bluuebunny/crossref_metadata_2025_split huggingface dataset:
O56 NIGHTTIME BLOOD PRESSURE REFERENCE VALUES FOR AMBULATORY BLOOD PRESSURE MONITORING AND THEIR RELATIONSHIP WITH AGE
Authors: Álvarez-Montoya Diego , Gallo-Villegas Jaime , Aristizábal-Ocampo Dagnovar 
Published: September 2024

Background and Objective:
Nocturnal hypertension is characterized by elevated blood pressure (BP) levels during sleep (systolic blood pressure [SBP]>120 mmHg or diastolic blood pressure [DBP]>70 mmHg) as measured by 24-hour ambulatory blood pressure monitoring (24-h ABPM) (ESH 2023 guidelines). With aging, there is a gradual decline in renal function and vascular health, leading to changes in BP patterns. This study seeks to evaluate the necessity of age-specific cutoff points in defining hypertension, particularly during nocturnal hours.

Methods:
A cross-sectional study was conducted, involving 3,220 patients without hypertension, defined by 24-hour BP values, who were not using any antihypertensive medications and were referred for 24-h ABPM. Patients with a body mass index (BMI) ≥30 kg/m2 were excluded. The sleep period was defined as spanning from midnight to 6 am. Reference percentiles were established and juxtaposed with standard references. To determine the significance of age-specific cutoff points for defining nocturnal hypertension, the ESH 2023 reference was compared with the 95th percentile (P95) for age.

Results:
Among the participants, 64.6% were female, with an average age of 51.0±15.0 years, BMI of 25.0±2.7 kg/m2, nocturnal SBP of 106.4±9.0 mmHg (P95=121.8 mmHg), and nocturnal DBP of 66.0±5.0 mmHg (P95=74.3 mmHg). Normal distribution was observed for both SBP and DBP (Jarque Bera test). Nocturnal SBP exhibited a “J” shaped curve concerning age, whereas the average DBP remained relatively stable. Significant differences were noted for SBP across different age groups (P value <0.00001). Proposed cutoff points for mean nocturnal SBP were suggested as follows: i) P95 <60 years=120 mmHg; ii) P95 60-70 years=125 mmHg; and iii) P95 >70 years=130 mmHg (Figure). A reference of 75 mmHg was proposed as the cutoff point for mean nocturnal DBP.

Conclusions:
The study highlights age-related variations in the P95 of mean nocturnal SBP, while DBP remains relatively stable across age groups. Consequently, we propose new cutoff points for defining these parameters.
O33 ARE METABOLICALLY HEALTHY OBESE INDIVIDUALS REALLY A BENIGN CARDIOVASCULAR GROUP? AN ANALYSIS OF 162,590 PARTICIPANTS WITH MEASURES OF ARTERIAL STIFFNESS IN UK BIOBANK
Authors: Ananda Roshan , Solomon Bethelemen , Ray Kausik 
Published: September 2024

Background and Objective:
There is conflicting evidence as to whether so called metabolically healthy but overweight and obese individuals are at increased cardiovascular risk or mortality. We assessed whether metabolic health correlates with vascular health among these individuals using arterial stiffness as a proxy for vascular health and cardiovascular risk.

Methods:
Participants in UK Biobank with body-mass index (BMI) and arterial stiffness index (ASI) recorded between 2006 and 2010, and free from cardiovascular diseases and not underweight (BMI<18.5 kg/m2) were included. Participants were stratified by BMI and metabolic abnormalities (hypertension, diabetes, dyslipidaemia). The primary outcome was the severity of ASI analysed using multivariate-adjusted linear regression.

Results:
Of 162,590 participants, 55.0% were female, their mean age was 57 years (SD 8), 42.5% were overweight and 24.4% were obese. Within the normal BMI strata, 50.7% had ≥1 metabolic abnormality. Compared to individuals with normal BMI and no metabolic abnormalities (reference group), increased BMI or metabolic abnormalities were similarly associated with higher ASI: normal BMI with metabolic abnormalities (adjusted β-coefficient 0.35;95%CI 0.30 to 0.40), overweight without metabolic abnormalities (β 0.32; 95%CI 0.26 to 0.37). Obese individuals with no metabolic abnormalities had higher ASI (β 0.65; 95%CI 0.57 to 0.74) but was lower than overweight participants with metabolic abnormalities (β 0.80; 95%CI 0.75 to 0.84). Obese participants with metabolic abnormalities had the highest ASI (β 1.07; 95%CI 1.02 to 1.12) among all six metabolic combinations, p<0.001 for each vs ref group. Sensitivity analysis suggested higher ASI with increasing number of metabolic abnormalities within BMI categories.

Conclusions:
Excess weight and metabolic abnormalities, are independently associated with adverse measures of vascular health to a similar degree, suggesting that the so called metabolically health overweight and obese are not benign groups. Primary prevention strategies should be considered in overweight, or obese individuals even if metabolic abnormalities are absent.
O80 A HIGH 24-HOUR URINE SODIUM-TO-POTASSIUM RATIO IS ASSOCIATED WITH WORSE RENAL OUTCOME
Authors: Olde Engberink Rik , Zwager Charlotte , Kwok Kevin , Slagmolen Famke , Vogt Liffert , van Vliet Myrthe 
Published: September 2024

Background and Objective:
Low sodium and high potassium intake are advised to control blood pressure and may improve long term cardiorenal outcomes. The optimal potassium intake for patients with chronic kidney disease remains to be defined and. We investigated whether the 24-hour urine sodium-to-potassium ratio (Na/K-ratio), which incorporates estimates of both sodium and potassium intake, could predict long-term renal outcome.

Methods:
We selected adult outpatients of a Dutch tertiary hospital who collected at least one 24-hour urine collection between 1998-2023. Patients with a history of dialysis or kidney transplantation were excluded. We examined the need for persistent renal replacement therapy (RRT), defined as dialysis or kidney transplantation, using Cox-regression. The association between the 24-hour urine Na/K-ratio and the estimated glomerular filtration rate (eGFR) slope was assessed using linear regression in patients who had ≥3 eGFR measurements available in ≥3 years, adjusted for age, sex, baseline eGFR, diabetes mellitus and hypertension. In the Cox-regression analysis, we additionally adjusted for the interaction between the 24-hour urine Na/K-ratio and baseline eGFR. Hypertension was defined as a clinical diagnosis or an office blood pressure ≥140/90 mmHg.
Results: We included 720 patients aged 50±15 years, of whom 52% were male, 58% had hypertension and 31% diabetes mellitus. The baseline eGFR was 64±34 ml/min/1.73m2. The 24-hour urine Na/K ratio was 2.5±1.2 in a median number of 1 (IQR=1-2) urine collection. During a median follow-up of 11.2±14.0 years, 29% of patients needed RRT. The median annual eGFR decline was 1.51 (IQR=0.49-3.98) ml/min/1.73m2. Every unit increase in 24-hour urine Na/K-ratio was associated with a 19% higher risk for RRT (HR 1.19, 95% CI 1.03-1.39; p=0.02) and an additional 0.44 ml/min/1.73m2 (95% CI -0.83, -0.04; p=0.03) annual eGFR decline.

Conclusions:
This study suggests that higher 24-hour urine Na/K-ratio is associated with faster kidney function decline and the need for RRT, independent of hypertension, in a selected group of outpatients with available 24-hour urine measurements.
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.