bluuebunny/crossref_metadata_2025_split huggingface dataset:
O05 TERMINAL DIGIT PATTERN IN COMMUNITY-BASED HYPERTENSION SCREENING PROGRAMS: 5-YEAR ANALYSIS FROM MAY MEASURE MONTH NEPAL
Authors: Inagaki Yoko , Koirala Sweta , Mishra Shiva Raj , Adhikari Tara Ballav , Acharya Pawan , Kumar Payal Rajender , Devkota Surya , Khanal Pratik , McLachlan Craig , Neupane Dinesh 
Published: September 2024

Background and Objectives:
Terminal digit preference leads to misclassification of hypertension. Despite strong promotion of community-based hypertension screening, the extent of terminal digit preference in such programs is not well understood. We aimed to identify the proportion of blood pressure (BP) ending in zero, and factors associated with the most repeated digit.

Methods:
A cross-sectional study was conducted using data from May Measure Month (MMM) Nepal 2017, 2018, 2020, 2021, and 2022. Participants with available data on the type of BP monitors were included. In MMM Nepal, adults≥18 years of age were eligible and recruited via convenience sampling. Data enumerators are community health workers or college students trained for BP measurement through short trainings. Without bias, the proportion of BP ending in zero is expected to be 10% and 20% for automated and manual monitors, respectively.

Results:
A total of 48,442 participant were included with 29.2% age≥50 years and 51.8% females. BP appeared to be normally distributed with “spikes” at terminal digits of zero (Figure 1). 90.9% of participants were measured their BP with automated monitors and 8.1% with manual monitors. The proportion of BP ending in zero was about 1.7 and 4.8 times greater than the expected proportion using automated and manual monitors, respectively (automated: 17.0% [SBP], 16.7% [DBP], manual: 95.3% [SBP], 93.8% [DBP]). Logistic regression showed age≥50 (OR 1.13 [95%CI 1.06, 1.20]) and SBP≥140mmHg (1.63 [1.49, 1.78]) were associated with SBP ending in zero, and age≥50 (1.14 [1.08, 1.22]) and DBP≥90 mmHg (2.11 [1.96, 2.28]) were associated with DBP ending in zero, both after controlling for sex, smoking, alcohol use, diabetes, cardiovascular diseases, antihypertensive medicine use, and the type of BP monitors used.

Conclusion:
The proportion of BP ending in zero was higher than expected with any type of BP monitors used. More studies are needed to investigate whether these distributions were by chance or due to errors.
O07 RENAL DENERVATION IMPROVES RIGHT VENTRICULAR FUNCTION, RESTORES MYOCARDIAL NOREPINEPHRINE LEVELS AND REVERSES VENTRICULAR SPECIFICITY OF SELECTED MARKERS IN HYPERTENSIVE RATS WITH HEART FAILURE INDUCED BY VOLUME OVERLOAD
Authors: Miklovic Matus , Gawrys Olga , Honetschlagerova Zuzana , Kala Petr , Huskova Zuzana , Kikerlova Sona , Vanourkova Zdenka , Adamova Marketa , Maxova Hana , Puertas-Frias Guillermo , Kvasilova Alena , Kitamoto Misuzu , Mracek Tomas , Sedmera David , Melenovsky Vojtech 
Published: September 2024

Background and objective:
Despite the known anti-hypertensive effect of renal denervation (RDN), its influence on the cardiac function, particularly of the right ventricle (RV) and the cardiac sympathetic nervous system in heart failure (HF) is poorly understood. This study aimed to investigate the effect of RDN on RV function, myocardial norepinephrine (NE), and left versus right ventricular (LV/RV) dominance of HF markers in HF induced by aorto-caval fistula (ACF).

Methods:
ACF was created in hypertensive Ren-2 transgenic rats. RDN was performed by phenol application. Cardiac function was measured by echocardiography and pressure-volume analysis. NE levels were measured using an ELISA kit, protein expression was assessed by western blotting, gene expression by TaqMan PCR assay, and ROS by Amplex Red assay.

Results:
RDN in ACF rats decreased RV hypertrophy and dilatation, decreased RV end-systolic pressure and end-diastolic pressure, improved RV function (Ees +45%, FAC +20%), decreased HF gene markers Nppa, Tgm2, Myh7/6 ratio, and increased SOD2 protein expression. RDN decreased plasmatic NE levels, increased NE in RV, and decreased monoamine oxidase (MAO-A) in RV.
NE levels and SOD2 were more dominant in RV than LV in control (sham/intact) rats and ACF changed their specificity towards RV dominance, while RDN had no effect in these parameters in ACF on ventricular specificity.
In sham/intact rats dominant for LV were hemodynamic parameters Ees, EDPVR, and molecular markers Mao-a, ROS production by MAO-A, Nppa, Myh7, Myh7/6 ratio, Tgm2, Uchl1, and Beta1/Chrm2 ratio. ACF changed the dominance of these selected markers from LV to RV. Interestingly, RDN reversed dominance back towards LV in gene markers Mao-a, Nppa, Myh7, Tgm2, Uchl1, and Beta1/Chrm2 ratio.

Conclusions:
RDN decreased RV ESP and EDP, improved RV systolic function, restored NE levels, decreased RV gene expression of selected HF markers, and reversed their RV/LV dominance, probably by reduction of central sympathetic nerve drive and alternations of the cardiac sympathetic nervous system.
O08 TESTOSTERONE CAN INDUCE CARDIAC HYPERTROPHY IN OVARIECTOMIZED SPONTANEOUSLY HYPERTENSIVE RATS THROUGH THE ACTIVATION OF THE mTORC2/Atg9a
Authors: Wang Wenting , Yu Jing 
Published: September 2024

Objectives:
The estrogen level of postmenopausal women decreased sharply, while the androgen level did not decrease significantly, which was characterized by the inversion of estrogen / androgen ratio. Therefore, it could be observed that relative excess androgen in the circulation of postmenopausal women, which may be one of the reasons for the increase of cardiovascular disease in postmenopausal women. In this study, the model of postmenopausal hypertension was established by bilateral ovariectomy in spontaneously hypertensive rats (SHR), and the specific mechanism of testosterone-induced myocardial hypertrophy in ovariectomized SHR was explored.

Methods:
24 SHR were randomly divided into four groups: WKY group (n=6), sham operation group (Sham group, n=6), bilateral ovariectomized group (OVX group, n=6) and testosterone propionate intervention group (OVX+T group, 6 mg/kg/Weekly, im for 4 weeks, n=6). Western Blot was used to detect the protein expression of β-MHC, ANP, Androgen receptor, Akt, p-Akt, mTORC2 and its subunits Rictor and LC3 and mitophagy related proteins.

Results:
1.The expression of β-MHC and ANP was significantly increased in the OVX and OVX+T groups when compared to the WKY and Sham groups. Additionally, the expression of androgen receptors was markedly upregulated in both the OVX and OVX+T groups. These findings strongly suggest that testosterone primarily induces myocardial hypertrophy in SHR after ovariectomy through androgen receptors.
2. Although no significant difference in mTORC2 expression was noted between the WKY, Sham, and OVX groups, testosterone exhibited a notable capacity to activate mTORC2 expression and the p-Rictor subunit in the OVX+T group.
3. The expression of LC3II/LC3I and DRP1 were increased in the OVX+T group when compared to the WKY, Sham and OVX groups. While the expression of MFN2 in the four groups shows no significant difference. Meanwhile, the expression of Atg9a was increased in OVX+T group.

Conclusions:
In bilateral ovariectomized SHR, testosterone has the potential to activate mitophagy by activating the mTORC2/Atg9a pathway, which, in turn, leads to cardiac hypertrophy.
O13 ASSOCIATION OF SECONDHAND SMOKE EXPOSURE IN RELATION TO HYPERTENSION TREATMENT STATUS WITH STROKE OCCURRENCE IN GHANA AND NIGERIA
Authors: Fakunle Adekunle , Asowata Osahon , Okekunle Akinkunmi , Sarfo Fred , Akpa Onoja , Wahab Kolawole , Akpalu Albert , Obiako Reginald , Akinyemi Rufus , Ovbiagele Bruce , Owolabi Mayowa 
Published: September 2024

Background and objective:
It is unclear whether secondhand smoke exposure (SHSE) in hypertensive states with a disproportionate gap in hypertension treatment status is fuelling the epidemic of stroke in sub-Saharan Africa. This study, therefore, assessed the association of SHSE in relation to hypertension treatment status with stroke occurrence among West Africans.

Methods:
The Stroke Investigative Research and Educational Network (SIREN) is a case-control study across 16 study sites in Ghana and Nigeria. Cases were acute stroke (n =3684) with age- and sex-matched stroke-free controls (n =3684). Hypertension definition was based on standard guidelines, and SHSE was based on self-reported exposure to smoke from a burning cigarette or exhaled from a smoker in any indoor area. We evaluated the associations of untreated hypertension, treated but uncontrolled hypertension, and controlled hypertension at BP of <140/90 mmHg with odds of stroke occurrence. Multivariable-adjusted logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) of the risk of stroke by hypertension treatment and SHSE status.

Results:
Overall, mean age was 59.0±14.9 years, and 54.2% were male. Among stroke cases, the prevalence of SHSE was 352 (20.7%), and the frequencies of no hypertension, untreated hypertension, treated but uncontrolled hypertension, and controlled hypertension were 4.0%, 47.7%, 37.1%, and 9.2%. The aOR and PAR (95% CI) for untreated hypertension were 6.58 (5.15-8.41) and 35.4% (33.4-37.4); treated but uncontrolled hypertension was 9.95 (7.60-13.02) and 35.9% (34.2-37.5); and controlled hypertension was 5.37 (3.90-7.41) and 8.5% (7.6-9.5) respectively. The aOR (95% CI) of stroke, given exposure to secondhand smoke, was 1.15 (0.94-1.41), while among untreated hypertensives and treated but uncontrolled hypertensives was 1.54 (0.99-2.37) and 1.15 (0.48-1.46) respectively.

Conclusion:
SHSE with hypertension significantly aggravated the odds of stroke occurrence, particularly when hypertension is untreated. Implementing targeted multi-sectoral interventions that advocate for clean air and aggressive hypertension treatment can potentially reduce the escalating burden of stroke in Africa.
O14 KIDNEY RESIDENT MEMORY T CELLS MEDIATE THE CHRONIC PROGRESSION OF HYPERTENSION
Authors: Deck Katherine , Liu Yunmeng , Mora Christoph , Guo Yunping , Rafferty Tonya , Benson Lance , Mu Shengyu 
Published: September 2024

A significant challenge in treating hypertension is insufficient blood pressure (BP) control and its recurrence. Previously, we described the contribution of CD8 T cells (CD8Ts) to the pathogenesis of salt-sensitive hypertension. Notably, despite antihypertensive therapy temporarily lowering BP in hypertensive mice, the T cell residency was not disrupted within the kidneys, and hypertension recurred when treatment was ceased. We hypothesize that the CD8Ts established a long-living resident memory (Trm) population in the kidney that instigates the recurrence of hypertension.
To examine this, we utilized both wild-type (WT) and T-cell-specific KO of TGFβRII (Tsp-TGFβRKO) mice, which prevents the formation of Trms. Blood pressure was recorded continuously with radiotelemetry. Hypertension was induced with the classic DOCA-salt model and an Angiotensin II (Ang II)-induced salt memory model to mimic the clinical recurrence of hypertension with high salt intake. In this salt-memory model, a one-week infusion of Ang II paired with high salt-induced hypertension before being allowed to return to normal blood pressure. A chronic high salt intake challenge then tested the recurrence of hypertension. Both splenic and renal T cell populations were characterized using flow cytometry.
As expected, DOCA-salt treatment led to salt-sensitive hypertension in WT mice along with the development of a significant CD8Trm population within their kidneys. These CD8Trms were notably diminished in the kidneys of DOCA-treated Tsp-TGFβRKO mice who also had attenuated blood pressure elevation. While testing the recurrence of hypertension during the Ang II-induced salt-memory model both WT and Tsp-TGFβKO reached the same degree of hypertension during Ang II-salt and baseline blood pressure before and after Ang II-salt. However, only the WT developed Trm and had the recurrence of hypertension with high salt challenge whereas both were lost in the Tsp-TGFβKO mice.
In summary, our study unveils the critical role of kidney CD8Trms in contributing to salt-sensitive hypertension and its recurrence. This leads to targeting key molecules that initiate the development of Trms to mitigate the persistency of hypertension.
O17 THE PROGRESSION OF HYPERTENSION WITH OBESITY AND DIABETES FAVORS CARDIAC PRO-INFLAMMATORY MACROPHAGES AND DIASTOLIC DYSFUNCTION
Authors: Sepúlveda R , Moya J , Rojas MSc J , Araos P , Amador C , Hermoso M , Gabrielli L , Jalil J , Ocaranza M 
Published: September 2024

Background:
In most patients, hypertension (HT) is accompanied by obesity and diabetes. Cell-specific mechanisms like accumulation of macrophages, and dysregulation of innate immune pathways play important roles in cardiac remodeling (CR). Macrophages (Mo) exhibit phenotypic heterogeneity in response to tissue micro-environment. It is unknown whether in the heart the subpopulations of pro-inflammatory Mo (CCR2+MHCII+) and resident repair Mo (CCR2-MHCII+ and CCR2-MHCII-) differ in the development of the chronic HT, obesity and diabetes. Objective. To determine in male with HT and or obesity and diabetes, the pro-inflammatory cardiac Mo derived from monocytes (CCR2+MHCII+) and the resident repair Mo (CCR2-MHCII+ and CCR2- MHCII-).

Methods:
12-week-old male C57BL/6N mice were assigned to experimental groups: control diet, high-fat diet (HFD, 60% kcal from fat), L-NAME (L,0.65 g/L in drinking water) and HFD+L for 5 and 15 weeks. Body weight (BW), systolic (SBP) and diastolic blood pressure, glucose and exercise capacity (EC), cardiac function and cardiac Mo CCR2+MHCII+, CCR2-MHCII+, CCR2- MHCII- were determined.

Results:
(mean ± SEM, n=9-12). During 15 weeks, HFD and HFD+L groups showed significantly higher BW and glucose intolerance vs. control and L (p <0.001, F=28.4; p<0.001, F=10.3, respectively). EC as lower in the HFD and HFD+L groups compared to control and L (p<0.059). Echocardiographic parameters showed a significant increase in the size of the left atrium (p<0.001, F=38.9) and diastolic dysfunction in the HFD+L group vs control, HFD and L (p<0.001, F=35.6). No changes in ejection fraction and shortening fraction. The thickness of the septal wall and posterior wall was significantly greater in the HFD+L and HFD groups (p<0.0001, F=10.6 and p<0.0001, F=14.6, respectively). The L hearts showed a significant increase in CCR2-MHCII- (p<0.0001, F=68.6) and a significant decrease in CCR2+ MHCII+ (p<0.001, F=13.7), compared to the control and HFD groups.

Conclusion:
The progression of HT with obesity and diabetes favors cardiac pro-inflammatory macrophages and diastolic dysfunction.
O21 PLATELET COUNT-TO-PLATELET DISTRIBUTION WIDTH RATIO AND OTHER PLATELET INDICES AS COST-EFFECTIVE MARKERS OF PREECLAMPSIA: A CASE CONTROL STUDY
Authors: Bashyal Ritu , Sharma Paban Kumar , Singh Alka , Maharjan Sanjay , Tuladhar Shreyashi , Bhattarai Binita 
Published: September 2024

Background and objective:
Platelet indices, like platelet count (PC), plateletcrit, mean platelet volume (MPV) and platelet distribution width (PDW), and their ratios have shown to be cost-effective and better predictors of preeclampsia (PE). However, PC/PDW ratio was not studied. Thus, this study aimed to compare platelet indices and their ratios between pregnant women with and without PE.

Methods:
An analytical, comparative, case-control study. Two groups were compared; pregnant women with PE (case, n=24) and without PE (control, n=72). The differences between cases and controls were compared using Student's t-test and Mann–Whitney U-test for continuous variables and chi-square tests and Fisher's exact test for categorical. Multivariable linear regression analysis for hematological parameters was performed to assess the effect of gestational age. Logistic regression was performed to calculate the odds ratio. Receiver operating characteristic curve was used to determine sensitivity, specificity and cutoff values. P < 0.05 was considered significant.

Results:
There was significant reduction in values of PC (p=0.004), plateletcrit (p=0.012), PC/MPV ratio (p=0.002), and PC/PDW (p= <0.001) among the pregnant women with PE compared to the control study group, while a significant increase was noticed in the values of PDW (p= <0.001) and MPV (p=0.021).
PC/PDW had the highest area under the curve (AUC) of 0.767, followed by PDW (AUC=0.752). At the cutoff value of 15.1 (p<0.001) for PC/PDW, sensitivity was 70.8%, and specificity was 81.9%. The odds of diagnosing true positive cases of PE was 11.02 (95% CI =3.79-31.99, p=<0.001) times higher compared to values below it at this cutoff point.

Conclusions:
Present study suggests that platelet indices are economical tests that can act as indicators of risk of PE. Among all the parameters, PC/PDW has the highest sensitivity and specificity in the detection of PE at the cutoff of 15.1 and has emerged as a better predictor of PE.
O26 SUSTAINED BLOOD PRESSURE CONTROL FOLLOWING A HOME BLOOD PRESSURE TELEMONITORING PROGRAM
Authors: Reynolds Kristi , Juan RA , Harrison TN , An J , Zhou H , Mefford MT , Marquez JM , Ong-Su AL , Brettler JW 
Published: September 2024

Background and Objective:
Home blood pressure telemonitoring (HBPT) facilitates HBP monitoring and reduces office BP. Evidence whether BP control can be sustained via HBPT is lacking. We examined the effects of a HBPT program on sustained BP control.
Methods: We included patients enrolled in a HBPT program at a large integrated US healthcare system from November 2019-June 2022. Patients with uncontrolled hypertension were enrolled by a clinician, given a BP device and provided consent through an app. Patients were asked to measure their BP three mornings and three evenings each week before taking antihypertensive medication. BP readings were synced to the app, and non-physician providers titrated medications. Patients were successfully discharged from the program after achieving control (at least two 1-week average BPs and last BP in one month <135/85 mmHg). We examined mean clinic BP reduction before and after enrollment to HBPT and sustained BP control (last clinic BP <140/90 mmHg in the 12 months following discharge). Multivariable robust Poisson regression was used to identify factors associated with sustained BP control at 12 months.

Results:
A total of 3574 patients were enrolled and 2123 (59%) consented; of these, 63 (3%) did not submit >1 BP, 780 (37%) were actively enrolled, 644 (30%) disenrolled without meeting BP control and 636 (30%) achieved control and were discharged after a mean of 4 months. Among the 636 successfully discharged, 527 (83%) had clinic BP during follow-up. Compared with the last clinic BP prior to HBPT enrollment, mean (SD) clinic SBP and DBP was reduced by 16.3 (22.6) mmHg and 10.0 (12.3) mmHg, respectively (p<.0001 for both) and 75% of patients sustained BP control at 12 months. Younger patients and patients with high SBP prior to HBPT were less likely to sustain BP control at 12 months (Figure).

Conclusions:
While the HBPT program in this healthcare system shows promise for sustained BP control, strategies to enroll/consent patients and spread the program are warranted.
O27 DEVELOPMENT OF A CONCEPTUAL EVALUATION MODEL AND TESTING ITS PERFORMANCE IN HYPOTHETICAL PAY-FOR-PERFORMANCE INTERVENTIONS TO IMPROVE HYPERTENSION CONTROL
Authors: Marklund Matti , Rao Krishna D. , Cherukupalli Rajeev , Appel Lawrence J. , Matsushita Kunihiro 
Published: September 2024

Background and Objective:
Hypertension is a growing concern, particularly in low- and middle-income countries. Financial incentives, such as pay-for-performance, have shown promise in improving non-hypertension outcomes. However, their efficacy and cost-effectiveness in hypertension management, especially in low-resource contexts, remain uncertain. Our objectives were to 1) document studies exploring health financial interventions for hypertension management 2) develop a conceptual model which can facilitate future research on health financing approaches for hypertension management, and 3) assess the model's performance in hypothetical pay-for-performance interventions.

Methods:
Our literature review identified few studies evaluating finance interventions on hypertension management with somewhat more evidence for pay-for-performance strategies. Thus, we developed a conceptual model and assessed its performance in hypothetical scenarios of pay-for-performance schemes to enhance public hypertension care in Bangladesh. Using a state-transition modeling framework, we estimated the incentive costs and impact on cardiovascular disease burden in 18 scenarios with varying intervention coverage, blood pressure effects, and incentive rates (Figure 1). Key model inputs were derived from the 2019 Global Burden of Disease Study, the 2018 WHO STEPS survey, and WHO-CHOICE. Our primary outcome was incentive costs per health-adjusted life year (HALY) gained.

Results:
Based on our model, the incentive costs per HALY gained depended on the intervention coverage, intervention effect and incentive rate (Figure). If only currently treated patients were included, the most optimistic scenario (i.e., the largest blood pressure reduction with the lowest incentive rate) was estimated to cost 11,043 USD in incentives per HALY gained (Figure). If the intervention also included new, previously untreated patients while maintaining the same total incentives, the estimated incentive costs per HALY gained was 5,515 USD.

Conclusions:
Our model suggests that pay-for-performance interventions for hypertension care may demand substantial financial resources, but that the intervention could become more favorable with increased treatment coverage. While more studies on the impact of financial interventions in hypertension care are necessary, our model can guide planning and designing such a study.