bluuebunny/crossref_metadata_2025 huggingface dataset:
PS-C18-8: MEAN ANNUAL INTRADIALYTIC BLOOD PRESSURE DECLINE AND CARDIOVASCULAR EVENTS IN JAPANESE MAINTENANCE HEMODIALYSIS PATIENTS
Authors: Takahashi Rina , Uchiyama Kiyotaka , Washida Naoki , Shibagaki Keigo , Yanai Akane , Nakayama Takashin , Morimoto Kohkichi , Itoh Hiroshi Itoh
Published: January 2023

Objective:

A decline in the intradialytic systolic blood pressure (SBP), which defines intradialytic hypotension, is associated with a greater risk of intradialytic symptoms. Intradialytic SBP decline may be associated with higher all-cause mortality. However, this association has neither been studied in Japanese hemodialysis (HD) patients, nor has seasonal variations in intradialytic SBP decline been considered. We evaluated the association between the mean annual intradialytic SBP decline in Japanese HD patients and clinical outcomes, including major adverse cardiovascular events (MACEs).

Design and method:

This retrospective cohort study included 47,219 HD sessions in 307 patients undergoing HD over one year (April 2019 to March 2020) in three dialysis clinics. The mean annual intradialytic SBP decline (predialysis SBP-nadir intradialytic SBP) for each patient was determined. The association of the mean annual intradialytic SBP decline with clinical outcomes, including MACEs, was assessed from April 2020 until March 2022. MACEs included cardiovascular death, nonfatal myocardial infarction or unstable angina, stroke, heart failure, and other severe cardiovascular events requiring hospitalization.

Results:

The study participants included 202 males (66%). The mean patient age was 69.0 ± 12.4 years and the median duration of HD was 4.1 (2.0–7.7) years. The mean annual intradialytic SBP decline was 28.2 ± 14.8 mmHg. MACEs occurred in 77 cases (25%), death or hospitalization due to a decline in Activities of Daily Living (death or hospitalization) occurred in 56 (18%) cases, and all-cause hospitalization occurred in 184 cases (60%). A Cox regression analysis adjusted for age, sex, HD duration, Charlson comorbidity index, and the mean annual predialysis SBP and ultrafiltration rate, showed that a greater intradialytic SBP decline (per 10) was significantly associated with increased risk of MACEs (hazard ratio [HR], 1.30; 95% confidence interval [CI], 1.09–1.54). Moreover, the greater intradialytic SBP decline (per 10) was associated with increased risks of death or hospitalization (HR, 1.32; 95% CI, 1.08–1.62) and all-cause hospitalization (HR, 1.22; 95% CI, 1.07–1.39).

Conclusions:

In Japanese maintenance HD patients, a greater intradialytic SBP decline was associated with worse clinical outcomes, including increased risks of MACEs, death or hospitalization, and all-cause hospitalization. Further studies are warranted to investigate interventions to attenuate intradialytic SBP decline and improve the prognosis of Japanese HD patients.
PS-C19-6: STUDY ON THE EFFICACY AND SAFETY OF TENG FU JIANGYA TABLET IN THE TREATMENT OF HYPERTENSION
Authors: Yang Wen qing , Li Yun lun , Wang Yu , Zhu Yu Shuo , Qi Yu Chen
Published: January 2023

Background:

At present, the most important task of cardiovascular disease health management that is to improving the blood pressure compliance rate of Hypertensive Patients. Traditional Chinese medicine (TCM) is an important part of complementary and alternative medicine. Research shows that traditional Chinese medicine has antihypertensive effect from multiple pathways and multiple targets. However, lack of clinical evidence-based medical evidence of TCM in the treatment of hypertension. The purpose of this study was to investigate the efficacy and safety of Teng Fu Jiangya tablet (TJT) in the treatment of hypertension.

Methods:

A prospective, randomized, single-blind, placebo-controlled clinical trial was conducted in order to evaluating the effectiveness and safety of TJT in the treatment of grade 1 hypertension (N = 130). On this basis, a multicenter, randomized, double-blind, placebo-controlled clinical trial was conducted on the treatment of grade 2 hypertension with TJT combined with valsartan / amlodipine (N = 288). During the experiment, the efficacy index of the subjects were recorded for effectiveness evaluation, and the safety index and adverse reaction events of the subjects were recorded for safety evaluation.

Results:

1. After 4 weeks of intervention in patients with grade 1 hypertension, there were significantly difference in the SBP and DBP compared with placebo group. The compliance rate of blood pressure of TJT group is 67.19% and in placebo group is 43.08%. TJT can improve the standard rate of blood pressure. There were also significantly difference in the level of Arachidonic acid, the thromboxaneB2 and the Prostaglandin E2 between the two groups. And there was no serious adverse event reported.

2. After 4 weeks of intervention in patients with grade 2 hypertension, in accordance blood pressure compliance rate, the systolic blood pressure compliance rate of the treatment group was 61.65%, and the placebo group was 37.68%. The treatment group could more effectively reduce the levels of arachidonic acid and thromboxane B2 and increase the level of prostaglandin E2, reduce inflammatory factors, so as to reduce the inflammatory.

Conclusion:

TJT tablet has good effectiveness and safety in the clinical treatment of hypertension. TJT also can effectively reduce the damage of vascular endothelium in the treatment of hypertension. Therefore, TJT play a key role in reducing blood pressure and protecting target organ damage. This is an innovative method for the treatment of hypertension.
PS-C20-2: HYPERTENSION DUE TO LENVATINIB INDUCTION
Authors: Shibata Keisuke , Tokushige Akihiro , Nitta Mina , Akasaki Yuichi , Higuchi Koji , Ikeda Yoshiyuki , Ohishi Mitsuru
Published: January 2023

Background:

Lenvatinib (LEN) is a multi-kinase inhibitor that blocks vascular endothelial growth factor and other factors and is often associated with hypertension due to its mechanism of action. However, there is insufficient information on LEN-related hypertension. The purpose of this study was to compare the degree, timing, and risk of developing Grade 2 or higher hypertension after LEN induction with those who did not develop.

Methods:

Of 36 patients who newly started LEN between January 2021 and March 2022 at our hospital, 33 patients were included, excluding those younger than 20 years and those who were introduced as outpatients.

Results:

The median age was 73 years, 57.6% were female, and 54.5% had hypertension. Hypertension was observed in 23 patients (69.7%) after the start of LEN, and 13 patients (39.4%) had Grade 3 or higher hypertension. The most common time of onset of hypertension was the day of LEN induction in 12 patients (52.2%). There were no differences in age, BMI, underlying disease, or stage of disease between the hypertension-onset group and the non-hypertension-onset group. The hypertension-onset group was significantly more likely to be female, have thyroid cancer, receive a higher initial dose of LEN, and have higher pre-start blood pressure. The mean blood pressure before LEN administration was 124/77 mmHg, which was significantly increased to 139/84 mmHg the morning after the day of administration (P < 0.00001). Systolic blood pressure was also significantly higher in the non-hypertensive group (P = 0.02), 100 mmHg before start vs. 116 mmHg the next morning. Ca antagonists were most frequently prescribed for hypertension.

Conclusion:

Early induction of LEN is associated with a high risk of blood pressure fluctuations and requires caution.
PS-C21-6: RENOPROTECTIVE EFFECT OF ALISKIREN MONOTHERAPY IN HYPERTENSIVE PATIENTS WITH OBESITY AND TYPE 2 DIABETES MELLITUS
Authors: Seki Yasufumi , Morimoto Satoshi , Kimura Shihori , Takano Noriyoshi , Yamashita Kaoru , Bokuda Kanako , Sasaki Nobukazu , Watanabe Daisuke , Ichihara Atsuhiro
Published: January 2023

Objective:

Renin-angiotensin system inhibitors have been reported to have protective effects from end-organ damages. However, roles of the direct renin inhibitor monotherapy have been still unknown. Therefore, in the present study, we compared effects of aliskiren monotherapy with those of amlodipine monotherapy on visceral fat area (VFA) and end-organ damages in hypertensive patients with obesity and type 2 diabetes.

Design:

A single-center, prospective, open-label and randomized study.

Methods:

Adult hypertensive patients with body mass index ≧ 25 kg/m2 and VFA ≧ 100 cm2 or those with type 2 diabetes, who had an office blood pressure 140–160/90–100 mmHg with or without antihypertensive drugs were randomly allocated to 24-week aliskiren or amlodipine monotherapy. The dose of amlodipine or aliskiren was increased up to 10 mg/day and 300 mg/day, respectively, and only doxazosin could be added at maximum to 8 mg/day if needed. The primary outcome of the study was the changes of waist circumference and VFA at 24 weeks of the study period. Changes in outcomes were analyzed using mixed-effects models for repeated measures, which included treatment, time, treatment-by-time interaction and the baseline values as fixed effects.

Results:

In a total of 62 participants (age, 57 ± 13 y.o.; 40 men; body mass index, 28.8 ± 4.8 kg/m2; waist circumference, 99.3 ± 11.9 cm; VFA, 134.8 ± 47.0 cm2; blood pressure, 141 ± 16/86 ± 13 mmHg), waist circumference and visceral fat area as a primary endpoint did not significantly change from baseline in both groups. Systolic blood pressure significantly decreased at 12 weeks (change in least squares means: -10 mmHg, P = 0.001) and 24 weeks (-10 mmHg, P = 0.001) in the amlodipine group and at 24 weeks (-11 mmHg, P = 0.001) in the aliskiren group. Diastolic blood pressure significantly decreased at 24 weeks (-6 mmHg, P = 0.009) only in the amlodipine group. Estimated glomerular filtration rates were not statistically different between the groups. Logarithm of urinary albumin excretion significantly decreased at 24 weeks only in the aliskiren group (-0.60, P < 0.001). The 24-weeks-changes in logarithm of serum pentraxin 3 levels, an inflammatory marker, were significantly lower in the aliskiren group than in the amlodipine group (-0.09 vs + 0.09, P = 0.017).

Conclusions:

These data suggested that aliskiren monotherapy may have a better renoprotective effect than amlodipine monotherapy while it does not affect VFA in hypertensive patients with obesity and type 2 diabetes mellitus.
PS-C21-9: REVISITING ORAL SALT LOADING TEST: A NEW CHEMILUMINESCENT IMMUNOASSAY OF 24-HOUR URINE ALDOSTERONE MEASUREMENT
Authors: Ozeki Yoshinori , Miyamoto Shotaro , Yoshida Yuichi , Okamoto Mitsuhiro , Gotoh Koro , Masaki Takayuki , Shibata Hirotaka
Published: January 2023

Primary aldosteronism (PA) is widely recognized as the most frequent cause of secondary hypertension, and its prevalence ranges from 5% to 10% in hypertensive patients. The number of patients diagnosed with PA has increased due to more frequent screening in JAPAN. PA is diagnosed by a screening test, followed by a confirmatory or exclusionary test and a subtype test using computed tomography and adrenal vein sampling. Measuring of the urinary aldosterone concentration is important in oral sodium loading test (OSLT), one of the confirmatory tests. Therefore, an accurate aldosterone measurement method is required for clinical practice. Since April 2021, the plasma aldosterone concentration has been measured by chemiluminescent enzyme immunoassay (CLEIA) in Japan. In the present study, we developed a new CLEIA using a two step sandwich method to measure the 24 hour urine aldosterone level. We collected urine samples and measured 24 hour urine aldosterone levels employing radioimmunoassay (RIA), CLEIA, and liquid chromatography tandem mass spectrometry (LC MS/MS). The results showed that the 24-hour urine aldosterone levels measured using CLEIA and LC MS/MS were significantly correlated. The 24 hour urine aldosterone levels measured using CLEIA and RIA were also significantly correlated. However, the aldosterone level measured by CLEIA was lower than that measured by RIA (slope, 0.729; intercept, 120.9). In Japan, a new guideline for primary aldosteronism has been announced, with changes in the aldosterone measurement method, and the cutoff values for oral sodium loading test (OSLT) were changed. Therefore, we examined the cut off value of the 24 hour urine aldosterone level after the OSLT. Receiver operating characteristic analysis revealed a cut off value for primary aldosteronism of 3 mcg/day.
PS-C22-2: UNDERSTANDING CLINICAL EFFECTIVENESS OF TELMISARTAN AS MONOTHERAPY FOR HYPERTENSION MANAGEMENT IN NEPAL
Authors: Tripathee Ashish , Jha Bipin Kumar , Sha Ram Krishna , Gupta Amit , Sharma Tripti
Published: January 2023

Background:

Telmisartan, a highly selective angiotensin II receptor blocker, approved for the treatment of hypertension, either as monotherapy or in combination with other antihypertensive agents and provides full 24-h blood pressure control. It also has established data with respect to long-term efficacy and safety.

Objective:

The present study aimed to evaluate the clinical effectiveness and safety of telmisartan as monotherapy for the management of patients with hypertension from Nepal.

Methods:

This was a multicentric, survey analysis conducted in patients aged > 18 years receiving telmisartan as monotherapy for the management of hypertension. Study was conducted between Nov 2020 and Jan 2021. Data was collected during each visit at baseline, day 45, and day 90, from selected clinics/hospitals.

Results:

A total of 185 patients (mean age, 54.6 years) were included in this study. Out of 185, 139 patients received telmisartan as monotherapy of various dosage patterns. Majority of patients (48.9%) received telmisartan 40 mg followed by telmisartan 60 mg (38.9%) and telmisartan 20 mg (12.2%). Diabetes was the most common comorbid condition observed in 45.9% of patients with hypertension. A significant reduction in the SBP/DBP was observed during the course of telmisartan monotherapy (Figure 1). The mean (95% confidence interval) change in SBP and DBP from baseline to day 45 and day 90 was 16.6 (15.4–17.9); P < 0.001 and 8.6 (7.7–9.5); P < 0.001, 26.0 (24.5–27.5); P < 0.001 and 13.6 (12.5–14.7); P < 0.001, and 9.3 (8.2–10.3); P < 0.001 and 5.0 (4.2–5.9); P < 0.001, respectively.

Conclusion:

Telmisartan as monotherapy was found to be effective in reducing blood pressure and achieving the blood pressure target in Nepalese patients with hypertension.

Conflict of interest: All other authors have nothing to disclose.
PS-C23-1: EFFECT OF OMEGA3,6,9 BLENDED OIL ON CIRCADIAN VARIATIONS OF AMBULATORY BLOOD PRESSURE IN PATIENTS WITH HYPERTENSION AND CAD
Authors: Bhardwaj Kshitij , Verma Narsingh
Published: January 2023

Flaxseed oil is considered to be a rich source of Alpha-Linolenic Acid(ALA), along with Lignans, fibers, protein, vitamins,s, and minerals. A number of studies have proved the beneficial role of ALA, EPA, and DHA found in flaxseed on health. Besides providing nutrition, they have anti-inflammatory, antihypertensive and cardioprotective properties. However pure flaxseed oil does not have oxidative stability due to which it could not be stored for long-term edible use. The blending process can be an alternative method for Partial hydrogenation, therefore we used this process to reduce the percentage of unsaturated linoleic and linolenic acids of Flaxseed oil with Palm oil in a stabilized ratio which helps in maintaining the overall oxidative stability and proper ratio of Omega 3, omega 6 and omega 9 content in the Blended product. Aim of this study was to access the effect of blended flaxseed oil on 24 hour seven day circadian variations of blood pressure in subjects with essential hypertension. Many Studies have proved that Chronobiological analysis of blood pressure by four to Seven-day continuous ambulatory blood pressure monitoring and assessment of CHAT (circadian hyper amplitude tension) is the best marker for cardiovascular function. We registered 100 subjects with Coronary Artery Disease (Group1) and Essential hypertension (Group2) and 100 control subjects with CAD/ Hypertension. Group 1 and 2 participants were supplemented with blended flaxseed oil (BFO) (30 ml/day) for the period of six months while the control group was not given any BFO (They were using their routine edible oil). Twenty-four hour seven days continuous ambulatory blood pressure monitoring was done initially, after three months and after six months of supplementation. There were significant changes noted in lipid profile along with Ambulatory blood pressure parameters like MESOR, ACROPHASE, Hyperbaric Indexes, and CHAT. Circadian hyper amplitude tension (CHAT) incidence decreased after BFO supplementation. Study results suggest that optimized doses of blended flaxseed oil have the required amount of ALA and essential fatty acids as per guidelines of AHA, Blended flaxseed oil administration can be a potent antihypertensive and helps in the synchronization of cardiac rhythms, and an effective vegetarian source in maintaining Omega 3 and omega 6 ratios.
PS-C24-5: PEGUERO LO PRESTI CRITERIA MODIFIED BY QRS DURATION AS PREDICTOR OF HFPEF IN HYPERTENSIVE PATIENTS
Authors: Jagannatha Gusti Ngurah Prana , Antara I Made Putra Swi , Yusrika Mirani Ulfa , Pertiwi Putu Febry Krisna
Published: January 2023

Objectives:

ECG markers as a predictor for heart failure (HF) with preserved ejection fraction (HFpEF) are not specific, however hypertension is the most common comorbid cause of HFpEF. A recent study found Cornell Product (CP) can be an ECG marker for HFpEF but has low sensitivity and specificity. Peguero Lo Presti is an LVH criterion with good sensitivity compared to other criteria. Since increasing LV mass also prolongs QRS duration, the Peguero Lo Presti modified with QRS (PMQ) duration can potentially be a good ECG marker for HFpEF. Aim of this study was to find out the relationship between PMQ ECG parameters and HfpEF, also finding the optimal cutoff in predicting HFpEF.

Design and method:

This study was a cohort retrospective using medical records that include ECG and Echo data of hypertensive patients at Sanglah General Hospital from 2018 until 2022, and 190 patients were enrolled. Subjects were divided into hypertensive patients who develop in to HFpEF and non develop in to HFpEF. Subjects with IVCD were excluded. PMQ is defined: (S wave amplitude in V4 + deepest S amplitude in any precordial lead) x QRS duration. The Mann-Whitney test was used to compare the mean ECG parameters and mean echocardiographic parameters between the HFpEF and non-HFpEF groups. An optimal cutoff value for PMQ and CP to predict the develop of HFpEF was evaluated using receiver operating characteristics (ROC).

Results:

Based on data, subjects with HFpEF were 52.1%, and non-HFpEF was 47.9%. The HFpEF group had higher LVMI (136.13 ± 34.55vs76.23 ± 14.11), higher mean E/E’ (16.97 ± 6.71vs13.25 ± 2.62), higher LAVI (52.46 ± 42.63vs28.97 ± 6.95) with all p-value < 0.05. On ECG parameters, the HFpEF group had a significantly longer QTc duration (486.53 ± 75.78vs437.33 ± 24.08), higher CP outcome (1823.6 ± 429.6vs1476.9 ± 273.8), and higher PMQ outcome (2919.8 ± 732.8 vs 2097.9 ± 535.2) with better sensitivity and specificity of PMQ cutoff than CP (PMQ > 2655, sensitivity 54.2%, specificity 92.6% vs CP > 1770, sensitivity 36.5%, specificity 91.5%). Subjects with a cutoff of PMQ (> 1770ms) were also significantly associated with HFpEF (PR 1.773; 95%CI 1.170–2.687; P < 0.001).

Conclusion:

Modified Peguero Lo Presti by QRS duration is an easy-to-apply ECG marker for HFpEF and has relatively good sensitivity and specificity reflecting the severity of diastolic dysfunction and LV hypertrophy.
PS-C25-3: THE EFFECT OF MOUNTAINEERING ON THE ASSOCIATION BETWEEN BLOOD PRESSURE AND PHYSICAL ACTIVITY. THE MOUNT FUJI STUDY
Authors: Komori Takahiro , Hoshide Satoshi , Kario Kazuomi
Published: January 2023

Objective:

It has not been fully investigated whether the response of blood pressure (BP) to activity at high altitudes differs from that at low altitudes or how temperature is involved in these differences. We hypothesized the BP response to activity during mountaineering would be increased compared to that in daily living, and conducted this study to compare physiological BP response to accelerometer measurements during mountaineering and daily living.

Design and method:

In 15 healthy people (mean age 33 ± 6 years), a new multi-sensor ambulatory BP monitoring (ABPM) device equipped with barometer, thermometer, and accelerometer was used to measure blood pressure responses to activity during a trip to Mt. Fuji and during daily life at low altitudes on another day. Associations between physical activity (log-transformed 5-min average values of accelerometer just before each ambulatory BP) and the corresponding BP were obtained from 843 and 676 readings during the Mt. Fuji trip and daily living, respectively.

Result:

All ambulatory systolic BP (SBP) parameters were significantly higher during the Mt. Fuji trip than during daily living at low altitudes (all p < 0.01). There were significant positive correlations between physical activity and corresponding BPs in both mountaineering and daily living (all P < 0.01), and there was an interaction between BPs and physical activity according to the two conditions (P < 0.01). On Mt. Fuji, multivariate regression analysis showed that increased physical activity and lower temperature were associated with increased 24-hr SBP and diastolic BP (DBP) (all P < 0.05). The goodness-of-fit values of the association between activity and 24-hr SBP or DBP were improved by adding temperature to the model of both 24-hr SBP and DBP. However, these associations were not found in the daily living model.

Conclusions:

BP response to activity was more pronounced during mountaineering than daily living. Lower temperature compounded the BP response to activity in the mountains but not in daily living.
PS-C25-7: PROGNOSTIC VALUE OF COMPUTED TOMOGRAPHY PSOAS MUSCLE SIZE IN PREDICTING MAJOR ADVERSE CARDIOVASCULAR EVENTS IN THE ELDERLY: A META-ANALYSIS.
Authors: Sanchez Alexis Joyce Tolentino , Bandong Irene
Published: January 2023

Background:

Cardiovascular diseases (CVD) are the leading cause of death globally (WHO). It accounts for > 17 million deaths each year (30% of all deaths) (WONG, 2014). Aging is associated with body composition changes such as a reduction in the muscle mass and an increase in visceral fat that shift the metabolism to an unfavorable state which increases the risk of CVD (EVANS, 2021). Psoas muscle mass index (PMI) has been growing recognition as an objective and quantitative marker to assess muscle wasting and has been suggested as a useful predictive marker for long-term outcome after cardiovascular surgery (MATSUMOTO, 2020). The aim of this study is to determine the prognostic value of psoas muscle size for development of major adverse cardiovascular events.

Methodology:

We searched PubMed and Google scholar. The Newcastle-Ottawa Scale assessment was used for quality assessment. Two investigators independently extracted patient baseline characteristics, CT psoas muscle size, and research endpoint such as all-cause mortality, myocardial infarction, and stroke. The hazard ratio (95% CI) and relative risk (95% CI) was calculated using a generic inverse variance approach. The overall effects was determined by Z-test and P-value < 0.05 were considered as statistically significant.

Results:

Out of 37 articles, 10 citations fulfilled the inclusion criteria. Sarcopenia was not associated with MACE (HR 14.6, 95% CI:5.69 - 37.48, p value < 0.00001, I2 0%) and all cause mortality (RR 2.04, 95% CI:1.55 - 2.69, p value of < 0.00001, I2 0%). The sub-group analysis shows no association between sarcopenia and MACE among patients > 60 years (HR 15.36, 95% CI: 5.54 - 42.53, p value < 0.0001, I2 0%), myocardial infarction (RR 1.96, 95% CI: 0.63 - 6.10, p value of < 0.24, I2 0%), and stroke (RR 1.62, 95% CI: 0.84 - 3.15, p value of < 0.15, I2 0%).

Conclusion:

Sarcopenia is not associated with MACE and all cause mortality. Among patients > 60 years, sarcopenia shows no association between myocardial infarction and stroke. Further studies should be done to determine the cut-off value for psoas muscle size for sarcopenia and sarcopenic obesity among elderly patients.
PS-C25-12: CORRELATION OF RENAL FUNCTION AND MUSCLE MASS IN YOUNG ATHLETES
Authors: Yasuda Osamu , Yasuda Hisayo , Ohishi Mitsuru
Published: January 2023

Objective:

Renal function is closely associated with the development of hypertension. Creatinine is often used as a serum marker of renal function. Since creatinine is a metabolite of muscle, its concentration in serum is affected by muscle mass. Therefore, serum creatinine levels are high in individuals with high muscle mass, and renal function is underestimated. On the other hand, in elderly people with low muscle mass, serum creatinine concentration tends to be low, and there is a risk that renal function is estimated better than it actually is. Since another renal function marker, cystatin C, is produced in every cell of humans, it is considered to be unaffected by skeletal muscle mass. Therefore, cystatin C is often used as a renal function marker that is less dependent on muscle mass than creatinine. In this study, we analyzed the correlation between muscle mass and renal function in young athletes with high muscle mass.

Design and Methods:

The subjects are 250 first-year male students at the National Institute of Fitness and Sports in Kanoya. The impedance method was used to measure muscle mass. Serum creatinine and cystatin C levels were measured by a clinical laboratory. Grip strength was measured with a Smedley-type hand dynamometer, and isometric measurement was performed to measure the leg extension force.

Results:

Muscle mass showed a significant correlation with left and right grip strength and right leg extension force. These results show that the muscle mass of the whole body measured in this study reveals the skeletal muscle mass, from which serum creatinine is derived. Muscle mass showed a significant correlation with serum creatinine levels. It also showed a significant correlation with the glomerular filtration rate estimated from creatinine concentration, age, and gender. Muscle mass also showed a significant correlation with serum cystatin C levels. It also showed a significant correlation with the glomerular filtration rate estimated from cystatin C, age, and gender.

Conclusion:

In general, serum creatinine concentration is a renal function marker that is affected by muscle mass, and cystatin C is a renal function marker that is less affected by muscle mass. The results in this study show that muscle mass should be taken into consideration for the evaluation of renal function based on serum cystatin C level in young athletes.
PS-C26-3: THE ASSOCIATION BETWEEN GLOMERULAR DIAMETER AND SECONDARY FOCAL SEGMENTAL GLOMERULOSCLEROSIS IN CHRONIC KIDNEY DISEASE
Authors: Zamami Ryo , Kohagura Kentaro , Ohya Yusuke
Published: January 2023

Introduction:

When nephron loss occurs, glomerular filtration rate (GFR) is suggested to be maintained by glomerular hypertrophy, but excessive hypertrophy can rather lead to the formation of focal segmental glomerulosclerosis (FSGS), thereby cause progressive kidney damage. However, it is not clear how much glomerular hypertrophy leads to the formation of FSGS. We examined the association between glomerular diameter and FSGS lesions in chronic kidney disease (CKD) patients.

Methods:

We recruited 77 patients who underwent renal biopsy during 2016–2017; however, those identified with primary FSGS and glomerulonephritis with active glomerular lesion were excluded. We evaluated the maximal glomerular diameter (Max GD), an indicator of glomerular size, in each renal biopsy specimen and examined its association with FSGS lesion.

Results:

The median age, blood pressure, and estimated GFR of the patients were 53 years, 122/70 mmHg, and 65 ml/min/1.73 m2, respectively. The optimal cutoff threshold of Max GD for predicting the presence of FSGS lesions, assessed by receiver operating characteristic curve analysis, was determined to be at 224 μm (area under the curve, 0.81; sensitivity, 81%; specificity, 72%). Multivariate logistic regression analyses demonstrated that Max GD ≧ 224 μm was significantly associated with the presence of FSGS lesions, independent of other confounding factors (odds ratio, 11.70; 95% confidence interval, 1.93–70.84).

Discussion/Conclusion:

Glomerular hypertrophy (Max GD ≧ 224 μm) has been associated with FSGS lesions in CKD patients and may reflect the limits of the compensatory process
PS-C26-5: RENAL ARTERY REMODELING AND RENAL RENIN ANGIOTENSIN SYSTEM IN CHRONIC KIDNEY DISEASE
Authors: Oshiro Nanako , Kohagura Kentaro , Kanamitsu Takafumi , Zamami Ryo , Ohya Yusuke
Published: January 2023

Purpose:

It has long been hypothesized that renin angiotensin system (RAS) is heterogeneously activated in the kidney and is associated with the development of hypertension, but the mechanism by which RAS hyperactivity occurs is unclear. In this study, we hypothesized that narrowing of the lumen of afferent arteriole in chronic kidney disease (CKD) is associated with increased renal RAS, and investigated whether renal arteriolar remodeling is related to urinary angiotensinogen (UAGT), an index of renal RAS.

Methods:

Of 172 patients who underwent renal biopsy between 2010 and 2013 at our department, 54 patients with UAGT data and less than 10 arterioles and those on RAS inhibitors were excluded. IgA nephropathy was the most common primary disease (57.4%). Microvascular remodeling was assessed by measuring the wall to lumen ratio (WLR), which was calculated as (outer diameter of arteriole - lumen diameter of arteriole)/interstitial lumen diameter. In addition to clinical parameters, we examined the association of WLR with high-sensitivity C-reactive protein (CRP), oxidative stress markers (dROM), flow-dependent vasodilatory response (%FMD), and UAGT.

Results:

The mean age and eGFR were 38 years and 81 mL/min/1.73 m2, respectively; Log UAGT showed a positive correlation with Log WLR, LDL, and Log dROM, respectively, and a negative correlation with eGFR. Multiple regression analysis showed that Log WLR was significantly associated with Log UAGT independently of factors such as eGFR and urinary protein (β; = 0.38, p = 0.04).

Conclusions:

Our results suggest that renal arrteriolar remodeling may be associated with increased renal RAS in CKD patients.
PS-C27-5: ASSOCIATION BETWEEN ANKLE-BRACHIAL INDEX AND KIDNEY OUTCOMES IN PATIENTS WITH HYPERTENSION
Authors: Ko Ye Eun , Jhee Jong Hyun , Lee Chan Joo , Park Sungha , Yoo Tae Hyun
Published: January 2023

Background:

Ankle-brachial index (ABI) used for diagnosis of peripheral vascular disease is related to endothelial dysfunction. Previous studies showed the relationship between endothelial dysfunction and chronic kidney disease (CKD). Therefore, we aimed to investigate the association between ankle-brachial index and CKD progression in patients with hypertension.

Methods:

A total of 2,429 patients with hypertension were enrolled from the prospective observational cohort of CMERC-HI (Cardiovascular and Metabolic Disease Etiology Research Center-High Risk). Patients were classified into quartile based on ABI (A1: ABI < 1.11, A2: ABI 1.11 to 1.17, A3: ABI 1.17 to 1.23, A4: ABI> 1.23). Primary outcome was progression of CKD, which was composite of at least 50% decrease in estimated glomerular filtration rate (eGFR) from baseline or end stage kidney disease requiring dialysis, or incident CKD which was defined as eGFR < 60 ml/min/1.73m2.

Results:

The mean age of study subjects was 60.1 ± 11.3 years and 1,346 (55.4%) were male. There were statistically significant differences in DM status (40.1%, 41.1%, 43.7%, 51.7% in A1, A2, A3, A4 group, respectively, P < 0.001) among ABI quartile groups. During a median follow-up of 42.5 months, the primary outcome met the pre-specified CKD progression in 490 (20.2%). In multivariate Cox analysis, A1 and A3 group were associated with increased risk of CKD progression (HR, 2.28; 95% CI, 1.30–4.00, P = 0.004, HR, 2.22: 95% CI, 1.27–3.90, P = 0.005) compared to A2 group. Moreover, low ABI showed increased risk of CKD progression (HR, 1.57; 95% CI, 1.04–2.38; P = 0.03) after adjusting confounding factors.

Conclusions:

Ankle-brachial index may be an independent predictor of renal outcome in patients with hypertension.
PS-C27-8: ELIGIBILITY OF FINERENONE INITIATION IN ASIAN CHRONIC KIDNEY DISEASE PATIENTS BY KIDNEY FUNCTION AND DIABETES STATUS
Authors: Teo Boon Wee
Published: January 2023

Background:

Patients with chronic kidney disease, CK, due to diabetes, DM, and hypertension, HTN, are at risk of rapid progression. The addition of a non-steroidal mineralocorticoid antagonist, finerenone, reduces blood pressure and retards CKD progression. However, it causes a rise in serum potassium, K, of about 0.23 mmol per L. We examined the serum potassium of CKD patients with and without DM by kidney function.

Methods:

We analyzed data from the Asian Kidney Disease Study. There were 232 CKD patients who underwent measured glomerular filtration rate, GFR, mL per min per 1.73 m2. There were 51 percent male, mean age 58.4, 12.8; 51 percent had DM, 119 of 232, median GFR 47, IQR 29–67. There were 185 of 232 patients using renin-angiotensin system, RAS, blockers. We stratified analyses by groups of K above 4.8, threshold for initiation of finerenone and by GFR above and below 25 where the risks of hyperkalemia is highest.

Results:

Overall, mean K is 4.35, 0.54. K is negatively associated with GFR; 4.596–0.0048 x GFR; p is 0.0002. There is no difference in serum potassium by use of RAS blockers, 185 of 232. Mean K was higher in DM patients 4.45, 0.58 vs. 4.24, 0.47; P is 0.0023. In patients with GFR below 25, there were 8 of 34 or 23.5 percent with K above 4.8, and 26 of 198 or 13.1% with K above 4.8 and GFR above 25. In DM CKD patients with GFR below 25, 6 of 18 or 33.3 percent had K above 4.8; and 16 of 95 or 16.8 percent had K above 4.8 with GFR above 25.

Conclusions:

There was 16.8 percent of DM CKD patients with GFR above 25 who had K above 4.8 who would require potassium binders in order to start finerenone.
PS-P07-10: ACCESSIBILITY OF SUBSIDIZED HYPERTENSION MEDICATION IN ULAANBAATAR, MONGOLIA A RETROSPECTIVE STUDY
Authors: Myanganbayar Maral , Ganbat BolorErdene , Baatarsuren Uurtsaikh , Davaadamdin Orkhonselenge , Dashdorj Naranbaatar , Dashdorj Naranjargal
Published: January 2023

Objective:

Mongolia has a total of 3.1 million population. Ulaanbaatar is the capital city with half of the population has migrated into the city and currently residing. For the past 3 years from 2019 to 2021, Mongolian government increased the healthcare budget for hypertension medication from 5,338,979 USD to 6,874,762 USD. The aim of the study is to examine the accessibility of subsidized hypertension medication in 7 districts of Ulaanbaatar between these years.

Design and method:

The data was collected from Health Insurance Fund database spanning from 2019 to 2021. The analysis was performed on Rstudio. The prevalence was calculated from 2019 Ulaanbaatar hypertension prevalence data.

Results:

The total population of Ulaanbaatar had increased from 1462000 in 2019 to 1534793 in 2021. Overall, the accessibility of subsidized hypertension medication increased from 31.2% to 40.7% between 2019 and 2021. The district with the most population, Bayanzurkh district, increased accessibility from 23.3% in 2019 to 31.3% in 2021. While the least populated district, Baganuur district increased accessibility to medication from 32.6% to 42.9%.

Conclusions:

In conclusion, the increase in healthcare budget had a positive effect on the accessibility of the subsidized hypertension medication in the city of Ulaanbaatar across all districts over the past 3 years. However, with improved accessibility of medication, more studies need to be done to assess hypertension control in Ulaanbaatar.
PS-P09-6: KNOWLEDGE, ATTITUDES AND PRACTICE OF SALT INTAKE AND BLOOD PRESSURE LEVEL IN A MULTI-ETHNIC POPULATION IN MALAYSIA
Authors: Chew Ming Tsuey , Chia Yook Chin , Oui Jethro Ee Keat , Ching Siew Mooi , Devaraj Navin Kumar , Lim Hooi Min , Chew Bee Nah , Mohamad Mohazmi , Ooi Pei Boon , Be Hooi Chin
Published: January 2023

Knowledge, attitudes and practice of salt intake and blood pressure level in a multi-ethnic population in Malaysia

Objective:

A changing lifestyle in the transition from a developing to a more developed country has led to increases in obesity, physical inactivity and unhealthy diet, including high salt intake. Studies have shown that salt consumption is high in Asia, but little is known about the practice among different ethnic groups. This study aimed to examine the knowledge, attitudes and practice of salt intake among Malaysian adults by different ethnic groups.

Design and method:

Participants aged =  > 18 years were recruited during a blood pressure health screening campaign from various centres. All participants completed a questionnaire that capturing information on socio-demographics, knowledge, attitudes and practice about salt consumption. Weight and height were measured and seated blood pressure (BP) measurements using an oscillometric sphygmomanometer were taken twice and averaged. Hypertension is defined as a systolic BP = > 140mmHg and/or diastolic BP = > 90 mmHg.

Results:

A total of 5128 participants were included in the study. The mean age of the participants was 39.5 ± 17.4 years and 59.6% were female. The mean SBP was 121.4 ± 17.6 mmHg and mean DBP 75.5 ± 11.1 mmHg. 61.5% knew the correct amount (< = 5 g) of daily dietary salt intake and 8.4% did not think it was important to reduce salt intake. 68.6% took measures to control salt intake; 69.9% avoided/minimized canned food, only 34.2% look at the salt labels and less than a third do not add salt during cooking, used spices during cooking and avoid eating in outlets and all of these practices were statistically significant between ethnic groups (p < 0 .001). Knowledge, attitude and practice of not reducing high intake of dietary salt does contribute to raise high BP as shown in Table 1.

Conclusion:

Our study reported that good knowledge does not translate into the desired attitude or practice of lower salt intake. More needs to be done to improve attitudes and behaviours about dietary salt intake, and to tailor it to different ethnic groups. This is warranted to prevent the increasing prevalence of hypertension.
PS-P09-7: ASSESSMENT OF DIETARY DIVERSITY AMONG ADULT HYPERTENSIVES
Authors: Deshmukh Akshada T , Patil Vishal , Patil Mansi
Published: January 2023

Introduction:

In contrast to developed countries, dietary quality is a growing challenge in developing countries. Several techniques of measuring food consumption using basic tools such as the 24-hour diet recall have been presented in recent years. This individual dietary diversity score (IDDS) proposed by FAO is a basic measure for evaluating diet quality, defined as the number of food groups represented in the diet across time.

Objective:

The goal of this study was to determine the individual dietary variety score of hypertensives who visited the hospital's out-patient department.

Materials and Techniques:

Data on the dietary intake of 200 hypertension patients was collected using an interviewer-administered questionnaire. In addition, anthropometric measurements were taken. The 14 food groups specified by the FAO were used to create IDDS classification tertiles.

Results:

Individual IDDS averaged 6 ± 1.83 food groups in the past 24hrs by hypertension patients. In our study, 8% of hypertension individuals had a high IDDS. Cereals, white tubers, other vegetables, legumes, oils and fats, and oils and fats were the most commonly consumed dietary groups by our people, at the expense of leafy vegetables, vitamin A fruits, other fruits and fish, nuts and seeds. In terms of anthropometric variables, waist circumference had a significant (p0.05) influence on food diversification in hypertensives, although BMI had no effect.

Conclusion:

When analysed on an individual DDS, the majority of patients do not meet the average based on 14 food groups. As a result, the average number of food categories ingested by the participants over the reference period is deemed inadequate. In contrast to cereals, oils, and fats, fruits and vegetables were the least consumed food groups. Given the importance of dietary diversity to nutrition and health, these findings suggest that efforts should be mobilised to ensure that people have better access to nutrition information. Despite the fact that this study needs to be expanded up to a multi-centric study and comparisons with other nations are needed to harmonise the technique, our findings demonstrate that using a basic tool can be beneficial when used at a community level. IDDS can be proposed as a ready to use tools across all healthcare sectors to promote dietary diversity.
PS-P09-9: DIETARY PATTERNS AND HYPERTENSION AMONG STROKE-FREE AFRICANS IN THE SIREN STUDY
Authors: Okekunle Akinkunmi Paul , Asowata Osahon Jeffery , Akpa Onoja Matthew , Fakunle Adekunle , Sarfo Fred Stephen , Wahab Kolawole , Obiako Reginald , Akinyemi Rufus , Ovbiagele Bruce , Owolabi Mayowa
Published: January 2023

Objective:

This study assessed the relationship of dietary patterns (derived from the frequency of food consumption) with hypertension among stroke-free controls recruited from Nigeria and Ghana in the Stroke Investigation Research and Educational Network (SIREN) study.

Design and Methods:

This study was a matched case-control study with 1500 hypertensives randomly selected and matched for the country of residence, age and sex with 1500 normotensives in the SIREN study. Factor analysis using principal component analysis was used to summarise food information and seven dietary patterns (DP); vegetables, poultry product and organ meat, whole-grain and fruit drinks, fried foods and sweetened drinks, red meat, processed foods and fruits were identified. Hypertension was defined as one of the following conditions; systolic blood pressure of 140mmHg/greater or diastolic blood pressure of 90mmHg/greater or previous diagnosis or use of antihypertensive medications. Multivariable adjusted logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for hypertension by the median of factors scores in each DP (adjusting for age, education, income, smoking, alcohol use, physical inactivity, family history of cardiovascular diseases and obesity) at a two-sided P < 0.05.

Results:

Mean age was 56.2 ± 13.5years and multivariable-adjusted OR (95%CI) for odds of hypertension by the median (with < median of factor score as reference) of DPs revealed higher consumption of whole grains and fruit drinks; 0.83 (0.73, 0.96; P = 0.01) was associated with lower odds of hypertension, but higher consumption of processed foods; 1.18 (1.00, 1.40; P = 0.04) was associated with higher odds of hypertension. Furthermore, multivariable-adjusted OR (95%CI) of hypertension for other DPs include; 0.88 (0.74, 1.04; P = 0.13) for vegetables; 0.89 (0.75, 1.05; P = 0.16) for poultry product and organ meat; 0.90 (0.76, 1.06; P = 0.21) for fruits; 0.90 (0.77, 1.07; P = 0.23) for fried foods and sweetened drinks and 1.03 (0.87, 1.21; P = 0.76) for red meat.

Conclusion:

Diet rich in whole grains was associated with lower hypertension risk, but higher consumption of processed foods was related to a deleterious hypertension risk. Also, higher consumption of plant-based diets presented a suggestive inverse relationship with hypertension, but diets dense with red meat presented a suggestive deleterious hypertension risk.
PS-R03-4: TRANSARTERIAL EMBOLIZATION, THORACIC SPINE DECOMPRESSION AND FUSION OF METASTATIC PHEOCHROMOCYTOMA: A CASE REPORT
Authors: Kinouchi Kenichiro , Mizutani Yosuke , Nakamura Toshifumi , Yamaguchi Shintaro , Homma Koichiro , Kobayashi Sakiko , Miyashita Kazutoshi , Kurihara Isao , Shibata Hirotaka , Itoh Hiroshi
Published: January 2023

Surveillance of metastatic lesions and biochemical control of catecholamines in patients with malignant pheochromocytoma remain a fundamental problem to be solved. Here we present a 60-year-old male who visited a local clinic because of headache, sweating, malaise, and loss of body weight. Hypertension, orthostatic hypotension, along with remarkable increase in serum and urine noradrenaline, and urine metanephrine and vanillylmandelic acid were noted, and pheochromocytoma was suspected accordingly. Magnetic resonance imaging failed to reveal adrenal gland or sympathetic plexuses, yet it uncovered metastatic lesions in the liver and spine. Functional imaging study using 131I-Metaiodobenzylguanidine (MIBG) scan detected notable uptake in the spinal lesion, albeit not in the hepatic lesion. On the other hand, positron emission tomography with fluorodeoxyglucose (FDG-PET) disclosed FDG uptake both in the hepatic and spinal masses. Biopsy of the hepatic tumors revealed chromogranin A-positive clusters of cells, a finding consistent with metastatic pheochromocytoma. Transarterial embolization (TAE) of the metastatic tumors in the liver was performed for the purpose of tumor mass reduction. Additionally, TAE followed by resection of the spinal lesion was conducted. Pathological examination of the spinal tumor also showed chromogranin A-positive cells, leading to diagnosis of malignant pheochromocytoma. Crucially, TAE of the liver and spinal tumors resulted in dramatic reduction of catecholamine production, likely constituting an effective therapeutic strategy against metastatic pheochromocytoma (Homma, et al. Hypertens Res 2006). Afterwards, the patient became unable to walk because of weakness in the left leg at the age of 64. It seemed attributed to spinal cord compression from the tumor at the level of thoracic vertebrae 7. The patient underwent posterior decompression and fusion, and his muscle strength of the left leg was recovered. At the age of 65, the patient developed paralytic ileus following a surgery against metastatic tumors in the skull. In this case report, we discuss early detection of metastatic lesions and biochemical control of catecholamines in patients with malignant pheochromocytoma.
PS-R03-7: PARTIAL ADRENALECTOMY IN A PATIENT WITH ACTH-INDEPENDENT MACRONODULAR ADRENAL HYPERPLASIA: A CASE REPORT
Authors: Takebayashi Shunta , Irie Junichiro , Kurihara Isao , Kobayashi Sakiko , Miyashita Kazutoshi , Kinouchi Kenichiro , Nakamura Toshifumi , Itoh Hiroshi
Published: January 2023

Background:

The standard treatment for ACTH-independent macronodular adrenal hyperplasia (AIMAH) with overt Cushing's syndrome is bilateral adrenalectomy. Here we show a case of AIMAH who underwent total adrenalectomy on one side and partial adrenalectomy on the other, resulting in the successful debulking of cortisol-secreting adrenal masses and improvement of Cushing's syndrome, yet not necessitating postoperative steroid replacement.

Case presentation:

A 74-year-old female patient with hypertension, type 2 diabetes and dyslipidemia developed edema of the legs. She visited her primary physician and was found to have lumbar vertebral compression fractures. The blood test and 24-hr urine collection revealed the plasma cortisol levels of 26.1 μg per dL, adrenocorticotropic hormone of 1.1 pg per mL, and urine free cortisol of 340 μg per day. Computed tomographic scan and adrenal scintigraphy confirmed bilateral adrenal nodules with notable tracer uptake. Diagnosis of AIMAH with Cushing's syndrome was made. Laparoscopic partial adrenalectomy, i.e., total removal of the left adrenal gland and partial removal of the right counterpart, was conducted aiming to avert from steroid replacement therapy. After the surgery, blood pressure and glycemic control were markedly improved and maintained for 4 years whilst adrenocortical functions were preserved.

Conclusion:

Partial adrenalectomy could be an effective therapy in selected cases of AIMAH.