bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS-P07-8: TREATMENT STRATEGIES AND ADHERENCE TO THE TRIPLE COMBINATION OF AN ANGIOTENSIN-CONVERTING ENZYME INHIBITOR, A CALCIUM-CHANNEL BLOCKER, AND A DIURETIC
Authors: Rea Federico , Morabito Gabriella , Savare Laura , Corrao Giovanni , Mancia Giuseppe 
Published: January 2023

Objective:
To compare adherence to antihypertensive treatment between patients prescribed the perindopril/amlodipine/indapamide single pill combination (SPC) vs the two pill combination of an angiotensin converting enzyme inhibitor (ACEI), a calcium channel blocker (CCB), and a diuretic (D).

Design and method:
Using the healthcare utilization database of the Lombardy Region (Italy), patients, aged 40 years or older, who received a prescription of perindopril/amlodipine/indapamide SPC during 2015 2018 were identified and the date of the first prescription was defined as the index date. For each patient prescribed the SPC, a subject who started ACEI/CCB/D treatment as a two drug SPC plus a third drug separately (i.e. 2 pills) at the index date was identified. Adherence to the triple combination was assessed over the year after the index date as the proportion of this year period in which prescription made the triple combination available, i.e. by the proportion of the follow up days covered (PDC) by prescription. The primary aim was to compare the odds of being highly adherent to the drug therapy (PDC> 75%) between groups. A secondary aim was to compare the odds of being poorly adherent (PDC < 25%).
Log binomial regression models were fitted to estimate the risk ratio, and its 95% confidence interval, of treatment adherence in relation to the drug treatment strategy, using the two pill combination as reference. Adjustments were made for several demographic and clinical covariates.

Results:
28,210 patients prescribed the perindopril/amlodipine/indapamide SPC were identified and matched to 28,210 patients prescribed ACEI/CCB/D in two pills. Compared with patients on the two pill combination, those treated with a SPC were slightly younger (68 vs 71 years) and more frequently men (54% vs 48%) with no between group difference in the clinical profile.
About 59% and 25% of patients prescribed the three drug treatment as SPC and two pill combination showed high adherence, respectively. Compared with patients under two pill combination, those who were treated with the SPC had a higher propensity to be highly adherent to the triple combination (risk ratio: 2.38, 95% confidence interval 2.32 2.44). This was the case regardless of the sex, age, patient clinical status, and number of co treatments. The odds of being poorly adherent to treatment was much lower in the SPC than in the two pill combination group (risk ratio: 0.33, 0.31 0.34).

Conclusions:
In a real life setting, patients who were prescribed the perindopril/amlodipine/indapamide SPC exhibited more frequently a good adherence to antihypertensive treatment than those prescribed a two pill combination of ACEI/CCB/D.
PS-P07-11: TRENDS OF ANTIHYPERTENSIVE DRUG PRESCRIPTION AND BLOOD PRESSURE CHANGES BY PREFECTURE USING NATIONAL DATABASE OF HEALTH INSURANCE CLAIMS OF JAPAN
Authors: Kuroda Shinnosuke , Sakuma Hirofumi , Matsuki Motoki , Hasebe Naoyuki , Nakagawa Naoki 
Published: January 2023

Background:
Blood pressure control is an important issue in extending the healthy life expectancy of the population. The Ministry of Health, Labour and Welfare's “Reference Data on the Promotion of Healthy Japan 21 (Second Phase)” set a target of a mean reduction of 4.2 mmHg in systolic blood pressure, but this target was not achieved from 1998 to 2009.

Objective:
The purpose of this study was to detect prefectures that have effectively lowered systolic blood pressure, and to discuss and examine effective countermeasures for hypertension.

Methods:
We analyzed prescription trends of antihypertensive drugs and changes in systolic blood pressure from the 1st to 6th national database of health insurance claims and specific health checkups of Japan (NDB) open data (specified health examinations from 2013 to 2018 and drug receipts from 2014 to 2019).

Results:
The average change in systolic blood pressure was calculated for each prefecture, and the prefecture with the greatest decrease in systolic blood pressure was Kagoshima Prefecture. Conversely, Yamanashi Prefecture showed the highest increase in systolic blood pressure. Further analysis of antihypertensive drug use revealed that the use of antihypertensive drugs in Kagoshima prefecture was 30.4% for men and 23.9% for women, which was higher than the national average (23.5% for men and 17.3% for women). Furthermore, the prescription rate of Angiotensin receptor blocker/calcium channel blocker (ARB/CCB) combination drugs in Kagoshima prefecture was found to be the highest in Japan at 27.3% (national average: 20.9%). Therefore, we examined the correlation between the prescription ratio of various antihypertensive drugs and mean change in systolic blood pressure, and found a significant negative correlation (r = -0.37 for males, p < 0.01; r = -0.29 for females, p < 0.05) between the prescription ratio of and mean change in systolic blood pressure in 2019. p < 0.05) was observed. On the other hand, th ARB/CCB combos ere was no clear correlation between ARB or Ca antagonist alone and mean change in systolic blood pressure. Based on these results, the increase in the prescription rate of ARB/CCB combos may have improved adherence to medication and blood pressure control.

Conclusion:
In addition to lifestyle modification, prescribing combination drugs may improve adherence to medication and be effective in combating hypertension.
PS-P08-1: RELATIONSHIP BETWEEN EDUCATION LEVEL AND OBESITY AMONG HEALTHY JAPANESE PEOPLE
Authors: Furuki Hideaki , Sonoda Nao , Morimoto Akiko 
Published: January 2023

Objective:
Obesity has been considered as one of the major causes of the onset of chronic diseases such as hypertension, diabetes, and dyslipidemia. Regarding the factors associated with obesity, many studies have focused on education level and investigated this relationship because of the possibility that a level of formal education being established at early adulthood influences their health throughout life. Previous studies conducted in the United States and European countries reported that low education level was associated with obesity risk. However, few studies have examined this relationship in Japan. Therefore, this study clarified the relationship between education level and obesity among healthy Japanese people.

Design and Method:
This cross-sectional mail survey was conducted in 2020 that involved all community residents with municipal National Health Insurance aged 40–64 years in five cities in three areas of A Prefecture, Japan. This survey included 33,902 community residents, and 12,446 (36.7%) agreed to participate in the survey. After exclusion of those with regular visits to medical institutions (n = 8,174) and those with missing data (n = 714), the analysis included 3,558 participants. Information on education level and obesity was obtained using a self-administered questionnaire. Body mass index (BMI) was calculated as self-reported weight (kg) divided by self-reported height squared (m2). According to the recommendation on Asia-Pacific criteria of obesity status given by the World Health Organization of the Western Pacific Region, we defined obesity as when an individual has a BMI of at least 25 kg/m2. The study protocol was approved by the Institutional Review Boards.

Results:
In this study, 23.6% were categorized as obesity. Additionally, 9.7% were categorized as low education level (< = 9 years of education), 43.2% as medium education level (> 9 years, <  = 12 years), and 47.1% as high education level (> 12 years). The proportions of those with obesity were 20.5% in those with high education level, 25.3% in those with medium education level, and 31.0% in those with low education level (p < 0.001). After adjusting for confounding factors, the multivariable-adjusted odds ratios and 95% confidence intervals for obesity were 1.33 (1.12–1.58) in those with medium education level and 1.61 (1.22–2.12) in those with low education level (p for trend < 0.001), compared with those with high education level.

Conclusions:
Education level was associated with being obesity among healthy Japanese people.
PS-P09-2: ASSESSMENT OF KNOWLEDGE, AWARENESS AND PRACTICES OF SALT INTAKE AMONG URBAN POPULATION
Authors: Patil Mansi , Patil Vishal 
Published: January 2023

Objective:
The prevalence of hypertension has been rising drastically in all populations. The dietary habits which have become unhealthy in past few decades contribute to this global health threat. The rise in salt intake has been seen consistently in many populations, especially from hidden sources. The goal of this study was to investigate the knowledge, attitude, and practice of urban populations, regarding dietary salt intake.

Designs and Methods:
A standardised questionnaire was used to perform a cross sectional survey among a representative sample of 500 persons aged 18 to 69 years in 2021. The questionnaire used for assessing the salt intake is a closed questionnaire and has been previously used in a similar setting and has been validated. It is a likert scale questionnaire with maximum 48 points possible.

Results:
The majority of them ate processed foods, and only a few read food labels before buying groceries. Most participants (64%) despite consuming processed foods, felt that they consumed the right amount of salt. Most participants were not aware of all foods which are categorized as processed foods. Only 26% of participants felt that excess salt intake could result in deleterious effects on health. The majority of participants (60%) believe that reducing salt in the diet is unimportant. Most participants added salt (98.8%) while cooking meals.
Most participants (76%) ranked poorly on the salt intake scale and only 13% ranked well on it. The practices of salt intake showed the worst scores among awareness and attitudes.

Conclusion:
Overall awareness of dietary salt intake in their diet was quite low among urban residents. The practices of the participants reflected high salt intake with poor attitudes. There is a need for introducing awareness campaigns to sensitize people towards sources of sodium, calculating salt intake and recommended allowances for salt intake.
PS-P09-5: DIET QUALITY PARTIALLY MEDIATES THE ASSOCIATION BETWEEN ULTRA-PROCESSED FOOD CONSUMPTION AND OBESITY
Authors: Shim Jee Seon , Ha Kyung Hwa , Kim Dae Jung , Kim Hyeon Chang 
Published: January 2023

Objective:
High consumption of ultra-processed food (UPF) is associated with an increased risk of obesity, which at least partly due to the poor nutritional profile of these foods. However, little is known about the magnitude of the direct and indirect effects of UPF consumption on obesity. Thus we evaluated whether the association between UPF consumption and obesity is mediated by overall diet quality.

Design and method:
This study is a cross-sectional analysis of the baseline data of adults aged 30–64 years (n = 6,894) which participated in the Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) cohort study. Dietary intake was assessed by a validated 112-items food frequency questionnaire. Using the NOVA food classification, 23 FFQ items were classified as UPF. Diet quality was assessed using the Korean Healthy Eating Index (KHEI) based on the 2015 Dietary Reference Intake for Koreans. Height, weight, and waist circumference (WC) were measured and body mass index (BMI, kg/m2) was calculated. Obesity was defined as ≧ 25.0 kg/m2. Abdominal obesity was defined as ≧ 90 cm for male and ≧ 85 cm for female. Single mediation models were used to estimate the mediating effect of UPF consumption (% kcal) on obesity, after adjusting for sex, age, research center, income, education, marital status, smoking, drinking, and sitting time. All analyses were performed using SAS version 9.4.

Results:
UPF accounted for 17.9% of total energy intake and the mean BMI and WC was 24.1 kg/m2 and 82.3 cm. The prevalence of obesity and abdominal obesity was 35.4% and 30.2%, respectively. UPF consumption (per 10% kcal increase) was associated with higher levels of BMI (0.13 kg/m2, P < 0.001) and WC (0.39 cm, P < 0.001), and also with higher odds of obesity (OR = 1.07, 10.1–1.13) and abdominal obesity (OR = 1.10, 1.04–1.17), after adjustment for confounders. The association of UPF consumption with BMI (14.3%, 95% CI: 1.9–26.8), WC (18.1%, 95% CI: 5.3–30.8), and abdominal obesity (20.9%, 95% CI: 6.0–35.8) were partially mediated by KHEI, but the association between UPF and overall obesity was not mediated by KHEI (17.2%, 95% CI: -1.1–35.4).

Conclusions:
Our findings suggest that the association between UPF consumption and obesity is partially, but not all, mediated by diet quality. Although our findings have a limitation on causal inference between UPF consumption and obesity, it may help understand the mediational structure between them and seek strategies for prevention of obesity.
PS-P09-8: ADHERENCE TO NON-PHARMACOLOGICAL MANAGEMENT AMONG HYPERTENSIVE PATIENTS
Authors: Karamulla Abbas Mohamed Ahmed , Abdelrahman Lina Saadeldin , Alnour Tanweer Elmahi , Mukhtar Shimaa Abdalla , Elhussein Shahd Salah , Elbashir Aamer Lotfi , Karamulla Jamaluddin Mohamed Ahmed 
Published: January 2023

Objective:
Hypertension is a leading cause of death and disability globally, along with increasing comorbidity. It is a major public health challenge in both developing and developed countries. The non-pharmacological management is one of the most effective measures to prevent and control the hypertension, while the non-pharmacological management of hypertension includes adoption of Dietary Approach to Stop Hypertension plans (DASH), exercise, moderate alcohol consumption and smoking cessation. Nonetheless, less emphasis has been placed on the non-pharmacological management compared with treating hypertension with medication. Therefore, this study was carried out to assess the adherence to non-pharmacological management among hypertensive patients.

Design and method:
A community based cross-sectional study was conducted among 250 hypertensive patients from March to May, 2022. All adult patients (> 18 years) diagnosed with essential hypertension and met inclusion criteria were recruited. The study participants were selected using a convenient sampling technique. The data were collected by an interviewer administered standard structured questionnaire which was adopted from published literature, data were processed using the software Statistical Package for Social Science (SPSS). Binary logistic regression model (AOR, 95% CI and P- value < 0.05) was also used to determine the significant associations between dependent variables and independent variables.

Result:
A total of 250 participants, 129 (51.6%) were females, 121 (48.4%) were males, 118 (47.2%) were > 55 years old, 140 (56.0%) graduated from university and 200 (80.0%) were married. The adherence to non-pharmacological management (diet, exercise, smoking cessation and being non-alcohol consumer) percentage was 25.2%. Out of all participants; 47.6% were adherent to the diet, 46.4% were adherent to exercise, 76.4% were adherent to smoking cessation and 96.4% were non-alcohol consumers. The variables associated with adherence to diet were university education and marriage (AOR 0.30; 95% CI: 0.09- 0.92), (AOR 0.23; 95% CI: 0.06- 0.81) respectively. The variables associated with adherence to exercise were being male and no comorbidities (AOR 0.34; 95% CI: 0.18- 0.64), (AOR 1.10; 95% CI: 0.37- 3.23) respectively. The variables associated with adherence to non-pharmacological management were duration of hypertension > 20 years (AOR 3.50; 95% CI: 1.01- 12.19) and good knowledge about hypertension (AOR 0.03; 95% CI: 0.11- 0.45).

Conclusion:
The study revealed that the majority of hypertensive patients are not adherent to non-pharmacological management. Therefore, more effort should be directed to increase knowledge about non-pharmacological management and draw attention to its importance.
PS-P10-1: ARTERIAL HYPERTENSION AS A COMMON DISEASE IN ACUTE KIDNEY INJURY AND ITS SIGNIFICANT DEPENDENCE ON THE DAMAGE MECHANISM
Authors: Kwiatkowska Marlena , Kawalec Malgorzata Twardowska , Malyszko Jolanta 
Published: January 2023

Objective:
Hypertension (HT) is an overwhelming finding in chronic kidney disease and but again data on hypertension prevalence in acute kidney injury-AKI are very scarce. The etiology of HT in AKI could be multifactorial and depend on the type of AKI. The aim of the study was to assess blood pressure control in patients with AKI admitted to the nephrology department.

Design and Method:
The retrospective analysis of 215 (mean age 58y) patients with AKI (N17) was made based on the medical documentation. Demographic data as well as type of hypotensive drugs, the presence of volume overload, and BP control, need for dialysis were analyzed. Among patients with AKI 35% requires acute hemodialysis-HD due to either clinical or biochemical indications. Prevalence of hypertension was 70%, with the highest in postrenal AKI- 85% followed by renal 75 and prerenal -30%

Results:
AKI patients requiring HD were significantly older than patients treated conservatively group (Me = 67 vs. Me = 54y, p < 0,01), had much higher both systolic and diastolic blood pressure values (p < 0.01 for both). The renal function was less present in AKI group requiring HD. The peripheral edema as well as pulmonary congestion was observed significantly more often in HD group with uncontrolled BP, and postrenal origin of AKI. The average number of hypotensive drugs was 5 in HD and 3 in non-HD patients. The most used hypotensive drug was calcium channel blocker, diuretic and beta-blocker.

Conclusions:
Hypertension is very common in AKI, however it depends upon the origin of AKI. Uncontrolled hypertension together with oedema and pulmonary congestion are the indications for HD initiation. However, caution should be exercised during HD to avoid hypotensive episodes.
PS-P10-8: RELATIONSHIP BETWEEN BLOOD PRESSURE AND PRESENCE OF TREATMENT FOR HYPERURICEMIA
Authors: Kuwabara Masanari , OhmotoSekine Yuki , Itoh Hidetaka , Hisatome Ichiro , Kodama Takahide 
Published: January 2023

Background:
Uric acid is strongly associated with hypertension. However, it is unclear whether drug treatment for hyperuricemia decreases blood pressure or not.

Methods:
This study is a cross-sectional study using the data from 13,087 participants (4,698 female) who had annual health check-up at the Health Management Center and Diagnostic Imaging Center, Toranomon Hospital, Tokyo in 2017. We compared systolic and diastolic blood pressure between participants with and without drug therapy for hyperuricemia. Moreover, we compared systolic and diastolic blood pressure between more than 7 mg/dL and 7 mg/dL and less of serum uric acid levels in participants with drug therapy for hyperuricemia. The presence or absence of drug therapy for hyperuricemia was confirmed by questionnaire methods.

Results:
The number of hyperuricemic participants was 18 in female and 642 in male. The number of hyperuricemic female was very small, and therefore, this study analyzed only hyperuricemic male. Of the 642 male, 153 participants were hyperuricemia without drug therapy and 489 participants were hyperuricemia with drug therapy. Serum uric acid levels and systolic and diastolic blood pressure in hyperuricemic participants with drug therapy is lower than those without drug therapy (serum uric acid levels 6.23 ± 1.01 mg/dL versus 7.25 ± 1.15 mg/dL; systolic blood pressure 124.2 ± 12.4 mmHg versus 125.1 ± 13.7 mmHg; diastolic blood pressure 79.13 ± 8.83 mmHg versus 79.69 ± 8.83 mmHg), even though the drug therapy group was significantly older than absence of drug therapy group (59.7 ± 9.7 years old versus 56.8 ± 11.2 years old, p = 0.002). In the drug therapy group, those with more than 7 mg/dL of serum uric acid (N = 79) had higher systolic and diastolic blood pressure than those with 7 mg/dL and less of serum uric acid (N = 410) (systolic blood pressure 125.2 ± 11.2 mmHg versus 124.0 ± 12.7 mmHg; diastolic blood pressure 80.52 ± 8.78 mmHg versus 78.86 ± 8.48 mmHg), even though those with more than 7 mg/dL of serum uric acid were significantly younger than those with 7 mg/dL and less of serum uric acid (57.3 ± 9.8 years old versus 60.2 ± 9.6 years old, p = 0.015).

Conclusion:
Drug therapy for hyperuricemia is associated with lower systolic and diastolic blood pressure compared with absence of drug therapy for hyperuricemia. Adequate hyperuricemia control could lead to good blood pressure control. Further randomized controlled trials are desired to reveal the relationship between blood pressure and presence of treatment for hyperuricemia.
PS-R03-10: CASE REPORT: CUSHING SYNDROME IN A YOUNG MALE
Authors: Ishiga Kohei , Yoshimura Shiori , Fukuoka Akihiro , Kobayashi Ryu , Kanaoka Tomohiko , Wakui Hiromichi , Toya Yoshiyuki , Tamura Kouichi 
Published: January 2023

A 27-year-old male without any significant past medical history was advised to visit a hospital for elevated blood pressure, elevated liver enzymes, and dyslipidemia in a workplace health checkup. His body weight had increased by more than 10 kg in the last two years. He presented to our department and underwent laboratory work-up. He had bilateral lower limb pitting edema, hypokalemia, and elevation of low-density lipoprotein. No sign of dysthyroidism, renin-angiotensin-aldosterone system disorder, or increased catecholamine secretion was found. Diet and exercise therapy and calcium channel blocker did not improve his hypertension, and he suffered from lumber vertebral fracture, refractory hypokalemia, and lower leg cellulitis. He was admitted to our department for detailed examination of worsening lower limb edema. On admission, he had striae on his abdomen and legs as well as edema of both lower extremities. The endocrinological data showed high levels of adrenocorticotropic hormone (ACTH) and cortisol. Overnight 1 mg dexamethasone suppression test resulted in a non-suppression response, and his circadian rhythm of cortisol was absent. Urine cortisol level was high. These findings confirmed the diagnosis of ACTH-dependent Cushing syndrome. A contrasted magnetic resonance imaging (MRI) scan demonstrated enlargement of the pituitary gland more than 1 cm in length.
Taking into account drug-resistant hypokalemia and vulnerability to infection, he was administered with metyrapone 500 mg per day until he underwent transsphenoidal hypophysectomy. The pathological findings were consistent with that of a pituitary adenoma. Postoperative MRI scan showed remnant lesions which stretch to the bilateral cavernous sinuses and the right middle cranial fossa. Although a decrease in urine cortisol was observed, the absence of a circadian rhythm of cortisol, hypertension, and hypokalemia persisted. He is now treated with somatostatin analog and craniotomy followed by gamma knife surgery is planned.
Cushing syndrome should be suspected in cases of early-onset hypertension with symptoms including weight gain, hypokalemia, and bone fracture.