bluuebunny/crossref_metadata_2025 huggingface dataset:
Adherence to CDC Guidelines for mpox Evaluation: Practice Patterns Across an Academic Medical System During the 2022 Epidemic
Authors: Garneau William M , Jones Joyce L , Dashler Gabriella M , Kwon Nathan , Hamill Matthew M , Gilliams Elizabeth A , Rudolph David S , Keruly Jeanne C , Klein Eili Y , Wang Nae-Yuh , Hansoti Bhakti , Gebo Kelly A
Published: September 2024

Background

Patients with suspected mpox presented to different venues for evaluation during the 2022 outbreak. We hypothesized that practice patterns may differ across venue of care.

Methods

We conducted an observational study of patients undergoing mpox testing between 1 June 2022 and 15 December 2022. We assessed concomitant sexually transmitted infection (STI) testing, sexual history, and anogenital examination and a composite outcome of all 3, stratified by site. Venue of care was defined as ED (emergency department or urgent care), ID (infectious disease clinic), or PCP (primary care or other outpatient clinic).

Results

Of 276 patients included, more than half (62.7%) were evaluated in the ED. Sexual history, anogenital examination, and STI testing were documented as performed at a higher rate in ID clinic compared to ED or PCP settings. STIs were diagnosed in 20.4% of patients diagnosed with mpox; syphilis was the most common STI among patients diagnosed with mpox (17.5%). Patients evaluated in an ID clinic had higher odds ratio of completing all 3 measures (adjusted odds ratio, 3.6 [95% confidence interval, 1.4–9.3]) compared to PCP setting adjusted for age, gender, and men who have sex with men status. Cisgender men who have sex with men, transgender males, and transgender females had higher odds ratio of completing all 3 measures compared to cisgender females (adjusted odds ratio, 4.0 [95% confidence interval, 1.9–8.4]) adjusted for age and venue of care.

Conclusions

Care varied across clinical sites. ID clinics performed a more thorough evaluation than other venues. Rates of STI coinfection were high. Syphilis was the most common STI. Efforts to standardize care are important to ensure optimal outcomes for patients.
Burden of Herpes Zoster in Individuals With Chronic Conditions in the Republic of Korea: A Nationwide Population-Based Database Study
Authors: Chen Jing , Shin Ju-Young , Bea Sungho , Ye Byong Duk , Lee Dong-Gun , Kim Hyungwoo , Choi Won Suk , Shantakumar Sumitra
Published: September 2024

Background

Chronic conditions (CCs) may increase the risk of herpes zoster (HZ) infection, leading to a greater healthcare burden in these individuals compared to those without CCs. It is therefore clinically important to quantify HZ disease burden in individuals with and without CCs, given the rapidly aging population in the Republic of Korea (ROK).

Methods

This retrospective cohort study examines the trends in incidence rates (IRs) and incidence rate ratios (IRRs) in individuals aged ≥18 years with CCs, using the National Health Insurance Service National Sample Cohort (NHIS-NSC) database from 2010 to 2019. These patients were stratified by age group, sex, HZ complications, and CCs. The annual average number of HZ patients, IRs, and IRRs were calculated for individuals with and without CCs.

Results

In total, 729 347 patients with HZ were eligible for the study. HZ IRs were highest in patients with diabetes, followed by chronic obstructive pulmonary disease, chronic kidney disease, asthma, and chronic liver disease, with HZ IRRs following a similar trend. Overall, HZ IRs generally increased with age, typically peaking at 60–64 or 65–69 years, and were similar for females and males. HZ IRs were highest among patients without complications, followed by HZ with other, cutaneous, ocular, and neurologic complications across all CCs. For each of the CCs, HZ IRs were consistently higher than those of the non-CC population regardless of sex.

Conclusions

The findings of this study reiterate the importance of HZ prevention for healthy aging, especially for CC populations at increased risk of HZ in the ROK.
Treatment of intracranial aneurysms using the Tubridge flow diverter
Authors: Yuan Dun , Zhenmei Nibu , Guo Yuxin , Cao Fang , Liu Junyu , Jiang Weixi , Li Yifeng , Yan Junxia
Published: September 2024

Objective

The Tubridge flow diverter (TFD) was recently developed to treat intracranial aneurysm (IA). In this study, we aimed to assess the safety and efficacy of this novel device.

Methods

A retrospective cohort of consecutive patients with IA was recruited between June 2017 and February 2022. The studied outcomes were perioperative complications, clinical quality of life, and angiographic IA occlusion. Multivariate logistic regression was performed to explore the potential predictors of perioperative stroke events and IA occlusion. A comprehensive literature review was conducted across five databases for evidence synthesis.

Results

Among the patients with IA in our cohort, 144 underwent successful TFD implantation. Postoperative stroke was observed in 11 (7.6%) patients, and 130 (90.3%) patients were discharged with modified Rankin scales (mRS) of ≤2. In the last clinical follow-up (mean, 16.9 months), 96.6% of the patients reported a satisfactory quality of life (mRS ≤2). IA occlusion was observed in 84.6% of the patients at the last angiographic follow-up (mean, 10.4 months). Aneurysmal subarachnoid hemorrhage [odds ratio (OR), 6.98; 95% confidence interval (CI), 1.11–43.91] and giant IA (OR, 5.63; 95% CI, 1.15–27.48) were associated with perioperative stroke events. The evidence synthesis found high rates of satisfactory quality of life (rate, 98.8%; 95% CI, 97.1–99.9%) and IA obliteration (rate, 78.5%; 95% CI, 74.0–82.7%) after TFD treatment. The pooled complication rate was 13.6% (95% CI, 10.9–16.5%).

Conclusions

This study identified a high rate of IA occlusion in patients who received TFD treatment. These patients also reported a satisfactory quality of life. Further studies in larger prospective cohorts with longer follow-up periods are warranted to verify our findings.

Key message What is already known on this topic  Flow diverter (FD) devices are an optimal tool to modify hemodynamics and treat intracranial aneurysms (IAs). However, the safety and efficacy of a novel self-expanding FD, namely the Tubridge flow diverter (TFD), remain to be fully established owing to the short-term follow-up periods and limited sample size of existing studies. What this study adds  In our cohort of patients who received TFD treatment, 96.6% of patients reported satisfactory quality of life at the last clinical follow-up (mean, 16.9 months); and 84.6% of IAs were successfully occluded at the last angiographic follow-up (mean, 10.4 months). Our comprehensive review and evidence synthesis of existing studies on TFD found high rates of satisfactory quality of life (98.8%; 97.1–99.9%) and IA obliteration (78.5%; 74.0–82.7%). How this study might affect research, practice or policy  TFD demonstrated satisfactory performance in the treatment of IAs in our cohort. Studies with larger prospective cohorts and longer follow-up periods are warranted to further investigate this promising novel approach.
Large language models and rheumatology: are we there yet?
Authors: Benavent Diego , Madrid-García Alfredo
Published: September 2024

The last two years have marked the beginning of a golden age for natural language processing (NLP) in medicine. The arrival of large language models (LLMs) and multimodal models have raised new opportunities and challenges for research and clinical practice. In rheumatology, a specialty rich in data and requiring complex decision-making, the use of these tools may transform diagnostic procedures, improve patient interaction, and simplify data management, leading to more personalized and efficient healthcare outcomes. The objective of this article is to present an overview of the status of LLMs in the field of rheumatology while discussing some of the challenges ahead in this area of great potential.
Estimated prevalence of obstructive sleep apnea by occupation and industry in England: a descriptive study
Authors: Kinoshita Ryohei , Quint Jennifer K , Kallis Constantinos , Polkey Michael I
Published: September 2024

Study Objectives

Obstructive sleep apnea (OSA) can induce excessive sleepiness, causing work-related injuries and low productivity. Most individuals with OSA in the United Kingdom are undiagnosed, and thus, theoretically, workplace screening, might by identifying these individuals improve both their individual health and overall productivity. However, the prevalence of OSA in different workplaces is unclear. This study aimed to estimate the prevalence of OSA by industries and occupations in England.

Methods

The Health Survey for England 2019 dataset was combined with Sleep Heart Health Study dataset. We applied multiple imputation for the combined dataset to estimate OSA in the English population aged 40–64. We estimated the pooled prevalence of OSA by both industry and occupation by separating samples by Standard Industry Classification and Standard Occupation Classification.

Results

The overall OSA prevalence estimated by imputation for ages 40–64 was 17.8% (95% CI = 15.9% to 19.9%). Separating those samples into industrial/occupational groups, the estimated prevalence of OSA varied widely by industry/occupation. Descriptive analysis revealed that the estimated prevalence of OSA was relatively higher in the Accommodation and food, Public administration and defence; compulsory social security, Construction industries, and Protective service occupations, health and social care associate professionals, and skilled construction and building trades occupations.

Conclusions

In England in 2019, Accommodation and food, Public administration and defence; compulsory social security, Construction industries, and Protective service occupations, health and social care associate professionals, and skilled construction and building trades occupations showed a relatively higher prevalence of OSA indicating that they may be target populations for workplace screening.
How “Ceremonial Openness” Prevents Organizational Change: An Analysis of Corporate Earnings Calls in the Oil and Gas Industry, 2007–2020
Authors: Ladegaard Isak , Rieger Annika
Published: September 2024

Incumbent firms resist change as they have much to lose if things go wrong. But inertia can also be costly, particularly in times of crisis. In a world on fire, does corporate transparency foster engagement with external threats to future organizational success? To answer this question, we conduct a mixed-methods analysis of 887 public earnings-calls meetings between executives, investors, and outside analysts from 24 major oil and gas companies in 2007–2020, a period marked by extreme weather events and increased popular and political pressure to slow global warming. We find that formal rituals that promote openness and debate to protect investors reproduce the status quo by cultivating narratives that deny the need for change.
O03 THE SEVERITY OF COGNITIVE IMPAIRMENT IN PATIENTS WITH ESSENTIAL HYPERTENSION AND VARIOUS FORMS OF ATRIAL FIBRILLATION
Authors: Yusupova Khafiza , Abdullaeva Guzal , Khamidullaeva Gulnoz , Mashkurova Zarina , Radjabova  , Sherbadalova N , Pulatova M
Published: September 2024

Objective:

comparative analysis of the severity of cognitive impairment in hypertensive patients with various forms of atrial fibrillation (AF).

Materials and methods:

During the observation period, 156 patients of both sexes with I–III degree of arterial hypertension (AH) were examined. The average age of patients was 63.8±9.07 years, duration of hypertension was 12.8±7.8 years. To analyze cognitive impairment in patients with AF 3 groups of patients were formed: Group I - hypertension and AF with a permanent form, n = 91, Group II - hypertension and AF with a paroxysmal form, n = 18, Group III - AH and persistent AF form, n=47. Cognitive functions were assessed using the Mini-Cog test, MOCA. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression levels. The results are presented as M±SD.

Results:

The analysis of psychological testing data showed that cognitive impairment is more pronounced in the group of patients with a permanent form of AF. Thus, the total score on the Mini-Cog test in group I of patients was 3.73±1.3 points, while in group II it was 4.0±1.11 points (p<0.05). According to MoCa scale, the total score was superior in group II patients, amounting to 19.7±6.14, while in group I this figure was 19.2±6.08 (p<0.05), and in group III is 18.8±7.22, which indicates a greater severity of cognitive impairment in patients with hypertension and AF with a permanent form and a persistent form. Cognitive functions such as memory are significantly better in group II compared to group I: 7.88±1.99 points versus 6.9±1.78 points, respectively (p>0.05), and decision-making function is significantly better in group III group. It should be noted that according to the HADS scale, the severity of anxiety and depression is higher in group III.

Conclusion:

A comparative analysis of psychological testing data taking into account the form of AF showed that cognitive impairment is more pronounced in patients with a permanent form of AF.
O06 HYPERTENSION CONTROL AND COMORBIDITIES: INSIGHTS FROM THE MAY MEASUREMENT MONTH CAMPAIGN, 2017-2019
Authors: Razo Christian , Beaney Thomas , Poulter Neil R. , Prabhakaran Dorairaj , Schutte Aletta E. , Johnson Catherine O. , Roth Gregory A
Published: September 2024

Background and Objective:

Hypertension frequently coexists with other chronic conditions and cardiometabolic risk factors. The identification of comorbidities is key in the management of hypertensive patients. May Measurement Month (MMM) is a global initiative aimed at enhancing the detection and awareness of hypertension. This study analyzes data from MMM collected between 2017 and 2019 to evaluate hypertension control among adults aged 18 years and the frequency of comorbidities.

Methods:

Three sitting blood pressure (BP) readings, anthropometric measurements, and self-reported history of diabetes, myocardial infarction and stroke were collected. Missing BP readings were inputted using multiple imputation based on available BP measurements and sociodemographic variables. Hypertension was defined as an average systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or taking antihypertensive medication. Hypertension treatment was defined as current medication use; control was defined as BP <140/90 mmHg.

Results:

Among 2,907,848 participants from 95 countries, 34.2% had hypertension, and 12.1% had a history of at least one other chronic condition. Specifically, 8.3% self-reported type 2 diabetes, 4.5% had experienced myocardial infarction, and 2.9% had a history of stroke. Some individuals had multiple comorbidities at the time of the screening: 6% had both myocardial infarction and type 2 diabetes, 8% had myocardial infarction and stroke, 2% had stroke and type 2 diabetes, and 8% had all three comorbidities.

Among those with hypertension, 58.9% were on medication and 24.0% had at least one additional comorbidity, specifically, 15.8% reported type 2 diabetes, 8.8% had experienced myocardial infarction, and 5.5% had a history of stroke.

Of those with hypertension on medication, 43.1% were controlled. Among treated individuals, hypertension control rates were higher in individuals with comorbidities (50% vs 30%). Conversely, individuals without comorbidities had poorer hypertension control.

Conclusions:

The data suggest a high prevalence of comorbidities within the screened population and among individuals diagnosed with hypertension. Additionally, individuals without comorbidities exhibited suboptimal hypertension management.
O29 LACK OF VALIDATED BLOOD PRESSURE DEVICES FOR USE IN PREGNANCY AVAILABLE FROM AUSTRALIAN PHARMACIES
Authors: Slater Kaylee , Chapman Niamh , Picone Dean
Published: September 2024

Background and objective.

Self-monitoring of blood pressure (BP) at home can aid in the management of hypertension, including during pregnancy. Only 20% of home BP devices have been validated for the general population. However, specific accuracy validation in pregnant women is required for use among this population. The availability of home BP devices that have been validated for use in pregnant women is unknown, which was the aim of this study. Secondary aims were to assess device cost and claims regarding use in pregnancy.

Methods.

A search of pharmacies with physical and online stores in Australia that sell upper-arm cuff home BP devices was conducted. Validation status in pregnant women was determined by checking model numbers on the STRIDE-BP website. Cost of device and claims about the devices’ use in pregnancy were extracted from instruction manuals and information on the pharmacy webpage.

Results.

Eighteen pharmacies and 40 unique home BP devices were identified. Four (10%) devices were validated for use in pregnancy, and these were more expensive than other devices (Table). Fifteen devices listed a caution warning to seek healthcare provider advice before use if pregnant, including all four that had been validated for pregnancy. Concerningly, information about four devices stated they were recommended for pregnancy, although evidence of validation was not found on STRIDE-BP. Information about one device stated it had not been tested on pregnant women and was not suitable for use, although this information was only available in the device manual and not point-of-sale. Nineteen devices had no mention of pregnancy at all.

Conclusion.

Very few home BP devices available from Australian pharmacies are specifically validated for use in pregnancy, are priced higher than non-validated devices and do not effectively target their intended users. To guarantee that only validated home BP devices are used in pregnancy increased awareness is urgently needed and could be assisted by clear labelling on devices provided at the point-of-sale instore or online.

Table. Home BP devices sold in 18 Australian pharmacies.

BP: blood pressure. Cost displayed in Australian dollars (AUD). The percentages add to more than 100% because some devices validated in the general population were also validated for pregnancy and pre-eclampsia.
O30 AVAILABILITY OF PROPERLY VALIDATED AUTOMATED BLOOD PRESSURE MEASURING DEVICES FOR CHILDREN: STRIDE BP SYSTEMATIC REVIEW
Authors: Menti Ariadni , Mariglis Dimitrios , Kyriakoulis Konstantinos , Kollias Anastasios , Palatini Paolo , Parati Gianfranco , Wang Jiguang , Schutte Aletta , Stergiou George
Published: September 2024

Background and Objective:

Properly validated automated upper-arm cuff blood pressure (BP) measuring devices are currently recommended for office, home, and ambulatory BP measurement. However, the validation of BP devices in children presents additional challenges, necessitating separate studies. This study assessed the evidence on accurate automated BP devices in children.

Methods:

STRIDE BP (www.stridebp.org) performs periodic systematic PubMed searches to identify validation studies of automated cuff BP monitors. Validation studies including children (3-12 years) conducted using an established protocol, including the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018), ANSI/AAMI/ISO 2013/2009, ESH-IP 2010/2002, AAMI 2002/1992/1987, and BHS 1993/1990, were identified from the STRIDE BP database.

Results:

Of 569 validation studies included in the STRIDE BP database, 47 (33 devices) were identified including children. Among them, STRIDE BP rejected 29 studies of which 18 were reported as “device pass” in the published paper. Among studies rejected by STRIDE BP but published as “pass”, main reasons for rejection were violations in the BP measurement procedure (sequence, number, repeats) (50%), inadequate reference device or cuffs for reference and test device (16.6%), inadequate sample size (22.2%), and single observer for reference BP (22.2%). Eventually 18 studies in children (38.3%) fulfilled all the validation protocol requirements, and 16 devices (10 available on the market) met the validation requirements and can be recommended for use in children. When additional ‘equivalent’ devices were considered (devices lacking validation studies but with differences from validated devices not affecting the measurement accuracy), 21 devices were found to be accurate, with 13 of them available on the market (Table).

Conclusions:

This analysis highlight a serious shortage of properly validated BP devices for children available in the market, with published validation studies often having major methodological issues. There is an urgent call to manufacturers and investigators to develop and properly validate more BP devices for children.

TABLE. Validated devices for office, home, and ambulatory BP measurement in children.
O31 VALIDATION ASSESSMENT OF A CUFF-BASED CENTRAL BLOOD PRESSURE DEVICE ACCORDING TO ARTERY SOCIETY RECOMMENDATIONS
Authors: Bui Tan , Picone Dean , Kosmala Wojciech , Kosowski MichaŁ , Zachwyc Jowita , Pucci Giacomo , Schultz Martin , Black Andrew , Dwyer Nathan , Roberts-Thomson Phillip , Adams Heath , Curcio Rosa , Arrivi Alessio , Paleri Sarang , Sharman James
Published: September 2024

Background and objective.

Uscom BP+ is a cuff-based blood pressure (BP) device designed to non-invasively estimate central BP as distinct from conventional brachial BP. This study aimed to assess the accuracy of the Uscom BP+ device compared to invasively measured BP.

Methods.

Automated non-invasive cuff central BP (using the Uscom BP+ device) and invasive central aortic BP (using fluid-filled catheters) were recorded simultaneously in 191 participants (65% male, aged 66±11 years) receiving coronary angiography at three independent research sites (Hobart, Australia, Perugia, Italy and Wroclaw, Poland). Validation assessment procedures were undertaken according to the Artery Society recommendations and with a minimal acceptable error of ≤5±≤8 mmHg as pass criteria.

Results.

Using the device default calibration technique (brachial cuff systolic [SBP] and diastolic BP [DBP]), cuff central SBP underestimated invasive central SBP [mean(SD) difference: -10.2(11.2) mmHg] and cuff central DBP overestimated invasive central DBP [mean(SD) difference: 9.7(8.6) mmHg]. When calibrating by cuff mean arterial pressure and DBP in a sub-group (n=140), SBP accuracy was improved, but variability remained high [mean(SD) difference: -6.4(13.8) mmHg, p=0.002 vs default calibration], whereas DBP accuracy and variability remained similar [mean(SD) difference: 9.0(8.4) mmHg, p=0.23 vs default calibration].

Conclusions.

The Uscom BP+ cuff device does not pass the Artery Society accuracy criteria compared with invasively measured central BP.
O66 CONCORDANCE BETWEEN THE PULSE WAVE VELOCITY ESTIMATED WITH TOTAL ARTERIAL COMPLIANCE AND CAROTID-FEMORAL PULSE WAVE VELOCITY MEASUREMENTS
Authors: Aristizabal-Ocampo Dagnovar , Espindola-Fernandez Diego , Correa-Correa Monica , Alvarez-Montoya Diego , Gallo-Villegas Jaime
Published: September 2024

Background and Objective:

Carotid-femoral pulse wave velocity (cfPWV), considered a reference measure of aortic stiffness, plays a role in cardiovascular risk stratification. However, its application in clinical settings has been limited due to the need for additional equipment and trained personnel. Recently, our group developed a non-invasive method to estimate pulse wave velocity (PWV) based on total arterial compliance (Ct). Yet, the validity of this method remains uncertain. The objective was to evaluate the concordance between PWV estimated using Ct and cfPWV.

Methods:

A cross-sectional study was conducted involving 56 adult patients who visited an outpatient cardiology center due to suspected hypertension. All participants underwent 24-hour ambulatory blood pressure monitoring (24-h ABPM). PWV was measured in all patients using two methods: i) the applanation tonometry technique, utilizing the SphygmoCor device (AtCor Medical, West Ryde, NSW, Australia); and ii) a novel method based on Ct derived from blood pressure and heart rate data obtained from 24-h ABPM, without the need for a pulse wave. This method utilized the relationship between Ct and PWV proposed by Vardoulis et al., derived from the Bramwell-Hill theory and experimental research, where PWV=√(36.7/Ct).

Results:

Among the participants, 58.9% were men, with an average age of 50.4±16.5 years and a body mass index of 28.0±4.3 kg/m2. The agreement of the PWV between the new method based on Ct and cfPWV was found to be very good (ICC 0.675; 95% CI 0.498 to 0.797), with a mean difference of 0.388±1.262 m/s (95% CI 0.050 to 0.726). Bland-Altman plots revealed that the differences between the methods were randomly distributed along the mean difference line (Figure).

Conclusions:

The ability to estimate PWV in humans using a new method based on Ct represents a significant advancement. This finding has the potential to streamline the implementation of PWV measurement as a risk marker in clinical practice.
O45 INDIVIDUAL VS. HEALTH SYSTEM FACTORS IN HYPERTENSION CONTROL PERFORMANCE: DISTRICT-LEVEL CARE CASCADE ANALYSIS
Authors: Muharram Farizal Rizky
Published: September 2024

Background:

High-quality health systems are crucial for achieving optimal health outcomes, particularly in managing chronic conditions like hypertension. Effective hypertension control reduces the risk of cardiovascular diseases (CVD). This study examines the relative importance of individual factors (social determinants of health, SDOH) versus health system factors in influencing the stages of the hypertension care cascade in Indonesia, focusing on the controlled rate as the endpoint. This study aims to analyze which factors impact the hypertension care cascade.

Methods:

The performance of 514 districts in Indonesia was analyzed using multivariate regression. Dependent variables included the percentages of individuals ever tested, diagnosed, treated, and controlled for hypertension. Independent variables encompassed healthcare resource availability, socioeconomic factors, and demographic factors.

Results:

The regression analysis revealed several key findings: The physician ratio positively and significantly impacted all stages of the care cascade, with coefficients increasing from 0.087 in testing to control 0.356 (p<0.01 for all). The midwife ratio positively influenced testing (0.072), diagnosis (0.135), and treatment (0.160) but not control (0.016, p>0.1). Conversely, Average years of schooling positively correlated with testing (0.111, p<0.05). GNI PPP per capita was positively associated with testing (0.235, p<0.01), diagnosis (0.189, p<0.05), and treatment (0.228, p<0.05), but not control (-0.253, p>0.1). Median age showed a strong positive association across all stages, with coefficients of 1.212 for testing, 1.443 for diagnosis, 1.509 for treatment, and 1.274 for control (p<0.01 for all).

Regression shows a pattern that while individual SDOH significantly influenced the early stages of the care cascade (testing and diagnosis), these factors had minimal impact on the control rate. Instead, health system performance was particularly critical for achieving control.

Conclusion:

Individual SDOHs are more influential in the early stages of the care cascade, while health system factors are crucial for controlling hypertension. Efforts to improve hypertension management should focus on enhancing health system resources to achieve better control rates and reduce CVD risks.
O49 DIABETES IS ASSOCIATED TO THE REDUCTION OF CAROTID BODY VOLUME IN RESISTANT HYPERTENSIVE PATIENTS
Authors: Cruz Da Silva Lamoel Mohandas , Vieira de Morais Camilla Giovanna , De Paula Morales Kevin Rafael , Rochitte Carlos Eduardo , Lacchini Silvia
Published: September 2024

Background and Objective:

Considering that carotid bodies (CB) are involved in the counterregulatory response to hypoglycemia and that their impact on blood pressure control still needs to be better clarified, the objective of this study was to characterize the volumetric reduction of CB in controlled and uncontrolled hypertensive patients.

Methods:

CT angiograms of hypertensive patients treated at the Heart Institute (University of São Paulo Medical School) were studied. The evaluated patients were separated into four groups: hypertensive (receiving 1 to 2 categories of antihypertensives) controlled (H-C, n=42) and uncontrolled (H-U, n=23), and resistant hypertensives (receiving 3 or more categories of antihypertensives) with controlled (HR-C, n=17) and uncontrolled (HR-U, n=23) blood pressure. CT angiograms (Aquilion ONE/PRISM–Canon) of the cervical arteries with iodinated contrast were evaluated. Artery reconstructions used 0.5 mm thick sections, with orthogonal measurements of CB to evaluate bilateral carotid diameters and bifurcations.

Results

The morphology of common, internal and external carotid arteries was very similar between the groups. The mean age between groups was not significantly different (H-C: 67±12; H-U: 63±16; HR-C:65±9; HR-U: 67±13 years). When evaluating the presence of atherosclerotic lesions, a similar proportion, approximately 50%, was found in all groups. On the other hand, the presence of diabetes in HR-U group was 52%, while in other groups it was 30%. Furthermore, CB volume (mm3) in the presence of diabetes, presented an important reduction, especially in resistant hypertensive patients (H-C: -4%; H-U: -27%; HR-C:-55%; HR-U: -64%).

Conclusions:

The reduction of CB volume may be associated with the loss of microvascularization, mediating a possible hyperactivity of CB, which consequently maintain the comorbidities observed in these patients. Experimental studies showed that bilateral resection of the carotid sinus nerve completely prevents insulin resistance and hypertension, reinforcing the strong effect of diabetes upon CB normal function found in the present study. Longitudinal studies will contribute to a better understanding of CB regulation and the impact of diabetic state on blood pressure control.
O75 INHIBITION OF PCSK9/NFAT AMELIORATES CARDIAC DYSMETABOLISM AND FIBROSIS IN EXPERIMENTAL RAT MODEL OF PCOS BY REDUCING ATHEROGENIC LIPID AND IMPROVING INSULIN SENSITIVITY
Authors: Olaniyi Kehinde Samuel , Areloegbe Stephanie , Areloegbe Lawrence
Published: September 2024

Background:

Polycystic ovarian syndrome (PCOS) remains an independent risk factor of cardiovascular disease (CVD), particularly in women of child-bearing age, and contributes to global increase in the prevalence/incidence of cardiovascular mortality and morbidity in women. Proprotein convertase subtilisin/kexin type 9 (PCSK9) has emerged as a promising therapeutic target to reduce residual CVD risk. Similarly, Nuclear factor of activated T cells (NFAT) is a transcription factor that is implicated in cardiac fibrosis. However, the role of PCSK9/NFAT in PCOS-associated cardiometabolic syndrome is not clear. Short chain fatty acids (SCFAs) play a multifaceted regulatory role in metabolic health. The present study therefore investigated the role of PCSK9/NFAT in cardiometabolic syndrome associated with experimental PCOS, and the therapeutic potential of SCFAs, especially butyrate.

Material and Methods:

Eight-week-old female Wistar rats were allotted into four groups (n=5). Polycystic ovarian syndrome was induced by administering letrozole (1 mg/kg p.o.) once daily for 21 days, thereafter the animals were treated with 200 mg/kg (oral gavage) of sodium butyrate for six weeks. Gene expression, biochemical parameters and cardiac/ovarian morphology were evaluated with appropriate methods.

Results:

Rats with PCOS showed androgen excess, multiple ovarian cysts and reduced insulin sensitivity. The rats in addition displayed atherogenic dyslipidemia (triglyceride/HDLc, TC/HDLc and LDLc), hypercorticosteronemia and elevated cardiac triglyceride, inflammatory biomarkers (NF-kappaB and TNF-alpha), caspase-6, 4-hydroxynonenal, inflammasome (NLRP3), fibrosis and depleted antioxidant defense (NrF2 and glutathione) as well as increased expression of PCSK9 and NFAT when compared to the control rats. Nevertheless, these systemic and morphological alterations were ameliorated following treatment with sodium butyrate.

Conclusion:

The present results collectively demonstrate cardiac dysmetabolism, inflammation, fibrosis as well as apoptosis in experimental PCOS rat model, which are driven by elevated expression of PCSK9/NFAT. The results further suggest that SCFAs, butyrate alleviates cardiometabolic syndrome and its attendant cardiomorbidity by suppression of PCSK9/NFAT. The present data provide a preclinical insight to prevention and management of CVD in PCOS individuals.
O79 DAILY URINARY POTASSIUM EXCRETION IS NOT A FIXED PERCENTAGE OF DAILY POTASSIUM INTAKE
Authors: Van Vliet Anne Myrthe , Rauh Manfred , Vogt Liffert , Titze Jens , Olde Engberink Rik
Published: September 2024

Background and Objective:

High potassium intake is associated with a lower blood pressure and lower incidence of cardiovascular events. For estimation of potassium intake, the World Health Organization advices to multiply the 24-hour renal potassium excretion by 1.3, considering the substantial fecal potassium loss. We examined the variation in the required conversion factor in healthy volunteers and evaluated the effect of factors associated with tissue cation storage on the renal potassium excretion.

Methods:

We performed a post-hoc analysis of the Mars long-term sodium balance studies. Healthy male participants consumed a fixed amount of salt (6, 9 and 12 grams/day for >29 days) and potassium (4 grams/day) for 105 (n=4) and 205 days (n=6). All urine was collected in 24-hour aliquots. We calculated the percentage of potassium intake that was excreted in the corresponding 24-hour urine collection during steady-state. A multivariable mixed-effects model was used to assess associations of this percentage with sodium intake, potassium intake, urinary aldosterone, urinary cortisol and urine volume.

Results:

The median renal potassium excretion was 80% of potassium intake (IQR 65-97%, range 24-304%), corresponding to a conversion factor of 1.25 (IQR 1.03-1.54). Within individual subjects we also observed a marked day-to-day variation in the percentage of renal potassium excretion: the average intraperson width of the IQR was 25%.

Sodium intake (figure A), urinary aldosterone (figure B), urinary cortisol (figure C) and urine volume (figure D) were positively associated with the percentage of renal potassium excretion, whereas potassium intake showed a negative association (figure A). A significant positive interaction between the effects of sodium and potassium intake was present (P<0.001).

Conclusions:

The percentage of dietary potassium that is excreted via urine varies considerably. During steady-state, this percentage is independently affected by sodium intake, potassium intake, urinary aldosterone, urinary cortisol, and urine volume. Our results suggest that the WHO's fixed 1.3 conversion factor may lead to inaccurate estimations of potassium intake.
O88 REDUCTION IN SYSTOLIC BLOOD PRESSURE FOLLOWING DIETARY FIBRE INTERVENTION IS DEPENDENT ON BASELINE GUT MICROBIOTA COMPOSITION
Authors: Snelson Matthew , Jama Hamdi , Rhys-Jones Dakota , Nakai Michael , Anderson Dovile , Creek Darren , Head PGeoffrey , Mackay Charles , Muir Jane , Marques Francine
Published: September 2024

Background/Objective:

Dietary interventions high in fibre have been shown to lower blood pressure (BP). This effect is via the gut microbiota, via fermentation of fibre and production of metabolites called short-chain fatty acids (SCFAs). Not all patients respond to dietary fibre interventions for unclear reasons. We aimed to determine if we can identify fibre-responders based on their gut microbiota and production of SCFAs.

Methods:

We performed a phase II cross-over placebo-controlled randomised clinical trial in untreated hypertensive patients. Twenty treatment-naive participants with hypertension received 40 g per day of fermentable fibre delivered as acetylated and butyrylated high amylose maize starch (HAMSAB) or the placebo for 3 weeks. Blood pressure was monitored at baseline and endpoint by ambulatory BP monitoring, with those experiencing a reduction of ≥2 mmHg in systolic BP classified as responders. The microbiota was determined by sequencing the V4-V5 region of the 16S rRNA gene in baseline stool samples. The relationship between baseline gut microbiota and response to dietary intervention was assessed with the MaAsLin2 package. Plasma SCFAs levels were quantified by mass spectrometry.

Results:

We observed a placebo-subtracted mean 24-hour systolic BP of –6.1 mmHg (p=0.03, reported in Jama et al., 2023 Nature Cardiovascular Research), with 14 (70%) individuals classified as responders and 6 (30%) as non-responders. Genera significantly enriched in responders included Dialister (β=1.29, q=1.921x10-134), Coprococcus (β=1.26, q=3.282x10-121), Bifidobacterium (β=1.67, q=1.11x10-81), Ruminococcus (β=0.161, q=1.11x10-8), and Roseburia (β=0.82, q=4.275x10-2). Responders also produced higher levels of the SCFAs butyrate (mean±SEM, non-responders 4.95±2.4 vs responders 51.15±14.7, p=0.0096), but no difference in other SCFAs.

Conclusions:

Participants who experienced a decrease in systolic BP following a dietary fibre intervention had increased bacterial genera known to contain species that produce SCFAs (Bifidobacterium, Roseburia, Ruminococcus) at baseline, and were able to produce more butyrate. These data suggest that baseline microbiota composition contributes to the response to dietary fibre intervention trials in people with hypertension, likely via increased capacity to produce butyrate.
O93 BRIGHT LIGHT EXPOSURE ATTENUATES BLOOD PRESSURE REDUCTION POSTEXERCISE
Authors: Oliveira Gustavo , Marin Thais , Azevedo Luan , Thosar Saurabh , Cipolla-Neto José , Forjaz Claudia , Brito Leandro
Published: September 2024

Background and objective:

A single session of aerobic exercise lowers blood pressure (BP), known as postexercise hypotension (PEH). Bright light (BL) exposure increases BP at rest compared to dim light (DL). However, whether BL exposure can attenuate PEH remains unknown, and this hypothesis was tested in the current study.

Methods:

Twenty healthy men (27±5 years) underwent two experimental sessions: one under BL (5000 lux) and another under dim light (DL ≤8 lux), performed in random order. In each session, subjects executed an aerobic exercise session on a cycle ergometer for 30 min at 50-60-% heart rate (HR) reserve. BP (oscillometric) and HR (HR monitor) were measured, and rate-pressure-product (RPP) was calculated (systolic BP * HR) pre- and postexercise. Additionally, subjects wore an ambulatory BP monitor (ABPM) for 24 hours after postexercise measurements.

Results:

Systolic BP decreased similarly postexercise in both sessions, but its levels were higher in BL than DL throughout the experimental session (Figure 1A). Diastolic and mean BPs decreased postexercise only in DL at 30 min, while they increased in BL at 60 and 90 min (Figure 1B and 1C, respectively). HR and RPP increased in both sessions postexercise, but RPP levels were higher throughout the experimental session in BL than DL (Figure 1D and 1E, respectively) and for the first three hours of ABPM.

Conclusions:

In healthy adult men, BL exposure increased systolic BP and cardiac work and attenuated PEH on diastolic and mean BPs.
O96 NICD LACTYLATION OF NOTCH SIGNALING IMPROVES MICROVASCULATION RAREFACTION IN HYPERTENSION
Authors: Liu Yuxin , Liang Jianwen , Zhang Meixin , Gao Datian , Yang Junqi
Published: September 2024

Background and Objective:

Microvascular rarefaction is a key pathophysiologic basis of hypertension-related cardiovascular disease. Exercise decreases blood pressure and promotes angiogenesis related to inhibition of NOTCH signaling. The activation of the NOTCH pathway depends on the transcriptional regulation of its intracellular active fragment NICD after nuclear translocation. The post-translational modification status of proteins plays a crucial role in the nuclear translocation effect of transcription factors. Lactylation is influenced by the level of lactate in the body. Exercise can promote glycolysis in endothelial cells, and increase intracellular lactate levels. Therefore, we explored whether the beneficial effects of Exercise were mediated by promoting NICD lactylation, inhibiting the NOTCH signaling, and promoting angiogenesis.

Methods:

To test our hypotheses, WKYs (normotensive rats) and SHRs (spontaneously hypertensive rats) were given exercise for 12 weeks. Blood pressure was determined by the tail-cuff method, and cardiac function was assessed by echocardiography. Using rats’ retina, gastrocnemius, and myocardium detected microvascular density. The expression levels of NOTCH signaling pathway related proteins and angiogenesis related factors were measured by Western Blotting. The level of lactate was measured by using a lactate assay kit. Protein modification omics was used to detect the modification types and levels of NICD in microvascular endothelial cells, followed by liquid chromatography tandem mass spectrometry (LC-MS/MS) to detect the lactylation sites of NICD in microvascular endothelial cells.

Results:

Exercise in SHRs resulted in reduced blood pressure and concentric hypertrophy. Exercise promoted angiogenesis and improved microcirculation rarefaction. Exercise also reduced the production of NOTCH pathway related proteins and increased the expression level of angiogenesis related factors. The lactate level increased after exercise, and the lactylation level of NICD increased.

Conclusions:

In summary, Exercise decreases hypertension and improves cardiac function in SHRs. Our research results indicated that exercise increases lactate production and induces NICD lactylation, thereby inhibiting the NOTCH signaling, upregulating the expression of angiogenic factors, promoting angiogenesis, and lowering blood pressure.
O99 RELATIONSHIP BETWEEN RENIN, ALDOSTERONE, ALDOSTERONE-TO-RENIN RATIO AND LEFT VENTRICULAR MASS INDEX IN YOUNG ADULTS
Authors: Ananda Roshan , Gwini StellaMay , Beilin Lawrence , Schlaich Markus , Stowasser Michael , Fuller Peter , Young Morag , Adler Brendan , Mori Trevor , Yang Jun
Published: September 2024

Background and Objective:

Primary aldosteronism (PA), characterised by excessive aldosterone production and mineralocorticoid receptor activation, is associated with adverse cardiovascular outcomes including left ventricular hypertrophy and failure. Elevated cardiovascular risk is observed even in milder and subclinical forms of PA, based on studies primarily conducted in middle-aged and elderly populations. It is unclear if the biomarkers of PA, including renin, aldosterone, and aldosterone-to-renin ratio (ARR), are associated with left ventricular mass index (LVMI), which is a strong predictor of cardiovascular diseases, in young adults.

Methods:

The Raine Study is a longitudinal, population-based cohort study in Western Australia that enrolled women during pregnancy. We analysed the data from the offspring of these women at age 27 years. Participants with elevated high-sensitivity C-reactive protein (>10 mg/L) and females who were on oral contraception were excluded. LVMI was measured by cardiac magnetic resonance imaging. We examined the relationship between LVMI and plasma renin, aldosterone, and ARR using multivariate-adjusted linear regression and used mediation analysis to test whether these relationships were dependent on systolic blood pressure (SBP).

Results:

Of 758 participants, 252 (33.2%) were females. Females had lower median plasma renin concentration (12.0 vs 15.4mU/L; p<0.001) and higher median ARR (21.0 vs 15.6; p<0.001) than males. There was no sex-difference in median plasma aldosterone concentration (257 vs 237pmol/L in males; p=0.143). Females had lower LVMI (52.2 vs 70.2 g/m2; p<0.001) than males. A significant association between LVMI and aldosterone was detected in males (β-coefficient 0.009; 95% CI 0.001 to 0.017; p=0.027), and between LVMI and ARR in females (β-coefficient 0.098; 95% CI 0.001 to 0.196; p=0.050) after adjusting for confounders. This relationship was not mediated by brachial SBP.

Conclusions:

An elevated aldosterone concentration or ARR was associated with higher LVMI in young adults, independent of brachial SBP. Long-term follow-up is required to determine if the relationship persists over time and leads to reduced cardiac function.
O100 IL15RA MEDIATES BLOOD PRESSURE ELEVATION, INFLAMMATION AND VASCULAR DAMAGE IN ANGIOTENSIN II-INDUCED HYPERTENSION
Authors: Nosalski Ryszard , Booth Emma , Saju Blessy , Szczepaniak Piotr , Siedlinski Mateusz , Urbanski Karol , Kraler Simon , Camici Giovanni , Bailey Matthew , Maffia Pasquale , Guzik Tomasz J
Published: September 2024

Cytokines are key mediators regulating blood pressure (BP) and target organ damage in hypertension. IL15 levels increase in cardiovascular diseases, but the role of IL15 and its receptor alpha (IL15R) in hypertension and hypertension-mediated inflammation and vascular damage is still unknown.

Wild-type and IL15Rα-/-mice (n=5-9) were infused with vehicle or angiotensin II (AngII, 490ng/min/kg). Recombinant IL15 was administered to WT mice (1ug, daily, 14 days) during AngII infusion. Telemetry, wire myography, luminometry, PSR staining, qPCR, immunoblotting, flow cytometry, and primary cell lines were used.

Hypertensive patients have increased levels of IL15Rα in arteries, which significantly correlated with systolic (r=0.33, p=0.002), diastolic (r=0.27, p=0.02) pressure and maximal constriction to phenylephrine ex vivo (r=0.27, p=0.03). Similarly, AngII infusion significantly increased serum IL15/IL15Rα (8.8±0.7pg/ml vs 12.1±0.7pg/ml, p<0.01), IL15Rα mRNA (1±0.1 vs 1.8±0.1, p<0.01) and protein (1±0.03 vs 1.8±0.28, p<0.01) levels in the aortas. BP lowering using hydralazine and hydrochlorothiazide treatment prevented these changes in vasculature. IL15Rα was induced by pathophysiological stretch (15%) or interferon-gamma in adventitial fibroblasts, vascular smooth muscles, and endothelial cells in vitro. In contrast, AngII, other inflammatory cytokines or oxidative stress mediators have no such direct effect. Il15Rα-/- blunted AngII-induced hypertension (199±5.6mmHg vs 148±7.3mmHg, p<0.001), protected against endothelial dysfunction (p<0.01) and aortic superoxide production (59.4±7.8 vs 36.4±7.6 RLU/sec/mg) compared to wild-type mice. This was accompanied by reduced perivascular inflammation, lack of immune cell recruitment and effector and memory T cell formation. Similarly, T cell interferon-gamma and interleukin-17 production was attenuated in Il15Rα-/- hypertensive mice. In contrast, simultaneous administration of AngII and rIL15 into WT mice enhanced these outcomes. Perivascular fibrosis was observed in WT, but not Il15Rα-/- hypertensive animals (111036±19117 μm2 vs 48689±5515 μm2, p<0.01) and was in line with significantly lower mRNA of collagen and fibronectin protein levels in Il15Rα-/- aortas.

IL15Rα plays a crucial role in immune activation, vascular damage, and AngII-induced hypertension. Targeting this pathway may offer potential therapeutic benefits for controlling hypertension and preventing associated vascular complications.