bluuebunny/crossref_metadata_2025 huggingface dataset:
PS-C24-3: INSUFFICIENT VITAMIN D LEVELS IN PATIENTS WITH HEART FAILURE.
Authors: Kozlova Irina Qriqoryevna , Samedov Rza Ismayil
Published: January 2023

Chronic heart failure despite the development of new treatment methods, remains the most common and prognostic adverse complication of all cardiovascular diseases.

Studies conducted in different countries over the past decades have convincingly proved that vitamin D deficiency is one of the important factors in the development of CCC diseases. Vitamin D (VDR) receptors were detected in more than 40 target tissues, including cardiomyocytes, smooth muscle and endothelial vascular cells and have convincingly proved, that eliminating vitamin D deficiency improves blood pressure in hypertension and also reduces myocardial hypertrophy.

The above studies also confirmed the effect of vitamin D on the development of prediabetes, diabetes, metabolic disorders. The effect of vitamin D on the prevention of atherosclerosis has also been confirmed. One of the mechanisms for the development of atherosclerosis is currently considered an inflammatory process. The effect of vitamin D on the course of inflammatory processes in the body was clearly manifested during the pandemic caused by the new coronavirus infection COVID-19. There was a clear correlation between vitamin D levels and the severity of infection.

In severe COVID-19, as a rule, either a deficiency or a lack of vitamin D in the body was determined. In addition, low vitamin D levels increase the risk of developing severe forms of coronary heart disease.

The study involved 30 patients < n = 30>diagnosed with heart failure(I-III NYHA)

In 12 < 40%> patients out of 30, vitamin D levels were below 20.0 ng/mL, consistent with this vitamin deficiency. In 14 < 46,67%>the level of vitamin D in the blood was between 20.0 ng/mL and 30.0 ng/mL and this corresponded about the lack of vitamin D. Only 4 < 13,33%> patients has level of vitamin D in reference values and this was due to the use vitamin D due to comorbid pathology: thyroid disease, autoimmune diseases or previously identified vitamin D hypovitaminosis. Vitamin D partially enters the body with food mainly found in animal products-liver, milk, eggs, butter, etc and is formed in the skin under the influence of ultraviolet rays.

However, patients with CHF often have concomitant diseases: kidney disease, diabetes, disorders and others, forcing them to adhere to a strict diet poor in vitamin D. Also, due to CHF, these patients mainly lead a sedentary lifestyle, and, as a result, receive little ultraviolet rays.

This explains the frequently detected deficiency and deficiency of vitamin D in patients with CHF, if, they do not receive drugs that compensate for its deficiency.
PS-C24-4: QUANTIFICATION OF EXERCISE-INDUCED HEMODYNAMIC CHANGE BY HEART SOUND ANALYSIS IN PATIENT WITH HEART FAILURE
Authors: Kaneko Tetsuya , Kotooka Norihiko , Node Koichi
Published: January 2023

Objective:

Since an elevation of pulmonary artery pressure (PAP) often precedes clinical worsening of heart failure, early and non-invasive detection of that sign is useful in heart failure care. The purpose of this study was to assess whether a non-invasive technology called cardiac acoustic biomarkers (CABs) to quantify heart sounds can detect the exercise-induced elevation of PAP in patients with heart failure.

Design and Methods:

Patients with heart failure scheduled to undergo right heart catheterization (RHC) were prospectively enrolled between February 2020 to September 2021. CABs were concurrently recorded with PAP and pulmonary capillary wedge pressure (PCWP) at rest (baseline) and while applying a handgrip (exercise).

Results:

Forty-nine patients were included in the analysis dataset and their mean PAP significantly increased at exercise compared to baseline (32.45 ± 11.28 mmHg vs 23.52 ± 8.41 mmHg; p < 0.001). Several CABs correlated significantly with mean PAP by absolute values, among which S2 Width (r = 0.354; p < 0.05 and r = 0.363; p < 0.05) and S3 Strength (r = 0.375; p < 0.05 and r = 0.386; p < 0.05) were consistent throughout baseline and exercise. The response of CABs to PAP elevation caused by exercise was divided into two patterns: increasing and decreasing. The frequency of cardiac index less than 2.2 mL/m2 was significantly higher in the decreasing pattern.

Conclusions:

CABs related to S2 and S3 can quantify heart sounds which reflect the exercise-induced hemodynamic change in patients with heart failure. It should be noted, however, that their reactions to hemodynamic change can be different depending on the background hemodynamics of individuals.
PS-C24-8: PLASMA ANGIOTENSIN CONVERTING ENZYME 2 ACTIVITY IN HOSPITALISED PATIENTS WITH ACUTE HEART FAILURE CLASSIFIED BY LEFT VENTRICULAR EJECTION FRACTION
Authors: Doumtsis Nicholas Alexander , Patel Sheila , Ramchand Jay , Lu Ken , Srivastava Piyush , Burrell Louise
Published: January 2023

Objective:

Angiotensin-converting enzyme 2 (ACE2) is present on endothelial cells with a role to degrade angiotensin II. In this study, we investigate plasma ACE2 levels in patients admitted with acute decompensated heart failure (ADHF) and determine if levels differ according to ejection fraction (EF).

Design and Method:

We prospectively recruited 9 controls and 117 ADHF inpatients, determined EF using echocardiography, measured plasma ACE2 activity using an in-house assay and NT-proBNP levels using a commercially available assay. Patients were classified according to 2021 European Guidelines as HF with reduced EF (HFrEF), mildly reduced EF (HFmrEF) or preserved EF (HFpEF).

Results:

In addition to NT-proBNP level, median plasma ACE2 activity was increased in ADHF patients (n = 117) compared to controls (1.33 [0.02, 4.02] vs 15.36 [9.02, 27.9] pmol/mL/min, p < 0.0001). In ADHF, plasma ACE2 activity was negatively associated with EF (r = -0.43, p < 0.0001). Overall, 58% of patients had HFrEF, 10% had HFmrEF and 32% had HFpEF. Patients with HFrEF had a higher median plasma ACE2 activity compared to those with HFpEF (18.3 [12.3, 30.0] vs 11.4 [4.8, 17.9] pmol/mL/min, p = 0.001) and higher NT-proBNP levels (p = 0.001). There was no difference in plasma ACE2 activity between patients with HFmrEF and HFpEF or HFmrEF and HFrEF.

Conclusions:

Plasma ACE2 activity is elevated in patients hospitalised with ADHF and is significantly higher in HFrEF compared to other types of HF. Further studies are needed to determine if measurement of plasma ACE2 can assist in better definition /classification of the patient phenotype to facilitate improved treatment.
PS-C24-12: HEALTH-RELATED QUALITY OF LIFE, AND OUTCOMES IN ADULTS WITH HEART FAILURE: AGE AND SEX-RELATED DIFFERENCES AND THE ROLE OF HYPERTENSION
Authors: Amusa Ganiyu Adeniyi
Published: January 2023

Objective:

Hypertension is the commonest cause of heart failure. Heart failure is a pandemic and major driver of mortality; limiting disease progression and improving health related quality of life remains the cornerstone of management. There is dearth of information on quality of life in Africans with heart failure. This study examined age and sex related differences and the role of hypertension in the profile, health related quality of life, and clinical outcomes in African adults with heart failure.

Design and method:

A cross sectional study conducted at the outpatient cardiology clinics of Jos University Teaching Hospital. Two hundred adults with stable heart failure were enrolled using a simple random method. Relevant history, functional class, Charlson comorbidity index were obtained. Physical examination which included electrocardiography, echocardiography, 6 minutes walk distance were done using standard guidelines. Health related quality of life was assessed using the Minnesota living with heart failure questionnaire and graded as good, moderate or poor. Data was analyzed using SPSS version 21. Simple descriptive statistics and multiple logistic regression to determine predictors of moderate and poor quality of life were done.

Results:

The participants comprised of 104 females and 96 males. More males belonged to higher social class, 21% of the males had health insurance compared to 17% of the females. 48% of the males had atrial fibrillation compared to 33% of the females. About 50% of the participants have heart failure with reduced ejection fraction, there was significant difference in heart failure aetiology below 45 years versus above 45 years in both sexes. The burden of comorbidities was significantly higher in the males and those above 45 years old. There were differences in the individual domain scores of MLHF scores across age groups and sex, the males have a statistically significant poorer quality of life similarly for above 45 year old compared to below 45 year old. The females had higher numbers of hospital admission within the past 12 months and higher hospitalization frequency. functional class 3 or more, 6MWT below 300metres, ejection fraction above 50% and above 6 classes of medication emerged as predictors of moderate/poor MLHF scores in both males and females.

Conclusion:

This study found significant age and sex-related differences in clinical profile, HRQOL, and clinical outcomes in African adults with HF. Hypertension was the commonest cause of HF. Improved control of hypertension and periodic health related quality of life assessment in patients with HF are advocated to improve outcomes.
PS-C25-1: ANGIOTENSIN II RECEPTOR BLOCKER AND STATIN COMBINATION THERAPY ASSOCIATED WITH HIGHER SKELETAL MUSCLE INDEX IN PATIENTS WITH CARDIOVASCULAR DISEASE
Authors: Harada Haruhito , Nishiyama Yasuhiro , Niiyama Hiroshi , Katoh Atsushi , Kai Hisashi
Published: January 2023

Objectives:

Reduction in skeletal muscle mass is the most important component in the diagnosis of sarcopenia. Aging and chronic heart failure due to cardiovascular diseases (CVDs) accelerate the reduction in skeletal muscle. However, no effective drugs for sarcopenia are available. The purpose of this study was to explore the associations of prescribed medications with higher skeletal muscle mass in patients with CVD.

Design and Methods:

This was a single-center, retrospective, cross-sectional analysis. The subjects were 636 inpatients with CVD who had been taking prescribed medicines for at least 4 weeks at the time of admission. Prescription data were collected from electronic medical records database. Drugs and drug combinations were selected for analysis when they were prescribed to more than 10% (64 cases) of all subjects. Because of their frequent use in clinical practice for CVD, various combinations of angiotensin II receptor blockers (ARBs), beta-blockers, calcium channel blockers (CCBs), and statins were also examined. Skeletal muscle volume was assessed with a bioelectrical impedance assay.

Results:

The mean age was 73 ± 12 years (male, 54.4%). The body mass index and skeletal muscle index (SMI) were 23.8 ± 4.3 kg/m2 and 6.46 ± 1.42 kg/m2, respectively. ACC/AHA stage C/D heart failure was shown in 21.4%. Single regression analysis showed that SMI was positively associated with the use of CCBs, ARBs, statins, antihyperuricemic agents, dipeptidyl peptidase-4 (DPP-4) inhibitors, oral antidiabetic agents excluding DPP-4 inhibitors, ARB/CCB combination, statin/CCB combination, ARB/statin combination, and ARB/beta-blocker combination. Diuretics, antiarrhythmic agents, and anticoagulants were negatively associated with SMI. Stepwise multivariate regression analysis revealed that ARB/statin combination was independently and positively associated with SMI whereas diuretics and antiarrhythmic agents were independently and negatively associated with SMI. After adjustment using propensity score matching, SMI was significantly higher in ARB/statin combination users than in non-users.

Conclusion:

Combination use of an ARB and a statin was associated with a higher SMI in patients with CVD. A future randomized, controlled trial is warranted to determine whether the ARB/statin combination will increase the SMI and prevent sarcopenia in CVD patients. The results of the present study may be useful for drug repositioning to screen for drug candidates.
PS-C25-6: HYPERTENSIVE RESPONSE TO EXERCISE AS PREDICTOR FOR DEVELOPMENT OF ESSENTIAL HYPERTENSION AND HOSPITALIZATION DUE TO MAJOR ADVERSE CARDIAC EVENT
Authors: Jagannatha Gusti Ngurah Prana , Yasmin AA Ayu Dwi Adelia , Pradnyana I Wayan Agus Surya , Kamardi Stanly , Wibawa Ida Bagus Satriya , Pangkahila Elionardo Enrique
Published: January 2023

Objective:

The aim of this study was to determine the structural and metabolic factors associated with hypertensive response to exercise (HRE) in non hypertensive patients and role of HRE in predict development of essential hypertension during follow-up and predict hospitalization due to major adverse cardiac event (MACE).

Design and method:

This study was a cross-sectional retrospective study using cardiac treadmill stress test (TST) data at Sanglah General Hospital, Bali from 2016–2020. Data analysis used SPSS version 21. Subjects were divided into positive HRE and negative HRE. Pearson-chi square test and Mann-Whitney test were used to compare categorical variables based on age, gender, smoking status, nutritional status, alcohol status, dyslipidemia, type 2 diabetes mellitus (T2DM), HbA1C, total cholesterol, LDL, HDL, triglycerides, history of kidney disease, and mean echocardiographic parameters based on the presence of HRE. Development of essential hypertension during follow up and history of hospitalization after cardiac TST due to MACE until April 2022 based on the presence of HRE was evaluated using receiver operating characteristics.

Results:

We evaluated 202 non hypertensive patients (47,1% with HRE) who underwent cardiac TST. During follow up, 19.8% experienced hospitalization and 26.1% developed hypertension. Obesity (PR1.727; 95%CI = 1.235–2.413), smoking status (PR1.773; 95%CI = 1.170–2.687), T2DM (PR2.29; 95%CI = 1.16–3.37), HbA1C (PR3.13; 95%CI = 2.31–4.22), high LDL level (PR1.853, 95%CI = 1.229–2.794) and history of kidney disease (PR1.985; 95%CI = 1.478–2.665), were significantly associated with positive HRE (all p-value < 0.05). Regarding the clinical outcomes, patients with HRE were associated with an increased risk of developing essential hypertension (PR1.72; 95%CI = 1.235–2.413 p = 0.05) and hospitalization due to MACE (OR2.27, 95% CI = 1.62–3.16, p = 0.0001) during follow up, with sensitivity of 76.7% and specificity of 93.6%. Subjects with HRE had higher LV mass index (82.34 ± 15.05 vs 70.62 ± 9.76), higher E/E ratio (16.31 ± 2.95 vs 16.01 ± 13.23), higher LAVI (39.75 ± 15.21 vs 34.27 ± 11.15) with all p-value were < 0.05.

Conclusions:

Patients with impaired cardiometabolic and the presence of cardiac remodeling commonly have HRE that could be detected by cardiac TST examination, which may predict the development of essential hypertension and major adverse cardiac events in the future.
PS-C25-9: COMPARISON OF ANTIHYPERTENSIVE EFFECTS OF ISOMETRIC HANDGRIP VERSUS AEROBIC EXERCISE IN ELDERLY HYPERTENSIVE PATIENTS: A RANDOMIZED CONTROLLED TRIAL
Authors: Jae Sae Young , Yoon Eun Sun , Kim Hyun Jeong , Cho Min Jeong
Published: January 2023

Purpose:

The purpose of this study was to compare the antihypertensive effects of isometric handgrip exercise (IHG) versus aerobic exercise (AE) on clinic, central and 24-hour ambulatory blood pressures in elderly hypertensive patients.

Methods:

We conducted a randomized controlled trial with a three-arm design. Fifty-four elderly hypertensive patients (mean age 69 ± 6 years) were randomized to IHG training (n = 17), AE training (n = 19), or non-exercise control group (n = 18; CON) for 12 weeks (3 times per week). Bilateral IHG training was performed four times of 2 min at 30% of maximal voluntary contraction using a digital handgrip device. AE training was a brisk walking and bike exercise for 30-min at moderate intensity. Resting clinic, central, and 24-hour ambulatory blood pressures were obtained at baseline and after 12-week intervention.

Results:

Compared with CON, office and 24-hour systolic blood pressure were significantly reduced in both IHG and AE groups (P < 0.05, both) and the magnitude of SBP reduction was not significantly different between both the exercise intervention groups. However, office, central and 24-hour diastolic blood pressure were more decreased in IHG vs. AE group as compared with CON.

Conclusion:

These findings suggest that both IHG and AE training reduced resting office blood pressure and 24-hour ambulatory blood pressure, but IHG training is more effective in improving office, central and 24-h ambulatory diastolic blood pressure than AE. Thus, IHG training may be an alternative antihypertensive therapy for elderly hypertensive patients.
PS-C25-10: ASSOCIATION BETWEEN SKELETAL MUSCLE MASS AND BLOOD PRESSURE DECLINE OVER A FIVE-YEAR PERIOD FOR COMMUNITY-DWELLING OLDER ADULTS
Authors: Ohata Yuka , Kabayama Mai , Kido Michiko , Godai Kayo , Nagano Masahiro , Kamide Kei
Published: January 2023

Objective:

To determine the association between skeletal muscle mass and systolic blood pressure decline over a 5-year period in older adults over 75 years old.

Methods:

Of those who got health checkups at private A clinic from May 2020 to March 2021, 118 subjects for whom data on systolic blood pressure (SBP) levels consequently collected for five years were included. Skeletal muscle mass was measured at the health checkup in this clinic, and the Skeletal Muscle Index (SMI) was calculated by dividing the sum of limb muscle mass by the square of height using the multi-frequency bioimpedance method. Lower SMI was classified as a relative skeletal muscle mass index less than 7.0 kg/m2 and 5.7 kg/m2 in men and women, respectively. SBP levels used the mean of office SBP at A clinic visits in 2020 and 2015. 5-year SBP changes were calculated and categorized into two groups: SBP decline group (decline of -3 or more) and SBP maintenance group. The main outcome was SBP decline, and the association with SMI was examined by chi-square test and logistic regression analysis adjusted for age and gender.

Results:

The mean age of the subjects was 81.1 ± 4.5 years, 76 (64.4%) were female, 76(64.4%) were taking anti-hypertensive medication, 40(33.9%) were lower SMI, and 39 (33.1%) for SBP decline group. The SBP decline group had a lower BMI and a higher percentage of lower SMI than the maintenance group (p < 0.05). Furthermore, logistic regression analysis showed that lower SMI was independently associated with SBP decline (odds ratio: 2.44, 95% CI: 1.07–5.54).

Conclusion:

Our results suggest that there may be an association between lower SMI and SBP decline over a 5-year period in community-dwelling older adults over 75 years old. Long term changes of SBP might be the useful biomarker for muscle mass decline for older adults, although further mechanistic investigations are necessary.
PS-C26-7: A SINGLE-CENTER, RETROSPECTIVE STUDY OF BLOOD PRESSURE EFFECTS OF DAPAGLIFLOZIN IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Kawano Rina , Hirawa Nobuhito , Haruna Aiko , Ozawa Moe , Haze Tatsuya , Suzuki Shota , Ohki Yuki , Kobayashi Yusuke , Fujiwara Akira , Saka Sanae , Tamura Kouichi
Published: January 2023

Backgrounds:

Sodium-glucose transporter 2(SGLT2) inhibitors are reported to have blood pressure lowering effects in addition to glucose-lowering effects. Previous studies have shown SGLT2 inhibitors, including dapagliflozin, reduce systolic blood pressure among patients with type 2 diabetes. Its mechanism is still uncertain; however, previous studies suggest plasma reduction by osmotic diuresis and natriuresis may contribute to lowering blood pressure. Dapagliflozin was recently approved as the treatment for chronic kidney disease in Japan. Blood-pressure lowering effects of SGLT2 inhibitors among patients with chronic kidney disease (CKD) are still unknown; therefore, we investigated blood-pressure effects of dapagliflozin in patients with CKD.

Design and method:

Patients with chronic kidney disease (estimated glomerular filtration rate (eGFR) of less than 60 mL/min per 1.73 m2, or markers of kidney damage, or both, of at least 3 months duration) were given 10 mg dapagliflozin daily for at least 4 weeks. Patients who had any changes in their antihypertensive drug prescription during this observation period were excluded. Clinical data including blood pressure measurements, eGFR, urine protein/creatinine ratio, and urinary sodium excretion before and after administration were taken and compared.

Results:

Contrary to previous reports, there was no significant difference in blood pressure at two months after administration. However, there was a trend of blood pressure decline at four months. Since this study is retrospective, measurement procedures were not aligned among patients, and body fluid evaluation was not considered. These inconsistent conditions may have affected the results. Also, dapagliflozin was administered to most patients in this study at the end of fall or beginning of winter, as it was approved for CKD patients in Japan in August 2021. Decreasing temperature may have limited or countervailed the blood pressure lowering effect of dapagliflozin in the first two months.

Conclusions:

Our findings indicate that the use of Dapagliflozin may serve as adjunct blood pressure lowering therapy in patients with CKD. Prospective study is needed to further investigate the blood pressure effects of dapagliflozin in CKD patients.
PS-C26-12: SIGNIFICANCE OF PODOCYTE DNA DAMAGE AND GLOMERULAR DNA METHYLATION IN CKD WITH PROTEINURIA
Authors: Yoshimoto Norifumi , Hayashi Kaori , Hishikawa Akihito , Nakamichi Ran , Sugita Erina , Yoshida Eriko , Hashiguchi Akinori , Itoh Hiroshi
Published: January 2023

Objective:

Previously we have reported that altered DNA methylation is associated with DNA damage repair in podocytes in CKD, including diabetic nephropathy or IgA nephropathy (Cell Rep 2019, Sci Rep 2020). This study is aim to investigate the association of podocyte DNA damage and DNA methylation with clinical manifestations and renal prognosis in various types of kidney diseases, which has not been adequately investigated.

Design and Method:

Patients diagnosed with minor glomerular abnormalities (MGA, n = 33), membranous nephropathy (MN, n = 9) or diabetic nephropathy (DN, n = 10), following kidney biopsy at Keio University Hospital from 2015 to 2017 were included. We evaluated podocyte DNA double strand breaks (DSBs) using both long-distance PCR of nephrin gene and γH2AX immunostaining, and glomerular DNA methylation levels by immunostaining of 5mC, and examined the relationship between clinical parameters of patients, and DNA damage and methylation.

Results:

In MGA patients, both podocyte DNA damage and glomerular DNA methylation was associated with the amount of proteinuria. Moreover, glomerular DNA methylation was also associated with 3-year eGFR decline. We also examined in DN patients, in which podocyte DNA damage has been found to be involved in our previous study. It was demonstrated that podocyte DSBs were associated with a decline in eGFR over 6 months, whereas glomerular DNA methylation was associated with 2 year- and 3 year-eGFR decline. In addition, samples from MN patients were evaluated, in which activation of DNA repair pathways in the glomeruli has been suggested. Interestingly, the association of DNA DSBs or DNA methylation with proteinuria or kidney function was not indicated in MN.

Conclusions:

To our knowledge, this is the first study to demonstrate the possible association of podocyte DNA damage and glomerular DNA methylation with kidney function and its decline in MGA patients, whereas it was not observed in MN patients, despite a limitation of small sample size. Focusing on podocyte DNA damage and following DNA methylation changes may lead us to novel approaches to estimate renal prognosis in addition to traditional evaluation of renal biopsy as well as to develop novel therapeutic targets in specific types of CKD.
PS-C27-3: MEASURING ANTIHYPERTENSIVE DRUG CONCENTRATIONS TO DETERMINE NON-ADHERENCE IN HYPERTENSIVE PATIENTS WITH AND WITHOUT KIDNEY TRANSPLANTATION
Authors: Peeters Laura EJ , Hesselink Dennis A , de Winter Brenda CM , Lafeber Melvin , Severs David , van den Hoogen Martijn WF , Sonneveld Michelle AH , Ramakers Chris RB , Bahmany Soma , van Gelder Teun , Koch Birgit CP , Versmissen Jorie
Published: January 2023

Introduction:

Non-adherence to antihypertensive drugs (AHDs) is one of the main causes of resistant hypertension which is defined as uncontrolled blood pressure despite the prescription of at least 3 AHDs.

Objectives:

Our primary objective was to determine the prevalence of non-adherence to AHDs in patients visiting the nephrology and vascular outpatient clinics. Inclusion rates at both departments allowed comparison between non-adherence of kidney transplantation (KT) patients with patients without KT as secondary objective.

Design and method:

This was a prospective observational study called RHYME-AD (Resistant Hypertension: MEasure Antihypertensive Drugs, MEC-2020–0096). Patients were eligible if they used at least 2 AHDs that could be measured with a validated UPLC-MS/MS method and had an office blood pressure > 140 and/or 90 mmHg. After informed consent was signed, rest material was collected from a regular venipuncture measurement. The total absence of drug in blood ( 140 and/or 90 mmHg despite the use of 3 or more AHDs.

Results:

Material was available from 143 patients of which 93 had a KT and 66 patients fulfilled the definition of resistant hypertension. The overall adherence rate was 78.3%. From the non-adherent patients 87.8% was partially non-adherent and 12.2% non-adherent for all prescribed AHDs. When looking at the two separate groups, with and without KT, more patients in the non-KT cohort fulfilled the definition of resistant hypertension as compared to the KT-cohort (62.0% vs 37.6%, p = 0.005). There was a significant difference between having resistant hypertension and being non-adherent (non-adherence RH vs non-RH, 31.8% vs 13.0%, p = 0.023) and having KT and being non-adherent (non-adherence KT vs non-KT, 14.0% vs 36.0%, p = 0.005). In addition, patients with KT and no resistant hypertension were the most adherent to AHDs (91.2%).

Conclusions:

Hypertensive patients with a KT are less likely to be non-adherent to their AHDs as compared to hypertensive patients without a KT. However, patients fulfilling the definition of having resistant have a higher risk of being non-adherent to AHDs.
PS-P07-3: EFFICACY AND SAFETY OF NIFEDIPINE GASTROINTESTINAL THERAPEUTIC SYSTEM VERSUS RAMIPRIL IN CHINESE AND EUROPEAN PATIENTS WITH HYPERTENSION
Authors: Zhang Wei , Liu Changyuan , Grzegorz Bilo , Soranna Davide , Zamabon Antonella , Kyriakoulis Konstantinos , Kollias Anastasios , Ceravolo Isabella , Cassago Silvia , Pengo Martino , Stergiou George , Parati Gianfranco , Wang Jiguang
Published: January 2023

Objective:

In a post-hoc analysis of a multinational, randomized trial, we investigated whether the efficacy and safety of nifedipine gastrointestinal therapeutic system (GITS) and ramipril differed between Chinese and European patients with hypertension.

Method:

Previously treated (2-week washout) and untreated patients with hypertension were randomly assigned to treatment with nifedipine GITS 30 mg or ramipril 10 mg for 12 months, if they had elevated clinic (≧ 140/90 mmHg) and daytime (≧ 135/85 mmHg) ambulatory systolic/diastolic blood pressure (BP) and standard deviation of home (> 7 mmHg) and daytime systolic BP (> 12 mmHg). BP was measured at each of the clinic visits at baseline and during follow-up. Ambulatory and 7-day home BP monitoring were performed at baseline and 10 weeks and 12 months of follow-up.

Results:

The 67 Chinese and 101 European patients significantly differed in age (50.9 vs. 54.6 years), body mass index (24.5 vs. 27.0 kg/m2), clinic diastolic BP (87.9 vs. 92.5 mmHg), clinic heart rate (75.0 vs. 70.8 beats/minute) and nighttime diastolic BP (79.3 vs. 75.9 mmHg). However, within each ethnicity, patients were comparable between the nifedipine GITS and ramipril groups (P≧ 0.05). In both Chinese and European patients, BP was similarly reduced in the nifedipine GITS and ramipril groups, except that daytime systolic/diastolic BP reductions were 7.4/4.1 mmHg greater in the ramipril than nifedipine GITS group in Chinese (P = 0.02). The safety profile significantly (P for drug*ethnicity interaction ≦ 0.046) differed between the Chinese and European patients for the incidence of all adverse events (lower on nifedipine GITS in Chinese), ankle edema (higher on nifedipine GITS in Europeans) and dry cough (higher on ramipril in Chinese).

Conclusion:

In the Chinese and European patients with hypertension, nifedipine GITS and ramipril had similar BP lowering efficacy, but different safety profile and tolerability.
PS-P07-9: USE OF INITIAL AND SUBSEQUENT ANTIHYPERTENSIVE COMBINATION TREATMENT IN THE CLINICAL PRACTICE. EVIDENCE FROM A POPULATION-BASED INVESTIGATION IN ITALY
Authors: Savare Laura , Rea Federico , Corrao Giovanni , Mancia Giuseppe
Published: January 2023

Objective:

Hypertension guidelines issued in the last twenty years have consistently recommended use of a combination of two or more antihypertensive drugs to treat most hypertensive patients. Two-drug combinations have also been recommended as initial treatment. Aim of this study was to assess the use of antihypertensive combination treatment, both as the initial and as subsequent therapeutic step over a three-year treatment period, based on data from a large Italian population. Three temporal cohorts (2012, 2015, 2018) were identified to determine whether mono versus combination treatment strategies had changed over the years.

Design and method:

The residents of the Lombardy Region (Italy), aged > 40 years, who were newly treated with antihypertensive drugs during 2012, 2015 and 2018 were identified through the regional healthcare utilization database. The drug treatment strategy (monotherapy and combination of two, three and > 3 antihypertensive drugs) was assessed at treatment initiation, and after 6 months, 1, 2, and 3 years of treatment. Data were also analysed after stratification for demographic and clinical categories, i.e. sex, age, signs of cardiovascular disease, co-treatments, and clinical status.

Results:

About one-hundred thousand patients were identified for each cohort. About four out of ten patients were aged > 65 years, half of them were women, one in four patients was prescribed > 5 co-medications, and one in 6 patients had a poor clinical status. In the 2012 cohort, monotherapy was the most common initial treatment strategy (74%), followed by two-drug single-pill combination (17%), two-drug free combination (6%), and combination of > 3 drugs (3%). There were no significant differences between the 2012, 2015 and 2018 cohorts, and among strata of age, sex, clinical status, co-treatments, number of co-medications and evidence of cardiovascular disease.

Use of two and three or more antihypertensive drugs increased during follow-up and reached about 32% (two drugs) and 11% (> 2 drugs) of the patients after 3 years from treatment initiation. Among patients prescribed a two-drug combination, the single-pill was the most common approach, whereas the use of the three-drug single-pill combination was extremely rare. There were no substantial differences in the use of combination treatment between the three cohorts and the results were similar in all demographic and clinical categories.

Conclusions:

In a real-life setting, use of antihypertensive drug combinations is low at treatment initiation and inferior to use of monotherapy during chronic treatment Contrary to guidelines recommendations, antihypertensive combination treatment did not show any noticeable increase over the years.
PS-P08-7: HYPERTENSION AND ITS CORRELATES AMONG PREGNANT WOMEN CONSUMING TOBACCO IN INDIA: FINDINGS FROM THE NATIONAL FAMILY HEALTH SURVEY-4
Authors: Anand Tanu , Grover Shekhar , Kishore Jugal , Sinha Dhirendra N , Malhotra Sumit , Dhawan Priyanka , Goel Sonu
Published: January 2023

Background:

Hypertension or high blood pressure during pregnancy has significant implications on maternal and perinatal morbidity and mortality. Tobacco use amplifies this burden and increases the risk of hypertensive disorders along with adverse birth outcomes. The current study aimed to evaluate the joint risk at the population level of tobacco use and hypertension among pregnant women in India.

Methodology:

Data of 32428 currently pregnant women aged 15 to 49 years were obtained from the National Family Health Survey NFHS4 to estimate bivariate i.e. tobacco user vs non-user and binomial logistic regression analysis in order to get odds ratios of having hypertension. The analysis included sociodemographic variables such as the respondents age, type of residence, wealth index, and education status.

Results:

The prevalence of hypertension among pregnant tobacco users 7.5% was significantly higher than that of non-users 6.1%. The odds of having hypertension were 1.17 95% CI 1.02 to 1.35 times among tobacco users than non-users and increased with age p less than 0.001 and in rural areas p 0.02. However, it varied inversely with education status p more than 0.05; NS and wealth quintile p 0.01.

Conclusion:

The present study identifies the higher co-existence of hypertension among tobacco-using pregnant women and highlights the need for tobacco control/cessation and hypertension prevention and management during pregnancy considering socio-demographic disparities.
PS-P09-10: ASSESSING THE RELATIONSHIP OF DIET QUALITY TO NUTRITIONAL STATUS AND BLOOD PRESSURE: IMPLEMENTATION OF THE DEVELOPED INDONESIA DIETARY INDEX
Authors: Faza Farah , Susetyowati Susetyowati
Published: January 2023

Objective:

Indonesia faces a surge of metabolic diseases such as obesity, hypertension, and type 2 diabetes mellitus. The main factor that triggered the diseases is a lifestyle, which was primarily contributed by dietary patterns. Recently, the developed Indonesia dietary index (IDI) was developed to rapidly assess diet quality in adults. Therefore, we aim to evaluate the IDI towards nutritional status and blood pressure as health outcomes.

Design and method:

Cross sectional study was conducted from 2016 to 2018 and involved 350 healthy adults 19 to 64 years of age in urban and rural areas in a province in Indonesia. The urban represented the most populated area and the rural represented lowland and mountainous areas. The underweight and pregnant or breastfed women were excluded. Data collection included sociodemographic, body mass index (BMI), and blood pressure. A BMI of 25.00 kg/m2 and above was categorized as obese. A blood pressure of 120 to 139 mmHg (systolic) or 80 to 89 mmHg (diastolic) was classified as prehypertension. The data was collected by trained nutritionists as enumerators. Diet quality was assessed by the IDI, which consisted of 12 multiple choice questions about the food consumed in the previous day and week. The scoring category for IDI: less than 40 was poor, 40 to 59 was need improvement, and 60 and above was good. Logistic regression was run to determine the factors that influenced prehypertension.

Results:

Subjects were dominated by females (56%). The prevalence of overweight and obesity was 62.9% and prehypertension was 69.1%. Based on the IDI, most adults had poor diet quality (50.6%), followed by a need for improvement (48%) and good diet quality (1.4%). Poor diet quality tended to increase the risk of overweight and obesity (PR unadjusted = 1.8, p = 0.06, 95%CI 0.9 to 7.5) yet not with blood pressure, even after being adjusted with covariates (gender, age, dwelling area, and smoking habit). The IDI scores were not significantly lower in the overweight and obese adults than in normal (36.8 vs. 38.3, p = 0.216) yet no difference in prehypertension adults than in normal (37.7 vs. 37.9, p = 0.835).

Conclusion:

Even though diet quality was not associated with BMI and blood pressure, overweight and obese adults had lower IDI scores than normal. Evaluating diet quality among Indonesian is quite challenging relating to various food and dishes consumed by people. Regardless of the insignificant findings, body weight and blood pressure should be managed by encouraging adults to improve their diet quality according to a healthy balanced diet.
PS-R03-3: INTERMITTENTLY SCANNED CONTINUOUS GLUCOSE MONITORING IN A DIFFICULT PATIENT WITH GESTATIONAL DIABETES MELLITUS AND SUBCLINICAL CUSHING'S SYNDROME: A CASE REPORT
Authors: Iwahara Akihide , Sugiyama Kazutoshi , Tsuchiya Tami , Itoh Arata , Nakajima Yuya , Saisho Yoshifumi , Kinouchi Kenichiro , Kobayashi Sakiko , Miyashita Kazutoshi , Irie Junichiro , Meguro Shu , Ikenoue Satoru , Tanaka Mamoru , Itoh Hiroshi
Published: January 2023

A 41-year-old woman was admitted to the obstetrics department because of epigastric pain, nausea, and fatigue at 31 weeks of gestation. She was suspected of subclinical Cushing's syndrome based on high plasma cortisol and low ACTH levels along with an incidentally discovered tumor in the left adrenal gland 4 years prior to conception. 3 months before admission, 75 g oral glucose tolerance test yielded one point positive (81–169–174 mg/dL) and diagnosis of gestational diabetes mellitus was made. Diet and exercise therapy was started on an outpatient basis. While blood glucose control had been favorable, she discontinued visits to outpatient clinics due to difficulty in physical activity.

At the time of admission, blood glucose level was running more than 200 mg/dl, and self-monitoring of blood glucose (SMBG) and insulin self-injection therapy were proposed for immediate blood glucose control accordingly. However, the patient had psychiatric symptoms that were presumably associated with delusional disorder and subclinical Cushing's syndrome. As such, she refused to implement both procedures on account of a strong fear against puncture, which caused blood glucose management difficult. Despite understanding the necessity of SMBG and potential risks to the fetus, the patient frequently expressed anxiety and could not perform SMBG. Given the difficult circumstance, intermittently scanned continuous glucose monitoring was installed to reduce invasive procedures. As a result, blood glucose levels were under good control with 0.43 U/kg of insulin per day until the delivery by cesarean section at 34 weeks of gestation. A healthy infant weighing 2442 g was delivered without complications.

Here we highlight utility and efficacy of intermittently scanned continuous glucose monitoring in a difficult patient with gestational diabetes mellitus and subclinical Cushing's syndrome.
PS-R05-1: CASE REPORT: A RARE CASE OF ALVEOLAR HEMORRHAGE AFTER COVID-19 VACCINATION IN A PATIENT WITH RENAL-LIMITED ANTI-NEUTROPHIL CYTOPLASMIC ANTIBODY-ASSOCIATED VASCULITIS
Authors: Nishioka Ken , Yamaguchi Shintaro , Yasuda Itaru , Yoshimoto Norifumi , Kojima Daiki , Kaneko Kenji , Aso Mitsuhiro , Nagasaka Tomoki , Yoshida Eriko , Uchiyama Kiyotaka , Tajima Takaya , Yoshino Jun , Yoshida Tadashi , Kanda Takeshi , Itoh Hiroshi
Published: January 2023

The coronavirus disease 2019 (COVID-19) vaccination campaign has progressed worldwide. Rare but severe adverse events of COVID-19 vaccination such as anaphylaxis and myocarditis have begun to be noticed. Of note, several cases of new-onset antineutrophil cytoplasmic antibody-associated vasculitis (AAV) after COVID-19 mRNA vaccination have been reported. In contrast, relapse of AAV in remission has not been recognized enough as an adverse outcome of COVID-19 vaccination. We report, to the best of our knowledge, a first case of renal-limited AAV in remission using every 6-month rituximab administration that relapsed with pulmonary hemorrhage, but not glomerulonephritis, following the first dose of the COVID-19 vaccine. Notably, the patient received the COVID-19 vaccine more than 6 months after the last dose of rituximab according to the recommendations. Ironically, his CD19 positive B cell counts were found to be increased after admission, indicating that our case might have been prone to relapse after COVID-19 vaccination. Although our case cannot establish causality between AAV relapse and COVID-19 mRNA vaccination, a clinical vigilance for relapse of AAV especially in patients undergoing rituximab maintenance therapy following COVID-19 vaccination should be maintained. Furthermore, the elapsed time between rituximab administration and COVID-19 mRNA vaccination should be carefully adjusted based on AAV disease-activity (Nishioka et al. Front Med 2022. in press).

JOURNAL/jhype/04.03/00004872-202301001-01135/figure1/v/2023-10-24T163949Z/r/image-jpeg
PS-R05-4: PREVENTION OF HYPOTENSION DURING LDL-APHERESIS BY NAFAMOSTAT MESYLATE: A CASE REPORT
Authors: Fujii Kentaro , Suji Wataru , Kato Ai , Yoshifuji Ayumi , Komatasu Motoaki , Ryuzaki Munekazu
Published: January 2023

Objectives:

The prevalence of peripheral artery disease (PAD) is high in hemodialysis patients and has a poor prognosis. More than 10,000 hemodialysis patients require lower-extremity amputation. LDL-apheresis has been initiated as a supportive treatment for patients with chronic limb-threatening ischemia (CLTI), especially in cases where revascularization by endovascular therapy (EVT) is not sufficiently effective. In 2021, a new adsorption-type blood purification device, Rheocana, that can selectively remove LDL-C and fibrinogen, was developed. In a clinical trial, 45.9% of the ulcers were healed using Rheocana. Since then, it has been widely used for dialysis patients with CLTI in Japan; however, hypotension during LDL-apheresis is still a major adverse event.

Design and Methods:

Case report.

Results:

An 83-year-old Japanese man presented with a right leg ulcer. He had started undergoing hemodialysis 3 years prior because of diabetic kidney disease. CLTI was recognized 6 months prior, and repeated EVT was ineffective and failed to improve the ulcer. His blood pressure was 129/71 mmHg and antihypertensive agents were not used. LDL-apheresis with Rheocana was initiated; however, his systolic blood pressure decreased to 60 mmHg, and LDL-apheresis was stopped immediately. After discontinuing LDL-apheresis, the his blood pressure recovered. Anticoagulants were changed from heparin to nafamostat mesylate, and LDL-apheresis was restarted. His blood pressure did not decrease after anticoagulation therapy, and his leg ulcer was successfully healed.

Conclusion:

During LDL-apheresis, factor VIII and kallikrein are activated when the plasma comes in contact with the negatively charged dextran surface, resulting in a decrease in blood pressure by promoting bradykinin production. And thus, in case of ACEI use is contraindicated. Nafamostat mesylate is thought to reduce bradykinin production by suppressing kallikrein. Blood pressure often decreases by approximately 30 mmHg when LDL-apheresis is started; however, nafamostat mesylate was dramatically effective in preventing decrease in blood pressure. Nafamostat mesylate should be used in patients with CLTI and low blood pressure.
PS-R05-5: A CASE OF SEPTIC PULMONARY EMBOLISM DUE TO MITRAL VALVE ENDOCARDITIS OCCURRING EARLY IN THE INDUCTION PHASE OF HEMODIALYSIS
Authors: Kishi Seiji , Nishimura Kenji , Kashihara Naoki , Nagai Kojiro
Published: January 2023

A 66-year-old man with end-stage kidney disease (ESKD) due to chronic glomerulonephritis who was scheduled to start hemodialysis after surgery for radiocephalic arteriovenous fistula (AVF) was admitted to our hospital because of volume overload. He developed fever and cough after an upper endoscopy was performed on the 20th hospital day. Chest CT revealed an infiltrative shadow in the right lower lung and he was diagnosed with bacterial pneumonia and treated with sulbactam/ampicillin and azithromycin. Two sets of blood cultures were negative. There were no findings suggesting infection of the AVF. His fever persisted and repeated CT on day 37 showed multiple nodule shadows along the blood vessels in the left lower lobe. We suspected septic pulmonary embolism (SPE) and transthoracic/esophageal echocardiography showed a newly developed MV regurgitation (MVR (II/IV), with a 17 mm vegetation and partial perforation. Repeat physical examination revealed nontender, small erythematous (Janeway) lesions on the toes and a new holosystolic murmur at the apex (II/VI). (The patient said he had similar lesions on his hands but they had disappeared.) Due to the accumulation of Ga-67 citrate in the peri-oral area and the MV, caries and periodontal disease were thought to be the source of infection.

Infectious endocarditis (IE) was diagnosed based on modified Duke criteria. Ceftriaxone was added to cover gram-negative bacilli in the oral cavity, including HACEK (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella). Antibacterial treatment reduced the size of the vegetation and the MVR improved. Pulmonary nodules also disappeared. Dental treatment was performed after the vegetation had almost disappeared. Three additional sets of blood cultures were also negative. There have been few reports of SPE due to left sided IE. The onset of SPE in this case may have been caused by an embolus that formed in the MV and flowed into the right sided heart via an AVF, as emboli were also found in the peripheral extremities.
PS-B10-11: PATHOPHYSIOLOGICAL STUDY OF COGNITIVE FRAILTY USING A MOUSE MODEL OF ALZHEIMER'S DISEASE
Authors: Takeshita Hikari , Yamamoto Koichi , Takeda Shuko , Ito Yuki , Rakugi Hiromi
Published: January 2023

Objective:

Hypertension is known to increase the risk of developing dementia including Alzheimer's disease (AD). The concept of cognitive frailty or motoric cognitive risk syndrome, representing a coexistence of physical and cognitive decline, has been attracting attention in the global aging society. However, the molecular mechanisms underlying the pathological interplay between these conditions remain largely unknown.

Methods:

We investigated the effects of AD pathogenesis on skeletal muscle by using APP23 mice, a mouse model of AD. Three-month-old male APP23 mice and wild-type mice from the same litter were evaluated for skeletal muscle function by grip strength, for cognitive function by passive avoidance and open field tests, and for glucose tolerance and 24-hour voluntary locomotion using a running wheel as factors related to both skeletal muscle function and cognitive function. After dissection, various organs, mainly skeletal muscle, were harvested and wet weight was evaluated.

Results:

Grip strength and some skeletal muscle weights of APP23 mice were lower than those of wild-type mice. The ipGTT was used to assess glucose tolerance, and the passive avoidance test and open field test were used to assess cognitive function, but there were no significant differences between genotypes. In the running wheel test, which measures voluntary locomotion, APP23 mice were significantly more active than wild-type mice suggesting that the muscle weakness in APP23 mice was not due to disuse.

Conclusions:

This study demonstrates that APP23 mice exhibit skeletal muscle deficits, including muscle weakness, along with cognitive dysfunction. In addition, APP23 mice showed behavioral abnormalities such as increased voluntary locomotion, which should contribute to increased skeletal muscle function, but skeletal muscle function was conversely decreased, suggesting that the effect of AD on skeletal muscle function is mediated by factors other than behavioral abnormalities due to cognitive dysfunction.