bluuebunny/crossref_metadata_2025 huggingface dataset:
PS-C17-9: RELEVANT BLOOD PRESSURE REDUCTION WITH ORAL SEMAGLUTIDE IN PATIENTS WITH TYPE 2 DIABETES AND OBESITY, INDEPENDENT OF PREVIOUS ANTIHYPERTENSIVE TREATMENT
Authors: Martinez-Martin Francisco Javier , Kuzior Agnieszka , Hernandez-Lazaro Alba , de Leon-Durango Ricardo , Rios-Gomez Carlos , Santana-Ojeda Borja , Perez-Rivero Jennifer Maria , Fernandez-Trujillo-Comenge Paula Maria , Santana-Suarez Ana Delia , Gonzalez-Diaz Paula , Arnas-Leon Claudia , Acosta-Calero Carmen
Published: January 2023

Objective:

The antihypertensive effect of oral semaglutide is apparently modest in published trials but it has not been explored in uncontrolled hypertensive patients. We sought to assess whether oral semaglutide may elicit a clinically relevant reduction of systolic blood pressure (SBP) in patients with type 2 diabetes (T2D), obesity and uncontrolled hypertension, and whether the attained SBP reduction is diluted by the previous antihypertensive treatment.

Design and Methods:

Retrospective analysis of the SBP and antihypertensive medication data were performed in consecutive patients with T2D and obesity who started therapy with oral semaglutide. Data were obtained from a baseline visit in which oral semaglutide was initiated, and a second visit after 3–4 months. Patients who initiated or changed antihypertensive medication simultaneously with oral semaglutide were excluded. Consent for anonymous analysis and reporting of data were obtained from all included subjects.

Results:

50 patients with T2D (by usual clinical criteria) and obesity (BMI < 30 kg/m2) were included; their age was 56 ± 11 years. 32 (64%) were female, and their diabetes duration was 6.9 ± 2.9 years. 41 (82%) of them were diagnosed with hypertension (sitting office SBP > 140 and/or taking antihypertensive drugs). Globally there was a significant but modest reduction in SBP (149.8 ± 11.7 to 146.7 ± 12.4 mmHg, p = 0.041, paired t-test), but this reduction was strongly correlated with the baseline SBP (Pearson's r 0.39, p < 0.001). In the Figure (A) the reductions in SBP for patients with controlled SBP (< 140 mmHg), stage 1 (SBP 140–159 mmHg), stage 2 (160–179 mmHg) and stage 3 hypertension (> 180 mmHg) are shown (p = 0.0056 for differences among SBP categories, one-way ANOVA). The Figure (B) also shows the reductions in SBP for patients taking 0, 1, 2 or > 3 different antihypertensive drugs, but there are no significant differences (p = 0.2312, one-way ANOVA). In the second visit the number of patients with SBP < 140 mmHg had increased from 19 (38%) to 25 (50%).

Conclusions:

Treatment with oral semaglutide in patients with T2D, obesity and uncontrolled hypertension elicits a clinically significant decrease in SBP, enough to bring about acceptable SBP control in a relevant fraction. As expected, the reduction in SBP was strongly dependent on the baseline SBP. Interestingly, this reduction does not seem to be diluted by the use of multiple antihypertensive drugs, suggesting that oral semaglutide could be considered as an add-on in patients with apparent resistant hypertension.
PS-C17-10: ORAL SEMAGLUTIDE REDUCES ALBUMINURIA IN PATIENTS WITH TYPE 2 DIABETES, OBESITY AND HYPERTENSION, WITH PARTIAL DEPENDENCE ON BLOOD PRESSURE CONTROL
Authors: Martinez-Martin Francisco Javier , Kuzior Agnieszka , Hernandez-Lazaro Alba , de Leon-Durango Ricardo , Rios-Gomez Carlos , Santana-Ojeda Borja , Perez-Rivero Jennifer Maria , Fernandez-Trujillo-Comenge Paula Maria , Santana-Suarez Ana Delia , Gonzalez-Diaz Paula , Arnas-Leon Claudia , Acosta-Calero Carmen
Published: January 2023

Objective:

GLP-1 receptor agonists reduce blood pressure (BP) and proteinuria in people living with type 2 diabetes (T2D) and obesity, but data on patients with uncontrolled hypertension are very scarce. Oral semaglutide showed interesting results in patients with moderate renal impairment in PIONEER 5, but their BP was well controlled, with SBP < 140 mmHg. We sought to assess the antiproteinuric effect of oral semaglutide in a group of patients with T2D, obesity and uncontrolled hypertension, and whether this effect is dependent on BP reduction.

Design and Methods:

Retrospective analysis of the data on SBP and albuminuria were performed in consecutive patients with T2D, obesity and uncontrolled hypertension (office sitting SBP < 140 mmHg) who started therapy with oral semaglutide. Data were obtained from a baseline visit in which oral semaglutide was initiated, and a second visit after 3–4 months. Mediation analyses with SBP reduction as mediator were performed post-hoc to quantify its relative contribution to albuminuria reduction. Patients who initiated or changed antihypertensive medication simultaneously with oral semaglutide were excluded. Consent was obtained from all included subjects.

Results:

Data were obtained from 33 patients, 21 (64%) were female, age 54.2 ± 11.9 years, diabetes duration 6.8 ± 2.7 years, baseline BMI 36.7 ± 5.2 kg/m2, baseline SBP 166 ± 12.2 mmHg, baseline eFGR (CKD-EPI) 58 ± 11.6 ml/min/1.73m2 and baseline albuminuria (geometric mean) 134 ± 125 mg/g Cr, with 16 patients (48.5%) having < 30 mg/g, 12 (36.4%) 30–300 mg/g and 5 (15.1%) > 300 mg/g. SBP reduction was 4.8 ± 2.1 mmHg (p = 0.012, paired t-test), albuminuria reduction was 36 ± 27 mg/g (-27%; p = 0.026, paired t-test), and eGFR change + 1.3 ± 1.6 mL/min/1.73m2 (not significant). There was a significant correlation between SBP and albuminuria reductions (Pearson's r: 0.26, p = 0.002). The mediation analyses showed that albuminuria reduction of 11 ± 10 mg/g (8.3%) was mediated by SBP reduction while 25 ± 14 mg/g (18.7%) was SBP-independent. 4 patients (12.1%) reduced their albuminuria to < 30 mg/g (Figure).

Conclusions:

In patients with T2D, obesity and uncontrolled hypertension, oral semaglutide significantly reduced SBP and albuminuria, without change in eGFR, and a relevant fraction of them (about 1/8) reduced albuminuria below the conventional normality threshold (< 30 mg/g). The decrease in albuminuria was only partially mediated by SBP reduction, suggesting additional mechanisms, possibly direct glomerular and/or tubular effects.
PS-C18-3: RENIN-ANGIOTENSIN SYSTEM INHIBITORS IN PATIENTS WITH ADVANCED CHRONIC KIDNEY DISEASE ASSOCIATED WITH A LOWER RISK OF UNPLANNED DIALYSIS INITIATION
Authors: Nakayama Takashin , Morimoto Kohkichi , Uchiyama Kiyotaka , Kusahana Ei , Washida Naoki , Azegami Tatsuhiko , Kanda Takeshi , Yoshida Tadashi , Itoh Hiroshi
Published: January 2023

Objective:

Unplanned dialysis initiation is associated with poor outcomes. Whether patients with advanced chronic kidney disease (CKD) should receive renin-angiotensin system (RAS) inhibitors remains controversial. This study aimed to evaluate the effect of RAS inhibitors in patients with advanced CKD on the incidence of unplanned dialysis initiation. Furthermore, the association between RAS inhibitor therapy and the estimated glomerular filtration rate (eGFR) decline rate for 6 months before dialysis initiation was also investigated.

Design and method:

This single-center, retrospective study included patients who started maintenance dialysis at our hospital between April 2014 and March 2021. Patients who initiated dialysis within six months of nephrology referral or after kidney transplant were excluded. Unplanned dialysis initiation was defined as urgent hospitalization for starting dialysis or unexpectedly starting dialysis in the hospital for any purpose other than dialysis initiation. Missing values were handled with multiple imputations.

Results:

Among 334 patients (median age 70.0 [interquartile range 59.0–79.0] years; 28.4% females), 186 (55.7%) and 148 (44.3%) had a planned and unplanned dialysis initiation, respectively. Overall, 144 patients (43.1%) did not use, 51 (15.3%) stopped, 136 (40.7%) continued, and 3 (0.9%) started RAS inhibitors for 6 months before dialysis initiation. Multivariate logistic regression revealed that use of RAS inhibitors was significantly associated with a lower incidence of unplanned dialysis initiation (odds ratio [OR], 0.35; P < 0.01). Female sex (OR, 0.51; P < 0.05), use of potassium binders (OR, 0.25; P < 0.01), earlier referral to nephrology (OR, 0.45; P < 0.01), and earlier discussion of renal replacement therapy (OR, 0.35; P < 0.01) were also significantly associated with a lower incidence, whereas older age (OR, 1.25; P < 0.05), higher Charlson comorbidity index (OR, 1.34; P < 0.01) and faster decline in eGFR (OR, 1.29; P < 0.01) were associated with a higher risk of unplanned dialysis initiation. In multivariate linear regression to assess the rate of eGFR decline for 6 months before dialysis initiation, use of RAS inhibitors (β;, -4.2; P < 0.05) as well as older age (β;, -2.5; P < 0.01), higher geriatric nutritional risk index (β;, -2.9; P < 0.01) and use of bicarbonate (β;, -6.3; P < 0.01) was significantly associated with preserved kidney function.

Conclusions:

RAS inhibitor therapy in patients with advanced CKD was associated with a lower risk of unplanned dialysis initiation and preserved kidney function.
PS-C18-9: THE ASSOCIATION BETWEEN FRAILTY OR SARCOPENIA AND INTRADIALYTIC HYPOTENSION
Authors: Ozawa Moe , Hirawa Nobuhito , Haruna Aiko , Haze Tatsuya , Kawano Rina , Komiya Shiro , Ohki Yuki , Kobayashi Yusuke , Fujiwara Akira , Saka Sanae , Hanaoka Masaaki , Mitsuhashi Hiroshi , Yamaguchi Satoshi , Ohnishi Toshimasa , Tamura Kouichi
Published: January 2023

Objective:

Recently, osteoporosis, sarcopenia, and frailty have become prognostic issues due to the increasing number and aging population of dialysis patients. Dialysis patients have high bone and muscle fragility due to their unique pathology, and we previously investigated the association between osteoporosis and muscle mass or strength in the cross-sectional study. We found that shorter calf circumference and weaker grip strength were associated with lower bone mineral density and the risk for osteoporosis among hemodialysis patients, independently of the management of chronic kidney disease-mineral and bone disorder, nutritional status, and dialysis adequacy. On the other hand, intradialytic hypotension is also one of the most common intradialytic complications, which can affect dialysis adequacy and prognosis. Although sarcopenia and frailty have been reported to cause orthostatic hypotension, the association between sarcopenia or frailty and intradialytic hypotension is not clear. Therefore, in this study, we examined the association between sarcopenia or frailty and intradialytic hypotension using our previous osteoporosis study.

Design and method:

This was a single-center cross-sectional study. We screened patients aged 20 years or older who underwent hemodialysis three times a week and selected 200 patients with a history of hemodialysis for at least 6 months for the study. Calf circumference, grip strength, and normal walking speed were measured to assess sarcopenia, and frailty was diagnosed based on the Japanese version of the Cardiovascular Health Study criteria. The behavioral characteristics and clinical history were obtained using a questionnaire and medical records. We analyzed the association between the frequency of intradialytic hypotension and frailty, or physical functions related to sarcopenia.

Results:

The final analysis included 121 subjects, mean age 66.1 ± 12.6 years, 28 women (23.1%). Mean calf circumference was 35.6 cm ± 3.8 cm, grip strength was 27.8 kg ± 9.6 kg, 26 (21.5%) were frail, 64 (52.9%) were prefrail, and 31 (25.6%) were robust. We are currently collecting and analyzing the data and will present our findings at the conference.

Conclusions:

We plan to present the relationship between intradialytic hypotension and frailty or physical function at the conference.
PS-C18-10: COVID 19 IMPAIRS ENDOTHELIAL FUNCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE ON HEMODIALYSIS
Authors: Santos Juan Carlos , Lepera Rosa Mabel , Serra Rocio Fernandez , Lossi Susana , Alanoca Saul , Turoni Claudio Joo , de Bruno Maria Peral , Maranon Rodrigo Oscar
Published: January 2023

Introduction:

Cardiovascular events are the leading cause of mortality in patients with chronic kidney disease on hemodialysis (CKD-HD). Recent evidence suggests that coronavirus-19 disease (COVID-19) would induce vascular endothelial function alterations to increase cardiovascular risk. However, whether COVID-19 contributes to endothelial dysfunction in patients with CKD-HD is unclear.

Objective:

To assess whether COVID-19 worsens endothelial function in a cohort of patients with chronic kidney disease on hemodialysis.

Materials and Methods:

Patients with chronic kidney disease on hemodialysis were divided into those without COVID-19 (CKD; n = 68) and mild COVID-19 (CKD-C19; n = 11, WHO criteria and PCR+). Informed consent was obtained. Systolic (SBP), diastolic (DBP) and mean (MAP) blood pressures, heart rate (HR), and endothelial function (EF) were evaluated for reactive hyperemia. It was determined dry weight, height, fat mass index (FMI), muscle mass index (MMI), and body mass index (BMI). Results were compared with normal people without CKD (Control = C, n = 10).

Results:

CKD and CKD-C19 presented a high SBP compared to the controls and without differences between them (C: 119 ± 3, n = 10 vs. CKD: 145 ± 2, n = 68 vs. CKD-C19: 143 ± 3 mmHg, n = 11; p < 0.05 vs. C). Patients CKD-C 19 presented greater endothelial dysfunction compared to CKD and the control group (EF: CKD-C19:2 ± 1, n = 11 vs CKD:4.5 ± 1, n = 28 vs. C:12.1 ± 1, n = 10; p < 0.05). In CKD and C-C19 an increase in BMI was observed in conjunction with an increase in fat mass, without differences in the muscle mass index between both groups (X2:p: NS). No association was observed between EF and BMI or IMG.

Conclusions:

The present study indicates that COVID-19 would aggravate endothelial dysfunction in patients with chronic kidney disease on hemodialysis. This would not be related to increased BMI or elevated blood pressure. However, more studies are needed to determine the role of COVID-19 on vascular function in this population.
PS-C19-1: EFFECTS OF COMBINED SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITORS AND LOOP DIURETICS ON SYSTOLIC BLOOD PRESSURE: SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Alshehri Mohammed A , Orayj Khalid
Published: January 2023

Background and Objective:

Sodium-glucose co-transporter-2 (SGLT2) inhibitors are considered a standard of care in patients with heart failure, chronic kidney disease (CKD), and diabetes. They have substantial positive effects on cardiovascular and renal outcomes including reducing heart failure hospitalization and slowing glomerular filtration rate (GFR) decline. Loop diuretics, on the other hand, are commonly prescribed to manage volume expansion in patients with CKD and heart failure. However, the effects of combining SGLT2 inhibitors with loop diuretics are not consistent across different clinical trials. The purpose of our meta-analysis is to investigate the effect of combined SGLT2 inhibitors and loop diuretics on systolic blood pressure.

Method:

Using Pubmed, Scopus, Web of Science, VHL, metaRegister of Controlled Trials (mRCT), and Clinical trials.gov, a systematic review and meta-analysis of literature on the effect of adding SGLT2 inhibitors to loop diuretics on blood pressure were conducted. The comprehensive review covered randomized controlled trials (RCTs), non-randomized studies, prospective, retrospective, and post hoc investigations examining the effect of SGLT2 inhibitors on systolic blood pressure in healthy and heart failure patients. The outcome was calculated using Cohen's d formula as the standardized mean difference between the first group (SGLT2 inhibitors plus loop diuretics) and the second group (loop diuretics alone). To ensure the data's validity, a sensitivity analysis was conducted using just RCTs.

Results:

Eleven studies with a total of 3343 participants met all the analysis's inclusion criteria. The pooled standardized mean difference for all studies was -0.17, indicating that SGLT2 inhibitors may have a little effect on blood pressure reduction (p value = 0.06). When RCTs were excluded from the analysis, the pooled standardized mean difference was -0.10 with a p value of 0.40.

Conclusion:

Compared to loop diuretic alone, SGLT2 inhibitors combined with loop diuretics are not associated with a significant reduction in systolic blood pressure in patients with heart failure.
PS-C19-7: HYPERTENSION INDUCED BY BEVACIZUMAB
Authors: Vanderhoeven Juan Francisco , Zanuzzi Matias Gabriel
Published: January 2023

Objectives:

To determine the incidence of the novo hypertension in patients under bevacizumab treatment. To determine the blood pressure (BP) effect of Bevacizumab in previously diagnosed hypertensive patients. To evaluate the clinical significance of Bevacizumab induced hypertension.

Design and Methods:

Retrospective, Cohort study. Time period from 1/2015 to 06/2020 at Hospital Privado Universitario de Córdoba, Argentina. Inclusion criteria: All patients over 18 years of age. Under Bevacizumab as antineoplastic treatment, either as a single or as a combined agent. No history of previous anti-VEGF treatment. Uncontrolled BP if mean office BP > 140/90mmHg.

Results:

n = 93. Mean age 63.7 years (40 - 81). Female 52.8%. Smokers 39.8%. BMI 26.3 ± 4.8. Previous HTN 56.6%, 90% under antihypertensive treatment. Hypertensive patients were older and with greater history of familiar with HTN than those normotensives. Before Bevacizumab administration, the prevalence of uncontrolled BP was 10.9% in previous normotensive and 19.5% in previous hypertensive patients. After 12 months of treatment with Bevacizumab, 75% of those previous normotensives and 87.5% of those previous hypertensives had uncontrolled BP. There were no differences in rates of cardiovascular events (5.4%), cardiovascular deaths (2.7%) and survival between those with controlled and uncontrolled BP after the administration of Bevacizumab (Figure 1).

Conclusions:

High prevalence of uncontrolled BP after initiation of Bevacizumab. While it is widely accepted that the long-term risks of hypertension are serious, the short-term risk seems to be less relevant. BP target could be higher than in the general population, adjusted to performance status and comorbidities.
PS-C19-8: A COMPARISON OF THE MEDICATION COST AND INCIDENCE RATE OF CARDIOVASCULAR EVENTS BETWEEN INTENSIVE AND STANDARD ANTIHYPERTENSIVE PHARMACOTHERAPIES IN JAPAN
Authors: Yoshihara Hiroshi , Igarashi Ataru , Tonoike Toru , Ono Hiromitsu , Nishiuchi Susumu
Published: January 2023

Objective:

Hypertension is a major health challenge, imposing an enormous economic burden as well as health burden worldwide. In Japan, the economic burden of hypertension and related diseases is estimated to be JPY1.7 trillion (USD 13 billion) per year, around 4% of total healthcare expenditures. This study aimed to compare treatment outcomes and costs between intensive and standard pharmacotherapies, focusing on the types of antihypertensive drugs and prescribing patterns.

Design and method:

We performed a retrospective cohort study using electronic medical record data obtained from 34 healthcare facilities in Japan. The incidence of cardiovascular events captured via claims data was set to be the outcome measure. Multivariable mixed effects Cox-proportional hazards model was applied to compare the costs and the outcomes from intensive pharmacotherapy arm (i.e., short prescribing interval/expensive drugs) and standard one (i.e., long prescribing interval/low-cost drugs).

Results:

During 6,013 person-years of follow-up, 74 events were observed. While age at the beginning of treatment had significant impact on the incidence of cardiovascular events [Hazard Ratio, 1.05 (95%CI 1.02 - 1.07); p < 0.001], no associations with cardiovascular events were found for mechanism of drug action (CCB) [1.37, (95%CI 0.839 - 2.24); p = 0.21] and for short prescribing interval (less than 30 days) [1.17 (95%CI 0.695 - 1.98); p = 0.55]. The mean medication costs per day per patient of CCB and ARB were JPY 28.9 and JPY 51.8, respectively.

Conclusions:

No significant impacts on treatment outcomes were observed for drug type and prescribing interval, although the medication costs of intensive pharmacotherapy arm were more expensive than standard arm.
PS-C19-10: SEASONAL VARIATION IN THE EFFECT OF ANTIHYPERTENSIVE TREATMENT WITH THE IRBESARTAN/HYDROCHLOROTHIAZIDE COMBINATION
Authors: Ye Xiaofei , Huang Qifang , Li Yan , Wang Jiguang
Published: January 2023

Objective:

There is increasing awareness of seasonal variation in blood pressure. In the present analysis, we investigated seasonal variation in antihypertensive treatment effect of the irbesartan/hydrochlorothiazide combination in patients with stage 2 and 3 hypertension.

Design and Methods:

The study participants were hypertensive patients enrolled in a 12-week therapeutic study. Antihypertensive treatment was initiated with the irbesartan/hydrochlorothiazide 150/12.5 mg/day, with the possible up-titration to 300/12.5 mg/day and 300/25 mg/day at 4 and 8 weeks of follow-up. The month of treatment commencement was classified as spring/summer (May to August) and autumn/winter (September to December).

Results:

Of the 501 enrolled patients, 313 and 188 commenced antihypertensive treatment in spring/summer and autumn/winter, respectively. The mean changes in systolic/diastolic blood pressure at 8 and 12 weeks of follow-up were greater in patients who commenced treatment in autumn/winter (-32.3/-16.5 and -34.2/-16.7 mmHg, respectively) than those in spring/summer (-28.4/-13.9 and -27.1/-12.8 mmHg, respectively), with a between-season difference of 3.9 (95% confidence interval [CI], 1.4–6.4, P = 0.002)/2.6 (95% CI, 0.9–4.2, P = 0.002) mmHg and 7.0 (95% CI, 4.7–9.3, P < 0.0001)/3.9 (95% CI, 2.4–5.4, P < 0.0001) mmHg, respectively. Further subgroup analyses showed a greater between-season difference in the changes in systolic blood pressure in patients aged 55 years and older (n = 255) than those < 55 years (n = 246, 12.6 vs. 6.9 mmHg, P = 0.02), and in patients with chronic kidney disease (n = 175) than those with normal renal function (n = 326, 12.1 vs. 7.4 mmHg, P = 0.06).

Conclusions:

There is indeed seasonality in antihypertensive treatment effect, with a greater blood pressure reduction in patients who commenced treatment in cold than warm seasons.
PS-C19-12: EFFECT OF FIXED TRIPLE ANTIHYPERTENSIVE COMBINATION THERAPY ON ARTERIAL STIFFNESS IN PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Yusupova Khafiza Furkat qizi , Abdullaeva Guzal Jaloliddinovna , Shukurova Dilafruz Yusupovna , Khamidullaeva Gulnoz Abdusattarovna , Sadullaeva Mohinur A , Mashkurova Zarina Tulkunovna , Masharipov Shukhrat Matkarimovich
Published: January 2023

The purpose of the study:

to evaluate the vasoprotective efficacy of fixed triple antihypertensive therapy (AHT) in patients with arterial hypertension (AH).

Material and methods of investigation:

According to the protocol, the study included patients with I-III stages of hypertension (ESC/ESH 2018) of both sexes, without severe concomitant diseases and cardiovascular complications (acute myocardial infarction, CHF, cerebrovascular diseases, cardiac arrhythmias, diabetes), in the amount of 85 patients. The average age of patients was 57.5 ± 11.3 years, the average duration of AH was 11.6 ± 7.4 years. To all patients before treatment and 6 months after therapy office BP was measured using the Korotkov method. Vascular stiffness was determined by applanation tonometry using the SphygmoCor device (AtCor Medical, Australia); there were studied: central systolic blood pressure (cSBP), central diastolic blood pressure (cDBP), central pulse pressure (cPP), aortic augmentation (AA), aortic augmentation index (AIx), pulse wave velocity (PWV). According to obtained data, a conclusion was made about the state of arterial stiffness. The patients were prescribed fixed triple AHT in the form of a combination of perindopril/indapamide/amlodipine («Triplixam», Servier, France) in a daily dose of 5/1.25/5 mg to 10/2.5/10 mg. Results are presented as M ± SD.

Results of the study:

In general, a significant positive antihypertensive efficacy of fixed triple AHT was obtained. Analysis of indicators of central hemodynamics and arterial stiffness revealed a positive 6-month efficacy of fixed triple AHT. Thus, the cSBP index was initially 162.4 ± 29.4 mm Hg and in dynamics - 144.3 ± 17.6 mm Hg (p < 0.02); cPP index was 77.9 ± 22.3 mm Hg versus 61.3 ± 16.4 mm Hg, respectively (p < 0.02); AA index was 21.3 ± 25.1 mm Hg versus 15.6 ± 9.2 mm Hg, respectively (p < 0.05); the PWV indicator was 11.2 ± 2.8 m/sec versus 9.8 ± 2.5 m/sec, respectively (p < 0.02). At the same time, the PWV movement indicator reached the standard values.

Conclusion:

The high antihypertensive efficacy of 6-month fixed triple AHT provided a positive dynamic in the parameters of central hemodynamics and arterial stiffness in patients with AH.
PS-C20-4: SGLT2I - A POTENTIAL ANTIHYPERTENSIVE AGENT IN HYPERTENSION PATIENTS WITH TYPE 2 DIABETES MELLITUS
Authors: Doan Long Pham Phuoc , Van Huynh Minh
Published: January 2023

Introduction:

Sodium-Glucose cotransporter 2 inhibitor is a class of treatment for type 2 diabetes mellitus (T2DM) recently recommended in the treatment of patients with heart failure. We evaluated the effect of blood pressure-lowering of this agent in patients with T2DM.

Methods:

A prospective study in all hypertensive patients with T2DM admitted to the Department of Cardiology Department of Hue Central Hospital who had not been treated with SGLT2i between 12/2020 and 05/2021. In the end, 236 patients were participating in the study, in which 110 patients received Dapagliflozin 10 mg daily with OMT and 126 patients received OTM. The patients were followed up at the hospital and 2 months after discharge. Comprehensive examination, and measurement of upper arm blood pressure (BP) with Omron HEM-7121.

Results and discussion:

The mean age was 66.77 ± 15.53. The patient had a 9 (0–40) year history of hypertension and a 5 (0–37) year history of T2DM. The baseline BP was 146.29 ± 19.17 / 83.78 ± 13.1 mmHg, with no significant difference in baseline BP values in the 2 groups of patients. The results after 2 months showed that in the group of patients in combination with SGLT2i, there was a significant decrease in the mean SBP value compared with the group of patients with OTM of 5.95 mmHg (95%CI: 2.08 - 9.82, p = 0.003) but the decrease in DBP was not significantly different (95% CI: -0.09 - 5.40, p = 0.058). Subgroup analysis showed that in the group of patients with resistant hypertension, the group of patients using SGLT2i reduced DBP more than the group of patients with OTM by 2.77 mmHg (95%CI: 1.89 - 4.24, p = 0.005) but was not significant for SBP. In contrast, in patients with isolated systolic hypertension, the SBP in the group of patients using SGLT2i decreased more than in the group without using SGLT2i by about 8.91 mmHg (95%CI: 6.20 - 11.24, p = 0.035). These results were not observed in patients with heart failure and chronic kidney disease.

Conclusion:

SGLT2i has shown potential to be used as an antihypertensive agent in patients with heart failure and chronic kidney disease and shows superior efficacy in patients with isolated systolic pressure and resistant hypertension.
PS-C20-9: ANTIPLATELET AND ANTICOAGULANT THERAPY DURING ANGIOPLASTY PROCEDURES FOR ATHEROMATOUS OR FIBROMUSCULAR DYSPLASIA RENAL ARTERY STENOSIS IN ESH EC FRENCHS CENTRES
Authors: Bouhanick Beatrice , Sfhta Members , Sublet Marilucy Lopez
Published: January 2023

Introduction:

Recommendations framing antiplatelet therapy (APT) and/or anticoagulation (AC) therapy during renal artery angioplasty procedures remain succinct or absent. However, the usefulness of this medical therapy is supported by pathophysiology and follow-up of these arterial damage (1).

Objectives:

The aim was to describe the practice of using APT and AC in the 17 French ESH-EC during renal artery angioplasties for atheromatous stenoses (AS) or fibromuscular dysplasia stenoses (FMD).

Materials and Methods:

Sending of a questionnaire via the French Society of Hypertension mailing to collect data with a reminder 1 month later.

Results:

Are summarized in the table. 12 centres responded partially or completely for AS and 10 for FMD. 2 centres considered that they did not recruit enough; 3 did not respond.

Discussion/Conclusion:

In AS, single APT before angioplasty is the rule, while double APT is routine after angioplasty for 1 month, followed by single APT over the long term. In FMD, in most cases (90% of cases) there is no double APT before or after angioplasty (except in the case of dissection), while a single APT is continued in 60% of cases over the long term. Anticoagulants are reserved for bolus injection in operating room (with some exceptions) for both AS and FMD.

For AS, the handling of APT (duration, dose) differs, due to the lack of recommendations. In contrast, the use of AC/APT seems to be homogeneous in FMD before and during angioplasty, in accordance with the recommendations (1). New observational studies and randomized controlled trials must be part of a future international guideline.

1. Gornik HL et al. J Hypertens. 2019 Feb;37(2):229–252

Members of the French Society of Hypertension (Société Française d’Hypertension Artérielle - SFHTA): B Bouhanick, J Amar, L Amar, J Blacher, PY Courand, P Delsart, T Denolle, J Doublet, JP Fauvel, P Fesler, X Girerd, S Le Jeune, C Pelletier, P Rossignol, M Rodière, F Silhol, M Lopez-Sublet.
PS-C21-7: IMPACT OF THE TIME OF DAY PERFORMING AVS ON THE SUCCESS RATE AND SUBTYPE DIAGNOSIS IN PRIMARY ALDOSTERONISM
Authors: Yoneda Mau , Kometani Mitsuhiro , Karashima Shigehiro , Usukura Mikiya , Mori Shunsuke , Aono Daisuke , Konishi Seigo , Mai Xurong , Furukawa Kenji , Takeda Yoshiyu , Yoneda Takashi
Published: January 2023

Purpose:

Adrenal vein sampling (AVS) is the gold-standard technique for the subtype diagnosis of primary aldosteronism (PA). Measurements of aldosterone and cortisol in adrenal venous blood are used to determine the success or failure of AVS and to diagnose the PA subtype, but these hormone secretions show diurnal change. In this study, we examined the effect of the time of AVS on the results.

Design:

Multicenter, retrospective, observational study

Setting:

Three centers in Japan

Patients:

591 patients diagnosed with PA and undergoing AVS at 3 centers were used. All patients underwent basal AVS and ACTH-stimulated AVS on the same day. 382 patients underwent AVS in the morning (AM-AVS) and 209 patients in the afternoon (PM-AVS).

Results:

In terms of Selectivity Index (SI) in AVS, there was no significant difference in the right adrenal vein in basal AVS (22 vs. 23, p = 0.26), but SI of AM-AVS group was significantly higher in the left adrenal vein (19 vs. 17, p = 0.03). 03) than PM-AVS. However, in AVS after ACTH loading, SIs of both right and left adrenal veins were significantly higher in the PM group (Right: 42 vs. 44, p = 0.03; Left: 48 vs. 50, p = 0.01). However, there was no significant difference in AVS success rates between the two groups for basal AVS (81% vs. 74%, p = 0.08) and ACTH-stimulated AVS (92% vs. 88%, p = 0.19). There was also no significant difference in the proportion of patients diagnosed with unilateral PA in basal AVS (57% vs. 48%, p = 0.09) and ACTH-stimulated AVS (17% vs. 14%, p = 0.41).

Conclusions:

In a multicenter observational study, there was no significant difference in AVS success rate or subtype diagnosis of AVS between the different AVS times.
PS-C23-8: COFFEE INTAKE AND RISK OF HYPERTENSION IN KOREAN ADULTS: RESULTS FROM KNHANES 2012–2016
Authors: Cho In Jeong , Pyun Wook Bum
Published: January 2023

Introduction:

Coffee is the most popular and widely consumed drink in South Korea. Coffee consumption seems to have both benefits and risk with respect to hypertension. But, results from studies evaluating effect of frequency of coffee consumption on risk of hypertension are mixed and inconsistent. Hence, this study investigated the effect of frequency of coffee consumption on risk of hypertension in Korean adults.

Methods:

Data from Korean National Health and Nutrition Examination Survey (KNHANES 2012–2016) was obtained and 12133 eligible participants were selected. The consumption of coffee was obtained at baseline using a food frequency questionnaire (FFQ). Subsequently coffee intake was categorized into three categories (cups/day): < 1, 1–3, and > 3 cups/day. Hypertension status was defined as a systolic blood pressure > 140 mmHg or a diastolic blood pressure > 90 mmHg, use of antihypertensive drug treatment, or both. Multivariable logistic regression analysis was used to examine the effect of coffee consumption on risk of hypertension.

Results:

Fifty-five percent participants drank coffee 1–3 cups coffee/day. A total of 2359 participants had hypertension. In all participants more than 3 cups of coffee intake in a day was significantly reduced the risk of hypertension with Odds Ratio (OR) 0.76 (95%C.I. 0.65,0.89). Participants in middle age (40–59 years) group OR 0.76 (95% C.I. 0.63,0.93), normal range BMI OR 0.65 (95% C.I. 0.52,0.80), not diabetic OR 0.79 (95% C.I. 0.64,0.98), normal cholesterol OR 0.76 (95% C.I. 0.63,0.94) had protective effect of coffee consumption against risk of hypertension.

Conclusion:

The beneficial effect of > 3 cups of coffee intake in a day were seen in middle age, normal BMI, not diabetic and normal cholesterol participants compared to consumption of < 1 cup/day.
PS-C23-11: CREATION OF TOMATOES WITH HIGH GABA ACCUMULATION BY GENE EDITING AND THEIR HYPOTENSIVE EFFECTS
Authors: Minako Sumiyoshi , Yatabe Junichi , Ezura Hiroshi , Takayama Mariko , Nagata Hiroshi , Kawasaki Tomohiro
Published: January 2023

Background and Purpose:

The number of functional food products containing gamma-aminobutyric acid (GABA), which is claimed to have a hypotensive effect, will exceed 300 in Japan by 2020. GABA containing foods has surpassed the number of applications for non-digestible dextrin, which is claimed to prevent high blood sugar. Sicilian Rouge High GABA tomato (High GABA tomato) is the world's first tomato that has been approved as a gene-edited food, which uses CRISPR/Cas9 to enable a dense accumulation of GABA. In this presentation, we will report the background of the development of the GABA hyper-accumulating tomato as well as the results of an in-house monitoring survey conducted on the consumption of this tomato.

Methods:

Through gene editing technology, we have successfully modified the auto-inhibitor-domain of the glutamate decarboxylase gene to enhance its activity and high GABA tomatoes were produced. Thirteen in-house monitors (5 normotensive and 8 mildly hypertensive) were asked to consume the high GABA tomatoes starting in November 2021. High GABA tomatoes were consumed fresh or cooked, with a daily dosage of 5 tomatoes. The monitored participants had their home blood pressure measured twice a day, in the morning and at night, and their blood pressure was compared between the two weeks before and the two weeks after the start of tomato consumption.

Results:

High GABA tomatoes contain 95 mg/100 g of GABA, and eating 5 tomatoes per day provided approximately 100 mg of GABA.

No clinically significant blood pressure changes were observed in the five participants with average baseline home systolic blood pressure < 135 mmHg. When the eight participants with baseline systolic blood pressure > = 135 mmHg were divided into groups, the systolic blood pressure in 3 out of 4 subjects in the upper half decreased significantly (from 155 mmHg to 150 mmHg, Δ-4.6 mmHg). On the other hand, systolic blood pressure of the lower half of the hypertensives increased significantly in 2 subjects, but the mean did not change significantly (from 137 mmHg to 139 mmHg, Δ + 1.8 mmHg).

Conclusion:

While further study is necessary, the results suggest that Sicilian Rouge High GABA tomato may contribute to blood pressure reduction when consumed by hypertensive individuals.
PS-C24-1: EFFECTS OF ANGIOTENSIN RECEPTOR-NEPRILYSIN INHIBITOR ON CAROTID ARTERIAL IMT AND ELASTIC MODULUS, BAPWV IN HYPERTENSIVE PATIENTS WITH HEART FAILURE
Authors: Yamagishi Toshio
Published: January 2023

Objective:

Sacubitril/valsartan is a first-in-class, novel-acting, angiotensin receptor neprilysin inhibitor (ARNI) that provides inhibition of neprilysin and the angiotensin (AT1) receptor. Effects of Sacubitril/valsartan on carotid arterial IMT and elastic modulus, baPWV in hypertensive patients with heart failure

Methods:

Thirty-three hypertensive patients with chronic heart failure (mean age 79 years, male 15) were assigned to receive Sacubitril/valsartan (gradual increase depending on the condition) of Sacubitril/valsartan added to existing drug therapies (average number of antihypertensive agents 3) or switched from ARB or ACE inhibitor for 6 months. Changes in home BP, BNP, NT-proBNP, hANP, estimated glomerular filtration rate (eGFR), baPWV and central blood pressure (cSBP) were evaluated. EΘ was obtained by the phased-tracking method (Kanai, Circulation 2003). At four locations of bilateral common carotid arteries, IMT and Etheta; were measured simultaneously.

Results:

The basal values before Sacubitril/valsartan administration of Body weight(BW), BNP, NT-proBNP, hANP, EF, serum K, eGFR, home early morning blood pressure, home early morning heart rate, baPWV, cSBP, IMT, EΘ were 63 ± 16 kg and 310 ± 237 pg /,mL, 1981 ± 237 pg / mL, 475 ± 514 pg / mL, 51 ± 14%, 4.2 ± 0.4 mEq / L, 46 ± 14 ml / min / 1.73 m2, 141 ± 8/75 ± 11 mmHg, 76 ± 14 bpm, 1526 ± 245 cm / sec, 137 ± 13 mmHg, 0.84 ± 0.12 mm, and 301 ± 141 kPa respectively. ARNI s reduced BW (-4%), BNP (-32%), NT-proBNP (-38%), home early morning blood pressure-17 / -10mmHg, and baPWV (-4%) significantly (p < 0.05). In addition, EF (+ 5%) and hANP were significantly increased, and serum K and eGFR were unchanged. On the other hand, IMT (-5%) in carotid echo decreased, and EΘ decreased significantly.

Conclusions:

Sacubitril/valsartan was effective for BP control improved cardiac function and arterial stiffness in hypertensive patients with chronic heart failure. EΘ is a good surrogate marker for the early detection of vascular remodeling such as improvement of endothelial dysfunction prior to changes in IMT.
PS-C26-11: THERAPEUTIC EFFECTS OF ADDING THIAZIDE DIURETIC OR MINERAL CORTICOID RECEPTOR BLOCKER IN HYPERTENSIVE PATIENTS GIVEN ARB AND CALCIUM CHANNEL BLOCKER
Authors: Ishimitsu Toshihiko , Honda Takeaki , Tojo Akihiro , Rai Tatemitsu
Published: January 2023

We compared the addition of a thiazide diuretic (TZD) and a mineral corticoid receptor blocker (MRB) to in 13 hypertensive patients who did not achieve the target blood pressure level with the combination of an angiotensin II receptor blocker (ARB) and a calcium channel blocker (CCB). A randomized crossover study was performed giving 1–2 mg trichlormethiazide (TCM) or 1.25–2.5 mg esaxerenone (ESX) in addition to ARB and CCB combination for 12–16 weeks each. The office blood pressure was comparable between the high-dose TCM period (131/73 mmHg) and the ESX period (129/72 mmHg). The morning and the evening home blood pressures were also comparable in the TCM and the ESX periods. As for the laboratory data, serum Na (-1.2 mEq/L, p = 0.013) was significantly decreased and uric acid (+1.1 mg/dL, p < 0.001) was increased by TCM, while serum K was slightly increased by ESX (+0.2 mEq/L, p = 0.042). The estimated GFR was significantly reduced both by TCM and ESX (66 and 67 vs 72 mL/min/1.73m2, p = 0.023 and 0.047), however, ESX but not TCM significantly reduced the urinary excretions of albumin (81 vs 148 mg/gCreatinine, p = 0.035) and liver-type fatty acid binding protein. Reductions in plasma brain natriuretic peptide (BNP) and high-sensitivity C-reactive protein (CRP) were significant in the TCM and the ESX periods, respectively. Circulating markers of oxidative stress such as oxidized LDL and reactive oxygen metabolites were not affected by either TCM or ESX. In the combination drug therapy of hypertension, ESX, as a MRB, has a hypotensive effects comparable to TZD and may have advantage over in protecting kidney without raising uric acid although care should be taken for the increase in serum K.
PS-C27-11: HYPERTENSION AND LOW EGFR AMONG MALE OCCUPATIONAL AUTO-RICKSHAW DRIVERS FROM NORTH INDIA- SCREENING FOR CHRONIC KIDNEY DISEASE RISK FACTORS
Authors: Gupta Anish Kumar , Singh Narinder Pal , Khanna Tripti , Aggarwal Neeru P , Gandhi Pratibha , Kaul Shaurya , Sarkar Taposh , Khullar Dinesh
Published: January 2023

Objective:

To find out the prevalence of low estimated Glomerular Filtration Rate (eGFR) and major Chronic Kidney Disease (CKD) risk factors such as hypertension, Diabetes Mellitus, obesity among male occupational auto-rickshaw drivers as they are highly exposed to air pollution.

Design and method:

The study population included male auto-rickshaw drivers of more than or equal to 18 years of age and driving for at least one year. Participant's demography (height, weight, waist circumference), and blood pressure were measured and medical history, history of substance abuse, and occupation history was obtained in a structured questionnaire. Blood and urinalysis were performed for measurement of serum creatinine, uric acid, and proteinuria respectively. eGFR was measured using the CKD-EPI equation.

Results:

A total of 900 male auto-rickshaw drivers were enrolled in the study. Age varied from 19 to 75 (mean 39.56 ± 10.5 years). 59.6% had less than 15 years of experience in driving an auto-rickshaw (mean 13.1 ± 9.7 years) with daily working hours of 10.3 ± 2.1. Among 900 participants, 3.9% had low eGFR (less than 60 ml/min), and 8.7% had proteinuria (more than 30 mg/dl). Prevalence of CKD, hypertension, and diabetes was found to be 3.9% (stage - 1 to stage - 4; 6.4%, 1.3%, 3.4%, 0.5% respectively), 37% and 8.4% respectively. One-third (33.6%) of auto-rickshaw drivers were newly diagnosed with hypertension and 15 (2.7%) were new-onset diabetic. Around one-fourth (24.5%) of autorickshaw drivers were prevalent with hyperuricemia (serum uric acid more than 7 mg/dl) and 5% were anemic (Hb (less than 13 gm/dl). Approximately 42% of the participants were overweight or obese (BMI more than 25 kg/m2) and central obesity was found in 7.4% (more than 102 cm) participants. Tobacco products and alcohol use among auto/taxi drivers were high (63% and 23.5% respectively).

Conclusion:

High prevalence of CKD and associated risk factors such as hypertension, diabetes, obesity hyperuricemia, and anemia were observed in male occupational auto-rickshaw drivers. A routine screening program should be implemented for primary prevention and management of risk factors of CKD among such populations that are highly exposed to air pollution.
PS-P07-4: THE USE OF SPECIFIC ANTIHYPERTENSIVE MEDICATION AND SKIN CANCER RISK: A SYSTEMATIC REVIEW OF THE LITERATURE AND META-ANALYSIS
Authors: Heisel Annalena GU , Vuurboom Mart D , Daams Joost G , de Rie Menno A , Vogt Liffert , van den Born Bert Jan H , Engberink Rik HG Olde
Published: January 2023

Objectives:

The use of hydrochlorothiazide has recently been linked to skin cancer in observational studies. This may be explained by its photosensitizing properties, but photosensitivity has also been reported for other antihypertensive drugs. We conducted a systematic review and meta-analysis to compare skin cancer risk among antihypertensive drug classes and between individual blood pressure lowering drugs.

Methods:

We searched Medline, Embase, Cochrane and the Web of Science to 9th of February 2022 and included studies that investigated the association between antihypertensive medication exposure and non-melanoma skin cancer (NMSC) or cutaneous malignant melanoma (CMM). We combined the extracted adjusted odds ratios (OR) using a random effects model. We performed sensitivity analyses comparing study type, population and studies with and without correction for important covariates.

Results:

We included 43 studies. Diuretics (n = 17,729,595), in particular hydrochlorothiazide (n = 17,710,679), and calcium channel blockers (CCB, n = 8,413,919) were examined more frequently than beta-blockers (n = 94,872) or renin-angiotensin system inhibitors (n = 2,019,786). Exposure to diuretics (OR 1.30, 95% CI [1.12–1.52]) and CCB (OR 1.06, 95% CI [1.04–1.09]) was associated with an increased risk for NMSC. No antihypertensive drug class was associated with an increased risk for CMM. Within every drug class, at least 1 individual drug was associated with an increased risk for NMSC: nifedipine, hydrochlorothiazide, sotalol, verapamil, enalapril and bendroflumethiazide. Increased NMSC risk was only observed in case-control studies and in studies that did not correct for important covariates. No increased NMSC risk was observed in cohort studies and studies that did correct for the covariates sun exposure, skin phototype or smoking. (Figure) Only 2 out of 43 studies provided information about antihypertensive co-medication. Eggers test revealed a significant publication bias for the subgroup of diuretics and hydrochlorothiazide concerning NMSC (both p < 0.001).

Conclusion:

Of all antihypertensive drugs, diuretics and calcium channel blockers may be associated with an increased risk of NMSC, but causal inferences remain difficult to make because of aforementioned substantial limitations in available data and evidence of publication bias.
PS-P08-2: FACTORS RELATED TO PARTICIPATION IN HEALTH CHECKUPS AMONG MIDDLE-AGED JAPANESE COMMUNITY RESIDENTS IN THE PRECONTEMPLATION STAGE
Authors: Sonoda Nao , Furuki Hideaki , Morimoto Akiko
Published: January 2023

Objective:

In Japan, all medical insurers are obliged to conduct annual specific health checkups. These checkups are part of the National Health Service system and target all insured people aged 40–74 years and aim to facilitate prevention and early detection of atherosclerosis-related diseases such as hypertension, diabetes, and dyslipidemia. However, the participation rate in specific health checkups is low in Japan, especially among middle-aged community residents with municipal National Health Insurance (NHI). Additionally, previous studies suggested that those in the precontemplation stage were at higher risk for non-participation in health checkups. Therefore, this study explored the factors related to participation in specific health checkups among middle-aged Japanese community residents with NHI in the precontemplation stage.

Design and Method:

This cross-sectional mail survey was conducted in 2020 that involved all community residents with municipal NHI aged 40–64 years in five cities in three areas of A Prefecture, Japan. This survey included 33,902 community residents, and 12,446 (36.7%) agreed to participate in the survey. After selecting those without missing data (n = 11,180) and those in the precontemplation stage, the analysis included 2,892 participants. Participants were classified into a participation group and a non-participation group. Those who selected “I underwent a specific health checkup in the past year” were classified as the participation group. The study protocol was approved by the Institutional Review Boards. Informed consent was obtained from all participants who were included in this study.

Results:

In this study, 994 (34.4%) participants were classified in the participation group, and 1,898 (65.6%) were classified in the non-participation group. Multivariable logistic regression analysis revealed factors related to participation in health checkups among those in the precontemplation stage. The factor with the highest odds ratio (OR) for participation in specific health checkups was recommendations from primary care physicians to participate in specific health checkups [multivariable-adjusted OR 3.19, 95% CI 2.45–4.15, presence of recommendations vs. absence of recommendations], followed by recommendations from public health nurses [multivariable-adjusted OR 2.07, 95% CI 1.26–3.41, presence of recommendations vs. absence of recommendations], and self-reported economic status [multivariable-adjusted OR 1.82, 95% CI 1.48–2.24, good vs. poor].

Conclusions:

In particular, recommendations from primary care physicians and public health nurses might be important factors related to participation in health checkups among middle-aged Japanese community residents with NHI in the precontemplation stage.