bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS-BPP04-5: BURDEN AND TRENDS OF HYPERTENSIVE HEART DISEASES IN SOUTH ASIA, 1990 TO 2019: ANALYSIS FROM THE GLOBAL BURDEN OF DISEASES
Authors: Islam Sheikh Mohammed Shariful , Moreno Sebastian Vicente , Huxly Racheal , Maddison Ralph 
Published: January 2023

Background:
There is lack of comprehensive population based studies on the burden of hypertensive heart diseases (HHD) in South Asia and its trends over time. We aimed to explore the burden of HHD, and how it changed over time from 1990 to 2019 in South Asia.

Methods:
We performed a systematic analysis of burden of hypertensive heart disease using the Global Burden of Disease (GBD) study data from South Asia, including Bangladesh, Bhutan, India, Pakistan, and Nepal. GBD data sources included surveillance and survey data, published, and unpublished research articles and reports, vital registration and hospital data. We assessed the prevalence, mortality, disability adjusted life years (DALY), years lived with disability (YLD) and years of life lost (YLL) attributable to HHD between 1990 and 2019 in South Asia. Data were presented as point estimates with their corresponding 95% uncertainty intervals (UI).

Results:
From 1990 to 2019 the age standardized prevalence for HHD in South Asia increased from 110.2 (95% UI, 77.4 - 156.8) to 111.8 (78.3 - 159.0) per 100,000 population, and from 8.7 (5.2 - 13.7) to 8.8 (5.2 - 13.9) for YLDs, in both genders, respectively. The prevalence increased with age and was higher among females. The age standardized rate decreased from 334.1 (206.3 - 452.4) to 229.2 (166.1 - 296.9) for DALYs, and from 19.0 (12.1 - 26.7) to 13.2 (9.3 - 17.4) for death, respectively. In 2019, HHD prevalence was highest in Pakistan (138.6, 95% UI, 96.2 to 196.9), and lowest in Nepal (69.9, 49.5 to 98.3). Countries with the biggest increase in YLDs were Bangladesh (8.3%, 95% UI, -3.9% to 22.8%), followed by India (5.0%, 2.4% to 7.7%), Bhutan (4.0%, -8.7% to 18.3%), Pakistan (3.4%, -3.5% to 10.8%), and Nepal (1.0%, -11.5% to 15.5%). The age standardized DALYs decreased from 334.1 (95% UI, 206.3 to 452.4) in 1990 to 229.2 (95% UI, 166.1 to 296.9) in 2019 with the highest significant percentage change in the India (-34.1%, 95% UI, -48.3% to -9.5%), followed by Bangladesh, Bhutan and Nepal. Deaths due to HHD significantly declined in all countries except Pakistan with a small increase (0.3%, -24.6% to 26.8%) and in Nepal with a decrease (-8.6, -38.8% to 36.8%), respectively.

Conclusion:
HHD remains a significant cause of disease burden in South Asian countries. The increased prevalence amongst older people and females warrants particular attention. Policies focusing on preventing modifiable risk factors and access to essential medicines is warranted.
PS-BPP05-2: TREATMENT STATUS OF HYPERTENSION DETECTED IN HEALTH CHECKUPS: AN OBSERVATIONAL STUDY OF JAPANESE EMPLOYEES
Authors: Shima Azusa , Tatsumi Yukako , Ohkubo Takayoshi , Arima Hisatomi , Miura Katsuyuki , Kiyohara Maiko , Kawatsu Yuichiro , Morino Ayumi , Godai Kayo , Miyamatsu Naomi 
Published: January 2023

Objective:
Despite the clear evidence for lowering blood pressure in hypertensive patients, control rates are insufficient, especially among younger adults. The first step in improving control rates is patient behavior to visit an outpatient when hypertension is detected at annual health checkups. The present study aims to explore the demographic and lifestyle characteristics related to the outpatient visits among employees who had untreated grade II or grade III hypertension.

Design and method:
An observational study was conducted using the data of annual health checkups and medical claims from 2012 to 2020 in an employee's health insurance society in Japan. We included participants if they were 20–69 years of age and had untreated grade II or grade III hypertension (blood pressure (BP)> = 160/100 mmHg and no use of BP-lowering medications) at the time of health checkups (first measurement) and had BP > = 140/90 mmHg in the previous years, to exclude transient hypertension. If more than one year of data met the criteria, the data from the first year was used to remove duplicates of individuals. Multilevel logistic regression with random effects of health checkup years was used to estimate odds ratios (ORs) with 95% confidence intervals (95%CIs) of demographics and lifestyle characteristics for newly outpatient visits (completing a clinic visit within 6 months).

Results:
The number of employees who had annual health checkups was approximately 10,000, and the number of applicable individuals for the present study was approximately 6% each year. In 2013–2020, after duplicate removal, 993 individuals (mean age 51.5 years, 63% women) had untreated grade II or grade III hypertension. Of these, 200 (20%) had an outpatient visit within 6 months. Among the independent variables, diabetes (ORs and 95% CI: 1.97, 1.19–3.26), body mass index (per 1-BMI increment: 1.04, 1.00–1.08), age (per 1-year increment: 1.03, 1.00–1.05), and systolic BP (per 1- mmHg increment: 1.04, 1.03–1.06) had significantly positive ORs for outpatient visits. The results of a similar analysis for antihypertensive medication after outpatient visits, no other factors besides systolic BP were associated with medication.

Conclusion:
Only 20% of individuals who detected grade II or grade III hypertension in annual health checkups visited outpatients within 6 months. The present findings suggested the necessity for more aggressive promotion of outpatient visits to younger adults without chronic illnesses or obesity.
PS-BPP05-6: THE ASSOCIATION BETWEEN SLEEP AND BLOOD PRESSURE CONTROL AMONG THE COMMUNITY DWELLING OLDER ADULTS TAKING ANTIHYPERTENSIVE DRUGS: THE SONIC STUDY
Authors: Mizuno Toshiki , Godai Kayo , Kabayama Mai , Akasaka Hiroshi , Isaka Masaaki , Yamamoto Koichi , Gondo Yasuyuki , Ogawa Madoka , Ikebe Kazunori , Masui Yukie , Arai Yasumichi , Ishizaki Tatsuro , Rakugi Hiromi , Kamide Kei 
Published: January 2023

Purpose:
Short sleep duration and poor sleep quality in middle age have been reported to affect blood pressure(BP) control. However, the association between sleep duration, sleep quality and BP control is controversial in older adults with hypertension taking antihypertensive drugs. The aim of this study was to investigate this association in 70–80-year-old participants in the Japanese study of Septuagenarians, Octogenarians and Nonagenarians Investigation with Centenarians (SONIC).

Method:
Of the participants in the SONIC study, we performed a cross-sectional analysis of participants with hypertension taking antihypertensive drugs aged 76 ± 1 (n = 242) and 86 ± 1 (n = 196) years who had cooperated in the sleep survey. Sleep duration and quality were evaluated by the Pittsburgh Sleep Quality Index(PSQI). The subjects were categorized as < 6(short) and > = 6 hours. A PSQI> = 6 defined poor sleepers and a PSQI< = 5 defined good sleepers. BP control was defined as average systolic BP < 140mmHg and diastolic BP < 90mmHg as controlled status. We performed the multivariable logistic regression to investigate the association between sleep duration, sleep quality and BP control adjusted for the following confounding factors: age, sex, body mass index, frail, smoking, alcohol consumption, medical history, depressive symptoms separately for each age group.

Results:
In the age 70 years, logistic regression analysis indicated that neither sleep duration nor sleep quality association BP control. On the other hand, in the age 80 years, sleep duration of < 6 hours was associated with poor BP control(OR = 4.87, 95% CI: 1.54–15.41,P = 0.007) when compared to sleep duration of > = 6 hours and sleep quality was not significantly associated with BP control.

Conclusion:
In the age 80 years, sleep duration of < 6 hour was associated with poor BP control. These results indicate that adequate sleep may be important for BP control in older adult, especially age around 80 years.
PS-BPR01-8: A CASE OF PHEOCHROMOCYTOMA WITH CONCOMITANT SPLENIC ARTERY ANEURYSM
Authors: Chonabayashi Minami , Tomino Yuki , Hayakawa Eri , Sugiyama Toru 
Published: January 2023

A 62-year-old man with a 30-year history of headaches and a 20-year history of treatment-resistant hypertension and diabetes mellitus was referred to our hospital for evaluation of his 5 cm retroperitoneal tumor found by abdominal ultrasound examination at a medical checkup. A simple CT and MRI scan showed a heterogeneous tumor (diameter, 5 cm) in the left adrenal gland and a splenic artery aneurysm (diameter, 2 cm). Endocrine examinations revealed increased levels of plasma-free normetanephrine (NMN) (853 pg/mL), urinary noradrenaline (NA) (670 μg/day), and urinary NMN (2.6 mg/day). 123I-MIBG scintigraphy showed high accumulation in the left adrenal region. He was diagnosed with NA-dominant left pheochromocytoma. His blood pressure was controlled at around 140/90 mmHg with 16 mg of doxazosin and 10 mg of amlodipine. His insulin-dependent diabetes was treated with multiple daily insulin injections (63 units/day), metformin, and miglitol. First, he underwent splenic artery aneurysm embolization under general anesthesia, which was completed without developing a hypertensive crisis. Two months later, he underwent laparoscopic left adrenalectomy, and the resected tumor was pathologically diagnosed as pheochromocytoma with a GAPP score of 1. He did not develop postoperative hypotension. His blood pressure was well controlled with only 10 mg of amlodipine, and his insulin requirement was reduced to 23 units/day after surgery.
Since few cases of pheochromocytoma with concomitant splenic artery aneurysm have been reported, we discussed the treatment plan with much consideration. Splenic artery aneurysms have a high risk of rupture due to intraoperative blood pressure elevation in pheochromocytoma, which could be fatal. Although the first choice of treatment for a splenic artery aneurysm is endovascular therapy, the use of contrast media is generally contraindicated in pheochromocytoma in Japan due to the risk of hypertensive crisis. In the present case, systemic management with a sufficiently high dose of alpha-blocker allowed the embolization to be preceded avoiding a crisis, and subsequent surgery for pheochromocytoma could be performed safely. A long history of hypertension and diabetes exacerbated by the pheochromocytoma may have contributed to the arteriosclerosis leading to the splenic artery aneurysm. Here we report a rare case of pheochromocytoma with concomitant splenic artery aneurysm and will discuss the pathogenesis and management of this case with a review of the literature.
PS-BPR02-1: A CASE OF ADVANCED ENDOMETRIAL CANCER AFTER NEPHRECTOMY FOR RENAL CELL CANCER WITH HYPERTENSION AND PROTEINURIA INDUCED BY LENVATINIB
Authors: Tajima Takaya , Itoh Hiroshi 
Published: January 2023

Background:
The combination of pembrolizumab plus lenvatinib is approved for advanced endometrial cancer that is not MSI-H or dMMR, is progressive on prior systemic therapy, and is not amenable to curative surgery or radiation. Lenvatinib is an oral, multi-targeted tyrosine kinase inhibitor (TKI) that exerts anti-malignant effects by inhibiting many tyrosine kinase receptors, such as VEGF receptors 1, 2, and 3, fibroblast growth factor receptors 1 through 4, platelet-derived growth factor receptor α, rearranged during transfection (RET), and stem cell factor receptor (KIT) signaling networks. Although lenvatinib's usefulness has been demonstrated, adverse effects such as hypertension and proteinuria often necessitate the discontinuation of administration. We encountered a patient with advanced endometrial cancer after nephrectomy for renal cell cancer who developed hypertension and proteinuria due to lenvatinib. We discussed TKI induced hypertension and proteinuria in patients on pre-existing eGFR decline.

Case presentation:
A 65-year-old Japanese female was diagnosed in 2011 with concurrent endometrial cancer and right renal cell cancer. She underwent total hysterectomy, bilateral salpingo oophorectomy, and right nephrectomy. She received 6 courses of CAP (cyclophosphamide, epirubicin and cisplatin) therapy as adjuvant chemotherapy for endometrial cancer. More than 7 years later, the patient presented with a vaginal cuff recurrence that was histologically confirmed and radiotherapy was indicated. In 2019, there was a recurrence in pelvic lymph nodes. Between 2019 and 2021, she underwent 9 cycles of chemotherapy with carboplatin plus paclitaxel, however the cancer progression was observed. In February 2021, the patient was started on pembrolizumab and Lenvatinib (20 mg/day) combination therapy. Her creatinine was 0.85 mg/dL, with an eGFR of 52 mL/min/1.73m2 before the administration of lenvatinib. The patient experienced continuous grade 3 hypertension (systolic blood pressure Hiragino Sans 160 mmHg or diastolic blood pressure ≧ 100 mmHg), and 2 antihypertensive agents(amlodipine and ormesartan) were required to control hypertension. Despite lenvatinib dose reduction and the aggressive use of antihypertensive agents, grade 3 hypertension had recurred several times, and then proteinuria gradually increased to 3.0 g/day. Lenvatinib was decreased to 10 mg/day (2 steps of dose reduction) within 2 months of treatment initiation, and finally, hypertention and proteinuria were ameliorated.

Conclusion:
A history of nephrectomy, pre-existing eGFR decline and hypertension are associated with developing TKI induced proteinuria. These patients should be monitored carefully, and appropriate measures for the early control of hypertension and proteinuria may result in higher-dose treatment with lenvatinib, thereby maximizing its therapeutic effect.
PS-BPR02-4: RENOVASCULAR HYPERTENSION FROM FIBROMUSCULAR DYSPLASIA WITHOUT ABNORMALITIES IN RENAL DOPPLER ULTRASOUND: A CASE REPORT.
Authors: Kato Kyosuke , Mizutani Yosuke , Nakamura Toshifumi , Kinouchi Kenichiro , Kobayashi Sakiko , Miyashita Kazutoshi , Itoh Hiroshi 
Published: January 2023

Background:
Renovascular hypertension (RVH) is one of the most common forms of secondary hypertension, and accounts for nearly 1% of all hypertension cases. It is characterized by compromised renal perfusion pressure, resultant renin secretion, and hypokalemia due to secondary hyperaldosteronism. Arteriosclerosis is a common underlying pathogenesis in middle-aged and older adults, whilst fibromuscular dysplasia is occasionally seen in younger patients with RVH. Since cardiovascular complications are of grave concern in RVH, early detection and appropriate therapeutic intervention are particularly important. Here, we report a case of renovascular hypertension from fibromuscular dysplasia which was incidentally unveiled during close examination of an adrenal tumor.

Case report:
A 55-year-old woman was being treated for hypertension by her primary care physician. She was referred to our hospital for a thorough examination of her right ureteral stone, which necessitated a CT scan incidentally revealing an left adrenal nodule measuring 8 mm in size. Primary aldosteronism was unlikely based on the lack of renin suppression (active renin concentration, 36.5 pg/mL; plasma aldosterone levels, 263 pg/mL and aldosterone-renin ratio < 40 under treatment with nifedipine 40 mg/day. Ultrasound of the kidney demonstrated a notable difference in size between the right and left kidneys of 87 mm and 106 mm, respectively, albeit Renal Artery Doppler failed to suggest the renal artery stenosis. CT scan with contrast material revealed the remarkable irregularity and “string on beads” sign on the distal main trunk of the right renal artery. Renovascular hypertension from fibromyalgia dysplasia was suspected, and percutaneous renal artery angioplasty was performed. After the pressure gradient across the stenotic lesion (105/99 mmHg on the distal side and 125/67 mmHg on the proximal side of the renal artery) was verified, balloon dilation was applied. The procedure was successful as the pressure gradient virtually resolved (105/95 mmHg on the distal side and 109/101 mmHg on the proximal side of the renal artery). Digital subtraction angiography indeed reaffirmed improvement in blood flow.

Conclusion:
Renovascular hypertension can go unnoticed solely based on renal Doppler Ultrasound. This was a case in which renovascular hypertension from fibromuscular dysplasia was incidentally identified in CT scan designated as a work-up for an adrenal tumor.
PS-BPR02-5: A CASE OF JUVENILE-ONSET HYPERTENSION WITH A GIANT LEFT ANTERIOR THORACIC ARTERIOVENOUS FISTULA
Authors: Nakatani Yoshihisa , Okada Nobutaka , Shimizu Kazuyuki , Miyake Sayoko , Kobayashi Norihiro , Nakano Yukihito , Arima Shuji 
Published: January 2023

(Case) 3X years old male:
(Current medical history) In school days he had been aware of a subcutaneous mass in the left anterior chest and from the same period he often had severe headache but left it unattended. He was diagnosed with hypertension at the age of 20 years old and with giant left anterior thoracic arteriovenous fistula. He was operated but could not completely remove it. Then he has performed vascular embolization at five times. He was hospitalized for the sixth embolization in 202x due to increased arteriovenous fistula. A high blood pressure (178/97 mmHg) was observed at admission and the sixth embolization of the left thoracic shoulder lateral thoracic and internal thoracic artery was performed the day after hospitalization. After embolization he was discharged one week later. However the high blood pressure continued even after discharge and the headache did not improve so he was referred to our department. His father and mother and grandparents and brothers had high blood pressure. It may be suggesting familial and juvenile hypertension. Blood pressure of upper limb left 171/108 mmHg / right 178/112 mmHg (not significantly difference) ABI left 1.13 / right 1.10 and PWV left 2069 / right 1804 cm/s and arteriosclerosis was remarkable. CT imaging showed no adrenal enlargement but multiple kidney stones. Serum Ca and Mg levels were in the normal range and no high ARR84 (renin/aldosterone ratio) was observed. Ask-Mark syndrome was negative. He started taking amlodipine 5 mg for hypertension and then increased the dose and exchanged NifedipineCR 40 mg. After that carvedilol 10 mg was added and the blood pressure decreased to 120–130 / 70–80 mmHg and the control became good. Blood pressure showed a tendency to increase in eight months after the sixth embolization again and at the same time CT showed a slight increase in arteriovenous fistula.

Conclusion:
We experienced a case of juvenile-onset hypertension in which blood pressure could be controlled using three antihypertensive drugs in addition to the treatment of giant thoracic arteriovenous fistula embolization. The cause of juvenile onset and increased blood pressure was thought to be related to the effects of congenital battlement and longitudinal arteriovenous fistula which do not exhibit pulmonary circulation or circulatory system. Conventionally congenital battlement / longitudinal arteriovenous fistula has a mild left ventricular load and almost no increase in blood pressure has been reported. However it may be possible the left ventricular load became larger and caused hypertension because of the huge thoracic arteriovenous fistula.
PS-BPR03-2: A RARE CASE OF TAKAYASU ARTERITIS INDUCED RENOVASCULAR HYPERTENSION IN A PATIENT WITH CROHN DISEASE
Authors: Nagayama Shohei , Suzuki Shota , Nakayama Izumi , Ozawa Moe , Kawano Rina , Kamiyama Akina , Oki Yuki , Fujiwara Akira , Saka Sanae , Iwamoto Tamio , Hirawa Nobuhito 
Published: January 2023

Takayasu arteritis (TA) is chronic inflammatory arteritis affecting large vessels, predominantly the aorta and its main branches. Vascular inflammation occurs wall thickening, fibrosis and stenosis. Arterial stenosis due to TA often causes secondary hypertension. Crohn disease (CD) is chronic granulomatous, inflammatory gastrointestinal disease, It can cause various extraintestinal complications. A few case reports and small case series reported complications of TA and CD. In recently, there are several reports that TA are revealed in patients treated with anti-tumor necrosis factor - alpha antibody for CD. We report a 18 years old male in whom TA was manifested mainly by severe hypertension and proteinuria after infliximab administration for CD.
He was diagnosed with CD at the age of 17. He had a great fever and high CRP levels (6.55 mg/dl), and endoscopic examination revealed multiple longitudinal ulcers in the large intestine and ileum. Although, he was treated with adalimumab and 5 -aminosalicylic acid, fever and CRP levels did not improve, Infliximab was administered. Following infliximab administration, his laboratory data revealed renal impairment (blood urea nitrogen level: 13 mg/dl, creatinine level: 1.28 mg/dl), proteinuria (10.0 g/gCr) and he had severe hypertension (about 190/100 mmHg). Both, his plasma aldosterone concentration (PAC) (RIA) and plasma renin activity (PRA) were significantly high (PAC: 798 pg/ml. PRA: 66.2 ng/ml/hr). In addition, magnetic resonance angiography and radioisotope renogram findings revealed stenoses of the right renal artery. Although, a simple CT scan performed 5 months earlier showed no abnormalities in both kidney, contrast-enhanced CT revealed stenoses of the right renal artery, superior mesenteric artery, right renal atrophy, and left renal enlargement. The 99mTc-DTPA Renography reveled severe right renal dysfunction (GFR 14.67/61.21 ml/min). Based on these findings, patient was diagnosed with TA induced renovascular hypertension complicated with CD, and oral administration of prednisolone from 1 mg/kg/day and antihypertensive drugs (amlodipine, doxazosin, and spironolactone) was started. After 14 days treatment, his blood pressure was about 170/90 mmHg. Finally, losartan was administered, his blood pressure was reduced to 120∼150/70∼90 mmHg, and no changes in his serum creatinine levels was observed. We report with a review of the literature.