bluuebunny/crossref_metadata_2025_split huggingface dataset:
P027 MAKING HEARTS SUSTAINABLE: IMPLEMENTATION RESULTS FROM A HYPERTENSION CONTROL PROGRAM IN GUATEMALA
Authors: Wellmann Alicia , Rodríguez José Javier , Batzin Benilda , Hegel Guillermo , Ayala Luis Fernando , Ozano Kim , Fort Meredith , Flores Walter , Ramírez Lesly , Palacios Eduardo , Martínez Mayron , Ramírez-Zea Manuel , Flood David 
Published: September 2024

Background:
More than 75% of deaths from cardiovascular diseases (CVD) occur in low- and middle-income countries, yet there is limited adoption of evidence-based interventions to prevent CVD in these settings. The HEARTS Technical Package in Primary Care is the model recommended by the WHO to address this implementation gap. A key barrier of HEARTS is that many health systems lack sufficient resources to provide free access to medications for CVD and lack a system for patient monitoring and follow-up.

Methods:
We evaluated the implementation of the first official HEARTS project in the Ministry of Health (MoH) of Guatemala. The project was carried out in 6 primary healthcare facilities across 3 rural municipalities over 8 months. The population were predominantly of Indigenous Maya ethnicity, an ethnic group historically underserved by the MoH. HEARTS consists of six evidence-based, cost-effective components. These were complemented by 3 patient-centered strategies to enhance sustainability: (1) community-based social accountability intervention; (2) revolving-fund pharmacy operated by municipal governments to provide low-cost generic medications; and (3) facility-based digital monitoring tool (DHIS2).

Results:
We observed a 4-fold increase in treatment rate and a 14% absolute increase in the proportion of patients achieving blood pressure control. The availability of free antihypertensive medications was enhanced through the MoH and the revolving-fund pharmacy, improving adherence in 37%. Additional process outcomes include: 28 health personnel received training on hypertension clinical management; 16 self-help groups for hypertensive patients were supported; 178 patient visits were tracked in the DHIS2 monitoring system.

Conclusions:
The results demonstrated significant improvements in hypertension control. The implementation of patient-centered strategies, coupled with intersectoral collaboration, contributed to the program's success. Challenges in the sustainability of the model were identified due to financial limitations. Overall, the project set an important precedent for addressing hypertension in rural communities. This pilot HEARTS project serves as a model for scaling-up hypertension management in the MoH primary care system.
P028 GLOBAL, REGIONAL, AND NATIONAL BURDEN OF HYPERTENSIVE HEART DISEASE ATTRIBUTABLE TO HIGH SODIUM INTAKE FROM 1990 TO 2021
Authors: Yin Zheng , Miao Huanhuan , Zhou Zhanyang , Yang Shijie , Zhang Yuqing 
Published: September 2024

Background:
High sodium intake is associated with increased blood pressure. Hypertensive heart disease (HHD) is a structural and functional alteration of the left ventricle caused by long-term high blood pressure, which is closely related to many adverse events. We aimed to assess the level and trend of the burden of HHD associated with high sodium intake based on the latest global burden of disease (GBD) study from 1990 to 2021.

Methods:
Data were obtained from Global Burden of Disease (GBD) study 2021. We estimated HHD-related deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMRs), and age-standardized DALYs rates (ASDRs) attributable to high sodium intake, stratified by age, sex, socio-demographic index (SDI), region, and country. We also calculated estimated annual percentage changes (EAPC) to assess temporal trends in ASMR and ASDR for HHD attributable to high sodium intake from 1990 to 2021.

Results:
In 2021, the number of HHD deaths and DALYs attributable to high sodium intake was 303,967 (95% CI: 641,085 to 63,832) and 596,048 (95% CI: 1230,061 to 150,532), respectively. Deaths and DALYs showed an overall downward trend globally with an EAPC of -1.46 (95% CI: -1.68 to -1.23 and -1.77 (95% CI: -1.99 to -1.55), respectively. However, ASDR and ASMR increased in high SDI regions, with EAPC of 0.77 (95% CI: 0.48 to 1.07) and 1.12 (95% CI:0.84 to 1.4), respectively. Central Europe exhibited the highest rates of HHD deaths and DALYs. The burden of hypertensive heart disease due to high sodium intake was highest in people over 65 years in 2021 and was higher in women than in men.

Conclusion:
Our research findings indicate that high sodium intake leads to a significant burden of HHD, with notable gender and geographic disparities. To address this pressing global health issue, it is essential to improve HHD prevention and sodium intake management strategies, particularly for populations in high SDI regions, the elderly, and women.
P033 HYPERTENSION AND SOCIAL DETERMINANTS OF HEALTH IN A POPULATION OF YOUNG ADULTS REGISTERED IN A PRIMARY CARE UNIT IN RIO DE JANEIRO
Authors: Guizzo Maria Eduarda Bazzanelli , de Vasconcellos Clara Avelar Mendes , Guimarães Luana Moreira Senra , Ferreira Manuela Bartholo , de Carvalho Spinola Gabriel Pedrosa , Ribeiro Laura Rodrigues , Vogel Beatriz , de Melo Samuel Bueno Cruz Pedrosa , de Souza Thomas Barbosa Leal , Duarte João Felipe Assad , de Souza Victoria Fidalgo , da Veiga Silva Caroline , Tenenbaum Rafaela Miller , Muxfeldt Elizabeth Silaid 
Published: September 2024

Background:
New cardiovascular (CV) risk factors have been studied (including social determinants of health - SDHs) that seems to influence the incidence of CV events, life expectancy and mortality rate.

Objective:
To evaluate the SDHs associated with high blood pressure (BP) in young adults living in the area of a primary care unit in Rio de Janeiro.

Methods:
Cross-sectional population study to assess the CV risk of adults aged between 20 and 50 years old. Sociodemographic characteristics, anthropometric measurements and CV risk factors were recorded. Pressure and HBPM were recorded. The race was self-declared. Low education was defined as having completed primary education or less. Those with formal or informal employment were considered to have a job.

Results:
483 individuals, 299 (62%) female with an average age of 37 ± 9 years. Non-whites people comprised 52% of the sample. 108 individuals (21%) have low education and 98 (20%) do not have a job. Sedentary lifestyle (44%), dyslipidemia (43%), obesity (26%) and hypertension (26%) were the most prevalent risk factors. Abdominal obesity was more prevalent among women (45% vs 26%) and high BP (33% vs 21%) and smoking (18% vs 9%) among men. Black people are older and have less education (24% vs 18%), but race had no relationship with BP levels. Lack of employment was more common among women (79% vs 58%) and in logistic regression it practically doubled the risk of hypertension (OR 1.76, 95%CI 1.02-3.04, p=0.042). Low education was prevalent among older men and logistic regression showed that it doubled the risk of smoking (OR 2.17: 95%CI 1.15-4.08, p=0.016) and high BP (OR 1. 82, 95%CI 1.10-3.03, p=0.021). Lack of employment was more common among women and was not associated with CV risk factors.

Conclusion:
Low education and lack of employment were the main social determinants of health associated with high BP.
P045 HEALTH AND CARE STATUS OF HYPERTENSIVE PATIENTS IN PRIMARY CARE UNITS IN THE CONOCOTO-QUITO-ECUADOR DISTRICT: BASELINE OF THE HEARTS INITIATIVE - 2019
Authors: Ortiz Patricia , Ortiz Alexis , Calderón Micaela , Pereira Hugo , Montero Verónica , Pesse Ph.D. Karen 
Published: September 2024

Background:
Hypertension is a significant global public health problem due to the burden of disease and premature death it causes. Its control depends on the quality and timeliness of diagnosis, treatment, and patient follow-up. Studies show an increase in prevalence, poor control, and low coverage in the diagnosis, treatment, and follow-up of hypertensive patients. In response to this problem, since 2019 the Ministry of Health of Ecuador has implemented the HEARTS Initiative proposed by PAHO in primary health care units. This study is part of the baseline prior to its implementation.

Objective:
To identify the health and care status of hypertensive patients attending primary care units in the Conocoto district.

Methodology:
A descriptive retrospective study was conducted, reviewing the medical records of 681 patients who attended follow-up consultations in the 9 health units of the district.
Results: The average age of the patients was 67.12 years (SD 14.2), with 72.1% being women and 96.7% of mixed ethnicity. The average annual number of consultations was 4.24; 40.4% of the patients were overweight and 41% obese. Of the patients who underwent laboratory tests, 45.1% had hypercholesterolemia, 48% had low HDL, and 10.9% had impaired renal function. An electrocardiogram was performed in 3.4% and a funduscopy in 1.7%. Most patients received counselling on lifestyle changes; 31.9% of the patients had uncontrolled hypertension; depending on the health unit this ranged from 11.3% to 52.3%.

Conclusions:
The lack of hypertension control is lower than reported in other studies, although many patients do not have the minimum necessary tests. Follow-up should be improved, not only of blood pressure control but also of the patient's clinical condition.
P050 PITFALLS IN ESTABLISHING THE DIAGNOSIS OF PHEOCHROMOCYTOMA ILLUSTRATED BY THREE CASE REPORTS
Authors: Hausberg Martin , Teber Dogu , Dietrich-Mgbor Jeannine , Ruf Juri , Reimer Peter , Rüdiger Thomas , Kisters Klaus 
Published: September 2024

Background and Objective:
Pheochromocytoma is a rare cause of secondary hypertension. Because of the low incidence, any diagnostic test has a low positive predictive value.

Methods:
We report three example cases with diagnostic pitfalls.

Results:
First case: A 72-year old Caucasian women was admitted for the evaluation of a right adrenal mass, measuring 4 cm. The patient was asymptomatic, never hypertensive. Standard endocrinological evaluation of the adrenal mass revealed significantly elevated plasma and urine normetanephrine (>2 fold upper normal range) and metanephrine levels (>10 fold upper normal range). Subsequent functional imaging with MIBG SPECT/CT confirmed catecholamine storage in the left adrenal mass. After pretreatment with phenoxybenzamine (causing hypotension) the mass was removed surgically and a pheochromcytoma confirmed histologically.

Second case:
A 59-year old Caucasian women with repetitive hypertensive crises for several years was screened for pheochromocytoma and significantly elevated plasma and urine normetanephrine levels (> 5 fold upper normal range) were observed. MRI demonstrated a small left adrenal mass of 2 cm. Although no relevant tracer uptake was observed on MIBG SPECT/CT, subsequent somatostatin receptor imaging with DOTA-TATE PET/CT suggested adrenal pheochromocytoma (Fig.). After pretreatment with doxazosine the mass was removed surgically and a pheochromocytoma confirmed histologically, blood pressure normalized after surgery.

Third case:
A 67 year old Asian woman was admitted for the evaluation of a large left adrenal mass measuring 7.5 cm. She had well controlled hypertension with dual antihypertensive medication and did not suffer from paroxysmal hypertensive crises. Plasma normetanephrine levels were substantially elevated (>20 fold upper normal range). MIBG SPECT/CT confirmed catecholamine storage in the adrenal mass that was partly necrotic. After pretreatment with doxazosine the mass was removed surgically, a largely necrotic pheochromocytoma was confirmed histologically. No further antihypertensive treatment was necessary.

Conclusions:
These cases demonstrate that a pheochromocytoma may be asymptomatic, any adrenal mass needs standard endocrinological workup. Standard functional imaging has a limited sensitivity, additional approaches have to be considered.
P055 ELECTROCARDIOGRAPHIC ABNORMALITIES AND ASSOCIATED FACTORS IN NORMOTENSIVE TYPE II DIABETIC PATIENTS
Authors: Udora Nneka Clara , Ejim Emmanuel Chukwudi 
Published: September 2024

Background/Objective:
Type II diabetes mellitus (T2DM) is a coronary heart disease (CHD) equivalent in the presence of target organ damage or at least three cardiovascular disease (CVD) risk factors. Resting electrocardiography (ECG) is recommended in T2DM patients only in the presence of hypertension or on suspicion of CVD. ECG abnormalities occur early in T2DM, are associated with future cardiovascular events/mortality after adjustment for traditional CVD risk factors. Early screening and detection may improve long term survival in T2DM patients hence, aim of study- to assess the patterns and factors associated with ECG abnormalities in T2DM patients without co-existing hypertension.

Methods:
One hundred normotensive (BP<130/80mmHg, not on any antihypertensive agent) T2DM patients were recruited consecutively, from the Endocrinology and Diabetes clinics of the Medical Outpatient Clinic and Family Medicine department of the University of Nigeria Teaching Hospital. Consents were obtained, before interviewers, administered questionnaire to get the biodata, T2DM history, complications and treatment. Anthropometric and blood pressure readings were taken using standard methods. A 12-hour overnight fasting blood sample was taken for biochemical assessment of blood glucose, glycated haemoglobin, lipids, urea and creatinine. A 12 lead ECG was performed and interpreted by one cardiologist using the Minnesota ECG code criteria. Descriptive statistics was used for patterns of ECG abnormalities while association between categorical variables were cross tabulated and tested using chi square.

Results:
Participants were majorly females 68(68.0%), overweight/obese 52(52.0%) with a mean age of 55.56±9.89 years. Duration of T2DM illness post diagnosis was 6.57±6.26years. T2DM was poorly controlled in 92(92.0%) while 93(93.0%) had dyslipidaemia. ECG was abnormal in 56(56.0%) with multiple abnormality in 12(21.4)%. Left atrial abnormality was the commonest 14(25.0%) ECG abnormality. No factor was associated with ECG abnormality.

Conclusions:
ECG abnormalities are common in T2DM, occurring early in the absence of co-existing hypertension. ECG should be done at diagnosis of T2DM irrespective of CVD risk factors, with frequent monitoring than recommended by guidelines.
Table. Pattern of electrocardiographic abnormalities in normotensive type II diabetic patients.
P056 ANGIOTENSIN CONVERTING ENZYME I (ACE) ISOFORMS ASSOCIATION, THE GENETIC MARKER IN PARTICULAR, AND PRESENCE OF METABOLIC SYNDROME IN VOLUNTEERS FROM VITÓRIA – ES – BRAZIL
Authors: Gomes Andreia Cristina Febba , Ronchi Fernanda Aparecida , Magri Lucas , Mill José Geraldo , Casarini Dulce Elena 
Published: September 2024

Introduction:
Socioeconomic and cultural modifications have directly influenced both population's lifestyle habits and health profile, about 75% of world deaths are characterized by the presence of Non-Transmissible Chronic Diseases (NTCD), such as Metabolic Syndrome (MS), which features the concomitance of cardiovascular risk factors, as arterial hypertension, hypercholesterolemia, and diabetes, central fat deposition, and insulin resistance. A two-phase populational study has researched the Angiotensin Converting Enzyme I (ACE) isoforms relating their presence, specially the 90 KDa one, as a possible biological marker in metabolic alterations and hypertension presence. Objectives: This study's objective is to evaluate whether the 90 kDa ACE isoform may be associated to MS presence in a sample population from the city of Vitoria/ES – Brazil (MONICA project, phase II).

Methods:
470 volunteers from the second phase of the MONICA project were assessed, including demographic information, clinical and biochemical parameters from biological samples. The Western Blotting technique was used for identifying ACE isoforms in urine, which were classified as follows: Group 1: 65, 90 and 190 kDa isoforms; Group 2: 65 and 90 kDa isoforms; Group 3: 65 and 190 kDa isoforms; and these groups distribution in positive and negative MS groups was also checked. Results: It was observed a higher percentage of women in the sample population (58.7% vs 41.3%), higher percentage of negative MS vs positive (74.8% vs 25.2%); both clinical and biochemical parameters presented significantly higher levels in the positive MS group; and MS was more frequently positive in Group 2 of ACE isoforms (Group 1: 44.4%; Group 2: 50%; Group 3: 5.6%).

Conclusion:
This study presenting significant results about the parameters that characterize the presence of MS. Further investigation is needed to identify whether there is a possible relation between 90 kDa ACE isoform and MS, increasing the chances of development and worsening the MS, emphasizing this isoform importance as a biological marker for NTCD.
P067 HOME BLOOD PRESSURE MEASUREMENTS ARE NOT PERFORMED ACCORDING TO GUIDELINES AND STANDARDIZED EDUCATION IS URGENTLY NEEDED: A MIXED-METHODS STUDY AMONG AUSTRALIAN ADULTS
Authors: Clapham Eleanor , Picone Dean , Carmichael Samuel , Sharman James , Chapman Niamh 
Published: September 2024

Background and Objective.
Home blood pressure (BP) measurement should be undertaken according to guideline recommendations to ensure accurate BP measurement. Patient education is required to provide knowledge and skills for home BP measurement. However, little is known about how BP is measured at home and what education is provided to patients, which was the aim of this study.

Methods.
A 30-item survey (n=350) and interviews (n=34) among Australian adults who measure BP at home (June–December 2023). Survey questions included steps taken and education received for home BP measurement. Interviews were conducted among a purposive sample to explore survey topics in detail.

Results.
No participants reported always undertaking home BP measurement according to all the guideline recommendations (Figure 1). However, most participants measured BP seated (n=316, 90%), with the cuff on a bare arm (n=269, 77%) and legs uncrossed (n=232, 66%). In addition, most participants recorded their BP measurements (n=280, 80%) and reported them to a medical professional (n=232, 79%). Interview participants reported measuring BP in an ad-hoc manner, using different steps each time they measure BP at home. “I [measure BP] at different times of the day after doing different things”.
Only 37% (n=112) participants received education for home BP measurement. Interview participants who received education described healthcare practitioners giving verbal instructions for BP measurement. However, there were no differences in performing home BP measurement according to guideline recommendations between participants that received education and those that did not. In the absence of education, many interview participants described mimicking BP measurement methods of their healthcare provider. “I do it the way I’ve seen them do it”.

Conclusions.
This study found that home BP measurement is not performed according to guideline recommendations and standardised, high-quality education is rarely delivered on how to measure BP at home. These findings highlight an urgent need for effective education strategies to support high-quality home BP measurement to appropriately inform BP management.
P070 ROLE OF NOVEL BLOOD PRESSURE METRICS IN EARLY BLOOD PRESSURE CONTROL ASSESSMENT: INSIGHTS FROM THE SPRINT TRIAL
Authors: Li Moran , Shi Jieying , Zhao Yifan , Zhang Yi 
Published: September 2024

Objective:
Innovative blood pressure (BP) metrics is pivotal to expedite the BP management among individuals with hypertension.

Methods and Findings:
This is a post-hoc analysis of the SPRINT (Systolic Blood Pressure Intervention Trial). A total of 8369 participants, who had comprehensive BP records and experienced no adverse events during the initial 90-day follow-up, were included. Two novel BP metrics, systolic blood pressure (SBP) burden and Time-in-Target-Range (TTR), were calculated by employing three-month SBP recordings from follow-up data. SBP Burden were derived as the proportion of area under curve (AUC) over a specific SBP threshold (SBP values >130 mmHg) in a short-term exposure period (from the first month to third month). SBP TTR was estimated by the proportion of time in a specified SBP target range (110 to 140mmHg) in the same exposure period. Major adverse cardiovascular events (MACE), as the primary outcome of this analysis, was a composite endpoint including myocardial infarction, stroke, heart failure, and cardiovascular death. Secondary outcomes included individual components of the primary outcome, as well as all-cause mortality. The relationship of novel BP metrics and study endpoints was accessed by using adjusted Cox proportional hazards regression models.
Over a median follow-up period of 3.90 [3.88-3.94] years, 559 MACEs occurred. Both SBP burden (Hazard Ratio [HR]: 1.126 [1.039-1.221]) and SBP TTR (HR: 0.862[0.783-0.949]) were independently correlated with MACEs according to adjusted Cox models. Evaluation using C-statistic and Net Reclassification Indexes (NRI) revealed that both two novel SBP metrics outperformed mean SBP and SBP standard deviation (SD) in predicting MACEs. Furthermore, the predictive value of SBP burden and TTR was consistent across MACE(P=0.383) and secondary endpoints (all P value > 0.05) in this analysis.

Conclusions:
Among non-diabetic patients with hypertension, both the cumulative SBP burden and TTR independently predict MACEs, surpassing the predictive power of mean SBP and SBP SD. This study substantiates the application of innovative BP measurements for early-stage assessment of BP control.
P074 STRIDE BP SYSTEMATIC REVIEW OF PUBLISHED VALIDATION STUDIES OF BLOOD PRESSURE MEASURING DEVICES
Authors: Menti Ariadni , Mariglis Dimitrios , Kyriakoulis Konstantinos , Kollias Anastasios , Palatini Paolo , Parati Gianfranco , Wang Jiguang , Schutte Aletta , Stergiou George 
Published: September 2024

Background and Objective:
The accuracy of blood pressure (BP) monitors is essential for an accurate diagnosis, yet few devices have been validated using an established protocol. This study assessed the published evidence on validation studies of BP monitors.

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

Results:
Of 569 validation studies included in the STRIDE BP database, 238 (42%) used the ESH-IP, 153 (27%) the AAMI/ISO, 132 (23%) the BHS, and 46 (8%) the AAMI/ESH/ISO Universal Standard. These studies evaluated 346 devices (upper-arm 290; wrist 56) intended for office (55), ambulatory (44), home (233), public space/kiosk (8), and hospital (6) BP measurements. Among the 569 reviewed studies the STRIDE BP review process rejected 202 (35.5%) due to major violation of the validation protocol and/or device failure to pass the protocol's requirements. Six of 46 validation studies that used the most recent AAMI/ESH/ISO Universal Standard were rejected (13%), versus 190 (36.3%) using older validation protocols. STRIDE BP concluded that 280 of total 346 BP devices (81%; upper-arm 236; wrist 44) fulfilled the protocol's requirements and can be recommended for clinical use. Among these 280 devices, 106 (37.6%) were selected by STRIDE BP as preferred devices (fulfilling additional requirements), and 182 (65%) are available on the market (Table).

Conclusions:
This analysis highlights a shortage of validated BP monitors available on the market, particularly for office and 24-hour ambulatory use. It is encouraging that fewer validation studies using the most recent AAMI/ESH/ISO Universal Standard were rejected by STRIDE BP than older studies using previous protocols, suggesting an improvement in the quality of published validation studies.

Table. STRIDE BP systematic review of published validation studies.