bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Botrytis cinerea in Petunia Using Cultivar Resistance and Biorational Products
Authors: Shrestha Sunil , Hausbeck Mary K.
Published: January 2023

Botrytis cinerea causes blight on the leaves, stems, and flowers of petunia ( Petunia × hybrida), a popular annual bedding plant. Our objectives were to evaluate (i) four standard and nine Wave petunia cultivars for resistance to Botrytis blight and (ii) 10 biorational products compared with the standard fungicide fenhexamid and an untreated control to limit disease. According to the final disease assessment and area under the disease progress curve (AUDPC) data, ‘Sophistica Blackberry’ had significantly less disease than ‘Tidal Wave Cherry’ in all trials. Tidal Wave Cherry also had significantly more disease according to ratings and AUDPC data than ‘Easy Wave Red Improved’, ‘Wave Purple Classic’, ‘Tidal Wave Silver’, ‘Shock Wave Red’, and ‘Easy Wave Blue’ in trials 1 and 3, whereas in trial 2, these differences were not observed. When evaluated on Shock Wave Red petunia, Prestop ( Gliocladium catenulatum) provided significant B. cinerea control and was similar to the fungicide standard Decree (fenhexamid) in both trials. According to the final disease severity assessment, treatment with Botector ( Aureobasidium pullulans), Zio ( Pseudomonas chlororaphis), or LifeGard ( Bacillus mycoides) also provided control similar to the fungicide standard but was significantly different from the untreated control in one trial only. Results from this study illustrate that certain biorational products can limit B. cinerea when used in conjunction with a cultivar that has disease resistance that limits the impact of the pathogen.
PL-2: TOWARD PRECISION MEDICINE OF METABOLIC DISEASES BASED ON GENETIC ANCESTRY
Authors: Imura Hiroo
Published: January 2023

Most of metabolic diseases such as obesity, diabetes and hypertension are becoming serious health problems in not only developed but also developing countries. To achieve precision medicine for these diseases, numerous genetic studies including genome-wide association studies have been performed that produced important information for understanding genetic bases of these disorders, but are difficult to use in daily practice. One practical way is to better understand differences of diseases in different races or with different genetic ancestries.

For example, obesity is far less common in East Asians, but more common in Pacific Islanders.

Most of other races are in between. Clinical pictures of diabetes mellitus are also different. Importance of understanding these differences in daily practice and their genetic background will be discussed.
FP-1: ROBOTICS AND HEALTH: AVATAR TECHNOLOGY FOR SUPPORTING OUR FUTURE SOCIETY
Authors: Ishiguro Hiroshi
Published: January 2023

The speaker has been involved in research on tele-operated robots, that is, avatars, since around 2000. Research on Geminoid modeled on oneself is not only scientific research that understands the feeling of presence of human beings, but also practical research that allows one to move one's existence to a remote place and work in a remote place. In this lecture, the speaker will introduce a series of research and development of tele-operated robots, avatars, such as Geminoid and discuss in what kind of society humans and robots will coexist in the future. By using avatars, anyone, including the elderly and people with disabilities, will be able to freely participate in various activities with abilities beyond ordinary people while expanding their physical, cognitive, and perceptual abilities using a large number of avatars. Anyone will be able to work and study anytime, anywhere, minimize commuting to work, and have plenty of free time in the future society.
FP-4: SPIRIT OF KYOTO, SPIRIT OF ZEN
Authors: Matsuyama Daiko
Published: January 2023

Welcome to Kyoto. Kyoto is the ancient capital of Japan, a university town, a gastronomic city, and one of the most religious cities in the world. Kyoto has developed a unique culture over its nearly 1,300-year history, and the influence of religion is particularly evident.

In particular, Kyoto is home to seven head quarters of Zen, and it is no exaggeration to say that it is the center of Zen in Japan. Zen has been supported by the ruling class since ancient times and has had a profound influence on Kyoto's culture, including its gardens, architecture, festivals, customs, and cuisine.

What is special about Kyoto culture? What is fascinating about it? I will talk about Kyoto's spirituality from a religious perspective to enrich your stay in Kyoto.

CV:Born in 1978 in Kyoto, Mr. Matsuyama obtained his Master's degree in Agriculture and Life Sciences from the University of Tokyo. After three and half years of training at Heirin-ji Temple, Niiza, he became the deputy priest of Taizoin Temple in 2007. Matsuyama is acclaimed for organizing intercultural activities such as Zen experience tours for foreign visitors and talks at embassies in Japan and at the Foreign Correspondents’ Club. In May 2009, he was elected as a Japan Tourism Agency's Ambassador for its “Visit Japan” Campaign. He has been a member of Kyoto's Ambassadors for Tourism since 2011, and was listed as one of “The Top 100 People of the New Generation 2016” in Nikkei Business. And he was appointed as a fellow of US-Japan Leadership Program from 2016. In 2018, he was invited to Israel as the delegate of Young Leaders Program. And he also became a visiting lecturer at Stanford Univ. He received The Award of Commissioner for Cultural Affairs and Shigemitsu Award from Japan society in Boston in 2019. He is serving as an appointed member of the Kyoto City Board of Education and an Outside Director of V-cube, a tech startup, since 2021.

As a young representative of the Zen Sect in Japan, Matsuyama has interacted with many religious leaders, such as having an audience with the Roman Catholic Pope and conversing with the 14th Dalai Lama. He also participated in the Davos World Economic Forum in 2014, and continues to work actively beyond national and religious borders. He is the author of the book, Forget What's Important First: 30 Zen Teachings for the Wavering Soul (Sekai Bunka Publishing, 2014) Strolling around Zen Gardens in Kyoto (PHP Publishing, 2016) Introduction of ZEN for workers (Kodansya Publishing, 2016).
ME-1: ROLE OF MINERALOCORTICOID RECEPTOR BLOCKERS IN RESISTANT AND REFRACTORY HYPERTENSION
Authors: Oparil Suzanne
Published: January 2023

Resistant hypertension is defined as blood pressure (BP) that remains above goal in spite of compliance with full doses of 3 or more antihypertensive medications of different classes. Ideally, a thiazide-like diuretic should be included in this 3 drug regimen. Classically, the recommendation has been to add a mineralocorticoid receptor antagonist such as spironolactone or eplerenone to the regimen of these resistant hypertensive patients to gain BP control. The study that deserves major credit for establishing this practice is the Prevention And Treatment of Hypertension With Algorithm based therapY (PATHWAY) study (Williams B, et al. Lancet. 386:2059–2068, 2015). PATHWAY compared the mineralocorticoid receptor antagonist spironolactone to doxazosin and bisoprolol in patients with resistant hypertension and demonstrated that spironolactone was overwhelmingly more successful in controlling the patient's BP and was also very well tolerated. The results of PATHWAY established aldosterone antagonists as the best add-on therapy for patients with resistant hypertension. However, spironolactone and other steroidal mineralocorticoid receptor antagonists such as eplerenone do have major adverse effects which can limit their use. These include sex hormone-related adverse effects such as gynecomastia and breast tenderness in women and erectile dysfunction and feminization in men. A solution to this problem, which is currently under active development, is use of non-steroidal mineralocorticoid receptor antagonists such as esaxerenone and finerenone (Figure 1). These non-steroidal mineralocorticoid receptor antagonists are bulky molecules which bind to the mineralocorticoid receptors and effectively prevent their activation. Specifically, esaxerenone has been shown to be as effective as eplerenone in lowering BP and to be well tolerated in Japanese patients with essential hypertension. Esaxerenone also has no sex hormone-dependent adverse effects. The question now is whether the non-steroidal mineralocorticoid receptor antagonists are to be the answer for resistant and refractory hypertension.

Figure 1. Molecular Structures of Steroids and MR Blockers

Adapted from: Tezuka Y, Ito S. The time to reconsider mineralocorticoid receptor blocking strategy: Arrival of nonsteroidal mineralocorticoid receptor blockers. Curr Hypertens Rep. 2022 Jul;24(7):215–224. doi: 10.1007/s11906-022-01177-6.
DB-2-4: NO, WE SHOULD NOT STOP ANTIHYPERTENSIVE MEDICATIONS FOR END-OF-LIFE PATIENTS WITH HYPERTENSION
Authors: Rakugi Hiromi
Published: January 2023

End-of-life patients, the Debate theme, are sometimes described as patients with limited life expectancy. Even if one is under the impression that death shortly is inevitable for the patient in front of them due to a specific disease, the duration of life expectancy varies and is difficult to estimate. Factors affecting the period of life expectancy are complicated, including the causative disease, comorbidities, the environment of care, and the individual's physical and mental capacity. Although high blood pressure does not directly affect life expectancy, hypertension affects life expectancy, quality of life, and ADL through the development or exacerbation of stroke, cardiovascular disease, and renal failure. This situation is the same even for end-of-life individuals, who are at high risk of hypertensive complications if their hypertension is poorly controlled. Worsened blood pressure control increases the risk of stroke and heart failure, even within a few months. The VALUE trial found a significant difference in the incidence of events within the first six months after randomization to the two treatment groups. This difference in event rate was attributed to differences in blood pressure levels between the two groups during that period. The VALUE trial did not include end-of-life patients. Still, it can be assumed that even in end-of-life patients, an increase in blood pressure due to withdrawal of antihypertensive medication may increase the incidence of events within a few months. Of course, deprescribing may be acceptable if blood pressure is still controlled within a level less than 140/90. However, there are currently no randomized controlled trials on the effects of such reduction of antihypertensive drugs. There have been several studies and systematic reviews on whether overall withdrawal of therapeutic drugs should be undertaken for end-of-life patients, not specific to antihypertensive medications. None of these studies has reached a clear conclusion in favor of drug treatment withdrawal. In the most plausible conclusion, “We should not stop antihypertensive medications for end-of-life patients with hypertension.”
SP-3: PRECISION MEDICINE
Authors: Dominiczak Anna Felicja
Published: January 2023

Precision Medicine is one of the most impactful global opportunities in healthcare. We can debate the name, whether it is precision, stratified or personal but at the highest strategic level, we all share a common goal to enable a world where healthcare is informed by each person unique clinical, molecular and lifestyle information.

Precision Medicine will spur a revolution in healthcare, bringing the prospects of earlier, pre-symptomatic diagnosis, more effective treatment, significant cost savings for the NHS and all the above combined with better patient outcomes.

Moreover, Precision Medicine will reach the global market value of £134 billion by 2025 thus contributing to unprecedented developments in Life Sciences industry, including new jobs creation, and a significant economic growth. The UK is in a prime position to lead on Precision Medicine globally due to the NHS facilitating advanced health data management, excellent genomics and other omics, new imaging modalities and major advances in the artificial intelligence applied to diagnostics. All the above is supported by the triple helix approach, which involves close collaborations among academic researchers, the NHS and industry.

The Covid-19 pandemic has made a major contribution to the UK molecular diagnostic capability. This legacy includes very high throughput laboratories, which should become key building blocks for the UK cutting edge Precision Medicine strategy for the next decade and beyond.
S-01-3: SMART WELLNESS HOUSING AND BLOOD PRESSURE CONTROL
Authors: Umishio Wataru , Ikaga Toshiharu , Kario Kazuomi
Published: January 2023

Objective:

Mortality due to cardiovascular diseases (CVDs) rises sharply in winter, a phenomenon known as excess winter mortality. It is partially explained by cold exposure induced hypertension. Nevertheless, existing countermeasures for the prevention of hypertension and CVDs place emphasis only on improving lifestyle habits. Improving life environment has attracted attention recently because people spend 60–70% of their time at home. Therefore, we aimed to quantitatively evaluate the relationship between housing thermal environment and blood pressure (BP) in a real-world setting.

Design and method:

We conducted a nationwide prospective intervention study named the Smart Wellness Housing survey in Japan, as a nonrandomized controlled trial. The intervention was the thermal insulation retrofitting of homes. Participants were recruited by construction companies throughout all 47 prefectures of Japan. Home BP and indoor temperature were measured for 2 weeks before and after the intervention in winter (November-March) of FY 2014 to 2019.

Results:

Cross-sectional analyses before intervention involving about 2900 participants (1840 households) showed that systolic blood pressure (SBP) in the morning had significantly higher sensitivity to changes in indoor temperature (8.2 mmHg increase/10°C decrease) than that in the evening (6.5 mmHg increase/10°C decrease) in participants aged 57 years (mean age in this survey). Interaction terms between age/women and indoor temperature were significant, indicating that SBP in older residents and women was vulnerable to indoor temperature change.

The association between BP variability and indoor temperature instability was also analyzed using the morning-evening (ME) difference as an index of diurnal variability and the standard deviation (SD) of 2-week data as an index of day-by-day variability. The analyses showed that the ME difference in indoor temperature was closely correlated with the ME difference in SBP (0.85 mmHg/°C). The SD of indoor temperature was also associated with the SD of SBP (0.61 mmHg/°C).

In the comparison of before and after intervention, insulation retrofitting significantly reduced morning SBP by 3.1 mmHg. In addition, there was heterogeneity in the effect of insulation retrofitting on morning SBP in hypertensive patients compared with normotensive occupants (-7.7 versus -2.2 mmHg).

Conclusions:

Hypertension might be not only lifestyle diseases but also life-environment diseases. Residents should keep the indoor temperature high to reduce BP level and keep it stable to reduce BP variability through strategies such as installing high thermal insulation. We expect that these results will be useful to prevent excess winter mortality due to CVDs.
S-02-1: ASSOCIATION OF HYPERTENSION AND DYSLIPIDEMIA WITH COGNITIVE FUNCTION IN COMMUNITY-DWELLING OLDER ADULTS: THE SONIC STUDY
Authors: Nakamura Yuko , Kabayama Mai , Godai Kayo , Akasaka Hiroshi , Gondo Yasuyuki , Masui Yukie , Arai Yasumichi , Ishizaki Tatsuro , Rakugi Hiromi , Kamide Kei
Published: January 2023

Aim:

Hypertension, dyslipidemia, and those combinations are very common in older adults. However, the association between cognitive decline and the combination of hypertension and dyslipidemia in older adults is still controversial. Therefore, we investigate the association between cognitive decline and hypertension, dyslipidemia, and their combination in community-dwelling older people in their 70 s, 80 s, and 90 s in the long-term observational Septuagenarians, Octogenarians, Nonagenarians, Investigation with Centenarians (SONIC) study.

Method:

We conducted the Montreal Cognitive Assessment Japanese version (MoCA-J) by trained psychologists and blood testing by medical staff in 1188 participants in their 70 s, 80 s, and 90 s who participated in the SONIC study. Multiple regression analysis was performed in each age cohort to assess these associations at 3-year follow-up after adjusting for covariate factors; sex, BMI, smoking history, Moca-J score at baseline, anti-dyslipidemia medications, anti-hypertensive medications, and diabetes mellitus. After that, we selected individuals with hypertension and then performed the analysis of the association between lipid levels and cognitive function.

Results:

At baseline, the percentages of hypertension were 64%(n = 368) in the age 70 s group, 81%(n = 446) in the age 80 s group, and 82%(n = 51) in the age 90 s group, and the percentages of dyslipidemia were 62%(n = 354) in the age 70 s group, 62%(n = 340) in the age 80 s group, and 63%(n = 39) in the 90 s group. The percentages of the participants combined both were 42%(n = 243) in the age 70 s group, 52%(n = 286) in the age 80 s group, and 52%(n = 32) in the 90 s group. The mean MoCA-J score adjusted by the educational level at baseline was 23.94 ± 3.10 in the age 70 s group, 22.25 ± 3.53 in the age 80 s group, and 19.68 ± 3.71 in the 90 s group. By conducting multiple regression analysis, no significant relationship was found between hypertension, dyslipidemia, and their combination and Moca-J score in every age group. On the other hand, high low-density lipoprotein cholesterol (LDL) and high high-density lipoprotein cholesterol (HDL) level resulted in higher Moca-J scores at follow-up in the age 70 s group (LDL: β = 0.074; P = 0.042, HDL: β = 0.096; P = 0.010). Subsequently, only participants with hypertension were selected to compare the association between each lipid level and Moca-J scores, and high HDL resulted in higher Moca-J scores at follow-up (β = 0.059, P = 0.025).

Conclusion:

The results suggest that maintaining HDL level may be important in sustaining cognitive function in the community-dwelling older adults population with hypertension.
S-03-3: ASSOCIATION BETWEEN PEP/ET AND LEFT VENTRICULAR EJECTION FRACTION OF PULSE WAVE MEASUREMENTS IN PATIENTS AT HIGH CARDIOVASCULAR RISK
Authors: Ishiyama Yusuke , Kabutoya Tomoyuki , Hoshide Satoshi , Kario Kazuomi
Published: January 2023

Background:

Increased pre-ejection period to ejection time (PEP/ET) obtained by pulse wave measurements is known to be associated with reduced cardiac function. However, PEP/ET and left ventricular function have not been studied in detail in patients at cardiovascular risk.

Methods:

Eight hundred and sixty-one patients enrolled in the Coupling study and underwent echocardiography were included. We measured brachial-ankle pulse wave velocity, and estimated the PEP/ET ratio. Left ventricular ejection fraction (LVEF) was measured by echocardiography and classified as normal (LVEF≥ 60%, N = 706), heart failure with preserved ejection fraction (HFpEF: LVEF 51–60%, N = 105), heart failure with mid-range ejection fraction (HFmrEF: LVEF 41–50%, N = 31), heart failure with reduced ejection fraction (HFrEF: LVEF< 40, N = 19), and the relationship between cardiac function and PEP/ET was examined.

Results:

PEP/ET and EF was significantly inversely associated with PEP/ET (R = -0.33, p < 0.001). PEP/ET increased progressively with normal, HFpEF, HFmrHF, and HFrEF (0.32 ± 0.07, 0.37 ± 0.09, 0.40 ± 0.13, 0.46 ± 0.16, ANOVA P < 0.001).The receiver operating characteristic curve predicting LVEF < 60% had a PEP/ET of 0.4 (area: 0.695); PEP/ET ≥ 0.4 was a significant predictor of EF < 60% (odds ratio 5.41, 95% confidence interval 3.54–8.26).

Conclusions:

Increased PEP/ET obtained by pulse wave measurements was associated with reduced contractility, and PEP/ET ≥ 0.4 was a significant predictor of reduced cardiac function.
S-04-4: INCONSISTENT GUIDELINES-BASED CONTROL STATUS OF OFFICE, HOME, AND AMBULATORY BLOOD PRESSURE MEASURED BY AN ALL-IN-ONE BP MONITORING DEVICE
Authors: Kario Kazuomi , Hoshide Satoshi , Tomitani Naoko , Nishizawa Masafumi , Yoshida Tetsuro , Kabutoya Tomoyuki , Fujiwara Takeshi , Mizuno Hiroyuki , Narita Keisuke , Komori Takahiro , Suzuki Daisuke , Nakazato Jun , Nakagawa Naoki , Katsuya Tomohiro , Harada Noriko
Published: January 2023

Objective:

Inconsistencies between office and out-of-office blood pressure (BP) values (described as white-coat hypertension or masked hypertension) may be attributable in part to differences in the BP monitoring devices used. We studied the inconsistency of the classification of BP control (well-controlled BP vs. uncontrolled BP) among office, home, and ambulatory BPs by using a validated all-in-one BP monitoring device.

Design and method:

In the nationwide, general practitioner-based multicenter HI-JAMP study, 2,322 hypertensive patients treated with antihypertensive drugs underwent office BP measurements and 24-h ambulatory BP monitoring (ABPM), consecutively followed by 5-day home BP monitoring (HBPM), using the same all-in-one device over a total of seven BP measurement days.

Results:

Using the thresholds of the JSH2019 and ESC2018 guidelines, the subjects with consistently well-controlled office (<140mmHg) and home systolic BP (SBP) (<135mmHg) (n = 970) also tended to have well-controlled 24-h SBP (<130mmHg) (n = 808, 83.3%). The subjects with consistently uncontrolled office and home SBP (n = 579) also tended to have uncontrolled 24-h SBP (n = 444, 80.9%). Among the subjects with inconsistent classifications of office and home BP control (n = 803), 46.1% had inconsistent ABPM-vs.-HBPM out-of-office BP control status. When the 2017 ACC/AHA thresholds or JSH2019 target BP thresholds were applied as an alternative, the results were essentially the same.

Conclusions:

The combined assessment of office and home BP is useful in clinical practice. Especially for patients whose office BP classification and home BP classification conflict, the complementary clinical use of both HBPM and ABPM might be recommended.
S-04-5: AUTOMATED DETECTION OF ATRIAL FIBRILLATION DURING ROUTINE OSCILLOMETRIC MEASUREMENT OF BLOOD PRESSURE: SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Kyriakoulis Konstantinos G , Kollias Anastasios , Chardouvelis Panagiotis , Ntousopoulos Vasileios , Menti Ariadni , Destounis Antonios , Stergiou George S
Published: January 2023

Objective:

Efficient screening strategies are necessary for detecting atrial fibrillation (AF) aiming at stroke prevention. In 2013 the UK National Institute for Health and Care Excellence recommended opportunistic AF screening during routine office blood pressure (BP) measurement using an automated monitor with high diagnostic accuracy. This systematic review and meta-analysis evaluated the current evidence on the diagnostic accuracy of AF detection technologies implemented in automated devices for office, home, and ambulatory BP measurement.

Design and method:

A systematic PubMed search was conducted using the algorithm: “atrial fibrillation” AND (“blood pressure” OR “blood pressure monitor” OR “blood pressure device” OR “blood pressure measurement”) AND (detect∗ OR screen∗), until May 2022.

Results:

Initial search retrieved 423 articles of which 37 were relevant and 17 were included in meta-analysis. Three studies (n = 1465, weighted age 77.8 years, males 51%, AF prevalence 10.4%) evaluated the diagnostic accuracy of office BP monitors. Meta-analysis showed pooled sensitivity, specificity, and accuracy: 94% (95% CI 88–98%), 94% (89–98), and 94% (89–97), respectively. Eleven studies (n = 8343, weighted age 66.7 years, males 47%, AF prevalence 7%) evaluated the diagnostic accuracy of home BP monitors. Pooled sensitivity, specificity and accuracy were 98% (93–100%), 94% (90–97) and 95% (91–97), respectively. Three studies (n = 238, weighted age 68.0 years, males 62%, AF prevalence 12%) evaluated the diagnostic accuracy of ambulatory BP monitors. Pooled sensitivity, specificity and accuracy were 94% (81–100%), 82% (77–87) and 83% (78–88), respectively. Simultaneous (or shortly before/after BP measurement) 12- or single-lead electrocardiography (ECG) was used as reference method in studies evaluating office/home BP monitors. For ambulatory BP monitors, two studies used 24h-continuous ECG Holter monitoring and one study used pacemaker recordings (implanted for sick sinus syndrome). Analysis per individual was performed for the evaluation of office and home BP monitors (an individual was considered as AF positive if the majority of BP readings indicated AF, e.g., 2 of 3). For ambulatory BP monitors, analysis per reading was performed (vs. simultaneous ECG trace). With increasing AF prevalence across studies, meta-regression analysis showed higher positive predictive value and a trend towards lower negative predictive value.

Conclusions:

There is considerable evidence that AF detection during routine automated BP measurement in elderly people using office, home, or ambulatory BP monitors has high diagnostic accuracy. AF screening in the elderly during routine office and out-of-office BP measurement is feasible and can increase early detection of asymptomatic AF.
S-05-2: DISASTER HYPERTENSION AND CARDIOVASCULAR DISEASE
Authors: Hoshide Satoshi
Published: January 2023

Previous papers have reported that cardiovascular events increase over the following months after earthquake. One of the reasons for the increase in events has been considered the activation of the sympathetic nervous system due to stress, dehydration and decreased activity. In addition, the increased intake of canned foods with high salt due to prolonged shelter living may lead to the development and exacerbation of hypertension, i.e., disaster hypertension. We reported that the estimated salt intake of the victims was related to their blood pressure (BP) levels, and aging, obesity, diabetes, and chronic kidney disease may be aggravating factors (Hoshide et al. Hypertension 2019; 74: 564–571).

After the Great East Japan Earthquake on March 11, 2011, we have been providing support to the affected areas. As a part of this effort, we introduced an information technology-based home BP monitoring approach (the web-based Disaster Cardiovascular Prevention: DCAP) for the purpose of BP control for victims in evacuation centers (Kario et al. Lancet 2011; 378: 1125–7). This system and was able to promptly identify danger signals of elevated BP and reflect them in treatment. This system is still in use today, the BP of the victims is well controlled (Nishizawa et al. J Clin Hypertens 2017; 19: 26–29).
S-06-1: HYPERTENSION AND STROKE IN ASIA
Authors: Turana Yuda
Published: January 2023

Stroke is the leading cause of disability and vascular death around the world, including Asia. Asian traits that differ from those of the West result in a higher incidence of stroke. Studies of the epidemiology of stroke across Asia have revealed different levels of mortality, incidence, prevalence, and illness burden. In Asia, hypertension is the most prevalent risk factor. In addition to ethnicity, systolic and diastolic blood pressure, as well as blood pressure variability, are positively connected with stroke incidence. In Asia, treating hypertension by increasing awareness and treatment adherence has become the main goal.
S-06-2: HYPERTENSION AND DEMENTIA ∼LEARNING A LESSON FROM THE SPRINT∼
Authors: Mogi Masaki
Published: January 2023

Midlife hypertension is generally known as a risk factor for dementia in the elderly, however, the effect of elderly hypertension on dementia and the beneficial roles of antihypertensive treatment for dementia prevention have not been well known. The Systolic Blood Pressure Intervention Trial (SPRINT) revealed that intensive antihypertensive treatment prevents fatal and nonfatal major cardiovascular events and death from any cause. SPRINT-Memory and Cognition in Decreased Hypertension (MIND) also demonstrated the beneficial roles of intensive blood pressure (BP) control in significantly reducing the risk of mild cognitive impairment. Post-hoc analysis of SPRINT tells us about the effects of the intensive blood pressure lowering treatment on cognitive function, blood flow, morphological change of the brain, etc. Thus, in this presentation, I will discuss the effect of intensive BP control on cognitive impairment with learning a lesson from the SPRINT.
S-06-6: HYPERTENSION MANAGEMENT IN ATRIAL FIBRILLATION PATIENTS IN MIDDLE EAST
Authors: Haji Ghazi Farhan
Published: January 2023

Introduction:

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Epidemiologic studies have shown that the presence of AF increases risk of mortality by 1.5–1.9 times in the age-matched general population.

Hypertension (HTN) is one of the most common conditions in the general practice. It is an independent predictor for the development of AF. Given that uncontrolled HTN increases the risk of cardiovascular diseases, coronary artery disease (CAD), stroke, and chronic kidney disease (CKD), it may be hypothesized that the coexistence of HTN and AF may be associated with higher morbidity and mortality.

Objective:
S-10-1: WHAT LEVEL OF BLOOD PRESSURE IS CONCERNING IN CHILDHOOD?
Authors: Flynn Joseph
Published: January 2023

The 95th percentile of blood pressure among healthy children is the currently accepted level used to denote a hypertensive blood pressure reading in children and adolescents. Yet, ample data have recently emerged showing that the harmful effects of high blood pressure can be demonstrated at blood pressure levels considered normal by current guidelines. Cardiac, vascular, cognitive and kidney effects have been shown starting at the 90th percentile in cross-sectional studies, and markers of adult cardiovascular disease appear in longitudinal cohorts whose members had modestly elevated or even normal blood pressure as youth. This presentation will summarize data that support a lower threshold of concern for children and adolescents, and outline some of the remaining questions to be answered before a lower threshold blood pressure level could be adopted.
S-10-3: CAN ACHIEVED AVERAGE SYSTOLIC BLOOD PRESSURE BELOW 130 MMHG CAUSE HARM IN ELDERLY HYPERTENSIVE PATIENTS WITH LEFT VENTRICULAR HYPERTROPHY?
Authors: Heimark Sondre , Julius Stevo , Mancia Giuseppe , Soraas Camilla , Mehlum Maria , Wachtell Kristian , Liestol Knut , Kjeldsen Sverre Erik , Weber Michael
Published: January 2023

Objectives:

We previously reported increased mortality in hypertensive patients > 55 yrs. (average 67 yrs., n = 9,193) with left ventricular hypertrophy (LVH) who achieved in-treatment systolic blood pressure (SBP) < 130 mmHg during an average of 5 yrs. of treatment. Possibly hypertrophic myocardium with degenerated microcirculation becomes ischemic causing fatal complications. The present study aimed to investigate similar elderly patients with LVH in a parallel outcome trial and test the hypothesis that achieved average SBP < 130 mmHg may cause harm in the elderly.

Design and Methods:

Of 15,245 participating hypertensive patients we identified a population without cardiovascular events during the first 18 months (n = 13,808) after enrollment with discontinuation of previous antihypertensive medications and subsequent up-titration of randomized study drugs and stabilization of SBP. Of these 2,458 patients had electrocardiographic LVH with or without strain. Patients who achieved average SBP > = 140 mmHg during the coming 30 months of follow-up (main population n = 5,505, LVH n = 1,200) served as reference groups. Cox-analyses adjusted for age, gender, and a number of baseline variables were used to compare the primary cardiac composite endpoint including fatal events, stroke and congestive heart failure for patients who achieved average SBP 130–139 mmHg (main population n = 5,833, LVH n = 939) and patients who achieved average SBP < 130 mmHg (main population n = 2,465, LVH n = 319).

Results:

The TABLE shows hazard ratios and 95% confidence intervals for groups with achieved average SBP 130–139 mmHg and < 130 mmHg for the primary cardiac endpoint, stroke and heart failure in the main population and in LVH patients. For the main population achieved average SBP < 130 mmHg prevented primary cardiac events and stroke but not heart failure. For the LVH patients achieved average SBP < 140 mmHg prevented the primary event but < 130 mmHg did not. However, the risks for stroke and heart failure were not significantly reduced with SBP < 140 mmHg in the LVH patients and the risk of heart failure was non-significantly increased < 130 mmHg.

Conclusions:

Achieved average SBP < 130 mmHg prevents the primary cardiac endpoint and stroke but not heart failure in elderly hypertensive patients. The risk of primary cardiac events was not significantly reduced < 130 mmHg in the LVH patients, and the risks for stroke and heart failure were not significantly reduced < 140 mmHg. On the contrary, < 130 mmHg the risk for heart failure was increased though not significantly. Target SBP thus remains highly uncertain in elderly LVH patients and needs further investigation.
S-10-6: BLOOD PRESSURE TARGETS FOR SECONDARY PREVENTION OF STROKE
Authors: Toyoda Kazunori
Published: January 2023

The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) showed the benefits of blood pressure (BP) lowering for secondary stroke prevention in stroke survivors for the first time after a long dispute in the last century and triggered active hypertensive therapy for stroke patients globally in this century. A post hoc analysis of PROGRESS demonstrated that both the lowest risks of ischemic stroke and of hemorrhagic stroke were among the one-quarter of patients with the lowest achieved follow-up BP levels (median 112/72 mmHg), and that these risks increased progressively with higher follow-up BP levels in the large cohort of patients with previous stroke or transient ischemic attack. A similar tendency for an increased risk of ischemic/hemorrhagic stroke by higher follow-up BP levels was reproduced in subsequent stroke trials. Several trials sought to clarify the preventive effect against recurrent stroke by randomizing patients into two groups with different BP lowering targets. In patients with recent lacunar stroke in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial, lowering systolic BP to < 130 mmHg significantly reduced the risk of intracerebral hemorrhage (ICH) by 63% and insignificantly reduced the risk of ischemic stroke by 16% compared to lowering to 130–149 mmHg. The Recurrent Stroke Prevention Clinical Outcome (RESPECT) Study, involving patients having a history of stroke within the previous 3 years showed similar results: lowering BP to < 120/80 mmHg, relative to < 140/90 mmHg, reduced the risk of ICH by 91% and that of ischemic stroke by only 9%. These trials failed to demonstrate a significant reduction in the risk of any stroke as the primary outcome by intensive BP lowering, since the incidence of ischemic stroke was much higher than that of ICH for both trials. A meta-analysis of these two trials and two more small studies finally succeeded in showing a statistically significant 22% reduced risk for any stroke recurrence by lowering systolic BP to at least < 130 mmHg. The current guidelines recommend systolic BP control aiming at < 130 mmHg or 120–130 mmHg for adults who experience ischemic stroke. RESPECT is epochal as the first large population trial to examine the importance of systolic BP lowering to < 120 mmHg. Such strict control would undoubtedly decrease incidental ICH, especially for patients taking antithrombotic agents. However, the necessity of strict BP control for protection of brain tissues from ischemic injury is still an unresolved matter that needs to be addressed in future studies.
S-12-2: ENHANCING MAS1:ETBR INTERACTION AS A POTENTIAL VASOPROTECTIVE STRATEGY IN STROKE-PRONE SHR
Authors: Kuriakose Jithin , Montezano Augusto , Lopes Rheure Alves , Sin Yuan Yan , McAbney John , Scott Kayley , Beattie Wendy , Graham Delyth , Baillie George Scott , Touyz Rhian
Published: January 2023

We previously demonstrated that Ang-(1–7) has anti-inflammatory effects in endothelial cells by inducing interaction between Mas1 and ETBR. Using HTS of > 20,000 druggable compounds, we identified several compounds that enhance Mas1:ETBR interaction as a novel strategy to promote vasoprotection.

The objective of this study was to evaluate effects of 2 candidate compounds, termed enhancers 3 and 4 (Enh3 and Enh4), on functional responses in vascular smooth muscle cells (VSMCs) and their therapeutic potential in hypertensive (SHRSP) rats. VSMCs from normotensive (WKY) and SHRSP rats were exposed to Enh3 and Enh4(10–5 M; 5–30 mins). Expression of pro-contractile and mitogenic molecules was assessed by immunoblotting. Ca2+ influx was evaluated using fluorescence microscopy. ROCK2 activity was assessed using a colorimetric immunoassay which detected MYPT1 phosphorylation at Thr696. Male SHRSP rats (18–21weeks) were treated subcutaneously with Enh4 (10 mg/kg/day) for 7 days. Changes in blood pressure and vascular function were assessed via radiotelemetry and wire myography respectively. In WKY VSMCs, Enh3 reduced basal ERK1/2 phosphorylation (26.8 ± 5.9% vs veh,), an effect absent in SHRSP VSMCs, while Enh4 had no effect. Only in SHRSP VSMCs, Enh3, but not Enh4, reduced basal AKT phosphorylation (63.5 ± 8.9% vs veh). Enh4, but not Enh3, reduced basal MLC20 phosphorylation (54.9 ± 7.5% vs veh) in WKY but not in SHRSP VSMCs. ET-1-induced Ca2+ influx in WKY and SHRSP VSMCs was unaffected by Enh3 and Enh4. Assessment of Ca2+ -independent contractile mechanisms in VSMCs showed that ROCK2 activity is increased in SHRSP compared to WKY VSMCs (WKY: 0.27 ± 0.05; SHRSP:4.78 ± 0.34) and Enh4, but not Enh3, reduced ROCK2 activity in SHRSP VSMCs (61.5 ± 0.43% vs veh). Enh4 treatment in SHRSP rats reduced daytime systolic (SBP), diastolic (DBP) and mean arterial pressure (MAP) (SBP:4.26 ± 1.98; DBP:1.48 ± 0.92; MAP:2.07 ± 0.99 vs veh) compared to baseline. Furthermore, Enh4 treatment reduced U46619 induced contraction in SHRSP rat vessels (Emax(Mn): Veh- 13.16 ± 1.81; Enh4- 9.48 ± 1.31). Taken together, enhancing Mas1:ETBR interaction attenuates mitogenic and contractile signaling pathways in WKY and SHRSP VSMCs, and does not increase Ca2+ signaling, important in VSMC contraction. Enhancing Mas1:ETBR interaction reduces blood pressure and improves vascular function in SHRSP rats. Hence, Mas1:ETBR enhancers may be of potential therapeutic use as a new vasoprotective strategy to improve vascular function and to reduce blood pressure in hypertension.
S-12-3: BENEFICIAL EFFECTS OF EMPAGLIFLOZIN ON METABOLIC PARAMETERS AND DIASTOLIC FUNCTION IN SPONTANEOUSLY HYPERTENSIVE RATS FED A HIGH-FAT DIET
Authors: Vaneckova Ivana , Hojna Silvie , Zicha Josef , Malinska Hana , Huttl Martina , Papousek Frantisek
Published: January 2023

Objective:

Non-alcoholic fatty liver disease (NAFLD) is a multifactorial pathological syndrome characterized by lipid accumulation in hepatocytes. This can lead to non-alcoholic steatohepatitis (NASH) which can progress to liver fibrosis, cirrhosis and liver cancer. Unfortunately, the pathogenesis of NAFLD is still unknown. However, current studies suggest that gliflozins, primarily antidiabetics, could have beneficial effects on liver metabolism. The aim of this study was therefore to examine whether empagliflozin (10 mg.kg-1.day-1 in drinking fluid) will have beneficial effects.

Design and methods:

NAFLD was induced by eight weeks of high-fat diet feeding (60% protein) in adult (6-month-old) spontaneously hypertensive rats (SHR). Control SHR were fed a standard diet. Then, the animals were either untreated or treated with empagliflozin for eight weeks. The evaluation of renal function (metabolic cages) and oral glucose tolerance (OGT) test were performed before the start of the treatment and at the end of the study. Cardiac function evaluated by echocardiography as well as metabolic parameters in serum and in liver were determined at the end of the experiment.

Results:

High-fat diet feeding increased body weight and visceral adiposity. Moreover, it worsened insulin resistance (evaluated as OGT test). In addition, it induced increase in triglycerides and cholesterol levels. Although it had no effect on renal function, it substantially deteriorated not only systolic but also diastolic function of the heart in SHR rats. Empagliflozin had no effect on body weight or visceral fat deposition but improved insulin sensitivity (OGT test) and several metabolic parameters (plasma insulin, non-esterified fatty acids, uric acid and HDL-cholesterol). Moreover, it had beneficial effects on systolic (fractional shortening) and especially diastolic (PWTd, RWT, and E/A ratio) function.

Conclusions:

Our results demonstrated that the treatment with empagliflozin had beneficial hepatoprotective and cardioprotective actions in hypertensive rats with experimentally induced non-alcoholic liver fatty disease.
S-13-6: RECENT ADVANCES IN THE MANAGEMENT OF PHEOCHROMOCYTOMA AND PARAGANGLIOMA
Authors: Tanabe Akiyo , Naruse Mitsuhide
Published: January 2023

Pheochromocytomas and paragangliomas (PPGL) are rare tumors that cause refractory hypertension and hypertensive crisis. Although metastatic disease accounts for 30% of PPGL, diagnosis of malignant is difficult without the presence of metastatic lesions. We review here several advancements in diagnosis and treatment of PPGL. A nationwide epidemiological survey in Japan revealed that the annual number of patients with PPGL was 3,000, higher than what was reported in previously. While plasma and urine fractionated metanephrines are recommended to be used as specific biochemical testing for diagnosis, creatinine-corrected fractionated metanephrines in spot urine samples which had been widely used in Japan as a convenient screening test was shown to be as useful as 24-hour urine fractionated metanephrines. Regarding imaging studies, a more specific functional imaging for PPGL, 68Ga DOTATATE, was newly developed. 68Ga DOTATATE provides a clear image with high sensitivity and specificity. Currently, PASS or GAPP histological scores and SDHB immunostaining are clinically used to attempt to discriminate benign from malignant tumor. However, since this distinguishing process remains difficult, all cases were classified as malignant with the possibility of metastasis in the WHO classification of endocrine tumor updated in 2017. Approximately 60% of PPGL have germline mutations of PPGL-related genes. Currently the genes are classified into 2 clusters based on their mechanism for etiology of tumorigenesis. Based on the possible mechanisms of tumor development associated with gene mutation, several molecular target drugs are under evaluation to explore more promising treatments for malignant PPGL.
S-15-1: EPIDEMIOLOGY AND CONTROL OF HYPERTENSION IN JAPAN
Authors: Miura Katsuyuki
Published: January 2023

The national surveys of Japan in the past 60 years showed a steady decrease in mean of systolic blood pressure (BP) among all age groups of men and women, but not in diastolic BP levels, particularly among men. Hypertension prevalence remains high: over 60% of men aged 50 years or over and women aged 60 years or over had hypertension in 2016. However, the control rates of hypertension (BP< 140/90) have continuously improved in the past 40 years, and were around 40% in 2016. Nonetheless, the over 50% prevalence of uncontrolled hypertension would still be the strongest risk factor of cardiovascular diseases in Japan. Of the estimated 43 million hypertensives in Japan, most (31 million, 72%) were under poor control. According to new Japanese hypertension guidelines (JSH 2019), there will be only a small increase (2.2 million, 2.1 percentage points) in adults who are recommended for antihypertensive medication compared with 2014 guidelines. However, an additional 5.3 million (22.1 percentage points) adults taking antihypertensive medication would have a BP above the target defined by JSH 2019. The number of hypertensives with poor control was targeted to decrease by 7 million (from 31 million in 2017 to 24 million in 2028) by the Japanese Society of Hypertension, when the followings are achieved: (1) the prevalence of hypertension decreases by 5 percentage points; (2) the treatment rate of hypertension among hypertensives increases by 10 percentage points; and (3) the control rate of hypertension, defined as BP < 140/90 mmHg, among individuals taking antihypertensive medication increases by 10 percentage points. Both high-risk and population strategies to manage and prevent hypertension deserve greater priority.
S-15-4: EFFORTS AIMED TO ACHIEVE HYPERTENSION ZERO IN COMMUNITY; EXPERIENCE IN MAKURAZAKI CITY
Authors: Ohishi Mitsuru
Published: January 2023

Although hypertension is the major risk factor for stroke, cardiovascular diseases and renal failure, more than half of hypertensive patients is uncontrolled, named as hypertension paradox. We hypothesize the simple scheme measure and normalize blood pressure (BP) reduces stroke, cardiovascular diseases and renal failure as well as creates abundant and healthy town via improvement of health literacy. Therefore, we planned 4 plans; Kagoshima hypertension seminar (intensive lecture for general physician); Prediction of hypertension development system by general check-up; Hypertension class for Tarumizu citizens; Hypertension zero city project in Makurazaki city. We analyzed 350,000 general check-up data and determined prediction of hypertension development system for effective use in health guidance. We performed 4 serial lectures for general physicians and granted the title of Kagoshima Hypertension Meister after passing a small test. Around 400 citizens in Tarumizu city measured home BP for more than 3 years and health guidance was performed each 2 months. Hypertension zero city project in Makurazaki city (21,960 people, the highest incidence of stroke in Kagoshima prefecture), to achieve hypertension zero in community. The project includes BP measurement at any area in the city, hypertension lecture for high school students and so on. According to these plans, BP measured by general check-up reduced more than 1.5mmHg in systole for 6 years only in Kagoshima. In this symposium, I would like to talk about our efforts to achieve hypertension zero in community.