bluuebunny/crossref_metadata_2025 huggingface dataset:
O81 EFFECT OF ANTIHYPERTENSIVE MEDICATIONS ON URINARY SODIUM TO POTASSIUM (Na/K) RATIO
Authors: Posse Veronica , Ryu Clara , Romero Cesar , Jeon Sihyun
Published: September 2024

Background:

The urinary sodium to potassium ratio (Na/K) greater than 2 indicating either excess sodium or insufficient potassium intake. However, the effect of antihypertensive medications on the urinary Na/K ratio has not been evaluated. We hypothesized that antihypertensive medication would acutely affect the urinary Na/K ratio.

Methods:

Male and female C57BL/6J mice, 14 weeks old, and a separate cohort of 24-month-old mice were subjected to a regular chow diet (NaCl 0.4%) and a high salt diet (4%). Urinary Na/K ratios in spot urine samples were measured three times a week. After baseline measurements, all animals were treated with one antihypertensive medication for 2 weeks, followed by a one-week washout period. The effects of enalapril (25 mg/kg/day), hydrochlorothiazide (25 mg/kg/day), and amlodipine (10 mg/kg/day)—were compared under a high salt diet mimicking human salt consumption. Urinary Na/K ratios collected on day 1 (acute) and day 8 (subacute) after initiating medication were compared to the vehicle period using a two-way ANOVA. Medication was administered with food using gel food pellets.

Results:

Under regular chow, the urinary Na/K ratio was 0.65±0.58 (n=15) with no interaction between sex or age (all p>0.05). Under a high salt diet, the urinary Na/K ratio increased to 4.5±2.2 (p<0.01 vs. regular chow) with no differences between sex and age. After the washout period, enalapril, both acutely and subacutely, did not affect the Na/K ratio. Similarly, hydrochlorothiazide did not affect the Na/K ratio in either period. However, amlodipine reduced the Na/K ratio in both acute and subacute periods (p<0.001). No interaction was observed with sex or age. The effect of amlodipine was related to higher potassium excretion (43.9±23 vs. 81.6±33 meq/L; p<0.001) with no changes in sodium excretion (152.2±75 vs. 173.3±43.5 meq/L; p=0.8).

Conclusion:

The Na/K ratio reflects salt and potassium consumption. The Na/K ratio is not affected by enalapril or hydrochlorothiazide. Amlodipine decreases the Na/K ratio acutely and subacutely due to increased potassium excretion.
O83 ESTIMATING CARDIAC OUTPUT FROM ARTERIAL BLOOD PRESSURE WITHOUT PRESSURE WAVEFORMS
Authors: Madrid-Muñoz Camilo , Álvarez-Montoya Diego , Fernández-Ruíz Ricardo , Gallo-Villegas Jaime , Aristizábal-Ocampo Dagnovar
Published: September 2024

Background and Objective:

Noninvasive estimations of cardiac Output (CO) using pulse wave analysis have been studied for over a century, yielding contrasting results. Our research group has developed a novel method for the noninvasive estimation of CO based on brachial blood pressure (BP) measurements and total arterial compliance (Ct), eliminating the need for arterial pulse wave analysis. This study compares all reported methods for estimating CO without pulse wave contours using the same dataset to assess their accuracy.

Methods:

A cross-sectional study was conducted involving 447 adult patients who underwent ambulatory transthoracic Doppler echocardiograms. Stroke volume (SV) was calculated as the product of the cross-sectional area of the aortic annulus and the average velocity of the left ventricular outflow tract. Simultaneously, oscillometric BP measurements were obtained, and CO was derived from Ct utilizing anthropometric variables, BP, and heart rates (HR). Calibration was conducted with 75% of the data using the formula: CO=K0+K1×estimator. The remaining 25% of the data was used for validation, with Bland-Altman analysis and the intraclass correlation coefficient (ICC). Calibration involved the following CO estimators: i) mean arterial pressure; ii) HR; iii) pulse pressure (PP); iv) PPxHR; v) Warner time-correction; vi) Liljestrand-Zander; vii) Wesseling-Langewouters; and viii) the new Ct-based method.

Results:

Of the participants, 51.2% were men, with an average age of 51.0±15.0 years, weight of 75.0±14.0 kg, and height of 166.0±9.5 cm. The CO by echocardiography had an average of 4.9±1.0 L/min, with a range of 2.0 to 8.5 L/min. Among the compared methods, the new Ct-based method showed the smallest mean difference and error, as well as the largest ICC. The Bland-Altman analysis shows a normal distribution for the new Ct-based method, with agreement limits between -1.56 to 1.48 L/min (Figure).

Conclusions:

The new Ct-based method developed surpasses other published methods and exhibits practical accuracy suitable for ambulatory use, such as hemodynamic monitoring of pathophysiological or therapeutic outcomes.
O84 BLOOD PRESSURE MEASUREMENT VIA IMPEDANCE CARDIOGRAPHY: AN ARTIFICIAL INTELLIGENCE BASED PROOF-OF-CONCEPT
Authors: Opatz Oliver , Bothe Tomas Lucca , Pilz Niklas , Patzak Andreas
Published: September 2024

Objective:

Accurate blood pressure (BP) measurement is crucial for the diagnosis, risk assessment, treatment decision-making, and monitoring of cardiovascular diseases. Unfortunately, the gold-standard, cuff-based BP measurement suffer from inaccuracies and discomfort. As a result, continuous, cuff-less, and non-invasive BP assessment methods are merging as promising alternatives. This study is the first to comprehensively assess impedance cardiography (ICG) for Machine Learning enabled BP measurement.

Methods:

We analysed ICG data from 71 young and healthy adults. Nine different Machine Learning algorithms were evaluated for their BP estimation performance. Accuracy measures comprised mean difference, standard deviation, Limits of Agreement, mean absolute error, and root mean squared error. Additionally, the B-Score was calculated to evaluate the “true”, relative performance of the best-performing model.

Results:

The Multi-Linear Regression model showed the highest performance (mean difference = -0.01, r = 0.82) for systolic BP. The Support Vector Regressor model achieved the best results (mean difference = 0.15, r = 0.51) for diastolic BP. Both models exhibited positive B-Scores, indicative of their predictive capability. All tested models’ estimations correlated with both systolic and diastolic reference BP (r > 0.72 / r > 0.34, p < 0.001).

Conclusion:

The study highlights the potential of ICG based Machine Learning algorithms for accurately estimating arterial BP. Such algorithms can provide accurate and continuous BP data. This offers the possibility of enhancing patient care, timely diagnostics, and treatment decision-making. Our approach is especially promising for post-surgical and intensive care environments.
O85 THE ACCEPTANCE, ADOPTION AND ACCESSIBILITY OF HEALTH TECHNOLOGICAL MANAGEMENT ON HOME BLOOD PRESSURE AMONG 18,867 PARTICIPANTS IN HONG KONG
Authors: Tsoi Kelvin Kf , Hao Ziyu , Cheung David YS , Chan Howard H , Tsang Davie MT , Yiu Karen KL
Published: September 2024

Objective:

Various health-related Apps have been launched to aid home blood pressure (HBP) self-management. This study aimed to investigate the acceptance, adoption, and accessibility of the HBP self-monitoring App using either photo recognition or manual input for the HBP records in Asia population.

Design and Method:

The participants downloaded HealthCap, the HBP self-monitoring App, aged 18 or above with at least 10 BP records were included. Elderly participants were selected from a community-based cohort for HBP self-monitoring. Well-being surveys were conducted to assess the demographic and morbidity. All participants were categorized into 2 groups, photo recognition and manually record input. Photo recognition was defined as using camera to capture the numbers on BP device for BP record upload. Manual record input was defined as selecting the number on the App. Logistic regression has been used to investigate the predictors among the group of photo recognition and manual input.

Results:

Total of 2,284,026 BP records collected from 18,867 participants in Hong Kong from June 2018 to November 2023. Among the 8,970 participants who met the inclusion criteria, BP records collected by photo recognition, manual input and mixture of both methods were 2,475(28%), 2,621(29%) and 3,892(43%) respectively. The mean frequency of weekly BP measurement was 4.21±7.91 times, the mean duration was 16 months, maximum was 37 months. The mean age of the participants using photo recognition, manual input and mixture were 63.81±13.14, 65.09±13.49 and 64.43±12.87 respectively. A subgroup of 1,321 elderlies aged 55 or above was analyzed with their characteristics. Logistic regression was applied to compare the group of photo recognition and manual input (Table 1). Elderlies living with children tended to use photo recognition. Less sarcopenia and those self-reported memory complaint without worries also tended to use photo recognition.

Conclusion:

Younger age, lower morbidity, and living with children are associated with higher usage of photo recognition for HBP self-management. Elderlies showed high acceptance, adoption, and accessibility of health technological management.

Table 1. Multivariate Analysis for the Usage of Photo Recognition on Blood Pressure Monitoring.
P003 ASSOCIATION BETWEEN SERUM URIC ACID AND BLOOD PRESSURE IN BOYS, GIRLS AND ADOLESCENTS WITH OVERWEIGHT and OBESITY ATTENDED IN PEDIATRIC HOSPITALS IN THE AUTONOMOUS CITY OF BUENOS AIRES. “MULTICENTRIC STUDY
Authors: Iturzaeta Adriana , Vaccari Marina , Toledo Ismael , Mannucci Carla , Scliar Cecilia , Romo Miriam Miriam , Maldonado María Laura , Pompozzi Luis , Deregibus María Inés , Torres Fernando
Published: September 2024

Introduction:

Childhood overweight and obesity are modifiable risk factors for the development of Hypertension (HTN). Elevated serum uric acid (UA) is a known cardiovascular risk factor in adults.

Objective:

To evaluate whether there is an association between high serum UA values and elevated BP in overweight and obese children and adolescents.

Methods:

Multicenter prospective cross-sectional study. Overweight and obese patients aged 5 to 18 years attended in HTN outpatient clinics of three tertiary pediatric hospitals in Buenos Aires were included. Office BP control, 24-hours ambulatory BP monitoring (ABPM) and laboratory tests (metabolic and lipid profile and serum UA measurement) were performed.

Results:

173 patients were enrolled, mean age 11.7±2.9 years, 63 women (36.4%), 50 were overweight (28.9%) and 123 obese (71.1%). 143 normotensive (NT) patients were registered, 14 with white-coat HTN, 11 with masked hypertension (MH) and 5 with sustained HTN. The mean value of serum UA was 5.1±1.2, 113 subjects were above the mean value and 24 were above 2SD.

Taking serum UA higher than the average (n:113) according to BP we observed 89/143 in NT vs. 13/14 in white-coat HTN (OR 7.8 95% CI 1.1-62.1 p=0.04), 89/143 in NT vs. 8/11 in MH (OR 1.6 95% CI 0.4-6.3 p=0.7) and 89/143 in NT vs. 3/5 in sustained HTN (OR 0.9 95% CI 0.1-5.2 p=0.9). Using serum UA >2SD (n:24) 14/143 above this value in NT vs. 7/14 in white-coat HTN (OR 9.2 95% CI 2.8-30.1 p<0.001), 14/143 in NT vs. 3/11 MH (OR 3.4 95% CI 0.8-14.5 p=0.1) and no subject with sustained HTN had serum UA values >2SD.

Conclusions:

Elevated serum UA was observed in subjects with white-coat HTN. The number of subjects with sustained HTN was not sufficient to evaluate the association with serum UA values.

These findings emphasize the importance of the systematic implementation of 24-hours ABPM for detection of white-coat HTN in overweight and obese children and adolescents.
P019 HYPERTENSION PREVALENCE, HEALTH POLICY, AND GUIDELINES MAPPING: A COMPARATIVE ANALYTIC STUDY ACROSS NINE AFRICAN COUNTRIES 2024
Authors: Beheiry HM , Dawi EA , Elamin NO , Kunene T , Markos S , Mastala Medical Doctor Y , Nur MA , Teny RG , Ahmed MEK , Auala THNG , Amaechi UM , Mutagaywa RK , Isiguzo G , Doku A , Odili AN
Published: September 2024

Background:

Hypertension, a global burden, increases mortality from cardiovascular and kidney diseases. Worldwide, in 2019, an estimated 1.3 billion adults developed hypertension. In Africa, the cumulative estimated prevalence of hypertension is ∼30.8%.

Main Objective:

To perform a comparative analysis between African countries focusing on hypertension prevalence, health policy, and guidelines mapping.

Methods:

A descriptive comparative analytic study compared hypertension data from nine African countries: Eswatini, Ethiopia, Ghana, Kenya, Malawi, Nigeria, Somalia, South Sudan, and Sudan, in 2024. Data included hypertension prevalence, health policy, guidelines’ mapping, and hypertension management responses. Mixed statistical methods of content analysis, percentages, means, and Spearman's correlations were used.

Results:

Hypertension prevalence varied from 27% in Ethiopia to 43% in Eswatini. Females consistently had higher prevalence than males, 30% in Ethiopia to 47% in Eswatini, suggesting gender-specific risk factors or disparities in healthcare access/utilization. Sudan had the second-highest prevalence 44%. Eswatini implemented strong blood pressure control measures, unlike Sudan. High prevalence was also found in countries with strong policies (Eswatini, Kenya, Nigeria, South Sudan), suggesting urgent improved healthcare delivery, policy enforcement, and addressing other risk factors. Ghana and Somalia had lower hypertension prevalence, though fewer policies.

Spearman's test showed strong negative correlations between national responses and hypertension prevalence. Salt Intake Surveys had the strongest negative correlation (-0.707) with hypertension prevalence, highlighting countries like Ethiopia and Malawi with salt intake surveys and lower prevalence, reinforcing dietary factors’ effectiveness in managing hypertension.

Kenya, Nigeria, and Ethiopia leverage trained non-physician health workers in hypertension management, thereby, improving treatment access and adherence.

Treatment guidelines were moderately negatively correlated (-0.335) with hypertension prevalence. The mere presence of guidelines is insufficient, signifying their implementation and enhancement with targeted interventions

Conclusions:

These findings highlighted the multifaceted nature of hypertension in African countries which requires comprehensive approaches encompassing considerations of gender, socioeconomic factors, lifestyle, salt reduction, policy implementation, healthcare access, and a unified African hypertension guideline.
P021 PROPORTION AND GEOGRAPHIC DISTRIBUTION OF HYPERTENSION PATIENTS AND THEIR ASSOCIATED SOCIODEMOGRAPHIC FACTORS IN COLOMBIA, 2019-2023
Authors: García Peña Ángel Alberto , Mejía Miguel Álvarez , Herrera Leaño Nancy Muriel , Insuasty Lussiana Folleco , Carvajalino Galeano Ana Beatriz , Henao Sergio , Cáceres Edward Andrés , David Pardo David Gabriel
Published: September 2024

Background and Objectives:

A substantial underreporting of hypertension data in Colombia has been documented, with a lack of recent updates. Access to updated data is crucial for planning effective public health interventions in our country. We aimed to determine both the proportion and the geographic distribution of patients with hypertension in Colombia, along with their associated demographic and regional factors

Methods:

We conducted a descriptive, cross-sectional, observational study. Data on the frequency and geographic distribution of individuals diagnosed with hypertension from 2019 to 2023 were collected, along with sociodemographic characteristics like age, gender, and socioeconomic status. These data were extracted from the SISPRO platform based on diagnoses coded according to the International Statistical Classification of Diseases and Related Health Problems (ICD-10).

Results:

During the study period, we identified a hypertension prevalence of 12.86% (6,719,193 individuals) across Colombia. Regionally, Bogotá D.C. and Antioquia reported the highest proportion of hypertension—19.21% (1,290,882 people) and 16.15% (1,085,420 people), respectively. Conversely, the lowest rates were found in Vaupés (0.01%, corresponding to 960 people) and Guainía (0.02%, corresponding to 1,592 people). The prevalence was significantly higher in females (60,80%) compared to males (39,20%). Additionally, the highest prevalence was found among individuals aged 55 to 74, accounting for 69,67% of cases. The highest frequency of diagnosis was noted in the contributory regime (68.95%), with the lowest in displaced persons, irrespective of their insurance status (0.33%).

Conclusions:

The prevalence of hypertension is notably higher in Colombia's major urban centers, while significantly lower in remote regions and among vulnerable populations, suggesting significant underreporting. This underreporting likely results in untreated conditions and increased future health complications. It is imperative to develop strategies to enhance the recording and diagnosis of hypertension in Colombia, particularly in remote and vulnerable groups.
P228 THE PORTRAIT OF THE HYPERTENSIVE PATIENT: THE REALITY OF A NORTHERN PORTUGUESE SUBPOPULATION IN THE CONTEXT OF PRIMARY CARE
Authors: Sousa Helder , Teles-Pinto Nuno , Leal Andreia , Morgado Ana Márcia
Published: September 2024

Background and Objectives:

Hypertension is a chronic disease, and is one of the main cardiovascular risk factors. Knowing the local reality, regarding the comorbidities of the hypertensive population, profile of pharmacological therapy and level of blood pressure control are fundamental for the design of management and treatment strategies for hypertensive disease. In Portugal, hypertension has a estimated prevalence of 26,78% and the overwhelming majority of patients are assisted in primary care, where the health professionals have software tools such as BI-CSP, which uses Microsoft's Power-BI platform, allowing the retrieval of data about different variables.

The aim of this study is to characterize a subpopulation studied at the Fânzeres Primary Care Center regarding demographic data, morbidity, blood pressure control and antihypertensive medication.

Methods:

This is an observational and cross-sectional descriptive study with an analytic component. The population consists of patients diagnosed with hypertension (N=3474). The retrieval of data was carried out using the MIMUF and BI-CSP.

Results:

In the population from which the 3474 hypertensive patients were selected, hypertension has a prevalence of 26%. The most common cardiovascular comorbidities were dyslipidemia (50%), Obesity (30%) and Diabetes (33%). 63% of patients had a systolic blood pressure (SBP) of <140mmHg and 28% had a SBP <130mmHg on the last measurement. Regarding the antihypertensives prescribed on a 4 month period, molecules that act on the renin-angiotensin axis are the main class used corresponding to 583K DDD (defined daily dose), followed by thiazides (300K DDD) and calcium channel blockers (250K DDD).

Conclusions:

There is still suboptimal control of hypertension in the population studied, which implies the adoption of more effective treatment strategies. It is important not only to involve adapting pharmacological treatment to the most recent guidelines, but also promote healthy lifestyles, control comorbidities and improve the follow-up of these patients. A multidisciplinary approach, using face-to-face and remote methods to strengthen contact with the healthcare team, can help to achieve these goals.
P031 SPATIAL ASSOCIATION BETWEEN HYPERTENSION AND AIR POLLUTION IN ULAANBAATAR, MONGOLIA
Authors: Baatarsuren Uurtsaikh , Myanganbayar Maral , Lkhagvajav Zoljargal , Bungert Andreas , Dashdorj Naranbaatar , Dashdorj Naranjargal
Published: September 2024

Background and Objective:

This study aims to assess the spatial association between hypertension prevalence and PM2.5 levels in Ulaanbaatar.

Methods:

To estimate the hypertension prevalence, we conducted a complex survey with a two-stage cluster sampling method in 2018. For PM2.5 level estimation, we used data collected during cold weather months (October to March) from 2015 to 2019. These estimates were used to predict PM2.5 levels across the entire city, using the Inverse Distance Weighted (IDW) interpolation method. The same approach was applied to predict the hypertension prevalence. We fitted a multiple linear regression model to estimate the association between PM2.5 and hypertension prevalence with adjustment for income, a proxy of socioeconomic factors to examine effect modification. In exploratory analysis, we estimated the association between PM2.5 level and income level. We used RStudio 1.3.1093 and ArcMap 10.8.2 for data analysis.

Results:

A total of 4515 participants were included in the sample. The hypertension prevalence was 46.5% with a threshold of 130/80 mm Hg. Adjusting for other covariates, a 10-unit increase in PM2.5 level is associated with a 6.66 (95% CIs;[10.23,10.23]) point increase in hypertension prevalence (p<0.001). With each 100,000 (MNT) increase in income level, the impact of 10-unit increases in PM2.5 level on hypertension decreases by 2.98 (95% CIs;[-5.48,-0.47]) points (p=0.02). In the partial F-test, an increase in income level was associated with a lower hypertension prevalence (p=0.002). In the exploratory analysis, a 100,000 (MNT) increase in income level was associated with a 0.23 (95% CIs;[-0.41,-0.05]) point decrease in PM2.5 level (p=0.011).

Figure 1. Spatial association between hypertension prevalence. A).Hypertension prevalence (%); B).Income level (MNT) PM2.5 level; C).PM 2.5 (μg/m3); D).Linear regression model. Note: Inverse Distance Weighted method is used for predictions. Green points indicate the PM2.5-measuring site locations.

Conclusions:

The people who live in lower-income areas experience a stronger influence of air pollution on hypertension prevalence compared to others in Ulaanbaatar.
P032 THE IMPACT OF NATURE IMMERSION THERAPY ON BLOOD PRESSURE IN HYPERTENSIVE SUBJECTS: A PILOT STUDY
Authors: Barros-Bohorquez Guillermo , Porto-Corbacho Daniel , Hernández-Nieto Bryan , Hernández-Herrera Johon , Géliz-Vilaro Carlos , Valle Carlos Campos-Del , Cárdenas-Castellanos Juan , Santacruz-Martinez Juan , Blandón-Rentería Leany , Urina-Triana Manuel , Urina-Triana Miguel , Quintero-Baiz Adalberto
Published: September 2024

Background and Objective:

Conscious nature immersion therapy, termed “Vitamin N”, has shown promise in reducing blood pressure levels in individuals with or without hypertension. This pilot study aims to assess the effect of nature immersion on blood pressure specifically in hypertensive subjects.

Methods:

A convenience sample of stable hypertensive individuals participated in a standardized 3-hour nature immersion session. Systolic and diastolic blood pressure levels were recorded before the intervention (Phase I), after 30 minutes of the intervention (Phase II), and 48 hours post-intervention (Phase III). Statistical analysis employed a one-way non-parametric ANOVA, Kruskal-Wallis test, and Dunn's post hoc test, with a bilateral significance level of 95%. A criterion of at least 3 mmHg reduction in blood pressure was set for clinical significance.

Results

Eighteen participants, comprising 12 women (64.67%) and 6 men (33.33%), with a mean age of 60±9.04 years and 61±6.88 years, respectively, were included. Six individuals had a medical history of Diabetes Mellitus Type 2, and one had a history of coronary heart disease. Significant differences in median systolic (MSP) and diastolic pressures (MDP) were observed across the three phases (p<0.05). Notably, Phase II and Phase III showed consistent reductions in blood pressure compared to Phase I, exceeding the established 3 mmHg reduction criterion.

Conclusions:

Conscious nature immersion therapy (“Vitamin N”) exhibited a significant effect in lowering both systolic and diastolic blood pressure levels among hypertensive individuals. These findings suggest the potential of nature immersion as a non-pharmacological intervention for managing hypertension.
P034 THE INFLUENCE OF SOCIODEMOGRAPHICAL CHARACTERISTICS AND COMORBIDITIES ON SURVIVAL IN ADULTS WITH HTN IN COLOMBIA
Authors: Peñuela-Sánchez Adriana , Herrera-Parra Lina Johana , Valbuena-García Ana María , Acuña-Merchán Lizbeth
Published: September 2024

Background and objective:

Awareness of the impact of hypertension (HTN) on health enables the implementation of effective measures to control the disease. This study characterizes the survival of the Colombian adult population with hypertension.

Methods: This longitudinal retrospective cohort study included adults diagnosed with HTN from July 1, 2013, to june 30, 2014, from the National Registry of Chronic Kidney Disease (NRCKD). The primary outcome was the time from diagnosis to all-cause mortality. The probability of from the date of diagnosis was estimated using Kaplan-Meier analysis. Log-rank test evaluated differences in survivor functions. Patients were followed from baseline until death, abandonment, or the end of follow-up on July 30, 2023.

Results:

Baseline characteristics: The analysis included 285,418 cases. The mean age at diagnosis was 59.17 ± 14.58 years. 61.25% were females, 67.13% were affiliated with third-payer insurance, and 28.81% resided in the Central region. At baseline, 36.77% of the study population had comorbidities, including diabetes mellitus (DM) or chronic kidney disease (CKD) or both. 36,110 all-cause deaths were recorded during the follow-up period.

Survival analysis: The 10-year overall survival (OS) rate was 0.84 (95% CI 0.84–0.84). The unadjusted log-rank comparisons revealed a lower probability of survival for men compared to women (0.81 vs. 0.86, respectively) and for individuals with state insurance compared to those with third-party insurance (0.80 vs. 0.86, respectively). The survival rates were found to be lower in individuals with HTA, DM, and HTN at baseline (0.68) compared to those with HTN and CKD (0.78), HTN and DM (0.81), or only HTN (0.88) (p < 0.001).

Conclusions:

The survival of individuals with HTN is influenced by a variety of sociodemographic characteristics and can be further complicated by the presence of other comorbidities, which can potentially amplify the negative effects on an individual's health. These findings may be useful for decision-makers to focus on the identification of patients with different characteristics of risk.
P036 INFLUENCE OF FOOD ENVIRONMENT IN AND AROUND SCHOOLS ON FOOD CHOICES AND PRACTICES OF STUDENTS: A MIXED METHODS STUDY – ANTICIPATORY FINDINGS
Authors: Mubashir Maira , Iqbal Romaina , Almas Aysha
Published: September 2024

Background:

The health behaviors of adolescents are significantly influenced by their living environments, with schools serving as crucial settings for promoting healthy behaviors. The school food environment, encompassing areas where food is provided and consumed within and around schools, plays a key role in shaping adolescents’ dietary choices. However, there is a notable scarcity of evidence regarding the school food environment in Pakistan. This study aims to examine the school food environment and associated factors, including the availability, accessibility, and affordability of foods within and around schools for adolescents, the facilitators and barriers school vendors face while offering healthy food options, and the perspective of policymakers on the role of food environments.

Objectives:

• To assess the school lunchtime food practice and sources of adolescents in schools in Karachi

• To explore facilitators and barriers to offering healthier food options to adolescents through school vendors both within and outside school premises

• To explore the perspectives of adolescents regarding the food choices available to them

Methods:

A mixed methods concurrent study design i.e. a cross-sectional study, interpretive descriptive qualitative study. Six schools, comprising three government and three private schools from District Central of Karachi, will be recruited. Students from grades 6 and 7 who provide consent and assent will be included, with an anticipated sample size of 430 participants. Descriptive statistics will be utilized to analyze quantitative data and a manual thematic analysis approach will be employed to analyze qualitative data.

Results:

The anticipated outcome of this study is to understand the school food environment holistically taking into consideration the practices and perspectives of key stakeholders i.e. school-going adolescents, vendors, and policymakers.

Conclusion

The groundwork done through this research project will help develop evidence-based healthy school food environment programs/interventions that can be feasibly deployed in government and private schools in Pakistan. The research outcomes will foster collaborative efforts among various stakeholders to co-create and implement viable solutions.
P059 IDENTIFYING PREDICTORS OF EARLY-ONSET HYPERTENSION IN MIDDLE-AGED INDIVIDUALS WITH OBESITY
Authors: Uzokov Jamol , Alyavi Bakhromkhon , Abdullaev Akbar , Azizov Shukhratjon , Payziev Djamshid
Published: September 2024

Background:

Hypertension is a leading risk factor for cardiovascular diseases, with obesity being one of its primary modifiable predictors. This longitudinal study aims to identify early predictors of developing hypertension in middle-aged individuals with obesity, contributing to targeted prevention strategies.

Methods:

A cohort of 112 middle-aged participants (mean age 48.6 ± 10.8 years, 55% male) with a body mass index (BMI) ≥ 30 kg/m^2 but without hypertension at baseline were followed for an average of 5.8 ± 2.4 years. The study sought to determine significant predictors for the development of hypertension, including demographic variables, lifestyle factors, and biochemical markers. Cox proportional hazards regression models were employed to estimate hazard ratios (HR) for the development of hypertension, with Kaplan-Meier analysis used to visualize time-to-event outcomes. Statistical significance was determined by p-values < 0.05.

Results:

Over the follow-up period, 34% of participants developed hypertension. Kaplan-Meier analysis indicated a significant difference in hypertension-free outcomes based on baseline insulin resistance levels and waist-to-hip ratio (WHR) (p < 0.01). Cox regression analysis revealed that insulin resistance (HR = 1.12 per unit increase, 95% CI: 1.06-1.19, p = 0.001) and WHR (HR = 2.48 for the highest quartile vs. lowest, 95% CI: 1.32-4.67, p = 0.005) were independent predictors of developing hypertension. Furthermore, a sedentary lifestyle was associated with an increased risk (HR = 1.89, 95% CI: 1.01-3.54, p = 0.046), whereas dietary factors did not show a significant relationship after adjusting for other variables.

Conclusion:

This study identifies insulin resistance and WHR as significant predictors of early-onset hypertension among middle-aged individuals with obesity, with lifestyle factors also playing a crucial role. These findings underscore the importance of targeted interventions focusing on reducing insulin resistance and central obesity, along with promoting physical activity, to prevent the development of hypertension in this high-risk population.
P064 SYSTEMATIC REVIEW OF PROPORTION OF FEMALES AND MALES RECRUITED IN BLOOD PRESSURE DEVICE VALIDATION STUDIES AND RELATIONSHIP WITH MEASUREMENT ACCURACY
Authors: Bothe Tomas Lucca , Bui Tan V. , Bao Yueyang , Chapman Niamh , Sharman James E. , Picone Dean S.
Published: September 2024

Background and Objective:

New to market automatic blood pressure (BP) devices should undergo clinical validation according to a scientifically recognised protocol to ensure accurate measurements. Some recent research suggests a reduced accuracy of automated cuff BP in females compared to males. Females have been underrepresented in many areas of clinical research, but it is unknown whether this is common among BP device validation studies and if it is a contributory factor to reduced accuracy in females. The aim of this study was to determine the proportion of females compared to males recruited to validation studies and whether there is any relationship with the accuracy of automated BP measurement.

Methods:

A systematic review of BP device validation studies published between 1987 and 2023 was conducted. Studies that tested automated, upper-arm devices compared to auscultatory BP in a general population, including children, were included. Descriptive statistics were used to determine the proportion of females and males recruited and weighted meta-regression analyses were used to assess the relationship between sex and measurement accuracy.

Results:

Out of 322 eligible validation studies, the proportion of females and males recruited was reported in 287 (89.1%) studies. Only six (2.1%) studies included <30% females or males, which is the current minimum requirement of international standards. An average of 50.8% females were recruited to validation studies, and this was consistent across different validation protocols and year of study publication. There was no relationship between sex and measurement accuracy (p>0.05), except for a negligible tendency of automated devices to overestimate manual measurements of diastolic BP among studies with a greater proportion of females (R2=0.017, p=0.027).

Conclusion:

Females are not underrepresented in BP device validation studies. There was no meaningful relationship between the proportion of females recruited and measurement accuracy. These findings indicate current protocols are adequate to ensure representation of females and males in validation studies.
P066 HOW BLOOD PRESSURE DEVICES ARE OBTAINED FOR HOME BLOOD PRESSURE MEASUREMENT: A MIXED-METHODS STUDY AMONG AUSTRALIA ADULTS
Authors: Clapham Eleanor , Carmichael Samuel , Sharman James , Picone Dean , Chapman Niamh
Published: September 2024

Background and Objective.

Only 20% of automated blood pressure (BP) devices available for purchase are validated. However, how consumers obtain devices for home BP measurement and whether their devices are validated remains unknown, which was the aim of this study.

Methods.

Surveys (n=225) and interviews (n=27) among adults who measure BP at home in Australia (June-December 2023). Survey questions included how the BP device was obtained, device details to determine validation status, and considerations in choosing a device. Interviews explored how and why BP devices were obtained in detail.

Results.

Most participants (n=216, 96%) used an upper-arm cuff device, of which 52% (n=118) were validated. Of 9 participants that used wrist cuff devices, 67% (n=6) were validated. Most participants purchased (n=176, 91%) their BP device, predominantly from pharmacy (n=126, 72%; 50% validated), followed by online (n=36, 16%; 52% validated). Validated BP devices were on average $38.53 AUD more expensive than non-validated devices (p<0.001).

Although accuracy was the most important consideration when choosing a BP device (n=112, 50%), few interview participants cited device validation status as a consideration. “I just assumed that they were all accurate”. Most interview participants avoided cheaper BP devices, believing these were less accurate, and they were willing to “make an investment” in their BP device due to the importance of getting an accurate BP measurement. Interview participants rarely received recommendations from their GP about which BP device to use and reported pharmacy staff provided retail support based on in-store device availability rather than information about accuracy.

Conclusion.

This study found only 50% of devices used by consumers for home BP measurement have been validated. Devices that are validated are more expensive, but critically, consumers are willing to make an investment in an accurate BP device. However, little guidance is provided to support consumers when selecting a BP device. These findings demonstrate the need for credible information and resources that support consumers to obtain validated BP devices.
P076 FACTORS INFLUENCING POST-COVID HOME BP AND HR FLUCTUATION WITHIN THE URBAN INDIAN DIABETIC POPULATION
Authors: Patil Vishal , Patil Mansi
Published: September 2024

Objective:

The impact of COVID-19 on cardiovascular health among adult diabetics remains underexplored, particularly concerning home blood pressure (BP) and heart rate (HR) variability. This study aims to elucidate the factors influencing post-COVID home BP and HR fluctuation within the urban Indian diabetic population.

Design and Methods:

A cross-sectional study was conducted, involving 1000 adult diabetic patients aged 30 to 80 years with prior COVID-19 infection. Home BP and HR readings were recorded twice daily over seven days, generating 28 measurements. Variability in BP and HR was determined using standard deviation calculations between morning and evening readings, as well as between consecutive measurements.

Results:

Older age (OR: 1.56, 95% CI: 1.23-1.98), cardiovascular comorbidities (OR: 2.09, 95% CI: 1.67-2.62), diabetes (OR: 1.84, 95% CI: 1.43-2.36), and elevated home BP (OR: 2.35, 95% CI: 1.87-2.95) emerged as independent predictors of increased morning-to-evening home BP variability. Similarly, older age (OR: 1.72, 95% CI: 1.34-2.21) and elevated home BP (OR: 2.14, 95% CI: 1.67-2.75) were determinants of heightened day-to-day BP variability, while a combination of older age (OR: 1.98, 95% CI: 1.52-2.58), female sex (OR: 1.43, 95% CI: 1.11-1.84), cardiovascular disease (OR: 1.89, 95% CI: 1.47-2.44), and elevated home BP (OR: 2.56, 95% CI: 1.98-3.31) predicted greater variability between consecutive readings. Conversely, younger age (OR: 0.76, 95% CI: 0.59-0.98) and elevated home HR (OR: 1.92, 95% CI: 1.51-2.44) were associated with increased morning-versus-evening HR variability. Additionally, younger age (OR: 0.67, 95% CI: 0.51-0.88), female sex (OR: 1.34, 95% CI: 1.04-1.73), and elevated home HR (OR: 1.78, 95% CI: 1.39-2.29) were predictive of greater variability between consecutive HR measurements.

Conclusion:

Understanding the determinants of home BP and HR variability post-COVID infection is crucial for prognostication and clinical management. Clinicians should prioritize counseling incorporating regular home blood pressure measurements, diabetes management, and cardiovascular disease prevention, particularly for high-risk diabetic patients.
P082 HOW LONG DO BLOOD PRESSURE LOWERING DRUGS TAKE TO WORK? A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIALS
Authors: Salam Abdul , Kota Vidyasagar , Dhurjati Rupasvi , Pant Rashmi , Rodgers Anthony
Published: September 2024

Background:

Evidence on the time course of antihypertensive drug (AHTD) efficacy is crucial to guide the frequency of visits recommended in guidelines and when it is appropriate to wait for further effects to accrue.

Objective:

To assess how quickly AHTD therapy works to lower blood pressure (BP).

Methods:

We systematically searched multiple electronic databases for relevant randomized, double-blind, placebo-controlled trials of untreated adults. These trials compared fixed doses of AHTDs from the five major classes to a placebo for a minimum of four weeks and reported BP data at baseline, and at least at weeks 2 and 4. Primary outcomes were systolic and diastolic BP reduction at weeks 2, 4, and 8. A fixed-effect meta-analysis was conducted, and a best-fit exponential association model was used to evaluate BP-lowering efficacy over time.

Results:

A total of 94 trials (25,637 participants) were included. Trial duration ranged from 4-16 (median 8) weeks. The best-fit exponential association model predicted that the reductions in systolic BP (SBP) at weeks 1, 2 and 3 were 64%, 79%, 85% of the reductions seen at week 4. There was no evidence of additional BP reduction after week 4. In absolute terms, after week 2 the additional reduction in BP averaged only 1.8/0.8 mmHg by week 4 and 0.4/0.2 mmHg between week 4 and week 8. This finding was consistent across trials by drug class, with no evidence that renin-angiotensin-aldosterone system inhibitors, diuretics, beta-blockers, calcium channel blockers, diuretics or combinations took longer to work. Baseline BP did appear to modify the effect, but still there was no additional benefit after 4 weeks.

Conclusion:

BP lowering drugs work quickly, with little additional BP lowering occurring after 2 weeks. These findings have relevance for guidelines and for addressing treatment inertia related to expectation of time needed for drugs to work fully.
P084 BLOOD PRESSURES MEASUREMENT WITH SITTING ON THE FLOOR POSITION FOR THE HOME BLOOD PRESSURE MONITORING FOR ASIAN LIFESTYLE
Authors: Shin Jinho , Kim Byung Sik , Heo Ran , Kim Hyun-Jin
Published: September 2024

Objectives:

The current standard method for home blood pressure (BP) measurement involves taking measurements while sitting in a chair. In cultures where floor sitting is common as like in Asian countries, the protocol only using sitting on the chair position can not be applied because of a lack of research for interchangeability.

Methods & Materials:

Among the participants who visited for evaluation of central blood pressure or pulse wave velocity, a total of 116 participants who agreed to participate in the study were randomly selected. All subjects rested for 5 minutes, and BP measurements were taken at 1-minute intervals according to a randomly assigned order of standard method (chair-sitting) and BP in a seated on the floor (floor-sitting).

Results:

Of the 116 participants, the median age was 67.5 (with an interquartile range of 59.0 to 75.0), and 82% were male. There were no significant differences in systolic BP (SBP, 127.0 [115.0, 142.2] mmHg in chair-sitting and 129.0 [115.5, 142.2] mmHg in floor-sitting, P = 0.228) and diastolic BP (DBP, 73.5 [66.0, 83.0] mmHg in chair-sitting and 72.0 [66.8, 81.3] mmHg in floor-sitting, P = 0.839) between the two positions.

Conclusions:

These findings provide important insights into securing the reliability of home BP measurements through the commonly practiced floor-sitting posture in cultures where floor sitting is common. Furthermore, this could serve as substantial evidence for providing specific home BP measurement guidelines to patients who adhere to a floor-sitting lifestyle.
P091 PROENKEPHALIN CONCENTRATION AND ITS DETERMINANTS IN PATIENTS WITH END-STAGE KIDNEY DISEASE TREATED WITH HEMODIALYSIS AND PERITONEAL DIALYSIS
Authors: Jakubowska Zuzanna , Grycuk Wiktoria , MaŁyszko Jolanta
Published: September 2024

Background and Objective.

Proenkephalin (PENK) has been recently shown to reflect glomerular dysfunction and predict new-onset acute kidney injury and heart failure. While previous studies investigated PENK utility in individuals with preserved renal function, PENK concentration in patients with end-stage kidney disease (ESKD) remained to be established. The study aimed to assess plasma PENK concentration in patients with end-stage kidney disease (ESKD) treated with hemodialysis (HD) and peritoneal dialysis (PD) and to investigate its correlation with heart failure. Additionally, we aimed to determine whether PENK is removed during a hemodialysis session.

Methods.

88 patients with ESKD (41 females) undergoing HD (n=66, 75%) and PD (n=22, 25%) were enrolled in this cross-sectional study. Blood samples for PENK determination were collected before and at the end of the hemodialysis session in HD patients and at a single time point in PD patients. Plasma proenkephalin concentration was assessed using a sandwich ELISA immunoassay. Samples for measurement of creatinine, urea, and NT-proBNP were drawn simultaneously.

Results.

The median (IQR) plasma PENK concentration in the overall population was 1.492 ng/ml (1.071-4.380). Both median eGFR (5 mL/min/1.73 m2 [4-7] vs. 5 mL/min/1.73 m2 [4-8], p=0,856) and plasma PENK levels (1.368 ng/ml [1.068-4.030] vs. 1.706 ng/ml [1.211-5.858], p=0.305) did not differ significantly between HD and PD patients. In HD patients, median PENK concentration was significantly higher before than after hemodialysis (1.368 vs. 2.061; p=0.003). No correlation was found between PENK level and urea (p=0.192), eGFR (p=0.922), duration of dialysis (p=0.637), and residual urine output (p=0.784). Heart failure (p=0.961), EF (p=0.361), and NT-proBNP (p=0.949) were not associated with increased PENK concentration.

Conclusions.

Our study proved that PENK is not removed during hemodialysis session. PENK concentration does not reflect renal function and cardiac status in patients with ESKD. The fact that PENK is not removed by hemodialysis calls into question the usefulness of PENK as an everyday use biomarker in acute kidney injury.
P106 ENZYMES INVOLVED IN THE CATABOLISM OF TRYPTOPHAN IN THE PROGNOSIS OF BLADDER CANCER
Authors: Lemes Douglas Edgard , de Oliveira Jéssica Lopes , de Souza Gomes Gabriela , De Faria Felipe Cunha , Ramos Henrique Roman , Dellê Humberto
Published: September 2024

Bladder cancer (BC) ranks third among the most common carcinomas in Brazil. Tumor immunology opens up perspectives for treatment, where the enzyme indoleamine 2,3-dioxygenase-1 (IDO1) stands out for degrading the amino acid tryptophan, initiating a cascade that culminates in the generation of catabolites (derived from kynurenine). These catabolites, in different associations, determine degrees of local immunosuppression. These catabolites are generated by other enzymes that have not yet been studied in BC.

We analyzed the expression of enzymes involved in tryptophan catabolism in order to correlate them with the stage, recurrence, and progression of BC.

Analysis of published microarray databases was performed using the NCBI (National Center of Biotechnology Information) and accessed through GEO Datasets (Gene Expression Omnibus). The descriptor “Bladder cancer” was used. Series that provided analysis of normal bladder tissue (Normal) versus BC, including cases of non-muscle invasive BC (CBNMI) and muscle invasive BC (CBMI), recurrence and progression. Statistical analysis was performed using the GEO2R and ROC curve was used. The transcripts were: Tryptophan 2,3-dioxygenase (TDO2), Indoleamine 2,3-dioxygenase (IDO1), Kynurenine Formamidase (AFMID), Kynureninase (KNYU), Kynurenine-oxoglutarate-transaminase 1 (KYAT1), and Kynurenine Monooxygenase (KMU).

GSE13507 series was selected, with ten Normal samples and 165 BC samples, including 104 CBNMI and 61 CBMI cases. CBNMI was predicted by KYNU, AFMID, and KYAT1 (AUC of 0.625, 0.589, and 0.638, respectively; p<0.05), while for CBMI were, IDO1, TDO2, and KMO (AUC of 0.662, 0.633, and 0.601, respectively; p<0.05). No enzyme was found to be important in predicting progression; however, the IDO1 enzyme was predictive of recurrence (AUC of 0.366; p<0.05). A relationship between the two IDO1/KYNU was established, which improved the prediction of stage for CBNMI (AUC of 0.733, p<0.05), non-progression (AUC of 0.619, p<0.05), and non-recurrence (AUC of 0.626, p<0.05).

The expression of enzymes involved in tryptophan catabolism may aid in the prognosis of BC. It is likely that these enzymes are involved in tumor immunomodulation, which will be explored in future studies.