of 472 patients with hyperuricemia and carotid plaques were included into the present analysis. Overall, the median serum uric acid level was 7.6 [7.1, 8.2] mg/dl at baseline, and a history of hypertension was found in 419 (88.8%) patients. Baseline characteristics were well balanced between the febuxostat group (n = 236) and control group (n = 236). During the 24-month follow-up period, the febuxostat group had a significantly lower adjusted mean systolic BP (128.4 [126.8 to 130.0] vs. 130.7 [129.1 to 132.2] mm Hg, p = 0.04) and CV of systolic BP (7.4 [6.7 to 8.0] vs. 8.2 [7.6 to 8.8], p = 0.04) than the control group. Adjusted SD of PR was also lower in the febuxostat group than their counterpart (5.95 [4.93 to 6.97] vs. 7.33 [6.32 to 8.33], p = 0.04).

Conclusions:

XO inhibition with febuxostat was associated with reduced visit-to-visit BP variability as well as reduced PR variability, illustrating the potential therapeutic effect of febuxostat in patients with hyperuricemia and carotid plaques.
S-24-5: REAL WORLD DATA IN HYPERTENSION: DATA FROM JAPAN MEDICAL ASSOCIATION DATABASE OF CLINICAL MEDICINE (J-DOME) STUDY IN KANAGAWA
Authors: Kobayashi Kazuo
Published: January 2023

Despite the ease of access for the diagnosis of hypertension and the progression of antihypertensive medications, the consultation for hypertension or the control of blood pressure (BP) is not sufficient, and hypertension remains the major cause of death due to cerebrovascular and cardiovascular diseases.

The Japan Medical Association Database of Clinical Medicine (J-DOME) was established in 2018 with the aim of advancing the level of medical care for lifestyle-related diseases (diabetes and hypertension). To compare the results of previous studies and clarify the current problems, Kanagawa Physicians Associations collaborated with J-DOME to conduct the Kanagawa hypertension study 2021 featuring with J-DOME.

We compared three studies: the 2011 study (n = 826); the 2014 study (n = 1098); and the 2021 study featuring with J-DOME (n = 830).

The BP values at office (mmHg) were 132.9 ± 13.2/75.8 ± 9.3 in 2011, 133.1 ± 14.6/77.2 ± 10.7 in 2014, and 136.5 ± 17.4/76.9 ± 11.6 in 2021 study. Significantly high systolic and diastolic BP were observed in the 2021 study (p < 0.001) and the 2014 study (p = 0.02). The BP values at home (mmHg) were 128.6 ± 10.6/75.5 ± 8.7 in 2011, 129.4 ± 10.2/76.2 ± 8.9 in 2014, 128.0 ± 8.1/76.6 ± 8.3 in 2021 study. A significantly higher systolic BP was observed in the 2014 study (p = 0.03).

Among patients whose target BP was < 140/90 mmHg at the office and < 135/85 mmHg at home, the achievement rates (at office/at home) were 72.5% and 75.8% in the 2011 study; 66.0%/68.5% in the 2014 study; and 46.7%/83.3% in the 2021 study. In contrast, among patients whose target BP was < 130/85 mmHg at office and < 125/75 mmHg at home, the achievement rates (at office/at home) were 31.6%/19.7% in 2011, 32.1%/16.9% in 2014, and 30.4%/19.1% in the 2021 study.

Lower utilization of Ca-channel blockers, ARBs, alpha-blockers, and diuretics was observed in the 2021 study (all p < 0.001).

Because JSH recommends that BP at home is given more importance than BP at the office, the improvement in the achievement of target BP by 135/85 mmHg at home is acceptable. However, efforts should be focused on the management of patients requiring strict BP control who showed extremely low achievement rates and did not show any improvement over the last decade. Furthermore, the low frequency of utilization of antihypertensive medications, despite the large number of diabetes patients, is also a major issue that general practitioners should address as soon as possible.
S-25-3: TRENDS IN SOCIOECONOMIC INEQUALITIES IN OBESITY AMONG KOREAN ADOLESCENTS: THE KOREA YOUTH RISK BEHAVIOR WEB-BASED SURVEY (KYRBS) 2006 TO 2020
Authors: Kim Eunji , Kim Hyeon Chang
Published: January 2023

Objective:

Studies reported the plateau of the rates of adolescent obesity and its masked socioeconomic inequality in developed countries. However, the burden of pediatric obesity continued to increase in Korea and its socioeconomic disparity remains poorly described. This study aims to investigate the recent trends of prevalence and socioeconomic disparity in obesity among Korean adolescents from 2006 to 2020.

Design and method:

We used annual data of self-reported height, weight, and socioeconomic information from the nationwide survey, Korea Youth Risk Behavior Web-based Survey (KYRBS), from 2006 to 2020. Adolescent obesity was defined as a sex-specific BMI for age of 95 percentile or greater among children aged between 12 and 19 years. Obesity prevalence was calculated according to each of four socioeconomic indicators (household income; parental education attainment; urbanicity). Also, socioeconomic inequality in it was quantified and compared using Relative Index of Inequality (RII). Identical analyses were repeated for the subgroups by sex or stage of school along with the total study population. The trend analyses of prevalence and inequalities were conducted using linear regression model with the variable of survey year.

Results:

The analytic sample consisted of 818,210 students, representing approximately 64% of adolescents in Korea. The overall prevalence of obesity continued to increase and doubled during the study period. Male and high school students showed higher absolute figures. Inverse relationships between obesity and socioeconomic status were observed across all subgroups. RIIs in household income and parental education attainments significantly increased with time. These socioeconomic disadvantages exercised greater influence on obesity among female and middle school students.

Conclusions:

This study showed increasing prevalence and widening inequality in obesity among Korean adolescents. These findings highlight parental educational attainments to understand socioeconomic disparities in adolescent obesity, along with household economic status. Relevant policymaking and intervention should focus on not only lowering the absolute figures among boys and high school students but also narrowing the gap among the disadvantaged girls and middle school students.
S-27-1: THE ROLE OF KIDNEY IN BLOOD PRESSURE REGULATION
Authors: Ito Sadayoshi
Published: January 2023

The kidney plays important roles in homeostasis of body fluid and electrolyte balances as well as blood pressure (BP) regulation. For these, two functions are required. One is a stable and huge (150L/day) amount of glomerular filtration rate (GFR) in the face of large variations of BP and dairy salt intake, and the other is pressure natriuresis. Even if BP changed acutely, glomerular capillary pressure of each nephron is maintained relatively stale by myogenic response and tubuloglomerular feedback (TGF). When salt intake is changed, GFR is maintained by exquisitely precise and elegant interplays among the rein-angiotensin-aldosterone (RAA) system, TGF and connecting TGF (cTGF). The cTGF is a recently discovered intrinsic mechanism controlling glomerular hemodynamics. The pressure natriuresis plays a crucial role in the maintenance of body fluid volume, and its site of action is renal medulla. Blood supply to renal medulla is governed by descending vasa recta, the efferent arteriole of the juxtaglomerulus. In outer medulla, thick ascending limb of juxtamedullary nephron makes direct contact with descending vasa recta. Studies indicate that nitric oxide and oxidative stress produced by this tubular segment affect vascular tone of descending vasa recta, a phenomenon called tubulo-vascular crosstalk. The tubule-vascular crosstalk is implicated to play an important role in oxygen metabolism in such conditions as heart failure and high salt intake. In this presentation, I will discuss above mentioned mechanisms that control renal hemodynamics, sodium balances and BP.
S-29-4: ASSOCIATION BETWEEN OBESE STATUS AND INCIDENT LEFT VENTRICULAR HYPERTROPHY DIFFERED BY ACHIEVED SYSTOLIC BLOOD PRESSURE LEVEL
Authors: Cai Anping , Liu Lin , Chen Jiyan , Zhou Yingling , Feng Yingqing
Published: January 2023

Background:

Obesity frequently coexists with hypertension, and both confer additive effects on left ventricular hypertrophy (LVH) development. Little is known whether a more intensive blood pressure (BP) control is needed to mitigate this risk. The primary aim of this study was to evaluate the association between obese status and incident LVH according to achieved systolic BP (SBP) level at follow-up in community hypertensive populations.

Methods:

Hypertensive patients without LVH at baseline (n = 1842; obesity was 19.7%) were included. The China and American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) criteria were used to define LVH. The association between obese status and incident LVH according to achieved SBP level at follow-up (equal to or greater than 140, 130–139 and less than 130 mm Hg) was evaluated using Cox regression model.

Results:

After a median follow-up of 2.90 years, the incidence of LVH in the normal weight, overweight and obese groups were 17.0%, 25.0% and 31.1% (P < 0.001). Obesity was associated with incident LVH, with adjusted hazard ratio (HR) of 3.64 (95% CI 2.39–5.55). When achieved SBP equal to or greater than 140 mm Hg and at 130–139 mm Hg, this association remained significant; when achieved SBP less than130 mm Hg, this association was attenuated (adjusted HR 1.51 and 95% CI 0.89–2.56). When applying the ASE/EVCAI criteria, the results were consistent except for the differences in classification of LV geometry.

Conclusion:

A lower achieved SBP level may be needed to mitigate the additive effects of obesity and hypertension on LVH development. Randomized clinical trials are needed to corroborate these findings.
S-30-3: ETHNICITY AND RISK OF CARDIOVASCULAR DISEASE
Authors: Khan Nadia A
Published: January 2023

Cardiovascular disease is the leading cause of death globally. Despite the widespread rise in hypertension and cardiovascular disease, there are differences in these conditions by ethnicity and region. Ethnic differences in cardiovascular disease occurrence, presentation, risk factors, and outcomes exist. Ethnic minority groups are often underrepresented in cardiovascular research further contributing to a lack of understanding of the underlying reasons for these differences and optimal treatment strategies. In this discussion, we will examine the differences in cardiovascular disease and cardiovascular risk hypertension by ethnicity and region. We will also discuss the possible underlying mechanisms for these differences.
S-31-3: BURDEN OF HYPERTENSIVE HEART DISEASE AND HIGH SYSTOLIC BLOOD PRESSURE IN AUSTRALIA FROM 1990–2019: RESULTS FROM THE GBD STUDY
Authors: Islam Sheikh Mohammed Shariful , Daryabeygi Reza , Ghaffari Payam , Xu Xiaoyue , Huxley Rachel , Maddison Ralph , Schutte Aletta E
Published: January 2023

Background:

There is a dearth of comprehensive studies on the burden of hypertensive heart disease (HHD) and high systolic blood pressure (SBP) among the Australian population over time. We aimed to explore the burden of HHD and SBP, and how it changed over time from 1990 to 2019.

Methods:

We analysed the 2019 Global Burden of Disease data with a focus on Australia. We assessed the prevalence, mortality, disability-adjusted life-years (DALY), years lived with disability (YLD) and years of life lost (YLL) attributable to HHD and high SBP between 1990 and 2019 in Australia. GBD data sources included surveillance and survey data, published, and unpublished research articles and reports, vital registration and hospital data. Data were presented as point estimates with their corresponding 95% uncertainty intervals (UI).

Results:

From 1990 to 2019, the burden of HHD and SBP in Australia decreased. Age standardized prevalence rate of HHD was 119.3 cases per 100,000 people (95% UI 86.6 to 161.0) in 1990, compared to 80.1 cases (95% UI 57.4 to 108.1) in 2019. HHD death stood at 3.4 cases per 100,000 population (95% UI 2.6 to 3.8) in 1990, compared to 2.5 (95% UI 1.9 to 3.0), 32.0 cases (95% UI 26.1 to 38.8) in 2019. HHD contributed to 57.2 cases per 100,000 population (95% UI 46.6 to 64.7) of DALYs in 1990 compared to 38.4 cases per 100,000 population (95% UI 32.0 to 45.2) in 2019. Death rates per 100,000 population attributable to high SBP declined significantly over time for both sexes from 1990 (155.6 cases; 95% UI 131.2 to 177.0) to approximately one third in 2019 (53.8 cases; 95% UI 43.4 to 64.4).

Conclusion:

Over the past three decades, the burden of HHD and high SBP in Australia reduced, but remains relatively high, particularly HHD. The contribution of HHD and high SBP to mortality, DALYs, and YLLs reduced significantly from 1990 to 2019. Efforts to identify people with high blood pressure early and population level measures for improving the management of blood pressure should be a priority for Australia.
S-31-6: CURRENT STATUS AND FUTURE PERSPECTIVES OF ELDERLY HYPERTENSION IN ASIA
Authors: Cho Myeong-Chan
Published: January 2023

Because of rapid aging and unhealthy life style in most of Asian countries, non-communicable diseases are increasing gradually and become significant disease burden and socioeconomic burden in Asia. However, the level of hypertension management is not good especially in the young adults.

Clinical decision-making for hypertension in the elderly should not depend on chronological age alone. Global risk assessment for individual patients, including comorbidities, frailty, functional status, polypharmacy, cognitive impairment, and variable life expectancy and the risk of orthostatic hypotension should be done for better management of hypertension and outcome. There are many conflicting results and discrepancies on the optimal target BP in elderly hypertensive patients.

Asians are different from Caucasians in genetic background, pathophysiology, clinical phenotypes, respond to medication, prognosis and etc. Although there are several hypertension guidelines in Asia, development of hypertension management guidelines for Asians is needed through pooled national cohort data, big health data analysis for precision medicine of hypertension. Hypertension is also good candidate for the digital smart healthcare in the near future.
S-32-3: RECENT IDACO ANALYSIS ON THE RISK OF PROGRESSION TO SUSTAINED HYPERTENSION FROM WHITE-COAT HYPERTENSION OR MASKED HYPERTENSION
Authors: Stolarz-Skrzypek Katarzyna
Published: January 2023

In the general population, the cardiovascular risk is increased in patients with masked hypertension (MH), whereas in individuals with white-coat hypertension (WCH) it is virtually the same as in the normotensive individuals. However, no conclusive evidence exists as to whether WCH and MH are accompanied by a greater rate of development of a sustained hypertensive state, i.e. hypertension both in and outside the clinical environment. We investigated the risk of progression to sustained hypertension in initially untreated participants of cohort studies included in the International Database on Ambulatory blood pressure in relation to Cardiovascular Outcome (IDACO) study.

Within the IDACO, 5 populations comprising 1081 individuals had ambulatory (ABP) and conventional (CBP) blood pressure measured at baseline and at follow up. We excluded from the analysis subjects on BP-lowering treatment at baseline (n = 252) and individuals with untreated sustained hypertension at baseline (n = 80), leaving 749 subjects included in the current analysis. The cut-off value for elevated CBP was > = 140/90 mm Hg and for daytime ABP > = 135/85 mm Hg.

At baseline, 110 individuals (14.7%) was defined as MH, 64 subjects as WCH (8.5%), and 575 (76.8%) as normotensives. MH patients were older (50 vs 45 years compared to normotensives, P < 0.01) and more frequently male (50.9 vs 31.5% compared to normotensives, P < 0.01). During median follow-up of 9.7 years, there were 264 incident cases of sustained hypertension. In the analyses adjusted for cohort, sex, age, body mass index, smoking and drinking, both MH (HR 2.23, 95%CI 1.57 to 3.17) and WCH (HR 1.84, 95%CI 1.37 to 2.47) significantly increased risk of progression to sustained hypertension.

In conclusion, long-term risk of progression to sustained hypertension is 2-fold higher in individuals with masked hypertension or white coat hypertension at baseline as compared to normotensive subjects at baseline. However, this observation might be due to more frequent initiation of antihypertensive therapy in both groups.
S-34-3: THE HEALTH AWARENESS AND SPILLOVER EFFECTS OF A COMMUNITY INTERVENTION BY HOME BLOOD PRESSURE MEASUREMENT: NOSE STUDY
Authors: Kabayama Mai , Wada Arisa , Godai Kayo , Kido Michiko , Hashimoto Sumiyo , Higashi Makiko , Hatanaka Hiromi , Kikuchi Takeshi , Dodo Takayuki , Tabara Yasuharu , Asayama Kei , Okubo Takayoshi , Rakugi Hiromi , Kamide Kei
Published: January 2023

Objective:

This study examined participants’ health-related awareness, changes in health consciousness, and their spillover effects observed through community-wide home blood pressure (BP) monitoring intervention.

Method:

This study was based on an ongoing community-based intervention study in Nose, Osaka, which was designed to assess the effect of home BP measurement on prolonging healthy life expectancy. This study included 446 participants aged 40–91 years. We asked participants to measured their home BP with an electronic oscillometric device (HEM-7281; Omron Healthcare CO., Ltd) twice in morning and evening and record the values in the diary. About six months later, we asked the participants by mailed questionnaire about the status of continued measurement and changes in medication and health awareness.

Results:

The responded participants were 414(93.8%), and we analyzed 400 without missing data. Of the analyzed participants, 30% were on hypertension treatment. The number of participants who continuously measured every morning and evening was 348(87.0%).Of those, 301 (75.3%) newly started measuring as a result of the intervention. In their responses, the changes in health awareness or consciousness resulting from continued home BP measurement were, in descending order, “became more aware of my own and family members’ BP,“ “became more aware of my own physical condition,“ and “became more conscious of dietary content,“. In addition, a spillover effect of further measurement promotion in the household was recognized, such as “family members started taking measurements“ and “couples are calling out to each other to take measurements. After the start of HBP measurement, 32 (8%) of the participants newly started taking antihypertensive medication based on the home BP values.

Conclusion:

We found that home BP measurement can help even non-hypertensive individuals to become aware of changes in their physical condition and improve their health awareness. In addition, BP measurement behavior in the home was found to have spillover effects, such as increasing family members’ interest in BP and promoting home BP measurement behavior. It was suggested that measuring home BP for everyone, including non-hypertensives, is effective in health promotion and disease prevention for the entire community, including those who are indifferent to their own health.
S-34-5: PERSPECTIVES FROM LONGITUDINAL COHORT STUDY IN NORTHERN JAPAN -HYPERTENSION, METABOLIC DISORDERS AND CARDIOVASCULAR DISEASE-
Authors: Saitoh Shigeyuki
Published: January 2023

The percentage of obese in the population of middle-aged Japanese has been increasing in recent years. With obese, population of metabolic disorder to be accompanied with diabetes mellitus, IGT increases explosively.The similar tendency is observed in the whole Asian countries. Recently, for the purpose of preventing cardiovascular disease, the conception of metabolic syndrome is proposed. Obesity, hypertension, glucose intolerance and lipid metabolism abnormality are included in this conception.

On the basis of data obtained through annual health examinations on about 2,000 residents in the two communities, we performed analysis and are currently reviewing cardiovascular disease and its relevant risk factors in this population. On the basis of the analysis, at this seminar, I will lecture on metabolic syndrome among the Japanese population in terms of frequency and characteristics as well as its impact on the onset of cardiovascular disease. Diagnosis of metabolic syndrome is based on the Japanese Criteria. When the sample consisted of those without a history of cardiovascular disease and not undergoing treatment for hypertension, diabetes, or hyperlipidemia, frequency of the syndrome was 20–25 percent for men and 5–7 percent for women, levels that have remained unchanged over the past 10 years. Those frequencies appeared to be on a level with those observed in other regions around the country. We also conducted a six-year follow-up of the male group. We found as a result that the relative risk of cardiovascular disease development, including coronary heart disease, was 2.3 times higher in syndrome males than in non-syndrome males.These studies suggest that the Japanese population exhibited a certain level of metabolic syndrome incidence due to accumulation of visceral fat, even though the rate of obesity is lower in this population than in the U.S., that metabolic syndrome affected a variety of atherosclerosis-related factors, and that the syndrome could practically serve as a predictive factor for cardiovascular disease.

Obesity is a basic factor in the onset of metabolic syndrome, and the BMI average among the Japanese population has increased over time. The significance of coronary heart disease against the backdrop of diabetes and metabolic syndrome will likely increase in the future. It is therefore necessary to develop primary preventive measures against coronary heart disease, tailored for the Japanese population, with a particular focus on improvement of lifestyle.
S-35-3: HAMA, AN EUROPEAN REGISTRY OF MALIGNANT HYPERTENSION SUPPORTED BY THE EUROPEAN SOCIETY OF HYPERTENSION: PRELIMINARY RESULTS AND CURRENT PERSPECTIVES
Authors: Rubin Sebastien , Lorthioir Aurelien , Halimi Jean Michel , Tharaux Pierre Louis , Antoine Cremer , Debeugny Stephane , Persu Alexandre , Philippe Gosse , Romain Boulestreau
Published: January 2023

Introduction:

Malignant hypertension (MH) is one of the most severe acute forms of hypertension. It is very high blood pressure and an acute lesion of target organ damage. Incidence is currently increased in high-income countries and is higher in low-income countries due to difficulty with antihypertensive drug access. Causes of MH are very various, and probably prognosis of MH depends on the etiology. However, MH is not well known. We are conducting a multicentric prospective registry of MH patients started in 2019, primarily in France and is currently undergoing a European expansion with the support of the European Society of Hypertension (ESH) to describe the different forms and prognosis of MH and increase our knowledge of the disease (NCT03755726).

Method:

From 2019, in the 36 centres in France, Patients with a BP > 180/100 mmHg AND Severe Hypertensive Retinopathy - stade II or III of Kirkendall classification - OR with three criteria among the following: 1) Heart damage (Left ventricular Mass > 140 g/m2 for men of > 120 g/m2 for women); 2) Brain damage (PRES or acute stroke or severe white matter lesions (WML) with a Fazekas score > 2 before 60 years old); 3) Kidney damage (acute kidney injury defined by KDIGO criteria) 4) presence of Thrombotic Microangiopathy (TMA) with the presence of schizocytes and low haptoglobin or high LDH) were included.

Results:

To date, 278 patients were enrolled. The reason for hospital admission was symptomatic hypertension for 210/272 (77%) and asymptomatic hypertension for 62/272 (23%) BP was 218 ± 28 / 127 ± 23 mmHg. The mean age was 48 ± 15 years old. Males were 186/278 (67%). Non-Caucasians were 114/278 (41%), 101/278 (36%) smoked and 45/278 (16%) had diabetes. Before enrollment, 108/278 (39%) patients had chronic hypertension. Severe retinopathy was present in 251/278 (90%), Heart damage in 172/278 (62%), kidney damage in 176/278 (63%), and creatinine was 261 ± 326 μmol/l at admission. Brain damage was present in 105/278 (38%), 47/105 (45%) patients had severe WML. TMA was present in 40/278 (14%) patients. At discharge, BP was 148 ± 19 / 89 ± 15 mmHg; creatinine was 248 ± 274 μmol/l. The etiology of hypertension was assessed in 181/278 (65%), and a specific cause was found in 75/181 (41%).

Conclusion:

This multicentric prospective cohort is the opportunity to considerably increase our knowledge of MH, a non-uncommon severe disease. A biobank is currently being started to identify patients clustering to differentiate the etiology, prognosis and pathogenesis of each form of MH.
S-35-4: PEAK OF NOCTURNAL BLOOD PRESSURE SURGE IN SECONDS IS ASSOCIATED WITH LEFT VENTRICULAR MASS INDEX IN OBSTRUCTIVE SLEEP APNEA PATIENTS
Authors: Kokubo Ayako , Kuwabara Mitsuo , Ota Yuki , Tomitani Naoko , Yamashita Shingo , Shiga Toshikazu , Kario Kazuomi
Published: January 2023

Background:

Nocturnal blood pressure (BP) surge in seconds (sec-surge), which is characterized as acute transient BP elevation over several tens of seconds, could be a predictor of target organ damage and trigger cardiovascular events. Sec-surges are induced by sleep apnea (SA) or sympathetic nerve activity. However, it is not clear that the severity of sec-surge is different between sec-surges induced by SA (apnea/hypopnea detected by polysomnography (PSG) or oxygen desaturation) and those induced by non-SA factors (rapid eye movement, micro arousal, etc.). Furthermore, it is also not clear whether the sec-surge increases the cardiac overload.

Methods and Results:

Firstly, we assessed the sec-surge severity between sec-surges induced by SA and those induced by non-SA factors by comparing the sec-surge variables. Secondly, we assessed the association between sec-surges and left ventricular hypertrophy (LVH) independently of conventional BP variables. We assessed these points with 41 patients (mean age 63.2 ± 12.6 years, 29% female) who underwent full PSG, beat-by-beat (BbB) BP, and cuff-oscillometric BP measurement during the night. All patients were included for the analysis comparing sec-surge severity between inducing factors (SA and non-SA factors).

There were no significant differences in the number of sec-surges/night, the peak of sec-surges defined as the maximum systolic BP in each sec-surge, and the amplitude of sec-surges defined as peak of sec-surge minus start point systolic BP in each sec-surge between SA-related sec-surges and non-SA-related sec-surges (19.5 ± 26.0 vs. 16.4 ± 29.8 events/night; 148.2 ± 18.5 vs. 149.3 ± 19.2 mm Hg; and 26.0 ± 4.3 vs. 25.8 ± 5.7 mm Hg, respectively).

Eighteen subjects who had inspection results of cardiac magnetic resonance imaging out of the 41 patients (mean age 65.0 ± 12.5 years, 33% female) were included for the analysis assessing the association between sec-surges and LVH. The peak of sec-surge was significantly and strongly correlated with left ventricular mass index (LVMI) (r = 0.607, p < .01). As a result of multiple regression analysis (n = 18), the peak of sec-surge was significantly and strongly associated with the LVMI (standardized β = 0.62, p = .02), compared with the mean nocturnal SBPs measured by oscillometric method (standardized β = -0.04, p = .87).

Conclusions:

This study suggests that peak of sec-surge could be a better predictor of LVH compared to parameters derived from regular nocturnal oscillometric SBP.
S-35-6: LONG-TERM REDUCTION IN MORNING AND NIGHTTIME BLOOD PRESSURE AFTER RENAL DENERVATION: 36-MONTH RESULTS FROM SPYRAL HTN-ON MED PILOT TRIAL
Authors: Kario Kazuomi , Mahfoud Felix , Kandzari David E , Townsend Raymond R , Weber Michael A , Schmieder Roland E , Tsioufis Konstantinos , Pocock Stuart , Fahy Martin , Boehm Michael
Published: January 2023

Objective:

Elevated morning and nighttime blood pressures (BP) are associated with increased risk of cardiovascular events such as stroke. Furthermore, those with resistant hypertension (hypertension despite > = 3 antihypertensive medications) are at particular risk. We compared the long-term changes in morning, daytime and nighttime blood pressure (BP) in patients prescribed > = 3 antihypertensive medications 36 months after radiofrequency renal denervation (RDN) vs. sham control in the SPYRAL HTN-ON MED pilot trial.

Design and method:

The SPYRAL HTN-ON MED pilot trial enrolled patients with uncontrolled hypertension and office systolic BP (SBP) between 150 and < 180 mmHg, office diastolic BP > = 90 mmHg and mean ambulatory SBP between 140 and < 170 mmHg, with 1–3 prescribed antihypertensive medications. Patients were randomized 1:1 to RDN or sham control. Long-term safety and efficacy of the RDN procedure was assessed at 36 months through collection of adverse events and BP assessment. Differences in BP changes were compared between RDN and sham control using ANCOVA, adjusting for baseline measurements.

Results:

There were 80 patients randomized to RDN (N = 38) or sham control (N = 42). The number of antihypertensive medications at baseline was 2.13 ± 1.40 for RDN vs 1.98 ± 1.14 for sham control (p = 0.59). At 36 months, RDN patients were prescribed 3.03 ± 1.20 antihypertensive medications compared to 3.05 ± 1.43 in sham control (p = 0.76). Major adverse events through 36 months were rare in both groups, and there were no renal artery re-interventions or major vascular complications. Baseline morning (7:00–9:00 AM), daytime (9:00AM-9:00PM) and night-time (1:00–6:00 AM) SBP measurements for patients prescribed 3 or more antihypertensive medications at 36 months were similar between RDN and sham control (Figure). However, morning and night-time SBP were significantly reduced from baseline for the RDN group compared to sham control (morning SBP: -23.9 vs. -8.0 mmHg, p = 0.029; night-time SBP: -20.8 vs. -7.2 mmHg, p = 0.001; (Figure). Difference in daytime SBP was not significantly different between groups (-19.6 vs. -13.7 mmHg, p = 0.13). Additional analyses of BP reduction in patients with varying antihypertensive medication burden will be presented for the first time at ISH 2022.

Conclusions:

Morning and nighttime SBP were significantly reduced in patients prescribed at least 3 antihypertensive medications at 36 months in the SPYRAL HTN-ON MED pilot trial after RDN compared to sham control. The results suggest RDN has significant benefit when the risk of cardiovascular events is highest.
S-36-3: NURSES CONTRIBUTION TO HYPERTENSION
Authors: Cloutier Lyne
Published: January 2023

Over the past 75 years the contribution of nurses to hypertension has evolved and expanded continually. First mainly involved in blood pressure monitoring, the role of nurses as educator has become a key component of blood pressure control. Today nurses and nurse practitioners are involved in all aspects of hypertension care from detection, prevention, diagnosis, management to follow up. They are involved in management of hypertension clinics and public health strategies development and implementation. At the heart of their practice remains the idea that patient-centered care through patient education, counseling will empower them into playing an even larger part into their care. The conference presented will highlight the different roles throughout time. highlighting research results demonstrating the efficacy and necessity to move forward towards a model of care into which nurses and nurse practitioners are pivotal.
S-36-4: STRATEGY OF HEALTH PROMOTION FOR HEALTH AND LONGEVITY IN OKINAWA, JAPAN
Authors: Ohya Yusuke , Sakima Atsushi
Published: January 2023

Okinawa was known as an area of longevity. The life expectance kept always top ranks in Japan, and centenarians kept their healthy and vigorous lives. In recent 10 years, however, their life expectancy of people did not increase as much as other areas in Japan. From epidemiological evidence, an increased intakes of fat after World War II (late 1940 s) and that of salt after the reversion to Japan after 1972 are considered as major causes. To recover health and longevity in Okinawa, we, team of University of the Ryukyus, designed, and then carried out the health promotion program. Main strategy to learn from old healthy Okinawa, namely healthy food and rich social capital. We campaigned to increase intake of vegetables including local Okinawan vegetables. We also promoted the health literacy through relationships with family and with neighbors. Such interventions decreased body weight of obese residents and increased vegetable intake. We also found that the promotion worked more effectively in an area where the social capital was rich. We are now accumulating evidence whether our approach is effective or not.
S-37-1: PROGNOSTIC UTILITY OF MORNING BLOOD PRESSURE SURGE
Authors: Chen Chen-Huan
Published: January 2023

Morning blood pressure surge (MBPS), defined as the difference between morning systolic blood pressure and the lowest nighttime systolic blood pressure, is a normal physiological phenomenon of diurnal blood pressure variability (BPV). Exaggerated MBPS is associated with morning hypertension and has been associated with adverse cardiovascular and cerebrovascular events, especially hemorrhagic stroke. However, MBPS has low reproducibility and there is an ethnic difference in the amplitude of MBPS and its prognostic value. More evidence is needed to prove its clinical usefulness in the management of hypertension. Since the risk of MBPS is mainly attributable to the elevated morning blood pressure, the focus therefore has shifted from MBPS to the control of morning hypertension.

Because MBPS focuses only on the amplitude rather than the rate of blood pressure rise, we calculated the MBPS rate as the slope of linear regression of sequential systolic blood pressure measures on the time intervals within the MBPS period. We found the reproducibility for the MBPS rate was better than the MBPS amplitude. The MBPS rate was a more sensitive and reliable prognostic factor of long term mortality than the MBPS amplitude. The prognostic values of MBPS rate were comparable in subjects with or without morning and nocturnal hypertension. Because the MBPS rate can easily be calculated from the ambulatory blood pressure monitoring data, it could become a routine parameter in daily practice in conjunction with other routinely derived parameters including MBPS amplitude.
S-37-2: CIRCADIAN RHYTHM OF PERIPHERAL AND CENTRAL ARTERIAL BLOOD PRESSURES IN RELATION TO ALL-CAUSE MORTALITY
Authors: Huang Jianfeng , An Dewei , Cheng Yibang , Li Mingxuan , Huang Qifang , Sheng Changsheng , Zhang Dongyan , Guo Qianhui , Wang Ying , Liu Chuhao , Xu Tingyan , Wang Jiguang , Li Yan
Published: January 2023

Objective:

Brachial blood pressure (BP) presents a circadian rhythm. Abnormal rhythms are associated with adverse outcomes. However, it is not clear about the circadian rhythm of central BP and its predictive value.

Methods:

The study participants were patients referred to the outpatient clinic of Ruijin Hospital for 24-hour ambulatory BP monitoring from the year 2017 to 2020. The 24-hour brachial and central ambulatory BP monitoring were performed with the use of the Mobil-O-Graph (Germany) monitors. Dipping, non-dipping, reverse dipping and extreme dipping were defined as a night-to-day systolic BP ratio of 0.8–0.9, 0.9–1.0, > 1.0, and < 0.8, respectively. In cross-classification analysis of brachial and central dipping status, extreme dipping and reverse dipping were grouped with dipping and non-dipping, respectively. The vital status of patients until Dec 2020 was ascertained according to the vital statistics of the Shanghai Center for Disease Prevention and Control.

Results:

In 26,023 enrolled patients (men 47.4%, average age 53.0 years) followed up for a median of 1.8 years, 120 deaths occurred. The prevalence of non-dipping (46.7% vs. 43.7%, respectively) and reverse dipping (16.0% vs. 13.1%) was significantly (P < 0.001) higher for central than for brachial BP. The hazard ratios (95% confidence intervals, [CI]) for all-cause mortality were statistically significant for reverse dipping (1.95 [1.18–3.23] and 2.37 [1.43–3.94], respectively), but not other dipping status, versus dipping in brachial and central BP, respectively. In the brachial and central cross-classification analysis, the prevalence of consistent dipping, consistent non-dipping, isolated central non-dipping, and isolated brachial non-dipping was 34.7%, 54.2%, 8.6%, and 2.5%, respectively. Taking the consistent dipping as reference, the hazard ratios (95% CI) for all-cause mortality were 1.83 (0.77–4.31), 1.34 (0.46–3.95), and 1.94 (1.20–3.15) for isolated central, isolated brachial and consistent non-dipping, respectively. Furthermore, cross-classification significantly improved the risk prediction of all-cause mortality with a net reclassification improvement index (95% CI) of 0.193 (0.069–0.304).

Conclusions:

Non-dipping and reverse dipping were more common for central than for brachial BP, and were associated with a higher mortality risk irrespective of brachial or central BP. Cross-classification of brachial and central dipping status further improved risk stratification.
S-37-4: TRANSCATHETER AORTIC VALVE REPLACEMENT DOES NOT RESULT IN SUSTAINED LOAD TRANSFER WITH INCREASED VASCULAR LOAD
Authors: Song Ning , Adji Audrey , Hungerford Sara , Namasivayam Mayooran , Hayward Christopher , Jabbour Andrew , Muller David
Published: January 2023

Objectives:

Transcatheter aortic valve replacement (TAVR) is an effective treatment for aortic stenosis (AS) by reducing the load placed on the left ventricle (LV) by the stenotic valve. Although systolic pressure is reported to increase in 50% of individuals after TAVR, its effects on steady and pulsatile vascular load represented by the systemic vascular resistance (SVR) and impedance of the proximal ascending aorta (Zc) respectively is less well understood. Using a previously validated non-invasive load estimation technique, we investigated the valvulo-arterial interaction in AS patients pre- and post-TAVR.

Design and Method:

In AS patients being assessed for TAVR, the proximal thoracic aorta flows, LV volume and function were recorded using 3T cardiac magnetic resonance (CMR) using phase-contrast velocity quantification. Simultaneous radial tonometric pressure was acquired during CMR and brachial cuff pressure was recorded. Aortic pressure was derived offline using SphygmoCor 8.1 (AtCor Medical, Sydney) from radial pressure, and calibrated to brachial pressure. Flow was acquired at 5 cm above the aortic valve at the level of the pulmonary artery bifurcation to avoid flow artefact from the TAVR prosthesis. Baseline and follow-up measurements were made before and after treatment with TAVR. Values pre- and post-TAVR were compared, and indices of pulsatile arterial load were calculated using frequency domain analysis.

Results:

A total of 17 patients (mean age 80 ± 6 years, 7 females) were recruited, with a median follow up of 54.5 days post-TAVR. In the post-TAVR measurements, a significant improvement in aortic peak volumetric flow (336 ± 79 ml/s vs 389 ± 110 ml, P = 0.011) was observed with an associated reduction in peak aortic velocity (189 ± 65 cm/s vs 126 ± 24 cm/s, P = 0.002). However, there was no statistical difference in heart rate (70 ± 9 beats per minute vs 68 ± 12 beats per minute), mean central aortic pressure (98 ± 13mmHg vs 99 ± 11mmHg), or the steady vascular load parameters of SVR (1860 ± 513 dynes.s/cm5 vs 1999 ± 561 dynes. s/cm5, P = 0.284) and pulsatile load Zc of the aorta (119 ± 51 dynes.s/cm5 vs 106 ± 43 dynes.s/cm5, P = 0.102).

Conclusion:

TAVR relieves valvular obstruction but does not result in significant alterations of vascular load in the short to medium term. The previously reported acute load transfer immediately following TAVR appears to resolve with time. Further study examining the effect of TAVR on external LV work may help to elucidate the energy consumption by the vascular system after correction of valvular obstruction from AS.
S-37-6: THE PROMISE OF CUFFLESS BLOOD PRESSURE MONITORING IN MANAGING HYPERTENSION
Authors: Schutte Aletta E
Published: January 2023

Although blood pressure measurement is perhaps the most common measurement done in clinical practice, many have started to challenge this procedure and calling for transformation in blood pressure monitoring. This is because blood pressure measurement in primary care has many problems, whether clinic, 24-hour ambulatory or home blood pressures are taken.

Cuffless blood pressure measurement technologies have been knocking on the door for years, with the first patents already registered over 20 years ago. With advancements in data science, machine learning, artificial intelligence, and mobile phone technologies, many start-ups and major global tech giants are now presenting to the end-user an array of highly innovative technologies. Cuffless monitoring includes many devices from wrist-worn watch-type devices to mobile phone tech (transdermal optical facial video processing or oscillometric finger pressing), wearable ultrasound patches, temporary graphene electronic tattoos, glasses, and even from a toilet seat.

These technologies has a major benefit, namely blood pressure being taken without any user awareness. But it also has the potential to harness long-term prognostic cardiovascular information over and beyond blood pressure that may become particularly useful. Continuous long-term cuffless monitoring will provide for the first time the opportunity to move from averaging snapshot readings to capturing the continuous dynamic fluctuations of blood pressure in a high-definition video recording.

There are, however, still several hurdles that need to be overcome before cuffless technologies can be implemented in clinical care. While biomedical engineers may exert their energy on ensuring that a cuffless innovation can accurately reflect brachial blood pressure, this is not the only aspect to consider. Manufacturers of conventional cuff-based devices have to painstakingly follow the ISO 81060–2:2018 Universal Standard to validate the device for accuracy. The rules are different for cuffless devices. Novel cuffless technologies vary substantially and use many techniques such as pulse transit time, pulse wave analyses, and ultrasound. The key question is whether these devices can accurately track the dynamic changes in blood pressure over time. Currently, an ISO 81060–3 standard is being developed to validate cuffless devices but due to the heterogenous technologies used by cuffless manufacturers there are major challenges.

For this and other reasons, the European Society of Hypertension has released a consensus statement that due to fundamental questions regarding the accuracy, performance and implementation of cuffless devices in practice, these devices cannot be recommended for clinical use, while recognising the considering potential.
S-38-7: CONTINUOUS NON-MUTAGENIC DNA DAMAGE IN PODOCYTES ACTIVATES PATHOGENIC MEMORY T CELLS THROUGH ALTERED DNA METHYLATION
Authors: Nakamichi Ran , Hayashi Kaori , Hishikawa Akihito , Chikuma Shunsuke , Yoshimoto Norifumi , Sugita Erina , Yoshida Eriko , Itoh Hiroshi
Published: January 2023

Objective:

Chronic kidney disease (CKD) is a common cause of hypertension and a complication of uncontrolled hypertension. Recent epigenome-wide studies suggested the association of altered DNA methylation in blood cells with kidney function. However, the mechanism and pathological significance has remained to be adequately elucidated.

Design and method:

To investigate the significance of DNA double-strand breaks (DSBs) in podocytes, we generated podocyte-specific I-PpoI-expressing mice (podocin-Cre ROSA26-STOP- I-PpoI, referred as I-PpoI-mice). I-PpoI is a homing endonuclease which causes non-mutagenic DSBs.

Results:

I-PpoI-mice showed severe albuminuria at 6 weeks of age and developed nephrotic syndrome. The mice died because of renal failure around 24 weeks of age following rapid deterioration of renal function. MeDIP-seq analysis using isolated podocytes revealed that 5219 DMRs were identified, and 5212 hypermethylated DMRs were detected in I-PpoI mice. No significant correlation between DNA methylation levels and the distance from I-PpoI cutting sites was observed. Single-cell RNA seq analysis using renal cortex revealed a marked expansion of immune cells, especially CD8+ T cells exhibited a KLRG1low IL-7Rhigh memory precursor effector cell phenotype, with high expression of NKG2D receptors in I-PpoI-mice. The expression of murine NKG2D ligands, which are upregulated by DNA damages, increased in I-PpoI-mice podocytes. In addition, the expression of human NKG2D ligands, MICB, in glomeruli was upregulated in patients with various kidney diseases including hypertensive nephropathy. Whole T cell depletion prevented exacerbation of albuminuria and attenuated glomerulosclerosis and fibrosis in I-PpoI mice, and similar results was obtained by NKG2D blocking. Me-DIP seq analysis using peripheral blood cells, which revealed hypermethylated DMRs in I-PpoI mice were enriched in binding sites for the STAT1 transcription factor. I-PpoI-mice showed a significant increase in CD44high memory/activated phenotype cells of peripheral CD8+ T cell populations, which was similar phenotype of STAT1 knockout mice. The chimeric WT mice with bone marrow (BM) cells of I-PpoI-mice exhibited an increase in albuminuria temporarily, whereas the chimeric I-PpoI-mice with BM cells of WT mice prevented renal fibrosis and renal death.

Conclusions:

Continuous non-mutagenic DSBs altered DNA methylation regardless of the distance from the primary DSB sites podocytes. Podocyte DNA DSBs also altered methylome of blood cells, including CD8+ T cells, leading sustained changes in immune microenvironment of the kidney and also BM. These results suggest the altered immune microenvironment in the kidney may be a therapeutic target preventing exacerbating glomerulosclerosis and renal fibrosis following podocyte DNA damage in CKD.