bluuebunny/crossref_metadata_2025_split huggingface dataset:
AW-NI-4: MAY MEASUREMENT MONTH 2021: AN ANALYSIS OF BLOOD PRESSURE SCREENING RESULTS FROM NEPAL
Authors: Inagaki Yoko , Koilala Sweta , Poudel Kiran , Tiwari Kiran , Sapkota Abhishek , Soti Pabitra Babu , Neupane Dinesh 
Published: January 2023

Objective:
This study presents the result of May measurement Month 2021 in Nepal, a global initiative of the International Society of Hypertension (ISH) aiming to screen high blood pressure and raise awareness at the population level.

Design and Methods:
An opportunistic cross-sectional survey of> = 18 years of age was conducted in 15 out of 77 districts from September-December 2021. The trained enumerators administered the structured questionnaire of the ISH adopted into Nepali and took three blood pressure (BP) readings while in a sitting position at 1-minute intervals, using electronic BP machines. Participants were identified with hypertension using the following criteria: 1) mean of the 2nd and 3rd BP readings> = 140/90 mmHg or 2) being on at least one antihypertensive medicine taken for raised BP. Ethical approval was obtained from the Nepal Health Research Council.

Results:
A total of 5,172 participants were included. The median age was 37.0 (IQR 25–51) years and 49.9 % were female. Self-reported tobacco use, alcohol drinking, diabetes, and history of myocardial infarction (MI) or stroke were reported in 21.7%, 21.9%, 4.1%, and 0.5% of participants, respectively. The mean of 2nd and 3rd BP readings or history of anti-hypertensive medication use were available for 5,167 participants. The mean was 123.9 mmHg ± 10.3 for systolic blood pressure, and 81.2 mmHg ± 9.3 for diastolic blood pressure. 1,066 (20.6%) met the criteria for hypertension, of which 399 (39.5%) were aware and 298 (29.5%) were treated with at least one anti-hypertensive medicine. Of those who were treated, 167 (56.0%) had their BP under control. With the BP threshold of the AHA/ACC guideline (i.e., SBP> = 130 mmHg or DBP> = 80 mmHg), 3,015 (58.9%) were identified with hypertension. Multivariate logistic regression using age, sex, smoking, alcohol use, diabetes, and history of MI or stroke as covariates showed a significant association between hypertension and age (<40: OR = 1.13, 95 CI:1.11–1.15, > = 40: OR = 1.05 95% CI:1.04–1.06), male (OR = 1.57, 95% CI:1.33–1.89), alcohol use (OR = 1.59, 95% CI:1.30–1.93), and diabetes (OR = 2.63, 95% CI:1.93–3.58).

Conclusions:
MMM 2021 in Nepal found more than half of the adults in communities were undiagnosed and untreated. Community-based campaigns such as MMM are meaningful for countries to collect hypertension cascade data in hard-to-reach areas and identify those at high-risk.
ISH-PP-7: SCALING-UP HYPERTENSION CARE IN RESOURCE-CHALLENGED SETTINGS GLOBALLY
Authors: Jafar Tazeen H 
Published: January 2023

High blood pressure (BP) is the leading modifiable risk factor for death. More than 1.4 billion people suffer from hypertension worldwide. BP control remains less than 30% in high-income countries and < 10% in low- and middle-income countries (LMIC) rural areas, leading to significant disparities in hypertension-related cardiovascular mortality. Immediate action is needed to address suboptimal hypertension care globally and related inequalities.
Evidence shows that strategies that leverage the existing infrastructure to deliver hypertension care are more likely feasible and rapidly scalable at marginal cost. The Control of Blood Pressure and Risk Attenuation-Bangladesh, Pakistan, Sri Lanka (COBRA-BPS) trial demonstrated that a community health worker-led multicomponent intervention tailored to rural settings improved BP control. It was also cost-effective and affordable (less than US$2 per capita annually). Likewise, community health worker-led models of hypertension care were beneficial in urban slums in Argentina, China, Colombia, India, Indonesia, Malaysia, Nepal, Pakistan, and Kenya.
The partnership between WHO and Resolve to Save Lives is an excellent initiative to focus national attention on hypertension treatment in many low- and middle-income countries. Strong advocacy and multi-sectoral collaborations are also needed to implement policy strategies for hypertension prevention, including access to healthy foods and the built environment to promote physical activity.
A (proposed) Global Hypertension Care Task Force jointly led by WHO and ISH could catalyse improvement in BP control rates. Every country should establish a dedicated national coordinating center for stewardship and implementing the hypertension control agenda through multifaceted, cost-effective strategies, including population-level policy initiatives and health systems strategies targeting high-risk individuals. Such efforts could save the lives of more than 100 million people aged 30–70 years, who would otherwise die prematurely by 2030, and help achieve Sustainable Development Goal 3.4
JS-NG-2: LONG-TERM EFFICACY AND SAFETY OF ALISKIREN IN FOUR CASES WITH MALIGNANT HYPERTENSION
Authors: Fujii Wataru , Yasukawa Minoru , Homma Fumika Ochiai , Morimoto Chikayuki , Asakawa Shinichiro , Nagura Michito , Arai Shigeyuki , Yamazaki Osamu , Tamura Yoshifuru , Fujigaki Yoshihide , Shibata Shigeru 
Published: January 2023

Objective:
Malignant hypertension (MH) is a form of hypertensive emergency defined by a severe increase in blood pressure (BP) with multiple organ injuries. One possible pathophysiology of MH is an acute activation of the renin-angiotensin system (RAS) driven by the intense stimulation of renin secretion in the juxtaglomerulosa cells. Considering this mechanism, aliskiren, a direct renin inhibitor (DRI), can be a treatment option for MH. However, there is little information on the efficacy and safety of DRI in controlling MH. We herein report four cases with MH that have been successfully controlled by DRI for a long term.

Case description:
All of the four cases (three male and one female; 34 to 57 years of age) developed advanced retinopathy (III or IV grade on Keith-Wagener classification) and severe hypertension (> 200/120 mmHg) at presentation, meeting the criteria for MH according to the 2020 ISH global hypertension practice guideline. Mean systolic/diastolic BP was 215 ± 5/148 ± 8 mmHg. All developed acute kidney injury, with the mean serum creatinine (sCr) of 4.47 ± 1.13 mg/dl on admission. The ranges of plasma renin activity (PRA) and plasma aldosterone concentration (PAC, as measured by RIA) were 11–33 ng/mL/hr and 371–1370 pg/mL, respectively. Followed by initial treatment with an intra-venous calcium channel blocker, these patients were prescribed aliskiren, starting at 150 mg/day once daily, after confirmation of the elevated PRA levels. In general, aliskiren was well tolerated and BP was successfully controlled in all of the four cases (at discharge, mean systolic/diastolic BP was 123/74 mmHg and mean sCr was 3.84 mg/dL). Patients continued to receive aliskiren (at a dose of 150 or 300 mg/day) after the discharge and mean systolic/diastolic BP and sCr were 131 ± 4/84 ± 3 mmHg and 2.02 ± 0.16 mg/dl at two years of follow-up, respectively. The ranges of PRA and PAC of four cases have fallen to 0.2–0.8 ng/mL/hr and 105–203 pg/mL, respectively.

Conclusions:
In our cases, severe hypertension and target organ damage were fairly controlled with aliskiren on acute and chronic phases of MH. In all of the four cases, PRA declined with anti-hypertensive treatment and was useful in guiding the doses of medications. Although DRI is not a first-line anti-hypertensive drug class, it may be useful in a certain form of MH with high PRA, which merits further study.
JS-NG-10: A RARE CAUSE OF TREATMENT-RESISTANT HYPERTENSION
Authors: Hausberg Martin , Seitz Karl Heinz , Teber Dogu , Reimer Peter , Rueciger Thomas 
Published: January 2023

Objective:
To present an educational case report.

Design and method:
In a 22-year old female arterial hypertension was diagnosed and she was treated to blood pressure target values with a combination of candesartan and lercanidipine. At the age of 27 years she planned a pregnancy, therefore antihypertensive treatment was switched to alpha-methyl-dopa and metoprolol. Blood pressure control was no longer achieved, the patient was symptomatic, mostly headaches.
A diagnostic work-up for secondary causes of hypertension was performed.

Results:
There were no signs of kidney disease, renal artery stenosis was ruled out by color-coded duplex-ultrasound, plasma metanephrines were normal, sleep apnea syndrome and hypercortisolism were clinically very unlikely and not formally ruled out.
No signs of hypertensive end-organ damage (left ventricular hypertrophy, microalbuminuria, carotid artery alterations) were detected.
The only pathologic finding confirmed was a marked secondary hyperaldosteronism. Plasma renin concentration was 230 pg/ml, plasma aldosterone concentration 508 pg/ml, along with low normal serum potassium (3.5 to 4 mmol/l).
Addition of nifedipine and low-dose HCT did not achieve blood pressure control, daytime ABPM mean was 144/102 mmHg, nighttime ABPM mean 127/86 mmHg.
Because of suspected missed renal artery stenosis (fibromuscular dysplasia) an MR-angiography of the renal arteries was performed revealing normal renal arteries and normal adrenal glands but a left kidney tumor - not observed in the previous ultrasound examination but confirmed with contrast-enhanced ultrasound.
Surgical removal of the tumor was performed. The histology was suggestive for a juxtaglomerular cell tumor (reninoma). After surgery, plasma aldosterone normalized to 57 pg/ml and plasma renin concentrations were low (3.4 pg/ml). Within 3 months after surgery, all antihypertensive medication could be discontinued and home blood pressure measurements averaged 119/78 mmHg. Soon thereafter the patient became pregnant and delivered a healthy girl. There were no pregnancy related complications and the patient remained normotensive.
A juxtaglomerular cell tumor represents a rare curable cause of hypertension. The first report dates for 1967, until 2019 only about 100 cases were reported in the literature. It may be suspected that the diagnosis juxtaglomerular cell tumors is missed in many cases since these tumors are not easy to detect in standard diagnostic workup of hypertension and many antihypertensive drugs interfere with plasma renin concentrations.
JS-ISH-KSH-4: EPIDEMIOLOGY OF RESISTANT HYPERTENSION IN KOREA: ABPM REGISTRY DATA
Authors: Shin Jinh 
Published: January 2023

Resistant hypertension (RH) may be one of the major challenges in improving the control rate in hypertension (HTN) management. Accurate diagnosis is usually difficult only by measuring office blood pressure(OBP).
For 1230 subjects taking one or more antihypertensive medication (AHM) enrolled in the Korean Ambulatory Blood Pressure Monitoring (Kor-ABP) registry, the prevalence of RH was calculated when RH was defined as uncontrolled BP by three AHM classes including diuretic or controlled BP by 4 or more classes. Prevalence of RH was 11.9 % (146/1230). By using nighttime BP criteria, there was significant difference in the prevalence of RH for OBP versus nighttime BP. Masked uncontrolled HTN was 16.9 % and white-coat uncontrolled HTN was 14.1 %. For nighttime BP control status, odd ratios for smoking (odds ratio(OR), 0.624), drinking (OR, 1.512), coronary artery disease (OR, 0.604), calcium antagonist (OR, 1.705), and loop diuretics (OR, 0.454) were all significant. The prevalence of RH by nighttime BP was significantly higher than using daytime BP criteria.
JS-ECCR/HBPRCA-2: HOMOCYSTEINE AND LIPOPROTEIN (A) AS A DETERMINANT OF ARTERIAL STIFFNESS AND A PREDICTOR OF HYPERTENSION MEDIATED TARGET ORGAN DAMAGE (HMOD)
Authors: Carnagarin Revathy , MwiPatayi Patrice , Schlaich Markus 
Published: January 2023

Background:
Despite advances in modern medicine, cardiovascular disease (CVD) remains a leading cause of global mortality. Among the many CVD determinants, hypertension is a leading modifiable risk factor and blood pressure control and prevention of hypertension mediated target organ damage (HMOD) has become the hallmark of cardiovascular risk management. Homocysteine and lipoprotein (a) are independent CVD risk factors, proposed to contribute to vascular compromise by facilitating thrombogenesis and atherosclerosis.

Aims:
We sought to determine in a real-world clinical setting whether these risk factors interact to facilitate vascular organ damage in hypertension.

Methods:
We performed a cross-sectional analysis of prospectively collected data in 131 hypertensive patients referred to our tertiary hypertension clinic at Royal Perth Hospital. The Lipoprotein (a), homocysteine and other biochemical parameters studied were assayed in the central hospital laboratory. We analysed the effect of the interaction between Lipoprotein (a) and homocysteine (Lpa-Hcy) on markers of HMOD including arterial stiffness, as assessed by pulse wave velocity (PWV).

Results:
The average age of participants was 56 ± 0.9 years, and there was a greater proportion of males than females (62% vs. 38%). The regression analysis demonstrated that Lp(a)-Hcy interaction was significantly associated with PWV [beta = 0.33; 95% CI 0.12, 0.55; p < 0.005], 24 h urinary protein excretion [beta = -10.9; 95% CI -14.5, -7.4; p < 0 .001], and estimated glomerular filtration rate [beta = 103.9; 95% CI 93.9, 113.8; p < 0.001], which persisted after adjusting for potential confounders such as age, sex, 24 h BP, inflammation, smoking, diabetes mellitus and other metabolic risk factors. Interaction analysis showed that increasing homocysteine and lipoprotein (a) concentration was associated with increasing arterial stiffness. Hcy levels does not affect the PWV if Lp(a) levels are normal and the knowledge of both Lp(a) and Hcy are necessary to determine arterial damage. Furthermore, Lp(a)-Hcy product exhibited a positive predictive relationship with every unit increase in Lp(a)-Hcy product associated with a 0.3 m/s increase in PWV which may represent a useful marker for cardiovascular risk stratification and may suggest the need for rigorous treatment to minimise HMOD progression. These clinical findings provide novel insights into the potential interaction between Lp(a) and Hcy in the pathogenesis of hypertension mediated vascular damage
JS-AHA: AHA SESSION CLINICAL CASE; CLINICAL-PATHOLOGICAL CONFERENCE (CPC) IN COOPERATION WITH HYPERTENSION, AN AMERICAN HEART ASSOCIATION JOURNAL
Authors: Fanelli Elvira , Persu Alexandre 
Published: January 2023

A 35-year-old woman, with a known history of right renal artery FMD, presented at the Hypertension Outpatient Clinic for evaluation of resistant hypertension. The patient was an active smoker and had a single kidney after left nephrectomy for kidney malformation during childhood.
The diagnosis of FMD had been made on the occasion of a previous pregnancy at 23 years, complicated by preeclampsia and an angioplasty had been performed. Work-up disclosed a recurrence of right renal artery stenosis, and a new renal angioplasty was performed. Blood pressure normalized after the procedure.
At 36 years, the patient had another pregnancy, also complicated by preeclampsia and preterm delivery. An Echo-Doppler performed during pregnancy and an Angio-CT after delivery, allowed ruling out recurrence of renal artery stenosis.
At 43 years, she was admitted to the emergency room for thoracic pain. The coronarography was in favour of a coronary spasm. There was no coronary stenosis or image suggestive of a Spontaneous Coronary Artery Dissection.
At 54 years, the patient was again admitted in emergency for malignant hypertension associated with severe acute renal failure. She also reported a history of lower limbs claudication since several months. An abdominal CT disclosed dissection complicated by occlusion of the right renal artery, dissection of both iliac arteries as well as a severe stenosis of the infra-renal aorta. An angioplasty with insertion of stents in the right renal artery and the aorta was performed. After the procedure, a partial normalization of renal function was observed, and blood pressure control was achieved on 3 medications.
During the recovery, the patient presented a skin rash associated with a general feeling of discomfort, with spontaneous resolution after a few days. One year later, following a control Angio-CT of the abdomen, an anaphylaxis episode occurred, requiring Adrenaline administration. Iodine contrast allergy was suspected, but milder hypersensitivity symptoms occurred in the following months, without exposition to a clear trigger. An allergology work-up was performed with final diagnosis of secondary Mast Cell Activation Syndrome. B-Blockers and ACE-inhibitors were contra-indicated and cautious premedication before further exposure to iodine contrast was recommended.
JS-HR-6: CONSIDERING FRAILTY AND EXERCISE FOR MANAGEMENT OF HYPERTENSION AND HYPERTENSIVE ORGAN DAMAGE
Authors: Toba Ayumi 
Published: January 2023

Frailty is defined as physiological decline and a state of vulnerability to stress and results in adverse health outcomes. It consists of multiple domains such as physical, social, and psychological factors. Cognitive decline is one of the factors concerning frailty, and blood pressure (BP) control reduced dementia or cognitive decline significantly in meta-analysis. However, in elderly population above 80 years, positive effect of antihypertensive therapy for preventing dementia was not proved. In the latest study in hypertension research, meta-analysis of prevalence of mild cognitive impairment (MCI) among hypertensive patients were conducted. Overall prevalence of MCI was 30% in a sample of 47179 patients. Another study which prospectively followed elderly hypertensive patients for 41 months, mortality rates were lowest in those with systolic blood pressure < 140mmhg with no frailty, and highest in those with systolic blood pressure < 140mmHg with frailty. Since frailty and cognitive decline is common in hypertensive patients, adequate blood pressure management in frailty patients are required. Further research accumulating scientific evidence with longitudinal data is needed for the guidance of blood pressure control in such patients. On the other hand, treatment of elderly hypertensive patients is complicated because their comorbidity, frailty, cognitive function, and social status should be taken into consideration. Individual assessment and constant follow up is imperative for the treatment of these patients.
In the era of technically advanced, people are spending less active which leads to cardiovascular risks including hypertension. However, guidelines emphasize the importance of non-pharmacological strategies such as life style modification and exercise to prevent diseases. In the latest study in hypertension research, a study compared different types of exercise which is beneficial for health. As for the result, combination exercise of aerobic and resistance training was most effective at improving cardiorespiratory fitness, muscle strength BMI, fat mass, glucose, cholesterol and triglyceride. Several studies showed isometric exercise training reduced systolic blood pressure. Other study showed vascular function improved with daily exercise habits such as stair climbing.
RAG-APAC-1: SOCIAL AGING IN THE ASIA-PACIFIC REGION
Authors: Kotruchin Praew 
Published: January 2023

There will be twice as many individuals over the age of sixty worldwide, including in the Asia-Pacific region by the year 2050, according to a report by WHO. The rise in hypertension prevalence, therefore, will be fueled by the anticipated rise in the elderly population.
Even though cardiovascular (CV) risk factors continue throughout a lifespan, older people are more likely to develop cardiovascular diseases (CVDs). Hypertension accounts for a significant share of major morbidities and mortalities in the Asia-Pacific area. Therefore, the main objectives of integrated healthcare for older populations are to minimize CV risks as well as to provide optimal treatment of CVDs and life-threatening conditions. Another critical factor is the continuity of healthy metabolic profiles including blood pressure from childhood to old age.
There are many challenges in hypertension management with social aging in the Asia-Pacific region. First, the common type of hypertension in the elderly is isolated systolic hypertension. Its prevalence is expected to rise in many parts of Asia, however, clear guidance for the management is not yet provided. Second, a relatively high salt intake which is known as one of the most important risk factors for hypertension has been reported in the Asia-Pacific region. The genetic epidemiology network of salt sensitivity dietary feeding study reported that nearly 40 percent of Chinese adults were salt-sensitive. Moreover, salt sensitivity is more common in older individuals who are more susceptible to CVDs. Therefore, the action to lower salt intake is an immediate requirement. Finally, relatively poor compliance is more common in older individuals, whether it is because of their impaired functions or because of possible intolerance of medications, and drug-drug interactions. The recent trials of fixed-dose combinations and polypills showed that they may help improve compliance. However, reimbursement is still a problem in some areas.
The Asia-Pacific regional strategy including adapting the healthcare systems to solve these challenges is needed to reduce CVD-associated morbidity and mortality in our older populations.
RAG-MENA-2: CV RISK PROFILE AND LIFESTYLE PATTERN IN THE MENA
Authors: Najem Robert N , Bahous Sola Aoun 
Published: January 2023

There are large and widening global disparities in hypertension prevalence and control in the Mena region.
Almost 40% of adults in the region are either overweight or obese with high rates of childhood obesity. More than a third of the adult population in these countries having either hypertension or diabetes or both. Age at onset of CVD is lower and HTN prevalence is increasing.The prevalence of hypertension in Lebanon increased from 23.1% as reported in 2005 to 35% in 2015 and 37% in 2019. 64.1% of them were aware of it, and only 62.6% of treated participants had a controlled BP.
Since only around half of patients with hypertension in Lebanon are aware of their disease as reported previously, screening for HTN and increasing awareness are of tremendous importance for the population in Lebanon.
Collaborative efforts from national and international stakeholders are urgently needed to combat the emerging hypertension burden in low- and middle-income countries.
Stakeholders should promote blood pressure screening, access to affordable healthcare and antihypertensive medications, and adherence to antihypertensive treatment to improve hypertension control in low- and middle-income countries.
Implementation of innovative, cost-effective, and sustainable programs for hypertension prevention and control should be a public health priority for these countries.