bluuebunny/crossref_metadata_2025_split huggingface dataset:
P228 THE PORTRAIT OF THE HYPERTENSIVE PATIENT: THE REALITY OF A NORTHERN PORTUGUESE SUBPOPULATION IN THE CONTEXT OF PRIMARY CARE
Authors: Sousa Helder , Teles-Pinto Nuno , Leal Andreia , Morgado Ana Márcia 
Published: September 2024

Background and Objectives:
Hypertension is a chronic disease, and is one of the main cardiovascular risk factors. Knowing the local reality, regarding the comorbidities of the hypertensive population, profile of pharmacological therapy and level of blood pressure control are fundamental for the design of management and treatment strategies for hypertensive disease. In Portugal, hypertension has a estimated prevalence of 26,78% and the overwhelming majority of patients are assisted in primary care, where the health professionals have software tools such as BI-CSP, which uses Microsoft's Power-BI platform, allowing the retrieval of data about different variables.
The aim of this study is to characterize a subpopulation studied at the Fânzeres Primary Care Center regarding demographic data, morbidity, blood pressure control and antihypertensive medication.

Methods:
This is an observational and cross-sectional descriptive study with an analytic component. The population consists of patients diagnosed with hypertension (N=3474). The retrieval of data was carried out using the MIMUF and BI-CSP.

Results:
In the population from which the 3474 hypertensive patients were selected, hypertension has a prevalence of 26%. The most common cardiovascular comorbidities were dyslipidemia (50%), Obesity (30%) and Diabetes (33%). 63% of patients had a systolic blood pressure (SBP) of <140mmHg and 28% had a SBP <130mmHg on the last measurement. Regarding the antihypertensives prescribed on a 4 month period, molecules that act on the renin-angiotensin axis are the main class used corresponding to 583K DDD (defined daily dose), followed by thiazides (300K DDD) and calcium channel blockers (250K DDD).

Conclusions:
There is still suboptimal control of hypertension in the population studied, which implies the adoption of more effective treatment strategies. It is important not only to involve adapting pharmacological treatment to the most recent guidelines, but also promote healthy lifestyles, control comorbidities and improve the follow-up of these patients. A multidisciplinary approach, using face-to-face and remote methods to strengthen contact with the healthcare team, can help to achieve these goals.
P031 SPATIAL ASSOCIATION BETWEEN HYPERTENSION AND AIR POLLUTION IN ULAANBAATAR, MONGOLIA
Authors: Baatarsuren Uurtsaikh , Myanganbayar Maral , Lkhagvajav Zoljargal , Bungert Andreas , Dashdorj Naranbaatar , Dashdorj Naranjargal 
Published: September 2024

Background and Objective:
This study aims to assess the spatial association between hypertension prevalence and PM2.5 levels in Ulaanbaatar.

Methods:
To estimate the hypertension prevalence, we conducted a complex survey with a two-stage cluster sampling method in 2018. For PM2.5 level estimation, we used data collected during cold weather months (October to March) from 2015 to 2019. These estimates were used to predict PM2.5 levels across the entire city, using the Inverse Distance Weighted (IDW) interpolation method. The same approach was applied to predict the hypertension prevalence. We fitted a multiple linear regression model to estimate the association between PM2.5 and hypertension prevalence with adjustment for income, a proxy of socioeconomic factors to examine effect modification. In exploratory analysis, we estimated the association between PM2.5 level and income level. We used RStudio 1.3.1093 and ArcMap 10.8.2 for data analysis.

Results:
A total of 4515 participants were included in the sample. The hypertension prevalence was 46.5% with a threshold of 130/80 mm Hg. Adjusting for other covariates, a 10-unit increase in PM2.5 level is associated with a 6.66 (95% CIs;[10.23,10.23]) point increase in hypertension prevalence (p<0.001). With each 100,000 (MNT) increase in income level, the impact of 10-unit increases in PM2.5 level on hypertension decreases by 2.98 (95% CIs;[-5.48,-0.47]) points (p=0.02). In the partial F-test, an increase in income level was associated with a lower hypertension prevalence (p=0.002). In the exploratory analysis, a 100,000 (MNT) increase in income level was associated with a 0.23 (95% CIs;[-0.41,-0.05]) point decrease in PM2.5 level (p=0.011).
Figure 1. Spatial association between hypertension prevalence. A).Hypertension prevalence (%); B).Income level (MNT) PM2.5 level; C).PM 2.5 (μg/m3); D).Linear regression model. Note: Inverse Distance Weighted method is used for predictions. Green points indicate the PM2.5-measuring site locations.

Conclusions:
The people who live in lower-income areas experience a stronger influence of air pollution on hypertension prevalence compared to others in Ulaanbaatar.
P032 THE IMPACT OF NATURE IMMERSION THERAPY ON BLOOD PRESSURE IN HYPERTENSIVE SUBJECTS: A PILOT STUDY
Authors: Barros-Bohorquez Guillermo , Porto-Corbacho Daniel , Hernández-Nieto Bryan , Hernández-Herrera Johon , Géliz-Vilaro Carlos , Valle Carlos Campos-Del , Cárdenas-Castellanos Juan , Santacruz-Martinez Juan , Blandón-Rentería Leany , Urina-Triana Manuel , Urina-Triana Miguel , Quintero-Baiz Adalberto 
Published: September 2024

Background and Objective:
Conscious nature immersion therapy, termed “Vitamin N”, has shown promise in reducing blood pressure levels in individuals with or without hypertension. This pilot study aims to assess the effect of nature immersion on blood pressure specifically in hypertensive subjects.

Methods:
A convenience sample of stable hypertensive individuals participated in a standardized 3-hour nature immersion session. Systolic and diastolic blood pressure levels were recorded before the intervention (Phase I), after 30 minutes of the intervention (Phase II), and 48 hours post-intervention (Phase III). Statistical analysis employed a one-way non-parametric ANOVA, Kruskal-Wallis test, and Dunn's post hoc test, with a bilateral significance level of 95%. A criterion of at least 3 mmHg reduction in blood pressure was set for clinical significance.

Results
Eighteen participants, comprising 12 women (64.67%) and 6 men (33.33%), with a mean age of 60±9.04 years and 61±6.88 years, respectively, were included. Six individuals had a medical history of Diabetes Mellitus Type 2, and one had a history of coronary heart disease. Significant differences in median systolic (MSP) and diastolic pressures (MDP) were observed across the three phases (p<0.05). Notably, Phase II and Phase III showed consistent reductions in blood pressure compared to Phase I, exceeding the established 3 mmHg reduction criterion.

Conclusions:
Conscious nature immersion therapy (“Vitamin N”) exhibited a significant effect in lowering both systolic and diastolic blood pressure levels among hypertensive individuals. These findings suggest the potential of nature immersion as a non-pharmacological intervention for managing hypertension.
P034 THE INFLUENCE OF SOCIODEMOGRAPHICAL CHARACTERISTICS AND COMORBIDITIES ON SURVIVAL IN ADULTS WITH HTN IN COLOMBIA
Authors: Peñuela-Sánchez Adriana , Herrera-Parra Lina Johana , Valbuena-García Ana María , Acuña-Merchán Lizbeth 
Published: September 2024

Background and objective:
Awareness of the impact of hypertension (HTN) on health enables the implementation of effective measures to control the disease. This study characterizes the survival of the Colombian adult population with hypertension.
Methods: This longitudinal retrospective cohort study included adults diagnosed with HTN from July 1, 2013, to june 30, 2014, from the National Registry of Chronic Kidney Disease (NRCKD). The primary outcome was the time from diagnosis to all-cause mortality. The probability of from the date of diagnosis was estimated using Kaplan-Meier analysis. Log-rank test evaluated differences in survivor functions. Patients were followed from baseline until death, abandonment, or the end of follow-up on July 30, 2023.

Results:
Baseline characteristics: The analysis included 285,418 cases. The mean age at diagnosis was 59.17 ± 14.58 years. 61.25% were females, 67.13% were affiliated with third-payer insurance, and 28.81% resided in the Central region. At baseline, 36.77% of the study population had comorbidities, including diabetes mellitus (DM) or chronic kidney disease (CKD) or both. 36,110 all-cause deaths were recorded during the follow-up period.
Survival analysis: The 10-year overall survival (OS) rate was 0.84 (95% CI 0.84–0.84). The unadjusted log-rank comparisons revealed a lower probability of survival for men compared to women (0.81 vs. 0.86, respectively) and for individuals with state insurance compared to those with third-party insurance (0.80 vs. 0.86, respectively). The survival rates were found to be lower in individuals with HTA, DM, and HTN at baseline (0.68) compared to those with HTN and CKD (0.78), HTN and DM (0.81), or only HTN (0.88) (p < 0.001).

Conclusions:
The survival of individuals with HTN is influenced by a variety of sociodemographic characteristics and can be further complicated by the presence of other comorbidities, which can potentially amplify the negative effects on an individual's health. These findings may be useful for decision-makers to focus on the identification of patients with different characteristics of risk.
P036 INFLUENCE OF FOOD ENVIRONMENT IN AND AROUND SCHOOLS ON FOOD CHOICES AND PRACTICES OF STUDENTS: A MIXED METHODS STUDY – ANTICIPATORY FINDINGS
Authors: Mubashir Maira , Iqbal Romaina , Almas Aysha 
Published: September 2024

Background:
The health behaviors of adolescents are significantly influenced by their living environments, with schools serving as crucial settings for promoting healthy behaviors. The school food environment, encompassing areas where food is provided and consumed within and around schools, plays a key role in shaping adolescents’ dietary choices. However, there is a notable scarcity of evidence regarding the school food environment in Pakistan. This study aims to examine the school food environment and associated factors, including the availability, accessibility, and affordability of foods within and around schools for adolescents, the facilitators and barriers school vendors face while offering healthy food options, and the perspective of policymakers on the role of food environments.

Objectives:
• To assess the school lunchtime food practice and sources of adolescents in schools in Karachi
• To explore facilitators and barriers to offering healthier food options to adolescents through school vendors both within and outside school premises
• To explore the perspectives of adolescents regarding the food choices available to them

Methods:
A mixed methods concurrent study design i.e. a cross-sectional study, interpretive descriptive qualitative study. Six schools, comprising three government and three private schools from District Central of Karachi, will be recruited. Students from grades 6 and 7 who provide consent and assent will be included, with an anticipated sample size of 430 participants. Descriptive statistics will be utilized to analyze quantitative data and a manual thematic analysis approach will be employed to analyze qualitative data.

Results:
The anticipated outcome of this study is to understand the school food environment holistically taking into consideration the practices and perspectives of key stakeholders i.e. school-going adolescents, vendors, and policymakers.

Conclusion
The groundwork done through this research project will help develop evidence-based healthy school food environment programs/interventions that can be feasibly deployed in government and private schools in Pakistan. The research outcomes will foster collaborative efforts among various stakeholders to co-create and implement viable solutions.
P059 IDENTIFYING PREDICTORS OF EARLY-ONSET HYPERTENSION IN MIDDLE-AGED INDIVIDUALS WITH OBESITY
Authors: Uzokov Jamol , Alyavi Bakhromkhon , Abdullaev Akbar , Azizov Shukhratjon , Payziev Djamshid 
Published: September 2024

Background:
Hypertension is a leading risk factor for cardiovascular diseases, with obesity being one of its primary modifiable predictors. This longitudinal study aims to identify early predictors of developing hypertension in middle-aged individuals with obesity, contributing to targeted prevention strategies.

Methods:
A cohort of 112 middle-aged participants (mean age 48.6 ± 10.8 years, 55% male) with a body mass index (BMI) ≥ 30 kg/m^2 but without hypertension at baseline were followed for an average of 5.8 ± 2.4 years. The study sought to determine significant predictors for the development of hypertension, including demographic variables, lifestyle factors, and biochemical markers. Cox proportional hazards regression models were employed to estimate hazard ratios (HR) for the development of hypertension, with Kaplan-Meier analysis used to visualize time-to-event outcomes. Statistical significance was determined by p-values < 0.05.

Results:
Over the follow-up period, 34% of participants developed hypertension. Kaplan-Meier analysis indicated a significant difference in hypertension-free outcomes based on baseline insulin resistance levels and waist-to-hip ratio (WHR) (p < 0.01). Cox regression analysis revealed that insulin resistance (HR = 1.12 per unit increase, 95% CI: 1.06-1.19, p = 0.001) and WHR (HR = 2.48 for the highest quartile vs. lowest, 95% CI: 1.32-4.67, p = 0.005) were independent predictors of developing hypertension. Furthermore, a sedentary lifestyle was associated with an increased risk (HR = 1.89, 95% CI: 1.01-3.54, p = 0.046), whereas dietary factors did not show a significant relationship after adjusting for other variables.

Conclusion:
This study identifies insulin resistance and WHR as significant predictors of early-onset hypertension among middle-aged individuals with obesity, with lifestyle factors also playing a crucial role. These findings underscore the importance of targeted interventions focusing on reducing insulin resistance and central obesity, along with promoting physical activity, to prevent the development of hypertension in this high-risk population.
P064 SYSTEMATIC REVIEW OF PROPORTION OF FEMALES AND MALES RECRUITED IN BLOOD PRESSURE DEVICE VALIDATION STUDIES AND RELATIONSHIP WITH MEASUREMENT ACCURACY
Authors: Bothe Tomas Lucca , Bui Tan V. , Bao Yueyang , Chapman Niamh , Sharman James E. , Picone Dean S. 
Published: September 2024

Background and Objective:
New to market automatic blood pressure (BP) devices should undergo clinical validation according to a scientifically recognised protocol to ensure accurate measurements. Some recent research suggests a reduced accuracy of automated cuff BP in females compared to males. Females have been underrepresented in many areas of clinical research, but it is unknown whether this is common among BP device validation studies and if it is a contributory factor to reduced accuracy in females. The aim of this study was to determine the proportion of females compared to males recruited to validation studies and whether there is any relationship with the accuracy of automated BP measurement.

Methods:
A systematic review of BP device validation studies published between 1987 and 2023 was conducted. Studies that tested automated, upper-arm devices compared to auscultatory BP in a general population, including children, were included. Descriptive statistics were used to determine the proportion of females and males recruited and weighted meta-regression analyses were used to assess the relationship between sex and measurement accuracy.

Results:
Out of 322 eligible validation studies, the proportion of females and males recruited was reported in 287 (89.1%) studies. Only six (2.1%) studies included <30% females or males, which is the current minimum requirement of international standards. An average of 50.8% females were recruited to validation studies, and this was consistent across different validation protocols and year of study publication. There was no relationship between sex and measurement accuracy (p>0.05), except for a negligible tendency of automated devices to overestimate manual measurements of diastolic BP among studies with a greater proportion of females (R2=0.017, p=0.027).

Conclusion:
Females are not underrepresented in BP device validation studies. There was no meaningful relationship between the proportion of females recruited and measurement accuracy. These findings indicate current protocols are adequate to ensure representation of females and males in validation studies.
P066 HOW BLOOD PRESSURE DEVICES ARE OBTAINED FOR HOME BLOOD PRESSURE MEASUREMENT: A MIXED-METHODS STUDY AMONG AUSTRALIA ADULTS
Authors: Clapham Eleanor , Carmichael Samuel , Sharman James , Picone Dean , Chapman Niamh 
Published: September 2024

Background and Objective.
Only 20% of automated blood pressure (BP) devices available for purchase are validated. However, how consumers obtain devices for home BP measurement and whether their devices are validated remains unknown, which was the aim of this study.

Methods.
Surveys (n=225) and interviews (n=27) among adults who measure BP at home in Australia (June-December 2023). Survey questions included how the BP device was obtained, device details to determine validation status, and considerations in choosing a device. Interviews explored how and why BP devices were obtained in detail.

Results.
Most participants (n=216, 96%) used an upper-arm cuff device, of which 52% (n=118) were validated. Of 9 participants that used wrist cuff devices, 67% (n=6) were validated. Most participants purchased (n=176, 91%) their BP device, predominantly from pharmacy (n=126, 72%; 50% validated), followed by online (n=36, 16%; 52% validated). Validated BP devices were on average $38.53 AUD more expensive than non-validated devices (p<0.001).
Although accuracy was the most important consideration when choosing a BP device (n=112, 50%), few interview participants cited device validation status as a consideration. “I just assumed that they were all accurate”. Most interview participants avoided cheaper BP devices, believing these were less accurate, and they were willing to “make an investment” in their BP device due to the importance of getting an accurate BP measurement. Interview participants rarely received recommendations from their GP about which BP device to use and reported pharmacy staff provided retail support based on in-store device availability rather than information about accuracy.

Conclusion.
This study found only 50% of devices used by consumers for home BP measurement have been validated. Devices that are validated are more expensive, but critically, consumers are willing to make an investment in an accurate BP device. However, little guidance is provided to support consumers when selecting a BP device. These findings demonstrate the need for credible information and resources that support consumers to obtain validated BP devices.
P076 FACTORS INFLUENCING POST-COVID HOME BP AND HR FLUCTUATION WITHIN THE URBAN INDIAN DIABETIC POPULATION
Authors: Patil Vishal , Patil Mansi 
Published: September 2024

Objective:
The impact of COVID-19 on cardiovascular health among adult diabetics remains underexplored, particularly concerning home blood pressure (BP) and heart rate (HR) variability. This study aims to elucidate the factors influencing post-COVID home BP and HR fluctuation within the urban Indian diabetic population.

Design and Methods:
A cross-sectional study was conducted, involving 1000 adult diabetic patients aged 30 to 80 years with prior COVID-19 infection. Home BP and HR readings were recorded twice daily over seven days, generating 28 measurements. Variability in BP and HR was determined using standard deviation calculations between morning and evening readings, as well as between consecutive measurements.

Results:
Older age (OR: 1.56, 95% CI: 1.23-1.98), cardiovascular comorbidities (OR: 2.09, 95% CI: 1.67-2.62), diabetes (OR: 1.84, 95% CI: 1.43-2.36), and elevated home BP (OR: 2.35, 95% CI: 1.87-2.95) emerged as independent predictors of increased morning-to-evening home BP variability. Similarly, older age (OR: 1.72, 95% CI: 1.34-2.21) and elevated home BP (OR: 2.14, 95% CI: 1.67-2.75) were determinants of heightened day-to-day BP variability, while a combination of older age (OR: 1.98, 95% CI: 1.52-2.58), female sex (OR: 1.43, 95% CI: 1.11-1.84), cardiovascular disease (OR: 1.89, 95% CI: 1.47-2.44), and elevated home BP (OR: 2.56, 95% CI: 1.98-3.31) predicted greater variability between consecutive readings. Conversely, younger age (OR: 0.76, 95% CI: 0.59-0.98) and elevated home HR (OR: 1.92, 95% CI: 1.51-2.44) were associated with increased morning-versus-evening HR variability. Additionally, younger age (OR: 0.67, 95% CI: 0.51-0.88), female sex (OR: 1.34, 95% CI: 1.04-1.73), and elevated home HR (OR: 1.78, 95% CI: 1.39-2.29) were predictive of greater variability between consecutive HR measurements.

Conclusion:
Understanding the determinants of home BP and HR variability post-COVID infection is crucial for prognostication and clinical management. Clinicians should prioritize counseling incorporating regular home blood pressure measurements, diabetes management, and cardiovascular disease prevention, particularly for high-risk diabetic patients.
P082 HOW LONG DO BLOOD PRESSURE LOWERING DRUGS TAKE TO WORK? A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIALS
Authors: Salam Abdul , Kota Vidyasagar , Dhurjati Rupasvi , Pant Rashmi , Rodgers Anthony 
Published: September 2024

Background:
Evidence on the time course of antihypertensive drug (AHTD) efficacy is crucial to guide the frequency of visits recommended in guidelines and when it is appropriate to wait for further effects to accrue.

Objective:
To assess how quickly AHTD therapy works to lower blood pressure (BP).

Methods:
We systematically searched multiple electronic databases for relevant randomized, double-blind, placebo-controlled trials of untreated adults. These trials compared fixed doses of AHTDs from the five major classes to a placebo for a minimum of four weeks and reported BP data at baseline, and at least at weeks 2 and 4. Primary outcomes were systolic and diastolic BP reduction at weeks 2, 4, and 8. A fixed-effect meta-analysis was conducted, and a best-fit exponential association model was used to evaluate BP-lowering efficacy over time.

Results:
A total of 94 trials (25,637 participants) were included. Trial duration ranged from 4-16 (median 8) weeks. The best-fit exponential association model predicted that the reductions in systolic BP (SBP) at weeks 1, 2 and 3 were 64%, 79%, 85% of the reductions seen at week 4. There was no evidence of additional BP reduction after week 4. In absolute terms, after week 2 the additional reduction in BP averaged only 1.8/0.8 mmHg by week 4 and 0.4/0.2 mmHg between week 4 and week 8. This finding was consistent across trials by drug class, with no evidence that renin-angiotensin-aldosterone system inhibitors, diuretics, beta-blockers, calcium channel blockers, diuretics or combinations took longer to work. Baseline BP did appear to modify the effect, but still there was no additional benefit after 4 weeks.

Conclusion:
BP lowering drugs work quickly, with little additional BP lowering occurring after 2 weeks. These findings have relevance for guidelines and for addressing treatment inertia related to expectation of time needed for drugs to work fully.