bluuebunny/crossref_metadata_2025 huggingface dataset:
PS-BPB10-6: THE RELATION BETWEEN PERICYTE DETACHMENT AND INTERSTITIAL FIBROSIS IN DAHL SALT-SENSITIVE HYPERTENSIVE (DAHLS) RATS
Authors: Ito Hiroki , Hirose Takuo , Sato Shigemitsu , Endo Akari , Yabana Ikuko Oba , Takahashi Kazuhiro , Mori Takefumi
Published: January 2023

Background:

Congestive heart failure produces the state of fluid volume overload, central venous pressure (CVP) elevation, and consequently renal venous pressure (RVP) elevation. We have recently developed a novel rat unilateral renal venous congestion model, in which ligation of the inferior vena cava between both renal veins artificially induced renal congestion in the left kidney only. In this model, pericyte detachment and pericyte-myofibroblast transition (PMT) around the vasa recta were involved in interstitial injury and fibrosis. Dahl salt-sensitive hypertensive (DahlS) rats on high salt diets exhibit hypertension, congestive heart failure, fluid volume overload, CVP and RVP elevation, and renal damage, considering to be a non-artificial renal congestion model. The relation, however, between renal interstitial injury and fibrosis, elevated RVP, and pericyte detachment in DahlS rats has not been reported. In the present study, we assessed the relation of pericyte detachment around the vasa recta and PMT with interstitial fibrosis in DahlS rats.

Methods:

Eight-week-old DahlS rats (Dahl/Mcwi) were divided into three groups: normal diet, 4% NaCl diet, and 8% NaCl diet groups, and their kidneys were analyzed after 2 weeks. Total mRNA and protein expression levels were quantified by real-time PCR and western blot, respectively. Tubulointerstitial damage and fibrosis were identified by histological analysis. Furthermore, we evaluated pericyte detachment around the vasa recta by low-vacuum scanning electron microscopy (LV-SEM).

Results:

The expression of KIM1, a tubulointerstitial damage marker; CNN1 and αSMA, interstitial fibrosis markers; and TAGLN, a smooth muscle protein22 and PMT marker; was significantly increased in a salt-dependent manner in DahlS rats. In histological analysis, hyperplasia of the extracellular matrix and renal tubular injury were detected in 4% and 8% NaCl diet groups. The positive area of PMT markers in the interstitial space around the vasa recta was also increased in the NaCl diet groups. Pericyte detachment from the vasa recta was observed in the NaCl diet groups by LV-SEM.

Conclusions:

Pericyte detachment and PMT are involved in tubulointerstitial injury and fibrosis of DahlS rats. Renal venous congestion and subsequent physiological changes could have a role in renal damage and fibrosis. Arterial hypertension has been emphasized for a long time in renal injury, and venous hypertension must also be focused on with the concept of renal congestion. Further understanding of this concept may lead to new therapeutic strategies for renal injury.
PS-BPC03-5: OFFICE AND HOME BLOOD PRESSURE AND CARDIOVASCULAR DISEASE IN PATIENTS WITH DIABETES, PREDIABETES AND NORMAL GLUCOSE METABOLISM
Authors: Suzuki Daisuke , Hoshide Satoshi , Kario Kazuomi
Published: January 2023

Objective:

Few studies have investigated whether the association between home blood pressure (BP) and cardiovascular disease (CVD) events is different according to prediabetes and diabetes populations.

The main purpose of this study is to clarify the impact of home BP and office BP on CVD events in prediabetes and diabetes.

Design and method:

We used the database of the J-HOP (Japan Morning Surge-Home Blood Pressure) study, which enrolled 4,310 patients having at least one cardiovascular risk. We classified the patients with a self-reported clinical history of a physician's diagnosis, using of medication of diabetes mellitus, a fasting plasma glucose greater than or equal to 126 mg/dL, a casual plasma glucose level greater than or equal to 200 mg/dL or hemoglobin A1c (HbA1c;NGSP) greater than or equal to 6.5 % as diabetes (n = 1,034), those with HbA1c 5.7–6.4 % as prediabetes (n = 1,167), and the remaining patients as the patients with normal glucose metabolism (NGM) (n = 2,024). Outcome was measured against composite CVD outcome (first occurrence of coronary artery disease, stroke and heart failure).

Results:

During a median 6.2 ± 3.8 year follow-up, 259 CVD events occurred. Prediabetes was a risk of CVD events (Unadjusted Hazard ratios [uHR],1.43; 95% confidence interval [CI], 1.05–1.95) and this association was followed by diabetes (uHR, 2.13; 95%CI, 1.59–2.85) compared to NGM. In NGM group, the adjusted HR expressing the risk of composite CVD events, were 1.15 (95%CI, 1.01–1.31) and 1.18 (95%CI, 1.03–1.36), 1.01(95%CI, 0.88–1.15) per 10 mmHg increase of morning and evening home systolic BP (SBP), office SBP, respectively. In diabetes, increased home SBP as a risk of composite CVD events had similar tendency and office SBP was also associated with a risk of CVD (adjusted HR, 1.16; 95%CI, 1.02–1.31). In prediabetes group, only morning home SBP was associated with a risk of CVD events (uHR, 1.15; 95%CI, 1.00–1.31), but was not in adjusted model.

Conclusion:

Prediabetes was a risk for CVD events as well as diabetes. Increased home BP contributes to CVD risk in diabetes, albeit weakly in prediabetes.
PS-BPC05-5: ATRIAL FIBRILLATION PREVALENCE IN HOSPITALIZED PATIENTS WITH CORONARY ARTERY DISEASE AND HYPERTENSION: A CROSS-SECTIONAL STUDY 2008–2018
Authors: Xin Qian , Wang Chi , Xue Hao
Published: January 2023

Background:

The prevalence of inpatients with comorbid of hypertension and coronary artery disease (HT-CAD) and AF are largely unknown. The aim of our study is to investigate the prevalence and clinical characteristics of patients with comorbid of HT- CAD and AF.

Methods:

This cross-sectional study was conducted in Chinese PLA General Hospital in Beijing, China, and included 20,747 HT-CAD inpatients with or without AF from August 2008 to July 2018. We explored the overall prevalence, clinical characteristics, comorbidity profiles, treatment patterns and blood pressure control of patients with HT-CAD and AF. Multivariate logistic regression was used to investigate the association of cardiovascular risk factors and AF in patients with HT-CAD.

Results:

The overall prevalence of AF in patients with HT-CAD was 4.9%, and increased with age. The AF prevalence was increased from 0.78% and 1.02% in aged < 45years old to 8.83% and 10.28% in age > 65 years for women and men, respectively. HT-CAD patients with AF had higher incidence of cardiovascular-related comorbidities than those without AF. Multivariate logistic regression showed that age, men, obesity, heart failure, and chronic kidney disease were independently associated with the risk of AF in HT-CAD patients. In patients with HT-CAD and AF, 73.4% of the subjects had CHA2DS2-VASc score > = 4, indicating a high risk of thrombo-embolism stroke. However, the use of oral anticoagulation (OAC) increased during the study period (6.0% vs 22.5%, p < 0.01), but remained at a relatively low level.

Conclusion:

Patients with comorbid of HT-CAD and AF had higher prevalence, with more cardiovascular-related comorbidities and lower the use of OAC. Emphasizing of OAC therapy and cardiovascular-related comorbidities management are urgent needs to reduce the recurrence of cardiovascular events.
PS-BPC05-7: HEMODYNAMIC MANAGEMENT OF RESISTANT HYPERTENSION
Authors: Lozsan Francisco Jose Chacon , Rojas Ruben Dario , Rodriguez Maryan Johanna
Published: January 2023

Background:

Hypertension is the most prevalent chronic disease worldwide and is related to a high probability of cardiac disease, kidney disease and cerebrovascular events. Blood pressure measurement was used in the last decades to diagnose and guide antihypertensive therapy; however blood pressure is the result of the interaction of more complex hemodynamic parameters previously reserved for experimental studies or critical care patients management using invasive methods. Since 1996 few studies have proposed the use of hemodynamic parameters to classify and guide hypertension therapy with good results.

Purpose:

The present study's purpose was to measure hemodynamic parameters in patients with non-controlled resistant hypertension and use it to guide pharmacologic treatment to archive control blood pressure values according to the European Society of Cardiology guidelines.

Methods:

A total of 84 patients between 32 and 95 years old diagnosed with non-controlled primary resistant hypertension were recruited and after previous therapy washout hemodynamic parameters were measured using noninvasive

Methods:

preload by central venous pressure (CVP) using inferior vena cava diameter, cardiac index and systemic vascular resistance using Lyljestrand & Zander modified formula. Patients were classified into 3 basic groups depending on which parameter was above normal value: hyperdynamic (HD) for high cardiac index > 3.5 L/min/m2, fluid overload (FO) for CVP > 8cmH2O and high systemic vascular resistance index (HSVRi) > 2500 dynes/sec/m2/cm5, also 3 combined groups were a patient had 2 simultaneous hemodynamic alterations (HD+FO, HD+HSVRi and FO+HSRVi), according to this classification pharmacotherapy was guided indicating Bisoprolol in HD group, Amlodipine to HSVR patients and Hydrochlorothiazide to FO patients, in combined groups, combined therapy was given. Patients were observed for 6 months period taking as primary endpoint blood pressure control, acute cardiovascular events and hypotension.

Results:

A significant reduction of hemodynamic parameters and blood pressure was observed in the first month of treatment obtaining a 100% hemodynamic and blood pressure goals in all patients in the third month of therapy without hypotension or acute cardiovascular event during this period, the HD+FO group reach goals at the 6th month of treatment without reported complications.

Conclusions:

In this preliminary study we observed that hemodynamic guided high blood pressure control may be a valuable tool for a better understanding, classification and treatment in patients with resistant hypertension; however larger outcome studies confirm this hypothesis.
PS-BPC06-8: FACTORS ASSOCIATED WITH POTENTIAL COGNITIVE FUNCTIONAL CHANGES IN OLDER PATIENTS WITH HYPERTENSION
Authors: Akasaka Hiroshi , Yamamoto Koichi , Yasunobe Yukiko , Shimizu Atsuya , Kozaki Koichi , Kuzuya Masafumi , Ohishi Mitsuru , Akishita Masahiro , Rakugi Hiromi
Published: January 2023

Objective:

There are many cases of potentially impaired cognitive function in older patients with hypertension. Therefore, we investigated factors associated with one-year changes in cognitive function in older hypertensive patients during outpatient visits.

Design and method:

We included 223 hypertensive patients (age 76.3 ± 6.3 years, 106 males) aged 65 years or older who attended outpatient hypertension clinics at six specialized institutions nationwide and had no prior diagnosis of dementia. We obtained the mini-mental state examination (MMSE) from all participants. We defined the impaired cognitive function as an MMSE score of 27 or less. At baseline and one year later, the participants were evaluated for comprehensive geriatric assessment, including MMSE, and muscle strength, with the converted group defined as having new cognitive decline at one year and the reverted group as having cognitive improvement one year after the cognitive decline. All participants gave informed consent, and our institutional review board approved the study protocol.

Results:

At baseline, 81 of 223 elderly hypertensive patients had impaired cognitive function. At one-year follow-up, 40 of 142 patients in the maintained cognitive function group were classified as converted, and 33 of 81 patients in the impaired cognitive function group were classified as converted. The converted group was older than the cognitively intact group (76.8 vs. 73.9 years, p < 0.05), had higher home blood pressure, and had more significant grip strength loss over the year. Multivariate analysis identified age (odds ratio 1.1, 95% CI 1.0–1.2) and change in grip strength (odds ratio 0.84, 95% CI 0.72–0.99) as factors associated with the converted group. The reverted group was younger, had a higher percentage of males, and had weaker grip strength than the group with persistent cognitive decline. In multivariate analysis, grip strength (odds ratio 0.80, 95%CI 0.68–0.94) was extracted as a factor associated with the revert group.

Conclusions:

Potential cognitive decline was observed in 36% of older patients with hypertension. Furthermore, we examined a high rate of cases of cognitive function change over one year. Age and grip strength decline was considered responsible for cognitive conversion and baseline grip strength for revert, respectively.
PS-BPC06-10: FATTY LIVER INDEX AND CARDIOVASCULAR RISK IN HYPERTENSIVE PATIENTS
Authors: Siafi Eirini , Andrikou Ioannis , Thomopoulos Costas , Konstantinidis Dimitrios , Kakouri Niki , Tatakis Fotis , Kariori Maria , Filippou Christina , Zamanis Ioannis , Manta Eleni , Drogkaris Sotirios , Liatakis Ioannis , Polyzos Dimitrios , Tsioufis Konstantinos
Published: January 2023

Objective:

The prevalence of nonalcoholic fatty liver disease (NAFLD) has been increasing rapidly worldwide affecting 25–30% of population. Fatty liver index (FLI) is a validated marker of NAFLD and can be used as a screening tool for hepatic steatosis. The purpose of the study was to evaluate the relationship between FLI and the risk of major cardiovascular events in hypertensive patients.

Design and method:

903 hypertensive patients without history of cardiovascular disease participated in the study (mean age 52.7 ± 11.4 years; males 55%; baseline clinic BP 149.8 ± 15.2/95.5 ± 10.1 mmHg). Participants were prospectively evaluated for a mean follow-up period of 6.0 ± 3.3 years with at least one annual visit. The diagnosis of NAFLD was based on FLI and consequently patients were divided in two groups according to the presence of NAFLD. The primary endpoint was a composite of major cardiovascular events.

Results:

The incidence of cardiovascular events during the follow up was 8.5% (n = 77). Patients without NAFLD (n = 625) had better BP control compared to their counterparts with NAFLD (n = 278) during follow up (43% vs 33%, p = 0.02). A Cox-regression analysis indicated that age (hR 1.09 CI 1.04–1.13, p < 0.01), smoking (hR 2.4 CI 1.1–5.2, p = 0.03) and FLI (hR 2.7 CI 1.9–4.1, p < 0.001) were significant independent determinants of the outcome. The presence of NAFLD at baseline visit was also a significant independent determinant of the outcome (hR 5.2 CI 2.4–11.1, p < 0.001).

Conclusions:

In conclusion, FLI has an independent prognostic value for the incidence of cardiovascular events in hypertensive patients. Therefore, it could be useful in identifying patients at higher risk of cardiovascular events. Further studies will clarify whether the early treatment of NAFLD could reduce the incidence of cardiovascular disease.
PS-BPC07-5: A REAL-WORLD ANALYSIS OF PHARMACO-UTILIZATION AND OUTCOMES OF PATIENTS ON PERINDOPRIL/AMLODIPINE/INDAPAMIDE FREE VS SINGLE-PILL COMBINATION IN ITALY
Authors: Borghi Claudio , Jayagopal Pathiyil Balagopalan , Konradi Alexandra , Bortolotto Luiz Aparecido , Esposti Luca Degli , Perrone Valentina , Snyman Jacques R
Published: January 2023

Objective:

To evaluate and compare medication adherence, cardiovascular (CV) events and mortality incidence among 2 cohorts of patients treated with Perindopril/Amlodipine/Indapamide (PER/AML/IND) as a free or single-pill combination in a real-world setting in Italy.

Design and method:

Data were extracted from administrative databases of Italian Healthcare Entities. Adult patients treated with PER/AML/IND as single-pill or free combination (during the period 2010–2020) were included and categorized into 2 cohorts. The index date (ID) corresponded to the first prescription of a single-pill combination (single-pill cohort) or the first prescription of the 3 drugs simultaneously (within 30 days) (free cohort). Patients were characterized in the year prior to ID and followed up from ID to the end of data availability. Patients who died during the first 12-month period were excluded. Propensity score matching (PSM) was applied to minimize selection bias and to reduce potential imbalances between the two cohorts. Adherence was calculated as the proportion of days covered (PDC: PDC < 40% non-adherence; PDC = 40–79% partial adherence; PDC> = 80% adherence). Incidence of mortality and CV events was analyzed after the first year of follow-up and reported as event rate per 1,000-person/year.

Results:

The analysis included 37,365 patients (54.3% male) in the single-pill cohort and 6,105 (50.8% male) in the free cohort. The post-PSM cohorts were balanced for their characteristics and comprised 6,105 (free-cohort) and 12,105 (single-pill-cohort) patients. The adherence to medication (PDC > = 80%) was better in the single-pill cohort compared to the free cohort (59.9% vs 26.9% adherent patients, p < 0.001). Accordingly, there were more non-adherent patients in the free (54.0%) than in the single-pill (20.8%) cohort (p < 0.001), while similar values were observed for partial adherence (19%, both cohorts). The mortality rate was higher in the free-cohort versus single-pill-cohort patients (33.7 vs 29.9 per 1,000-person/year, p < 0.05). The same effect was reported for incidence of death and CV events as a composite endpoint: 139.0 (free-cohort) versus 105.8 (single-pill-cohort) per 1,000-person/year (p < 0.001).

Conclusions:

This real-world analysis among hypertensive patients showed that the treatment with PER/AML/IND as a single-pill, as opposed to free combination, could be associated with better medication adherence in the single-pill cohort at one year and with a lower incidence of cardiovascular events and mortality.
PS-BPC07-9: BLOOD PRESSURE LOWERING EFFICACY OF THE HYPERTENSION EDUCATION PROGRAM OF THE GERMAN SOCIETY OF HYPERTENSION AND PREVENTION
Authors: Hausberg Martin , Krämer Bernharnd , Sanner Bernd , Tholl Ulrich , Krieger Horst , Zidek Walter , Krönig Bernd , Lohmann Friedrich , Eckert Siegfried
Published: January 2023

Objective:

In 2013 the German Society of Hypertension and Prevention initiated a hypertension education program (HEP) - Mein Blutdruck - OK!

(https://www.hochdruckliga.de/hypertonie-schulung-fuer-patienten.html).

The objective of this study was to evaluate the blood pressure lowering efficacy of the HEP.

Design and method:

The HEP consists of 5 modules (blood pressure regulation, non-pharmacological treatment 1 and 2, pharmacological treatment, adherence) of group (4–6 patients) teaching, held by trained physicians and medical staff who underwent a specially designed train the trainer program. Each module consisted of 90 minutes training and patients underwent all 5 modules within 4 weeks.

The validation study was performed in 8 hypertension outpatient clinics. Patients with mild (stage 1) hypertension, treated or untreated were included, and pharmacologic antihypertensive treatment was not altered during 6 months. The clinics were randomized to HEP or standard care. Blood pressure was monitored at baseline and after 6 months by standardized office measurements, home measurements (automatic oscillometric device, patients training) and 24 h ABPM. Primary endpoint was an at least 5 mmHg greater reduction of systolic office blood pressure by HEP compared to usual care.

Results:

4 hypertension outpatient clinics were randomized to HEP, including 35 patients, 4 hypertension outpatient clinics were randomized to usual care, including 53 patients in the study. ABPM data were available in only 71 out of 88 patients. Data are presented in tables 1 and 2.

Conclusion:

The HEP resulted in significantly greater reductions of office and home blood pressure values as compared to usual care. The primary endpoint was met. Changes in ABPM daytime means did not differ significantly between groups, possibly due to insufficient available data. These results were obtained in patients with mild hypertension, either treated or untreated, and may differ in patients with severe or resistant hypertension.
PS-BPC08-1: VALIDATION OF PRIMARY ALDOSTERONISM DIAGNOSIS DURING THE TRANSITIONAL PERIOD OF ALDOSTERONE ASSAY AND GUIDELINE CHANGES IN JAPAN
Authors: Yoshida Sumiko , Endo Furi , Toujima Yuuki , Asai Takahito , Yamagami Hiroki , Hara Tomoyo , Mitsui Yukari , Kurahashi Kiyoe , Endo Itsuro , Fukumoto Seiji , Abe Masahiro
Published: January 2023

Objectives and Methods:

In Japan, the plasma aldosterone concentration (PAC) measurement method was changed from RIA to CLEIA method in April 2021. From then until August 2021, when the 2021 clinical practice guidelines for the diagnosis and management of primary aldosteronism (PA) were published, we diagnosed PA using the RIA-converted PAC value (conversion formula from CLEIA (X) to RIA (Y): Y = 1.174X + 42.3) and the conventional positive decision criteria of the screening and confirmatory tests in PA diagnosis. The new criteria were then used to re-determine and confirm the agreement.

Results:

PAC(CLEIA) and renin activity (PRA) or active renin concentration (ARC) were measured simultaneously for PA screening at our hospital from April to August 2021 in 122 patients (135 measurements in total). PAC values (CLEIA) were less than 4 pg/mL in 21 measurements (16%). This value was converted to PAC(RIA) at 47 pg/mL based on the formula. (i) PA screening tests: 10% of the measurements were found to be ‘not excluded’ by the conventional criteria and negative by the new criteria. This was due to the fact that the calculated PAC(RIA) values were higher than they should be when the conversion formula to RIA was applied to cases with low PAC(CLEIA) values, resulting in higher estimated ARR values (PAC(RIA)/PRA or PAC(RIA)/ARC ratio). (ii) PA confirmatory tests: In the captopril challenge test, one case was found to be positive by the conventional criteria and negative by the new criteria due to the same reason as that on point (i). In the saline infusion test, PAC(CLEIA) of 12–15 pg/mL was determined to be less than PAC(RIA) 60 pg/mL by the conversion formula, which was deemed negative by the conventional criteria but borderline by the new criteria. (iii) PA diagnosis using the confirmatory tests: In one case, the diagnosis did not match the positive (borderline) classification based on the new criteria, although the patient was deemed negative by the conventional criteria. This was due to discrepancies of the saline infusion test results.

Conclusion:

During the transition period of PA diagnosis from the RIA to CLEIA method, it was necessary to review the data and retest the patients according to their symptoms because of possible inconsistencies between the new and conventional criteria-based diagnostic results. PA diagnosis and treatment should be judged comprehensively on a case-by-case basis, without relying entirely on the values of the criteria.
PS-BPC09-2: EFFECTIVENESS OF OROPHARYNGEAL EXERCISES AND PRANAYAMA ON BLOOD PRESSURE, AND QUALITY OF SLEEP AMONG HYPERTENSIVE WITH MODERATE OBSTRUCTIVE SLEEP APNEA.
Authors: Kaur Amrit , Mitra Mahesh , Msp Ganesh
Published: January 2023

Introduction and Objectives:

Burden of cardiovascular disease around the global is a major health concern and prevalence is high in adults with obstructive sleep apnea (OSA). Lowering blood pressure (BP) can greatly reduce cardiovascular disease risk and lifestyle modification including regular physical activity is routinely prescribed to achieve this goal. The relationship between sleep disordered breathing especially obstructive sleep apnea (OSA) and hypertension has been well investigated in both cross sectional and longitudinal studies. Many people with OSA suffer from severe fatigue and daytime sleepiness with poor exercise intolerance due to poor sleep quality and nocturnal hypoxemia. The objectives of this study was To evaluate the efficacy of a 6 week oropharyngeal exercises and Pranayama training program for reducing blood pressure and improving sleep quality in hypertensive patients with OSA .

Design and method:

This is a single site double blind randomized clinical trial. Total 40 patients with history of hypertension and moderate sleep apnea were selected that further divided into two groups oropharyngeal exercises and Pranayama group and control group. Patients were evaluated at study entry and at end by evaluating blood pressure pulse rate anthropometric measurements snoring frequency (range 0 to 4) and Pittsburgh sleep quality (0 to 21) questionnaires.

After initial evaluation oropharyngeal exercises and Pranayama along with regular brisk walking for 30 to 40 mins 5 days in week is prescribed to experimental group. Pranayama consists of three phases: Puraka (inhalation) kumbhaka (retention) and rechaka (exhalation) that can be either fast or slow. Oropharyngeal exercises refers to 12 exercises of the 20 minutes duration involving tongue (4 exercises) soft palate (2 exercises) jaw (2 exercises) and lateral pharyngeal wall (4 exercises) to be performed twice a day for 6 weeks. The exercises were taught individually and were supplemented with a pamphlet for reinforcement. And only regular brisk walking for 30 to 40 mins 5 days in week is prescribed to control group.

Results:

Experimental group significantly (p < 0.05) decreased systolic & diastolic blood pressure snoring neck circumference and improved sleep quality. Heart rate changes were insignificant (p = 0.9).

Conclusions:

Oropharyngeal exercises and Pranayama are effective in reducing blood pressure and snoring in hypertensive patients with moderate OSA. Its also effective in improving in quality of sleep in these patients.
PS-BPC09-3: THE ASSOCIATION BETWEEN THE FRAILTY CLASSIFICATION AND ANTIHYPERTENSIVE TREATMENT IN OLDER PATIENTS: A CROSS-SECTIONAL STUDY.
Authors: Akasaka Hiroshi , Yasunobe Yukiko , Onishi Yuri , Minami Tomohiro , Sugimoto Ken , Yamamoto Koichi , Rakugi Hiromi
Published: January 2023

Objective:

The prevalence of frailty and hypertension are both increases with age. However, the treatment target in older hypertensive patients with frailty has not yet been clearly defined. Therefore, we conducted a registry study to clarify the current status of antihypertensive treatment for older patients at our institution.

Design and method:

We recruited the study participants from consecutive patients who visited the Department of Geriatrics and Hypertension, Osaka University Hospital, between April 2012 and March 2022 and underwent physical function tests and comprehensive functional assessment. We obtained the data on blood pressure and treatment regimen from the medical record. All participants gave informed consent, and our institutional review board approved the study protocol. We defined frailty according to the Japanese version of the cardiovascular health study (J-CHS) criteria. Then, we performed a cross-sectional analysis of frailty and antihypertensive treatment.

Results:

The participants were 1,228 (537 men, aged 75.1 + /-8.5 years), classified according to the J-CHS criteria: 234 (19.0%) robust, 778 (63.4%) pre-frail, and 216 (17.6%) frail. The percentage of antihypertensive medication use was lower in the order of frail/ pre-frail/ robust (chi-square 6.71, p = 0.035). Blood pressure levels were not associated with the frailty classification. When examined by gender, neither antihypertensive treatment nor blood pressure was associated with frailty classification in women. On the other hand, in men, the antihypertensive treatment decreased with an increasing degree of frailty, and blood pressure values and pulse pressure tended to increase. Still, the mean office blood pressure in the male frailty group was 127/69 mmHg. The association between frailty classification and antihypertensive medication remained significant after adjustment for age and gender.

Conclusions:

At our institution, we found that antihypertensive prescriptions have decreased with the degree of frailty in older patients, especially men. The reasons for withholding antihypertensive treatment for frail older patients and its impact on the risk of cardiovascular disease require further investigation.
PS-BPC09-4: THE FACTORS RELATED TO HYPERTENSION IN YOUNG MALE ATHLETES
Authors: Yasuda Hisayo , Yasuda Osamu , Ohishi Mitsuru
Published: January 2023

Objective:

There are many studies on hypertension in middle-aged or older athletes, however few studies in young athletes are reported. The purpose of this study is to clarify the factors related to hypertension in young athletes.

Design and Methods:

The subjects are 256 young male athletes (18.3 ± 1.0 years) of the College of Physical Education. Physiological measurement data and blood samples as fasting status were collected at the time of admission by medical checkup. Muscle mass was evaluated by bioelectrical impedance.

Results:

Mean height was 172.0 ± 6.4 cm, body weight (BW) 69.3 ± 11.8 kg, body mass index (BMI) 23.4 ± 3.3 kg/m2, systolic blood pressure (SBP) 123.8 ± 12.0 mmHg, and diastolic blood pressure (DBP) 63.4 ± 8.5 mmHg. Using the severity classification of the Japanese Society of Hypertension Guidelines 2019, there were 83 normal blood pressure (BP), 74 high normal BP, 91 elevated BP, 7 grade I hypertension, and grade II hypertension or higher were not present.

We investigated correlations between physiological, laboratory parameters and blood pressure (BP). SBP had significant correlations with body surface area (p < 0.001), height (p < 0.01), weight (p < 0.0001), BMI (p < 0.0001), muscle mass (p < 0.0001), Heart Rate (HR) (p < 0.0001), Red blood cell (p < 0.05), and uric acid (p < 0.01). SBP showed no significant correlations with LDL-cholesterol, hemoglobin, fasting blood glucose, AST, ALT, Cr, eGFR. Multiple regression analysis showed that only BW and HR were significantly associated with SBP (y = 89.63 + 0.329 × BW + 0.16 × HR, p < 0.0001). Blood pressure in young athletes is associated with body weight. Strength-trained athletes such as judo are heavier than endurance trained athletes, and tend to have a high percentage of people with high blood pressure. Subsequent years of strength-trained exercise can lead to hypertension.

Conclusions:

Prehypertension and hypertension in young athletes are more strongly associated with body weight than lipids and blood glucose levels. The type of sport, strength-trained or endurance-trained, may affect the development of hypertension.
PS-BPC10-1: SAFETY AND EFFICACY OF USING CEREAL FOOD (FRUGRA®) TO IMPROVE BLOOD PRESSURE AND BOWEL HEALTH IN PATIENTS WITH CKD
Authors: Okuma Teruyuki , Ueda Seiji , Kobayashi Takashi , Nagasawa Hajime , Otsuka Tomoyuki , Nakata Masami , Sato Koji , Kaifu Kumiko , Matsushita Satoshi , Murakoshi Maki , Gohda Tomohito , Suzuki Yusuke
Published: January 2023

Background:

Hypertension is known to increase the risk of developing cardiovascular disease, chronic kidney disease (CKD), and death. One of the main causes of hypertension is excessive salt intake. Frugra®, a cereal food that has a low salt content of 0.5 g per serving, may help reduce salt intake. Additionally, Frugra is rich in dietary fiber, thereby beneficial for CKD patients.

Methods:

We enrolled 11 patients who underwent maintenance hemodialysis (HD), and 20 non-dialysis CKD patients. The usual breakfast was replaced with Frugra for 8 weeks, and the effects on blood pressure, urinary toxins, bowel movements, and body composition were examined.

Results:

In HD patients, Frugra reduced BNP and significantly decreased systolic and diastolic blood pressure. In addition, almost all subjects showed improved bowel movements, and blood levels of indoxyl sulfate, a urea toxin derived from intestinal bacteria, were significantly reduced. In non-dialysis CKD patients, decreasing blood pressure levels, improvement in stool characteristics measured by bristol scale and improvement in bowel movements and indoxyl sulfate levels were also tended to be decreased.

Conclusion:

These results suggest that intake of Frugra in patients with CKD could be a useful tool for health and may contribute to the prevention of cardiovascular disease by correcting blood pressure and fluid retention, improving the intestinal environment, and lowering urinary toxins.
PS-BPC11-1: ASSOCIATION BETWEEN INCREASED ABDOMINAL CIRCUMFERENCE AND FUTURE DEVELOPMENT OF HYPERTENSION IN MILDLY OBESE MIDDLE-AGED INDIVIDUALS
Authors: Ninomiya Yuichi , Kawasoe Shin , Kubozono Takuro , Tokushige Akihiro , Ichiki Hitoshi , Ikeda Yoshiyuki , Miyahara Hironori , Tokushige Koichi , Ohishi Mitsuru
Published: January 2023

Objective:

While increased abdominal circumference is reportedly associated with an increased risk of hypertension, few studies have examined sex-specific differences in this relationship. Here, we investigated sex-specific differences in the association between increased abdominal circumference and future development of hypertension.

Design and method:

Among 53,281 middle-aged (40 to 59 years old) individuals who underwent a health examination at least once between 2007 and 2014, we examined 890 of 1,744 individuals with mild abdominal obesity (above the median waist circumference) because examination data at 3- and 8-year follow-ups for these individuals were available. Propensity score (PS) matching, based on the first examination data, was used to match participants with an increased waist circumference (IWC; ≧ 3 cm at the 3-year time point, IW group) with those not meeting this criterion (non-IW group). Variables, such as age, body mass index, smoking status, alcohol consumption, estimated glomerular filtration rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and hypertension (defined as SBP ≧ 140 mmHg and/or DBP ≧ 90 mmHg), were used for PS matching. Blood pressure and hypertension incidence were compared between two groups at the 8-year time point.

Results:

PS matching resulted in 91 men and 85 women in each group. In men, SBP and hypertension incidence at the 8-year time point were significantly higher in the IW than in the non-IW group (SBP: 126.2 ± 12.8 vs. 121.7 ± 14.8 mmHg, P < 0.05; hypertension incidence: 44.0% vs. 27.5%, P < 0.05). In women, there were no significant differences in these two parameters between the two groups (SBP: 123.3 ± 15.8 vs. 120.2 ± 16.8 mmHg, P = 0.22; hypertension incidence: 24.7% vs. 29.4%, P = 0.49).

Conclusions:

A sex-specific association between increased abdominal circumference and future development of hypertension was observed in mildly obese middle-aged men, but not women.
PS-BPC11-2: PEDIATRIC BLOOD PRESSURE CATEGORY PREDICTS LONGITUDINAL VARIABILITY IN BLOOD PRESSURE IN YOUTH
Authors: Azegami Tatsuhiko , Uchida Keiko , Sato Yasunori , Takeda Ayano , Inokuchi Mikako , Itoh Hiroshi , Mori Masaaki
Published: January 2023

Objectives:

In order to identify risk factors that cause elevated blood pressure during adolescence, we aimed to evaluate the predictive effect of childhood factors on longitudinal variability of individual blood pressure during youth.

Methods:

Childhood data were obtained from medical checkups of Japanese male and female junior high school students aged 12–13 years during the period from 2009 to 2010. Childhood measurements were height, body weight, body mass index (BMI), systolic and diastolic blood pressures, complete blood counts, uric acid, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. Childhood blood pressure was categorized as normal, elevated blood pressure, or hypertension according to the American Academy of Pediatrics (AAP) clinical practice guideline. Linear mixed-effects models for repeated measures were used to estimate the effect of baseline childhood factors on longitudinal changes in systolic and diastolic blood pressures.

Results:

A total of 1304 participants were followed up to the 10th year. At baseline, the mean age was 12.6 years [SD, 0.3] and 26.2% were female. Among male participants, 6.3% were categorized as having elevated blood pressure and 8.8% were categorized as having hypertension, while among female participants 6.1% were categorized as having elevated blood pressure and 8.5% were categorized as having hypertension. Boys in the hypertension category had higher BMI, higher uric acid, and lower HDLC compared with those in the normal blood pressure category, but this trend was not statistically significant in girls. Of each childhood factor, the baseline blood pressure category according to AAP clinical practice guideline fit best with longitudinal changes in both systolic and diastolic blood pressure in the linear mixed-effects models.

Conclusion:

These results suggest that the AAP pediatric blood pressure category is the strongest predictor of longitudinal variability in individual blood pressure in youth.
PS-BPC11-4: LOW SOLUBLE KLOTHO IS ASSOCIATED WITH RESISTANT HYPERTENSION IN CKD: FROM THE KNOW-CKD STUDY
Authors: Koh Jaehee , Jo Sangmin , Yang Jihyun , Lee Kyubeck , Kim Hyang , Oh Kookhwan , Hyun Young Youl
Published: January 2023

Objective:

Apparent treatment-resistant hypertension (ATRH) is highly prevalent in chronic kidney disease (CKD) and is a risk factor for rapid progression of CKD. Soluble klotho is an extracellular domain of klotho released into the circulation. Although soluble klotho is known to be a risk factor for hypertension, the association between soluble klotho and ATRH is unknown. The aim of this study is to evaluate the association of soluble klotho with ATRH in CKD.

Design and method:

In this cross-sectional study, we analyzed 1,737 predialysis CKD patients enrolled in the prospective Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD). Apparent treatment-resistant hypertension was defined as systolic blood pressure > = 140 mm Hg or diastolic blood pressure > = 90 mm Hg with concurrent use of three antihypertensive medication classes or use of four or more antihypertensive medication classes regardless of blood pressure level. Serum klotho levels were measured using an enzyme-linked immunosorbent assay. Participants were divided into quartiles.

Results:

Among study subjects, 303 patients (17.4%) had ATRH. Prevalence of ATRH were 21.9%, 18.9%, 18.2% and 10.8% for the 1st to 4th quartiles of soluble klotho, respectively (p for trend < 0.001). The adjusted OR [95% CI] of 1st to 3th quartile of soluble klotho in reference to 4th quartile were 2.01 (1.32–3.06), 1.59 (1.04–2.42) and 1.69 (1.11–2.57).

Conclusions:

Soluble klotho level was inversely associated with the presence of ATRH in Korean predialysis CKD patients. This relationship was independent of various cardiovascular risk factors.
PS-BPC11-6: USEFULNESS OF BONE BROTH SOUP FOR THE REDUCTION OF SALT INTAKE
Authors: Ohta Yuko , Kuwahara Yukie , Fukamatsu Yuki , Tsuruta Hiroshi , Nakamura Hidetoshi , Tsuchihashi Takuya
Published: January 2023

Objective:

Salt reduction is most important in guidance regarding lifestyle modifications in Japanese hypertensive patients as well as for the health of the general population. However, low-salt diets have not been preferred because they are not delicious. Thus, we investigated the influence of bone broth soup on the saltiness and palatability in this study.

Design and method:

Subjects comprised 103 staffs working at Kokura Daiichi Hospital (22 males, 81 females, mean age 35 ± 12 years old). They tested 0.9% NaCl solutions (A), 0.6% NaCl solutions (B) and 0.6% NaCl solutions with bone broth soup (C). Evaluations of saltiness and palatability for each solution were conducted using a visual analog scale in a double-blinded randomized manner. We estimated 24-hour salt excretion using spot urine samples and also assessed BP, the awareness of salt intake using self-description questionnaire score (range 0 to 35, from the lowest to the highest), medication and other confounding factors including lifestyles.

Results:

In all subjects, average estimated salt intake was 9.0 ± 2.0 g/day and each rate of achievement of salt intake was 15.1% in 73 female without hypertension (< 6.5 g/day), 23.5% in 17 male without hypertension (< 7.5 g/day), 0.0% in 13 hypertension (< 6.0 g/day). Both in saltiness and palatability, B was significantly lower than A, but C was significantly higher than B. Salt intake levels were categorized into quantile (Q1, lowest; Q3, highest). C in palatability was significantly higher in the Q1 group than in the Q3 group (0.6 ± 1.4 vs -0.2 ± 1.1, p < 0.01). Urinary sodium-to-potassium ratio and total average score for the awareness of salt intake on the questionnaire in the Q1 group was significantly lower and compared to that in the Q3 group (2.34 ± 2.34 vs 4.54 ± 2.16, p < 0.01; 11.7 ± 5.1 vs 13.5 ± 4.5, p < 0.05).

Conclusions:

Most subjects failed to achieve the goal of salt intake. Group with high salt intake might be able to feel less palatable. Our results indicate that bone broth soup seems effective in reducing salt intake without loss of palatability.
PS-BPC11-10: BLOOD PRESSURE IN PATIENTS WITH FABRY DISEASE
Authors: Higuchi Koji , Ohishi Mitsuru
Published: January 2023

Background:

Fabry disease is a lysosomal storage disorder caused by a deficiency of α-galactosidase A (α-gal A) activity, one of the lysosomal hydrolases. A defect in α-gal A activity leads to the systemic accumulation of glycosphingolipids resulting in multiple organ involvement such as acroparesthesia, hypohidrosis, angiokeratoma, and corneal opacities. In many patients with Fabry disease, cardiac and/or cerebrovascular disease is the primary cause of death. Control of hypertension, which is a risk factor for cardiac and cerebrovascular disease, is therefore important. The prevalence of uncontrolled hypertension in patients with Fabry disease is unknown.

Method:

We st udied uncontrolled hypertension (systolic blood pressure(SBP)< 130 mmHg or diastolic blood pressure(DBP) < 80 mmHg) at the first visit of 31 patients who were diagnosed with Fabry disease in our department from April 2015 to December 2021. Of these, two children and four whose blood pressure had not been measured were excluded.

Results:

We examined 7 males(28%) and 18 females(72%). Uncontrolled hypertension was present in 76% of the patients with Fabry disease (males; 57,1%, females; 83.3%). Median SBP was 125 mmHg and median DBP was 83mmHg.

Conclusion:

In our study, we found a very high prevalence of uncontrolled hypertension in patients with Fabry disease, especially in women. Given that the leading causes of death in Fabry disease are cardiac and cerebrovascular disease, our data suggest the importance of blood pressure control in patients with Fabry disease. Our study was limited by the single-center data and the limited number of cases.
PS-BPC12-6: ASSESSMENT OF LDL CONTROL IN POST-ACUTE CORONARY SYNDROME PATIENTS: STATINS ARE NOT ENOUGH
Authors: Chan Yin Chun Alex , Osman Hanad , Doddamani Parveen , Rufus Prabha , Rahman Faiz , Patel Prashanth , Gupta Pankaj
Published: January 2023

Objective:

Cardiovascular disease (CVD) is one of the leading causes of death worldwide, with nearly 18 million people dying from CVD in 2019. In the UK, CVD was responsible for the premature deaths of nearly 170,000 people with around 65,000 being attributed to acute coronary syndrome (ACS). High levels of low-density lipoprotein (LDL) is one of the main risk factors associated with ACS. A recent European guideline has set out a target for secondary prevention in ACS patients of a LDL < 1.4 mmol/l and 50% or more reduction from baseline.

This study seeks to identify the proportion of patients meeting the LDL reduction target for secondary prevention and also to assess whether there are other alternative treatments that are more effective in achieving satisfactory lipid control.

Design and Methods:

The Myocardial Ischaemia National Audit Project (MINAP) database was used to identify patients admitted into the University Hospitals of Leicester NHS Trust (UHL) between May 2017 and May 2018. The MINAP database records information on how patients admitted into hospital with ACS are cared for.

694 patients were identified. Hospital records were reviewed at 6 months post discharge to determine medications prescribed on discharge and LDL levels. The study was part of a quality improvement project to optimise lipids in patients with ACS (UHL internal audit number 9397).

Results:

This study found that 97.5% of patients were prescribed a statin upon discharge, which is marginally higher than the national average of 96.4%. 83.4% of patients were discharged with a high-intensity statin as recommended by national guidelines.

However only 37.6% of patients reached a LDL level of below 1.4 mmol/l at follow-up. Furthermore of those patients with a baseline LDL prior to or during the myocardial infarction related admission, only 25.1% of patients also achieved a LDL reduction of 50% or more.

Patients that were prescribed Ezetimibe showed a slightly better reduction in LDL with 57.1% of patients achieving a LDL level of below 1.4 mmol/l at follow-up and 28.6% of them also achieving a LDL reduction of 50% or more.

Conclusions:

This study suggests that patients are not achieving a reduction in their LDL levels to < 1.4 mmol/l and 50% or more reduction from baseline despite the majority of patients being prescribed a high-intensity statin as recommended by national guidelines.

Therefore there may be a need for the most high risk of patients being offered Ezetimibe in addition to ensure LDL reduction targets are reached.
PS-BPP02-3: FACTORS FOR NEW-ONSET ISOLATED DIASTOLIC HYPERTENSION AND PROGRESSION TO SYSTOLIC HYPERTENSION IN JAPAN
Authors: Sakoda Takashi , Akasaki Yuichi , Kawasoe Shin , Kubozono Takuro , Sasaki Yuichi , Ikeda Yoshiyuki , Ohishi Mitsuru , Miyahara Hironori , Tokushige Koichi
Published: January 2023

Objective:

Factors for New-Onset of isolated diastolic hypertension (IDH: systolic blood pressure ≧ 140 mmHg and diastolic blood pressure ≧ 90 mmHg) have been identified as increasing body mass index (BMI), young age at baseline, male, and BMI by analysis of the Framingham Study in middle-class Caucasians. However, in Japanese, there are few reports of predictors of IDH or the progression from IDH to systolic and diastolic hypertension (SDH: systolic blood pressure ≧ 140 mmHg and diastolic blood pressure ≧ 90 mmHg).

Method:

The present study analyzed 42,591 subjects aged 35 to 65 years who underwent a health checkup between 2007 and 2013 and re-examined 5 years later. A logistic regression analysis was performed for three patterns of blood pressure change (normal to IDH, normal to SDH, and IDH to SDH) after 5 years from the time of the first health checkup. Systolic and diastolic blood pressure, age, gender, smoking habit, exercise habit, fasting blood glucose level, total cholesterol level, heart rate, and BMI were used as factors for adjustment.

Results:

At the time of the first checkup, 29,965 subjects were normotensive, 1,169 had IDH, and 11,457 had SDH. Of the 29,965 normotensive subjects, 566 developed IDH after 5 years. Multivariate logistic regression analysis adjusted for blood pressure showed a 1-unit increase in age (OR 0.96, CI[0.95–0.97], p < 0.0001), men (OR 1.44, CI[1.14–1.82], p = 0.002), BMI (OR 1.03, CI[1.00–1.06], p = 0.002), and a 1-unit increase in heart rate (OR 1.02, CI[1.01–1.03], p < 0.0001) were independently significant predictors of developing IDH.

Of the 29,965 normotensive subjects, 4,631 developed SDH after 5 years, and all factors except heart rate were independently significant predictors. On the other hand, 612 (52%) of the 1,169 subjects with IDH at the initial visit developed SDH 5 years later. The first checkup systolic blood pressure was significantly (p < 0.0001, 132.3 ± 5.5 mmHg vs. 129.5 ± 6.5 mmHg) higher, but no factors were found to be associated with the development of SDH.

Conclusions:

In Japanese subjects, IDH predominantly occurs in young, male, obese, and high heart rate individuals. However, the progression from IDH to SDH is difficult to predict, and it is important to prevent obesity from developing IDH.