bluuebunny/crossref_metadata_2025_split huggingface dataset:
S-44-6: ASSESSING THE EFFECT OF SIMPLE CARBOHYDRATE RESTRICTED DIET ON BLOOD PRESSURE LEVELS OF HYPERTENSIVE
Authors: Patil Mansi V , Patil Vishal S 
Published: January 2023

Objective:
In the recent past, various functional foods have been proposed to be effective tools for alleviating hypertension. There is a paucity of evidence on the efficacy of restricted sugar intake in an Indian setting and most evidence comes from non-validated studies. Studies have proposed that sugar acts by decreasing nitric oxide, increasing low-grade inflammation, increasing insulin resistance and promoting obesity.
The objective of the study is to assess the efficacy of restriction of simple carbohydrate intake on change in body weight, blood pressure and anthropometry [waist circumference (WC), waist to hip ratio(WHR) and body mass index (BMI)] after 30 days in males with pre-dominant hypertension.

Design and Methods:
A Case-Control Study with a sample size of 200 urban patients with clinical blood pressure > 140/90 were selected and divided into 2 groups.
A 1800kcal/day diet restricted in simple carbohydrates was given and Blood pressure, body weight, anthropometry (height, WC, HC, BMI, WHR, BSL (F, PP) were measured after 30 days. The participants had been following a structured 1800 kcal/day 3 months prior to the carbohydrate-restricted intervention. Complex carbohydrates were allowed. No change in physical activity was initiated.

Results:
A significant reduction was observed in the intervention group consuming a restricted carbohydrate diet along with a structured diet. Diet recall was taken using food frequency questionnaires and daily pictures of the plate that the participants consumed.

Conclusion:
A restricted simple carbohydrate diet was found to be effective in weight loss and reduction of systolic and diastolic blood pressure in patients with hypertension. The intervention group has a higher odds ratio and is positively associated with SBP, Weight loss and WC as compared to the control group. The source of simple carbohydrates in the majority of the participants was noted as bakery products, sauces and other hidden sources of carbohydrates. Participants were regularly counselled towards healthy eating and dietary sources of various nutrients.
S-46-3: ANTIHYPERTENSIVE TREATMENT IN MASKED HYPERTENSION FOR TARGET ORGAN PROTECTION (ANTI-MASK): A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL
Authors: Huang Jianfeng , Zhang Dongyan , An Dewei , Li Mingxuan , Chen Xin , Feng Yingqing , Zheng Qidong , Li Yan , Wang Jiguang 
Published: January 2023

Objective:
Masked hypertension is associated with target organ damage and adverse outcomes. However, up to now there is no interventional evidence that antihypertensive therapy will be beneficial to the patients.

Design and methods:
The ANTIhypertensive treatment in MASKed hypertension for target organ protection (ANTI-MASK) trial is a multicenter, randomized, double-blind, placebo-controlled clinical trial (NCT02893358). Eligible patients were 30 to 70 years old, had untreated masked hypertension and at least one sign of target organ damage (TOD). Masked hypertension was defined as a normal office blood pressure (BP, < 140/90 mmHg) and an elevated 24-hour (> = 130/80 mmHg), daytime (> = 135/85 mmHg) or nighttime BP (> = 120/70 mmHg) at both screening visits. TOD included electrocardiogram diagnosed left ventricular hypertrophy (LVH), brachial-ankle pulse wave velocity (ba-PWV) > = 1400 cm/s, or a random urinary albumin-to-creatinine ratio (ACR) > = 2.5 mg/mmol in men and > = 3.5 mg/mmol in women. Randomized patients were treated with alisartan 80 mg per day or placebo. If ambulatory BP was uncontrolled, drug dosage was doubled at the 2-month visit, and amlodipine 2.5 mg or matching placebo was added at the 4-month visit. The primary endpoint was the improvement rate of TOD after 12 months treatment, defined as the reverse (yes to no) of TOD or a significant decrease of ba-PWV or ACR by > = 20% of the baseline level.

Results:
From Feb 2017 to Oct 2020, 317 patients with masked hypertension (43.2% women, mean age 54 years) were randomized in 13 hospitals in China. Overall, baseline office, 24-h, daytime and nighttime BPs averaged 130/81,137/85, 141/87, and 126/77 mmHg, respectively. At baseline, 98% had an elevated ba-PWV, 12% microalbuminuria, and 8% LVH. 252 patients completed the 12-month treatment and 65 (20.5%) withdrew from the trial. In the intention-to-treat analyses, the improvement rate of TOD was significantly higher in the antihypertensive treatment group than the placebo group (47.4% vs 26.1%, P < 0.0001), as well as the decrease of the 24-h systolic/diastolic BPs (-9.1/-5.7 vs -1.5/-1.0 mmHg, P < 0.0001).

Conclusions:
Antihypertensive treatment was beneficial for patients with masked hypertension in terms of TOD protection.
S-47-2: DIAGNOSIS OF PRIMARY ALDOSTERONISM USING ARTIFICIAL INTELLIGENCE
Authors: Eisenhofer Graeme 
Published: January 2023

Testing for primary aldosteronism (PA) involves an arduous multistep process culminating in either resection of an adrenal in patients identified with unilateral disease after adrenal venous sampling (AVS) or mineralocorticoid receptor blockade in patients without AVS-based evidence of lateralized aldosterone secretion. Multiple difficulties plague each step, including the confirmatory step where immunoassay interferences lead to many false-positive results (1). Mass spectrometry-based steroidomics provides an alternative approach that combined with artificial intelligence might be used for both screening and stratification of patients for therapeutic intervention. The approach may be particularly useful for identification of patients with unilateral disease due to somatic KCNJ5 mutations, who after imaging studies may proceed directly to adrenalectomy without need for confirmatory studies or AVS. To establish this approach, we developed machine learning (ML) models using a retrospective cohort of 462 patients tested for PA, including 139 with unilateral disease of whom 58 had KCNJ5 mutations (2) ML models are now undergoing external validation in a prospective multicenter study (PROSALDO), which has to date enrolled 542 eligible patients. Among these 186 have received follow-up, which has enabled exclusion of disease in 73 and confirmation of unilateral disease in 38 others according to post-surgical biochemical cure. Among the latter, genotyping in 19 patients identified KCNJ5 mutations in nine, all of whom showed post-operative cure and were correctly predicted by ML to have PA with KCNJ5 mutations. Among these nine and four others who were not part of the PROSALDO trial (3) 10 had their adrenals removed without AVS evidence of lateralization. In an interim analysis (with recognition that ML models were likely compromised by incorrect classifications due to immunoassay inaccuracy), among the 542 PROSALDO patients, 138 and 404 were respectively classified with and without PA. According to areas under receiving-operating characteristic curves (AUC), our ML model for screening performed equally poorly (AUC = 0.927) compared to aldosterone:renin ratios (ARR) determined by mass spectrometry (AUC = 0.909) and immunoassay (AUC = 0.895) measurements of aldosterone. Significantly improved performance was achieved by incorporation of plasma potassium and renin with steroidomics-based models (AUC = 0.9511). Results to date indicate promise for ML approaches to both more accurately screen for PA than possible with the ARR and also identify patients with unilateral disease due to KCNJ5 mutations who may directly proceed to surgery without need for confirmation studies or AVS.
S-47-4: THE BURDEN OF CARDIOVASCULAR DISEASE ATTRIBUTABLE TO HIGH SYSTOLIC BLOOD PRESSURE ACROSS CHINA AND ITS PROVINCES FROM 2005 TO 2018
Authors: Cao Xue , Zhao Zhenping , Kang Yuting , Tian Yixin , Song Yuxin , Wang Liming , He Yuna , Zhang Linfeng , Chen Zuo , Zheng Congyi , Chen Lu , Hu Zhen , Zhou Haoqi , Zhou Maigeng , Wang Zengwu 
Published: January 2023

Background:
The temporal trends and geographical disparity in the burden of cardiovascular diseases (CVD) attributable to high systolic blood pressure (SBP) have not been fully discussed before in Chinese population. The current study was performed to quantify the CVD burden attributable to high SBP in China, which is crucial to inform and improve blood pressure control measures.

Methods:
We evaluated death numbers, age-standardized mortality rate and years of life lost (YLLs) and corresponding estimated annual percentage changes (EAPC) for CVD and its subcategories attributable to high SBP from 2005 to 2018. We polled data from China Chronic Disease and Risk Factor Surveillance, the China Health and Nutrition Survey and China Hypertension Survey to estimate the BP level between 2005 and 2018. A comparative risk assessment method was applied to compute the deaths and health burden attributable to high SBP for CVD and its subtypes by age, sex, year and provinces.

Findings:
We estimated that 2·67 million (95%UI 2·61 to 2·73) CVD deaths in China were attributable to elevated SBP in 2018. Age-standardized CVD mortality rate associated with high SBP decreased by 17·89% for China overall between 2005 and 2018, and the EAPC was -1·50 (95% UI -1·55 to -1·45). The death numbers for ischemic heart disease, ischemic stroke due to high SBP showed a relative growth in most provinces, while age standardized mortality rates declined in 2018 compared with 2005 in most provinces, which were in line with the national trend. YLLs for total CVD attributable to high SBP increased from 40·13 million (95%UI, 39·70 to 40·52) in 2005 to 48·16 million (95%UI, 47·44 to 48·90) in 2018 for China overall. YLL rates varied considerably across provinces, ranging from 3217·15 per 100 000 (95%UI 2947·43 to 3441·83) in Fujian to 7196·20 per 100 000 (95%UI 6864·28 to 7498·94) in Heilongjiang in 2018. Age-standardized YLL rates for ischemic heart disease and ischemic stroke attributable to high SBP were high in northeast provinces, including Heilongjiang, Liaoning and Jilin.

Interpretation:
The deaths and YLLs for CVD attributable to high SBP increased substantially in recent years, especially for the elderly, although age-standardized CVD mortality rate has decreased in China between 2005 and 2018. Preventive interventions should be implemented to lower the prevalence of high SBP among Chinese overall in order to reduce the SBP-related CVD adverse health effect.
S-50-2: ULTRAFAST LC-MS ANALYSIS FOR THE CHEMICAL ADHERENCE TESTING: SUB MINUTE RUN TIMES FOR A PANEL OF NINE CARDIOMETABOLIC MEDICATIONS
Authors: Lane Dan , Ng Leong , Jones Donald JL , Gupta Pankaj 
Published: January 2023

Objective:
Non-adherence in hypertension can be as high as 30–45%. Chemical adherence testing (CAT) is the preferred method to assess non-adherence in European guidelines. New randomised controlled trials (RCTs), like the RADIANCE-HTN TRIO, have also started to implement CAT into their study framework to diagnoses non-adherence. Using high performance liquid chromatography (HPLC) in tandem mass spectrometry (MS/MS), existing quantitative urine CATs take > 40 minutes. These provide a yes/no answer. Recent guidance has suggested run-time be an area of development, along with the research of quantitative assays in plasma. Translated from the field of therapeutic drug monitoring, UltraFast (<1 minute) run times were explored using ultra performance short (UP)-LC columns with MS/MS for the detection and quantitation of nine cardiometabolic medications in plasma for use in CAT. UltraFast methods could increase clinical and research capacity while reducing cost.

Design:
An UltraFast quantitative CAT using UPLC-MS/MS was developed and optimised for the parallel detection of nine cardiometabolic medications in plasma. These medications were amlodipine, atenolol, atorvastatin, bisoprolol, edoxaban, enalapril, propranolol, ramipril, and saxagliptin.

Methods:
A mixed internal standard (IS; 10 ng/mL) was added to 100 μL of sample before the addition of 100 μL of water. The entire solution was added to pre-conditioned Oasis PRiME hydrophilic lipid balance (HLB) 96-well μElution solid phase extraction (SPE) plates. The loaded wells were washed (200 μL 5% methanol) and eluted (50 μL methanol/ acetonitrile) prior to UPLC-MS/MS analysis on a Waters Xevo TQ-XS triple quadrupole system. Sub 45 s run times were achieved using a Raptor Biphenyl Guard column cartridge (5 x 2.1 mm, 2.7 μm) as the UPLC column, used in reverse phase, and pumped at a 1.4 mL/min flow rate. Five replicate calibration curves were extracted over the range 0.01–500 ng/mL to assess model fits and detection limits.

Results:
All medications in plasma had lower limits of detection (LOD) between 0.01 ng/mL (atorvastatin) and 20 ng/mL (amlodipine). Optimum calibration curves were obtained. These were a mixture of quadratic and linear models. R2 ranged from 0.837 (enalapril) to 0.971 (atorvastatin). Clear chromatographic separation was achieved with the first eluted peak was atenolol, detected at 3 s. The last eluted peak was edoxaban at 22 s. Quantitation was possible over the range 0.01–500 ng/mL.

Conclusion:
A <45 second UPLC-MS/MS run time was achieved for a panel of nine cardiometabolic medications. LODs were well within the therapeutic range of interest, and quantitation was made possible over 0.01–500 ng/mL, the therapeutic range of interest. This method could be applied in clinical laboratories for same day adherence testing, or to large RCTs for their timely processing.
S-50-6: HOW TO ASSESS BENEFICIAL EFFECTS OF ANTIHYPERTENSIVE TREATMENTS
Authors: Piskorz Daniel Leonardo 
Published: January 2023

Most hypertensive patients could have hypertension mediated organ damage (HMOD) at the moment of the diagnosis. Even in low 10-year cardiovascular risk patients HMOD is frequent. The presence of HMOD is related to increased cardiovascular risk and mortality, so, at the same time HMOD should be considered as a therapeutic target and a surrogate marker of blood pressure un/controlled.
The effects of impaired renal function and left-ventricular hypertrophy could identify patients at a mortality very high risk. Guidelines considered arterial stiffening evaluated as high carotid-femoral pulse wave velocity a factor influencing cardiovascular risk, and a documented carotid artery stenosis > 50 % as a marker of very high cardiovascular risk. The Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA) showed that 50% of the participants at risk category one had a mean of one atherosclerotic plaque, and 80.7 % of individuals at category two had a mean of 2.2 atherosclerotic plaques. The hazard ratio of having a vascular event could increase by 50% in the presence of one HMOD and by 3.8 times when three HMOD are present.
In this scenario, to prevent that at least some patients could be misclassified as low risk, screening of HMOD as modifiers of cardiovascular risk estimated by different scores could be recommended in hypertensive patients.
The non-significant net reclassification improvement of cardiovascular risk and the lack of evidence suggesting a relationship between vascular images biomarkers regression independently of blood pressure lowering and a reduction in cardiovascular events precludes the routine search of arterial stiffness or carotid atherosclerotic plaques out of research scenarios.
A reduction in left ventricular mass during treatment is a favorable prognostic marker that predicts lesser risk for subsequent cardiovascular morbidity and mortality. The association between left ventricular mass regression and cardiovascular outcomes is independent of baseline left ventricular mass, baseline clinic and ambulatory blood pressure, and degree of blood pressure reduction. Suboptimal blood pressure control is a significant covariate of persistent left ventricular hypertrophy, independent of the number and class of antihypertensive drugs.
RAS blockade is recommended as the initial treatment of hypertension in patients with reduced glomerular filtration rate or albuminuria since they are the most effective at reducing progression to end stage kidney disease, but a combination with calcium channel blockers or diuretics is recommended due to the difficulties to achieve the targets with monotherapy.
S-51-5: DIFFERENT CONTRIBUTION OF AFFERENT RENAL NERVES TO DEVELOPMENT OF HYPERTENSION AND HYPERTENSIVE HEART FAILURE IN SEVERAL RAT MODELS OF HYPERTENSION
Authors: Shinohara Keisuke , Ikeda Shota , Nakashima Ryosuke , Matsumoto Sho , Yoshida Daisuke , Ono Yoshiyasu , Tsutsui Hiroyuki 
Published: January 2023

Objective:
Renal nerves contain efferent and afferent fibers. Acute stimulation of the afferent nerves increases central sympathetic outflow. This study aimed to investigate the contribution of afferent renal nerves to the development of hypertension and hypertensive heart failure in several rat models of hypertension.

Design and method:
Selective afferent renal nerve denervation (ARDN) or sham operation was performed in the following models: (1) SHRSP at 9 weeks of age; (2) 4% high-salt diet (HS)-fed SHRSP at 8 weeks (HS from 8 weeks); (3) 8% HS-fed Dahl salt-sensitive rats at 9 weeks (HS from 6 weeks); and (4) 8% HS-fed Dahl salt-sensitive rats at 9 weeks (HS from 7 weeks). Dahl rats fed 0.3% low-salt diet (LS) were used as controls for (3) and (4). Blood pressure (BP) was measured by telemetry in (1) and (2), and by tail-cuff method in (3) and (4). The experimental period ended at the following age: (1) 11 weeks; (2) 11 weeks; (3) 16 weeks (“HFrEF’’ phase); and (4) 19 weeks (“HFpEF’’ phase).

Results:
(1) Mean BP was significantly elevated from 9 weeks to 11 weeks in sham-SHRSP (155.2 ± 2.0 vs 144.0 ± 1.9 mmHg, n = 10, p < 0.05). Mean BP in ARDN-SHRSP (157.8 ± 2.7 mmHg, n = 10) was not different compared to sham-SHRSP at 11 weeks. (2) Mean BP was significantly increased from 8 weeks to 11 weeks in sham-HS-SHRSP (191.5 ± 8.1 vs 126.5 ± 4.0 mmHg, n = 6, p < 0.05). Mean BP in ARDN-HS-SHRSP (186.0 ± 7.1 mmHg, n = 6) did not differ from sham-HS-SHRSP at 11 weeks. (3) Systolic BP was significantly increased (243.6 ± 7.0 vs 140.0 ± 2.7 mmHg, n = 9 each, p < 0.05) and echocardiographic left ventricular fractional shortening (LVFS) was significantly decreased (25.9 ± 1.7 vs 48.8 ± 0.4 %, p < 0.05) in sham-HS-Dahl rats compared to LS-Dahl rats at 16 weeks. Compared to sham-HS-Dahl rats, systolic BP was not different (223.4 ± 5.5 mmHg, n = 7); however, the decreased LVFS was significantly attenuated (42.2 ± 1.2 %, p < 0.05) in ARDN-HS-Dahl rats. (4) Systolic BP was significantly increased in sham-HS-Dahl rats compared to LS-Dahl rats at 19 weeks (207.8 ± 4.5 vs 135.7 ± 3.2 mmHg, n = 8 and 6, p < 0.05), and this increase was not affected in ARDN-HS-Dahl rats (220.7 ± 2.9 mmHg, n = 7). By echocardiography, LVFS did not differ between the three groups, whereas E/e’ ratio was significantly increased in sham-HS-Dahl rats compared to LS-Dahl rats and was attenuated in ARDN-HS-Dahl rats.

Conclusion:
The signals from afferent renal nerves contribute to the development of HFrEF and HFpEF without affecting BP in Dahl salt-sensitive hypertensive rats, but not of hypertension in SHRSP and HS-fed SHRSP.
S-52-1: CARDIOVASCULAR OUTCOMES IN HYPERTENSIVE PATIENTS WHO DISCONTINUE STUDY MEDICATION IN A LARGE OUTCOME TRIAL. THE LIFE STUDY.
Authors: Wachtell Kristian , Julius Stevo , Okin Peter M , Greve Anders M , Devereux Richard B , Oparil Suzanne , Kjeldsen Sverre E , Boman Kurt 
Published: January 2023

Objective:
Patient discontinuation of study medication during an outcome trial has significant implications for study power. However, patients who discontinue cardiovascular outcome trials are not well described. We aimed to assess readily available patient characteristics and outcomes in patients with hypertension and left ventricular hypertrophy (LVH) who discontinued the study drug but otherwise remained in the study until the end of follow-up.

Methods:
In patients who discontinued vs. those continuing, Cox proportional hazards models identified baseline variables that had a significant impact on the occurrence of the primary composite endpoint (cardiovascular death, stroke, and myocardial infarction) in 9,193 hypertensive patients and LVH in the LIFE study.

Results:
During a mean follow-up of 4.8 years, 3,281 patients (35.7%) discontinued one or more days during the trial, not counting death as a reason for discontinuation. The distribution of days to discontinuation was highly skewed towards the first part of the study; the 25th percentile was at day 161, and the median was at day 669.
Reasons for discontinuation were a clinical adverse event (50%), a secondary study endpoint (19%), required study therapy (11%), withdrawal (2%), administrative (18%), and lost to follow-up (0.2%).
Those who discontinued were older, more often male, had slightly lower body mass index, higher systolic and lower diastolic pressure, higher Framingham Risk Score (FRS), and more ECG LVH determined by either Cornell voltage-duration product or Sokolow-Lyon criteria compared to those who continued in the study. Of particular note, the discontinuation rate between the two study drugs was not equal. Patients randomized to losartan discontinued less than those randomized to atenolol. Multivariate analyses showed that older age, male gender, FRS, Sokolow-Lyon criteria, atenolol treatment as well as a history of pre-study myocardial infarction, cerebral vascular disease, peripheral vascular disease, and atrial fibrillation as well as lower levels of hemoglobin, higher serum creatinine and lower cholesterol all independently predicted discontinuation from the study drug.

Conclusions:
Patients discontinued during the first part of the study mainly due to experience of a clinical adverse event. Patients who discontinued the study drug had, on average, more previous and concurrent cardiovascular disease than those who continued until the study ended. There is no risk reduction and futility if an outcome study recruits patients with too little risk. However, too high risk implies early drug discontinuation and thus reduction in the study power.
S-56-6: HOME BLOOD PRESSURE SURVEY IN SOUTHEAST AND EAST ASIA
Authors: Wang Tzung-Dau 
Published: January 2023

Home blood pressure monitoring (HBPM) is a promising tool that can aid in the diagnosis and management of hypertension. Experts from 11 countries/regions in Asia conceptualized a large-scale survey to examine the current realities of HBPM. A cross-sectional survey was conducted among health care professionals from China, India, Indonesia, Japan, Malaysia, the Philippines, Singapore, South Korea, Taiwan, Thailand, and Vietnam between November 2019 and June 2021. Physicians’ responses were summarized using descriptive statistics. A total of 7,951 physicians participated in the survey. Among all respondents, 50.3% and 33.5% viewed HBPM as highly recognized by physicians and patients in their country/region, respectively. Lack of understanding of HBPM and concern with the accuracy and reliability of HBPM devices were identified as key barriers to HBPM recognition. Nearly all physicians (95.9%) reported recommending HBPM to their patients; however, they reported less than 50% of their patients measured home blood pressure (HBP). Among physicians who recommended HBPM, only 22.4% and 54.1% cited HBP diagnostic threshold values and timing of taking antihypertensive drugs that were consistent with available guidelines, respectively. The survey reveals that the recognition of HBPM as a valuable tool to diagnose and manage hypertension is suboptimal in most parts of Asia. Despite high recommendation of HBPM to hypertensive patients by physicians, there are considerable discrepancies between guidelines recommendations and practice realities.