bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS-P04-5: A COMPARISON OF PREVALENCE OF HYPERTENSION AND BLOOD PRESSURE MEASUREMENTS BETWEEN SHORT-STATURE AND TALLER IN HEAVIER ADULTS OF BANGLADESH
Authors: Abrar Ahmad Khairul , Afroza Ummay , Choudhury Sohel Reza 
Published: January 2023

Objective:
To compare the odds of hypertension and means of Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), and Pulse Pressure (PP) in different quartiles of stature among the heavier adults of Bangladesh with a priory hypothesis- the overnutrition in adulthood with poor nutrition in early life is associated with a higher risk of hypertension.

Design and method:
To attain the objectives, we analyzed the Non-communicable Disease Risk Factor Survey 2018 data. This population-based national cross-sectional study was conducted in equally distributed 496 urban and rural PSUs in all divisions of Bangladesh. Total 8185 adults (18–69 years) completed STEP-1 and STEP-2 of the survey. After exclusion of the extreme values participants who had complete information on height, weight, and blood pressure measurements (n = 7969), were included in the analysis. Short-stature and heavier adults were defined as participants belonging to the sex-specific first quartile of height and fourth quartile of weight, respectively. Hypertension was defined as an SBP ≧ 140 mmHg or/and a DBP ≧ 90 mmHg, or current use of antihypertensive medication. MAP and PP were calculated with standard formulae. Differences between means were compared by ANOVA. Multivariate logistic regression model was used.

Result:
Prevalence of hypertension was higher in the short-stature heavier adults (men 41.7%, women 49.0%) than the taller and heavier adults (men 35.1%, women 37.6%). Odds of hypertension in short-stature women were 59% higher compared to taller (OR:1.59, 95% CI:1.02–2.49, p < 0.05).
Among heavier adults, mean of the blood pressure measurements founded to be lower in the taller participants compared with short stature. In short-stature men (n = 72) mean SBP (129.24 mmHg), DBP (85.21 mmHg), and MAP (99.89 mmHg) were higher than mean SBP (127.69 mmHg), DBP (82.91 mmHg), and MAP (97.83 mmHg) of the taller men (n = 441). In short-stature women (n = 96) mean SBP (129.09 mmHg), DBP (86.52 mmHg), MAP (100.71 mmHg), and PP (42.58 mmHg) were more than mean SBP (124.22 mmHg), DBP (84.69 mmHg), MAP (97.87 mmHg), and PP (39.53 mmHg) of the taller women (n = 407). Differences in the means were not statistically significant.

Conclusion:
Stature is an indicator of poor nutrition in early life in countries prevailing undernutrition. The association found from this nationally representative data supports the theory of a critical ontogenetic dependence of adult blood pressure, especially in women.
PS-P04-10: IMPACT OF BLOOD PRESSURE VARIABILITY ON THE RISK OF STROKE AND PREMATURE DEATH
Authors: Courcoul Leonie , Barbieri Antoine , Woodward Mark , Jacqmin-Gadda Helene , Tzourio Christophe 
Published: January 2023

Objective:
Visit-to-visit blood pressure variability (BPV) has been identified in several recent studies as a risk factor for stroke, independently of the level of BP. If true, this finding could help to identify patients at higher risk of stroke and to develop new preventive strategies. However, studies on BPV are exposed to important methodological challenges including conditioning on the future, which violates the assumption of the Cox model, using endogenous variables like the expected BP and its variance, and not handling properly the measurement error. Our objective was to address these issues by designing a joint model with heterogeneous variance for the repeated measures of BP, allowing us to analyze the association between BPV and the risk of stroke and the competing risk of death.

Design and Method:
We used data from PROGRESS (Perindopril Protection against Stroke Study), a placebo-controlled BP-lowering randomized trial for the prevention of stroke recurrence in 6105 patients with a previous history of stroke or TIA. During 5 years of follow-up, BP was measured 12 times, and 727 strokes and 438 non-stroke deaths were observed. We designed an innovative and dedicated joint model combining a linear mixed model, including a subject-specific random effect for the residual variance and two proportional hazard models for the two competing risks of stroke and death. In this model, the risk of each event may depend on the current value and current slope of the individual expected trajectory of BP as well as the intra-subject residual variance.

Results:
In separate analysis of each arm of the trial, we found that the risk of stroke increased with the current level of BP (HR = 1.13 per 5 mmHg, 95%CI = [1.08; 1.17], p-value < 0.001) but was not associated with its intra-individual variability (HR = 0.89, 95%CI = [0.71; 1.12], p-value = 0.317). Conversely, the risk of non-stroke death increased with the intra-individual variability of BP (HR = 1.43, 95%CI = [1.08; 1.88], p-value = 0.011) but not with its current level (HR = 1.03, 95%CI = [0.97; 1.09], p-value = 0.317). Results were similar on the complete sample adjusting for the randomized treatment.

Conclusion:
Using appropriate modeling accounting for measurement error and limiting selection and other potential biases, we found a differential effect of expected BP and BPV on the risk of stroke and of death. These results, if confirmed and enlarged to other populations, would have important consequences to design efficient and individualized preventive strategies.
PS-P05-7: WEIGHT OF EVIDENCE OF LONG-TERM EFFECTS OF HEAVY METALS ON THE CARDIOVASCULAR SYSTEM AT A POPULATION LEVEL
Authors: Saadeh Rami , YoussefAgha Ahmed , Piatt Jennifer , Klaunig James 
Published: January 2023

Background/Objectives:
Heavy metals chronic exposure is a major contributor to cardiovascular diseases (CVD) at the population level, and regions with high levels of heavy metals contamination showed increased rate of mortality rate from cardiovascular diseases. Among different heavy metals; Arsenic, Lead, Mercury, and Cadmium are the most toxic to human health.
The purpose of the study was to weigh the amount of evidence presented in the literature for an association between each heavy metal and five cardio-vascular diseases: coronary heart disease, cerebrovascular disease, peripheral arterial disease, hypertension, and atherosclerosis.

Methods:
Literature review was done. PubMed, google scholar, and science direct were searched using keywords cardiovascular diseases and 4 heavy metals, separate and all together. Irrelevant articles were excluded, and only relevant epidemiological articles were included. Bradford Hill criteria of causality was used to assess the association of each of the heavy metals with the five CVD.

Results:
The results of recent studies showed that the correlation between the four heavy metals and CVD are inconsistent with those of earlier studies and the general picture of the correlation between exposure to heavy metals and CVD presented by these studies is either inconsistent or not conclusive.

Conclusion:
Among the nine-criterion mentioned by Sir Bradford Hill, this study was only compatible with two out of nine criterions mentioned. The first criterion is the strength of the association, and the second criterion is the consistency of the association. Other criterions are not compatible with this study.
Although this study tried to examine the effect of 4 heavy metals on CVD, most studies linked only 1 heavy metal to 1 or 2 CVD, due to the interactive effects of heavy metals, and the absence of clear understanding to the mode of action. Nonetheless, there is a great need to do further research and explore more about the effect of these 4 metals on CVD.
PS-P06-6: GENDER DIFFERENCES ON DETERMINANTS OF GOOD KNOWLEDGE ON RECOGNITION OF STROKE SYMPTOMS AND ACTIONS DURING A STROKE AMONG HYPERTENSIVE PATIENT
Authors: Ching Siew Mooi , Chia Yook Chin , Devaraj Navin Kumar , Lim Hooi Min , Beh Hooi Chin 
Published: January 2023

Early recognition and action during a stroke are extremely important to improve stroke prognosis. This study aimed to examine the gender difference in the KAP of stroke in hypertensive patients.
This was a cross-sectional study conducted on adults 18 years and older who participated in a community blood pressure (BP) screening program in Malaysia during MMM2017. The questionnaire was derived based on the acronym F.A.S.T recommended by the American Stroke Association and two common symptoms of middle cerebral artery occlusion (paralysis of one side of the body and numbness or tingling sensation of one side of the body). Using multivariate logistic regression, the determinants of recognizing stroke symptoms and knowing what to do during a stroke in female and male hypertensive patients were identified.
Among 1019 hypertensive patients, 85.% of women versus 84% of men were able to recognise symptoms of stroke (p = 0.564) but the prevalence of good knowledge of actions to be taken by being hospitalised within 4.5 hours during a stroke was 74% among women vs. 80% in men (p = 0.05). Using multivariate logistic regression, the determinants for recognising stroke symptoms among male hypertensive patients were age more than 45 year old(OR: 2.670,p = 0.016) compared with those aged below 45, symptom of body paralysis (OR: 9.37,p = 0.001) and symptom of numbness of the body(OR:6.177,p < 0.001);whereas in female hypertensive patient were symptoms of body paralysis (OR:26.582,p < 0.001), being Malay (OR:2.306, p = 0.034) vs. non-Malay and age more than 45 year old(OR:2.706,p = 0.024) compared to those under 45 years old. The determinants of good knowledge on actions to be taken during a stroke among male hypertensive patient were symptoms of body paralysis (OR:8.25,p = 0.031) compared to female respondents were symptom of body paralysis (OR:5.603,p < 0.001),symptom of slurred speech (OR:5.597,p = 0.003) and diastolic BP (OR:0.962, p = 0.005).
Men know better what to do during a stroke. Symptoms of body paralysis was the most common stroke symptoms recognized by all hypertensive patients regardless in order to take further action. Clinicians need to be aware of these findings, and more action needs to be taken to educate female hypertensive patients about other stroke symptoms so that further action can be taken.
PS-R01-4: SAME, SAME BUT DIFFERENT: WHY ABSOLUTE BLOOD PRESSURE VALUES DO NOT ALWAYS PROVIDE AN ABSOLUTELY TRUE PICTURE
Authors: Oh Tania Wei Ling , Mondry Adrian 
Published: January 2023

A 45 year old woman was hospitalised for acute, symptomatic Dengue Fever with thrombopenia. Besides body ache and pruritus, she complained of non- postural giddiness. Her blood pressure throughout was in the hypotensive range, hovering between 80- 90 mm Hg systolic and 45–65 mm Hg diastolic. This raised concerns for Dengue- virus mediated endothelial dysfunction and shock. Symptomatic swelling of hands and feet were suspicious for capillary leak syndrome, which would be a relative contraindication for crystalline volume substitution. At the same time, however, the heart rate remained bradycardic, ranging from 52- 74 beats per minute despite febrile temperatures. With incipient thrombocyte recovery, patient requested discharge but agreed to outpatient follow up.
In clinic, she revealed that she had had known low blood pressure and bradycardic heart rate for all her adult life. She had been a competitive swimmer in her youth with up to 10 weekly training sessions until age 17. Given thyroid function and cortisol levels were normal, we carried out two non- invasive cardiac assessments using the NICAs device (NIMedical), which evaluates cardiac function via bioimpedance cardiography. At rest, NICAs showed hypotension (86/47 mm Hg), bradycardia 58 bpm and subnormal cardiac output (3.8 L/min) and cardiac index (2.4 L/min/m2). NICAs was repeated after brief aerobic exercise (50 squats, 20 push-ups, 30 straight leg raises). This brought heart rate into the low normal range, averaging at 61bpm. Systolic blood pressure could be normalised to 92 mm Hg, but diastolic pressure remained low at 51 mm Hg. At the same time, cardiac output and cardiac index moved into the normal range at 4.0 L/min and 2.6 L/min/m2, respectively. While still suffering from mild giddiness, symptoms improved on exercise.
While the measured absolute blood pressure values were in the hypotensive range, the patient was haemodynamically stable. The improved cardiac parameters after exercise and her personal exercise history suggest a permanent set-point to lower sympathetic drive. As such, medical alerts for this patient needed to be individually adjusted, and a personalised approach to treatment is likely to yield better outcomes. The case serves as a reminder that our guidelines are based on studies on large populations, while our patients need to be assessed as individuals if we aim to provide optimal care.
PS-R01-6: SUCCESSFUL ANTIHYPERTENSIVE TREATMENT USING SACUBITRIL/VALSARTAN ALONE IN A PATIENT WITH OBSTRUCTIVE SLEEP APNEA SYNDROME
Authors: Sugihara Ryuta , Sugihara Yuusaku , Sugihara Itsuko 
Published: January 2023

Obstructive sleep apnea syndrome (O-SAS) is one of the emerging non-communicable health hazards with high rates of morbidity and mortality. O-SAS is known to induce excessive activity of sympathetic nervous system and result in secondary hypertension. Although continuous positive airway pressure (CPAP) is the first line therapy for O-SAS, its poor adherence induces resistant hypertension. Sacubitril/valsartan has a sympatho-inhibitory effect and may contribute to antihypertensive therapy in patients with O-SAS. We present a successful case of a 39-year-old male with O-SAS using sacubitril/valsartan alone. He visited our clinic with severe hypertension noted during a routine health checkup. He was a heavy drinker, resulted in high body mass index. His family members worried about his loud snoring and witnessed apnea during sleep. The polysomnography showed a markedly increased apnea-hypopnea index of 37, which led to a diagnosis of severe obstructive sleep apnea. At first, we started treatment with CPAP and azilsartan, but he stopped CPAP due to excessive drinking. Then, we switched azilsartan to sacubitril/valsartan, and succeeded in improving his blood pressure.
This case indicates that sacubitril/valsartan may be an effective therapy for uncontrollable hypertenstion due to O-SAS even without CPAP.
PS-R02-9: A PATIENT HAS THE ONLY CONNECTION BETWEEN THE ATRIUM AND VENTRICLE IS AN ACCESSORY PATHWAY
Authors: Ulusan Sebahat , Kuyumcu Mevlut Serdar 
Published: January 2023

Case report:
A 62-year-old woman without cardiovascular risk factors such as hypertension, diabetes, smoking and hyperlipidemia was admitted to our cardiology outpatient clinic with palpitations and syncope history. Her electrocardiography showed preexcitation possible posteroseptal accessory pathway. We performed electrophysiological study and found posteroseptal accessory pathway. Tachycardia was not induced in inductions. ERP detected below 240 msn. The area where the shortest V-A interval was detected. His signal was not detected in this region. We determined that it was anatomically far from the AV node. We started radiofrequency ablation and in the 5. second of ablation, we saw that the patient entered 3. degree AV block. Ablation was immediately stopped then sinus rhythm restored in patients qucikly. We search his signal with ablation catheter in right atrium but could not find the signal. We detected that the AV block and accessory pathway were found together in the patient. Since the patient had a history of syncope and ERP < 250 ms was detected, we planned ablation after pacemaker implantation in the patient. We implant DDDR pacemaker and 2 weeks later we make successfully accessory pathway ablation.

Discussion:
In these patients, atrioventricular conduction is done only, and entirely, via the accessory route. A complete block, nodal or sub-Hissian, underlying, will only be visible on the ECG if there is concomitant blockage of the atrioventricular conduction through the accessory pathway. The appearance of atrioventricular conductive disorders after radiofrequency ablation of an accessory pathway, located at a distance from the atrioventricular junction, is not considered by some authors to be a real complication of this procedure. It would rather be a prior conductive disorder having been unmasked following the blockage of the accessory pathway thanks to ablation. It is therefore logical to review the indication for the removal of the accessory pathway in these cases, especially in asymptomatic patients who have never reported a history of palpitation attacks. The only possible tachycardia remains atrial fibrillation on WPW. Only the study of anterograde refractory periods makes it possible to specify the correct indication for ablative treatment. The indication for the implantation of a pacemaker is still appropriate given the risk of progressive and subsequent degeneration of the accessory pathway. In addition, conduction via the accessory pathway, whether continuous or intermittent, would help prolong the longevity of the pacemaker by inhibiting ventricular pacing in the event of atrioventricular conduction through the accessory pathway.
PS-BPB01-5: LOX-1 DEFICIENCY INCREASES RUPTURED ABDOMINAL AORTIC ANEURYSM VIA THINNING OF ADVENTITIAL COLLAGEN
Authors: Takahashi Kayo , Aono Jun , Nakao Yasuhisa , Hamaguchi Mika , Suehiro Chika , Kurata Mie , Kakino Akemi , Sawamura Tatsuya , Inoue Katsuji , Ikeda Shuntaro , Suzuki Jun , Yamaguchi Osamu 
Published: January 2023

Objective:
Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) is a key mediator of inflammation and plays an important role in the pathogenesis of atherosclerosis. Both inflammation and atherosclerosis have been proposed as contributors to abdominal aortic aneurysm (AAA) pathogenesis. However, the role of LOX-1 in AAA pathogenesis remains unknown. We aimed to investigate effects of Olr1, which encodes LOX-1, deletion on angiotensin II (Ang II)-induced AAA in apolipoprotein E knockout (ApoE KO) mice to determine whether LOX-1 deficiency mitigates AAA development.

Design and method:
Either Ang II (1.44 mg/kg/day) or saline (control) was administered continuously through a subcutaneously implanted osmotic pump for 4 weeks in the following 8-week-old male mice: Apoe-/-Olr1+/+
mice (Ang II, n = 40; saline, n = 10), Apoe-/-Olr1+/-
mice (Ang II, n = 30; saline, n = 9), and Apoe-/-Olr1-/-
mice (Ang II, n = 39; saline, n = 9).

Results:
Ang II infusion raised systolic blood pressure by tail-cuff methods in all three groups. Serial non-invasive assessment with ultrasound demonstrated that Ang II gradually increased the maximum area of the suprarenal abdominal aortas leading to AAAs. Although the incidence and expansion rate of AAA were comparable among genotypes, Olr1 deletion significantly increased the severity and rupture rate of AAAs (p = 0.01; incidence of type IV and ruptured AAA was 25% in Apoe-/-Olr1-/-
mice vs 5% in Apoe-/-Olr1+/+
mice). Since atherosclerosis is considered a major contributor to the development of AAAs, the extent of the atheroma burden localized in aneurysmal lesions was evaluated by Oil Red O staining. Olr1 deletion did not decrease atherosclerosis formation in the aneurysmal wall. Interestingly, further histopathological analysis revealed that aneurysmal lesions in LOX-1-deficient mice had fewer fibroblasts and myofibroblasts, as well as thinner adventitial collagen, although the degree of elastin fragmentation or disruption was similar between LOX-1-deficient and control mice. These in vivo data suggested that adventitial fibroblasts play a pivotal role in the increased severity of AAA in LOX-1-deficient mice. To further determine the effects of Olr1 deletion on fibroblast differentiation, fibroblasts were isolated from the adventitia of abdominal aortas harvested from 8-week-old Apoe-/-Olr1+/+
and Apoe-/-Olr1-/-
mice, and then cultured with Ang II stimulation. An in vitro study confirmed that Olr1 deletion completely abolished the Ang II-induced proliferative activity in the aortic adventitial fibroblasts (p = 0.02).

Conclusions:

Olr1 deletion may not mitigate aneurysm development but rather increase the vulnerability to rupture by suppressing adventitial fibroblast proliferation and collagen.
PS-BPB01-9: OMEGA-3 FATTY ACIDS ATTENUATE OXIDATIVE STRESS-INDUCED DNA DAMAGE THROUGH NRF-2 IN VASCULAR ENDOTHELIAL CELLS
Authors: Sakai Chiemi , Ishida Mari , Ishida Takafumi 
Published: January 2023

Objective:
Impaired vasodilation is one of the characterizations of hypertension. The effects of the omega-3 fatty acids on blood pressure and vascular function have been examined in many randomized controlled trials. In this study, we investigated the effects of omega-3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), on DNA damage, which has crucial effects on vascular endothelial cell function.

Design and method:
We examined the effects of EPA and DHA on H2O2-induced DNA damage response in human aortic endothelial cells (HAECs). DNA double-strand breaks (DSBs) were detected by immunofluorescence staining of the phosphorylated form of the histone H2AX (gamma-H2AX).

Results:
EPA and DHA significantly reduced accumulation of DSBs and phosphorylation of ATM, a serine/threonine kinase recruited and activated upon DSBs, in HAECs. Since EPA and DHA attenuated DNA damage without enhancement of DNA repair response, the effects of EPA and DHA on oxidative stress, a DNA damage inducer, were examined. CM-H2DCFDA measurement showed that EPA and DHA significantly reduced intracellular reactive oxygen species. In addition, mRNA levels of antioxidant molecules, such as heme oxygenase-1 and thioredoxin reductase 1, were significantly elevated by EPA and DHA. Silencing the gene encoding nuclear factor erythroid 2-related factor 2 (Nrf2) abrogated these increases. Furthermore, EPA and DHA reduced H2O2-induced senescence-associated beta-galactosidase activity, which was revoked by Nrf2 silencing.

Conclusions:
Our results suggest that EPA and DHA attenuate oxidative stress-induced DNA damage and cell senescence in vascular endothelial cells partly via antioxidant response mediated by Nrf-2. Therefore EPA and DHA may play a role in the prevention of impairment in vasodilation by their genome-protective properties.