bluuebunny/crossref_metadata_2025_split huggingface dataset:
P184 CURRENT CONCEPTS IN THE MANAGEMENT OF HYPERTENSION IN HYPERTENSIVE DISORDERS OF PREGNANCY - A REVIEW OF GUIDANCE FROM DIFFERENT INTERNATIONAL GUIDELINES
Authors: Danielli Marianna , Moothathamby Thurkga , Gupta Ajay 
Published: September 2024

Background and Objective:
Hypertensive disorders of pregnancy (HDP) are a leading cause of adverse maternal and perinatal outcomes internationally. This review aims to critically analyse international guidelines pertaining specifically to the management of HDP in cases of gestational hypertension and pre-eclampsia. By highlighting best practices and addressing discrepancies in the classification, diagnosis and management of treatment approaches, this review seeks to equip healthcare professionals with the necessary knowledge to improve the quality of care of pregnancy hypertension.

Methods:
We searched for published guidelines spanning from January 2010 to April 2024, utilising databases such as MEDLINE and EMBASE; guidelines were only included if they were not primarily or entirely derived from other guidelines and if written in English. All guidelines meeting the criteria were extracted for a full-text review. Additional databases were explored, including the Emergency Care Research Institute (ECRI) Guidelines Trust, and the Guidelines International Network's website (GIN). Twelve international HDP guidelines were reviewed, and their recommendations compared.

Results:
All guidelines were consistent in their definition of gestational hypertension and pre-eclampsia but differed in the diagnostic criteria for pre-eclampsia. Despite agreement on which antihypertensives to avoid, the recommended blood pressure thresholds for initiation of antihypertensive medication and treatment targets varied. The use of aspirin and calcium were universally recommended as prophylactic treatment for pre-eclampsia. The guidance on non-pharmacological interventions such as obesity, exercise and the role of salt restriction in diet lacked evidence of benefit and showed discrepancies among guidelines.

Conclusion:
All guidelines acknowledge the significant morbidity associated with HDP and advocate for timely diagnosis and management. We highlight areas of consensus that may be of practical value to healthcare professionals aiding in decision-making. More research is needed to understand optimal BP thresholds at which to initiate antihypertensive medication regimens, the choice of antihypertensive in pregnancy, and the efficacy and benefits of non-pharmacological interventions in HDP. These findings exhibit knowledge gaps, and call for new guideline development.
P185 CHARACTERISTICS OF CENTRAL HEMODYNAMIC CHANGES IN PREGNANT WOMEN WITH PRE-EXISTING ARTERIAL HYPERTENSION II UZBEK POPULATION DEPENDING BODY MASS INDEX
Authors: Sadulloeva Mokhinur , Zakirova Feruza , Hazratkulov Rustam , Yenaliyeva Diana 
Published: September 2024

Background and Objective:
In Central Asia, hypertension accounts for 14.5% of all maternal deaths. In Uzbekistan for 2022-2023, pre-existing/chronic hypertension (CHTN) accounts for 3.6% of all maternal deaths. So, the aim was to identify the features of hemodynamic parameters in pregnant women with CHTN

Methods:
Study included 75 pregnant women of the 2nd-3rd gestation period, divided into 2 groups. Group 1 (n=44) included women without any cardiovascular or somatic pathology (healthy group). Group 2 (n=31) included pregnant women with CHTN (2018 ESC/ESH). HR was assessed, BP was measured, body mass index (BMI) was calculated. Central hemodynamic parameters were assessed using echocardiography. Statistical processing was carried out using Statistica 13.0 program. p < 0.05 was considered statistically significant.

Results:
Analysis showed, the mean age of 2 gr women was older than in 1 gr, 32.67±4.75 years vs 27.24±5.79(p < 0.0001). The mean level of BP corresponded to mild AH (2018 ESC/ESH), amounting to SBP 153.83±16.43 mmHg in 2 gr vs 102.72±10.42 mmHg in 1 group (p< 0.0001) and to DBP 96.16±7.62 mmHg vs 64.77±5.9 mmHg (p<0.0001). According to BMI 23 women (74.2%) with CHTN were overweight, 15 (48%) were with I and II obesity degree. In healthy group, were only 7 overweight women (16%) and no obese women. Analysis of hemodynamics did not reveal signs of cardiac remodeling (LVH, LVDD), but size of the LV walls, the LV mass were greater in 2 gr. Thus, LVEDD in group 2 was 4.79±0.44 cm versus 4.51±0.42 cm in group 1 (p= 0.0068); IVST was 0.976±0.14 cm versus 0.81±0.07 (p< 0.0001); LVEDV was 108.45 ± 23.72 ml versus 94.25 ± 19.48 (p = 0.0058); LV ind.mass was 90.96 ± 22.94 g/m2 versus 65.11 ± 15.28 g/m2 (p < 0.0001). Moreover, in group 2, E/A ratio was 1.52±0.34 versus 1.28±0.24 in group 1 (p = 0.0012).

Conclusion:
It was shown that CHTN in pregnancy, in more than 70% of cases, associated with overweight and initial manifestations of cardiac remodeling.
P187 CO-DESIGNING AN INTERVENTION FOR CARDIOVASCULAR DISEASE RISK ASSESSMENT AND MANAGEMENT AFTER HYPERTENSIVE DISORDERS OF PREGNANCY
Authors: Slater Kaylee , Taylor Rachael , McLaughlin Karen , Pennell Craig , Forbes Karyn , Marcetic Milena , Collins Clare , Hutchesson Melinda 
Published: September 2024

Background and objective:
Women with a history of hypertensive disorders of pregnancy (HDP) are at two-to-fourfold increased risk of developing cardiovascular disease (CVD) within 10 years post-pregnancy. Despite clinical practice guidelines recommending general practitioners (GPs) for ongoing CVD preventative care, no intervention strategies exist within primary care aimed at improving risk assessment or management for women after HDP. This study aimed to co-design an intervention to enhance the implementation of CVD risk assessment and management following HDP for primary care settings in Australia.

Methods:
Researchers used the Integrated Knowledge Translation (IKT) framework and conducted five co-design meetings with the investigative team and end-users. Meetings were informed by the Behaviour Change Wheel (BCW) framework for intervention development and incorporated research findings from a systematic review and meta-analysis, surveys, and an online discussion. Data from activities and audio recordings following each meeting were analysed iteratively to inform ongoing intervention development.

Results:
The 18 end-users included women with lived HDP experience (n=8), obstetricians (n=2), midwives (n=5), and GPs (n=3). The target priorities were to improve communication between hospital staff and GPs following HDP occurrence and increase knowledge of GPs and women regarding CVD prevention post-HDP. Part 1 of the intervention is delivered within the hospital setting via physical resources to address communication gaps between hospital and primary care providers for women after post-HDP. Part 2 is delivered via an update to existing GP education platforms and resources for use within GP consultations to provide education for women and GPs on CVD prevention post-HDP.

Conclusions:
The IKT and BCW frameworks played a crucial role in development of a tailored intervention aimed at bridging gaps in current primary care practice and enhancing implementation of CVD risk assessment and management for women following HDP. This an important step in addressing CVD risk in women of childbearing age.
P190 POST-COVID INFECTION AS AN INDEPENDENT PREDICTOR OF DIASTOLIC HYPERTENSION IN AFRICAN POPULATION: SUDAN MMM 2022
Authors: Beheiry Hind , Ahmed of Cardiology Amjad , Abukaraig Fel Egbal , Ahmed Omer , AbdelFatah Deena , Homidh Eman , Abdellah Walleed , Hamid Abubaker , Abdoalkrem Mohamedalmontser , Hago Maha , Ali Ibtisam , Shaheen Mahasin , Mohamed Yasir 
Published: September 2024

Introduction:
Several clinical studies reported a mutual relationship between coronavirus disease 2019 (COVID-19) and high blood pressure (BP) readings. It was established that hypertension is associated with increased COVID-19 severity, morbidity, and mortality; however, its effect on the future blood pressure reading and development of hypertension is not apparent.

Methods:
This is a cross-sectional analytic study based on MMM 2022, Sudan data. The targeted population was >18 years old. Blood pressure was measured on 3 consecutive measures. Participants who had a history of hypertension were excluded. Systolic hypertension was defined if systolic blood pressure (SBP) ≥ 140 mmHg, and diastolic hypertension was defined if diastolic blood pressure (DBP) ≥ 90 mmHg. Continuous data was presented in mean and standard deviation, and categorical data was presented in frequency and percentages. Logistic regression models (unadjusted and adjusted) were used to predict high blood pressure readings.

Results:
A total of 14,402, (42.92%) were male and the mean age was (35.1±14.7 years) patients were included in this study. The prevalence of associated medical conditions, diabetes, heart attack, heart failure, arrhythmia, and stroke were 6.3%, 1.12%, 1.5%, 0.8%, 4.8%, and 1.1% respectively. The mean SBP was (118.88±17.42) mmHg, and the mean DBP was (78.89±11.0) mmHg. Furthermore, the COVID-19 infection affected (4.48%) of this study population. They were older (36.8±12.2 vs. 35.0±14.8, p=0.003), more frequently males (56.1% vs. 42.3%, p <0.001), and diabetic (8.8% vs. 6.2%, p=0.006). The incidence of systolic hypertension and diastolic hypertension, in the population, was (10.98%) and (14.57%) respectively. The post-COVID patients had a significantly higher mean DBP (80.0±10.7 vs. 78.8±11.0, p=0.008) but not the SBP. Using unadjusted and adjusted logistic regression, the odd ratio is significant for predicting high DBP post-COVID infection (table 1).

Conclusions:
Post-COVID infection carries a huge burden on healthy individuals. After adjusting for the possible confounders, post-COVID-19 infection was an independent predictor of diastolic hypertension in the African population.
P194 VERY LOW-DOSE CYPROTERONE ACETATE (12.5 MG/DAY) IS EFFECTIVE AS ANDROGEN BLOCKER; WELL TOLERATED AND NOT ASSOCIATED WITH HYPERTENSION DEVELOPMENT IN YOUNG FEMALE TRANSGENDER PEOPLE
Authors: de Leon-Durango RJ , Hernandez-Lazaro A , Rios-Gomez C , Santana-Ojeda B , Molinero-Marcos I , Arnas-Leon C , Hernandez-Hernandez I , Acosta-Calero C , Kuzior A , Perez-Rivero JM , Perez-Garcia MP , Martinez-Martin FJ 
Published: September 2024

Background and Objective:
Cyproterone acetate (CPA) has serious adverse effects (hyperprolactinemia, obesity, depression, thrombogenesis, liver toxicity, meningioma…) but the optimal dose has not been established. CPA is associated with a high risk of hypertension development, even with doses as low as 25 mg/day. We sought to establish if a very low CPA dose (12.5 mg/day) is effective as antiandrogen, its side effect profile, and if it is associated with hypertension development.

Methods:
Consecutive non-orchidectomized transgender women <30 years were offered CPA 12.5 mg/day instead of the regular 50-100 mg/day dose, along with estradiol (individually titrated); CPA dose was increased to 25 (eventually 50) mg/day if plasma testosterone was >2 nmol/L or there was clinical hyperandrogenism. Body weight, blood pressure, AST, ALT, GGT, prolactin, FSH, LH, estradiol and testosterone were monitored. A matched group of patients with LHRH agonist as antiandrogen plus estradiol served as control. Hypertension was diagnosed according to the current ESH guidelines. All patients gave informed consent.

Results:
39 patients were recruited, median follow-up was 2.3 years. 32 were maintained on CPA 12.5 mg/day, two increased to 25 mg/day, one to 50 mg/day, two withdrew due to gender-affirming surgery; one was lost to follow-up. There were no serious side effects or related withdrawals. The control group included 35 patients without significant differences at baseline. Suppression of testosterone, LH and FSH were effective and comparable with the control group but a moderate increase in prolactin was observed (26±12 to 38±22 ng/mL, p=0.034). Neither group had changes in liver enzymes. Blood pressure and body weight did not increase significantly in either group; the incidence of hypertension was low in both groups (1 patient each).

Conclusions:
Very low-dose CPA was effective and well tolerated as antiandrogen in a large majority of our patients. While CPA is reportedly associated with a striking dose-dependent increase in the incidence of hypertension in the 25-100 mg/day dose-range, the 12.5 mg/day dose appears to be safer.
P195 CARDIOVASCULAR OUTCOMES IN PATIENTS WITH AORTIC STENOSIS AND HYPERTENSION UNDERGOING AORTIC VALVE REPLACEMENT
Authors: Dueñas Criado Karen Alexandra , Ortiz Carlos Andres , Perez Oscar Mauricio , Alarcon Nicolas , Camacho Jaime , Cabrales Jaime , Echeverry Dario , Pineda Ivone , Garcia Laura 
Published: September 2024

Background and Objective:
Aortic valve stenosis (AS) is most common valvular heart disease and in its severe form requires aortic valve replacement (AVR). The prevalence of both AS and arterial hypertension (HTN) increases with age and the conditions therefore often co-exist. Co-existence of AS and HTN is associated with higher global left ventricular (LV) pressure overload, more abnormal LV geometry and function, and more adverse cardiovascular outcome. Management of HTN in AS has historically been associated with prudence and concerns, mainly related to drug-induced potential adverse consequences.
We evaluated the cardiovascular outcomes of patients with AS and HTN undergoing to AVR

Methods:
A retrospective cohort study where all the patients who underwent AVR between 2019- 2024, in a 4-level center in Bogotá, Colombia. A descriptive analysis was performed. Continuous variables were expressed as mean or median with their respective measure of dispersion, standard deviation or interquartile range (ICR), the categorical variables were expressed in proportions and absolute numbers.

Results:
We analyzed 1043 Patients with moderate/severe AS undergoing AVR, 64.3% (671 with HTN), median age for all of 69.8 years ICR (61.7-77.4) Hypertensive patient being older (72 years p<0.0001). In the HTN group 57.8% were men, and more frequently they had diabetes and dyslipidemia comorbidities (p<0.001) as well as greater baseline renal involvement (p<0.001) comparatively with NO-HTN. In addition, hypertensive patient had better LVEF and were treated with ARA II/IECA (55,6% vs 19.4% p<0.001), beta blockers (60.4% vs 47.3% p< 0.001) and anti-calcium medication (13,1% vs 19,5% p<0.001).Table 1. Cardiovascular outcomes showed greater tendency towards worsening of renal function. There were no statistically significant differences in mortality.

Conclusions:
AVR is presented as a safe procedure in patients with AS and HTN in developing countries. The institutional results show a safe technique, associated with low mortality rates. Hypertensive patients had more acute kidney injury in the post-surgical period, which leads us to propose kidney protection strategies in this group.
P196 UNVEILING THE LINK BETWEEN ISOLATED NOCTURNAL ARTERIAL HYPERTENSION AND OBSTRUCTIVE SLEEP APNEA
Authors: Geliz-vilaro Carlos , Mercado-Marchena Riguey , del Valle Carlos Campos , Hernandez-Nieto Bryan , Pimienta Camilo , Barrios-Agamez Wilfrido , Buelvas-Herazo Jannes , Urina-Triana Manuel , Urina-Triana Miguel , Quintero-Baiz Adalberto , Barros Guillermo , Corbacho Daniel Porto 
Published: September 2024

Background and Objective:
Isolated nocturnal hypertension (INH), characterized by elevated nighttime blood pressure alongside normal daytime readings, often correlates with obstructive sleep apnea (OSA). However, understanding this association remains limited. This study aims to elucidate the relationship between OSA and INH, facilitating early interventions and optimizing patient outcomes.

Methods:
A convenience sample of patients diagnosed with INH via ambulatory blood pressure monitoring (ABPM), regardless of prior hypertension diagnosis, was included. Polysomnography assessed the presence of OSA. Patient demographics were analyzed, and OSA patterns within this cohort were described.

Results:
Forty-three participants with an average age of 60.6±13.54 were enrolled, comprising 30 individuals with hypertension and 13 without hypertension, with 24 males and 19 females included in the analysis. Polysomnography findings revealed obstructive sleep apnea (OSA) in 97.64% of participants (n=42) across all severity levels. Specifically, severe OSA was observed in 10 subjects, moderate in 20, and mild in 12. Interestingly, the distribution of OSA severity was similar between hypertensive and non-hypertensive subjects.

Conclusions:
This study found a close correlation between nocturnal arterial hypertension and the presence of obstructive sleep apnea in both hypertensive and non-hypertensive subjects. Therefore, INH is a strong predictor of OSA, and it could be better than other predictive tests.
P199 HYPERTENSIVE EMERGENCIES: CHARACTERISATION, TREATMENT, AND OUTCOMES IN A SINGLE-CENTRE STUDY
Authors: Graziani Laura , Ramirez Eliel Ivan , de los Angeles Tenuta Maria , Ojeda Valentin , Vargas Pablo , Moles Julieta , Arrupe Matias , Ramirez Jesica Magalí , Diez Emiliano Raul , Renna Nicolás Federico 
Published: September 2024

Objective:
• Characterise patients admitted to the Coronary Care Unit with hypertensive emergency.
• Analyse the reasons leading to hospitalisation.
• Evaluate treatment and discharge diagnosis.

Methodology
A single-centre longitudinal prospective registry was conducted, including patients admitted to the Coronary Care Unit of the Spanish Hospital of Mendoza with a diagnosis of hypertensive emergency, from May 1, 2022, to April 30, 2024. Age, gender, pre-discharge treatment, cardiovascular risk, pre-existing diagnosis of hypertension, quantity and type of medications at admission, quantity and type of medications at discharge, presence of target organ damage, and diagnosis of secondary hypertension were recorded. Statistical analysis was performed using JAMOVI.

Results:
Fifty-nine patients with hypertensive emergency were admitted, 61% of whom were women. Sixty-four percent had a prior diagnosis of hypertension. Of these, 72% had no treatment at admission, 12% were on monotherapy, and 10% were on dual therapy. Only 10% of patients on combination therapy had preferred combination therapy. Twenty-five percent had low cardiovascular risk, 42% moderate, 25% high, and 6% very high. Fifty-four percent were diagnosed with target organ damage. Secondary causes were found in 31.5% of patients, including gestational hypertension or preeclampsia (19%), primary hyperaldosteronism (7%), renovascular hypertension (3%), and pheochromocytoma (2%). The mean number of medications at admission was 0.64 (CI=0.52,0.76) and at discharge was 2.90 (CI: 2.72,3.24). All were preferred combinations. No re-admissions were recorded during the 2-year follow-up.

Conclusions:
According to the data, non-adherence and medical inertia were the most frequent causes of hospitalisation for hypertensive emergency. Only 12% of patients had a diagnosis of secondary hypertension, and 19% of admissions were related to pregnancy. However, it is noteworthy that more than half of the patients had target organ damage, reclassifying patients at higher cardiovascular risk. Following guidelines and using preferred combinations controlled cardiovascular events 100% during follow-up.
P211 PRESCRIPTION AND DISPENSING DURATION OF MEDICINES FOR CHRONIC CONDITIONS: A REVIEW OF INTERNATIONAL POLICIES AND EVIDENCE TO INFORM THE AUSTRALIAN SETTING
Authors: Geijerstam Peder Af , Falster Senior Research Fellow Michael O. , Chalmers John , McLachlan Andrew J. , Rodgers Anthony , Schutte Aletta E. 
Published: September 2024

Objective:
To summarize the current legislative and regulatory framework in Australia and abroad, as well as evidence on the potential impact that dispensed quantity and prescription durations may have on patient outcomes and costs.

Methods:
We searched the PubMed database for peer-reviewed articles using the search terms “prescription duration”[title], “*duration prescriptions”[title], “prescription length”[title], “prescription period”[title], “extended prescription”[title], “repeat prescription”[title], “repeat prescribing”[title], and “dispensing duration”[title]. In addition, for a selection of countries, we also searched for and asked national health care authorities or local experts via e-mail regarding dispensing and prescription duration limitations based on legislation, health service guidelines, and subsidy program regulations. To achieve a representative sample, we included the world's 5 most populous countries, as well as the most populous country from each continent. We defined “prescription duration” as the entire period of treatment, based on the quantity of medication, for which a healthcare provider may prescribe a medication, and “dispensing duration” as the period of treatment for which a pharmacist may dispense the medication at a single time point.

Results:
In 31 countries, the most common limitation for dispensing durations were either 30, 60 or 90 days, and for prescription durations either 3, 6 or 12 months. Evidence on the impact of dispensing and prescription durations is limited in quality, but suggests that longer dispensing durations are less costly to the patient (and funder) and improve adherence compared with shorter dispensing durations. There is not enough evidence to draw any conclusions regarding the effects on medicines supplies or health outcomes. To understand the full effects of different prescription and dispensing durations, and to improve the quality of evidence of what previous studies have thus far suggested, randomized controlled trials are needed.

Conclusions:
Prescription and dispensing durations vary widely between countries, but the effects of such limitations are largely unknown. More rigorous research is needed to identify the ideal prescription duration by also addressing the impact it has on other aspects such as health outcomes, medicine waste, savings to the health system and loss of working hours.
P212 COMPARISON OF COLLEGE STUDENTS’ HEALTH METRICS DURING TRADITIONAL AND VIRTUAL REALITY BASED CYCLING
Authors: Stoltzfus Diana , Cadet Ishmael , Carvalho Alex , Veerabhadrappa Praveen 
Published: September 2024

Background:
Most college students do not meet the recommended physical activity guidelines. Novel technology such as virtual reality (VR) may be used to promote physical activity among sedentary students. Purpose: To investigate physiological changes in heart rate (HR), blood-pressure (BP) and rating of perceived exertion (RPE) among college students during stationary cycling with and without VR.

Methods:
Twenty-two college-students (7 M/15F; 18-30years) were recruited on campus. Students separately & randomly completed 2 separate cycling-sessions (with and without VR). The VZFit Ring Racer application with Meta Quest 2 VR Headset synced to a RENPHO smart AI bike was used for the VR session. HR, BP and RPE were assessed at 5-min intervals.

Results:

Only, RPE at 5-min interval was significant (p=0.032) between the non-VR and VR groups, which may be attributed to the fact that participants were focused more on the VR environment rather than the exercise session, potentially lowering their RPE.

Conclusions:
In this preliminary data, college students HR, BP & RPE were influenced during the VR session with RPE being lower. This suggests that VR may reduce the perception of effort for a given exercise intensity, and it could be used as a tool to engage students and promote physical activity, in an otherwise sedentary student population.