bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS-C18-7: EFFECT OF TOLVAPTAN IN PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE G5 AND IMPACT OF CONCOMITANT USE OF THIAZIDE DIURETICS
Authors: Uchiyama Kiyotaka , Kojima Daiki , Hama Eriko Yoshida , Nagasaka Tomoki , Nakayama Takashin , Takahashi Rina , Tajima Takaya , Morimoto Kohkichi , Washida Naoki , Itoh Hiroshi 
Published: January 2023

Objective:
Tolvaptan, a vasopressin V2 receptor antagonist, is used to treat congestive heart failure (CHF). Its diuretic effect in patients with severe renal dysfunction remains poorly characterized. Thiazide diuretics decrease urinary volume (UV) in patients with nephrogenic diabetes insipidus, in which V2 receptor function is absent. Likewise, thiazide diuretics may decrease UV in patients receiving tolvaptan.

Design and method:
This retrospective cohort study included inpatients with chronic kidney disease stage G5, in whom tolvaptan was administered for CHF. UVs at 24-h pre- and post-tolvaptan administration as well as 30-day dialysis initiation were compared between patients with and without thiazide diuretics.

Results:
Thiazide diuretics were used in 26 of 106 recruited patients (73.4 ± 13.0 years, estimated glomerular filtration rate: 8.07 ± 3.13 mL/min/1.73 m2). In contrast to those who received thiazide diuretics (1177.3 ± 686.5 vs. 1173.1 ± 629.1 mL/day, p = 0.93), patients without thiazide diuretics had significantly higher 24-h UV pre- and post-tolvaptan administration (1043.4 ± 645.6 vs. 1422.2 ± 774.0 mL/day, p < 0.001). In a multivariate regression model, the use of thiazide diuretics was significantly associated with decreased 24-h UV (beta coefficient, -486.7 [95% confidence interval (CI), -674.5 to -298.8]) and increased urine osmolality (beta coefficient, 37.7 [95% CI, 17.1–58.4]), bodyweight (beta coefficient, 0.62 [95% CI, 0.31–0.92]) and 30-day dialysis initiation (odds ratio 3.40 [95% CI, 1.18–9.82]) after tolvaptan administration.

Conclusions:
Tolvaptan had significant diuretic effects on patients with CHF, even in those with severe renal dysfunction. Concomitant use of thiazide diuretics diminished these effects.
PS-C18-12: STRESS AND COPING STRATEGY AMONG CAREGIVERS OF HYPERTENSIVE PATIENTS UNDERGOING HEMODIALYSIS- A PROSPECTIVE STUDY
Authors: Kaul Shaurya , Singh Narinder Pal , Gupta Anish Kumar , Sarkar Taposh 
Published: January 2023

Objective:
To find out the level of burden/stress, and quality of life (QoL) among caregivers of hypertensive patients undergoing hemodialysis. And, to access the coping strategies used by caregivers.

Design and Methods:
This was a prospective observational study of caregivers of hypertensive patients undergoing hemodialysis having a history of caring for hemodialysis patient for at least 3 months and who had more than or equal to 18 years of age. A scheduled interview was arranged for each participant to complete the validated inventory questionnaire; Caregivers burden (CGB) Scale, WHO-QOL-BREF scale, and COPE inventory questionnaire to measure the level of stress, QoL and coping strategies used by the caregivers.

Results:
A total of 100 caregivers of hypertensive patients undergoing hemodialysis were enrolled in the study. Age varied from 20 to 76 years (mean 39.66 ± 12.74 years). The majority of the participants were male (62.9%) married (83.5%), employed (68%), and literate (95.8%). Around half (50.5%) of the patients had reimbursed the cost of dialysis from the Government schemes. Around half of the caregivers reported medium to high (medium, high; 40.21%, 10.31% respectively) levels of stress on utilizing the CGB scale. Using the WHOQOL-BREF questionnaire, it was found that participants had an overall good QoL (Table 1). Most of the caregivers adopted turning to religion, seeking social support, positive reinterpretation, planning, and acceptance as a coping strategy (Table 1).

Conclusion:
In view of moderate to high levels of stress among caregivers of hypertensive patients undergoing hemodialysis, there may be recommendations for developing a practicing guideline to address the caregiver assessment, education, and provision of referral to support services.
PS-C19-5: SAFETY PROFILES OF SACUBITRIL/VALSARTAN IN EARLY POST-MARKETING PHASE VIGILANCE FOR THE INDICATION OF CHRONIC HEART FAILURE AND HYPERTENSION
Authors: Araki Tsunenori , Mitani Hironobu , Eguchi Shunsuke , Yarimizu Daisuke , Mori Hiromasa , Nakamura Yumiko , Tasaki Junko , Iekushi Kazuma 
Published: January 2023

Background:
The objective was to investigate and report the safety profile of Sacubitril Valsartan Sodium Hydrate (Sacubitril/Valsartan) (Entresto®) in Early Post-marketing Phase Vigilance (EPPV).

Methods:
In accordance with the regulation, the 6-month EPPV was conducted for the physicians or pharmacists at all medical institutions to which the drug was delivered. Safety information was collected and tabulated for the indication Chronic Heart Failure (CHF) (August 26, 2020 - February 25, 2021) and Hypertension (September 27, 2021 - March 26, 2022). The adverse drug reactions (ADRs) were classified using the basic terms of Medical Dictionary for Regulatory Activities (MedDRA). In addition, we focused on the five risks (hypotension, renal dysfunction/renal failure, hyperkalemia, angioedema, and dehydration) listed as Safety Specification in the Risk Management Plan (RMP).

Results:
The estimated number of patients treated with Sacubitril/Valsartan for the indication of CHF and hypertension was 24,898 and 165,000 during the data collection period. The number of ADRs were confirmed to be 850 (345 serious) for CHF and 455 (84 serious) for hypertension. No new safety findings were identified in both EPPVs. For both indications, the most common RMP-related ADRs were hypotension-related ADRs that occurred within 30 days after initiation were 87 (162 had, followed by renal dysfunction-related ADRs.
Furthermore, hypotension-related ADRs were 268 (75 serious) for CHF and 93 (three serious) for hypertension. Hypotension-related ADRs that occurred within 30 days after initiation were 87 (162 had an unavailable date of onset) for CHF and 19 (71 had an unavailable date) for hypertension.
Regarding renal dysfunction-related ADRs, the number of ADRs were 45 (45serious) for CHF and 19 (19serious) for hypertension. Renal dysfunction-related ADRs that occurred within 30 days after initiation were 17 (23 had an unavailable date of onset) for CHF and three (14 had an unavailable date) for hypertension.
The number of hyperkalemia-related ADRs, angioedema, and dehydration were 35 (including 19 serious), five (five serious), and 25 (two serious) for CHF, and nine (five serious), four (four serious), and four (sero serious) for hypertension, respectively.

Conclusion:
No new safety findings were identified during the 6-month EPPV. Furthermore, there were no differences in safety profile by indication.
PS-C19-9: CLINICAL EFFECTS OF ARNI (SACUBITRIL/VALSARTAN) IN PATIENTS WITH CHRONIC KIDNEY DISEASE WITH HYPERTENSION
Authors: Kobayashi Norihiro , Nakatani Yoshihisa , Shimizu Kazuyuki , Nakano Yukihito , Sakaguchi Mika , Arima Shuji 
Published: January 2023

Purpose:
ARNI (Sacubitril / Valsartan) is known to have natriuretic effects in addition to vasodilatory effects, cardiac hypertrophy, and antifibrosis. Therefore, it is considered to have a great effect on blood pressure and is used as an antihypertensive drug. However, the details of improvement of blood pressure changes in CKD patients are clearly unknown. Here we examine the clinical effects of ARNI administration in CKD patients by stage of renal function.

Subject and Method:
41 CKD patients who started enresting for hypertension from September 27, 2021 to February 28, 2022, and 26 of them were able to follow up for a period of 3 months or more after oral administration. Patient profiles by renal function are 9 persons stage G3 (eGFR30–59), 4 persons stage G4 (eGFR15–29), 9 persons stage G5 (less than eGFR15), 3 persons stage G5D (during dialysis) PD, and 1 person HD + PD. Blood Pressure, eGFR, protein quantification, and NT-proBNP are measured before and after administration for a period of 3 months or more, and analysis was performed by two-way ANOVA with a mixed model using SPSS. In addition, ABPM was performed before and after ARNI administration in 9 of them (6 treatment-resistant hypertension), and the diurnal variation pattern, changes in proteinuria and renal function were also examined.

Result:
Before and after ARNI administration, blood pressure decreased and edema improved in most patients. There was no interaction with the rate of decrease in GFR (significance probability 0.972). In addition, urinary protein increased to 1.57 g/gCre (mean difference 95% confidence interval 0.175–2.966, significance probability 0.006 interaction). NT-proBNP decreased before and after administration.
In stage G3, the dipper type of ABPM did not change, and the non-dipper type improved slightly. In stage G5 it was improved the degree of descent at night, and a change in category. However, in the case of peritoneal dialysis, the mean blood pressure did not improve, and the effect of pattern improvement was not observed.

Discussion / Conclusion:
ARNI was found to exert a strong antihypertensive effect on CKD patients that has not been treated with dialysis. And ARNI did not affect the antihypertensive effect even if there is residual urine during the dialysis period. In addition, edema can be expected to have a reducing effect regardless of proteinuria, and if blood pressure can be lowered firmly, it can also be expected to have a reducing effect on proteinuria.
PS-C20-7: CARDIOVASCULAR SAFETY OF OLMESARTAN FOR MODERATE HYPERTENSIVE PATIENTS: A MULTICENTER COHORT STUDY USING A COMMON DATA MODEL
Authors: Kim Ju Hyeon , Lim Subin , Chung Se Hwa , Yum Yunjin , Joo Hyung Joon , Kim Yong Hyun , Kim Eung Ju 
Published: January 2023

Objective:
Olmesartan has been linked to numerical imbalances of cardiovascular mortality compared to placebo group. There is a paucity of contemporary data on real world evidence of this agent in different study populations. We sought to investigate clinical outcomes between olmesartan and other anti-hypertensive medications in moderately hypertensive patients.

Design and method:
This multicenter, retrospective study used the Korea University Medical Center database built on electronic health records from 2017 to 2020. Patients prescribed with at least two antihypertensive drugs as combined therapy were followed up for 3 years. The primary endpoint was a composite of all cause mortality, myocardial infarction, stroke, and heart failure. Adjusted outcome was compared with the use of propensity score matching (PSM).

Results:
Among 20,835 patients, 3,508 (16.8%) were olmesartan initiators from Jan 2017 to Dec 2017. Average age was 64 years, 45% were men, and 41% had diabetes. Olmesartan group were younger, more often women, and less likely to have diabetes mellitus and chronic kidney disease. The 3 year cumulative incidence of the composite primary endpoint was similar in both groups (4.9% vs. 5.7%, log rank p = 0.06). After PSM, the adjusted 3 year rate of the primary endpoint was similar between two groups (7.4% vs. 7.1%, log rank p = 0.72). In multivariable analysis, olmesartan use was associated with an adjusted hazard for the primary outcome of 0.95 (95% confidence interval, 0.83 to 1.10).

Conclusions:
Olmesartan combination for moderately hypertensive patients showed similar cardiovascular outcomes in real world practice, and there is no robust signal for harm with olmesartan use.
PS-C21-5: EFFICACY OF SWITCHING FROM EPLERENONE TO ESAXERENONE FOR THE TREATMENT OF PRIMARY ALDOSTERONISM
Authors: Sugiyama Toru , Tomino Yuki , Chounabayashi Minami , Saeki Kousuke , Hayakawa Eri 
Published: January 2023

Background:
Mineralocorticoid receptor (MR) antagonist is the first choice for medical therapy for primary aldosteronism (PA) due to bilateral adrenal disease. However, there are many cases of PA in which blood pressure control are inadequate and/or suppression of renin are insufficiently released even under the maximum dose of eplerenone (EPL) approved in Japan. In this study, we investigated the effect of switching to the novel MR antagonist Esaxerenone (ESX) in PA patients whose renin suppression was not released even under the maximum dose of EPL.

Methods:
Twenty-seven patients (age; 53 ± 10 years, male/female; 14/13) who were diagnosed with PA at our hospital and showed plasma renin activity (PRA) < 1.0 ng/mL/hr even under EPL 100 mg/day were switched to ESX. We investigated changes in blood pressure, PRA, plasma aldosterone concentration (PAC), blood biochemical findings, and concomitant antihypertensive agents in these patients for 12 months.

Results:
Systolic and diastolic blood pressure decreased significantly from 1 month (133 ± 12/84 ± 8 mmHg) to 12 months (127 ± 10/80 ± 9 mmHg) compared to before switching to ESX (140 ± 16/88 ± 11 mmHg), whereas the rate of concomitant use of other antihypertensive agents did not change (44.4% ¡ú 45.0%). PRA (0.5 ± 0.4 ng/mL/hr) increased significantly from 6 months (0.6 ± 0.4 ng/mL/hr) to 12 months (0.8 ± 0.6 ng/mL/hr). PAC (191 ± 83 ¡ú 188 ± 110 pg/mL), serum potassium (4.3 ± 0.3 ¡ú 4.4 ± 0.4 mEq/L), AST (20 ± 6 ¡ú 22 ± 4 U/L), ALT (21 ± 11 ¡ú 21 ± 5 U/L) and γGTP (34 ± 41 ¡ú 38 ± 34 U/L) did not change. Estimated GFR (78 ± 14 ¡ú 70 ± 15 mL/min/1.73m2) gradually decreased.

Conclusions:
These results suggest that ESX is a more potent antagonist of MR with equivalent safety to EPL in the management of PA.
PS-C22-4: ASSOCIATION OF ATRIAL NATRIURETIC PEPTIDE GENETIC POLYMORPHISMS WITH ARTERIAL HYPERTENSION IN MONGOLIAN POPULATION
Authors: Unurjargal Tsolmon , Byambatsogt Bolortuul , Sodovsuren Naranchimeg , Sukhbaatar Pagmadulam 
Published: January 2023

Objective of the present study was to evaluate the association between polymorphisms of atrial natriuretic peptide(ANP) gene and arterial hypertension.

Design and method:
This study was conducted in Ulaanbaatar between October 2018 and November 2019 years. A case-control study was performed in 123 subjects including 82 hypertensives and 41 normotensive subjects, aged 20–60 years. The family history of cardiovascular disease and risk factors of hypertension were taken by questionnaires and body mass index, systolic and diastolic pressures were evaluated by physical examination. Hypertension was defined as systolic BP ≧ 130 mm Hg and/or diastolic BP ≧ 80 mm Hg. After isolation DNA from peripheral blood, specific primers were used for PCR to detect the mutations of gene by using ThermoFisher dream Tag DNA Polymerase. QIAGEN QIAquick PCR purification kit and QIAquick Gel extraction kit were used to establish nucleic acid sequence. The study was approved by the Ethics Committee of Mongolian National University of Medical Sciences and all subjects participated in the study after making signed informed consents.

Results:
The mean age of the participants was 40.2 years and 56.1% were men. The T2325C variant of ANP gene was identified in 4.9% of all participants. According to the genotype results, the frequencies of T2325C polymorphism of the ANP gene were 1.2% in hypertensive patients and 12.2% in normotensive subjects respectively. The partial DNA sequence in ANP gene was shown in Figure 1. DNA sequencing showed a thymine to serine substitution at nucleotide 2325. Compared with individuals without T2325C polymorphism, individuals with T2325C polymorphism had higher percentage of family history of cardiovascular disease.

Conclusion:
The genetic polymorphism in ANP gene identified for the first time in the Mongolia.
This case-control study indicated that the ANP T2325C gene polymorphism may have no relationship with arterial hypertension.
PS-C22-6: PERFORMANCE OF PREDICTION ALGORITHM FOR THE SUBTYPE DIAGNOSIS OF PRIMARY ALDOSTERONISM WHICH WAS ADVOCATED IN THE JAPAN PRIMARY ALDOSTERONISM STUDY
Authors: Kobayashi Sakiko , Kurihara Isao , Yokota Kenichi , Kinouchi Kenichiro , Nakamura Toshifumi , Miyashita Kazutoshi , Itoh Hiroshi 
Published: January 2023

Objective:
In the part of the Japan Primary Aldosteronism Study (JPAS), the prediction algorithm for the subtype diagnosis of primary aldosteronism (PA) was advocated and published in 2018 (Umakoshi.H et.al, J Clin Endocrinol Metab, 2018, 103(3):900–908). In the algorithm, patients with PA with bilateral normal results on CT and normokalemia likely have a low prior probability of a lateral form of PA in AVS (6.2%) and could be treated medically, whereas those with unilateral visible mass on CT and presence of hypokalemia have a high probability of a lateralized form of PA in AVS (70.6%). To validate the efficacy of the algorithm, we applied the algorithm for recent PA cases in our institute, Keio University hospital.

Patients:
A total of 77 patients with PA who underwent adrenal venous sampling (AVS) between November 2018 and October 2019 were enrolled in this study. They were classified into four groups according to CT findings and potassium status. Subtype diagnosis of PA was determined by AVS.

Results:
In our case, the prevalence for unilateral hyperaldosteronism on AVS was as follows: CT-negative with normokalemia, 7.9%; CT-positive with normokalemia, 15.4%; CT-negative with hypokalemia 22.2%, and CT-positive, 71.4%. The results were quite similar to the results in the previous report. In the algorithm, it was stated that AVS could be spared in patients with unilateral lesion on CT and hypokalemia if they were younger than 35 years, however, in our cases, there was one patient whose age was 30 with unilateral lesion on CT and hypokalemia and the AVS result of whom indicated bilateral PA. In the algorithm, it was also stated that AVS could be spared in patients with bilateral lesions on CT and normokalemia if plasma aldosterone concentration was less than 8 ng/dl and it was consistent in our cases.

Conclusion:
Overall, the prediction algorithm for the subtype diagnosis of PA developed in JPAS could be applied well in our recent PA cases.
PS-C27-2: RISK OF PSEUDO-MICROALBUMINURIA DURING MENSTRUAL SITUATION IN APPARENTLY HEALTHY WORKERS
Authors: Munakata Masanori , Hattori Tomomi , Nakayama Fumie , Konno Satoshi , Ioue Nobutaka , Nakamura Tomohiro , Hozawa Atsushi 
Published: January 2023

Background:
Measurement of urinary albumin excretion (UAE) is useful for the prediction of future cardiovascular event and is now used not only in clinical but also in health-check up or industrial settings. Especially, microalbuminuria (MA) is an important category of early vascular marker to alert lifestyle modification and/or pharmacological treatment. In the working female population, however, examination of urine in above settings could encounter menstrual situation. Contamination of menstrual blood into urine could induce pseudo-microalbuminuria. However, it has never been studied in apparently healthy women how much of contamination of menstrual blood could increase the risk of pseudo-microalbuminuria. To address this issue, we examined the relationship between urine occult blood level and UAE or frequency of MA cases during menstrual and non-menstrual situation in apparently healthy workers.

Subjects and method:
We studied 735 female school workers who participated in the Miyagi Karoshi Prevention study. Urinary albumin excretion adjusted for creatinine (UAE) from morning spot urine sample was examined together with annual health check-up in 2019 and 2020. Menstrual situation was confirmed by a questionnaire at the time of examination. One hundred and forty-four non-diabetic, non-hypertensive women without chronic kidney disease (36.9 ± 9.2yrs) were studied either during menstrual or non-menstrual situation in the 2 consecutive years. We compared clinical data during menstrual and non-menstrual situation and then examined the dose-response relationship between urine occult blood category (negative to three plus) and UAE or frequency of MA cases at menstrual and non-menstrual situation.

Results:
Menstrual situation was associated with significantly higher UAE (4.6 vs. 3.4 mg/gCr, p < 0.001), systolic BP (113.6 ± 13.1 vs. 111.3 ± 12mmHg, p = 0.015) and uric acid level (4.3 ± 0.8 vs. 4.10.9 ± mg/dl, p = 0.004) and was associated with significantly lower high density lipoprotein cholesterol (70.0 ± 14.4 vs. 72.7 ± 16.3 mg/dl, p < 0.001) and eGFR(85.0 ± 14.6 vs, 87.7 ± 16.9 ml/min/1.73m2, p = 0.003) as compared with non-menstrual situation. In menstrual situation, UAE was dose-dependently increased with an increase in urine occult blood category (p < 0.001). Frequency of MA in each urine blood category was 0, 0, 4.5, 0 and 17% (p = 0.001), respectively. UAE was not correlated with systolic BP or other parameters during menstrual situation. In non-menstrual situation, there was no correlation with UAE and urine occult blood level.

Conclusion:
Risk of pseudo-microalbuminuria could abruptly rise if urine occult blood level reach three plus in menstruated women.
PS-C27-4: CONTROLLED RESISTANT HYPERTENSION FOLLOWING A SUCCESSFUL RENAL ARTERY STENTING: A RARE CASE REPORT IN A DEVELOPING COUNTRY
Authors: Munita Fatihatul Firdaus , Wahyudi Dendy Puji , Tiksnadi Badai Bhatara , Hadian Widi Nugraha 
Published: January 2023

Introduction:
Renal artery stenosis is among the etiologies of secondary hypertension in which the diagnosis and therapy are difficult. We report a case of a patient suffered from uncontrollable hypertension with frequent episode of malignant hypertension, treated with renal artery stenting.
Case Description: A 36-year-old female visited cardiovascular policlinic on a routine control for her hypertension. Having diagnosed with hypertension for two years, he had several episodes of malignant hypertension. At the beginning of her treatment, she was prescribed an angiotensin-converting-enzyme inhibitor yet her pressure was not only uncontrolled but also worsen. By the visit, she was medicated using two alpha-2-adrenergic agonists, a loop diuretic, a beta-blocker, a calcium-channel blocker, an angiotensin-receptor blocker, and an aldosterone-receptor antagonist without any satisfactory outcome on her blood pressure status. She had a blood pressure of 196/130 mmHg with tachycardia of 112 times/minute. We found cardiomegaly on physical examination which proven by chest x-ray. Echocardiography indicated hypertensive heart disease. Screening for secondary hypertension, including laboratory tests (complete blood count, potassium, sodium, creatinine, fasting glucose, fasting lipid profile, urinalysis, thyroid stimulating hormone, 24H urinary free cortisol) suggested normal results. Renal ultrasound and doppler were also conducted and showed a suspicion of right renal artery stenosis. Therefore, angiography of the renal artery was conducted for diagnostic and therapy when indicated. The angiography suggested a normal left renal artery while the right artery had a 95% stenosis on the proximal part. An intravascular ultrasound-guided percutaneous transluminal angioplasty on her right renal artery was conducted and two vascular stents were implanted. The patient showed a remarkable development following her decreasing blood pressure on follow-up. After 1 week, her blood pressure is now controllable on a single antihypertensive and antiplatelet therapy.

Conclusion:
The diagnosis and management of a patient with resistant hypertension might be challenging, particularly in the setting of a developing country. Renal artery angiography, among other examination, might be crucial in the diagnosis sequence, yet was not always readily available. We present a case in which diagnosis of renal artery stenosis was made followed by a definite treatment resulting in a remarkable hypertension control. An identifiable etiology is the key to a proper and the best treatment option for the patient.