bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS-P03-6: SOCIODEMOGRAPHIC AS ATTRIBUTABLE RISK FACTORS OF PREHYPERTENSION: A POPULATION STUDY FROM URBAN AND RURAL
Authors: Susetyowati Susetyowati , Faza Farah , Budiatmaja Yusuf Ahmad 
Published: January 2023

Background:
Prehypertension is undetected and considered a precursor of hypertension and cardiovascular diseases. Prehypertension can be attributed not only to diet patterns and lifestyle but also to the basic cause such as sociodemographic factors. Understanding the sociodemographic factor and its relationship with prehypertension can adjust the best prevention action to control the rise of prehypertension. We aim to investigate the association between sociodemographic factors with prehypertension among healthy adults.

Method:
Cross-sectional study was conducted from 2016 to 2018 and involved 653 healthy adults 19 to 64 years of age in urban and rural areas in a province in Indonesia. The urban represented the most populated urban area and the rural represented lowland, mountainous, and coastal areas. The pregnant or breastfed woman was excluded. Data collection included sociodemographic, namely gender, age, educational degree, occupation, family history of diseases, smoking history, and dwelling area. A blood pressure of 120 to 139 mmHg (systolic) or 80 to 89 mmHg (diastolic) was classified as prehypertension. Logistic regression was run to determine the factors that influenced prehypertension.

Result:
Subjects were dominated by females (62.2%) and the prevalence of prehypertension was 66.5%. Gender, age, occupation, smoking history, and dwelling area were associated with prehypertension. Being female increased the risk 3.1 times higher of prehypertension than male (p < 0.001, 95% CI 2.1–4.5). The middle adult had a 2.9 times higher risk of prehypertension than early adults (p < 0.001, 95% CI 1.8–4.7), while no significant risk for the elderly compared to early adults. Civil servants or private officers had a 1.9 times higher risk of prehypertension than unemployed/housewives/students (p < 0.001, 95% CI 1.3–2.7). Smokers increased a 1.6 times higher risk of prehypertension than non-smokers (p = 0.018, 95% CI 1.1–2.3). Adults who were living in urban had a 1.5 times higher risk of prehypertension than adults in rural (p = 0.026, 95% CI 1.1–2.0).

Conclusion:
Being female, middle adult, working as civil servants or private officers, being active smokers, and living in urban were significant risk factors for prehypertension. The importance of designing different interventions which were suitable for the different sociodemographic backgrounds is important to control blood pressure.

Keywords:
sociodemographic, prehypertension, adults, urban, rural
PS-P03-8: INFLUENCE OF AVERAGE AIR TEMPERATURE, PRESSURE AND AIR RELATIVE HUMIDITY ON BLOOD PRESSURE
Authors: Chen Xin , Hu Zhe , Wang Jiguang 
Published: January 2023

Objective:
To investigate the influence of average air temperature, pressure and air relative humidity on blood pressure (BP) and blood pressure variability in population.

Methods:
A total of 97,784 participants were included from the May Month Measurement 2020 in China. BP was measured three times consecutively in the sitting position with a 1-minute interval, using a validated electronic BP monitor. Trained volunteer investigators administered a questionnaire to collect information on medical history, lifestyle, and use of medications. Average air temperature, pressure, and air relative humidity of the day were recorded. The mean BP was taken as the mean of the second and third BP, and the systolic blood pressure variability (SBPV) was the standard deviation/mean of three systolic blood pressures (SBP). Statistical analysis was performed using SAS 9.4.

Results:
Linear regression analysis found that the average air temperature was negatively correlated with the mean SBP and SBPV in all participants and hypertensive subjects (P < 0.0001, P = 0.01). The average pressure was positively correlated with the mean SBP and SBPV in all participants and hypertensive subjects (P < 0.0001, P < 0.0001). The average air relative humidity was negatively correlated with SBPV in hypertensive subjects (P = 0.03). The relationship between average air relative humidity and SBP in all participants and hypertensive subjects, between average air relative humidity and SBPV in all participants was not found. After adjustment for age, sex, body mass index, taking antihypertensive medicine, smoking, alcohol consumption, diabetes, history of heart disease and previous stroke, the average air temperature and pressure remained associated with mean SBP in all participants and in hypertensive subjects.
Logistic regression analysis showed that for every 1°C increase in air temperature, the risk of hypertension decreased by 1.8%, and for every 10hpa increase in pressure and 1% increase in air relative humidity, the risk of hypertension increased by 0.3% and 0.4%, respectively. When air temperature increased 1°C, the happen of hypertension control increased by 2.3%, and decreased by 0.2% for every 1% increase in air relative humidity. The relationship was not found between mean pressure and control of hypertension.

Conclusion:
The lower average air temperature and higher average pressure are possibly related with higher SBP, more likely to suffer hypertension, while the lower average air temperature and the higher average air relative humidity may resulted in more difficult hypertensive control.
PS-P04-7: ALERTING REACTION OF BLOOD PRESSURE AND AGE: MAY MEASUREMENT MONTH 2019
Authors: Kerr Gabriele Keziah , Schlaich Markus , Schutte Aletta E , Stergiou George , Poulter Neil , Beaney Thomas 
Published: January 2023

Objective:
The extent of the alerting reaction on systolic blood pressure (BP) measurements has been shown to be related to age and the magnitude of the first reading, with implications for the monitoring and diagnosis of hypertension. We investigated the effects of age on the direction and magnitude of change in both systolic and diastolic BP from the first to subsequent readings, using data from the May Measurement Month (MMM) global BP screening campaign in 2019.

Design and method:
We examined the relationship between the value of the first reading (BP1) and the change in BP from BP1 to the average (BPA) of the second (BP2) and third readings (BP3) taken at 1 minute intervals in participants with three BP readings. Mixed effects regression models were fit, stratified by age, and using random intercept for country of screening site to account for clustering. This approach was repeated for diastolic and systolic BP.

Results:
Of the 1,133,008 participants with three BP readings, 58.7% had a decrease in systolic and 54.2% a decrease in diastolic BP from BP1 to BPA. Above an age dependent threshold value in BP1, a higher BP1 was associated with a greater decrease from BP1 to BPA. Older participants on average exhibited relatively smaller changes in systolic BP from systolic BP1 to systolic BP2 for equivalent values of systolic BP1 than younger age groups (Fig.1A). The average difference between diastolic BP1 and diastolic BPA showed a “U shaped” interaction with age such that the largest difference was observed in the youngest and oldest age groups and the smallest difference in those aged 40 to 49 and 50 to 59 years (Fig.1B). These patterns of BPV across values of BP1 and age persisted when the models were adjusted for antihypertensive medication or sex, or if the difference in BP from BP1 to BP2 or BP3 were used as the outcome.

Conclusions:
Age had a significant and differential modifying effect on the fall in systolic and diastolic BP from first to subsequent readings taken on a single occasion. These results could reflect age related variation in homeostatic capabilities to regulate BP following an initial stress response or differential sizes of alerting response by age. This highlights the importance of taking multiple BP readings when assessing BP, particularly in younger individuals, to avoid overestimation and overdiagnosis.
PS-P06-2: HEALTHCARE EXPENDITURE AND CARE SEEKING PATTERNS AMONG PEOPLE WITH CHRONIC CONDITIONS DURING THE PANDEMIC
Authors: Gamage Anuji Upekshika , Gunasekera Therani , de Silva Amala 
Published: January 2023

Objective:
Public health strategies resorted to world-wide, to reduce the transmission of COVID-19 had economic impacts which led to care seeking changes among people with pre-existing chronic diseases. We aimed to assess the household expenditure and, care seeking among people with chronic diseases due to COVID-19 pandemic in Sri Lanka.

Design and Methods:
An online survey was conducted in 2021 involving 449 adults living in the Western-Province of Sri Lanka. Data on participants socio-demographic and economic status, co-morbidities, healthcare utilization, and healthcare-seeking behaviours were collected using a pre-tested questionnaire. The questionnaire link was distributed through social media and by emails. Categorical data were expressed as proportions/percentages with 95% confidence intervals where relevant. Quantitative data, normally distributed, were summarized in terms of mean and standard deviation (SD) and non-normally distributed as the median and interquartile-range (IQR).

Results:
449 respondents completed the survey. Majority (55%; n = 173) responded that they experienced a negative impact on their main income. Nearly 30%(n = 130) of the participants had an additional source of income before the pandemic; and of them majority (74%; n = 97) reported a negative impact on the income. Twenty six percent (n = 115) mentioned that they had a doctor-diagnosed chronic disease or a disability and of them 72% (n = 83) were on regular medication. Nearly half (n = 55;48%) mentioned that there was a delay in seeking healthcare during the pandemic and 27% (n = 30)reported not having sought treatment during the lockdown period. Of the people with delayed healthcare seeking 25% had hypertension, 16% diabetes, and 12.2% asthma. The pandemic led to changes in healthcare utilization patterns among patients. Majority had to obtain the drugs from the pharmacy 65% (n = 70) and the laboratory tests from private labs 58% (n = 62). Forty-eight percent agreed that the pandemic led to delays in healthcare seeking, mostly because they were unaware of the services rendered. The incurred high OOPE during the pandemic. Of the participants, 9% (n = 39) and 3.2% (n = 14) had incurred catastrophic healthcare expenses at 10% and 25% of their total income.

Conclusions:
Residents of the Western-province were severely economically affected by the COVID-19 pandemic. Participants had incurred high out-of-pocket expenditures which led to changes in care seeking patterns among people chronic conditions. Strategies to ensure continuity of care especially for chronic conditions while protecting people from financial hardships is necessary to move towards Universal Health Coverage.
PS-P06-8: TEXT MESSAGING AND HOME BLOOD PRESSURE MONITORING FOR PATIENTS WITH UNCONTROLLED HYPERTENSION: A PILOT RANDOMIZED CONTROLLED TRIAL
Authors: Campos Claudia L , Jones Deanna N , Rocco Michael V , Justin Moore B , Carolyn Pedley f , Beverly Snively M 
Published: January 2023

Objective:
Improving adherence to antihypertensive medications is the most significant modifiable patient related factor to achieving blood pressure (BP) control. Elevated BP remains the leading cause of death globally. BP trends show disparities in the burden of hypertension in black and low socioeconomic status (LSES) populations, accompanied by low levels of awareness, treatment and control rates. Telehealth systems using text messaging (SMS) and home blood pressure monitors (HBPM) represent attractive scalable tools to reduce BP in those with health disparities.

Design and methods:
In three ambulatory clinics that serve a large number of those with LSES affiliated with an academic institution, we conducted a randomized controlled pilot study for low medication adherent patients with poorly controlled hypertension (BP > 130/80). The pilot aimed to (1) evaluate the feasibility of recruiting LSES participants to an effectiveness trial of SMS plus HBPM vs HBPM only; (2) measure the acceptability of the SMS system and (3) estimate the effects of the SMS approach on lowering BP. Satisfaction was measured using the validated systems usability survey (SUS). The SMS system was designed with the input of LSES focus groups and used Twilio® as its bidirectional platform. From February 2021 to October 2021, 24 participants were randomized (1:1) to either SMS intervention plus HBPM with an Omron BP cuff or HBPM alone for 12 weeks.

Results:
During the study period, the study coordinator enrolled 24 participants, averaging 3 per month. Demographics: participants were male (N = 14/24), predominantly African American (AA); (n = 19/24); 13/24 had high school education or less; mean age 55.7 (SD 12); weight 97.4 kg (SD 14); Mean initial SBP 156 mmHg (SD 20), DPB 100 mmHg (SD 11). Acceptability: 8/12 participants responded via SMS with at least one BP measurement in the SMS arm. Two participants were lost to follow up in each arm. Mean SUS was 81.6 (scale of 0 to 100, > 68 is considered above average). Reduction in SBP at 12 weeks in the SMS group and control group was 15 mmHg and 13 mmHg respectively (p = 0.58).

Conclusion:
Recruiting and retaining LSES participants with uncontrolled HTN for a larger trial of telehealth with SMS and HBPM is feasible and well accepted. Similar BP reductions were achieved in both arms. Utilizing the SMS and HBPM shows promise in reducing BP in the LSES population. A larger efficacy trial is needed to determine best practice and reduce cardiovascular health disparities.
PS-P06-10: ASSOCIATIONS OF TONGUE CLEANING AND MORNING TOOTH BRUSHING HABITS WITH BLOOD PRESSURE AND DIABETES AMONG JAPANESE MEN AND WOMEN
Authors: Fujimori Yuki , Funakubo Narumi , Eguchi Eri , Nagao Masanori , Takada Midori , Shimizu Yuji , Okada Takeo , Kiyama Masahiko , Yamagishi Kazumasa , Imano Hironori , Muraki Isao , Iso Hiroyasu , Ohira Tetsuya 
Published: January 2023

Objective:
Recently, a bidirectional relationship between periodontal and systematic diseases has been reported. Because periodontal disease is caused by periodontopathogenic bacteria found in dental plaque and bacteria increase during sleep, it is important to clean the mouth, especially in the morning. Although the importance of tooth brushing has been reported in many studies,none has investigated both tongue cleaning habit and timing of tooth brushing. Therefore, the purpose of this study was to identify the association of tongue cleaning and morning tooth brushing habits with blood pressure (BP) and diabetes in a cross-sectional study.

Design and method:
1005 residents (656 in 2020, 349 in 2021, 430 men and 575 women) in Ikawa-machi, Akita Prefecture, aged 40–91 years (mean 65.3) who underwent health-checkup in 2020–2021 and answered both whether they had a tongue cleaning habit and their timing of tooth brushing, were surveyed. If participants answered in both years, the 2020 data was used. Participants who answered brushing their teeth at least once after waking up or after breakfast were defined as having a morning tooth brushing habit. Participants who answered “under treatment’’ or had an HbA1c of ≧ 6.0% in the health-checkup were defined as having diabetes, and those who had a systolic BP of ≧ 140 mmHg or a diastolic BP of ≧ 90 mmHg were defined as having poor BP control. Logistic regression analysis was used to calculate odds ratios (95% confidence interval (CI)) for the prevalence of poor BP control or diabetes in those who did not, based on those who had both tongue cleaning and morning tooth brushing habits. Covariates were sex, age, lifestyle habits (drinking, smoking, exercise), and taking antihypertensive medication.

Results:
The proportion of participants with both tongue cleaning and morning tooth brushing, with tongue cleaning, or with morning tooth brushing were 37.0%, 39.0%, and 92.2%, respectively. Those who did not have both tongue cleaning and morning tooth brushing were more likely to have poor BP control and diabetes than those who did, with odds ratios (95% CI) of 1.76 (1.14–2.72) and 1.33 (1.00–1.77), respectively. The association with poor BP control was particularly pronounced among those aged ≧ 65 years, with an odds ratio (95% CI) of 1.77 (1.04–3.03).

Conclusions:
Unable to have both tongue cleaning and morning tooth brushing habits may be associated with prevalent risk of hypertension and diabetes. Future longitudinal studies will be conducted to demonstrate a causal relationship.
PS-P06-11: LATE-ONSET HYPERTENSION AS A CONTRIBUTING FACTOR TO THE CHANGES IN THE CHA2DS2-VASC SCORE AND INCIDENT ATRIAL FIBRILLATION IN THE ELDERLY
Authors: Zhang Wei , Chen Yi , Hu Leixiao , Xia Jiahui , Ye Xiaofei , Cheng Yibang , Wang Ying , Guo Qianhui , Li Yan , Lowres Nicole , Freedman Ben , Wang Jiguang 
Published: January 2023

Background:
Hypertension is closely associated with the risk of atrial fibrillation. However, hypertension is already prevalent in young adults, but atrial fibrillation usually only occurs in the elderly. In the present study, we investigated incident atrial fibrillation in relation to early- and late-onset hypertension in an elderly Chinese population.

Methods:
Our study participants were elderly (≧ 65 years) hypertensive residents, recruited from five community health centers in the urban area of Shanghai (n = 4161). Early- and late-onset hypertension were defined as the use of antihypertensive medication or elevated blood pressure (systolic/diastolic blood pressure ≧ 140/90 mmHg), respectively, at entry and during follow on at least 2 consecutive clinic visits. Atrial fibrillation was detected by a 30-second single-lead electrocardiography (ECG, AliveCor® Heart Monitor) and further evaluated with a regular 12-lead ECG.

Results:
During a median of 2.1 years follow-up, the incidence rate of atrial fibrillation was 7.60 per 1000 person-years in all study participants; it was significantly higher in patients with late-onset hypertension (n = 368) than those with early-onset hypertension (n = 3793, 15.76 per 1000 person-years vs. 6.77 per 1000 person-years, P = 0.007). After adjustment for confounding factors, the hazard ratio (HR) for the incidence of atrial fibrillation was 2.67 (95% confidence interval [CI] 1.04–6.87, P = 0.04) in patients with late-onset hypertension versus those with early-onset hypertension. The association was even stronger in those aged 75 years and over (HR 5.93, 95% CI 1.59–22.05, P = 0.008) and when patients with a duration of hypertension ≧ 5 years were considered as reference (HR 2.48, 95% CI 1.30–4.76, P = 0.006).

Conclusions:
Our study showed a significant association between late-onset hypertension and the incidence of atrial fibrillation in elderly Chinese.
PS-P06-12: COGNITIVE CAPACITY AS THE BRIDGE FOR HYPERTENSIVE PEOPLE TO EXPERIENCE MEMORY DECLINE
Authors: Astuti Riska Dwi 
Published: January 2023

Objective:
Previous clinical studies have uncovered how hypertension affects patient brain performance that in turn generate its cognitive consequences. This study aims to analyze the long-term impact of hypertension on cognitive capacity that eventually affecting memory decline.

Design:
Socioeconomic and health information of 16,047 respondents were obtained from the Indonesian Family Life Survey. Ten percent of sample were people with hypertension. This longitudinal data allows author to access information about respondent condition across times with delta among waves is seven years. Respondents were considered to have hypertension if they reported that they were ever diagnosed as hypertensive patient by medical workers. Cognitive capacity is measured using respondent ability to solve figural task and arrange a sequence. In addition, respondents were considered experiencing memory decline by calculating if there was any reduction in the score of memorizing task.

Method:
Econometric analyses were conducted using ordinary least square (OLS) regression and logistic regression. In order to reduce to potential endogeneity, covariates were involved including respondents nutritional status based on BMI measurement, years of schooling, gender, and characteristic of living location. First analysis was conducted to investigate the influence of hypertension in the basis year to present cognitive capacity using OLS regression. Cognitive capacity in figural measurement and sequence were examined consecutively. Later analysis was conducted by employing logistic regression to find out the effect of current cognitive capacity to memory decline.

Conclusions:
Results show that hypertension has long-term impact on patient cognitive capacity, and eventually generate higher potency to experience memory decline. These results are robust when the measures of cognitive capacity were changed from figural task to questions about sequence. Former analyses show that hypertension influences future cognitive capacity. Hypertensive respondents statistically have lower cognitive capacity compared with respondents without hypertension. Next analyses found that current cognitive capacity significantly affects memory decline in negative direction. It implies that lower cognitive capacity is strongly related with memory decline. Following analysis shows that hypertensive respondent cognitive aspect has bigger impact to memorizing ability compared with non-hypertensive respondents.