bluuebunny/crossref_metadata_2025_split huggingface dataset:
S-25-5: ASSESSING THE LEVEL OF PRACTICE AMONG PRIMARY CARE PHYSICIANS REGARDING HYPERTENSIVE DISEASE OF PREGNANCY(HDP): A CROSS-SECTIONAL NATIONAL SURVEY IN MALAYSIA
Authors: Sivaratnam Dhashani , Ching Siew Moi , Krishnan Girija Mohana , Hio Ahmad Najmi , Sultan Nursyafiqah Mohd , Neezar Mohd Nabil Mohd , Lim Hui Zhi , Zafirah Ain Aliah 
Published: January 2023

Objectives:
Hypertensive disorders in pregnancy are one of the leading causes of maternal and neonatal morbidity and mortality worldwide. In Malaysia, The percentage of maternal death due to HDP rose from 15.2% (1997) to 18.1% (2007), resulting from the inaccessibility of healthcare services, lack of knowledge of complications by patients, and inadequately trained staff handle the difficulties. This study aimed to determine and evaluate the level of good practice for HDP among primary care physicians and the factors that influenced good knowledge regarding the management of HDP.

Design and method:
This cross sectional study recruited PCP practising in government or private clinics from Malaysia. It employed universal sampling through social networking, which was carried out using a validated self administered questionnaire through an online google form. The questionnaire consisted of 4 sections; social demography of the respondents, knowledge, attitude and practices involving HDP patients. Multivariate logistic regression was used to determine factors associated with poor practice on HPD.

Results:
A total of 176 participants were recruited for this study with a response rate of 46%, with a median age of 35 years (SD 7.28 years, 29 to 73.years). Most of the respondents were female (70.5% and practised in urban areas (55.7%) or the suburbs (31.8%). Most were in a group practice (75.6%), and only half the respondents had attended courses on HDP (53.5%). The following factors were found to correlate with good clinical practice: (1) age (p = 0.01), (2) practice location(p = 0.101) (3) average number of HDP patients seen in a week(p = 0.08) (4) availability of CPG in the clinic(p = 0.125) (5) duration since highest qualification (p = 0.04), (6) duration in primary care practice (p = 0.03) (7) Total of HDP attitude score(p = 0.04). In multiple logistic regression, duration since highest qualification(p = 0.02, OR 0.96, 95 %CI 0.886 to 1.040) and the average number of HDP patients seen per week(p = 0.025, OR 1.957, 95 %CI 1.038 to 1.731) were found to be predictors for good clinical practice.

Conclusion:
There is a low level of good practice among senior physicians and those who do not manage many HDP patients per week. Greater priority towards delivering more continuous medical education on HDP is required; to augment the clinical knowledge and skills, especially among senior physicians. Our study also revealed that physicians who worked with more HDP patients ensured their practice was up to date by the greater availability of the CPG in their clinic.
S-26-5: RENAL DENERVATION IN ASIA: GUIDELINES AND PERSPECTIVES IN CLINICAL PRACTICE
Authors: Kario Kazuomi 
Published: January 2023

Hypertension Research will launch the special issue “A recent advance in renal denervation to clinical practice” in 2023 (Figure). Since the first proof-of-concept study in 2009, it has been passed for 13 years, the renal denervation is going to be introduced into clinical practice. The new clinical trials using the sham-control group have been performed. The meta-analysis and systematic review demonstrated that renal denervation is effective to reduce 24-hr blood pressure (BP), regardless of denervation techniques (Hypertens Res 2022;45:210–220). In 2022, the 2 major sham-controlled pivotal trials using the 2 different denervation techniques will be released. These study subjects had uncontrolled hypertension even medicated with one or more drugs. One is the SPYRAL On-Med Pivotal trial using the radiofrequency denervation technique and another is RADIANCE II trial using ultrasound technique, in which the trial, the Otsuka Holdings Co. Ltd (ReCor Medical Inc.). Inc released information on positive results in the market news.
In addition, a recently longer follow-up result of SPYRAL On-Med feasibility study demonstrated a long-term BP lowering effect for 24 hours persisted for at least 3 years (Lancet 2022;399:1401–1410). Especially, even after initiating the medication titration, in those with drug-resistant hypertension, who were medicated up to 3 or more drugs, a significant difference in the nighttime and morning BPs between the renal denervation group and sham-controlled groups was overt (ISH2022, Rapid online publication in Hypertens Res). This indicates that renal denervation exhibit an “always on” BP lowering effect throughout 24 hours, which covers nighttime and morning periods, the “pits’ fall” time of medication.
Recently guidelines/guidance and consensus statement include RDN in the option of antihypertensive treatment strategy. Positioning of renal denervation in the total management of hypertension in combination with non-pharmacological intervention and medication should be discussed. In addition, the patient preference studies demonstrated a consistently significant number of hypertensive patients preferred renal denervation. Cost-effectiveness should be soon addressed before clinical use.
Once 2 pivotal trials demonstrated clearly clinically meaningful positive results, renal denervation will be accepted to introduce into clinical practice. During the clinical practice after regulatory approval, the residual challenges of renal denervation such as how to detect the responders and how to assess the successful endpoints of the procedures should be addressed in real-world studies.
The Asia Renal Denervation Consortium consensus conference of Asian physicians actively performing renal denervation has been recently convened to share up-to-date information and regional perspectives, with the goal of consensus on RDN in Asia (Hypertension 2020;75:590–602).
S-28-2: EFFECT OF ESAXERENONE ON NOCTURNAL BLOOD PRESSURE COMBINED WITH RENIN-ANGIOTENSIN SYSTEM INHIBITOR OR CALCIUM CHANNEL BLOCKER IN UNCONTROLLED HYPERTENSION
Authors: Kario Kazuomi , Ito Sadayoshi , Itoh Hiroshi , Rakugi Hiromi , Okuda Yasuyuki , Yamakawa Satoru 
Published: January 2023

Objective:
To evaluate the nighttime blood pressure(BP)-lowering effects of esaxerenone with different concomitant antihypertensive treatments, we conducted a post hoc analysis of a multicenter, open-label, long-term phase 3 study (NCT02722265) of esaxerenone, a highly selective mineralocorticoid receptor blocker, alone or in combination with a calcium channel blocker (CCB) or a renin-angiotensin system (RAS) inhibitor in patients with essential hypertension.

Design and method:
Patients had previously untreated essential hypertension, or had received only one RAS inhibitor or CCB as a baseline antihypertensive agent at the start of the study. All patients had a sitting systolic BP of 140 to < 180 mmHg and a sitting diastolic BP of 90 to < 110 mmHg, a 24-h ambulatory BP of ≧130/80 mmHg. In this post hoc analysis, patients were classified into 3 treatment groups; esaxerenone monotherapy, combination with a CCB and combination with RAS inhibitor and targeted on the patient without any additional antihypertensive treatment at Week 28. For these 3 groups, mean changes in 24-hour, early morning, daytime, and nighttime systolic BP in 24-h ambulatory BP, mean changes in N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, and changes in dipping pattern (extreme dippers, dippers, non-dippers, risers) were evaluated at 28 Week to include as many patients as possible available for analysis.

Results:
Of the total 368 patients in the study, 248 patients were included in this analysis and there were 153 in esaxerenone monotherapy, 48 in combination with a CCB and 48 in combination with a RAS inhibitor. Nighttime systolic BP statistically significantly decreased in all groups at Week 28 compared to baseline, with combination with a RAS inhibitor group showing the greatest change (-20.6 mmHg). Those changes were numerically greater than the daytime systolic blood pressure in all groups. The decrease in NT-proBNP from baseline to Week 28 was statistically significant in all group (p < 0.001, respectively) and the decrease in combination with RAS inhibitor was numerically greater than that of monotherapy.
A statistically significant shift in dipping pattern and changes from riser/non-dipper to dipper/extreme dipper pattern were found at Week 28 in Monotherapy (p < 0.05) and the same trend of shifting was shown in combination with RAS inhibitor (p = 0.1615). The prevalence of riser/non-dipper pattern was decreased from 58.2% to 47.7% in monotherapy and from 54.2% to 39.6% in combination with RAS inhibitor.

Conclusions:
Esaxerenone would provide a useful treatment option for nocturnal hypertension, especially in combination with RAS inhibitor, in uncontrolled hypertension.
S-28-4: ASSOCIATION BETWEEN INCOME AND PROGRESSION OF CHRONIC KIDNEY DISEASE IN JAPAN: A NATIONWIDE COHORT STUDY
Authors: Ishimura Nana , Inoue Kosuke , Kondo Naoki 
Published: January 2023

Introduction:
Chronic kidney disease (CKD) is one of the major public health issues, causing 1.4 million death in 2019 worldwide. While previous studies have shown the relationship between socioeconomic status and CKD, little is known about whether its relationship exists even in a country where insurance is comprehensively covered. Thus, we conducted a nationwide study to examine the association between individual income levels and the progression of CKD in Japan, a country with universal health coverage.

Methods:
We used the national database from the Japan Health Insurance Association (kyokai-kempo) between April 2015 and March 2021. We included 6,318,952 adults who undertook health check-ups in 2015 and had estimated Glomerular Filtration Rate (eGFR) measured at least twice during the study period. A multivariable linear regression model was used to investigate the association between income deciles and the average change in eGFR per year. A multivariable Cox proportional hazard regression model was used to estimate the hazard ratio [HR] for kidney replacement therapy (dialysis or kidney transplantation) according to deciles of individual income. We conducted the subgroup analysis by gender and prefectures.

Results:
The mean age was 48.8 years and 33.5 % were women. After adjusting for potential confounders, the lowest income group (bottom 10th percentile) showed a 0.08 [95%CI, 0.06–0.09] ml/min/1.73 m2/year larger decrease in eGFR than the highest income group (top 10th percentile). In our time-to-event analysis, we found an increased risk of kidney replacement therapy among the lowest income groups (HR [95%CI], 2.22 [1.99–2.48]) than among the highest income group. We found a similar pattern across gender and prefectures.

Conclusion:
Individual income levels were associated with the progression of CKD, particularly for the initiation of kidney replacement therapy in Japan. Our findings highlight the importance of considering socioeconomic status in CKD prevention and management even when insurance is covered.
S-28-7: GENE VARIANTS THAT NEUTRALIZE MORTALITY RISK FROM HYPERTENSION AND THEREBY INCREASE LIFESPAN
Authors: Morris Brian J. , Chen Randi , Donlon Timothy A. , Maskai Kamal H. , Willcox D. Craig , Davy Philip M.C. , Allsopp Richard C. , Willcox Bradley J. 
Published: January 2023

Objective:
To determine whether longevity genes extend lifespan by protecting against hypertension and/or other cardiometabolic diseases.

Design:
Prospective population based longitudinal study.

Methods:
We followed a cohort of 3,584 Japanese American men living on Oahu, Hawaii, who were recruited from 1965 to 1968 for the Kuakini Honolulu Heart Program, until Dec 2019 when 99% were deceased. Genotype frequencies of longevity associated SNPs in the genes FOXO3, PIK3R1, GHR, MAP3K5, CTGF, EGFR, FLT1, SIRT5 and SIRT7 were compared between subjects with and without ageing related diseases.

Results:
For FOXO3, PIK3R1, GHR, FLT1, MAP3K5 and EGFR, but not the other 3 longevity genes, longevity genotype increased lifespan by protecting against elevated risk of death posed by having hypertension, coronary artery disease or diabetes (cardiometabolic diseases, CMD), as follows: For FOXO3, covariate adjusted hazard ratios (HRs) for each of 9 longevity associated SNPs were 0.82 to 0.95 (P = 0.00008 to 0.020); covariate adjusted haplotype analysis HR = 0.81 (P = 0.0003); survival curve difference (covariate adjusted Cox proportional HR) was P = 0.0002. Strikingly, those men with a CMD who had the FOXO3 longevity genotype had similar survival as men without CMD. For the other genes, hazard ratios for reduction in the elevated risk of mortality from various CMDs conferred by the longevity associated SNP were: for PIK3R1, from hypertension or coronary artery disease, 1.17, for GHR, from hypertension, 1.20, for FLT1, from hypertension, 1.78, for MAP3K5, from CMD, 1.23, EGFR, from CMD, 1.10. None protected against risk of death from cancer.

Conclusions:
6 of 9 longevity genes exert their longevity effect by protecting against hypertension and/or other CMDs, possibly by amelioration of disease related cellular stress.
S-31-5: SOCIO-ECONOMIC IMPACT AND BURDEN OF HYPERTENSION IN THE PHILIPPINES PROJECTED IN 2050
Authors: Asis Leilani Basa Mercado Asis , Ona Deborah Ignacia David , Bonzon Dolores , Vilela Gilbert , Diaz Alejandro , Balmores Benjamin , Co Marlon , Mina Arnold Benjamin , Cabral Esperanza , Aquino Abdias , Abelardo Nelson , Gomez Lynn , Valdez Les Paul , Castillo Rafael 
Published: January 2023

Objective:
Hypertension has remained the number one cause of cardiovascular death in the Philippines for over three (3) decades. Despite this finding, the burden accounted for by hypertension is investigated to a lesser extent in the country. We performed this study to determine the socio-economic impact and burden of hypertension if Filipinos are affected with uncontrolled high blood pressure and the results projected in the next 30 years.

Design and method:
Primary data thru interviews and Labor Force Survey were gathered (N = 806). Secondary data were obtained from the following agencies; Philippine Statistics Authority (PSA), Family Income and Expenditure Survey (FIES), National Demographic and Health Survey (NDHS), National Nutrition Survey, Institute for Health Metrics and Evaluation (IHME), United Nations World Population Prospects, and World Health Organization (WHO). Consequently, cost of illness (COI) was calculated using the direct costs, morbidity costs, and mortality costs.

Results:
Sixty-eight percent (68%) of the respondents were in the active workforce. The majority do not have comorbidities (87%), but those who have hypertensive heart disease, stroke, and kidney problems were the top comorbid conditions. The source of funds for expenses is primarily out-of-pocket (41%). Nearly all patients were not hospitalized (92%) in the past year. The few hospitalized (8%) were mainly due to hypertensive emergency. The impact (% of respondents) of uncontrolled hypertension on productivity at work showed the following; four (4) days missing work (72%) and ten (10) days lost of productivity (63%). The impact (% of respondents) of uncontrolled hypertension on productivity at home showed the following: six (6) days of household suspended (66%), eleven (11) days reduced household work (78%), and five (5) days affected social activity (60%). Hypertension sufferers 40 years and older will get the most significant share of productivity loss due to uncontrolled hypertension. The productivity loss of premature mortality accounts for a 17% of total economic burden in 2020 and this is expected to increase to 20% by 2050. In 2020, about 70% of the total economic burden is accounted for direct & indirect care. In the next 30 years (2020 - 2050), the economic cost of hypertension its present value is expected to increase from Php52.6 billion ($1 billion) in 2020 to Php97.3 billion ($1.8 billion) by 2050.

Conclusion:
The socio-economic impact of uncontrolled hypertension in the Philippines was enormous. The economic cost of hypertension will almost double in the next 30 years. Both productivity loss and premature mortality will have significant impact on the Philippine economy by 2050.
S-34-2: TRENDS IN HYPERTENSION IN SINGAPORE AND EVIDENCE-BASED SOLUTIONS
Authors: Jafar Tazeen H 
Published: January 2023

Trends data on Singapore from the Institute of Health Metrics and Evaluation show that the attributable risk of cardiovascular disease (CVD) from high blood pressure (BP) declined from 1990 to 2010, then plateaued till about 2015, and has increased over the last five years. Moreover, several data sources, including the multi-institutional Sing Health Diabetes Registry, indicate a worsening in BP control from 2013 to 2019. Singapore acute myocardial infarction (AMI) registry shows a rise in the incidence of AMI during this time. These alarming trends collectively call for immediate action to improve BP control.
The SingHypertension cluster randomized controlled trial evaluated a multicomponent intervention versus usual care in eight polyclinics in Singapore: 4 clinics were randomized to intervention and 4 to usual care. 916 adults with uncontrolled hypertension were enrolled. The intervention comprised of physicians trained in risk-based treatment, subsidized single-pill combination (SPC) medications, nurse-delivered motivational conversation, and telephone follow-ups. At 24 months, the intervention led to improved BP control, lowered cardiovascular risk and albuminuria, and better quality of life in patients in intervention clinics compared to those in than care.
Wide-scale implementation of a multicomponent intervention such the SingHypertension is likely to reduce hypertension-related morbidity and mortality in Singapore and possibly many other countries.
S-35-2: THE IMPACT OF RENAL DENERVATION PROCEDURE ON THE USE OF ANTIHYPERTENSIVE DRUGS. A REAL-LIFE INVESTIGATION FROM ITALY
Authors: Rea Federico , Morabito Gabriella , Savare Laura , Corrao Giovanni , Mancia Giuseppe 
Published: January 2023

Objective:
Randomized controlled trials have shown that renal denervation lowers office and ambulatory blood pressure. However, the clinical environment of controlled trials is different from that characterizing medical practice, making real-life data appropriate to provide information on a number of issues, e.g. whether renal denervation is followed by a change in the intensity and type of antihypertensive drug use. The aim of the present study was to evaluate whether patients undergoing renal denervation procedure in a real-life setting have a reduction in antihypertensive drug prescription over the subsequent years.

Design and method:
Using the healthcare utilization database of the Lombardy Region (Italy), the 136 patients who, during the period 2011–2016, were prescribed four or more antihypertensive drugs and underwent renal denervation were included in the study cohort. The number and type of antihypertensive drugs were assessed over the year before and during the three-year period after renal denervation. Hospitalizations for cardiovascular diseases were also assessed during the three years before and during the three years after renal denervation.

Results:
The median age of the patients was 67 years and 68% of them were men. Based on a multisource comorbidity score, about 40% of patients showed a poor or very poor clinical status. Before renal denervation, about 80% of the patients were prescribed four or five antihypertensive drugs. The number of drugs decreased after the denervation: after three years, patients prescribed 4/5 drugs were 57% and patients prescribed six drugs decreased from 18% to 2%.
Reduced prescription extended to all antihypertensive drugs throughout the post-denervation period. Compared to the year before the denervation, after three years prescription of diuretics was reduced by 15%, calcium channel blockers by 21%, angiotensin-converting enzyme inhibitors by 32%, angiotensin receptor blockers by 22%, beta-blockers by 20%, alfa-blockers by 30%, and mineralocorticoid receptor antagonists by 30%.
Hospitalizations for cardiovascular diseases did not show appreciable differences between the two periods (before and after the renal denervation).

Conclusions:
In the real-life setting, patients who underwent renal denervation had a clearcut reduction in antihypertensive drug prescription over the following years.
S-36-5: TEAM-BASED CARE TO DIAGNOSE, TREAT AND CONTROL HYPERTENSION: FINDINGS FROM RESOLVE TO SAVE LIVES (RTSL)
Authors: Appel Lawrence J 
Published: January 2023

In order to achieve population-wide control of hypertension, team-based care is essential, especially in low- and middle-income countries (LMIC) where there are insufficient numbers of physicians to diagnose hypertension and prescribe medications. RTSL is a global initiative to dramatically improve hypertension control from 14% to 50% worldwide. One key aspect of our approach to team-based care is generating evidence useful in transforming health care delivery. Types of evidence can broadly be classified as follows: (1) literature synthesis to understand evidence on the types and effects of team-based care for hypertension, and (2) empirical studies of health system changes designed to scale up and improve hypertension care. The empirical studies are typically community-based and involve community health workers (CHWs) who are given greater responsibility beyond basic administrative and clinical tasks. Below are a sample of RTSL studies.
Our first study involved understanding the global gap between physician capacity and patient need. We documented that most low- and lower middle income countries did not have the physician capacity to provide 3 annual visit for patients with hypertension (figure). Our principal conclusion is that health system and policy changes are needed, including task-sharing. In a second study, we conducted a meta-analysis and documented that team-based care significantly lowers blood pressure in LMIC, with the extent of blood pressure reduction related to the clinical training of team members. In a third study, we conducted surveys to understand current level of task sharing and barriers to task sharing; few countries allowed non-physicians to conduct advanced clinical tasks, e.g. diagnosing hypertension, initiating treatment, and titrating medications. In a fourth study, MUTU conducted in Nepal, we tested a health system change in which CHWs, under the supervision of a physician, initiated and titrated treatment with amlodipine (MUTU results will be presented at ISH on Oct 16). Currently, we are designing a study in which CHWs, supervised remotely via telemedicine, initiate and titrate medication in persons with untreated hypertension in rural Bangladesh. Other studies involve developing and evaluating training materials for non-physician health care workers and modelling the effects of task shifting on the number of persons treated for hypertension in India, along with associated costs.
While these studies are being conducted, many RTSL countries have already implemented health system initiatives that involve team-based care for hypertension. These initiatives studies and RTSL studies hold great promise as a means to improve hypertension control rates in LMIC.