bluuebunny/crossref_metadata_2025 huggingface dataset:
PS-C13-11: EFFECT OF HYPOKALEMIA ON LEFT VENTRICULAR STRUCTURE AND FUNCTION IN PATIENTS WITH ESSENTIAL HYPERTENSION
Authors: Wang Qiongying
Published: January 2023

Object:

Analyzing the changes of left ventricular structure and function in essential hypertension patients with hypokalemia, we want to provide an evidence for clinical diagnosis and treatment of early heart damage caused by hypertension and hypokalemia.

Methods:

413 patients with hypertension who were hospitalized in the Hypertension Center of Lanzhou University Second Hospital from January 2015 to June 2021 were selected, including 270 cases of essential hypertension and 143 cases of essential hypertension with hypokalemia. Collect patient general information, biochemistry, urine routine, office blood pressure, 24 h ambulatory blood pressure, left atrial diameter, left ventricular end diastolic diameter, left ventricular end systolic diameter, ventricular septal thickness, left ventricular posterior wall thickness and other indicators. After propensity score matching, 108 cases in the essential hypertension group and the essential hypertension with hypokalemia group were each, and statistical analysis was performed.

Results:

Albumin, and urea-creatinine ratio levels of the essential hypertension with hypokalemia group were significantly reduced, and the ratios of sodium ions and sodium potassium were lower than those of the primary hypertension group. Correlation analysis shows that the left ventricular mass index was positively correlated with and the course of hypertension, systolic blood pressure, diastolic blood pressure, mean arterial pressure, creatinine, sodium-to-potassium ratio, mean systolic blood pressure during the day, mean diastolic blood pressure during the day, mean systolic blood pressure at night, mean night diastolic blood pressure. Multiple linear regression analysis showed that the left ventricular mass index was independently positively correlated with systolic blood pressure, hypertension course, creatinine, sodium-to-potassium ratio, night systolic blood pressure, 24 h average systolic blood pressure, and 24 h systolic blood pressure load rate; potassium ion, low density Lipoprotein, angiotensin II and left ventricular mass index are independently and negatively correlated.

Conclusion:

There are more obvious ventricular structural changes in essential hypertension patients with hypokalemia; serum potassium ion concentration and sodium-to-potassium ratio are independent risk factors for left ventricular mass index in essential hypertension patients with hypokalemia.
PS-C14-3: HEART RATE RECOVERY IN CORONARY ARTERY DISEASE PATIENTS WITH HYPERTENSION: RELATIONSHIP WITH CLINICAL FEATURES AND LEFT VENTRICULAR REMODELLING
Authors: Tarsidin Najmi Fauzan , Tiksnadi Badai Bhatara
Published: January 2023

Objective:

Heart rate recovery after treadmill exercise testing reflects autonomic dysfunction and is related to higher major adverse cardiac events. Numerous studies suggested the correlation of Heart rate recovery with hypertension and left ventricular remodeling. This study aimed to assess factors related to HRR in coronary artery disease patients who have undergone revascularization and Beta-blocker.

Design and method:

This cross-sectional study includes CAD patients who came to the outpatient clinic for six to 24 months after hospitalization in Dr. Hasan Sadikin General Hospital from February to August 2021. All patients undergo treadmill tests and transthoracic echocardiography. The treadmill stress test is conducted using Bruce or Modified Bruce Protocol. Transthoracic echocardiography is conducted using GE Vivid 7 ultrasound machine. Heart rate recovery at one minute defines as abnormal if < 18 beats per minute. The t test was used for continuous variables, and the Chi-square or Fisher exact test was used for categorical data. A p-value < 0.05 was considered statistically significant.

Results:

A total of 63 consecutive coronary artery disease patients with (n = 43, HP) and without (n = 20, NHP) were included in this study. All subjects underwent treadmill exercise testing. Up to 90% of patients have undergone revascularization by percutaneous coronary intervention or coronary artery bypass graft. All patients on Beta-blocker therapy. Peak heart rate (152 ± 29 vs. 132 ± 24, p = 0.010) and Heart rate recovery at one minute (129 ± 18 vs. 118 ± 19, p = 0.025) were significantly higher in the NHP group. Older age and lower peak heart rate were associated with lower heart rate recovery at one minute in the HP group. The previous history, such as diabetes, smoking history, ejection fraction, left wall mass index, and functional capacity, does not correlate with heart rate recovery at one minute in NHP or HP group.

Conclusion:

The present results demonstrate that heart rate recovery at one minute is affected by older age and peak heart rate. The left ventricular remodelling and other risk factors and their associations in coronary artery disease population who have undergone revascularization and are on beta-blocker medications should be investigated more with larger samples.
PS-C14-8: SINGLE GRAFT AFTER MALFUNCTIONING STENT IN CORONARY ARTERY DISEASE WITH DIABETES AND HYPERTENSION
Authors: Jain Rajesh , Husseini Siyamak Jalal , Shoghli Mohammadreza , Fesseha Hermon Eyob
Published: January 2023

Introduction:

A 65-year-old woman was sent to the Heart Center Hospital emergency room because she had a history of persistent chest pain that had gotten worse during demanding conditions and strenuous activities. She has had diabetes and hypertension for ten years and is on medication with reasonable control. She had an angiography two years ago due to related complications. When the patient was taken to the Cath Lab for the second angiography it was discovered that the cardiology interventionist had wrongly put the stent after the LAD proximal and left the LAD artery stenosis significantly untreated. All of the specific symptoms of complications were, of course, connected to the stenosis of the LAD. The stenosis of the LAD was about 90% in the third stage.

Discussion:

The patient had an EF of 50% a PAP of 29 and no severe Echo issues were instantly found. Her stenosis was rapidly worsening, the angle of the stent used in the angioplasty was the standard size for the LAD and the fibrosis in the LAD pathway had unusual anatomy, making the second angioplasty exceedingly dangerous. An open-heart procedure seemed to be the only option to prevent a potential arterial rupture in angiography since the stenosis site was severely injured and fibrosis had developed due to the stent. The left internal mammary was anastomosed to the LAD artery after the stent had been implanted in a patient undergoing open-heart surgery. And only one incision was made for the bypass surgery.

To be clear bypass surgery was the only viable option in this complex situation because removing the stent could have badly disrupted the intimal layer of the artery, progressively increasing the likelihood of thrombosis. It should be emphasized that the left and right coronary arteries were in good shape, with standard size and runup.

Given the significance of the LAD and that it supplies the heart with about 70% of its blood, myocardial infarction would have been quite likely in this case if there had been no surgery.

Past History: DM.HTN. MI RECENT

ECHO Finding

EF: 50% Normal

LV and RV the average size

S/P recent PCI on LAD average LV size with mild systolic dysfunction LVEF 50 % abnormal septal motion GI LV diastolic dysfunction, average RV size with mild systolic dysfunction MILD MAC Mild to moderate MR Thickened and mildly calcified AV
PS-C16-3: HYPERTENSION AND RISK FACTORS ASSOCIATED WITH IN-HOSPITAL DEATH IN PATIENTS WITH COVID-19
Authors: Elamin maha Ismail , Hassan Dina Ahmed , Bashir Intisar Abdelrahim , Mahmoud Tarig E
Published: January 2023

Objective:

To explore the prevalence of hypertension and the common risk factors associated with increased death rate among (Covid-19) patients.

Design and method:

This is a retrospective cohort study using de-identified data retrieved from clinical records of patients from two COVID 19 isolation centers. Medical history, demographic data, self-reported comorbidities, symptoms, disease complications and laboratory investigations were extracted from clinical records of 406 confirmed COVID 19 hospitalized patients between Feb 2020 and July 2021. The outcomes of interest were death or discharge from the hospital. Logistic regression analysis was used to assess the impact of age, gender, associated comorbidities and some laboratory abnormalities on increased death rate among in-hospital (Covid-19) patients.

Results:

The prevalence of hypertension, was 59.6%, followed by diabetes (47.3%). COVID-19 patients with hypertension were older (67.0 ± 10.7vs 65.0 ± 13.0 P = 0.001). 70.4% were males. Undiagnosed high blood pressure was detected among 14.5%. Overall mortality was 46.2%, while mortality among normotensives, known hypertensives and undiagnosed hypertension was 47.7%, 54.7% and 37.6%, respectively (p < 0.005). Death was significantly higher among the age group > 65 years compared to ≦ 65 years old (53.6% % vs 39.0% (P = 0.005) irrespective of their blood pressure. Severe respiratory and gastrointestinal symptoms were significantly higher among hypertensives. Type I Respiratory failure 22.1%, and acute kidney injury 11.8% were the most typical complications among hypertensives. Leucocytosis (24.2%), Lymphopenia (56.8%) and higher levels of D-Dimer (47.7%) and C-reactive protein (49.7%) were mainly observed among hypertensive patients.

Logistic Regression analysis after adjusting for age significantly showed age OR: 1.81, 95% CI: (1.12: 2.73, p = 0.01), undiagnosed HTN OR: 5.65, 95% CI: (2.04:15.67, p = 0.00), low platelets count OR: 6.53, 95% CI, (1.23:35.23, p = 0.02), higher levels of urea OR:1.67, 95% CI, (1.04:2.63, p = 0.03) and creatinine OR:1.71, 95% CI, (1.063:2.70, p = 0.02), were associated with worse prognosis and in-hospital death among Covid- 19 patients.

Conclusion:

The age group, more than 65 years with undiagnosed BP of more than 140/90, is significantly associated with higher in-hospital death. Thrombocytopenia and elevated urea and creatinine levels were the most prominent laboratory markers and may be used as a potential indicator for prognosis and outcome among Covid 19 hypertensives.
PS-C16-8: CONSEQUENCES OF DISCONTINUING ANTIHYPERTENSIVE TREATMENT DURING THE FIRST WAVE OF A COVID-19 PANDEMIC
Authors: Vachulova Anna , Urban Lubos , Filipova Slavomira
Published: January 2023

Arterial hypertension (AH), especially insufficiently and inadequately treated, is a disease with serious morbidity-mortality consequences. AH was the most common comorbidity in patients with COVID-19 infection. During the first wave of the COVID-19 pandemic, Slovakia has low number of COVID 19 patients. However, worldwide was reported 2-fold higher mortality in COVID 19 positive patients with untreated AH compared to patients with treated AH. Many patients have discontinued antihypertensive treatment due to changes in access to healthcare as well as the dissemination of unverified information.

The aim of our study was to evaluate the AH treatment in patients during the first wave of the COVID-19 pandemic, to analyze the consequences of changes in AH treatment.

It is a retrospective analysis of antihypertensive treatment of patients followed in the tertiary center. A total of 112 consecutive patients with AH who had a scheduled follow-up during the months of March-April 2020 were included. A telephone check-up was performed 6 months after the scheduled follow-up. These were patients with a mean age of 64 ± 18.1 years, 73 patients (65.2%) were male, and the mean number of antihypertensives per patient was 3.6 ± 2.2 drugs. Out of a total of 112 patients, 9 (8%) patients completely discontinued AH treatment, 15 (13.4%) patients discontinued ACEI / ARB without substitution, 5 (4.5%) patients discontinued ACEI / ARB with subsequent AH adjustment treatment. In the observed period March-April 2020, patients with newly diagnosed AH were absent. In our followed patient population (1.8%) were tested as COVID positive, 0 patients were hospitalized for COVID 19 infection. 4 (16,7%) patients overcame stroke, 1 (4.2%) patient overcame TIA, 1 (4.2%) was hospitalized for ACS, 2 (8.3%) for AF with rapid ventricular response, 2 (8.3%) for pulmonary edema, 2 (8.3%) patients died. In the group of patients who had adjusted treatment or did not discontinue AH treatment (a total of 88 patients) 1 (1.1%) patient overcame stroke, 1 (1.1%) was hospitalized for ACS, 1 (1.1%) for newly diagnosed AF, 1 (1.1%) patient died.

Unjustified complete or partial discontinuation of antihypertensive treatment during the first wave of the COVID-19 pandemic has led to an increase in complications of arterial hypertension. Achieving BP targets should also be crucial during the COVID 19 pandemic.
PS-C16-13: CARDIORESPIRATORY STATUS AFTER SARS-COV-2 INFECTION: THE ROLE OF HYPERTENSION AS RISK FACTOR
Authors: Kariori Maria , Fragoulis Christos , Polyzos Dimitrios , Siafi Eirini , Tatakis Fotis , Zamanis Ioannis , Kouremeti Maria , Leontsinis Ioannis , Drogkaris Sotirios , Manta Eleni , Grigoriou Kalliopi , Dimitriadis Kyriakos , Konstantinidis Dimitrios , Thomopoulos Costas , Tsioufis Costas
Published: January 2023

Objective:

Few data have been published regarding the holistic approach of post-Covid patients, examining physical health. The purpose of our study was to examine the impact of arterial hypertension in the cardiopulmonary status of post-covid patients 3 months after the first day of infection.

Design and Method:

All participants who recovered Covid-19 infection underwent cardiorespiratory exercise using either Bruce or modified Bruce protocol where all parameters were evaluated and transthoracic echocardiogram. The population was separated into two groups based on history of hypertension. Group I (n = 29) included hypertensive subjects and Group II (n = 75) included normotensive subjects.

Results and Conclusion:

A total of 104 patients were assessed 3 months after the onset of COVID-19 symptoms. We recorded a mean age of 49 ± 15 years, 50.5% of them were males, 8.7% had a history of coronary heart disease. Hypertensives had higher BMI (29.24 ± 24 vs 26.64 kg/m2 p < 0.01) and BSA (2.09 ± 0.25 vs. 1.95 ± 0.58, p = 0.001). They were hospitalized in higher percentage comparing to normotensives (72.4% vs. 41.3%, p < 0.01). Left atrial diameter (41 ± 6 vs. 35 ± 5.5 mm, p < 0.001) was significantly larger in hypertensives. Furthermore, A wave (79 ± 21 vs. 58 ± 18 cm/s p < 0.001) and ratios of E/A (1.01 ± 0.42 vs. 1.28 ± 0.44, p < 0.01) and E/E (7.3 ± 3.7 vs. 5.9 ± 4.3, p < 0.01) differed between two groups. Finally, LVEF (%) was significantly impaired in hypertensive comparing to normotesive subjects (53 ± 13% vs. 59 ± 7%). This finding was depicted in lower maximum oxygen consumption (VO2 22 ± 4.5 vs. 28 ± 8 ml/kg/min p < 0.001), metabolic equivalents (METS) at peak, 9.1 ± 3 vs. 14 ± 20 p < 0.001), maximum heart rate (maxHR 147 ± 17 vs. 165 ± 21 bpm p < 0.001) and HR1st minute recovery (123 ± 28 vs. 138 ± 21 bpm, p: 0.02) comparing to normotensive. Systolic blood pressure (SBP 180 ± 29 vs. 165 ± 25mmHg, p: 0.02) during the 1st minute of recovery was higher in hypertensives. Finally, the duration of exercise was significantly lower in patients with hypertension (7.3 ± 2.7 vs. 9 ± 4 min, p:0.02). To conclude, the current study highlighted the negative impact of hypertension in the ability to exercise. Regardless of the disease severity, post-covid patients need a comprehensive approach for rehabilitation including the modification of risk factors like hypertension and obesity.
PS-P01-7: THE COHERENCE OF INFECTIOUS AND CHRONIC DISEASE EPIDEMICS; AMONG ELDERLY IN RURAL URBAN PERSPECTIVES
Authors: Waiswa Moses , Kavuma James , Mugabi Dennis
Published: January 2023

Background:

Chronic diseases are the leading causes of disability and premature death among the elderly population in Uganda. The study, using data from the National Statistical office through censuses and surveys, examined the prevalence and determinants of chronic diseases among the population aged 60 + in Uganda by applying bivariate and logistic regression analyses and used a non-linear decomposition technique to understand the urban-rural differences in the coherence of chronic diseases.

Methods:

About 25% of the elderly in Uganda reportedly have at least one chronic disease. Seventeen percent elderly in rural areas and 29% in urban areas suffer from a chronic disease. Hypertension and diabetes account for about 68% of all chronic diseases. Those with higher levels of education, staying in urban areas, those who are economically dependent on others, staying alone or without spouse and children, and belonging to wealthy households have a higher likelihood of having a chronic disease.

Results:

The probability of having a chronic disease is 1.15 times higher among urban residents as compared to their rural counterparts. Elderly rural women, compared to elderly rural men, and never-married, widowed, and divorced elderly urban women, compared to married elderly urban men, are significantly more likely to suffer from chronic ailments. Differences in education, wealth status, and caste are the three most significant contributors to the urban-rural gap in chronic diseases.

Conclusion:

The high risk of chronic diseases among certain subsets of the elderly population must be recognized as a key public health concern. The findings of our study will likely help promote healthy ageing in Uganda.
PS-P03-5: QUALITATIVE INSIGHTS INTO THE BARRIERS TOWARDS BLOOD PRESSURE SCREENING, TREATMENT ADHERENCE AND LIFESTYLE MODIFICATIONS IN SINGAPORE
Authors: Lwin May Oo , Malik Shelly , Lim Fann , Kang Vernon
Published: January 2023

In Singapore, despite numerous blood pressure (BP) campaigns, hypertension prevalence amongst adults has increased to 35%, exceeding the global rate of 31.1%. In light of the worrying trend, this research aims to examine major barriers faced by Singapore residents in their management of BP health. Through a novel reverse socialisation program, the study reached out to at-risk family members through their children and employed an in-depth qualitative lens to gain meaningful insights into the barriers faced at various stages of BP management care.

An intergenerational hypertension education program was launched among Singapore grade 5 students. Students were educated about hypertension and taught how to utilize a BP monitor. They then shared their knowledge and measured their family members BP at home. Family members found with borderline or high BP were invited for an interview and had their BP measurements validated by a medical professional. In-depth semi-structured interviews were conducted with 15 adults who were identified to have borderline hypertension or hypertension. Transcripts were analysed using the constant comparative approach, an analytic strategy based on grounded theory.

The study identified varying personal, psychosocial, and/or external barriers faced at three different stages of BP management care - regular screening, medical adherence and lifestyle modifications (Table 1).

Firstly, a major barrier towards regular BP screening was low perceived need to seek medical care due to a lack of physiological symptoms, suggesting that many respondents perceived themselves as being less susceptible to hypertension.

Secondly, barriers towards medical adherence were especially a concern for diagnosed hypertensives. A dominant factor was a lack of self-efficacy in following-up with the required care, such as fear of failing doctors expectations in follow-up appointments, lack of time and inability to comply with prescribed sudden changes to dietary and exercise habits

Thirdly, the inability to comply with recommended lifestyle modifications was nuanced by various factors related to ones identity such as age, job, familial obligations and culture.

The in-depth qualitative perspectives revealed a complex web of barriers to BP screening, adherence and lifestyle modifications. These have important implications for future health intervention designs. Particularly, health education and communication to at-risk communities require tailored interventions to overcome the varied personal, psychosocial, and external gaps at different stages of hypertension management care. For instance, threat-framed messages could be more effective in tackling the barrier of low perceived susceptibility to hypertension, while coping-framed interventions may be better suited for improving self-efficacy for treatment adherence.
PS-P03-6: SOCIODEMOGRAPHIC AS ATTRIBUTABLE RISK FACTORS OF PREHYPERTENSION: A POPULATION STUDY FROM URBAN AND RURAL
Authors: Susetyowati Susetyowati , Faza Farah , Budiatmaja Yusuf Ahmad
Published: January 2023

Background:

Prehypertension is undetected and considered a precursor of hypertension and cardiovascular diseases. Prehypertension can be attributed not only to diet patterns and lifestyle but also to the basic cause such as sociodemographic factors. Understanding the sociodemographic factor and its relationship with prehypertension can adjust the best prevention action to control the rise of prehypertension. We aim to investigate the association between sociodemographic factors with prehypertension among healthy adults.

Method:

Cross-sectional study was conducted from 2016 to 2018 and involved 653 healthy adults 19 to 64 years of age in urban and rural areas in a province in Indonesia. The urban represented the most populated urban area and the rural represented lowland, mountainous, and coastal areas. The pregnant or breastfed woman was excluded. Data collection included sociodemographic, namely gender, age, educational degree, occupation, family history of diseases, smoking history, and dwelling area. A blood pressure of 120 to 139 mmHg (systolic) or 80 to 89 mmHg (diastolic) was classified as prehypertension. Logistic regression was run to determine the factors that influenced prehypertension.

Result:

Subjects were dominated by females (62.2%) and the prevalence of prehypertension was 66.5%. Gender, age, occupation, smoking history, and dwelling area were associated with prehypertension. Being female increased the risk 3.1 times higher of prehypertension than male (p < 0.001, 95% CI 2.1–4.5). The middle adult had a 2.9 times higher risk of prehypertension than early adults (p < 0.001, 95% CI 1.8–4.7), while no significant risk for the elderly compared to early adults. Civil servants or private officers had a 1.9 times higher risk of prehypertension than unemployed/housewives/students (p < 0.001, 95% CI 1.3–2.7). Smokers increased a 1.6 times higher risk of prehypertension than non-smokers (p = 0.018, 95% CI 1.1–2.3). Adults who were living in urban had a 1.5 times higher risk of prehypertension than adults in rural (p = 0.026, 95% CI 1.1–2.0).

Conclusion:

Being female, middle adult, working as civil servants or private officers, being active smokers, and living in urban were significant risk factors for prehypertension. The importance of designing different interventions which were suitable for the different sociodemographic backgrounds is important to control blood pressure.

Keywords:

sociodemographic, prehypertension, adults, urban, rural
PS-P03-8: INFLUENCE OF AVERAGE AIR TEMPERATURE, PRESSURE AND AIR RELATIVE HUMIDITY ON BLOOD PRESSURE
Authors: Chen Xin , Hu Zhe , Wang Jiguang
Published: January 2023

Objective:

To investigate the influence of average air temperature, pressure and air relative humidity on blood pressure (BP) and blood pressure variability in population.

Methods:

A total of 97,784 participants were included from the May Month Measurement 2020 in China. BP was measured three times consecutively in the sitting position with a 1-minute interval, using a validated electronic BP monitor. Trained volunteer investigators administered a questionnaire to collect information on medical history, lifestyle, and use of medications. Average air temperature, pressure, and air relative humidity of the day were recorded. The mean BP was taken as the mean of the second and third BP, and the systolic blood pressure variability (SBPV) was the standard deviation/mean of three systolic blood pressures (SBP). Statistical analysis was performed using SAS 9.4.

Results:

Linear regression analysis found that the average air temperature was negatively correlated with the mean SBP and SBPV in all participants and hypertensive subjects (P < 0.0001, P = 0.01). The average pressure was positively correlated with the mean SBP and SBPV in all participants and hypertensive subjects (P < 0.0001, P < 0.0001). The average air relative humidity was negatively correlated with SBPV in hypertensive subjects (P = 0.03). The relationship between average air relative humidity and SBP in all participants and hypertensive subjects, between average air relative humidity and SBPV in all participants was not found. After adjustment for age, sex, body mass index, taking antihypertensive medicine, smoking, alcohol consumption, diabetes, history of heart disease and previous stroke, the average air temperature and pressure remained associated with mean SBP in all participants and in hypertensive subjects.

Logistic regression analysis showed that for every 1°C increase in air temperature, the risk of hypertension decreased by 1.8%, and for every 10hpa increase in pressure and 1% increase in air relative humidity, the risk of hypertension increased by 0.3% and 0.4%, respectively. When air temperature increased 1°C, the happen of hypertension control increased by 2.3%, and decreased by 0.2% for every 1% increase in air relative humidity. The relationship was not found between mean pressure and control of hypertension.

Conclusion:

The lower average air temperature and higher average pressure are possibly related with higher SBP, more likely to suffer hypertension, while the lower average air temperature and the higher average air relative humidity may resulted in more difficult hypertensive control.
PS-P04-7: ALERTING REACTION OF BLOOD PRESSURE AND AGE: MAY MEASUREMENT MONTH 2019
Authors: Kerr Gabriele Keziah , Schlaich Markus , Schutte Aletta E , Stergiou George , Poulter Neil , Beaney Thomas
Published: January 2023

Objective:

The extent of the alerting reaction on systolic blood pressure (BP) measurements has been shown to be related to age and the magnitude of the first reading, with implications for the monitoring and diagnosis of hypertension. We investigated the effects of age on the direction and magnitude of change in both systolic and diastolic BP from the first to subsequent readings, using data from the May Measurement Month (MMM) global BP screening campaign in 2019.

Design and method:

We examined the relationship between the value of the first reading (BP1) and the change in BP from BP1 to the average (BPA) of the second (BP2) and third readings (BP3) taken at 1 minute intervals in participants with three BP readings. Mixed effects regression models were fit, stratified by age, and using random intercept for country of screening site to account for clustering. This approach was repeated for diastolic and systolic BP.

Results:

Of the 1,133,008 participants with three BP readings, 58.7% had a decrease in systolic and 54.2% a decrease in diastolic BP from BP1 to BPA. Above an age dependent threshold value in BP1, a higher BP1 was associated with a greater decrease from BP1 to BPA. Older participants on average exhibited relatively smaller changes in systolic BP from systolic BP1 to systolic BP2 for equivalent values of systolic BP1 than younger age groups (Fig.1A). The average difference between diastolic BP1 and diastolic BPA showed a “U shaped” interaction with age such that the largest difference was observed in the youngest and oldest age groups and the smallest difference in those aged 40 to 49 and 50 to 59 years (Fig.1B). These patterns of BPV across values of BP1 and age persisted when the models were adjusted for antihypertensive medication or sex, or if the difference in BP from BP1 to BP2 or BP3 were used as the outcome.

Conclusions:

Age had a significant and differential modifying effect on the fall in systolic and diastolic BP from first to subsequent readings taken on a single occasion. These results could reflect age related variation in homeostatic capabilities to regulate BP following an initial stress response or differential sizes of alerting response by age. This highlights the importance of taking multiple BP readings when assessing BP, particularly in younger individuals, to avoid overestimation and overdiagnosis.
PS-P06-2: HEALTHCARE EXPENDITURE AND CARE SEEKING PATTERNS AMONG PEOPLE WITH CHRONIC CONDITIONS DURING THE PANDEMIC
Authors: Gamage Anuji Upekshika , Gunasekera Therani , de Silva Amala
Published: January 2023

Objective:

Public health strategies resorted to world-wide, to reduce the transmission of COVID-19 had economic impacts which led to care seeking changes among people with pre-existing chronic diseases. We aimed to assess the household expenditure and, care seeking among people with chronic diseases due to COVID-19 pandemic in Sri Lanka.

Design and Methods:

An online survey was conducted in 2021 involving 449 adults living in the Western-Province of Sri Lanka. Data on participants socio-demographic and economic status, co-morbidities, healthcare utilization, and healthcare-seeking behaviours were collected using a pre-tested questionnaire. The questionnaire link was distributed through social media and by emails. Categorical data were expressed as proportions/percentages with 95% confidence intervals where relevant. Quantitative data, normally distributed, were summarized in terms of mean and standard deviation (SD) and non-normally distributed as the median and interquartile-range (IQR).

Results:

449 respondents completed the survey. Majority (55%; n = 173) responded that they experienced a negative impact on their main income. Nearly 30%(n = 130) of the participants had an additional source of income before the pandemic; and of them majority (74%; n = 97) reported a negative impact on the income. Twenty six percent (n = 115) mentioned that they had a doctor-diagnosed chronic disease or a disability and of them 72% (n = 83) were on regular medication. Nearly half (n = 55;48%) mentioned that there was a delay in seeking healthcare during the pandemic and 27% (n = 30)reported not having sought treatment during the lockdown period. Of the people with delayed healthcare seeking 25% had hypertension, 16% diabetes, and 12.2% asthma. The pandemic led to changes in healthcare utilization patterns among patients. Majority had to obtain the drugs from the pharmacy 65% (n = 70) and the laboratory tests from private labs 58% (n = 62). Forty-eight percent agreed that the pandemic led to delays in healthcare seeking, mostly because they were unaware of the services rendered. The incurred high OOPE during the pandemic. Of the participants, 9% (n = 39) and 3.2% (n = 14) had incurred catastrophic healthcare expenses at 10% and 25% of their total income.

Conclusions:

Residents of the Western-province were severely economically affected by the COVID-19 pandemic. Participants had incurred high out-of-pocket expenditures which led to changes in care seeking patterns among people chronic conditions. Strategies to ensure continuity of care especially for chronic conditions while protecting people from financial hardships is necessary to move towards Universal Health Coverage.
PS-P06-7: ASSOCIATION OF COGNITIVE FUNCTION WITH OXYTOCIN AS A SOCIAL HORMONE IN A COMMUNITY DWELLING JAPANESE WOMEN; UKU STUDY
Authors: Enomoto Mika , Fukami Ako , Morikawa Nagisa , Yamamoto Maki , Sato Hiromi , Adachi Hisashi , Fukumoto Yoshihiro
Published: January 2023

Cognitive impairment leads to loss independence in daily activities. Maintain of cognitive function keeps daily high living activity. Oxytocin is an essential hormone for mammalian labor and lactation. The relationship between oxytocin and social cognition is supported by impairment of social recognition, which is associated with learning and memory integrity, in animal study. We investigated whether oxytocin levels are associated with cognitive function. Subjects were 219 residents (90 men and 129 women) who participated in a health check-up examination in Uku Town in Sasebo city in 2016. Oxytocin concentrations were measured in 129 women and using radioimmunoassay. Cognitive function was assessed by Mimi-Mental State Examination (MMSE). Cognitive dysfunction was defined as smaller than 26 MMSE scores. Mean plasma oxytocin levels were 7.3(3.0–69.5) μU/ml. Mean MMSE scores were 28.2 ± 2.3 points. The subjects with normal cognition were 110, and those with cognitive dysfunction were 17. Mean oxytocin levels in 17 subjects with cognitive dysfunction were much higher than in 110 subjects with normal cognitive function (8.0 μU/ml) (p = 0.67). In the linear regression analysis, MMSE was related to age (p = 0.001; inversely) whereas; MMSE was not related to oxytocin (p = 0.223). In the multiple regression analysis after adjustment for age, MMSE was not associated with oxytocin (p = 0.357). In conclusion, this study demonstrated that cognitive dysfunction was not associated with oxytocin levels in women. A prospective study is needed to examine the causal relationship between cognitive dysfunction and oxytocin including men.
PS-P06-8: TEXT MESSAGING AND HOME BLOOD PRESSURE MONITORING FOR PATIENTS WITH UNCONTROLLED HYPERTENSION: A PILOT RANDOMIZED CONTROLLED TRIAL
Authors: Campos Claudia L , Jones Deanna N , Rocco Michael V , Justin Moore B , Carolyn Pedley f , Beverly Snively M
Published: January 2023

Objective:

Improving adherence to antihypertensive medications is the most significant modifiable patient related factor to achieving blood pressure (BP) control. Elevated BP remains the leading cause of death globally. BP trends show disparities in the burden of hypertension in black and low socioeconomic status (LSES) populations, accompanied by low levels of awareness, treatment and control rates. Telehealth systems using text messaging (SMS) and home blood pressure monitors (HBPM) represent attractive scalable tools to reduce BP in those with health disparities.

Design and methods:

In three ambulatory clinics that serve a large number of those with LSES affiliated with an academic institution, we conducted a randomized controlled pilot study for low medication adherent patients with poorly controlled hypertension (BP > 130/80). The pilot aimed to (1) evaluate the feasibility of recruiting LSES participants to an effectiveness trial of SMS plus HBPM vs HBPM only; (2) measure the acceptability of the SMS system and (3) estimate the effects of the SMS approach on lowering BP. Satisfaction was measured using the validated systems usability survey (SUS). The SMS system was designed with the input of LSES focus groups and used Twilio® as its bidirectional platform. From February 2021 to October 2021, 24 participants were randomized (1:1) to either SMS intervention plus HBPM with an Omron BP cuff or HBPM alone for 12 weeks.

Results:

During the study period, the study coordinator enrolled 24 participants, averaging 3 per month. Demographics: participants were male (N = 14/24), predominantly African American (AA); (n = 19/24); 13/24 had high school education or less; mean age 55.7 (SD 12); weight 97.4 kg (SD 14); Mean initial SBP 156 mmHg (SD 20), DPB 100 mmHg (SD 11). Acceptability: 8/12 participants responded via SMS with at least one BP measurement in the SMS arm. Two participants were lost to follow up in each arm. Mean SUS was 81.6 (scale of 0 to 100, > 68 is considered above average). Reduction in SBP at 12 weeks in the SMS group and control group was 15 mmHg and 13 mmHg respectively (p = 0.58).

Conclusion:

Recruiting and retaining LSES participants with uncontrolled HTN for a larger trial of telehealth with SMS and HBPM is feasible and well accepted. Similar BP reductions were achieved in both arms. Utilizing the SMS and HBPM shows promise in reducing BP in the LSES population. A larger efficacy trial is needed to determine best practice and reduce cardiovascular health disparities.
PS-P06-10: ASSOCIATIONS OF TONGUE CLEANING AND MORNING TOOTH BRUSHING HABITS WITH BLOOD PRESSURE AND DIABETES AMONG JAPANESE MEN AND WOMEN
Authors: Fujimori Yuki , Funakubo Narumi , Eguchi Eri , Nagao Masanori , Takada Midori , Shimizu Yuji , Okada Takeo , Kiyama Masahiko , Yamagishi Kazumasa , Imano Hironori , Muraki Isao , Iso Hiroyasu , Ohira Tetsuya
Published: January 2023

Objective:

Recently, a bidirectional relationship between periodontal and systematic diseases has been reported. Because periodontal disease is caused by periodontopathogenic bacteria found in dental plaque and bacteria increase during sleep, it is important to clean the mouth, especially in the morning. Although the importance of tooth brushing has been reported in many studies,none has investigated both tongue cleaning habit and timing of tooth brushing. Therefore, the purpose of this study was to identify the association of tongue cleaning and morning tooth brushing habits with blood pressure (BP) and diabetes in a cross-sectional study.

Design and method:

1005 residents (656 in 2020, 349 in 2021, 430 men and 575 women) in Ikawa-machi, Akita Prefecture, aged 40–91 years (mean 65.3) who underwent health-checkup in 2020–2021 and answered both whether they had a tongue cleaning habit and their timing of tooth brushing, were surveyed. If participants answered in both years, the 2020 data was used. Participants who answered brushing their teeth at least once after waking up or after breakfast were defined as having a morning tooth brushing habit. Participants who answered “under treatment’’ or had an HbA1c of ≧ 6.0% in the health-checkup were defined as having diabetes, and those who had a systolic BP of ≧ 140 mmHg or a diastolic BP of ≧ 90 mmHg were defined as having poor BP control. Logistic regression analysis was used to calculate odds ratios (95% confidence interval (CI)) for the prevalence of poor BP control or diabetes in those who did not, based on those who had both tongue cleaning and morning tooth brushing habits. Covariates were sex, age, lifestyle habits (drinking, smoking, exercise), and taking antihypertensive medication.

Results:

The proportion of participants with both tongue cleaning and morning tooth brushing, with tongue cleaning, or with morning tooth brushing were 37.0%, 39.0%, and 92.2%, respectively. Those who did not have both tongue cleaning and morning tooth brushing were more likely to have poor BP control and diabetes than those who did, with odds ratios (95% CI) of 1.76 (1.14–2.72) and 1.33 (1.00–1.77), respectively. The association with poor BP control was particularly pronounced among those aged ≧ 65 years, with an odds ratio (95% CI) of 1.77 (1.04–3.03).

Conclusions:

Unable to have both tongue cleaning and morning tooth brushing habits may be associated with prevalent risk of hypertension and diabetes. Future longitudinal studies will be conducted to demonstrate a causal relationship.
PS-P06-11: LATE-ONSET HYPERTENSION AS A CONTRIBUTING FACTOR TO THE CHANGES IN THE CHA2DS2-VASC SCORE AND INCIDENT ATRIAL FIBRILLATION IN THE ELDERLY
Authors: Zhang Wei , Chen Yi , Hu Leixiao , Xia Jiahui , Ye Xiaofei , Cheng Yibang , Wang Ying , Guo Qianhui , Li Yan , Lowres Nicole , Freedman Ben , Wang Jiguang
Published: January 2023

Background:

Hypertension is closely associated with the risk of atrial fibrillation. However, hypertension is already prevalent in young adults, but atrial fibrillation usually only occurs in the elderly. In the present study, we investigated incident atrial fibrillation in relation to early- and late-onset hypertension in an elderly Chinese population.

Methods:

Our study participants were elderly (≧ 65 years) hypertensive residents, recruited from five community health centers in the urban area of Shanghai (n = 4161). Early- and late-onset hypertension were defined as the use of antihypertensive medication or elevated blood pressure (systolic/diastolic blood pressure ≧ 140/90 mmHg), respectively, at entry and during follow on at least 2 consecutive clinic visits. Atrial fibrillation was detected by a 30-second single-lead electrocardiography (ECG, AliveCor® Heart Monitor) and further evaluated with a regular 12-lead ECG.

Results:

During a median of 2.1 years follow-up, the incidence rate of atrial fibrillation was 7.60 per 1000 person-years in all study participants; it was significantly higher in patients with late-onset hypertension (n = 368) than those with early-onset hypertension (n = 3793, 15.76 per 1000 person-years vs. 6.77 per 1000 person-years, P = 0.007). After adjustment for confounding factors, the hazard ratio (HR) for the incidence of atrial fibrillation was 2.67 (95% confidence interval [CI] 1.04–6.87, P = 0.04) in patients with late-onset hypertension versus those with early-onset hypertension. The association was even stronger in those aged 75 years and over (HR 5.93, 95% CI 1.59–22.05, P = 0.008) and when patients with a duration of hypertension ≧ 5 years were considered as reference (HR 2.48, 95% CI 1.30–4.76, P = 0.006).

Conclusions:

Our study showed a significant association between late-onset hypertension and the incidence of atrial fibrillation in elderly Chinese.
PS-P06-12: COGNITIVE CAPACITY AS THE BRIDGE FOR HYPERTENSIVE PEOPLE TO EXPERIENCE MEMORY DECLINE
Authors: Astuti Riska Dwi
Published: January 2023

Objective:

Previous clinical studies have uncovered how hypertension affects patient brain performance that in turn generate its cognitive consequences. This study aims to analyze the long-term impact of hypertension on cognitive capacity that eventually affecting memory decline.

Design:

Socioeconomic and health information of 16,047 respondents were obtained from the Indonesian Family Life Survey. Ten percent of sample were people with hypertension. This longitudinal data allows author to access information about respondent condition across times with delta among waves is seven years. Respondents were considered to have hypertension if they reported that they were ever diagnosed as hypertensive patient by medical workers. Cognitive capacity is measured using respondent ability to solve figural task and arrange a sequence. In addition, respondents were considered experiencing memory decline by calculating if there was any reduction in the score of memorizing task.

Method:

Econometric analyses were conducted using ordinary least square (OLS) regression and logistic regression. In order to reduce to potential endogeneity, covariates were involved including respondents nutritional status based on BMI measurement, years of schooling, gender, and characteristic of living location. First analysis was conducted to investigate the influence of hypertension in the basis year to present cognitive capacity using OLS regression. Cognitive capacity in figural measurement and sequence were examined consecutively. Later analysis was conducted by employing logistic regression to find out the effect of current cognitive capacity to memory decline.

Conclusions:

Results show that hypertension has long-term impact on patient cognitive capacity, and eventually generate higher potency to experience memory decline. These results are robust when the measures of cognitive capacity were changed from figural task to questions about sequence. Former analyses show that hypertension influences future cognitive capacity. Hypertensive respondents statistically have lower cognitive capacity compared with respondents without hypertension. Next analyses found that current cognitive capacity significantly affects memory decline in negative direction. It implies that lower cognitive capacity is strongly related with memory decline. Following analysis shows that hypertensive respondent cognitive aspect has bigger impact to memorizing ability compared with non-hypertensive respondents.
PS-R01-7: A CASE REPORT OF ACCELERATED-MALIGNANT HYPERTENSION SUCCESSFULLY TREATED WITH SACUBITRIL/VALSARTAN
Authors: Morita Ryutaro , Azushima Kengo , Urate Shingo , Ebihara Masayuki , Kinguchi Sho , Kanai Daisuke , Kanaoka Tomohiko , Wakui Hiromichi , Toya Yoshiyuki , Tamura Kouichi
Published: January 2023

Angiotensin receptor-neprilysin inhibitor (ARNI) is an emerging therapeutic strategy for cardiorenal syndrome. Although the treatment with ARNI for hypertension is covered by governmental insurance systems in Japan, a putative position of ARNI in clinical hypertension guidelines is yet to be determined. However, clinical and experimental evidence is now accumulating concerning the therapeutic effects of ARNI for hypertension, in addition to heart failure, in Japan. Here we would like to present a case in which treatment with ARNI for hypertension was effective to beneficially control cardiorenal syndrome as well as hypertension. A 51-years-old man with a history of hypertension since 35 years-old experienced shortness of breath on exertion and on supine position visited Yokohama City University Hospital. Severely elevated blood pressure (234/165 mmHg) with hypertensive retinopathy (Keith-Wagner IIb, Scheie S2H3), as well as cardiorenal dysfunction (LVEF 39% on UCG, eGFR 25.4 mL/min/1.73m2, UPCR 0.56 g/gCr), were noted, and he was admitted to the hospital due to accelerated-malignant hypertension. On admission, the patient was administered with intravenous nicardipine to achieve blood pressure level around 160/110 mmHg, and then treated with oral nifedipine (40–80 mg daily) with tapering of intravenous nicardipine administration. After treatment transition to single oral nifedipine therapy (80 mg daily), his blood pressure was still around160/110 mmHg. Thus, treatment with ARNI (sacubitril/valsartan) was initiated with a starting dose of 50 mg daily on Day 9. On Day 10, his blood pressure was improved to around 130/90 mmHg without evident worsening of kidney function or elevation of serum potassium level. The patient was successfully treated with appropriate control of blood pressure without initiation of dialysis. This case suggests that ARNI is an interesting therapeutic strategy to treat cardiorenal syndrome with severe hypertension.