bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS-C32-10: EVALUATION OF ISH TREATMENT PROTOCOLS AMONG HYPERTENSIVE ADULTS
Authors: Arain Mudassar Iqbal , Fricovsky Eduardo 
Published: January 2023

Objective:
To assess the international society of hypertension treatment protocol among those adults who had confirmed diagnosis of Hypertension at different clinical setups of Hyderabad, Sindh, Pakistan.

Methodology:
The prospective study was conducted for a period of one year during 2020. A total of 1000 prescription of hypertensive patients were collected in the study based on random sampling method. The study was conducted in six different clinical setup of Hyderabad territory. The data were transformed into pre-designed data sheet and assess based on ISH treatment protocols.

Results:
Among 1000 enrolled data maximum number were classified under grade 1 i.e. 548 followed by grade II i.e. 276. For grade 1 patients, data showed that only 26% prescribed medications according to ISH guidelines while remaining were not prescribed. For grade II patients, 37% of the prescriptions showed compliance with ISH guidelines while remaining did not followed the procedure.

Conclusion:
The study was clearly revealed that the treatment protocol of ISH guidelines in adults was not accordingly so proper CMEs must be conducted to aware the health care professionals.
PS-B10-4: AFFERENT RENAL NERVOUS SIGNALS CONTRIBUTE TO THE DEVELOPMENT OF HFPEF WITH SYMPATHOEXCITATION IN DAHL SALT-SENSITIVE HYPERTENSIVE RATS
Authors: Ryosuke Nakashima , Shinohara Keisuke , Ikeda Shota , Matsumoto Sho , Yoshida Daisuke , Ono Yoshiyasu , Tsutsui Hiroyuki 
Published: January 2023

Objective:
Sympathetic activation is involved in the pathophysiology of heart failure with preserved ejection fraction (HFpEF). Renal nerves contain sympathetic efferent and sensory afferent fibers. Excitation of the renal efferent nerves increases renal renin release and sodium/water retention. On the other hand, the renal afferent nerves are activated by the renal injury associated with hypertension, and acute stimulation of the afferent nerves increases sympathetic output from the brain. In this study, we investigated whether the signals from the renal afferent nerves contribute to the development of hypertensive HFpEF using a novel method of selective afferent renal nerve denervation (ARDN) in Dahl salt-sensitive rats, a widely used animal model of HFpEF.

Design and method:
Male Dahl salt-sensitive rats were fed 0.3% low-salt diet (LS) or 8% high-salt diet (HS) from 7 weeks of age. At 9 weeks, LS-fed rats received sham operation (LS-Sham), and HS-fed rats were randomly divided into ARDN (HS-ARDN) or sham operation (HS-Sham). At 19 weeks, blood pressure, echocardiographic parameters, organ weights, and plasma norepinephrine levels were measured, and the histological and biochemical analysis of the heart were performed.

Results:
Systolic blood pressure was significantly increased in HS-Sham compared to LS-Sham, and this increase was not affected in HS-ARDN. By echocardiography, left ventricular (LV) fractional shortening did not differ between the three groups; however, E/e’ ratio was significantly increased in HS-Sham compared to LS-Sham and was attenuated in HS-ARDN. LV weight / body weight ratio and lung weight / body weigh ratio were significantly increased in HS-Sham compared to LS-Sham, and were decreased in HS-ARDN. Plasma norepinephrine levels were significantly higher in HS-Sham than LS-Sham, and this increase tended to be inhibited in HS-ARDN. LV fibrosis evaluated by Masson trichrome staining was significantly increased in HS-Sham compared to LS-Sham and was attenuated in HS-ARDN. ANP mRNA expression in LV tissue was extremely increased in HS-Sham compared to LS-Sham and was significantly attenuated in HS-ARDN.

Conclusion:
The signals from afferent renal nerves contribute to the development of HFpEF with sympathoexcitation in Dahl salt-sensitive hypertensive rats.
PS-B12-8: ANGIOTENSIN II TYPE I RECEPTOR SIGNAL REGULATES MITOCHONDRIAL DYNAMICS, CAUSING MUSCULAR MITOCHONDRIAL DYSFUNCTION AND SARCOPENIA UNDER METABOLIC STRESS
Authors: Uebo Shota , Ikeda Yoshiyuki , Uchikado Yoshihiro , Akasaki Yuichi , Ohishi Mitsuru 
Published: January 2023

Introduction:
Metabolic stress, such as oxidized low density lipoprotein (ox-LDL) and advanced glycation end products (AGE) cause atherosclerotic cardiovascular diseases through dysfunction of mitochondria, which undergo quality control by mitochondrial dynamics, fission and fusion. Mitochondria also plays a crucial role in regulating muscular function, and its dysfunction leads to sarcopenia. This study aims to clarify whether and how mitochondrial dynamics are involved in the development of sarcopenia under metabolic stress.

Methods:
We used human skeletal muscle cells (HSMC) in in vitro experiments and C57BL6 (WT), apolipoprotein E (ApoE) deficient and the double knockout of ApoE and AT1R (DKO) mice in in vivo experiments.

Results:
Administration of either ox-LDL or AGE to HSMC induced mitochondrial fission through activation of fission factor, Drp1, decreased mitochondrial membrane potential assessed by JC-1 staining and increased reactive oxygen species assessed by Mito-sox Red staining and apoptosis, which were restored by Drp1-specific inhibitor, mdivi-1. Inhibition of angiotensin II type 1 receptor (AT1R) by AT1R blocker also ameliorated excessive mitochondrial fission, its function and oxidative stress induced by either ox-LDL or AGE in HSMC. These results suggest that metabolic stress induces mitochondrial fission and its dysfunction, which may cause sarcopenia. Muscular strength and the ratio of muscle weight to tibia length were lower in ApoE than those in WT. The number of fused mitochondria and mitochondrial function were lower and oxidative stress and the number of apoptotic cell were higher in ApoE KO than those of WT. Muscle strength, the ratio of muscle weight to tibia length, the number of fused mitochondria and its function were higher and the number of apoptotic cell were lower in DKO than those in ApoE KO mice. Taken together, these results suggest that either ox-LDL or AGE causes sarcopenia through AT1R signal-dependent mitochondrial fission and subsequent mitochondrial dysfunction.

Conclusion:
Either ox-LDL or AGE induces mitochondrial dysfunction through AT1R signal-regulating mitochondrial fission, which causes sarcopenia. Inhibition of AT1R signal may be a potential therapeutic strategy to avoid development of sarcopenia in patients with life style related diseases, such as dyslipidemia and diabetics.
PS-C28-2: STROKE RISK OF THE ELDERLY PATIENTS WITH NOCTURNAL HYPERTENSION DEFINED USING HOME BLOOD PRESSURE MONITORING IN JAPANESE GENERAL PRACTICE POPULATION
Authors: Fujiwara Takeshi , Hoshide Satoshi , Kario Kazuomi 
Published: January 2023

Objective:
To investigate the association between nocturnal hypertension defined using home blood pressure (BP) monitoring (HBPM) and the prevalence, extent of cardiovascular target organ damage (TOD), and cardiovascular disease (CVD) event risks in participants with ≧ 65 years in general clinical practice.

Design and method:
We used the dataset of the Japan Morning Surge-Home BP (J-HOP) Study that recruited 4,310 participants with cardiovascular risk factors. Among them, we assessed the participants with ≧ 65 years who measured nocturnal home BP (n = 1,349, mean age 72.0 year, 48.6% men). We define nocturnal hypertension as nocturnal systolic (SBP) ≧ 120 mmHg or diastolic (DBP) ≧ 70 mmHg, using HBPM. Nocturnal home BP was automatically measured at least 1 day within the 14 days (2 AM, 3 AM, and 4 AM). We use the average of all nocturnal home BP values. N-terminal pro-brain natriuretic peptide (NT-proBNP) and urine albumin: creatinine ratio (UACR) were used as surrogate markers of TOD. The CVD outcomes were incident stroke and coronary heart disease (CHD) events.

Results:
The prevalence of nocturnal hypertension defined by HBPM was 61.7% of all study participants with ≧ 65 years. The participants with nocturnal hypertension defined by HBPM presented higher levels of log-transformed NT-proBNP and UACR at baseline compared to those with controlled nocturnal BP group. Over a median 4.0-year follow-up (5,453 person-years), 36 stroke events and 31 CHD events occurred, respectively. The nocturnal hypertension group had a higher incidence rate of stroke events compared with the controlled BP group. Concerning CHD, the incidence rate of CHD was similar between two groups (Figure). Cox model results suggested that the participants with nocturnal hypertension had a higher risk of stroke compared to those with controlled nocturnal BP group after adjustments for log-transformed NT-proBNP and UACR levels (adjusted hazard ratio 3.42; 95% confidence interval 1.15–10.19).

Conclusions:
In this Japanese population with ≧ 65 years, the participants with nocturnal hypertension defined by HBPM was significantly associated with stroke risk, independently of the extent of TOD.
PS-C29-10: WEIGHT GAIN IS ASSOCIATED WITH INCREASED ARTERIAL STIFFNESS IN HIGH-RISK PREGNANT WOMEN
Authors: Bourgeois Sophia , Phan Kim , Labos Christopher , Messidi Amira El , Abenhaim Haim , Gagnon Robert , Daskalopoulou Stella S 
Published: January 2023

Objective:
There have been increasing efforts to establish effective screening tools for preeclampsia in early pregnancy. Arterial stiffness is a composite indicator of vascular health, reflects endothelial dysfunction, and has been shown to be predictive of cardiovascular events in the general population, while it has been noted to be increased at the time for preeclampsia. Pregnancy is characterized by acute weight gain. However, whether pregnancy weight gain can affect arterial stiffness is not known. Therefore, we aimed to investigate the impact of pregnancy weight gain on arterial stiffness in high-risk pregnant women.

Design and method:
In this prospective longitudinal cohort study, pregnant women (n = 177) in their first trimester (10–13 weeks gestation) who met established clinical criteria for high-risk of preeclampsia were recruited from obstetrics clinics. Arterial stiffness measurements and weight were recorded every 4 weeks throughout pregnancy. Arterial stiffness was measured non-invasively using the validated tonometry-based SphygmoCor System.

Results:
Continuous variables were analyzed using linear. Analysis adjusted for maternal age showed that an increase in total pregnancy weight gain was significantly associated with increased arterial stiffness during pregnancy (0.213 [95%CI: 0.007, 0.068], p < 0.02). More specifically, an increase in late pregnancy weight gain, from second to third trimester, was significantly associated with an increase in arterial stiffness during pregnancy (adjusted beta: 0.052 [CI: 0.002, 0.102], p < 0.05).

Conclusion:
An increase in total pregnancy weight gain and more specifically late pregnancy weight gain is associated with an increase in arterial stiffness. This is important as arterial stiffness could be a predictive tool for preeclampsia in clinical practice.
PS-C30-9: CHALLENGES IN MANAGING PERIPARTUM CARDIOMYOPATHY COMPLICATED WITH SEVERE PRE-ECLAMPSIA IN SUBURBAN AREA: A CASE REPORT
Authors: Sudirman Adrian Reynaldo , Surya Steven Philip , Sitompul Sanggap Indra 
Published: January 2023

Background:
Peripartum cardiomyopathy (PPCM) is a life-threatening condition, refers to rare dilated cardiomyopathy causing heart failure in late pregnancy or early postpartum woman. The diagnosis was based on pregnant/peripartum woman who had sudden cardiac decompensation without any history of cardiac disease. Pre-eclampsia (PE) could be co-existed with PPCM because of similar pathophysiology mechanism, which leads to higher mortality. Hereby we present the challenges of managing PPCM complicated with severe PE in suburban areas.

Case Illustration:
A 36-year-old woman referred to hospital with shortness of breath. Her past medical history was remarkable for severe-PE and had undergone caesarean section two-day-ago. Upon arrival, her saturation-75%, HR-120x/min, BP-140/80 and RR exceeds-40x/min. She was in respiratory distress with JVP increased, coarse crackles at basal lungs, and leg swelling. Laboratory studies were unremarkable. The x-ray revealed cardiomegaly and ECG showing LVH. Initial echocardiography demonstrated left ventricular systolic dysfunction with ejection fraction-34%. The patient was suggestive for PPCM with previous history of PE. Continuous administration of IV-furosemide-5 mg/h, spironolactone-25 mg, bisoprolol-2.5 mg, and candesartan-8 mg were administered. Her condition improved rapidly with increased saturation from 75% to 95% and significant reduced in dyspnoea. She was transferred to intensive cardiovascular unit for further management and discharged after 7-days for outpatient control.

Discussion:
PPCM is a devastated diagnosis among pregnancy woman. The diagnosis should be distinguish from PE induced heart failure. In PPCM, the echocardiography findings is related with left ventricular systolic dysfunction and reduced EF, whereas diastolic dysfunction with preserved EF is identified in PE induced heart failure patient. PE is associated with PPCM based on the shared pathophysiology. It is related with the angiogenic imbalance and excess expression of antiangiogenic factor sFlt1 soluble fms-like tyrosine kinase-1, which have found increased in both of the diseases. This is explained why PE has been recorded to occur in 30% of PPCM cases and it contributes to the increasing maternal mortality when most of the causes of maternal death are preventable.
PS-C31-1: SIGNIFICANCE OF SCREENING AND DIAGNOSING PRIMARY ALDOSTERONISM (PA) IN GENERAL MEDICINE
Authors: Kusunoki Hiroshi , Nagasawa Yasuyuki , Motone Masaharu , Yoshihara Fumiki , Shimizu Hideo , Shinmura Ken 
Published: January 2023

Background:
Primary aldosteronism (PA) is a frequent secondary hypertension that is more frequently associated with cerebrovascular disease than essential hypertension, and thus requires appropriate diagnosis and treatment. The Japan Endocrine Society has published the new guideline for the diagnosis and treatment of primary aldosteronism, following the change of aldosterone measurement system in 2021. In this presentation, we will discuss a case of PA experienced at a dental school hospital.

Case
75 years old male

Current medical history:
He had been diagnosed as hypertensive more than 10 years ago and had been prescribed antihypertensive medication, but he had stopped taking it. When he visited an oral surgeon for a tooth extraction, hypertension was noted and he was referred to internal medicine.
<Physical findings> Blood pressure: 208/120 mmHg, Pulse: 83/min,
<Biochemistry> Cre 1.09 mg/dL, Na 139mEq/L, K 3.7mEq/L.
<Endocrine metabolism>
fT4 0.95ng/dL, TSH 2.58micro-IU/mL, Plasma renin activity: PRA (EIA method) 0.6ng/mL/hr, Plasma aldosterone concentration: PAC (CLEIA method) 130pg/mL.
<Abdominal CT> There was a nodule on the right adrenal gland.
<Progress and discussion>
The patient had a high aldosterone-renin ratio: ARR = PAC/PRA = 130/0.6 = 217 at the time of initial examination, and PA was suspected. CT showed a nodule in the right adrenal gland, raising suspicion of unilateral disease. Because of the high basal plasma aldosterone level and low K level, we referred the patient to a specialized facility because we thought that if PA was confirmed by functional confirmation testing, the case could be aggressively localized and typed by adrenal vein sampling (AVS). In this presentation, we would like to discuss the significance of screening and diagnosis of PA in primary care and general practice settings such as dental school hospitals, based on the results of functional confirmation testing at specialized facilities, and in light of current guidelines.
PS-C31-12: CHALLENGES IN MANAGING HYPERTENSION IN A SINGAPORE PRIMARY CARE SETTING: A QUALITATIVE STUDY
Authors: Ng Chirk Jenn , Tan Reuben , Moosa Shiwaza Aminath , Oka Prawira , Lee Cia Sin , Tan Ngiap Chuan 
Published: January 2023

Objective:
The prevalence of hypertension among adults in Singapore has increased signifincantly from 24% (2017) to 35% (2020); half of those who have been diagnosed remained uncontrolled. Most of the patients with hypertension are managed in the primary care setting. Therefore, this study aimed to explore the experiences, challenges and needs of primary care providers in managing hypertension in Singapore

Design and method:
This qualitative study reported preliminary findings from 10 individual in-depth interviews with healthcare providers (5 doctors, 3 nurses and 2 pharmacists) in 2 primary care polyclinics in Singapore. The subjects were recruited purposively (based on experience and position) and recruitment continued till saturation was achieved. An experienced qualitative researcher conducted the interviews using an interview guide developed based on theories, literature review and expert discussion. All interviews were audio-recorded, transcribed verbatim, checked and managed using NVivo qualitative data management software. Thematic analysis was used for data analysis.

Results:
Four main challenges emerged from the preliminary analysis: (1) Lack of adequate blood pressure readings for decision making; (2) Lack of clarity of roles and responsibilities of healthcare team in hypertension care; and (3) Practice variations and lack of standardised training and (4) Usability and utility issues with the electronic medical record.

Conclusions:
Despite clear evidence on home blood pressure monitoring, team-based care, patient and clinician education, and technology in enhancing hypertension care, this study found a gap in implementing these clinical evidence. There is a clear need to find effective and sustainable strategies to overcome these barriers to improve hypertension care in primary care.
PS-C32-5: GENDER DIFFERENCE IN HYPERTENSIVE PATIENTS ASSOCIATED WITH PROBABLE OSA
Authors: Ching Siew Mooi , Loke Wen How , Ng Jun Ying 
Published: January 2023

Objectives:
Obstructive Sleep Apnea (OSA) has high association with hypertension and cardiovascular disease. OSA has been widely proven to be more common in men than women possibly due to pathophysiological difference and clinical presentations. However, there are limited studies on assessing the gender difference in correlation between OSA and hypertensive patients. This study aimed to examine the determinants of probable OSA according to gender among hypertensive patients in primary care clinics.

Design and Methods:
A cross-sectional study was carried out using systematic random sampling method in hypertensive patients who attended two government primary care clinics in Sarawak, Malaysia. A validated STOP-Bang questionnaire was used in this study and socio-demographic data was captured with questionnaire. Probable OSA was defined as STOP BANG score of 3 and above. SPSS version 23 was used to do the analysis and multivariate logistic regressions were used to determine the determinants of probable OSA according to gender.

Results:
440 hypertensive patients were enrolled into this study, 60.7% of them were female. There was a higher proportion of male patients (92.5%) found to have probable OSA as compared to female patients (30%) (p < 0.001). Looking into criteria of STOP BANG, between female and male patients, there were significant differences in daytime symptoms (p = 0.020) and BMI categories (p = 0.001).
As for demographic data, the determinant of probable OSA in men were low income (<RM3,000) (AOR = 4.320, P = 0.022, 95% confidence interval [CI] 1.23,15.15), longer duration of hypertension (AOR = 1.269, P = 0.029, 95% CI 1.03,1.57) and being married (AOR = 5.612, P = 0.021, 95% CI 1.30,24.22). For female, the determinant of probable OSA were neck circumference (AOR = 1.613, P = 0.002, 95% CI 1.19,2.81) and Chinese ethnicity (AOR = 11.711, P = 0.013, 95% CI 1.67,81.95).

Conclusion:
In conclusion, this study reported that among hypertensive patients, OSA is more prevalent in men than women, and criteria of STOP BANG and clinical characteristics are significantly different between gender. Primary care clinicians should be aware of these difference and screen for probable OSA accordingly for further early intervention.
PS-C33-1: CIRCADIAN RHYTHM DISTURBANCES AND BLOOD PRESSURE LEVELS IN OBESE PATIENTS WITH TRUE AND PSEUDO-RESISTANT HYPERTENSION
Authors: Shalimova Anna 
Published: January 2023

Background:
The aim was to conduct a comparative assessment of the circadian rhythm (CR) abnormalities and blood pressure (BP) levels between pseudo- and true resistant hypertension (RH) in obesity.

Methods:
The study included 302 patients with uncontrolled hypertension and obesity. Initial treatment efficacy was assessed 3 months after dual therapy was administered. Those patients who did not reach target BP in dual therapy were transferred to triple therapy. Among patients who received triple therapy, 69 people did not reach target BP. All patients were additionally examined 6 months after the therapy initiation.

Results:
In the absence of a difference in BP levels, patients who subsequently become resistant, already at the stage of inclusion, significantly more often had a violation of CR with a predominance of the non-dipper rhythm. After 3 months of follow-up, there was a significant difference in the indicators of both office and out-of-office BP in resistant and non-resistant patients; however, the distribution of CR remained the same as at the stage of inclusion in the study. Despite the achievement of target BP after 6 months of therapy, in the majority (91.42%) of patients without resistance, the circadian rhythm normalized, while resistant patients had a normal CR only in 60.87%. At the stage of enrolling patients into the study and 3 months after the start of therapy there was no significant difference in BP levels between true and pseudo-resistance, then after 6 months of therapy, patients with true resistance had significantly higher office SBP (p < 0.01) and 24 h average SBP according to ABPM data (p < 0.05) compared with pseudo-resistant patients. Already at the stage of inclusion in the study, the normal CR in patients with true resistance was significantly less common than in patients with pseudo-resistance, and during the prescribed therapy, a similar trend persisted: after 6 months of antihypertensive therapy, 71.05% of pseudo-resistant patients had a normal CR, while with true resistance only about half of the patients had a normal CR.

Conclusions:
Even when target BP levels in antihypertensive therapy are achieved, obese patients with resistant hypertension are characterized by more pronounced disturbances of CR (most often in the form of non-dipper) and higher levels of office and out-of-office BP, compared with non-resistant patients. Compared with pseudo-resistant patients, the presence of true resistance in obesity is associated with higher SBP levels and a higher incidence of CR disturbances.