bluuebunny/crossref_metadata_2025_split huggingface dataset:
O38 A SOCIAL DETERMINANT AND SIMPLE CLINICAL VARIABLES AS THE BEST PREDICTORS OF ESRD BY AN XGBOOST MACHINE LEARNING MODEL IN CKD
Authors: Giraldo-Castrillon Y , Giraldo E , Sánchez-Martínez Y , Hernández-Quiñonez D , Martínez-Bello D , Gómez-Montoya I , Castañeda A , García C. , López-López JP , López-Jaramillo P 
Published: September 2024

Background and Objective:
Chronic Kidney Disease (CKD) is a complex disease that affects approximately 13% of the world's population and is growing rapidly due to the increase in aging and the prevalence of type 2 diabetes mellitus, obesity and hypertension. It is difficult to predict who will develop End-Stage Renal Disease (ESRD) and, so far, no prediction model is applied in clinical practice. Our aim was to develop and externally validate an ESRD prediction model with potential utility in clinical decision making.

Methods:
A longitudinal study was conducted with an 8-year follow-up of sociodemographic, biological, and clinical variables. Individuals with a diagnosis of CKD belonging to the cardiovascular risk program were recruited in two cohorts for derivation and external validation of the model. Classical and machine learning models on an imputed data matrix and sub-databases were explored by bootstrapping and cross-validation, as well as the change in GFR between measurements that predicted ESRD. Measures of calibration, discrimination, and overall predictive performance were presented. Models were trained and tested in sub cohorts and the best performing model was validated in an independent cohort and its uncertainty established.

Results:
A total of 2514 patients were included, 1650 in the derivation cohort, mean age of 74 years, 40.4% were women. A machine learning xgboost model identified previous GFR, creatinine, blood glucose, HbA1c, HDL cholesterol, BUN and income level as the main predictors of ESRD. Likewise, an inter-measurement GFR delta of 3.09 ml/kg/min was associated with a significant increase of ESRD. In the external validation cohort, with 864 patients, the model maintained an accuracy of 0.98, an AUC of 0.776, a recall of 1.00 and an F1-score of 0.99. The uncertainty of the AUC given by the 95%CI was 0.68-0.826.

Conclusions:
A machine learning xgboost model identified the most important predictors of ESRD, maintaining adequate predictive performance when cross-validated in an independent cohort of patients. The model could be applied in real clinical practice.
O42 USABILITY AND EFFECT OF A HYPERTENSION MOBILE APPLICATION IN KNOWLEDGE AND GUIDELINES ADHERENCE OF FAMILY AND COMMUNITY MEDICINE RESIDENTS
Authors: Salabi Sitti Khadija , Francisco Peter Julian , Marcelo Portia Grace , Trutna Timothy Francis 
Published: September 2024

Background:
Mobile health (mHealth) applications have become integral in medical education and information access, yet effectiveness varies, and barriers to engagement persist.
OBJECTIVE: This study aimed to assess the usability and effectiveness of the mHealth application entitled Hypertension Now in increasing knowledge and guideline adherence among residents.

Methods:
A before-and-after educational intervention study was conducted among residents of the Department of Family and Community Medicine (DFCM), Philippines General Hospital from January to August 2023. The intervention was a newly developed medical reference app for managing hypertension based on the latest local and international hypertension guidelines. Usability, knowledge score, and adherence rate were measured using a questionnaire, pre- and post-intervention examinations, and medical chart audits.

Results:
All 32 DFCM residents participated in the study. The app was rated high on ease of use and usefulness for practice by the residents. It was also rated high on interface and overall satisfaction. It significantly increased the knowledge scores of the residents by 1.6 points (p=0.001). The proportion of those who passed the exam significantly increased post-intervention (37.5% vs. 59.4%, p=0.035). Moreover, the app increased the adherence of the residents to proper physical examination (82% vs. 91%, p=0.024), diagnosis (80% vs. 90%, p=0.012), and pharmacologic treatment (53% vs. 83%, p=0.001). There was no increase in adherence to proper risk assessment (83% vs. 78%, p=0.371), laboratory examination (35% vs. 40%, p=0.329), and non-pharmacologic treatment (77% vs. 81%, p=0.470).

Conclusion:
The mHealth app for hypertension management was usable and effective in increasing the knowledge of family and community medicine residents in managing hypertension. While the app increased guideline adherence to physical examinations, diagnostics, and pharmacological treatments for hypertension, it did not increase adherence to risk assessment, laboratory examination, and non-pharmacologic treatment.
O43 ADHERENCE OF CLINICIANS TO HYPERTENSION CLINICAL PRACTICE GUIDELINES: A MULTICENTER CROSS SECTIONAL STUDY
Authors: Villar Juan Carlos , Cuevas José D. Cruz , Moreno Angélica M. 
Published: September 2024

Background:
Hypertension is the cardiovascular risk factor that accounts for most preventable deaths worldwide. Implementation of clinical practice guidelines (CPG) reduces variability in care and improves outcomes. In Colombia, clinicians’ adherence to recommendations is rarely reported. The aim of this study was to assess the adherence of clinicians to hypertension CPG in out-patient clinics from Bogotá.

Methods:
we performed a cross-sectional study as part of the baseline measurement of a cluster randomized trial. A panel of experts selected seven prioritized recommendations from the Colombian hypertension CPG. Clinicians from 5 health-care institutions in Bogotá, Colombia, who voluntarily accepted to participate were included. We consulted electronic health-records of a consecutive sample of patients with hypertension treated by the participating clinicians to evaluate the applicability of, and adherence to, selected recommendations.

Results:
The 37 clinicians included had a mean age of 36.9 years, 54.05% were male, most of them general physicians (83.7%) and the mean clinical experience was 10.5 years. Evaluation of 4872 recommendations by reviewing health-records from 696 patients (67% female, mean age 68.5 years, 51.5% less than 5 years since diagnosis) showed an overall applicability of 21.3% (CI95% 20.1-22.4%) and adherence was 29.1% (CI95% 26.3-37.9%). We identified a significant variation in adherence between recommendations, being highest for treating with combination of antihypertensive medications for stage 2 hypertension (58.7%) and lowest for proteinuria screening (7.8%) (figure 1). Adherence was better in male clinicians (25% vs 32%, p=0.008) and those with more clinical experience (35% for >10 years of experience vs 26% for <10 years of experience, p=0.014). Also, clinicians were more adherent to recommendations related to treatment with moderate certainty of evidence (39.5%), compared to those on screening with high certainty (15.2%).

Conclusions:
in a sample of physicians practicing in Bogotá, adherence to strong recommendations from the Colombian hypertension CPG varied greatly by clinicians’ sex, clinical experience and the type of recommendations, and was overall poor.
O44 LOW ADHERENCE TO HYPERTENSION MANAGEMENT IN THE COLOMBIAN COMMUNITY IMPLEMENTATION RE-HOPE STUDY
Authors: Giraldo-Castrillon Yessica M. , Gomez-Montoya Isabela , Sánchez-Martínez Yuri , Hernandez-Quiñones Daniela , Martinez-Bello Daniel , Otero Johanna , Castañeda Álvaro , Lopez-Lopez Jose Patricio , Lopez-Jaramillo Patricio 
Published: September 2024

Background and objective:
Uncontrolled hypertension is a leading cause of death worldwide, and it's associated with a high socioeconomic burden. Demographic, social, behavioral, and health system-related factors contribute to low adherence to hypertension management. Recognizing adherence rates is a mainstay for improving hypertension control. This study examined the level of adherence to hypertension management and control in the participants belonging to the implementation, integration, and institutionalization of a community-based care strategy to reduce the risk of cardiovascular disease in Santander (ReHOPE) study.

Methods
This cross-sectional analysis was conducted in 12 municipalities of Santander, Colombia, from May to December 2023. Participants over 18 with hypertension, not in a cardiovascular risk program, were included. Data were collected door-to-door by trained community health providers using standardized questionnaires for socio-demographic information, medication use, lifestyle details, and hypertension knowledge. Physical exams provided anthropometric and blood pressure values. Medication adherence was assessed with the Morisky 4-item scale. Continuous variables are presented as central tendency measures, and categorical variables as frequencies and proportions. Analysis was performed using R software.

Results:
A total of 2,617 participants were included. The mean age was 65.09 (SD 12.09), and 64.3% were women. The mean systolic blood pressure was 133.94 mmHg (SD 16.53). The median waist-to-hip ratio (WHR) was 0.96 (IQR 0.92-1.00) in men and 0.91 (IQR 0.87-0.96) in women. Among participants, 33.9% had uncontrolled hypertension, 28.5% were not aware of their condition, and 69.2% reported no physical activity. High WHR was found in 84.8% of the participants. Antihypertensive monotherapy use was reported in half of the participants (53.8%). The most frequently used pharmacological group was angiotensin-converting enzyme inhibitors (81.8%). Hypertension control was observed in 66.1%, and 12.6% had high adherence.

Conclusions:
Low medication adherence was observed, only 12.6% of participants reported high adherence and nearly 40% had uncontrolled hypertension. Additionally, nearly 30% were undetected by the healthcare system. Thus, improving medication adherence and healthcare strategies is essential to enhance health outcomes.
O50 EFFECT OF LONG-TERM USE OF CONTINUOUS POSITIVE AIRWAY PRESSURE ON BLOOD PRESSURE PATIENTS WITH RESISTANT HYPERTENSION AND OBSTRUCTIVE SLEEP APNEA
Authors: Da Costa Fernandes Ana Cristina Tenorio , Oliveira De Carvalho Carlos Fernanda , de Azevedo João Carlos Moreno , Pimentel Chiara Donnangelo , da Silva de Sousa Vitória Mirian , Jardim Duarte Mr Carlos Henrique , Margallo Victor , Muxfeldt Elizabeth Silaid , de Souza Fabio 
Published: September 2024

Background and Objective:
Obstructive Sleep Apnea (OSA) is strongly associated with Resistant Hypertension (RHT). Continuous positive airway pressure (CPAP) is the treatment of choice for moderate-severe OSA. Its benefit in terms of blood pressure (BP) control is still unclear. The objective of the study is to evaluate the effect of CPAP on BP in patients with RHT and moderate-severe OSA.

Methods:
This was a prospective intervention study that included 124 patients with RHT and moderate/severe OSA (AHI>15/hour) divided in 2 groups. Patients using CPAP uninterruptedly for a minimum period of 12 months (CPAP group) were compared with those who refused to use CPAP despite clinical indication (Control group). Office BP and 24-hour ABPM were obtained at baseline and after follow-up. Primary outcomes were changes in office and ambulatory BPs, and nocturnal BP reduction.

Results:
124 individuals were included (37.9% male with a mean age of 60.7 ± 7.8 years), 65 in the CPAP group and 59 in the control group with a median [interquartile range] follow-up time of 68 [49-81] months. There was a reduction in office systolic BP (SBP) of -7.5 mmHg ([CI95%: -16.3 to -1.1],p=0.089), in nocturnal SBP and diastolic BP (DBP) of – 6.1 mmHg ([CI95%: -12.4 to 0.3],p=0.06) and -3.5 mmHg ([CI95%: -7.4 to 0.6],p=0.092), respectively, without reaching statistical significance. Otherwise, after excluding 9 patients of CPAP group with low adherence, we found a reduction in office SBP of -10.3 mmHg ([CI95%: -19.7 to 0.9],p=0.031), in 24-hour SBP and DBP of – 4.8 mmHg ([CI95%: -10.5 to 0.8],p=0.095) and -3.4 mmHg ([CI95%: -6.8 to 0.1],p=0.045), and in nocturnal SBP and DBP of – 8.1 mmHg ([CI95%: -14.7 to -1.5],p=0.017) and -5.3 mmHg ([CI95%: -9.6 to -1.1],p=0.014), respectively.

Conclusion:
Long term use of CPAP reduced office, 24-hour and nighttime SBP specially in resistant hypertensives with good CPAP adherence.
O52 KIDNEY ARTERIOLAR RESPONSES TO LIVER-TARGETED SMALL INTERFERENCE RNA (SIRNA) TARGETING ANGIOTENSINOGEN IN DIABETIC RATS: COMPARISON WITH OTHER RENIN-ANGIOTENSIN SYSTEM BLOCKERS
Authors: Cruz-Lopez Edwyn , Martini Alexandre , Foster Don , Zlatev Ivan , Kasper Anne , Sequeira-Lopez Maria-Luisa , Gomez Ariel , Danser A.H. Jan 
Published: September 2024

Objective:
Inhibition of the renin-angiotensin system (RAS) with ACE inhibitors (ACEi) or angiotensin receptor blockers (ARB) is associated with concentric thickening of renal arteries and arterioles and parenchymal disease. Here we evaluated to what degree this also occurs during RAS inhibition with siRNA targeting hepatic angiotensinogen (AGT).

Methods:
Male hypertensive heterozygous transgenic rats overexpressing mouse renin (TGR(mRen2)27 rats), made diabetic with streptozotocin, were treated with the ARB valsartan (4 mg/kg/day), the ACEi captopril (6 mg/kg/day), AGT siRNA (30 mg/kg every 2 weeks), AGT siRNA + valsartan, or captopril+valsartan for 3 weeks, starting at 15 weeks after induction of diabetes. After 3 weeks of treatment, kidneys were removed, and immunocytochemistry was performed on Bouin's fixed kidney sections using antibodies against renin or α-smooth muscle actin. Juxtaglomerular index and wall thickness were assessed using tiling pictures of both renin and α-smooth muscle actin sections from the slides. Tubular degeneration was scored by summing up scores for tubular atrophy, interstitial fibrosis, and tubulointerstitial inflammation. Concentric vascular hypertrophy was assessed in a blinded manner.

Results:
All treatments increased juxtaglomerular index, and the largest increases were observed in dual treatment groups, consistent with the highest degree of RAS blockade in these groups. Tubular scores increased after induction of diabetes, and the highest scores were seen in dual treatment groups, significance versus vehicle being reached in the valsartan+captopril group only (P<0.05). Afferent arteriole wall thickness increased in all treatment groups, and the greatest increases were observed during dual treatment. Finally, concentric vascular hypertrophy was observed in 1 of 7 diabetic Ren2 rats; this percentage increased during RAS blocker treatment of these rats, numerically reaching the highest values during dual treatment.

Conclusions:
Our data suggest that, in the hypertensive diabetic rat model, high levels of RAS blockade, irrespective of the type of blockade, may result in an increase in afferent arteriole thickness and concentric vascular hypertrophy. AGT siRNA in combination with RAS inhibitors should be further explored in clinical studies.
O58 CONTINUOUS MEASUREMENT OF BLOOD PRESSURE DURING NIGHT - INSIGHTS INTO THE GENESIS OF THE NOCTURNAL BLOOD PRESSURE FLUCTUATIONS
Authors: Patzak Andreas , Bothe Tomas Lucca , Küchler Gert 
Published: September 2024

Background and Objective:
Nighttime blood pressure (BP) is a strongly predictive marker for overall cardiovascular risk. Traditional cuff-based BP measurements methods provide only discrete BP data. Short-term BP fluctuations are not detectable with such methods. Therefore, we applied two independent and continuously measuring methods with the aim to characterize systolic nocturnal blood pressure fluctuations (NBPF) related to sleep apnoea or periodic leg movements (PLM).

Methods:
BP fluctuations were analysed in patients with suspected sleep disturbances. The Portapres™ device (Penaz method) and a system based on the measurement of the pulse transit time (SOMNOscreen®) were used to measure the BP in addition to a polysomnography performed under the conditions of a clinical sleep laboratory. The calculation of the BP by the SOMNOscreen® was performed using a BP-pulse wave velocity (PWV) transfer function.

Results:
We saw BP fluctuations which occurred in connection with obstructive apnoeic events as well as in connection with PLM. Both methods recorded the same apnoea related NBPF. The amplitudes of these NBPF accounted for 24.7 mmHg and 22.8 mmHg (Portapres™ and SOMNOscreen®, respectively, 11 patients, number of events: n=695). PLM related PB fluctuations (in 5 of 11 patients, n=317) amounted to 18.4 mmHg (Portapres™ and 16.9 mmHg (SOMNOscreen®). Most of the patients did not show BP dipping when comparing awake with sleep time periods and they had a moderate to severe apnoea/hypopnoea index.

Conclusions:
The study demonstrates a strong relation between apnoeic events/PLM and NPBF. The NBPF were similarly detected by two different BP measuring methods suggesting that the more indirect method of BP determination using the PWV provides a reliable measurement of NBPF. The results suggest that OSA and PLM related NBPF strongly contribute to non- or reverse dipping of patients with these sleep disorders.
O61 HYPERTENSION IN COLOMBIA: ETHNIC GROUP COMPARISONS IN CHARACTERIZATION AND SURVIVAL
Authors: Quintero Martínez Juan Andrés , Herrera Parra Lina Johana , Urina Triana Miguel Alberto , Valbuena García Ana María , Ocampo Dagnovar Aristizábal , Moreno Cortes Javier Alfredo , Donado Rodrigo Oñate , Acuña Merchán Lizbeth Alexandra , Quintero Baiz Adalberto Elias 
Published: September 2024

Background and objective:
Research has shown that ethnic minorities may be disproportionately affected by arterial hypertension. The aim of this study is to compare the overall survival (OS) HTN patients within the Colombian health system, by their ethnic group.

Methods:
Design: Longitudinal retrospective cohort study. Population: Adults diagnosed with HTN from June 1, 2014, to July 30, 2015, from the National Registry of Chronic Kidney Disease (NRCKD). The follow-up period was until July 30, 2023. Analysis: The probability of global survival from the date of diagnosis was estimated using Kaplan-Meier analysis. An unadjusted Royston Parmar flexible regression model was fitted. Right-censoring was defined as abandonment or completion of follow-up without death occurring.

Results:
5,634,812 cases were identified from june 1st 2022 to july 30th 2023, and 299,161 incident cases were included in the survival analysis. 95.29% had no ethnic group, 1.20% were indigenous, 3.47% were Afro-descendant and 0.03% were Gypsy (ROMA). ROMA group had a higher proportion of residents in Bogotá, D.C. compared to other groups (13.96% vs ∼3%). Afro-descendant group had a higher proportion of obesity (30.61% vs. 27.86%) and diagnosis of Chronic Kidney Disease (27.31% vs. 15.69%) compared to cases with no ethnic group, while ROMA group had a higher occurrence of DM cases (23.46% vs. 21.66%). 9 years OS was higher in ROMA group (OS = 0.85; CI 95% 0.71 – 0.93) compared to indigenous (OS = 0.83; CI 95% 0.81 – 0.84) and afro-descendants (OS = 0.83; CI 95% 0.83 – 0.84). The probability of all-cause mortality was approximately 20% higher among afro-descendants and indigenous people (HR = 1.20; 95% CI 1.14 – 1.25 and HR = 1.22; 95% CI 1.12 – 1.32, respectively) compared to the non-ethnic group. In contrast, the ROMA did not present differences (p = 0.712).

Conclusions:
In the Colombian health system, differences in OS among afro-descendant and indigenous groups are observed compared to non-ethnic population.
O35 THE SYNERGISM BETWEEN HIGH GLUCOSE AND INTERLEUKIN-1beta PROMOTES INFLAMMASOME ACTIVATION AND THE RELEASE OF SMALL EXTRACELLULAR VESICLES IN HUMAN AORTIC SMOOTH MUSCLE CELLS
Authors: Valencia Inés , Hipólito-Luengo Álvaro , Villacampa Alicia , Vidal-Gómez Xavier , Shamoon Licia , Cuadrado Ana , De la Cuesta Fernando , Martínez Mª Carmen , Andriantsitohaina Ramaroson , Peiró Concepción , Sánchez-Ferrer Carlos F. 
Published: September 2024

Background and objective:
Hyperglycemia and inflammatory cytokines like interleukin (IL)-1beta play a key role in the vascular complications associated to diabetes melllitus (DM), such as atherosclerosis and hypertension. Understanding the pathophysiological mechanisms involved, including altered intercellular communication, is essential to identify potential therapeutical targets. We investigated the synergism of IL-1beta and high glucose on: (1) the activation of nucleotide-binding-oligomerization-domain, leucine-rich-repeat, and pyrin-domain-containing-3 (NLRP3)-inflammasome, an innate immunity component linked to vascular disease, and (2) the production and cargo of small extracellular vesicles (sEVs) as key players in vascular intercellular communication.

Methods:
Human aortic smooth muscle cells (HASMC) were challenged for 18 h with IL-1beta (10 ng/ml) in the presence of normal (5,5 mmol/L) or high glucose (22 mmol/L). Protein levels were quantified by Western blot, while the formation of ASC-like specks, reflecting NLRP3 activation, was assessed by indirect immunofluorescence. sEVs were determined by nanotracking analysis and endothelial senescence by the beta-galactosidase activity assay.

Results:
In HASMC cultures, IL-1beta favored NLRP3-inflammasome priming, as shown by NF-kappaB (phospho-p65) activation while NLRP3 and pro-IL-1beta levels were increased. The cytokine equally promoted NLRP3-inflammasome complex assembly, caspase-1 activation, and a subsequent release of mature IL-1beta in an auto-inflammatory loop. High glucose alone did not promote these effects, but it exacerbated some actions of IL-1beta and potentiated the release of HASMC-derived sEVs induced by IL-1beta, increasing their cargo content in NLRP3-inflammasome components. Moreover, these sEVs induce autocrine NLRP3-inflammasome activation in naïve HASMC and paracrine senescence in human endothelial cells. The IL-1 receptor blocker anakinra (1 mg/ml) blunted the IL-1beta effect, as well as their exacerbation by high glucose.

Conclusion:
High glucose exacerbates the activation of NLRP3-inflammasome by IL-1beta and alters intercellular communication by modifying the number and content of sEVs, which can expand inflammation in neighboring tissues. By preventing such synergy, biological drugs blocking IL-1beta receptors arise as potential pharmacological tools to attenuate DM associated vascular abnormalities.