bluuebunny/crossref_metadata_2025 huggingface dataset:
PS-C06-7: NT- PRO BNP IN ARTERIAL HYPERTENSION
Authors: Unurjargal Tsolmon , Sodovsuren Naranchimeg , Khorloo Chingerel
Published: January 2023

Objectives of the present study were to evaluate the association of N-terminal pro-B-type natriuretic peptide to hypertension and to compare NT-pro BNP levels in groups with and without arterial hypertension.

Design and method:

The study included 253 participants with cardiovasular risk aged 35–64 years and who had no clinical symptoms of heart failure. All participants were divided into to two groups: hypertensive and normotensive. High risks for heart failure included arterial hypertension, diabetes, obesity, excessive drinking of alcohol, smoking and family history of cardiovascular disease were detected by clinical examinations. Hypertension was defined as systolic BP ≧ 140 mm Hg, diastolic BP ≧ 90 mm Hg, and/or receiving treatment with anti-hypertensive agents. The NT-pro BNP determination was performed using immunoassay analyzer which utilizes reagent strip to obtain quantitative NT- pro BNP results in plasma. The cut-off point for NT-pro BNP was 125 pg/ml. All statistical analyses were made with the SPSS version 25.0. Differences between the study groups were analyzed with the chi-square test for categorical variables. P value less than 0.05 is considered as statistically significant.

Results:

The study sample consisted of 100 men and 153 women. The mean age of participants was 51.1 ± 8.2 years. In all, 49% of participants were hypertensive.

The mean age, body mass index and abdominal circumference in hypertensive group were significantly higher than in normotensive group. Elevated NT-pro BNP levels ≧ 125 pg/ml were detected in 12.6% of participants. Increased NT- pro BNP values were detected in 21.0% subjects with hypertension and in 4.6% subjects without hypertension. The mean N-terminal pro-B-type natriuretic peptide value among patients with and without hypertension were 145.0 ± 98.0 pg/ml and 112.6 ± 59.6 pg/ml. Multivariate linear regression analysis showed that age β; = 0.240, P = 0.021 and systolic blood pressure β; = 0.256, P = 0.008 were positively correlated with NT-pro BNP levels in hypertensive group.

Conclusions:

NT-pro BNP levels were significantly increased in participants with hypertension.

The present study showed that age and systolic blood pressure were significantly positively associated with NT- pro BNP levels. In case of elevated NT- pro BNP we recommend using echocardiography
PS-C07-1: CENTRAL AND BRACHIAL PULSE PRESSURE PREDICTS CARDIOVASCULAR AND RENAL EVENTS IN TREATED HYPERTENSIVE PATIENTS
Authors: Takenaka Tsuneo , Ohno Yoichi , Eguchi Kazuo , Miyashita Hiroshi , Suzuki Hiromichi , Shimada Kazuyuki
Published: January 2023

Purposes:

Central blood pressure is a stronger predictor of cardiovascular prognosis rather than brachial blood pressure. Reflection wave reaches abdominal aorta sooner than ascending aorta. Thus, the contribution of central pulse pressure (cPP) to renal events may differ from that to cardiovascular events.

Methods:

The sub-analysis of ABC-J II study was performed. Subjects were 3434 treated hypertensive patients with mean follow-up of 4.7 years. Left ventricular hypertrophy, an index of cardiovascular risk, correlated with cPP better than central systolic blood pressure in this cohort. The contribution of brachial pulse pressure (bPP) and cPP to cardiovascular and renal events were analyzed. Multivariate Cox regressions were performed by restricting independent variables according to the number of events. The independent variables, which were either significant in univariate Cox regression or of clinical interest, were applied.

Results:

Total of 63 cardiovascular and 34 renal events were occurred. Multivariate Cox proportional-hazard analysis revealed that sex (p < 0.001), height (p < 0.05), history of cardiovascular diseases (p < 0.001), numbers of antihypertensive drugs (p < 0.05) and cPP (p < 0.05) contributed to cardiovascular events (Table 1). However, multivariate Cox proportional-hazard analysis disclosed that baseline serum creatinine (p < 0.001) and bPP (p < 0.05) predicted renal events (Table 2).

Conclusions:

The present findings suggest that cPP and bPP contribute to cardiovascular and renal events in treated hypertensive patients.
PS-C07-4: COST EFFECTIVE SCREENING FOR BLOOD PRESSURE IN A LMIC: COMPARISON OF STANDARD AND RANDOM METHODS FOR HOME BLOOD PRESSURE MONITORING
Authors: Khan Aamir Hameed , Baqar Jaffer Bin , Jaffari Anzal Abbas , Javed Wajiha
Published: January 2023

Background:

Hypertension is a leading risk factor for worldwide mortality and has become an important public health concern. Globally one billion people are suffering from hypertension and this rate may reach up to 1.56 billion by 2025. The prevalence of hypertension in Pakistani adults is upto 50%. The National Institute for Clinical Excellence and Pakistan Hypertension League guidelines recommend home blood pressure monitoring (HBPM) for screening and diagnosis of hypertension in Pakistan; whereas, the current gold standard of hypertension diagnosis is still ABPM. However, the utility of HBPM is restricted due to the cumbersome standard method for HBPM, which requires timed blood pressure measurements pre-breakfast & pre dinner.. We need pragmatic ways of measuring home blood pressure which will lead to higher patient compliance.

Objective:

To compare the limits of agreement between standard and random methods for HBPM in patients with or without hypertension.

Design & Method:

A cross sectional study with n = 345 participants will be conducted in The Aga Khan University Hospital. After receiving due ethical approvals, participants 18 80 years of age will be recruited with or without hypertension. A HBPM device (OMRON M7 Intelli) will be provided to each participant for 14 days. In first week, BP readings will be taken as per standard method (2 readings pre breakfast & 2 pre-dinner) and random method (6 readings anytime during a day) will be followed in subsequent week. Besides demographics, history of comorbid, medications status and BP charting, international physical activity questionnaire short form will be filled. SPSS software will be used for data management and analyses. Pearson correlation coefficients, Bland Altman plots and ROC curve will be used to determine the correlation limits of agreement and level of accuracy in predicting hypertension for both methods.
PS-C08-3: TOO-LARGE AND TOO-SMALL CUFF SIZES RESULTS RESULTS IN SUBSTANTIAL BLOOD PRESSURE MEASUREMENT ERROR: RESULTS FROM THE CUFF(SZ) RANDOMIZED TRIAL
Authors: Brady Tammy Mcloughlin , Charleston Jeanne , Ishigami Junichi , Prokopowicz Greg , Miller Edgar , Matsushita Kunihiro , Appel Lawrence
Published: January 2023

Objective:

Proper cuff-size based on measured mid-arm circumference is recommended for accurate blood pressure (BP) determination. The impact of mis-cuffing (using a too-small or too-large cuff) on BP when using an automated BP device has not been rigorously tested. We aimed to determine the effects of mis-cuffing on automated BP.

Design and Methods:

We conducted a randomized cross-over trial of 195 community-dwelling adults [mean age 54 yrs, 34% male (n = 67), 68% Black (n = 132)]. Participants had 3 sets of triplicate BP measurements (WelchAllyn ProB 2000) using an appropriately sized cuff and two additional cuff sizes (too-small and/or too-large), in random order.

Results:

31% (n = 60) of the study participants had systolic BP (SBP) > = 130 mmHg, and 36% (n = 71) had a body mass index > = 30 kg/m2. As shown in the Figure, among persons in whom a small adult cuff was appropriately sized, too-large cuffs resulted in significantly lower SBP readings [regular adult cuff: -3.6 (-1.7 to -5.6) and large adult cuff: -7.5 (-5.5 to -9.6)]. In contrast, among persons in whom an extra-large adult cuff was appropriately sized, too-small cuffs resulted in significantly higher SBP readings [large adult cuff: + 9.6 (+7.3 to + 11.9) and regular adult cuff: + 19.5 (+16.1 to + 22.9)]. Similar effects were seen for mis-cuffing when an appropriate cuff was either a regular adult cuff or large adult cuff. We also observed similar patterns for diastolic BP.

Conclusions:

Appropriate cuff selection is essential for accurate BP measurement. Choosing a too-large or too-small cuff can result in clinically meaningful errors in BP reading which could lead to under- or over-treatment of hypertension.
PS-C08-6: COMPARING BLOOD PRESSURE MEASUREMENTS BETWEEN A NOVEL CUFF-LESS EARPHONE-TYPE DEVICE BASED ON GREEN REFLECTED PHOTOPLETHYSMOGRAPHY AND A STANDARD CUFF-BASED SPHYGMOMANOMETER
Authors: Kanai Daisuke , Wakui Hiromichi , Sato Shohei , Lee Jihyoung , Urate Shingo , Tanaka Shohei , Tamura Kouichi
Published: January 2023

Objective:

Blood pressure (BP) measurement with conventional sphygmomanometers often causes discomfort and pain to the users due to arterial occlusion pressure caused by the inflatable cuff, making it difficult to perform continuous or frequent measurements for rigid blood pressure control. Developing unconstrained wearable electronics that can measure BP continuously would be useful in the healthcare field. We have developed a novel earphone-type device for cuff-less BP monitoring based on photoplethysmography with green light. In the present study, we compared the measured BP values between this novel cuff-less BP monitoring device and a conventional cuff-based sphygmomanometer.

Design and Methods:

From August 2020 to October 2021, 20 healthy subjects and 40 hypertensive patients (outpatients attending Yokohama City University Hospital and Yokohama Minami Kyosai Hospital, Yokohama, Japan) were recruited. Each participant's BP was measured using the novel cuff-less BP monitoring device as well as a standard cuff-based sphygmomanometer under four different conditions: static, BP rising and falling, and reproducible after the one-month interval. The results of measurements under the four conditions were integrated and analyzed. The BP measurements were determined to be comparable between the standard cuff-based sphygmomanometer and the novel cuff-less earphone-type device, if the mean absolute difference (MAD) of the measurements was within 7 mmHg. We also performed Bland-Altman agreement analyses.

Results:

The participants’ characteristics were as follows. Male to female ratio was approximately 50% in both groups. Age was 27.5 [interquartile (IQR) 24.5–33.0] years old for the healthy subjects and 65.0 [IQR 49.5–74.0] years old for the patients with hypertension (HTN). BMI was 21.2 [IQR 20.1–22.5] kg/m 2 and 23.8 [IQR 21.8–24.9] kg/ m 2, respectively. MAD between the novel cuff-less device and the reference using the standard cuff-based sphygmomanometer among the healthy subjects was 5.8 mmHg for systolic BP (SBP) and 5.3 mmHg for diastolic BP (DBP). MAD in the patients with HTN was 7.8 mmHg for SBP and 4.4 mmHg for DBP. In Bland-Altman agreement analyses, mean difference in the healthy subjects was 2.7 (95% confidence interval [CI] −13.4, 16.8) mmHg for SBP and 2.4 (95% CI −10.7, 15.5) mmHg for DBP. Mean difference in the patients with HTN was 0.9 (95% CI −20.0, 21.9) mmHg for SBP and 0.7 (95% CI −10.9, 12.3) mmHg for DBP.

Conclusions:

Our newly developed cuff-less earphone-type device based on green reflected photoplethysmography able to predict BP in healthy subjects, but it was difficult to predict SBP in the patients with HTN.
PS-C09-2: EFFECT OF DIETARY APPROACHES TO STOP HYPERTENSION OR MEDITERRANEAN DIET ON BLOOD PRESSURE IN ADULTS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Filippou Christina , Thomopoulos Costas , Konstantinidis Dimitrios , Manta Eleni , Tatakis Fotis , Polyzos Dimitrios , Drogkaris Sotiris , Tsioufis Konstantinos
Published: January 2023

Objective:

To determine whether the Dietary Approaches to Stop Hypertension (DASH) diet and the Mediterranean diet (MedDiet) is accompanied by blood pressure (BP) reduction in adults with and without hypertension.

Design and method:

We systematically searched Medline and the Cochrane Collaboration Library databases for randomized controlled trials (RCTs) investigating the BP effects of the DASH diet and the MedDiet in individuals with and without hypertension. We identified 30 RCTs (n = 5,545 participants) that explored the BP effects of the DASH diet compared to the control diet and 35 RCTs (n = 13,943 participants) that explored the MedDiet BP effects compared to the usual diet or another dietary intervention (e.g., lowfat diet). For each diet, the random-effects model was used to calculate the mean attained systolic BP (SBP) and diastolic BP (DBP) differences during followup.

Results:

Compared to the control diet, the DASH diet reduced SBP and DBP (difference in means: -3.2 mm Hg; 95% CI: -4.2, -2.3 mm Hg; P < 0.001, and -2.5 mm Hg; 95% CI: -3.5, -1.5 mm Hg; P < 0.001, respectively). Hypertension status did not modify the diets effects on BP reduction. Compared to the usual diet the MedDiet reduced SBP and DBP (difference in means: -3.1 mm Hg; 95% CI: -4.8, -1.3; P = 0.001, and -1.6 mm Hg; 95% CI: -2.6, -0.6; P = 0.002, respectively), while compared to all other active intervention diets or only to the low-fat diet the MedDiet did not reduce SBP or DBP. We were unable to compare the BP effects of the MedDiet between hypertensive and non-hypertensive patients, but in a limited number of studies conducted in normotensive individuals, the MedDiet BP effects were not significant.

Conclusions:

The adoption of the DASH diet or the MedDiet was accompanied by significant BP reduction in adults with and without hypertension. Our findings give further support to the current guidelines, supporting the adoption of a healthy, balanced diet, such as the DASH diet or the MedDiet.
PS-C09-4: PATIENTS PREFER HOME OVER AMBULATORY BLOOD PRESSURE MONITORING
Authors: Lustigova Eva , Wei Rong , Bowling Barrett , Cannavale Kimberly , Harrison Teresa N , Muntner Paul , Shimbo Daichi , Schwartz Joseph E , Sim John J , Qian Lei , Reynolds Kristi
Published: January 2023

Objective:

Ambulatory blood pressure monitoring (ABPM) and home BP monitoring (HBPM) are two recommended approaches for measuring out-of-office BP. We assessed the willingness and preferences of older adults taking antihypertensive medication to complete out-of-office BP monitoring with ABPM or HBPM and if differences were present across demographic characteristics.

Design and method:

We conducted a survey within a prospective cohort study of patients aged 65 + years who were diagnosed with hypertension and taking antihypertensive medication within a diverse integrated health care system. Enrolled participants underwent 24-hour ABPM followed by HBPM for 7 days. Participants who completed both ABPM and HBPM were asked to fill out a self-reported survey on their willingness to undergo ABPM or HBPM if their healthcare provider suggested it, and their preferences for ABPM or HBPM. Group means were compared using t-tests. Chi-square or Fisher's exact test were used to compare group proportions.

Results:

We included 167 participants (mean age 74.3 years [range 65–95 years]; 55.7% female; 46.7% non-Hispanic white, 16.8% Hispanic, 15.6% non-Hispanic Black and 17.3% Asian and Pacific Islander; mean research office systolic/diastolic BP 131/68 mm Hg). Overall, 84.4% and 67.1% of participants reported that they would be completely or very willing to perform HBPM for a week and a 24-hour ABPM, respectively, if their doctor thought it would be helpful to measure out-of-office BP. Also, 77.2% (n = 129) of participants preferred HBPM, 21.0% (n = 35) preferred ABPM and 1.8% (n = 3) did not have a preference. A higher proportion of females versus males preferred HBPM (Table). There were no statistically significant differences in preference for ABPM or HBPM by age, race/ethnicity or mean research office BP.

Conclusions:

The study results suggest that most older adults taking antihypertensive medication may be willing to undergo either ABPM or HBPM if recommended by their physician. However, HBPM was preferred to APBM.
PS-C10-5: CORRELATION OF SERUM URIC ACID LEVELS WITH CERTAIN ANTHROPOMETRIC PARAMETERS AND ARTERIAL BLOOD PRESSURE IN OVER WEIGHT AND OBESE SUBJECTS
Authors: Verma Shivam
Published: January 2023

Background:

Asymptomatic hyperuricemia without comorbidities predicts the development of hypertension. Moreover, hyperuricemia also contributes to the development of hypertension from prehypertension.

Aim:

To find out correlation of serum uric acid levels with certain anthropometric parameters and arterial blood pressure in over weight and obese subjects

Methodolgy:

The study included 224 urban drug naive over weight and obese Indian subjects above 18 years of age from general population of city of north India. Uric acid concentrations were estimated by the uricase method. Blood pressure was measured by using Automatic Digital Sphygnomanometer with mean of 3 readings following all standard pre requisite. Anthropometric measurements and information on lifestyle factors and disease history were collected by inperson meeting.

Results:

All participants of the study subjects had BMI more than 23.5. Correlation of weight, BMI, SAD, WHR, SBP & DBP was positively correlated & statistically significant. Pearsons Correlation between Anthropometric parameter and Serum Uric Acid

Conclusion:

Statistical data shows remarkable results for significant correlation of uric acid level with BMI, WHR, SAD, SBP & DBP. Hypertrophy results into and oxidative stress when the supply of energy starts to exceed the storage capacity of adipocytes, as a result adipokines such as interleukin-1, interleukin-6 and tumor-necrosis factor alpha are released more frequently which lead to low-grade chronic inflammation. Evidence indicates that uric acid can cause direct endothelial injury and dysfunction. Uric acid levels are much lean towards visceral obesity than overall body fat content.
PS-C10-9: EFFECTIVENESS OF AMLODIPINE ON 24-HOUR AMBULATORY BLOOD PRESSURE IN ADULT PATIENTS WITH MILD-MODERATE ESSENTIAL HYPERTENSION: A MULTICENTRE OBSERVATIONAL, REAL-WORLD STUDY
Authors: Dorairaj Prabhakar , Guha Santanu , Sharma Shweta , Pinto Colette , Gaurav Kumar , Rathod Rahul , Kotak Bhavesh
Published: January 2023

Objective:

Inadequate 24-hour blood pressure control could cause complications, especially in high-risk hypertensive individuals. Hence, it is recommended that the targeted blood pressure levels be maintained round the clock. This prospective, observational study assessed the 24-hour ambulatory blood pressure (ABP) control with 8-week amlodipine therapy 5/10 mg/day in patients with hypertension.

Methods:

Adult patients (62 m, 42 f) with mild-to-moderate essential hypertension received oral amlodipine 5 mg/day (n = 68) or 10 mg/day (n = 36) for 8 weeks. The study was approved by the independent ethics committee and informed consent was obtained from all participants. Primary outcome was change at 8 weeks from baseline in mean 24-hr ABP (systolic and diastolic), and secondary outcomes were change from baseline in mean morning, daytime, night-time, and last 6-hr dosing interval ABP. A repeat measures analysis of covariance (ANCOVA) was done for changes in ABP over 8 weeks, with age, gender, BMI and associated comorbidities as covariates. Nocturnal dippers were assessed as those greater than or equal to 10% reduction in ABP at 8 weeks. Sub-groups were created based on age, duration of hypertension, occupation, baseline BMI and amlodipine dose. Safety was evaluated based on clinical adverse events and 12-lead electrocardiogram.

Results:

Of the 104 patients from 2 study centers, 49 completed 8-weeks therapy and were included for per-protocol analysis. Significant reductions in the mean 24-hr blood pressure were seen for both SBP and DBP (figure 1). The mean 24-hr. reduction was -10.82 and -6.25 mmHg with 5 mg amlodipine and -19.81 and -11.19 mmHg with 10 mg amlodipine for SBP and DBP respectively (p < 0.0001). The mean morning, daytime, night-time, and last 6-hr reductions in SBP were -14.06, -18.63, -20.42, and -13.51 respectively (p < 0.0001), and DBP reductions were -7.78, -10.27, -11.07, and -6.44 respectively (p < 0.0001). Significant reduction in ABP was seen in all sub-groups (p < 0.0001). Greater reduction in SBP and DBP were observed in patients with stage-2 hypertension. At baseline, there were 30 (61.2%) non-dippers which decreased to 18 (36.7%) at 8 weeks. At the end of the study, 40% of non-dippers were converted to dippers by Amlodipine, whereas none of the dippers were converted to non-dippers. No adverse effects were reported.

Conclusion:

Amlodipine significantly reduces the 24-hr. mean morning, daytime, night-time, and last 6-hr. ABP and converted non dippers to dippers in adult patients with mild to moderate essential hypertension. The Study highlights the consistent effects of amlodipine on both quantity and quality of 24 hours BP control which is important for associated CV risk reduction.
PS-C10-11: COMPARISON OF MEASUREMENT OPTIONS FOR NOCTURNAL HYPERTENSION. STUDY PROTOCOL
Authors: Kocianova Eva , Stanke Ladislav , Genzor Samuel , Vohralik Tomas , Obrova Jana , Kamasova Monika , Jelinek Libor
Published: January 2023

Background:

Nocturnal hypertension is strongly associated with adverse cardiac events and affects patients prognosis. However, to distinguish between true night hypertension and sleeping disorder might be tricky as patients often misinterpret sleep pattern and the role of standard device inconvenience during the 24 hour ABPM measurement. The effect of sleep disturbance on the validity of the results has not been thoroughly investigated.

Aim:

The main objective is to examine the validity of currently used conventional methods of ABPM in patients with nocturnal hypertension potentially disturbed by monitoring itself. The secondary objective is to determine whether the new (less obtrusive) methods are more effective in detecting true nocturnal hypertension and whether they are applicable to patients.

Methods:

The study will enter patient treated for arterial hypertension. They will be recruited consecutively and randomized. The study will have an intrasubject experimental design. Patients will first be measured sleep quality using an actigraph and a proposed questionnaire for this purpose (PSQI + own questionnaire of relation to technologies). We plan to enrol two groups of at 100 probands, with the first group being measured in the following way after baseline actigraphy is detected: 1. Measurement using the Spacelab Healthcare ABPM tonometer. 2. Measurement using a wrist tonometer (Beurer BC54) 3. Measurement using a smart watch tonometer (OMRON HeartGuide). In all of these cases, the actigraphy, or other variables indicating quality and sleep progression (HRV), will be measured simultaneously. For the second group, the order will be reversed, moving from the least obtrusive methods to the more obtrusive ones to eliminate bias sequencing. For the testing of the tonometer obtrusivity during the nigh time BP monitoring BP tonometers were improved by additional Blueetooth receivers, so they can be externally triggered by the command send from the tablet equipped with the specifically designed application. The application can trigger the measurement, consequently collect the measured data and securely send them to the hospital server. Measured sound level is used as one of the correlates of the tonometers obtrusivity along with the actigraphy and subjective perception of the obtrusiveness and sleep disturbance that is also evaluated by the developed questionnaire.

Results:

Number of true verus pseudonocturnal hypertension will be provided according to whether the root problem is poor sleep quality, which causes changes in blood pressure, or pathological changes in blood pressure itself, which causes a deterioration in sleep quality.

Supported by MH CZ DRO (FNOl, 0098892), Mex reg. n.: 8787
PS-C11-6: SIMULTANEOUS MEASUREMENT OF 24-HOUR AMBULATORY BLOOD PRESSURE IN BOTH ARMS REVEALS CLINICALLY RELEVANT DIFFERENCES: A WAKEUP-CALL FOR HYPERTENSION MANAGEMENT
Authors: Bothe Tomas Lucca , Patzak Andreas , Pilz Niklas
Published: January 2023

Objective:

Cuff-based 24-hour ambulatory blood pressure measurement is the gold standard for hypertension diagnosis and treatment monitoring. The clinical value of ambulatory blood pressure (BP) measurement is ubiquitously accepted. This study wants to quantify the measurement discrepancies in simultaneous and synchronized 24-hour ambulatory BP measurements on both arms. Identifying and understanding measurement uncertainties could improve future hypertension management and originate true confidence in alternative, cuff-less systems with equal measurement precision.

Methods:

We conducted simultaneous 24-hour ambulatory blood pressure measurements on both arms in 52 healthy young adults. The broadly used and validated cuff-devices (BoSo TM-2430) were synchronized to start BP measurement within one second of each other. Further, we recorded, cuff-pressures of both cuff-based devices and the hydrostatic pressure differences between both cuffs. We then scored pressure curves for disturbances (e.g., pressure spikes during deflation) and were able to correct measurements for hydrostatic differences between the arms. This enabled us to not only quantify the extent of measurement uncertainty but to describe its origins and possible countermeasures.

Results:

Measured BP levels from left and right arm showed limits of agreement in the Bland Altman Plot of > 33 mmHg for systolic and > 30 mmHg for diastolic values over 24 h. Daytime values deviated more than nocturnal values (systolic: > 35 mmHg vs. > 27 mmHg systolic, and diastolic: > 32 mmHg vs. > 24 mmHg). Linear regression retrieved R2 = 0.39 (p < 0.001) for systolic and R2 = 0.20 (p < 0.001) for diastolic values. Exclusion of disturbed cuff pressure curves improved limits of agreement to > 23 mmHg for systolic and > 19mmHg for diastolic measurements. Subsequently, it improved correlation coefficients to R2 = 0.54 (p < 0.001) for systolic and R2 = 0.35 (p < 0.001) for diastolic values. Correction of hydrostatic differences between the arms had an negligible effect on limits of agreement and strength of correlation.

Conclusion:

Comparison of synchronized 24-hour BP measurements on both arms showed large measurement uncertainties with possible implications on clinical grading of hypertension and dipping pattern. Exclusion of disturbed cuff pressure curves, not detected by the conventional software of BP devices, mitigates the effect but still results in worrying discrepancies. These results are an imperative to further investigate the clinical implications of BP measurement uncertainty. It further inspires the courageous exploration of alternative means of BP measurement which might offer comparable measurement certainty.
PS-C12-2: VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY AND CLINICAL EVENTS IN OLDER PATIENTS RECEIVING HOME MEDICAL CARE: THE OHCARE STUDY
Authors: Koujiya Eriko , Takeya Yasushi , Kabayama Mai , Yamamoto Mariko , Murakami Naoko , Yano Tomoko , Nakamura Chika , Rakugi Hiromi , Kamide Kei
Published: January 2023

Aim:

We investigated the associations of visit-to-visit variability(VVV) of blood pressure (BP) with clinical events (death, hospitalization, falling) in older patient around 85 years old receiving home medical care.

Methods:

This study was performed in OHCARE (Osaka Home CAre REgistry), which is a prospective cohort study targeted old patients receiving home-based medical care in Japan. There were 103 eligible patients fulfilling the inclusion criteria: aged 65 years or older; BP measurements at least three occasions before the baseline date (median 4.78 occasions); BP measurement interval in 16 ± 13 days (median ± 1SD). We used the standard deviation (SD), Coefficient of variation (CV) of SBP measured at baseline as the VVV of BP. Main outcomes were clinical events including hospitalizations, falling and death during follow-up period.

Results:

It was clarified that VVV of BP was exists in older patients receiving home medical care (10.7 / 7.2 mmHg). Regarding the relationship between VVV and clinical events during follow-up, the rate of hospitalization was significantly higher in the group with the largest SBP-SD than in the group with the smallest. Furthermore, multivariate analysis adjusted by age, sex, ADL and current diseases showed that SD and CV of SBP were independent positive association of hospitalization events.

Conclusion:

In older patients with frailty requiring home medical care, a higher VVV in SBP may be related to the occurrence of events leading hospitalizations. Furthermore, higher VVV in SBP could be a predictive marker of clinical events leading to hospitalization.
PS-C12-4: OPEN-ANGLE GLAUCOMATOUS OPTIC DAMAGE ASSOCIATED WITH DAYTIME AND NOCTURNAL DIPS IN BLOOD PRESSURE
Authors: Melgarejo Jesus D , Eijgen Jan Van , Wei Dongmei , Maestre Gladys E , Aswad Lama A Al , Mena Luis J , Vanassche Thomas , Janssens Stefan , Verhamme Peter , Keer Karel V , Stalmans Ingeborg , Zhang ZhenYu
Published: January 2023

Background:

Impaired ocular perfusion pressure via systemic hypoperfusion plays a pivotal role in the pathogenesis of open-angle glaucoma (OAG). Extreme dips in mean arterial pressure (MAP) during 24-h are associated with OAG, however, whether this is driven by diurnal or nocturnal dips remains undocumented. We aimed this study to investigate the association of OAG damage with daytime and nocturnal dips in MAP.

Methods:

We conducted a retrospective longitudinal study that included 110 primary OAG patients who underwent 24-h ambulatory blood pressure monitoring. OAG damage was defined as changes in mean deviation (MD) of visual field tests during follow-up. MAP variability independent of the mean (VIMmap) was computed for daytime and nighttime. Dips were the five daytime and three nighttime lowest drops in MAP. We also calculated the night-to-day ratio and defined low diurnal and nocturnal MAP levels. We applied mixed models to evaluate changes in MD (expressed as decibels [dB]) during follow-up in relation to diurnal and nocturnal variability and dips in MAP.

Results:

The mean age was 64.0y (53% women). The median follow-up was nine years. In adjusted mixed models, every + 3 mmHg increase in daytime VIMmap was associated with a -2.57 dB longitudinal change in MD (P < 0.001). The longitudinal changes in MD associated with daytime dip measures ranged from -2.56 dB (95% confidence interval [CI], -3.61 to -1.51; P < 0.001) to -3.19 dB (95% CI, -4.53 to -1.84; P < 0.001). For nighttime measures, the MD changed -0.71 dB (CI, -1.24 to -0.17; P = 0.009) per every -5 decrease in the nighttime MAP level. Nocturnal MAP level < 74 mmHg and every 0.05 decrease in the night-to-day ratio were related to -7.23 (P = 0.003) and -0.96 (P = 0.011) changes in MD. Nighttime VIMmapP and nocturnal dips were not associated with changes in MD (P > 0.097).

Conclusions:

Extreme daytime dips in MAP relate to OAG damage independently of the MAP level. Whereas, the association between OAG damage and nocturnal measures is driven by the nocturnal MAP level rather than variability or dips in MAP. The assessment of diurnal patterns in MAP might offer an opportunity to understand the pathogenesis of OAG. This is also critical as the perfusion pressure to the eyes is physiological 30% lower than at the brachial level in the standing or sitting positions. Therefore, a physiological lower perfusion pressure combined with extreme diurnal dips in MAP would exacerbate the hypoperfusion state in the optic nerve, leading to further glaucoma damage.
PS-C12-10: “CHRONOBIOLOGY” THE NEW PARADIGM OF CLINICAL APPROACH
Authors: Sagam Dinesh Reddy
Published: January 2023

1) Definition: Chronobiology is the study of biological rhythms. Over the past few decades, chronobiology has developed into a multidisciplinary field.

2) The suprachiasmatic nucleus (SCN) is a bilateral structure located in the anterior part of the hypothalamus. It is the central pacemaker of the circadian timing system and regulates most circadian rhythms in the body.

3) Why your circadian rhythm matters? Our circadian rhythm matters in all parts of our life. For eg: if your sleep times are off, your hunger could be off or your eating times. We often see people who are sleep deprived either their hunger goes up or down. And the time when they get hungry changes.

4) How to tell it is time to reset our circadian rhtym ?

You might need to reset your circadian rhythm:: if you have trouble falling asleep, staying awake in the evening, waking in the morning, focusing on daily tasks and responsibilities.

5) Our circadian rhythms evolve over time. As we age, our circadian timing gets earlier. People in their 50 s, 60 s and 70 s may start to want go to bed earlier and wake up earlier. If you were a night owl as a teenager, you could be a morning person when you are an older adult.

6) Small Study at LMR Hospital:

TARGET PEOPLE 1) ELDERLY PEOPLE WITH HYPERTENSION 2) MID AGED PEOPLE BOTH MALE AND FEMALE 25-40 YEARS WITH BORDERLINE HYPERTENSION

Observations:

1) In a group of 1000 elderly people with HTN correction in 1 hour of sleep cycle has improved their quality of life by 60 to 70 percent and thereby reducing the dose of antihypertensives. 2) In middle aged females and males of 1000 people (age 30–40) with prehypertension timely sleeping, avoiding nighttime electronic gadgets tv, increased physical activity almost avoided the need for the antihypertensives.

Conclusions:

A very small variation in the circadian rhythm will have great impact on our health. For eg:: 1 hour deprivation of sleep may increase the stroke risk from 40 % to 80 % and thereby increasing mortality rate. It is very important to note that even in clinical trials of many drugs, circadian rhythm should also be taken in to consideration. for eg:: dippers and non dippers in population.

9) Goal of this Entire Study:

Doctor treating the patients accordingly to the biological clock will give the chance for getting excellent results without increasing the dose of medication.
PS-C13-5: SPECTRUM OF ECG ABNORMALITIES SEEN AT THE FIRST VISIT OF PATIENTS TO A CARDIOLOGY CLINIC IN ENUGU, NIGERIA
Authors: Nwigwe Scholastica Ijeoma , Okwulehie Vincent , Okonkwo Alex , Oguanobi Nelson , Ejim Emmanuel Chukwudi
Published: January 2023

Objective:

Hypertension, heart failure and chest pain are among the commonest indications for referral of patients to cardiologists in Nigeria. Often times these patients present at advanced stages of the illnessess, when cardiovascular complications are already present. It is therefore not surprising that many patients referred to the cardiologists in Nigeria present for the first time with significant ECG abnormalities. We set out to find the common ECG abnormalities seen at the first presentation of patients at a cardiology clinic in Enugu, Nigeria.

Design and Method:

The case notes of all the patients referred to the Cardiology clinic of Kenechukwu Specialist Hospital, Enugu from January 2012 to April 2022 were retrospectively reviewed. Data obtained from the case notes included age, gender, indication for referral, pulse, blood pressure and ECG findings at first presentation. Data was analyzed using SPSS version 22.0.

Results:

A total of 356 patients aged 15–100 years were referred to the clinic within the period under review, made up of 223 males (62.6%) and 133 females (37.4%). The mean age of the patients was 55.21 ± 16.8 years.

The commonest indications for referrals were hypertension (65.4%), breathlessness (8.4%), and chest pain (6.5%).

The commonest structural abnormalities on ECG were left atrial abnormality (19.4%), left ventricular strain pattern (9.8%), and old infarcts (7.9%). The commonest rhythm abnormalities were atrial fibrillation (2.8%), atrial flutter (0.8%), complete heart block (0.6%).

First degree atrioventricular block was the commonest conduction abnormality (10.4%), followed by left anterior hemiblock (5.1%) and complete right bundle branch block (4.8%).

Conclusion:

A good number of patients referred to specialist cardiology clinics in Nigeria are hypertensive, and present with significant electrocardiographic abnormalities at the time of first assessment. This may be explained by the asymptomatic nature of hypertension which makes a lot a patients seek medical attention only when they have symptoms. These symptoms are often from the complications of hypertension, some of which may be produce significant abnormalities on ECGs.
PS-C14-1: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS OF PDE5 INHIBITOR SILDENAFIL IN THE TREATMENT OF HEART FAILURE WITH PRESERVED EJECTION FRACTION
Authors: Sun Runmin
Published: January 2023

Background:

The results of clinical trials of phosphodiesterase (PDE) 5 inhibitors for the treatment of HFpEF patients are inconsistent. Thus, we undertook a meta-analysis to evaluate the clinical value of sildenafil for HF with preserved EF (HFpEF) patients.

Methods:

Relevant studies were searched and identified in the PubMed, Cochrane Library and EMBASE databases. We searched randomized controlled trials (RCTs) that compared PDE5i with placebo in HFpEF and extracted relevant clinical data.

Results:

Six RCTs enrolling 471 HFpEF patients were included in the meta-analysis. Compared with placebo, sildenafil was not significantly associated in death (OR = 1.12, 95%CI: 0.06 to 19.40), adverse events (OR = 2.55, 95%CI:0.67 to 9.62) . Also, sildenafil therapy had no impact on the patient's six-minute walk test, PASP, E/e’, peak VO2, NT-proBNP but improved at PVR(SMD = -1.04, 95% CI = -1.96 to -0.13) significantly compared to placebo in HFpEF patients. Whereas, if only the RCT study with HFpEF combined with pulmonary hypertension is included, sildenafil therapy was associated with a marked improvement in E/e’ (SMD = -0.745, 95% CI = -1.24 to -0.25) in HFpEF patients combined with pulmonary hypertension.

Conclusions:

Compared with placebo, sildenafil therapy was associated with the improvement of diastolic function in HFpEF patients combined with pulmonary hypertension, while sildenafil treatment of HFpEF patients does not increase death or rehospitalization.
PS-C14-2: QUANTITATIVE METHODS FOR ASSESSING CONTRACTILE RESERVE IN PATIENTS WITH DIASTOLIC HEART FAILURE
Authors: Tselov Nikolay Valeriev , Tsonev Svetlin , Marinov Rumen , Slavchev Boris , Zlatancheva Galina , Hristova Krasimira
Published: January 2023

Aim:

The effectiveness of isometric handgrip exercise on changes of cardiovascular hemodynamical parameter in patients with diastolic heart failure is unknown. We assessed the effect of several hemodynamic parameters and it changes during handgrip maneuvers in patients with different stages of diastolic heart failure during chemotherapy and their improvements after 4 months follow up (4mFU) treatment with single pill combination of ACE inhibitor ACE) and beta blocker(BB).

Methods:

The study population included 65 patients female / mean age of 45 ± 12 years/ 55 with breast cancer and undergoing chemotherapy / 30 pts with HFpEF and 25 pts with HFmrEF / and 10 pts with HFnEF and without chemotherapy. The effect of handgrip maneuver on hemodynamic parameters were studied by speckle tracking echocardiography. Following maximal squeeze by 100%, during the next 3 minutes patients were instructed to apply pressure at 50%. The global longitudinal strain were extracted by 3, 4 and 2 chamber apical view images on 70 fr/s and MAP and HR were performed at basal level, 1st, 2nd and 3rd minutes during handgrip stress test. The contractility /force/ of LV were also calculate as ratio SBP / ESV. Patients with HFmrEF and HFpEF received for 4 months treatment with single pill combination ACE (perindorpril)/ BB (bisoprolol) 5/5 mg.

Results:

Heart rate(HR) and mean arterial pressure(MAP) increased significantly after handgrip maneuver / from 75 ± 6 beats /min to 101 ± 12 beats/ min, 109 ± 15 mmHg to 118 ± 19mmHg, p < 0,05 /. Pulmonary artery systolic(s) and diastolic (d) pressure(PAP),pulmonary capillary wedge pressure (PCWP), cardiac index(CI), LVEF did not change significantly(p > 0,5) after handgrip maneuvers. On the other hand, LV force (SBP/ ESV ratio),MAP and HR decreases significantly (p < 0,01) in group with HFmrEF. In same group were found significantly decreased GLVLS at 2nd and 3rd minutes during stress- test comparable with other 2 groups with HFpEF and HFnEF. After 4mFU and treatment with 5/5 mg doses combination of ACE / BB were found improvement in parameters: HR /p < 0,001/, MAP /p < 0.01/ and contractile reserve as well as LV force /p < 0, 01/ and GLVLS /p < 0,001/.

Conclusion:

Cardiovascular response to handgrip maneuver may be a marker of failure to respond to compensatory mechanisms. Patients with good LV reserve had a rise in stroke work with little or no change in LVEDP. Patients with poor contractile reserve had a fall in stroke work reserve together with a substantial rise in LVEDP. It is concluded that the stress imposed by sustained handgrip provides a simple test for evaluation of LV contractile reserve in patients, who will develop cardiotoxicity during chemotherapy treatment. The treatment with combination with small doses ACE/BB is a big challenge in patients with HFmrEF and HFpEF to improve the contractile reserve.
PS-C14-4: PROLONGED QT AND ITS RELATION TO LEFT HEART SYSTOLIC FUNCTION IN HYPERTENSIVE PATIENTS
Authors: Pham Duong Hai , Nguyen Hoai Thi , Nguyen Huy Anh
Published: January 2023

Background:

The aim of this study is to assess the prevalence of prolonged QTc in people with hypertension and its relation to left heart systolic function (evaluating by EF) in this group of patients.

Method:

The study was cross-sectional in design. Subjects were recruited from patients hospitalized in Cardiology Department, Hue University of Medicine and Pharmacy Hospital from May/2020 to Feb/2021, patients were diagnosed with hypertension according to ISH 2020 criteria and indicated to perform echocardiogram in order to evaluate their left heart systolic function (manifest as EF) and other related indices. Prolonged QTc was defined as QTc > 450 ms in females and > 460 ms in males. A p-value of < 0.05 was considered statistically significant.

Results:

Among 187 patients who agreed to participate in the research, 133 patients were qualified with all inclusion and exclusion criteria. 41 of them (30.8%) had prolonged QTc, while the remaining 92 (69.2%) had normal QTc interval. Patients with prolonged QTc had significantly higher prevalence of lower ejection fraction (EF), higher LVMI, besides, they also had higher prevalence of being diagnosed with heart failure, peripheral edema, dyspnea, higher mean heart rate (HR), longer PR interval compared to patients with normal QTc.

Conclusion:

This study demonstrated high prevalence of prolonged QTc in patients with hypertension. In the mentioned group, prolonged QTc has relation to left heart systolic function. In addition, affected patients also had significantly higher prevalence of factors associated with bad prognosis.

Keywords:

QTc, QT interval, hypertension, LVMI, EF, systolic dysfunction, Hue University of Medicine and Pharmacy Hospital.
PS-C14-9: DIFFERENTIAL DIAGNOSIS OF HYPERTROPHIC CARDIOMYOPATHY AND HYPERTENSIVE HEART DISEASE
Authors: Nurbay Zhanar , Tuleutaev Rustem , Zhakaev Maksat , Bagramov Akan , Ibragimov Timur , Daniyarova Laura , Konisbekova Akzhan , Abzaliev Kuat , Muzaev Vladimir , Sultanov Galymzhan , Ishakbaeva Guzel , Nagimatullaeva Aigerim
Published: January 2023

Objective:

To conduct a differential diagnosis of hypertrophic cardiomyopathy and hypertensive heart.

Material and Methods:

The study included 40 patients with hypertrophic cardiomyopathy without left ventricle outflow tract obstruction, mean age 57.3 ± 9.5 years, 26 women and 30 patients with hypertensive heart, mean age 49.0 ± 8.7 years, 21 men.

Results:

The diagnosis of hypertrophic cardiomyopathy was established on the basis of clinical and anamnestic data, electrocardiography and echocardiography, genetics, upon detection of left ventricle myocardial hypertrophy with a maximum wall thickness of > 15 mm without dilatation of its cavity in the absence of other heart diseases. Hypertensive heart was diagnosed in patients with left ventricle myocardial hypertrophy > 12 mm due to hypertension. Hypertonic disease was detected according to the data of 24 hour blood pressure monitoring when systolic blood pressure > 135 mm Hg was recorded during wakefulness, diastolic > 85 mm Hg. The patients of both groups were comparable in terms of gender and age. Left ventricle myocardial mass index, interventricular septum thickness in diastole in patients with hypertrophic cardiomyopathy significantly exceeded those in patients with hypertensive heart. The thickness of the posterior wall of the left ventricle was almost the same in both groups. The maximum pressure gradient in hypertrophic cardiomyopathy at a load of 9 to 22 mm Hg. According to blood pressure monitoring data, arterial hypertension was detected in 65% of patients with hypertrophic cardiomyopathy. The degree of arterial hypertension was higher in patients with hypertensive heart. Exercise tolerance in patients with hypertension was higher than 111.0 ± 22.2. The maximum systolic blood pressure at the peak of physical activity in hypertrophic cardiomyopathy was significantly lower than in hypertensive heart 159.6 ± 21.1 and 196 ± 7.9 mmHg. Dyspnea as a reason for discontinuation of the test was more often observed in hypertrophic cardiomyopathy, 39% and 5%. In 26% of patients with hypertrophic cardiomyopathy, frequent ventricular extrasystole occurred at the height of the load, and no rhythm disturbances were recorded in patients with hypertensive heart.

Conclusion:

According to echocardiography data, there was no significant difference; systolic blood pressure at the height of the load in patients with hypertensive heart was significantly higher. Despite the above differences between patients with hypertrophic cardiomyopathy and hypertensive heart, it is not possible to single out an absolute sign that allows for a differential diagnosis. Important is the history of the disease, complaints and genetic analysis to identify mutations in hypertrophic cardiomyopathy.
PS-C14-11: COFFEA ARABICA SEEDS EXTRACT HAS ANTIHYPERTENSIVE AND CARDIOPROTECTIVE EFFECTS IN L-NAME-INDUCED HYPERTENSIVE RATS
Authors: Singh Amit Kumar , Pandey Abhay Kumar
Published: January 2023

Objective:

A large percentage of the adult population worldwide is affected by hypertension, which is the most common cardiovascular disease. Essential hypertension is primarily caused by an absence of nitric oxide (NO), which leads to endothelial dysfunction. This study examined whether Coffea Arabica seeds extract (CA) was effective against L-NAME-induced hypertension and oxidative stress in wistar rats.

Method:

Approximately 40 mg/kg of L-NAME, a non-specific nitric oxide inhibitor, was administered to male Wistar rats to induce hypertension in them, while CoQ10 served as a standard anti-hypertensive agent. L-NAME was administered orally to all of the other groups along with the CA extract for three weeks. A direct cannulation procedure was used to measure hemodynamic parameters after the treatment. The lipid profile, kidney and cardiac functions along with markers of oxidative stress were examined, as well.

Result:

It has been found that L-NAME increases blood pressure, depletes NO, causes oxidative imbalance, and damages cardiac and kidney function in animals. As compared to control and L-NAME groups, the CO-treatment group had significantly lower levels of cardiac markers than the L-NAME only group. The CA treatment of hypertensive rats significantly reduced the levels of angiotensin converting enzyme (ACE) and mineralocorticoid receptor expression. It was found that when L-NAME and CA extract were administered concurrently, all injuries were prevented without affecting the heart rate or raising the blood pressure.

Conclusion:

This study confirms the antihypertensive action of Coffea Arabica seeds extract and indicates its protective properties in a L-NAME induced hypertension model in rats, most likely due to the presence of antioxidant potential and by inhibiting inflammation in the tissues.