bluuebunny/crossref_metadata_2025 huggingface dataset:
PS-C01-11: ARTERIAL STIFFNESS AND SOCIOECONOMIC STATUS
Authors: Deng Peizhi
Published: January 2023

Objective:

No study has been examined to synthesize the association between scores composed of multiple indicators and arterial stiffness (AS). We aim to explore whether the socioeconomic scores can influence the AS in a large ongoing cohort.

Design and method:

We analyzed data from the UK Biobank, which prospectively followed up 502,413 participants ranging from 40 to 69 years of age from 2006 to 2010. Education score, income score, and Town send deprivation index were defined as three socioeconomic variables. Arterial stiffness index (ASI) was measured noninvasively from the pulse waveform. Linear regression models were developed to examine associations of socioeconomic background with AS. Restricted cubic spline RCS models were developed to examine dose response relationships. In addition, we also examined effect modifications by sex, age and body mass index.

Results:

This cross sectional study used a target sample of 149,781 UK Biobank participants aged more than 40 years. After full adjustments, in reference to the lowest education score, income score, and Town send deprivation index quartile, those in the highest were associated with higher ASI (beta = 0.306 m/s, 95% CI: 0.253 to 0.359; beta = 0.163 m/s, 95% CI: 0.106 to 0.220; beta = 0.070 m/s, 95% CI: 0.017 to 0.123, respectively). The positive association between 3 socioeconomic scores and ASI was more pronounced among lean and younger adults, and women were more associated with AS in the highest income score quartile.

Conclusion:

Socioeconomic score was associated with an increased prevalence of arterial stiffness, which are influenced by age, sex, and body mass index. Our findings indicate that special attention can be paid to the composite indicators from the evaluation of socioeconomic status in order to prevent the underlying arterial stiffness.
PS-C01-15: EFFECTIVENESS OF MOBILE APP-ASSISTED INTERVENTIONS FOR IMPROVING SALT RELATED BEHAVIOR IN HYPERTENSIVE PATIENTS
Authors: Kim Yong-Jae , Kim Hyun-Sook , Lim Yu-Jin , Park Jong-Ho , Jo Sang-Ho , Kim Eung-Gyu , Kim Eun-Mi , Lee Seung Hee , Kim Won-Ho
Published: January 2023

Objective:

Current evidence supports that an increased intake of dietary salt was related to an increased prevalence of cardiovascular diseases. Interventions to reduce salt intake are essential to reduce hypertension and its disease burden. The use of mobile health care is becoming increasingly popular in the self-care of chronic diseases such as hypertension.

Design and method:

This study is an open-label intervention study that aims to assess the effect of a mobile application specifically designed to aid in lowering the dietary salt. Participants will be asked to answer a questionnaire regarding their behaviors about salt-related dietary management and knowledge about the control of hypertension. Primary outcomes focus on feasibility measures of implementation and acceptability of the interventions. Secondary outcomes will include changes in blood pressure, dietary salt intake and hypertension-related behaviors. Sodium intake was estimated with the spot urine sodium content using the Kawasaki equation. User instructions for the mobile applications provides sodium content and calories for the dietary intake records made by the participants.

Results:

Preliminary data from 50 subjects are as follows. Hypertension management behaviors of the subjects changed significantly in all categories. The total score of Confidence changed from 11.67 ± 2.94 points to 12.73 ± 2.25 (p < 0.001), Knowledge from 13.23 ± 2.08 to 14.02 ± 2.32 (p < 0.05), Action from 35.08 ± 7.03 to 39.12 ± 5.85 (p < 001), and Diet from 6.07 ± 2.13 to 7.87 ± 2.26 (p < 001). Significant changes were observed in the BP. The systolic BP decreased from 134.09 ± 11.34 mmHg to 127.27 ± 10.87 mmHg (p < 0.001), and diastolic BP decreased from 80.81 ± 8.19 mmHg to 77.97 ± 8.96(p < 0.05).

Conclusion:

This trial is currently enrolling patients. To date, 226 patients have been enrolled, surpassing the pre-calculated sample size of 220. Results will be available in the winter of 2022. This trial tests the efficacy of dietary intervention through a novel mobile app. If effective, this mobile app based intervention could reduce the health burden of hypertension.
PS-C02-5: HYPERTENSION IS NOT A PREDICTOR OF ATRIAL FIBROSIS IN PATIENTS WITH ATRIAL FIBRILLATION - EVIDENCE FROM ATRIAL BIOPSY
Authors: Takahashi Yuya , Yamaguchi Takanori , Otsubo Toyokazu , Nakashima Kana , Shinzato Kodai , Osako Ryosuke , Shichida Shigeki , Node Koichi
Published: January 2023

Objective:

Hypertension is considered to promote atrial fibrosis and contribute to the development of atrial fibrillation. The purpose of this study is to investigate the effect of arterial hypertension on atrial fibrosis in patients with atrial fibrillation (AF).

Design and method:

We examined 234 patients (67 ± 12 years old, 72 female genders, 145 non-paroxysmal AF type) who underwent right atrial septum biopsy under the guidance of intracardiac echocardiography and fluoroscopy (Figure A) during catheter ablation for AF. The extent of histological fibrosis (%Fibrosis) was quantified using digital imaging platform based on the Masson trichrome staining (Figure B). Clinical factors possibly associated with %Fibrosis were evaluated using simple and multiple linear regression analysis.

Results:

A total of 132 patients had hypertension. The mean %fibrosis was 7 ± 4% (range 1–20%). There was no significant difference of %Fibrosis in patients with and without hypertension (Figure C). Univariate analyses identified age, female gender, smaller body surface area (BSA), decreased eGFR, non-paroxysmal AF type, larger left atrial volume/BSA, and higher E/e were associated with increase in %Fibrosis. Multivariate analysis showed that only non-paroxysmal AF type and left atrial volume/BSA were identified as significant clinical factors associated with %Fibrosis (Figure D).

Conclusions:

Our data suggest that hypertension is not an independent predictor of atrial histological fibrosis in patients with AF. The mechanism of atrial fibrosis would not be directly related to arterial hypertension contrary to previous hypotheses.
PS-C02-7: ANALYSIS OF ELECTROLYTE CHARACTERISTICS IN PATIENTS WITH PRIMARY ALDOSTERONISM COMPLICATED WITH ARRHYTHMIA
Authors: Long Zhang you , Liang Wei , Wang Ming ming , Chen Rong xin , Si Ni dan , Yu Jing
Published: January 2023

Background:

primary aldosteronism is important for electrolyte balance in addition to its direct cardiovascular effects. High aldosterone can aggravate electrolyte disorder, resulting in low potassium, low calcium, high sodium, low phosphorus and so on. Electrolyte balance is the basis of maintaining normal electrophysiological activity of cells. Electrolyte disturbance can affect cardiac electrical activity, and then may induce a series of arrhythmias, increase cardiovascular burden, hospitalization rate and mortality rate.

Objective:

To study the electrolyte characteristics of arrhythmia in patients with primary aldosteronism.

Methods:

A retrospective study was performed on 287 patients diagnosed with primary aldosteronism who were admitted to the Department of Cardiology, Second Clinical Hospital of Lanzhou University from January 2018 to May 2021, and they were divided into arrhythmia group (n = 137 cases) and non-arrhythmia group (n = 150 cases) according to whether they had arrhythmia. The electrolyte characteristics of the two groups were compared.

Results:

There were no significant differences in age, gender, basal blood pressure, activity of sitorenin, blood sodium, blood calcium, blood magnesium and blood phosphorus between the two groups (P > 0.05). Compared with the group without arrhythmia, serum potassium in the group with arrhythmia was lower(P < 0.05)., the sitting plasma aldosterone and body mass index (BMI) were higher (P < 0.05), and the detection rate of hypokalemia was higher in patients with arrhythmia (P < 0.0)5). Speatman correlation analysis showed that there was a positive correlation between sitting aldosterone and BMI (R = 0.311, P < 0.05), and a negative correlation between sitting aldosterone and potassium (R = -0.253, P < 0.05).

Conclusion:

Hypokalemia is the characteristic of electrolytes in patients with arrhythmia. In the electrolysis disorder caused by increased aldosterone, hypokalemia is more likely to induce arrhythmia. In addition, patients with primary aldosteronism with higher BMI are more likely to develop arrhythmias, and there may be a certain correlation between BMI and blood potassium, which needs further demonstration.
PS-C02-10: IMPACT OF SARCOPENIA AND ATRIAL FIBRILLATION ON THE INCIDENCE OF HEART FAILURE IN ELDERLY PATIENTS
Authors: Tani Akihiro , Soeki Takeshi , Ozaki Yuji , Aihara Ken-ichi , Sata Masataka
Published: January 2023

Objective:

Sarcopenia is an age-dependent skeletal muscle disorder that is associated with multiple adverse outcomes including cardiovascular events. Sarcopenia can influence the outcomes of patients with heart failure, myocardial infarctions, and atrial fibrillation (AF). This study aimed to clarify the clinical significance of sarcopenia in the incidence of heart failure in elderly individuals.

Design and method:

A total of 118 elderly participants with cardiovascular risk factors (mean age 76.7 years old) were included in the study. The body composition including the skeletal muscle mass index (SMI), body fat percentage, ratio of extracellular water to the total body water (ECW/TBW), and phase angle were measured using a multifrequency bioelectrical impedance analysis (BIA). Sarcopenia was defined according to the criteria of the Asian Working Group, which involves a low grip strength or slow gait speed and low SMI. Heart failure (HF) was defined according to the Framingham criteria. Statistical associations between those BIA-related parameters and the incidence of HF were evaluated by multiple logistic regression analysis. The threshold for a statistical significance was set at p < 0.05.

Result:

Sarcopenia was observed in 33 subjects (28.0%) and AF was observed in 29 (25.4%) of 118 participants. The ECW/TBW, which reflected cellular edema, was higher in patients with HF than in those without whereas the body fat percentage and phase angle did not differ between the patients with and without HF. Although AF was associated with the incidence of HF and sarcopenia was not associated with it, concomitant sarcopenia and AF, was associated with the incidence of HF than sarcopenia or AF alone. A multiple logistic regression analysis showed that AF accompanied with sarcopenia and ECW/TBW were significantly and positively associated with the incidence of HF independently of the age, gender, and other cardiovascular risk factors.

Conclusion:

In the present study, AF complicated with sarcopenia and cellular edema increased the incidence of HF in elderly individuals with cardiovascular risk factors. The obtained results suggested that the management of sarcopenia and cellular edema is a critical problem for the prevention of HF in elderly patients with AF.
PS-C02-11: ASSOCIATION BETWEEN BROAD P WAVE AND ECHOCARDIOGRAPHIC FINDINGS ON 12-LEAD ECG IN HYPERTENSIVE PATIENTS
Authors: Kabutoya Tomoyuki , Hoshide Satoshi , Kario Kazuomi
Published: January 2023

Background:

Broad P waves have been shown to be associated with the development of atrial fibrillation and cardiovascular events. The relationship between broad P waves, left atrial and left ventricular findings assessed by echocardiography is unclear in hypertensive patients.

Methods:

We enrolled 3952 hypertensive patients in the Coupling study. P waves were measured by 12-lead electrocardiogram and defined broad P as P waves with a maximum P wave width ≧ 140 ms. Left atrial diameter (N = 436) and left ventricular mass index (LVMI, N = 736) were measured by echocardiography. LVH was defined as any LV mass 115 g/m2 in men and 95 g/m2 in women.

Results:

The Broad P group (N = 296) had more men and more history of heart failure than the control group (N = 3656) (men: 71 vs. 49%, p < 0.001; heart failure: 11 vs. 3%, p < 0.001). Office blood pressure levels did not differ significantly in both groups (systolic blood pressure: 136.3 ± 16.6 vs. 134.9 ± 16.2 mmHg, p = 0.15, diastolic blood pressure76.7 ± 10.7 vs. 77.0 ± 10.6 mmHg, p = 0.65). Left atrial diameter (LAD) and LVMI were greater in the broad P group than those in control group (LAD: 39.1 ± 6.3 vs. 35.3 ± 5.4 mm, p < 0.001, LVMI 116 ± 34 vs. 97 ± 22 g/m2, p < 0.001). After adjusting for age and sex, broad P was an independent determinant of LVH (odds ratio 3.40, 95% CI 1.91–6.04, p < 0.001).

Conclusions:

Broad P waves in hypertensive patients were independently associated with left ventricular hypertrophy and left atrial diameter.
PS-C04-4: ASSOCIATIONS OF OFFICE BRACHIAL BLOOD PRESSURE, OFFICE CENTRAL BLOOD PRESSURE, AND HOME BRACHIAL BLOOD PRESSURE WITH ARTERIAL STIFFNESS
Authors: Mizuno Hiroyuki , Hishide Satoshi , Nozue Ryoko , Shimbo Daichi , Kario Kazuomi
Published: January 2023

Accurate blood pressure (BP) measurement is necessary for the evaluation and treatment of hypertension to prevent the progression of subclinical vascular disease, including arterial stiffness. We investigated the associations between brachial ankle pulse wave velocity (baPWV), a measure of arterial stiffness, and each of office brachial systolic BP (SBP) with and without an observer present (attended or unattended office brachial SBP), attended or unattended office central SBP, and home brachial SBPs (specifically, the means of morning, evening, or morning and evening home brachial SBP) in patients being treated for hypertension. Measurements were performed among 70 adults (mean age, 67.0 ± 9.4 years; women, 51.4%) with a mean attended office brachial SBP of 127.6 ± 14.5 mmHg and mean baPWV of 16.3 ± 2.8 m/s. Univariate analysis showed that higher attended office brachial SBP, morning home brachial SBP, and morning and evening home brachial SBP were each statistically significantly associated with higher baPWV (r = 0.25, P = 0.04; r = 0.37, P = 0.002; and r = 0.32, P = 0.006, respectively). Multiple linear regression analysis with adjustments for traditional cardiovascular risk factors showed that only morning home brachial SBP was statistically significantly associated with baPWV [beta = 0.06, 95% confidence interval (0.01 to 0.11), P = 0.02). In conclusion, higher morning home brachial SBP, but none of the office measured SBP values, was associated with arterial stiffness.
PS-C04-7: REPRODUCIBILITY OF CAROTID TONOMETER AND FEMORAL CUFF-BASED PULSE WAVE VELOCITY: INTERACTION WITH OPERATOR SKILL
Authors: Cox James R , Tan Isabella , Avolio Alberto P , Butlin Mark
Published: January 2023

Objective:

Large artery stiffness is strongly correlated with cardiovascular outcomes. The stiffness of the artery can be measured non-invasively using carotid-femoral pulse wave velocity (cfPWV). Originally cfPWV assessment was performed by ECG-gated applanation tonometry at the carotid and femoral site. High quality applanation tonometry is a learned skill. To increase ease of use, many commercial devices now use a pneumatic cuff for femoral pulse acquisition but still retain tonometry-based carotid pulse acquisition. Lack of clinical uptake of cfPWV may be due to perceived poor repeatability, especially where a learned skill is required. This study aimed to quantify how many measurements a skilled and unskilled operator are required to take to obtain an acceptable cfPWV measurement.

Design and method:

Supine cfPWV measurements (SphygmoCor XCEL, AtCor, Sydney) was measured in healthy participants (n = 15, age 30 ± 15 years, 12 female) by both an inexperienced and experienced operator 10 times in each participant. True cfPWV was taken as the average of twenty cfPWV measurements (regression to the mean). The time required to perform the cfPWV assessment by an experienced operator was additionally recorded in a separate set of participants referred to the clinic. Data analysis was performed using regression analysis and Bland-Altman plots.

Results:

The first cfPWV measurement made by both operators (experienced and inexperienced) resided within ± 0.36 m/s (cut off for a 10% increased risk of cardiovascular events) of the true cfPWV in 87% (n = 13) of individuals. The average of the first two cfPWV measurements fell within ± 0.36 m/s of true cfPWV for all participants for the experienced operator and 93% of participants for the inexperienced operator (Figure). Distance measurements were not significantly different between operators (p = 0.14). The total time required to perform a full cfPWV assessment (one distance measurement and two cfPWV measurements), on average, was 238 ± 79 seconds (3 minutes and 58 seconds).

Conclusion:

Irrespective of operator experience an accurate measurement of cfPWV can be obtained by averaging two measurements. These results suggest that cfPWV measurement error should not necessarily be a contributing factor to the limited clinical uptake of cfPWV. The measurement does take considerable time, and this may be a barrier of uptake, along with perceived clinical applicability of arterial stiffness measurement.
PS-C05-1: INCIDENCE OF VERY REDUCED LEFT VENTRICULAR EJECTION FRACTION DURING LONG-TERM FOLLOW-UP AFTER ACUTE MYOCARDIAL INFARCTION: IMPACT FOR MID-TERM OUTCOMES
Authors: Yoshioka Goro , Tanaka Atsuhi , Taguri Akina , Natsuaki Masahiro , Shibata Yoshisato , Node Koichi
Published: January 2023

Background:

For survivors of myocardial infarction (MI), very reduced left ventricular ejection fraction (LVEF) in acute-phase (within hospitalization) occurred about 5% of patients and that was well known as risk factor of cardiac death. Therefore, very reduced LVEF was one of the criteria for Implantable cardioverter defibrillator. However, the very reduced LVEF in chronic-phase were received limited study.

Method:

We evaluated 2241 consecutive patients with acute MI who received follow-up echocardiography at chronic-phase (after 6-month). Primary outcome was incidence of very reduced LVEF at chronic-phase. Very reduced LVEF was defined LVEF (modified simpson) < 35%. Secondary outcome was cardiac death.

Result:

During follow up (median 1471 days), very reduced LVEF occurred 9.7% patient. As shown in Kaplan-meier curve, very reduced LVEF occurred 9.3% of patients per 10-year. According to figure, these patients revealed high rate of cardiac death. Even if LVEF at acute-phase exceeded 35%, cardiac death rate of these patients was 9.7%.

Conclusions:

Very reduced LVEF at chronic-phase occurred 9.3% per 10-year in MI survivors. Regardless of LVEF at acute-phase, very reduced LVEF at chronic-phase associated with cardiac death.
PS-C05-8: ERYTHROCYTE SEDIMENTATION RATE LEVELS AND ITS ASSOCIATION WITH CORONARY ARTERY INVOLVEMENT IN KAWASAKI DISEASE
Authors: Sadicon Merian Doyenne Revillosa
Published: January 2023

Objectives:

The general objective of this study is to determine association of ESR with cardiovascular involvement in Kawasaki Disease (KD) patients.

Specific Objectives:

Design and method:

This is a cross sectional study conducted at National Childrens Hospital (NCH), a tertiary pediatric hospital. Data was gathered using charts from the medical records of patients diagnosed with KD. Study population included patients diagnosed with KD with classical presentation from year 2013–2018.

The diagnostic criteria for KD require presence of fever for five days or more and at least four of five of the following: bilateral conjunctival infection without exudates, polymorphous exanthema, strawberry tongue, desquamation of palms and soles, and cervical lymphadenopathy. ESR levels were recorded both as a numerical variable and categorical variable based on the level (below 80 mm/hr, more than 80 mm/hr). Patients with coronary artery involvement included perivascular brightness, coronary artery dilatation, or coronary aneurysm on two-dimensional echocardiography done during admission for KD.

Descriptive statistics was done using frequency and percentages for categorical variables, and standard deviations for continuous variables was calculated to describe the profile of the respondents. Determination of the association between ESR and CAD among KD patients was analyzed using Chi square test and stratified analysis. Odds ratio and the 95% confidence interval was also calculated. Significance was set at p value of < 0.05.

Results:

Of the 116 patients, 72.4% of the population were noted to have cardiac involvement and 50% had coronary artery involvement. The most common coronary artery involvement was on the proximal right coronary artery. Moreover, pericardial effusion and valvular regurgitation mostly involving the mitral valve were the most common cardiac involvement. In the population, 61 (52.6%) were male, and 26 (42.6%) of which developed CAD however no correlation between sex and CAD was revealed.

Conclusion:

This study showed no correlation between the level of ESR and the development of CAD. It is not recommended to obtain ESR in patients who qualify as complete KD. Hence the study does not support the practice of obtaining ESR upon admission of KD patients. Further studies on the association of ESR with CAD with higher sample size and adjusting for other confounding variables are needed.
PS-C05-9: COMBINED EFFECT OF INTER-ARM SYSTOLIC BLOOD PRESSURE DIFFERENCE AND CAROTID ARTERY PLAQUE ON CARDIOVASCULAR EVENTS
Authors: Yun Cuijuan , Xin Qian
Published: January 2023

Objectives:

Previous studies have confirmed the relations between inter-arm systolic blood pressure difference (IASBPD) and carotid artery plaque with the risk of cardiovascular diseases (CVD) respectively. But it is unclear whether the combined effect of IASBPD and carotid artery plaque further increases the risk of CVD and all-cause mortality.

Methods:

We enrolled 4970 participants (≧ 40 years old) in the prospective Kailuan Study. All participants underwent dual-arm blood pressure and carotid artery ultrasounds. IASBPD was the absolute value of the difference between dual-arm blood pressure. All the participants were divided into four groups according to their IASBPD levels and the presence or absence of carotid artery plaque, Cox proportional hazards models were used to calculate the hazard ratios (HRs) and 95% confidence interval (CI) for incident CVD and all-cause mortality.

Results:

During a median follow-up of 7 years, 179 CVD events and 266 deaths occurred. Multivariable Cox Regression showed that participants with IASBPD ≧ 10mmHg and plaque had a significantly higher incidence of CVD, cerebral infarction (CI) and myocardial infarction (10%, 7.27%, 1.36%, respectively). After adjusting for covariates, the IASBPD ≧ 10mmHg and carotid plaque group significantly increased risks for CVD (HR 2.38; 95% CI, 1.40∼4.05), CI (HR, 2.47; 95% CI, 1.31∼4.67), and all-cause mortality (HR, 2.08; 95% CI, 1.20∼3.59).

Conclusions:

Our study indicated that the combination of IASBPD and carotid artery plaque was associated with incident CVD and all-cause mortality.
PS-C07-9: BLOOD PRESSURE MONITORING IN THE COMMUNITY: A SURVEY WHETHER RURAL GPS ARE USING VALIDATED BLOOD PRESSURE MONITORS IN THEIR PRACTICES
Authors: Voll Jessika , Grace Gary , Gupta Ankur
Published: January 2023

Objective:

Poorly controlled hypertension is a leading cause of morbidity and mortality around the world. Chronically elevated blood pressure contributes to vascular disease, cardiac events, strokes and renal disease. Blood pressure (BP) measurement is therefore a critical part of a patients clinical assessment. BP needs to be measured accurately with validated equipment in order to avoid mismanagement of hypertensive patients.

STRIDE BP is a non-profit research and educational organization providing international scientific guidance for BP measurement, methodology and technology.

This study surveyed rural New Zealand General Practices (GP) investigating the equipment they used to meet these standards.

Design:

Local GP practices were invited to participate in our survey via e-mail. The survey established what blood pressure monitoring equipment was being used and whether they provided any monitors for home use. 10 out of 15 GP regional practices responded to the survey and their BP monitoring equipment data was collected and collated in a Microsoft Excel data sheet.

Method:

BP monitors provided by GP practices were compared against the STRIDE BP validated blood pressure monitoring equipment available at https://stridebp.org/bp-monitors.

Results:

Office Blood Pressure monitors

All of the practices who responded reported that they have BP monitors for use in their offices. However only 3 practices were using blood pressure monitors validated by STRIDE.Home blood pressure monitors

Only five of the ten practices who responded report providing blood pressure monitors for their patients to use at home. Of these five practices only one practice used validated BP machine. This practice provides four validated home BP devices for patients to loan for home use. The four other practices that provide devices for home use are providing equipment that has not been validated as per STRIDE BP criteria.Ambulatory blood pressure monitors

Seven out of the ten practices do not provide these for their patients, and the three practices who do all provide equipment that does comply with STRIDE BP validation criteria.

Conclusions:

Our pilot survey on BP monitors for GP practices in rural New Zealand demonstrated minimal use of STRIDE BP validated equipment for BP measurements in hypertension management. This puts a lot of our GPs at risk of making decisions based on inaccurate information. Our primary conclusion from this pilot study is that there is a clear need for an education programme in our region to provide information to GPs on up to date BP monitoring technology.
PS-C08-5: VALIDATE-CKD - PRELIMINARY FINDINGS ON CENTRAL BLOOD PRESSURE DEVICES ACCURACY IN PATIENTS WITH STAGES G4-G5 CHRONIC KIDNEY DISEASE
Authors: Cote Nadege , Abbaoui Yasmine , Spanneut Theo , Agharazii Mohsen , Goupil Remi
Published: January 2023

Objective:

Measurement of brachial cuff blood pressure (BP) was designed as a convenient surrogate to the aortic BP, which is the BP that dictates perfusion to target organs. In the general population, brachial cuff systolic BP (SBP) has a somewhat acceptable accuracy towards aortic BP but less is know in populations with marked high arterial stiffness, such as in G4-G5 CKD. Central BP devices were designed to directly estimate the aortic BP through pulse wave analysis to a greater accuracy than brachial cuff BP. The aim of the ongoing VALIDATE-CKD study is to compare the accuracy of brachial and central BP readings towards the intraarterial aortic SBP, in patients with and without Stage G4-G5 CKD.

Design and method:

In patients with and without Stage G4-G5 CKD (eGFR < 30 ml/min/1.73m2) undergoing non-urgent coronary angiograms, invasive aortic and non-invasive (WatchBP and Mobil-o-graph devices) BPs were measured simultaneously following the ARTERY Society protocol. Accuracy was defined by the mean difference (± SD) between the aortic SBP and the corresponding non-invasive SBP.

Results:

To date, 8 individuals with Stage G4-G5 CKD and 26 control subjects are enrolled. The following table presents clinical characteristics and non-invasive BPs accuracies in patients with and without Stage G4-G5 CKD.

Conclusion:

These preliminary results indicate that brachial SBP significantly underestimates aortic SBP in patients with Stage G4-5 CKD as compared to control subject. Furthermore, central BP devices provide a highly accurate estimation of aortic SBP in this population. The ongoing VALIDATE-CKD study may support that the use of central BP devices could be beneficial for the management of patients with advanced CKD.
PS-C09-6: FEATURES OF DAILY BLOOD PRESSURE PROFILE IN PATIENTS WITH ARTERIAL HYPERTENSION WITH CHRONIC KIDNEY DISEASE
Authors: Duysenbaeva Aziza Ikhtiyarovna , Mirakbarova Kamola Abdusattarovna , Srojidinova Nigora Zaynutdinovna
Published: January 2023

Purpose of the study:

To study the daily profile of blood pressure in patients with arterial hypertension (AH) with chronic kidney disease (CKD).

Materials and methods of the study:

The study included 120 patients with AH I-III degree, who received inpatient treatment. CKD stages were determined according to the modern KDIGO 2013 classification. Daily blood pressure profile (DAP) was assessed using the Medicomcombi device (Russia).

Results of the study:

Among the examined patients, preserved renal function of CKDC1 (eGFR> 90 ml/min/1.73 m2) was observed in 20.8% (n = 25); CKDC2 (eGFR 60–89 ml/min/1.73m2) in 50.8% (n = 61); CKDC3A (eGFR 45–59 ml/min/1.73m2) in 19.2% (n = 23); CKDC3B (eGFR 30–44 ml/min/1.73m2) in 9.2% (n = 11) p < 0.001. CKDC4 and terminal stages were not detected. When analyzing ambulatory blood pressure monitoring (ABPM), it was revealed that according to increasing of degree of CKD, values of the average daily SBP (122.52 ± 9.25 vs 122.13 ± 12.30 vs 121.74 ± 9.43 vs 134.36 ± 15.32 mm Hg, p < 0.013) average daytime SBP (123.56 ± 8.99 vs. 124.00 ± 611.89 vs 123.74 ± 9.73 vs 134.27 ± 15.12 mmHg, p < 0.04), mean night SBP (119.80 ± 13.39 vs 116.75 ± 14.59 vs 116.09 ± 12, 04 vs 135.09 ± 16.66 mm Hg, p < 0.001) significantly rises. The load index of elevated daytime and nighttime SBP was high in AH patients with lower eGFR values. Index of SBP daytime: 13.00 ± 14.05 vs 15.43 ± 21.22 vs 10.70 ± 15.04 vs 35.10 ± 34.14% respectively, p < 0.01. Index of SAP nighttime were 33.75 ± 29.35 vs 26.04 ± 31.07 vs 26.58 ± 27.87% vs 66.10 ± 36.05% respectively,p < 0.001. A normal daily profile of SBP/DBP had 28%/32% of patients of the 1st group vs 24.61%/37.70% of patients of the 2nd group vs 37.78%/21.73% of patients of the 3rd group vs 0% /0% of patients of the 4th group, SBP p < 0.01; DBP p < 0.001. The number of non-dippers in SBP was somewhat higher in the group of patients with CKDC3b: night reduction speed (NRS) SBP 40% in group 1 vs 49.1% in group 2 vs 52.17% in group 3 vs 54.54% in group 4 group, p < 0.02. In the group of patients with CKDC3b, individuals with a daily profile of SBP/DBP “night-pickers” significantly prevailed: 32%/20% vs 14.75%/13.11% vs 13.04%/13.04% vs 45.45%/ 54.54% (in groups 1, 2, 3 and 4, respectively) in SBP p < 0.001, in DBP p < 0.001. There was a significant increase in patients with a daily profile of “over-dipper” according to DBP in patients with CKDC3b:0% vs 4.91% vs 13.04% vs 27.27% p < 0.001.

Conclusion:

AH patients with CKD have more pronounced disturbances in the daily blood pressure profile, which contribute to an increased risk of developing complications of arterial hypertension.
PS-C09-11: THE EFFICACY OF SACUBITRIL/VALSARTAN FOR NONDIPPER AND EXTREME DIPPER HYPERTENSION USING 24 AMBULATORY BP MEASUREMENT
Authors: Kihara Hajime
Published: January 2023

Sacubitril/Valsartan increases natriuresis and diuresis and makes superior blood pressure control compared with usual RAS inhibitors. In Japanese clinical cicumstances,ideal blood pressure control to attain BP < 130/80mmHg is difficult for next reasons. 1, Japanese predisposition towards high sodium intake. 2, Salt sensitivity due to Gene Polymorphism. 3, Increasing morbidity of obesity and Metabolic syndrome. 4, Clinical inertia to attain ideal blood pressure control especially in high risk hypertension patients ex. CKD and DM.

These high risk patients often suggest nocturnal hypertension by 24 hour ambulatory blood pressure monitoring,24Hr ABPM. Nocturnal hypertension consists of non-dipper pattern, riser pattern, and often associated with cardiovascular event. On the contrary, extreme dipper pattern is sometimes found by24 Hr ABPM and it suggests high systolic BP during daytime in spite of night systolic BP decline. iIt sometimes results in stroke. Therefore antihypertensive therapies to these high risk patients by monitoring only clinic BP are surely insufficient to prevent CVD. Furthermore checking Home BP immediately after wake up is off course necessary, but still inadequate. Without monitoring by 24hr ABPM during nighttime,it is impossible to distinguish between non-dipper pattern, riser pattern and morning surge pattern. Quoting from literature, superiority of Ambulatory over Clinic Blood pressure measurement is proved in predicting mortality,The Dublin Outcome Study. It is essential to check 24hr ABPM to high risk patients. These high risk CKD or DM patients are accompanied by the diminished renal capacity to excrete sodium during daytime and compensate sodium excretion by elevating night blood pressure. This mechanism could be a component of the non dipper or riser pattern. Sacubitril/Valsartan `s effect of natriuresis and diuresis effect could be effective to excrete sodium excretion at daytime and Np makes vasodilatory effect and prohibits of aldosterone production.,and valsartan is anAT1 receptor blockade and prohibits of angiotensin2 effect. Sacubitril/Valsartan is very effective for characteristic “salt sensitive hypertension” Japanese patients.

In our clinic, we prescribed 250 patients,120 patients are RAS inhibitor naive, and the rest of130 patients are switched from RAS inhibitor. We present 2 clinical cases prescribing Sacubitril/Valsartan 400 mg every morning and monitored 24hrABPM before and after prescription.

1st case is 48yrs old male, HT, DM and CKD showing non dipper-pattern. 2nd case is 86 yrs female, HT and old cerebral lacuna and left common iliac aneurysma showing extreme dipper pattern. 2 weeks after administration of Sacubitril/Valsartan, 24hr ABPM were checked and non dipper pattern disappeared in Ist patients and extreme dipper pattern disappeared in 2nd case,. Normal circadian rhythms are attained in both patients.
PS-C10-2: POTENTIAL IMPACT OF THE 2017 AMERICA COLLEGE OF CARDIOLOGY/AMERICAN HEART ASSOCIATION HIGH BLOOD PRESSURE GUIDELINES ON SECONDARY PREVENTION POPULATION
Authors: Mahmud Azra , Guidan Musab , Iyad Farah , Mukhtar Abdul Majed
Published: January 2023

Objective:

The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Hypertension Guidelines for adults have redefined blood pressure (BP) thresholds for diagnosis and treatment initiation as well as BP goals. We wanted to explore the potential impact of these recommendations on the prevalence of uncontrolled hypertension and target achievement in a secondary prevention population receiving anti-hypertensive treatment in line with the previous Guidelines.

Design & Methods:

This was a retrospective study in ambulatory patients attending a secondary cardiovascular disease prevention programme(mean age 62 ± 14, 77% male)using prospectively collected data from electronic medical records (Apollo Lx). Data analysed using JMP, version 7.1(SAS for Windows). Hypertension and target achieved were classified on the basis of previous International (BP < 140/90 mm Hg) as well as the new ACC/AHA Guidelines (BP < 130/80 mm Hg). Results were analysed using JMP Version 7.1(SAS for Windows).

Results:

Applying the new ACC/AHA cut-offs for BP, the proportion of patients with high normal BP decreased from 63% to 28% (p < 0.001), which translated into an increase in the prevalence of Stage I (39% vs. 15%, p < 0.0001) and Stage II hypertension (14.7% vs. 0.9%, p < 0.001). Overall, BP target was achieved in 75% of the patients using the old definition, compared with 43% with the new ACC/AHA Guidelines. Using the old definition, men were more likely to achieve target BP (78% vs. 72%, P < 0.0001) than women; however with the new cut-offs, BP target achieved was similar in men(42.8%) and women(43%). Using the old definition, some 84% of diabetics achieved BP control, decreasing to 52%with the new Guidelines. 71% of patients with renal impairment had BP targets achieved using the previous definition, compared with 41% in line with the new Guidelines.

Conclusions:

Compared with the previous European, British and American Guidelines, the new 2017 ACC/AHA recommendations resulted in a substantial increase in the prevalence of uncontrolled hypertension and reduction in patients achieving BP targets in our population. If taken up, these recommendations carry significant implications of increase in the number of anti-hypertensive drug prescribing, issues like polypharmacy, non-adherence and adverse drugs effects, with resultant escalation in health care costs.
PS-C10-4: ARE HOME BLOOD PRESSURE DEVICES ACCURATE? A SYSTEMATIC REVIEW OF THE EVIDENCE
Authors: Hiremath Swapnil , Gaur Aditi , TurnerPatry Jamie
Published: January 2023

Background:

Out of office blood pressure (BP) measurements, especially home BP monitoring, are recommended for diagnosis and management of hypertension by many societies including by the Canadian Hypertension Education Programme (CHEP). Though validation protocols exist for individual monitors, little data exists on the real world accuracy of home BP monitors, in actual use. We undertook this systematic review to estimate the accuracy of home BP monitors as reported in the literature.

Methods:

We undertook a literature search of MEDLINE and EMBASE from 1946 and 1947 until April 2021 respectively. We included studies that evaluated the accuracy of home BP devices against a mercury sphygmomanometer considered as the gold standard. Two reviewers independently selected studies, extracted data and assessed quality. Disagreements between the two reviewers were resolved by a third author.

Results:

Our search revealed 797 non-duplicate citations. After applying selection criteria, nineteen studies, involving 4954 patient-devices (median 91, interquartile range 69, 489) were included in the systematic review. The reported inaccuracy of home BP monitors compared to mercury sphygmomanometer ranged from 10% to 72% for systolic BP, with each study using different thresholds for inaccuracy. The absolute mean difference for systolic BP between home BP monitor and the standard ranged from 2.4 mm Hg to 10.4 mm Hg and for diastolic BP from 1 to 8.7 mm Hg.

Conclusion:

The existing literature reports a relatively high degree of inaccuracy in home BP monitors being used. Data is limited by varying definitions being used for reporting inaccuracy. Consideration should be given to standardised definitions of accuracy, and real world monitoring of accuracy as home BP monitors use for clinical decision making becomes widespread. Research into predictors of inaccuracy is also necessary.
PS-C11-2: FACTORS AFFECTING HOME BLOOD PRESSURE AND HEART RATE VARIABILITY POST-COVID INFECTION
Authors: Patil Vishal , Patil Mansi
Published: January 2023

Objective:

There is a scarcity of data on the factors that influence home blood pressure (BP) and heart rate (HR) variability. This study was undertaken to determine the factors that influence home BP and HR fluctuation post COVID infection in the urban Indian population.

Designs and Methods:

We conducted a cross-sectional study among 1000 patients between the ages of 30 and 80 who were previously infected with COVID-19 infection, but not hospitalized. These patients were guided and trained to measure BP at home. BP and HR readings were taken at home twice a day, in the morning and evening, for seven days (28 measurements). The SD of morning minus evening, and first minus second readings was used to calculate BP and HR variability.

Results:

Old age, cardiovascular illness, diabetes, and high home blood pressure were all found to be independent predictors of an increased morning than evening home blood pressure variability. Old age, and high home blood pressure were all independent determinants of greater day-to-day home blood pressure variability, while old age, female sex, cardiovascular disease, and high home blood pressure were all independent determinants of greater first versus second home blood pressure variability. Young age, and high home HR, on the other hand, were all independent drivers of increased morning vs evening variability. Young age, female sex, and a high home HR were also independent predictors of first versus second home HR variability.

Conclusion:

Considering home BP and HR fluctuation have prognostic value, it is critical for clinicians to understand the underlying reasons for these variables. Doctors should focus on alcohol, diabetes, and cardiovascular disease prevention counseling for their high-risk patients.
PS-C12-1: HEATED TOBACCO PRODUCTS VS TRADITIONAL TOBACCO CIGARETTES EFFECTS ON BLOOD PRESSURE AND OTHER CARDIOVASCULAR RISK PREDICTORS AMONG SMOKERS: A META-ANALYSIS
Authors: Barrientos Marie , Reano Joan Dymphna , Arimado Reginald , Castillo Rafael
Published: January 2023

Introduction:

Over the last decades, a large body of evidence has already demonstrated the association between traditional tobacco cigarette (TTC) smoking and cardiovascular events. More recently, heated tobacco products (HTPs) have been introduced, to potentially reduce exposure to harmful constituents in cigarette smoke and reduce the health burden of smoking-related diseases.

Methods:

Randomized controlled trials comparing TTCs and HTPs with outcomes on blood pressure (BP), heart rate (HR) and other predictors of cardiovascular risk such as flow mediated dilatation (FMD), pulse wave velocity (PWV), high density lipoprotein (HDL), low density lipoprotein (LDL), triglycerides (Tg) and total cholesterol (TC) were searched through PubMed, Google Scholar and Cochrane database. A total of 13 studies were included.

Results:

Pooled analysis of studies showed that HTPs showed significant difference compared to TTCs on HR (MD -3.16 beats per minute [bpm] with 95% CI of -5.41 to -0.91, p = 0.006), FMD (in % change) (MD + 2.53% with 95% CI of 0.17 to 4.89, p = 0.04) and HDL (MD 0.18 mg/dL with 95% CI of 0.07 to 0.28, p = 0.0009). No significant differences were noted on systolic BP, diastolic BP, LDL, Tg and TC. Only 1 study had complete report of outcomes on PWV, showing no significant difference.

Conclusion:

Evaluating the effects on BP, HR and other known predictors of cardiovascular risk, HTPs, compared to TTCs, showed significant reduction in HR, and significant increases in FMD and HDL cholesterol, which may impact favorably in terms of cardiovascular risk reduction. There are no statistically significant differences in BP, LDL cholesterol, Tg, TC and PWV. Larger and long-term studies are still needed to support the cardiovascular benefits of HTPs.
PS-C12-9: CARDIO ANKLE VASCULAR INDEX AS A PREDICTOR OF SUCCESSFUL RENAL DENERVATION AND IMPROVED BP VARIABILITY IN SUBJECTS WITH RESISTANT HYPERTENSION
Authors: Postadzhiyan Arman , Tochev Sotir , Andreeva Lora , Rifai Nizar , Finkov Bozidar
Published: January 2023

Objective:

The aim of the study was to determine the clinical characteristics of patients with increased arterial stiffness (AS) undergoing renal sympathetic denervation (RSD) and to examine the role of cardio ankle vascular index (CAVI) measurement in predicting the outcome of RSD. Another task was to assess the effect on the indices of blood pressure variability.

Design and method:

Consecutive patients with resistant hypertension who underwent RSD workout at the University Hospital Saint Anna, Sofia, between January 2014 and December 2020 were included. CAVI was measured using the VaSera system (Fukuda Denshi Co, Japan). RSD was performed with the Symplicity Flex catheter (Medtronic, Minneapolis, MN, USA) according to a standardized protocol. Blood pressure variability was assessed by weighted 24 h BPV by ABPM.

Results:

The study included 62 patients with treatment resistant hypertension, after out of office blood pressure measurement and intensification of therapy, renal denervation was performed in 32 (51.6%). Patients with increased arterial stiffness, defined as CAVI >median of 8.3, were older, with a larger waist circumference and previous cardiovascular events. A longterm effect of the RSD, reported as a reduction in 24-hour systolic blood pressure above 10 mmHg at month 12, was found in 22 patients (68.8%). The median of the observed reduction of the 24 hour systolic blood pressure was 16 mmHg at 95% confidence interval 9.1 to 21 mmHg. Despite similar baseline out of office and office blood pressure and concomitant antihypertensive therapy, patients with lower arterial stiffness had a more significant blood pressure effect of renal denervation, a result that persisted within 12 months of follow up. More profound and significant drop of BP variability was also noticed in this group of patients. In contrast, the effect of the procedure was clinically insignificant among patients with baseline CAVI values above 8.3.

Difference in office and out of office BP between the baseline values and those at month 12 after RSD in patients with low arterial stiffness.

Conclusions:

These findings hold the promise that AS might be used as a selection criterion for RSD, thereby improving outcome following RSD.
PS-C12-12: EFFECT OF CHRONOTHERAPY ON BLOOD PRESSURE VARIABILITY IN HYPERTENSIVE AND CHRONIC KIDNEY DISEASE ADULT PATIENTS IN NIGERIA
Authors: Ogunba Adejumoke , Adebusoye Lawrence , Avwerhota Oludayo , Fakunle Olakunle , Adeoye Abiodun
Published: January 2023

Background:

Blood pressure is synchronized predictably with the circadian activity-rest cycle. Few available studies have shown that chronotherapy may improve blood pressure variability (BPV) among hypertensive and chronic kidney disease patients. Empirical evidence is lacking among Nigerians.

Objective:

This study ascertained the effect of chronotherapy (taken as the use of antihypertensive medications at bedtime) on BPV of adult patients aged 18 years and above diagnosed with hypertension (control) and chronic kidney disease (CKD) using ambulatory blood pressure monitoring over three months follow up.

Design and method:

We conducted a retrospective analysis of data of respondents included in the Ibadan Ambulatory Blood Pressure Registry (IABPR) at the University College Hospital, Ibadan, Nigeria. Sociodemographic characteristics, lifestyle habits, and anthropometric measurements were obtained. Paired t-test was used to test the differences in the mean BP parameters before and after the study at p 0.05.

Results:

There were 52 respondents, 24 hypertensive controls (mean age 58.6 ± 11.3years) and 28 CKD patients (mean age 45.2 ± 11.1years). The hypertensive controls had significantly reduced mean systolic, diastolic, and arterial BP at the end of the study. Similarly, the wake-up and sleep periods mean systolic, diastolic, and arterial BP decreased significantly among the hypertensive controls. However, the CKD patients showed no significant BP variability with chronotherapy at the end of the study. Both the hypertensive controls and CKD patients experienced no significant BP dipping during the study period.

Conclusion:

Hypertensive patients in our study experienced a significant reduction in their BP parameters with chronotherapy, while CKD patients showed no significant changes in their BP. Further studies are needed in Nigeria to determine the beneficial effects of chronotherapy in this population.