bluuebunny/crossref_metadata_2025_split huggingface dataset:
S-53-1: SOCIOECONOMIC FACTORS AND PREVENTION OF CARDIOVASCULAR DISEASES IN ASIA
Authors: Gupta Rajeev 
Published: January 2023

Focus on social determinants of health is important for primordial and primary prevention of cardiovascular diseases (CVD). There are multiple social determinants and are macrolevel factors: social and human development, location related factors, and policies that influence rural and urban planning, environmental pollution, healthcare infrastructure, health financing, quality of health systems, taxation on harmful products (tobacco, alcohol, trans fats), and subsidizing healthy foods. Individual level factors are: multiple social factors, education, income, employment, stress, early life events, addictions including tobacco, and availability, affordability and adherence to medicines and healthy lifestyles. Studies have shown that countries with better development have lower CVD incidence and mortality, also in Asia. Healthy lifestyles (healthy diet, physical activity, tobacco control) and awareness, treatment and control of major risk factors (hypertension, diabetes, dyslipidemias) are more in better developed Asian countries due to better health systems and universal health coverage policies. At individual level higher socioeconomic status and better educational level are associated with lower prevalence of CVD risk factors and better treatment and control of hypertension, dyslipidemias and diabetes.
Interventions to address social determinants are limited and include focus on political, economic and social interventions. UN Sustainable Development Goals related to poverty eradication, zero hunger, good health and wellbeing, quality education, gender equality, decent work, economic growth, reduced inequalities, sustainable communities, responsible consumption or production, and climate action address social determinants of health. Creation of health infrastructure in rural and deprived locations, macrolevel financing, manpower deployment and workforce training are important evidence-based interventions.
Interventions to improve quality of general education and health literacy and education of medical professionals and non-physician health workers have shown to ameliorate CVD related disparities. Public health interventions include life-course approach for prevention and control of risk factors, better and safe facilities for promotion of physical activity, tobacco, smoking and alcohol control policies, taxation on trans fats, sugars, sugar-sweetened beverages and salt, universal health care focussed on early CVD diagnosis and management, availability of medicines and focus on technological innovations to promote adherence to medicines and healthy lifestyles. At the individual level better CVD risk-factor control can be achieved by focus on individual social determinant and improved professional-patient communication via professional medical education, health worker related focus, patient health literacy, and greater patient involvement.
S-55-5: CT GUIDED AND TRANSVENOUS RADIOFREQUENCY ABLATION FOR PRIMARY ALDOSTERONISM
Authors: Takase Kei 
Published: January 2023

We are developing minimally invasive treatments for primary aldosteronism. In this presentation, we will introduce our research and clinical studies on percutaneous and transvenous radiofrequency ablation (RFA).

Based on the preclinical studies, a protocol for ablating human adrenal glands and intraoperative blood pressure control methods were developed. First-in-human procedure was performed. Flexible RFA catheter was inserted into the upper lateral tributary of the left adrenal vein. The position of the RFA catheter was confirmed by CT. Ablations were performed while applying energy of 7000 J twice to each location, pulling back the catheter several millimeters in sequence. The aldosterone-producing adenoma was completely ablated to normalize the serum aldosterone level.
CT-guided RFA was able to treat PA with a high success rate. However, approximately 50% of the left aldosterone producing adenomas were difficult to puncture due to anatomical reason, while most of the right adrenal adenoma could be treated by CT-guided RFA. The transvenous RFA catheter is much easier to insert into the left adrenal vein than into the right, suggesting that the two RFA methods have complementary roles. Furthermore, it may be possible to perform AVS diagnosis and RFA treatment in a single procedure.
S-56-2: HOME BLOOD PRESSURE MEASUREMENT FOR HYPERTENSION MANAGEMENT IN THE REAL WORLD: THE IMPORTANCE OF REPORTING HOME BLOOD PRESSURE TO DOCTORS
Authors: Rhee Moo Yong , Kim Je Sang , Won Ki Bum , Kim Ji Hyun , Do Ungjeong , Kim Hae Young , Nah Deuk Young 
Published: January 2023

Introduction:
Most studies that sought the effect of home blood pressure (HBP) measurements were conducted in controlled conditions or by measuring office BP. We investigated the effects of HBP measurements on the management of hypertension in the real world, through measurement of ambulatory BP.

Methods:
Patients taking antihypertensive drugs (>1 year) and > = 20 years of age were recruited. A survey asking the duration and frequency of HBP measurements if the participants reported their HBP results to their clinicians was conducted. The patients were divided into (1) HBPM(-) group: HBP was not measured (n = 467), (2) HBPM(+)UR group: HBP was measured but not reported (n = 81), and (3) RHBPM(+)R group: HBP was measured and reported (n = 125).

Results:
The HBPM(+)R group had lower office systolic blood pressure (SBP, 125.8 ± 9.9 vs 128.5 ± 11.4 mmHg, p = 0.035), 24-hour SBP (121.0 ± 9.8 vs 124.1 ± 11.2 mmHg, p = 0.009), and daytime SBP (122.7 ± 10.9 vs 125.9 ± 12.2 mmHg, p = 0.017) than the HBPM(-) group, and lower nighttime SBP (114.8 ± 11.8 vs 119.9 ± 10.8, p = 0.005) and diastolic blood pressure (DBP, 72.6 ± 9.0 vs 76.6 ± 8.4 mmHg, p = 0.008) than the HBPM(+)UR group. In the multivariate analysis, the difference in 24-hour and daytime SBP and nighttime DBP remained significant. There was a significant difference between groups in regard to the control of office DBP [70.6% for HBPM(+)R, 60.4% for HBPM(-), and 55.0% for HBPM(+)UR groups; p = 0.047]; 24-hour SBP (68.3%, 57.0% and 53.1%, respectively; p = 0.046), nighttime SBP (36.7%, 31.2% and 18.5%, respectively; p = 0.021) and nighttime DBP (20.8%, 19.8% and 7.4%, respectively; p = 0.023). Nighttime SBP and DBP control rate of the HBPM(+)R group were higher than those of HBPM(+)UR group (p = 0.007 and 0.010). Among the patients measuring home BP, the adjusted odds ratio for 24-hour and nighttime BP control in the HBPM(+)R group were 2.176 (95%CI, 1.010–4.687) and 36.651 (95%CI, 1.110–12.005), respectively, compared to the HBPM(+)UR group.

Conclusion:
This study shows that patients with hypertension should not only take HBP measurements but also report these to the treating clinician for appropriate management of hypertension.
APSH-OP-1: THERAPEUTIC TARGET AND CLINICAL IMPACT OF DAY-TO-DAY BLOOD PRESSURE VARIABILITY IN HYPERTENSIVE PATIENTS WITH COVID-19
Authors: Jagannatha Gusti Ngurah Prana , Yasmin AA Ayu Dwi Adelia , Pradnyana I Wayan Agus Surya , Kamardi Stanly , Pangkahila Elionardo Enrique 
Published: January 2023

Objectives:
Blood pressure variability (BPV) plays an important role in hypertensive patients, and frequently associated with organ damage. Although hypertension is the most common comorbidity in COVID-19, the impact of BPV and therapeutic target of BPV to outcome in COVID-19 patients with hypertension remain unclear. The aim of this study is to investigate the relationship between BPV and severity of COVID-19, in-hospital mortality, hypertensive status, and efficacy of antihypertensives in suppress hypertensive covid-19 patient's BPV.

Design and method:
This was a cohort retrospective study that enrolled 351 patients hospitalized with COVID-19. Subjects were classified according to the presence of hypertension, the severity of COVID-19, and BPV status. Mean Arterial Pressure (MAP) was measured at 6 a.m. and 6 p.m. during hospitalization, and BPV was calculated as the coefficient of variation of MAP (MAPCV). MAPCV values above the median were defined as high BPV. We compared the hypertensive status, COVID-19 severity, in-hospital mortality and antihypertensive agents between the BPV groups.

Results:
The mean age was 53.85 ± 18.84 years-old. Subjects with high BPV were significantly associated with hypertension status (PR = 1.38; 95%CI = 1.13–1.70; p = 0.003) or severe COVID-19 (PR = 1.39; 95%CI = 1.09–1.76; p = 0.005). In laboratory findings, high BPV group had higher CRP (55.15 ± 50.80 vs 97.79 ± 77.17), higher creatinine cerum (1.80 ± 3.15 vs 0.91 ± 0.14) and high BPV status also significantly increased risk of mortality (HR = 2.30; 95%CI = 1.73–3,86; p = <0.001). Patients with combination of severe COVID-19 status, hypertension (+) and high BPV status had the highest risk of in-hospital mortality (HR = 3.51; 95%CI = 2.32–4,97; p < 0.001) compared to other combination status of groups. In COVID-19 patients with hypertension, combination teraphy with CCB as well as CCB monoteraphy significantly decreased BPV (PR = 0.50; 95%CI = 0.27–0.93; p = 0.004) and mortality (HR = 0.17; 95%CI = 0.05–0.56; p = 0.004).

Conclusions:
High BPV was associated with hypertensive status and severe COVID-19, and these factors together increased in-hospital mortality. CCB are antihypertensive agents that were potentially effective in suppressing BPV and mortality in COVID-19 patients.
APSH-OP-3: VITAMIN D DEFICIENCY EXACERBATES MONOCROTALINE-INDUCED PULMONARY ARTERIAL HYPERTENSION IN RATS: POSSIBLE INVOLVEMENT OF TGF- β/α-SMA SIGNALING PATHWAY
Authors: Shah Sadia , Yadav Harlokesh Narayan 
Published: January 2023

Objective:
Vitamin D deficiency is highly prevalent and associated with poor prognosis in patients with pulmonary arterial hypertension (PAH). Therefore, this study compared the disease severity in normal and vitamin D deficient rats in terms of hemodynamic, echocardiographic, biochemical, histopathological, and immunohistochemical parameters. We also examined whether vitamin D supplementation would benefit the symptoms in normal and deficient rats. The molecular basis of vitamin D action, which may be exerted via the TGF- β/α-SMA signaling pathways, was studied by molecular techniques in vivo and in vitro.

Design and method:
Wistar rats were fed with a standard or a vitamin D deficient (VDD) diet to induce vitamin D deficiency. PAH was induced by a single s.c. dose of monocrotaline (MCT) 50 mg/kg. Normal rats were divided into vitamin D 100 IU/d pre-treated and 100 IU/d or 200 IU/d treated groups whereas VDD rats were treated with 100 IU/d (Fig. 1 a). siRNA was used to silence the vitamin D receptor in human umbilical vein endothelial cells (HUVECs). Calcitriol (50 nm) was added to HUVECs before and after the exposure of TGF- β (10ng/ml) (Fig 1 b). The expression and level of TGF- β and α-SMA were done using immunohistochemistry, western blot and PCR techniques in vivo and in vitro.

Results:
The same dose of MCT significantly increased the disease-associated parameters in the vitamin D deficient group compared to the rats with normal serum vitamin D levels. Effect of vitamin D 100 IU/d in VDD rats was comparable to 100 IU/d pre-treated and 200 IU/d treated normal rats measured in terms of hemodynamic, echocardiographic, histopathological, oxidative stress parameters and expression and level of TGF- β and α-SMA, which were significantly attenuated by administration of L-NAME (20 mg/kg), a selective inhibitor of eNOS. Exposure of TGF-β markedly increases the expression of α-SMA in vitamin D silenced HUVECs and also in normal HUVECs, which were averted by treatment or pre-treatment of calcitriol (50 nM).

Conclusion:
The disease severity increases in the rats with low serum vitamin D levels, which is ameliorated with vitamin D treatment. Moreover, vitamin D is more effective in treating PAH in vitamin D deficient rats than in normal rats, even at a low dose. This effect of vitamin D in the PAH disease model is mediated by the TGF- β/α-SMA signaling pathway.
AW-AD-3: ATRIAL FIBRILLATION AS PREDICTOR OF MORTALITY IN HEMODIALYSIS PATIENTS WITH CARDIOVASCULAR DISEASE
Authors: Febrianora Mega , Akbar Mohammad Rizki , Iqbal Mohammad 
Published: January 2023

Background:
The predictors of mortality in hemodialysis patients remain unknown, especially in patients with cardiovascular disease.

Aim:
To find the predictor of mortality in hemodialysis patients with cardiovascular disease.

Methods:
A number of 444 hemodialysis patients with cardiovascular disease in 2018 participated in the study. We performed history taking to determine comorbid (history and duration of hypertension, history of diabetes, coronary artery disease, congestive heart failure, stroke, vascular disease, liver disease, and alcohol consumption) and electrocardiography as baseline data. The patients then were followed up to assess the death event. Cox proportional hazards models were used to estimate hazard ratios (HR) and their 95% CI for various covariates.

Results:
Among 444 hemodialysis patients, 266 patients matched the inclusion and exclusion criteria, 166 patients were completely followed up in December 2019. The mean age was 50.8 ± 14.68 years, 52.4% female, mean duration of follow-up duration was 11.2 ± 10.08 months. History of hypertension was found in 149 (89.8%) patients. We observed all-cause death in 109 patients (65.7%) patients. Hypertension, diabetes, coronary artery disease, congestive heart failure, stroke, and vascular disease were not associated to death. We found out that atrial fibrillation was associated as a predictor of death (HR 2.540; 95% CI, 1.558–4.140, p = <0.001).

Conclusions:
Atrial fibrillation was associated with a higher incidence of death in hemodialysis patients with cardiovascular disease.
AW-APSH-2: “MINERALOCORTICOID RECEPTOR (MR)-ASSOCIATED HYPERTENSION” IN “GREEDY ORGAN HYPOTHESIS”
Authors: Itoh Hiroshi 
Published: January 2023

Spironolactone has been used for more than 60 years. Eplerenone is MR-specific MRB and esaxerenone possesses non-steroidal structure with high affinity and specificity to MR and exhibits long half-life. We conducted a double-blind phase III study of esaxerenone compared with eplerenone in patients with essential hypertension in 2020. Esaxerenone 2.5 mg elicited comparable hypotensive effect to eplerenone 50 mg and 5 mg exhibited significantly stronger effect than 2.5 mg. We also investigated the efficacy of dosage-escalation of esaxerenone added to a RAS inhibitor in hypertensive patients with type 2 diabetes (DM) (HbA1c:6.8%) and albuminuria (212 mg/gCr). 5 mg esaxerenone induced 20/8mmHg blood pressure reduction and reduced albumin excretion significantly. Interestingly, in these studies, esaxerenone exerted similar hypotensive action in the patients with RAS inhibitors, compared to the groups without them. This observation indicates that MR can be activated being independent of renin-angiotensin-aldosterone system. In 2012, we proposed the concept of “MR-associated hypertension”, hypertension caused by over-activation of MR with wide range of plasma aldosterone level. Primary aldosteronism is the typical example of MR-associated hypertension, but even in low plasma aldosterone concentration state, such as obesity, DM, CKD, MR can be over-activated. There are several postulated mechanisms of over-activation of MR. Increased expression of MR, increased sensitivity of MR and MR protein stabilization. We are interested in the activation of MR by salt and sugar themselves. We focus on MR expressed in the intestine for sodium absorption. Administration of DOCA and high salt induced up-regulation of epithelial sodium channel, ENaC, the target molecule of MR. And intestine specific knock-out of MR mice exhibited blunted increase of blood pressure by DOCA and high salt loading. We also demonstrated that high sugar induces MR protein stabilization by PKC activation, O-GlcNac modification or EGFR-ERK activation. More recently, in relation to excessive salt and sugar intake and occurrence of non-communicable diseases (NCDs), including hypertension, we have proposed “Greedy Organ Hypothesis”. Excessive intake of salt and sugar are sensed by the kidney and the intestines, and these organs up-regulate SGLT, sodium-glucose co-transporters and come to absorb salt and sugar greedily. Excessive salt intake through SGLT2 makes the kidney greedy to induce hypertension/CKD. Excessive food intake through SGLT1 make the intestines greedy to induce obesity/DM. Furthermore, there is “crossing” relationships between “greedy organs” and NCDs. Greedy kidney and intestines over-activate MR and induce MR-associated hypertension. Therefore, MRB are effective to alleviate Greedy Organs and to suppress NCDs.
ISH-PP-2: VIRTUAL MANAGEMENT OF HYPERTENSION: ISH POSITION PAPER
Authors: Khan Nadia A 
Published: January 2023

The COVID-19 pandemic caused an unprecedented shift from in-person care to delivering health care remotely. To limit the infectious spread, patients and providers rapidly adopted distant evaluation with online or telephone-based diagnosis and management of hypertension. However, many patients and care providers were unprepared for this rapid shift and may not be delivering optimal hypertension assessment and management. Given that it is likely that virtual care of chronic diseases including hypertension will continue into the future, the International Society of Hypertension developed a position paper to provide practical guidance on the virtual management of hypertension to improve its diagnosis and blood pressure control. This position paper is based on the currently available evidence, hypertension guidelines, and international expert opinion. Virtual care is defined as the delivery of healthcare remotely between patients, their carers, and healthcare providers. As different regions and patients have varying degrees of virtual care resources, skills, and preferences, we conceptualize the basic, advanced and complete virtual care models representing advancing degrees of virtual care.
This presentation will review the position statements in these three levels of virtual care and discuss the position statements and rationale for selecting blood pressure monitoring devices, cuffless devices, accurate home blood pressure assessments, optimizing patient education, health behavior change, medication adjustment, and long-term monitoring in a virtual care environment.
JS-NG-3: UNIQUE IMAGING FINDINGS IN RENAL ARTERY FIBROMUSCULAR DYSPLASIA
Authors: Kang Yuanyuan , Xu Jianzhong , Wang Jiguang 
Published: January 2023

A 35-year-old female patient with fluctuating blood pressure was referred to hypertension department for investigation of possible secondary hypertension. Computed tomographic angiography (CTA) of the renal arteries was performed, demonstrating abnormal right renal artery at the medial portion of the vessel with complete tubular narrowing and right kidney atrophy (right 79*35 mm, left 109*45 mm) (Panel A). Subsequent renal arteriography confirmed the long tubular narrowed right renal artery (Panel C) and the established severe tortuosity collateral vessel from the abdominal aorta (Panel B). The etiological diagnosis of the renal artery stenosis in this young woman was challenging and was supposed to be congenital renal dysplasia. Catheter-based angioplasty was not recommended. However, intravascular ultrasound (IVUS) revealed that it was not congenital narrowed artery, but concentric intimal-medial thickening caused stenosis of the vessel (Panel E). Therefore, renal artery fibromuscular dysplasia (FMD) was diagnosed and considered to be intimal type. Balloon angioplasty was performed, and IVUS showed that the lesion lumen was dilated successfully (Panel F). However, a bailout stent had to be placed because of intimal dissection during angioplasty, and renal blood flow was restored after procedure (Panel D). One month after the procedure, the patient was normotensive without any antihypertensive medication. At 1 year follow-up, the 99mTc-glomerular filtration rate of the right kidney increased from 19.7 to 40.4 ml/min.
FMD is a nonatherosclerotic, noninflammatory vascular disease that most commonly affects renal arteries and is recommended to be classified according to angiographic finding as multifocal FMD or focal FMD. Compared with multifocal FMD, focal FMD is less often seen, and the diagnosis of some cases is challenging. In the present case, such a long tubular stenosis of renal artery is rare, and the diagnosis was confirmed by IVUS. IVUS may be a useful tool for the diagnosis of focal FMD.
JS-HR-11: HOT TOPICS IN URIC ACID RESEARCH
Authors: Kuwabara Masanari , Kodama Takahide 
Published: January 2023

The mechanism between hyperuricemia, arteriosclerosis, hypertension, chronic kidney disease, and cardiovascular disease is becoming clearer (Figure cited from the article ‘Update on Hypertension Research in 2021’, Hypertension Research. 2022;45(8):1276 to 1297). However, it remains unclear whether treatment of hyperuricemia improves these diseases. In this session, we will introduce some recent topics of uric acid research.
The PERL (Preventing Early Renal Loss in Diabetes) trial and the CKD-FIX (Controlled Trial of Slowing of Kidney Disease Progression from the Inhibition of Xanthine Oxidase) showed that urate-lowering treatment with allopurinol, one of xanthine oxidase (XO) inhibitors, did not slow the decline in eGFR as compared with placebo. These results were similar with the results of FEATHER (Febuxostat Versus Placebo Randomized Controlled Trial Regarding Reduced Renal Function in Patients with Hyperuricemia Complicated by Chronic Kidney Disease Stage 3) from Japan. Furthermore, the PRIZE (Program of Vascular Evaluation Under Uric Acid Control by the Xanthine Oxidase Inhibitor Febuxostat: Multicenter, Randomized, Controlled) study showed that febuxostat did not delay progression of carotid atherosclerosis in patients with asymptomatic hyperuricemia. These results suggest that treatment of hyperuricemia could not directly prevent chronic kidney disease (CKD) and/or arteriosclerosis. In contrast, there are many studies that showed the positive relationship between uric acid and hypertension. Lowering serum uric acid levels could reduce blood pressure, but it is unclear that lowering serum uric aclid levels might be directly causing the results in preventing CKD progression, arteriosclerosis, and cardiovascular events. These results suggest that we should carefully choose the treatable patients with hyperuricemia and hypertension.