bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS-BPP02-3: FACTORS FOR NEW-ONSET ISOLATED DIASTOLIC HYPERTENSION AND PROGRESSION TO SYSTOLIC HYPERTENSION IN JAPAN
Authors: Sakoda Takashi , Akasaki Yuichi , Kawasoe Shin , Kubozono Takuro , Sasaki Yuichi , Ikeda Yoshiyuki , Ohishi Mitsuru , Miyahara Hironori , Tokushige Koichi 
Published: January 2023

Objective:
Factors for New-Onset of isolated diastolic hypertension (IDH: systolic blood pressure ≧ 140 mmHg and diastolic blood pressure ≧ 90 mmHg) have been identified as increasing body mass index (BMI), young age at baseline, male, and BMI by analysis of the Framingham Study in middle-class Caucasians. However, in Japanese, there are few reports of predictors of IDH or the progression from IDH to systolic and diastolic hypertension (SDH: systolic blood pressure ≧ 140 mmHg and diastolic blood pressure ≧ 90 mmHg).

Method:
The present study analyzed 42,591 subjects aged 35 to 65 years who underwent a health checkup between 2007 and 2013 and re-examined 5 years later. A logistic regression analysis was performed for three patterns of blood pressure change (normal to IDH, normal to SDH, and IDH to SDH) after 5 years from the time of the first health checkup. Systolic and diastolic blood pressure, age, gender, smoking habit, exercise habit, fasting blood glucose level, total cholesterol level, heart rate, and BMI were used as factors for adjustment.

Results:
At the time of the first checkup, 29,965 subjects were normotensive, 1,169 had IDH, and 11,457 had SDH. Of the 29,965 normotensive subjects, 566 developed IDH after 5 years. Multivariate logistic regression analysis adjusted for blood pressure showed a 1-unit increase in age (OR 0.96, CI[0.95–0.97], p < 0.0001), men (OR 1.44, CI[1.14–1.82], p = 0.002), BMI (OR 1.03, CI[1.00–1.06], p = 0.002), and a 1-unit increase in heart rate (OR 1.02, CI[1.01–1.03], p < 0.0001) were independently significant predictors of developing IDH.
Of the 29,965 normotensive subjects, 4,631 developed SDH after 5 years, and all factors except heart rate were independently significant predictors. On the other hand, 612 (52%) of the 1,169 subjects with IDH at the initial visit developed SDH 5 years later. The first checkup systolic blood pressure was significantly (p < 0.0001, 132.3 ± 5.5 mmHg vs. 129.5 ± 6.5 mmHg) higher, but no factors were found to be associated with the development of SDH.

Conclusions:
In Japanese subjects, IDH predominantly occurs in young, male, obese, and high heart rate individuals. However, the progression from IDH to SDH is difficult to predict, and it is important to prevent obesity from developing IDH.
PS-BPP04-1: CLINICAL CHARACTERISTICS OF UNAWARE-UNTREATED HYPERTENSIVE SUBJECTS: FINDINGS FROM A JAPANESE HEALTH CHECKUP
Authors: Fujishima Shinichiro , Kodama Satoko , Sakai Togo , Abe Isao , Tsuchihashi Takuya 
Published: January 2023

Background and Objective:
Hypertension (HT) is one of the most important risk factors for cardiovascular disease; however, about 30% of hypertensive subjects in Japan are estimated to be left unaware-untreated. The authors studied clinical characteristics of unaware-untreated HT (UAUT-HT) subjects using data of a large health checkup and public medical insurance.

Methods:
In a Japanese city, 54,287 persons underwent a public health checkup for 40–74 years old in 2017. The information on their medical diagnosis were obtained from the national medical insurance system. Among all examinees, 28,167 (51.9%) were hypertensive (systolic blood pressure (SBP) > = 140 mmHg, diastolic BP (DBP) > = 90 mmHg, took antihypertensive agents, or had diagnosis of hypertension on the national medical insurance system). If subjects took antihypertensive agents or had HT diagnosis, they were considered as aware HT. If not, the subjects were considered as UAUT-HT. Demographic factors were compared between UAUT-HT and aware HT.

Results:
Of all HT subjects, 13,426 (47.7%) were SBP < 140 and DBP < 90 mmHg (well controlled) under treatment, 6,727 (23.9%) were BP > = 140 /90 mmHg (poorly controlled) under treatment, 3,147 (11.2%) were aware of HT but untreated, and 4,867 (17.3%) were UAUT-HT. Compared with aware HT, the UAUT-HT group was younger (age < 65y; UAUT-HT, 25%; aware HT, 16%), leaner (BMI> = 25; 27%, 36%), had more female (57%, 52%), more subjects without proteinuria (82%, 75%), higher SBP and DBP (SBP, 148 ± 11, 136 ± 16; DBP, 85 ± 10, 78 ± 11), lower fasting blood glucose (99 ± 34, 103 ± 23, mg/dl), lower HbA1c (5.8 ± 0.7, 5.9 ± 0.8, %), higher LDL-cholesterol (133 ± 33, 120 ± 30, mg/dl), lower serum uric acid (5.2 ± 1.3, 5.4 ± 1.3, mg/dl), and higher eGFR (71 ± 13, 67 ± 14, ml/min/1.73^2). These were all significant differences (p < 0.01).

Conclusion:
These results suggest that the UAUT-HT subjects are young and have favorable health condition except for high BP and LDL-cholesterol level compared with aware HT. In such relatively healthy subjects, blood pressure may not be paid enough attention to consult and treat. Social enlightenment on HT for broader population may be needed.
PS-BPP05-3: ESTIMATED IMPACT OF MEDICATION DISPENSING REFORMS FOR PUBLIC HYPERTENSION TREATMENT COVERAGE IN INDIA
Authors: Marklund Matti , Mattingly T Joseph , Sahoo Swagata Kumar , Moran Andrew E , Appel Lawrence J , Matsushita Kunihiro 
Published: January 2023

Background:
Reforms to scale up hypertension treatment are needed in India, where < 20% of individuals with hypertension have controlled blood pressure. Limited medication supply and short prescription periods are two key barriers to increase hypertension treatment coverage in the public health system.

Objective and Design:
We estimated the benefits on medication coverage of three medication dispensing reforms to increase hypertension medication coverage in India's public health system. The reforms included: 1) Increased use of single pill combinations (SPC, i.e., multiple medication classes within a pill); 2) Focused procurement by reducing the number of antihypertensive medication classes (from n = 5 to n = 3) and selecting one medication within class (e.g., amlodipine for calcium channel blockers) to be procured; and 3) Extended prescription duration (from one to three months) to reduce medication refill frequency. The alternative scenarios assuming implementation of individual or combined reforms were compared to a base case scenario (no use of SPC, current procurement of multiple medications across classes, and 1-month prescription duration). For each scenario, the maximal number of patients that could receive adequate medication was estimated using constrained optimization with a fixed budget (i.e., the cost of procuring and dispensing medication for n = 1,000 patients in the base case scenario). Microsimulation was utilized to simulate medication dispensation for individual patients, each with a specific medication requirement. Key input data on prescription patterns and medication costs were derived from publicly available sources.

Results:
We estimated that, at the same total costs as the base case scenario, ∼25% more patients could receive sufficient medication if either the use of SPC increased or if the number of medication types procured and dispensed was restricted (Figure). Even greater medication coverage was estimated if both reforms were combined (+63%,) or if all patients were dispensed SPC (+80%). Extending the prescription duration from one to three months was estimated to alone increase the medication coverage by ∼40% and could substantially enhance the effects of the other reforms when combined (e.g., Figure). The combination of only SPC and 3-month prescription can almost triple the number of patients able to receive antihypertensive medication.

Conclusion:
In India's public health care system, without additional costs to the health system, three reforms (increasing SPC use, restricting the number of medication types, and extending prescription periods) could substantially increase the number of patients to receive hypertension medications. Our study encourages the combination of these reforms to improve hypertension management coverage in India.
PS-BPP05-4: PRESCRIPTIONS OF ANTIHYPERTENSIVE DRUGS ARE INFLUENCED BY THE CHARACTERISTICS OF GENERAL PRACTITIONERS AND THEIR PATIENTS
Authors: Humbert Xavier 
Published: January 2023

Background:
Hypertension is associated with significant cardiovascular morbimortality. However, hypertension control is low, especially in France. The reasons influencing general practitioners (GP) prescription of antihypertensive drugs (AD) remains unclear. This study aimed at assessing the influence of GP and patient characteristics on AD prescriptions.

Methods:
A cross-sectional study based on a sample of 2,165 GPs working with French national health insurance was realized in Normandy (region of France) in 2019. Only GPs meeting the criteria for full-time GP practice were included. The ration of AD prescription to overall prescription volume, a relative measure of AD prescription level, was calculated for each GP and permited the low-high AD prescriber definition. Associations of this AD prescription ratio with GP age, gender, practice location, number of years of practice, number of home visits and consultations, number and age of registered patients, patient income and number of patient with a chronic condition were assessed using univariate and multivariate analysis.

Results:
The low prescribers GPs were 51.3 ± 11.2 year-old and were mainly women (56%) and practiced in urban context (53%). They prescribed less antihypertensives drugs (4% vs 8%, p < 0.001) and had more low-income patients (6% vs 4%, p < 0.001). In the multivariate analysis, low prescribers were associated to urban practice (OR: 1.47, 95%CI: 1.14;1.88), GP younger age (OR: 1.87, 95%CI:1.42;2.44), patients younger age (OR: 3.39, 95%CI: 2.77;4.15), more patients consultations (OR: 1.33,95%CI: 1.11;1.61), more low-income patients (OR: 1.44, 95%CI: 1.17;1.76) and less diabetes mellitus patients (OR: 0.72, 95%CI:0.59;0.88).

Conclusions:
Our study described a profile of the typical low er AD prescriber GP. In future work, a more detailed assessment of all components of the consultation (in particular home blood pressure monitoring use) is necessary to explain AD prescription in general practice.
PS-BPP06-3: NON-HIGH-DENSITY LIPOPROTEIN CHOLESTEROL LEVELS AS A RISK FACTOR FOR SHORT-TERM MORTALITY IN ELDERLY CHINESE: A POPULATION-BASED COHORT STUDY
Authors: Li Yan , Yuan Hong , Lu Yao 
Published: January 2023

Background:
Non-high density lipoprotein (non-HDL) levels were an important predictor of cardiovascular disease risk. However, it is unclear the relationship between non-HDL and mortality risk. This study explores the relationship between non-high-density lipoprotein levels and the risk of mortality, and the impact on long-term and short-term mortality risk.

Methods:
We analysis 621,164 elderly individuals from healthcare management receiving check-up in China basic public health service in 2010–2020. We analyzed the non-linear rela-tionship between non-HDL and all-cause and cause-specific mortality in patients receiving lipid-lowering treatment or not. Finally, the relationship between non-HDL and long-term or short-term mortality was investigated.

Results:
26,758 (4.3%) deaths were recorded at a mean follow-up of 2.03 years. The association between non-HDL and mortality was non-linear for elderly individuals. After multivariable adjustment, individuals with non-HDL < 3.29 mmol/L and > = 4.85 mmol/L increase the risk of all-cause mortality and cardiovascular mortality compared to non-HDL of 3.29 - 4.85 mmol/L. Only non-HDL < 3.29 mmol/L significantly increase the risk of cancer mortality (HR: 1.11; 95% CI: 1. 04 - 1.18, P < 0.001) and other mortality (HR: 1.16; 95% CI: 1.10 - 1.22, P < 0.001). Non-optimal concentrations of non-HDL had significant effects on both the long-term and the short-term risk of mortality, but the effect was more powerful for short-term (3 months) mortality. The non-optimal concentrations of non-HDL significantly in-creased the risk of all-cause mortality, cardiovascular mortality, and cancer mortality within 3 months. The association between non-HDL and all-cause and cause-specific mortality was not statistically significant in the elderly population receiving lipid-lowering treatment.

Conclusions:
Non-HDL was non-linearly associated with the risk of mortality, and non-optimal con-centrations of non-HDL significantly increased short-term mortality in elderly Chinese. As the possibility of confounding may exist, further research is necessary.
PS-BPP06-4: AGE-DEPENDENT INCREASE IN DIETARY SALT INTAKE IN THE JAPANESE ADULTS
Authors: Dohi Yasuaki , Sugiura Tomonori , Takase Hiroyuki 
Published: January 2023

Objective:
More than half of all cardiovascular disease deaths have been attributed to high blood pressure. Although numerous factors are involved in the development of hypertension, excess dietary salt intake is quite important because it is a modifiable factor. Obviously, tracking alterations in salt intake with age is important for developing population-based strategies to lower salt intake. However, how salt intake changes with age at the individual level has not been intensively studied in the general population. Thus, the present study was designed to investigate changes in salt intake with age in individuals in the general population.

Design and Methods:
In this observational follow-up study, apparently healthy men and women age > 30 years who participated in a baseline medical checkup (2008–2009) at our center and had a medical checkup 10 years later (n = 2598) were enrolled. Salt intake was estimated by spot urine analysis. Yearly changes in salt intake were also assessed in participants with complete annual data over the course of 10 years from baseline (n = 1543).

Results:
The follow-up study demonstrated increased salt intake (8.8 ± 2.0 to 9.3 ± 2.1 g/day, P < 0.001) with increasing age (54.0 ± 9.7 to 64.0 ± 9.8 years). Salt intake increased year over year in participants who had a health checkup annually for the 10-year follow-up period (n = 1543; analysis of variance, P < 0.001). The increase in salt intake with age correlated with an increase in blood pressure. Then, regional levels of salt intake in the baseline period (between July 2008 and June 2009) and the period 10 years later (between July 2018 and June 2019) were compared using cross-sectional analyses. The propensity-matched model revealed similar regional levels of salt intake in the baseline period (8.9 ± 2.0 g/day, 55.8 ± 11.1 years, n = 5018) and at 10 years (8.8 ± 2.0 g/day, P = 0.21; 55.9 ± 13.0 years, P = 0.65, n = 5105).

Conclusions:
Dietary salt intake gradually increased with age in men and women in the general population during the 10-year follow-up period. This should be considered in devising for population-based strategies to lower dietary salt intake.
PS-BPR01-4: A CASE OF ALDOSTERONE-PRODUCING ADENOMA DIAGNOSED BY ADRENAL ARTERIOGRAPHY AND BRANCH SELECTIVE ADRENAL VENOUS SAMPLING
Authors: Nishikawa Masaru , Kinouchi Kenichiro , Kobayashi Sakiko , Miyashita Kazutoshi , Takeda Toshikazu , Tamura Masashi , Nakatsuka Seishi , Mizutani Yosuke , Otomo Yusuke , Aoyama Kazuki , Yokota Kenichi , Kurihara Isao , Itoh Hiroshi 
Published: January 2023

Case report:
A 43-year-old man had been followed up for hypertension and hypokalemia, but self-interrupted his hospital visits for the last four years. Based on the serum potassium level of 2.7 mEq/L, plasma aldosterone concentration of 202 pg/mL, and plasma renin activity of 1.1 ng/mL/hr, he was suspected of primary aldosteronism and was admitted to the previous hospital. A saline suppression test and a rapid ACTH stimulation test were both positive, and 24-hr urinary aldosterone level was 19 μg/day under sodium loading of 170 mEq/day, leading to the diagnosis of primary aldosteronism. Since contrast-enhanced CT showed an 8 mm-sized adenoma in the lower portion of the left adrenal gland, an aldosterone-producing adenoma was suspected and a non-segmental adrenal venous sampling (AVS) was performed. However, it yielded apparent bilateral aldosterone suppression in the main trunk of the bilateral adrenal veins, where the aldosterone-to-cortisol (A/C) ratio was lower than that in the inferior vena cava even after ACTH loading. The patient was referred to our hospital for a segmental AVS. Arteriography was first performed from the left inferior adrenal artery to confirm the outflow vessels from the adenoma. Strikingly, there was an aberrant vein which drained into the proximal segment of the left adrenal vein. CT imaging at the time of arteriography revealed, in addition to the known adenoma, a 6 mm-sized micronodule in the lateral region of the left adrenal gland, and the aberrant vein appeared to be the main outflow vessel from the micronodule. A segmental AVS was performed, and blood samples were taken from the bilateral adrenal veins including the aberrant vein and the main trunk of the left adrenal vein proximal to its confluence. The A/C ratio was highest in the aberrant vein, followed by in the main trunk of the proximal left adrenal vein, while it was markedly suppressed in other branches and the main trunk of the left adrenal vein distal to the confluence of the aberrant vein. Based on these results, the presence of aldosterone-producing adenoma in the left adrenal gland was suggested. Laparoscopic partial left adrenalectomy was performed without postoperative complications. Hypertension and hypokalemia were fully resolved afterwards.

Conclusions:
Adrenal arteriography and segmental AVS should be considered in such cases that apparent bilateral aldosterone suppression is noted in conventional AVS in patients with clinically suspected aldosterone-producing adenoma.
PS-BPR02-9: RECURRENCE OF RENAL ARTERY STENOSIS BY PONATINIB, A MULTI-TARGETED TYROSINE-KINASE INHIBITOR
Authors: Kusahana Ei , Wakino Shu , Kanda Takeshi , Itoh Hiroshi 
Published: January 2023

Introduction:
Cardiovascular disease and drug induced hypertension have been reported with tyrosine-kinase inhibitor including ponatinib treatment in chronic myeloid leukemia (CML) and Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL). We report bilateral renal artery stenosis (RAS) in a patient who had received ponatinib for relapsing Ph+ALL after 2nd allogeneic stem cell transplantation.

Case:
A patient was a 40-year-old woman with no history of cardiovascular disease and hypertension. She developed myocardial damage that appeared to be ponatinib -induced, and catheterization of the heart revealed multiple coronary artery lesions and started optical medical therapy. 16 months after ponatinib treatment, she was referred to the nephrology department for evaluation of hypertension and increase in serum creatinine from 1.47 to 2.02 mg/dL. Renal ultrasonography and MRI revealed significant stenosis of the right renal artery, and angiography and stenting were performed. 5 months after the stent treatment, progression of renal dysfunction due to exacerbated RAS was observed. Intravascular ultrasonography revealed diffuse intimal thickening occurred in-stent restenosis, and balloon dilation was performed. She required balloon dilatation a total of three times even after the discontinuation of ponatinib treatment. The patient was thought to have systemic vascular endothelial damage caused by ponatinib.

Discussion:
It should be considered when hypertension and renal dysfunction occurs after ponatinib use
PS-B03-1: MECHANISM FOR INCREASED BLOOD PRESSURE VARIABILITY AND EFFECT OF AZELNIDIPINE IN RATS INFUSED WITH NORADRENALIN
Authors: Jiang Danfeng , Matsuzaki Minami , Kawagoe Yukiko , Kitamura Kazuo , Tsuruda Toshihiro , Kaikita Koichi , Asada Yujiro , Kato Johji 
Published: January 2023

Objective:
Augmented blood pressure variability (BPV) has been shown to be associated with cardiovascular diseases. There are various types of BPV depending on time periods for which BP levels are evaluated, while there are reportedly factors, such as aging and stiffened large arteries, which are related to any type of BPV. However, the mechanistic relationships between these factors and augmented variability remain to be specified. Recently, we found that 24-h BPV was augmented following continuous infusion of noradrenalin (NA) over 14 days in rats, assuming this animal as a model of augmented BPV of 24-h ambulatory BP monitoring (ABPM) of humans. The aim of the present study was to explore the mechanism underlying NA-induced BPV and the pharmacological action of the calcium channel blocker (CCB) azelnidipine, focusing on alterations in baroreceptor reflex sensitivity (BRS) and morphological findings of the aortic arch, where baroreceptors are thought to be located.

Methods:
Nine-week-old male Wistar rats were continuously infused with subcutaneous 30 ug/h NA with or without oral administration with 30 mg/kg/day azelnidipine for 14 days. BPV was evaluated by a coefficient of variation (CV) of BP recorded every 15 min under an unrestrained condition via an abdominal aortic catheter by a radiotelemetry system. To estimate BRS, data obtained from continuous BP monitoring were analyzed by a sequence technique with the software HemoLab. Sections of the aortic arch were stained with hematoxylin-eosin, and cross-sectional areas were determined by computerized measurement.

Results:
CVs of systolic and diastolic BP during 24-h period almost doubled at day 7 and 14 following continuous infusion of NA. Increased 24-h variabilities were accompanied by impaired BRS (P < 0.01) and thickened aortic media (P < 0.01) at day 14 of the infusion. Meanwhile, azelnidipine administration mostly (P < 0.01) suppressed NA-induced BPV, and significantly (P < 0.01) alleviated impairment of BRS and aortic medial thickening. When analyzed for all groups by a simple regression, CV of systolic BP at day 14 significantly correlated with reduction in BRS (r = 0.45, P < 0.01), which was associated with aortic medial area (r = 0.57, P < 0.01).

Conclusions:
The present findings suggest a possible mechanism underlying NA-induced BPV: aortic arch stiffened by medial thickening may be partly involved in impaired BRS, resulting in augmented BPV. Meanwhile, azelnidipine alleviated BPV, preserving BRS probably via inhibition of NA-induced aortic medial thickening in rats.