bluuebunny/crossref_metadata_2025_split huggingface dataset:
S-56-1: CLINICAL TRIALS OF TELEMONITORING TO SUPPORT THE MANAGEMENT OF HYPERTENSION IN PRIMARY CARE AND PREGNANCY
Authors: McManus Richard J 
Published: January 2023

This talk will review the evidence of telemonitoring in the remote management of hypertension both in primary care and in pregnancy. It will start by introducing the issues around why current hypertension management is sub-optimal. It will review the evidence that self-monitoring of hypertension, linked to electronic can assist both clinicians and their patients in the management of hypertension. It will review the impact on blood pressure of different types of intervention, concentrating on telemonitoring. It will consider the pros and cons of including patients in their own management, including self-management. The pregnancy section will review the translation of lessons learnt in the wider field into the care of pregnancy hypertension and summarise the results of recent clinical trials and linked studies.
The lecture will be illustrated with examples from the literature including from the TASMIN trials, HOME-BP and the recently published BUMP trials. The use of trial data linked to clinical epidemiology will be used to show how such results can inform daily practice.
The session will end with consideration of how such evidence is now being implemented into daily practice and consideration of how this has allowed remote care to be maintained during the pandemic.
S-58-2: CUFFLESS WEARABLE 24-HOUR BLOOD PRESSURE MONIT ORING VERSUS STANDARD AMBULATORY MONITORING
Authors: Tan Isabella , Gnanenthiran Sonali R , Chan Justine , Kyriakoulis Konstantinos G , Schlaich Markus P , Stergiou George S , Schutte Aletta E 
Published: January 2023

Objective:
Cuffless wearable blood pressure (BP) monitors have great potential in assessing 24-hour BP without user disturbance for weeks and months. However, it is uncertain whether these devices can accurately track BP changes during usual daily activities and sleep as with standard 24-hour ambulatory BP monitoring (ABPM). We assessed daytime and nighttime BP using a commercially available cuffless wearable BP device versus classic ABPM.

Design and method:
We included 45 individuals (age 58 ± 14 years [mean ± SD], 33% female, 80% hypertensive) in two centres (Perth, Australia; Athens, Greece). Participants used a cuffless wearable BP monitor (Aktiia, Switzerland) continuously for 7–10 days and 24-hour ABPM (MicroLife WatchBP O3, Switzerland) on the first and the last day of cuffless BP monitoring. Daily 24-hour, daytime, and nighttime BP values were averaged across the total study days for the cuffless device and across the two ABPM days.

Results:
The cuffless device reported higher systolic BP for 24-hours by 6.8 mmHg, 95%CI [3.7, 9.7], daytime by 3.8 mmHg [1.0, 6.7], and nighttime by 17.5 mmHg [13.6, 21.4] (all p < 0.01). Cuffless 24-hour diastolic BP was comparable with ABPM (difference 1.2 mmHg, 95%CI [-1.0, 3.5]), as was daytime diastolic BP (-0.8 mmHg [-3.0, 1.3]) (both p. < 27). However, the cuffless device reported higher nighttime diastolic BP by 9.2 mmHg, 95%CI [6.3, 12.2] (p < 0.001). Nighttime dip as measured by the cuffless device, namely systolic BP (-5.1 mmHg, 95%CI [-13.7, 3.6]) and diastolic BP (-3.8 mmHg [-11.6, 4.2]) were substantially less than ABPM (systolic BP dip: -18.0 mmHg [-35.5, -1.2]; diastolic BP dip: -13.8 mmHg [-27.2, -0.8]). The cuffless device identified 44 nighttime non-dippers (defined as a relative dip < 10%) for systolic BP and 42 non-dippers for diastolic BP, compared to 10 non-dippers for both systolic and diastolic BP as identified by ABPM (both comparisons p < 0.001).

Conclusions:
The Aktiia cuffless wearable BP device considerably overestimated average systolic BP compared to classic ABPM and was unable to adequately track diurnal BP variation.
S-58-4: ARE CUFFLESS BLOOD PRESSURE MEASURING DEVICES READY FOR CLINICAL USE?
Authors: Stergiou George S 
Published: January 2023

Several cuffless BP measuring devices are currently available on various markets claiming that they provide accurate measurements, and few have some regulatory approval. These technologies may provide numerous BP readings in different settings and activ ities of daily life without using a disturbing cuff. Thus, they have considerable potential to improve the awareness, treatment, and management of hypertension by. The crucial question is whether thjey can provide accurate measurement of BP. Microsoft Research recently published a major engineering paper presenting results of the Aurora Project assessing the accuracy of several PWA and PWA-PAT devices using radial tonometry, photoplethysmography, electrocardiography, and accelerometry signals in 1,125 participants, including younger and older individuals with low or high BP. The overall results were negative. Smaller recent studies also showed negative results. In a recent study, finger PPG waveform analysis and PAT explored during several interventions inducing BP changes the test device had some value in predicting changes in auscultation SBP but not DBP. Another study of a cuff-calibrated wristband device tested against standard 24-h ambulatory BP showed that the cuffless device was unable to track the BP drop during nighttime sleep. In a third study, a cuff-calibrated smartwatch device showed a systematic bias towards the cuff BP at calibration and could not accurately measure BP compared to standard 24-h ambulatory monitoring.
On the other hand, two recent studies showed positive results. The first showed that a cuff-calibrated device could almost perfectly predict average ambulatory BP, and the second showed that a demographics-calibrated device could predict invasive BP. Although the scientific community, patients, and the public are eager to adopt cuffless BP devices in routine use, further research is needed to bring these technologies to primetime. A recent statement by the ESH Working Group on BP Monitoring recommended not to use cuffless BP devices for the diagnosis and management of hypertension. These technologies and devices require further development and proper testing in independent studies. In addition, there is an urgent need for establishing protocols which are specific for validating cuffless devices, as the Universal Standard (AANMI/ESH/ISO) for testing automated cuff devices is not applicable to cuffless devices. Developing such protocols is challenging, and the current ones require further vetting (IEEE 2014 and ISO under development). Thus, fundamental research questions need to be carefully addressed before cuffless BP devices can be recommended for clinical use.
APSH-OP-4: HISTOLOGICAL MEASURES OF STRUCTURAL KIDNEY DAMAGE ARE ASSOCIATED WITH SHORTENING OF KIDNEY TELOMERE LENGTH
Authors: Akinnibosun Olutope Arinola , Eales James , Nguyen Huy , Bogdanski Pawel , Szczechowska Ewa Zukowska , Denniff Matthew , Dromer John , Tomaszewski Maciej , Charchar Fadi 
Published: January 2023

Objective:
Telomeres shorten with each cell division and serve as markers of cell senescence. The rate of telomere attrition varies across tissues within the same individual. Telomere attrition and dysfunction has been associated with various disease states. Studies have shown that leukocyte telomere length (LTL) may be predictive of telomere length in other tissues of the body. Several histological changes occur in the kidney before functional impairment becomes evident. It is unclear if telomeres are associated with these early changes. We sought to (i) investigate whether LTL is a proxy of kidney telomere length (KTL), and (ii) estimate the extent to which both measures of biological ageing associate with histological markers of kidney damage.

Design and Methods:
Study group consisted of 200 participants (Female 38% and Male 62%) from the TRANScriptome of renaL humAn TissuE (TRANSLATE) study. Participants had no personal history of primary nephropathy and were eligible for unilateral elective nephrectomy because of sporadic non-invasive renal cancer. Kidney tissue samples were collected from the healthy (unaffected by cancer) pole immediately after nephrectomy and fixed in 10% formalin, then embedded in paraffin blocks. The extent of kidney histological damage was assessed using a semi-quantitative method of kidney slide evaluation. LTL and KTL were quantified using quantitative polymerase chain reaction.

Results:
There was a significant negative correlation between KTL and age (r = -0.287, P < 0.001). The correlation between LTL and age showed directionally consistent, but non-significant pattern (r = -0.135, P = 0.063). Unadjusted and adjusted analysis showed insignificant association between LTL and KTL (r = 0.042, P = 0.575). However, both KTL and LTL correlated with tubular atrophy (r = -0.28, -0.16; P < 0.001, 0.05, respectively). Each increased unit of both KTL and LTL also associated with a decrease of 61.3% and 47.4%, respectively in likelihood of developing tubular atrophy (Table 1). Shorter KTL was associated with increased odds of developing interstitial fibrosis, interstitial inflammation, and Bowmans capsule thickening (Table 1). KTL also associated with percentage of Bowmans capsule thickening (β = -0.214, P = 0.027), percentage of sclerosed glomeruli (β = -0.227, P = 0.017), and Remuzzi score (β = -0.280, P = 0.001). In contrast, LTL did not show an association with any other kidney histology variables, except with tubular atrophy in adjusted analysis.

Conclusions:
LTL shows only a weak association with tubular atrophy and KTL is a much more accurate measure of histologically confirmed structural kidney damage than LTL. LTL cannot be used as a proxy of KTL or the extent of kidney damage.
AW-NI-2: A HIGH-FIBRE DIET ATTENUATES HYPERTENSION BY IMPROVING GUT BARRIER INTEGRITY VIA SCFA-RECEPTOR SIGNALLING
Authors: Muralitharan Rikeish R , Dinakis Evany , Xie Liang , Jama Hamdi , Nakai Michael , Paterson Madeleine , Johnson Chad , Salimova Ekaterina , Bitto Natalie , Liaskos Maria Kaparakis , Donnell Joanne A O , Mackay Charles R , Marques Francine Z 
Published: January 2023

Objective:
The gut microbiome has been recently discovered to play a role in blood pressure (BP) regulation. Short-chain fatty acids (SCFAs), produced from the fermentation of fibre by the gut microbiota, are protective in experimental hypertension models. However, whether the protective effects of fibre are dependent on SCFA-receptor (GPR41, GPR43) signalling is not known. This is relevant as hypertensive patients have a deficiency in GPR43. We aimed to determine whether SCFA-receptor signalling is relevant in hypertension, whether the protective effects of a high-fibre diet depend on SCFA-receptor signalling, and the underlying mechanisms involved.

Design and Methods:
We induced hypertension using angiotensin II (Ang-II, 0.5 mg/kg/day) in wild-type and the novel GPR41/43 double knockout (DKO) male mice (n = 9–15). We fed wild-type and DKO mice high-fibre (n = 6–7) or standard diets (n = 9–15). Another cohort received TLR4 antagonist treatment (n = 6–7). We measured BP by tail-cuff, performed Mason trichrome staining for fibrosis in the heart and kidney, and immunofluorescence staining for zonulin-1, a key tight junction protein to determine gut permeability, in the colon.

Results:
When fed a standard diet and challenged with Ang-II, DKO mice had significantly higher BP, mortality, cardiorenal hypertrophy and fibrosis, and lower zonulin-1 in the colon compared to wild-type mice (all P < 0.05). A high-fibre diet partially protected DKO mice, resulting in significantly lower BP, mortality, cardiorenal hypertrophy, and fibrosis (all P < 0.05). Mice fed high-fibre had significantly higher zonulin-1 expression in the colon (P < 0.05), meaning that a high-fibre diet improved gut barrier integrity. This suggests that the protective effects of high-fibre partially depend on GPR41/GPR43 signalling. Hypertensive wild-type and DKO mice had significantly higher plasma TLR4 activation suggesting its ligand, microbial lipopolysaccharides (LPS), is in the circulation (P < 0.05). TLR4 activation leads to inflammation and subsequent tissue damage that could be responsible for the phenotype observed. Thus, we treated hypertensive DKO and wild-type mice with a TLR4 antagonist (i.p., injection of 50 μg/kg/body weight twice weekly). The severity of DKO hypertensive mice was rescued to the level of WT when treated with the TLR4 antagonist - no difference from wild-type mice in terms of BP, mortality, organ weights, and fibrosis.

Conclusions:
We revealed for the first time that a high-fibre diet attenuates hypertension by improving gut barrier integrity via the SCFA-receptors GPR41 and GPR43. This leads to lower translocation of harmful microbial substances such as LPS from the gut and activation of its receptor TLR4 to induce inflammatory responses that promote hypertension.
AW-NI-5: COST-EFFECTIVENESS OF INTENSIVE VERSUS STANDARD BLOOD-PRESSURE CONTROL AMONG HYPERTENSIVE PATIENTS IN TAIWAN: A SIMULATION MODELLING STUDY
Authors: Liao ChiaTe , Toh Han Siong , Wei Dongmei , Melgarejo Jesus , Chang WeiTing , Zhang Zhenyu 
Published: January 2023

Objective:
Based on the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial and A Randomized Trial of Intensive versus Standard Blood-Pressure Control (SPRINT) trial, the 2022 Taiwan hypertension guidelines recommend the definition of hypertension as 130/80mmHg and a universal BP target of < 130/80 mmHg. Based on the guidelines, we aimed to analyze the lifetime cost-effectiveness of intensive versus standard blood-pressure control from the perspective of Taiwan national payer.

Design and method:
A simulation model was employed to apply the SPRINT treatment effects for hypertensive patients aged 50–54 and 55–64 years and STEP treatment effects for those aged 65–74 and 75+ years. The medical costs and utility were extracted from national sources or published data to a hypothetical cohort of SPRINT-eligible and STEP-eligible patients in Taiwan. Incremental cost-effectiveness ratio (ICER) against the willing-to-pay threshold at the one-time gross domestic product (GDP) per capita was used to evaluate whether intensive versus standard blood-pressure control was cost-effective.

Results:
Intensive blood-pressure control produced more lifetime medical costs than standard control, i.e., US$39,348–22,978 versus US$20,239–33,414, while intensive treatment also contributed to more quality-adjusted life-year (QALY), i.e., 7.60–16.28 versus 7.37–15.74. ICER values of intensive versus standard treatment were approximate US$10,989 (NT$329,670), US$11,220(NT$336,600), US$11,485(NT$344,550), and US$11,865(NT$355,950) per QALY gained for hypertensive patients aged 50–54, 55–64, 65–74, and 75+ from the perspective of Taiwanese national payer. Simulation results indicated that intensive treatment is very likely to be cost-effective, i.e., all probabilities are greater than 99.8% below the willing-to-pay threshold of US$36,000 (NT$1,080,000).

Conclusions:
In this simulation study, intensive blood-pressure control in the Taiwanese population produced fewer cardiovascular events and acceptable costs per QALY gained, enormously below the willing-to-pay threshold. The cost-effectiveness of intensive blood-pressure control was consistent across different ages, and the advantage was more predominant in younger hypertensive patients.
JS-NG-5: THROMBOTIC MICROANGIOPATHY OR MALIGNANT HYPERTENSION: WHICH COMES FIRST? A CASE REPORT FROM A TERTIARY CARE HOSPITAL
Authors: Vitkauskaite Monika , Macioniene Ernesta , Janusaite Marta Monika , Cerkauskaite Agne , Asakiene Egle , Dobrovolskiene Rasa , Serpytis Mindaugas , Judickas Sarunas , Miglinas Marius 
Published: January 2023

A 66-year-old woman with a history of arterial hypertension was admitted to the emergency department (ED) due to disorientation. She reported a severe headache, nausea, vomiting in the evening prior the admission; her blood pressure (BP) when the ambulance arrived was 220/100 mmHg. During admission, BP was 158/91 mmHg, pulse 95 beats/minute, oxygen saturation 88% on room air, body temperature 36.6°C.
The urine examination showed that urine protein was 3+, red blood cell count 10 mg/L. The whole blood cell analysis revealed neutrophilic leukocytosis, thrombocytopenia (Table). There was 1 schistocyte seen in the peripheral blood smear. The serum creatinine and urea values were raised (Table) with elevated level of D-dimers (1690 mcg/L (< 250 mcg/L)). Head CT showed no signs of hemorrhage or ischemia. Ceftriaxone, ampicillin, and acyclovir were initiated for suspected neuro-infection, she also underwent transfusion with 4 units of platelets due to thrombocytopenia. Patients GCS fell from 11 to 9 over 13 hours, therefore she was transferred to the intensive care unit (ICU). Cerebrospinal fluid analysis showed cytosis 15 cells/mcL (predominance of lymphocytes) and protein level of 1,073 g/L; PCR panel for the most common bacterial and viral meningitis agents came back negative.
On day 2, lactate dehydrogenase level was raised at 3086 U/L (125–243 U/L), haptoglobin was < 0.08 g/L (0.3–2.0 g/L) and Coombs test was negative. Due to worsening renal function (Table) hemodialysis was initiated. The differential diagnosis included thrombotic thrombocytopenic purpura, atypical hemolytic-uremic syndrome (HUS), secondary thrombotic microangiopathy (TMA), immune thrombocytopenic purpura (ITP) and disseminated intravascular coagulation (DIC). ADAMTS-13, CH50, SC5b-9 levels were tested (0.53 TV/ml (0.40–1.50 TV/ml), 60 U Eq/ml (55–75 U Eq/ml), 4689 ng/ml (200–325 ng/ml), respectively). The patient started on plasmapheresis. On day 3, fundoscopy showed cotton wool spots (ischemia) with hemorrhages and soft exudates next to the optic nerve disc; intravenous methylprednisolone pulse therapy was administered (1 g daily for three days followed by oral methylprednisolone 32 mg daily). Renal biopsy on day 5 revealed active TMA damaging the glomeruli and acute tubular necrosis. After 15 days in the ICU, she remained hypertensive and anuric despite given treatment. Moreover, pulmonary edema occurred on day 15.
Malignant hypertension (MH) is characterized by severe hypertension and multi-organ ischemic complications. It can cause TMA and the overall presentation may imitate primary TMA. The approach of renal TMA in MH remains challenging. Herein, we reported a case of MHT with biopsy-proven TMA in the kidney.
JS-NG-7: ASSOCIATION BETWEEN PLASMA ALDOSTERONE CONCENTRATION AND AMBULATORY BLOOD PRESSURE PROFILE IN PATIENTS WITH PRIMARY ALDOSTERONISM
Authors: Morita Ryutaro , Azushima Kengo , Sunohara Sumire , Kanaoka Tomohiko , Wakui Hiromichi , Toya Yoshiyuki , Tamura Kouichi 
Published: January 2023

Background:
Primary aldosteronism (PA) is a major cause of curable hypertension with its morbidity rate 5–10% in hypertensive patients reported, and thus is highly prevalent in patients with hypertension, a cause of resistant hypertension, and closely associated with target organ damage compared with essential hypertension. Although an altered circadian blood pressure (BP) rhythm estimated by ambulatory blood pressure monitoring (ABPM) has been highlighted as a major contributor of CVD in essential hypertension, there would be very few reports investigating clinical significance of ABPM in PA patients. Therefore, we aimed to examine a possible association between plasma aldosterone concentration (PAC) and ABPM profile in PA patients.

Methods:
Consecutive 27 PA patients, who had been diagnosed by the functional tests and underwent adrenal venous sampling (AVS) from April 2015 to March 2020, were included in this study. All clinical indexes including 24-hour ABPM were measured during the hospitalization, and all participants received dietary salt restriction with 6 g/day of salt. The 24-hour ABPM was performed from the first day of hospitalization to the next day, and AVS was performed on the third day in the morning. Regarding PAC measurement, we collected blood samples during AVS. After resting for 30 minutes in a supine position, blood samples were collected from inferior vena cava by catheterization. During AVS, we also performed ACTH stimulation, and blood samples were collected essentially 1 hour after the stimulation.

Results:
We firstly analyzed a correlation between PAC and ABPM profile and found that PAC measured after ACTH stimulation (post-PAC) was negatively correlated with nocturnal dipping rate in both systolic and diastolic BPs (SBP and DBP) (R = -0.430, P = 0.025, and R = -0.431, P = 0.025, respectively), while PAC measured before ACTH stimulation (pre-PAC) was not. Thus, according to the median of post-PAC, we divided participants into lower PAC and higher PAC groups and compared clinical characteristics between the two groups. Compared to the lower PAC group, nocturnal SBP and DBP dipping rates and serum potassium levels were significantly decreased in the higher PAC group (SBP dipping 10.3 ± 6.4 vs 3.5 ± 7.7 %, P = 0.02; DBP dipping 13.6 ± 7.7 vs 5.5 ± 6.3 %, P = 0.01; serum potassium 4.1 ± 0.3 vs 3.7 ± 0.4 mEq/L, P = 0.03).

Conclusions:
In this cross-sectional study, higher PAC was significantly associated with a non-dipper circadian BP profile characterized by lower nocturnal BP dipping rates in PA patients. Prospective longitudinal study is warranted to seek for a causal relationship between hyperaldosteronism and ABPM profile.