bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS-P01-1: EFFECT OF FOOT MASSAGE ON DECREASING BLOOD PRESSURE AND ANXIETY IN OLDER PEOPLE WITH HYPERTENSION IN INDONESIA
Authors: Anwar Nursanti , Irwan Andi Masyitha , Saleh Ariyanti , Usman Suharno 
Published: January 2023

Background:
Globally, the prevalence of hypertension in the world is quite high, especially in older people, which continues to increase every year. In addition to increasing blood pressure, many of the older people also experience anxiety. Intervention is needed to reduce blood pressure and overcome anxiety, and one of which is by giving foot massage interventions.

Objective:
To determine the effect of foot massage on reducing blood pressure and anxiety in older people with hypertension

Method:
This study was a quasi-experimental study with time-series design for measuring blood pressure and assessing the degree of anxiety after repeated foot massage interventions for 12 sessions.

Results:
A significant decrease in anxiety was observed after six days and 12 days of foot massage intervention (p < 0.05). A significant decrease was also observed in systolic blood pressure after the 12thintervention compared to baseline and 8th intervention (p < 0.05).

Conclusion:
Foot massage intervention is effective in reducing blood pressure and anxiety in older people with hypertension
PS-P01-6: IMPLEMENTATION OF A BLOOD PRESSURE ACTION SHEET IN A RURAL COMMUNITY SETTING IN INDONESIA
Authors: Rahmawati Riana , Fauziyati Ana , Sholawati Aliza Ayu Puspita 
Published: January 2023

Objective:
The Blood Pressure Action Sheet (BPAS) was developed as a written material that provides information about hypertension, records blood pressure monitoring, and facilitates communication among patients, community health workers, and healthcare professionals. The purpose of this study was to evaluate whether the BPAS would help to improve patient adherence to antihypertension medication. Adherence to medication is important in blood pressure control, which helps to reduce the risk of morbidity and mortality. Nonadherence to antihypertensive medications is a serious problem in both developed and developing countries. In this study, the perspectives of community health workers of the implementation of BPAS were also explored.

Design and method:
This was a community based study in Yogyakarta province, Indonesia. Members of the Integrated Health Service Post for the Elderly who were 45 years or older and had stage 2 hypertension were included in the study. This was a mixed methods study that included a pre post interventional study to assess whether medication adherence improved followed by a qualitative study to explore community health workers perspectives of the implementation of BPAS. Adherence to medication was assessed using the Indonesian version of the Medication Adherence Rating Scale (MARS) questionnaire. Adherence was compared from before to 3 months after the intervention. An in depth interview was conducted among community health workers.

Results:
One hundred eight patients fulfilled the inclusion criteria. Most were female (87%) and had a low education level. The average age was 67.2 ± 9.2 years. The MARS score was significantly higher after than before the intervention (20.5 ± 3.4 vs (18.7 ± 4.5, respectively; p < 0.05). The percentages of patients categorized as completely adherent (score 24 or 25) were 11.9% before and 19.6% after the intervention. The percentages of nonadherent patients (MARS score < 20) decreased from 46.2% before to 21.6% at 3 months after the intervention. Community health workers perceived the BPAS as user friendly and useful, and that it had potential for implementation in the Integrated Health Service Post for the Elderly. The challenges for implementation relate to its use for illiterate patients.

Conclusion:
The 3 month implementation of the BPAS improved patients adherence to antihypertension medication. Despite the positive findings, the adherence after the intervention was still not optimal. Further studies are needed to evaluate the effects of administering of the BPAS in different settings.
PS-P02-8: HOST GENOMIC INFLUENCE ON THE GUT MICROBIAL METABOLITE-BLOOD PRESSURE RELATIONSHIP
Authors: Posma Joram M , Perez Isabel Garcia , Karaman Ibrahim , Gao He , Chan Queenie , Daviglus Martha , Horn Linda Van , Holmes Elaine , Nicholson Jeremy K , Elliott Paul 
Published: January 2023

Objective:
The human metabolic profile is affected by host genetic, microbiome, environmental/lifestyle, and dietary factors which may all influence human raised blood pressure (BP). We aim to delineate metabolite-BP relationships by evaluating the effect of single-nucleotide polymorphisms (SNPs) mapped to enzyme-coding genes involved in metabolic pathways on this association. We specifically focus on human commensal urinary gut microbial co-metabolites.

Design and Method:
Two cross-sectional datasets of over 4,000 individuals in total were used in a two-stage design. The first cohort uses two timed 24-hr urine samples for the discovery and replication of urinary metabolites associated with BP. The second cohort uses spot urine samples to validate the associations and subsequently investigates the influence of BP and other metabolic syndrome-related SNPs on these associations. Urine samples from both cohorts were measured with 600 MHz 1H Nuclear Magnetic Resonance spectroscopy. The SNPs were mapped to metabolites using a bioinformatic approach, which also incorporates the microbiome in establishing the metabolic distance between SNPs and metabolites through biochemical reactions and pathways.

Results:
11 urinary metabolites, replicated within the first cohort and validated in the second cohort (adjusted P-values 1.68 × 10–15 to 1.08 × 10–4) were associated with systolic BP (SBP); 9 of these were also associated with diastolic BP (DBP) in both cohorts as well as 2 further metabolites with DBP only (adjusted P-values 9.18 × 10–13 to 1.23 × 10–4). The analysis of the host-genomic (SNPs linked to GLYAT, KYAT3 and SULT13A genes) effect on gut microbial co-metabolites phenylacetylglutamine, hippurate and 4-cresylsulfate and their association with BP revealed a significant contribution of SNPs on the metabolite-BP association (P-values 1.08 × 10–133 to 2.87 × 10–29). Other metabolite-BP associations, such as for amino acids tyrosine, glycine, lysine, and leucine, also demonstrated a significant effect of individual SNPs (P-values 1.54 × 10–303 to 2.04 × 10–8) on the relationship. These associations were validated with null models of random SNPs with the same minor allele frequency also mapping to enzyme-coding genes, as well as a null model demonstrating that these metabolites have more SNPs linked to them than other metabolites with similar network topologies in other metabolic pathways.

Conclusions:
We have shown that human commensal urinary gut microbial co-metabolites are reliably associated with BP differences in two cohorts, and we demonstrated a significant host-genetic component that contributes to these associations. These relationships indicate potential complex mechanisms involving host genetics, the gut microbiome, and metabolic changes associated with BP that may lead to new ways to prevent high BP.
PS-P03-7: 24 HR-AMBULATORY BLOOD PRESSURE PROFILE AND CLINICAL FEATURES OF HYPERTENSIVE AND PREHYPERTENSIVE HEALTH CARE WORKERS IN A PHILIPPINE TERTIARY CENTER
Authors: Abarquez Anna Francesca S , Llanes Elmer Jasper B , Santos Lourdes Ella G , Bongcawil Roxanne C , Cruz Angelica C Dela 
Published: January 2023

Background:
Hypertension is a leading cause of cardiovascular morbidity, and its prevalence is increasing most rapidly in developing countries like the Philippines, where there is poor hypertension treatment and control ABPM is an important diagnostic tool among patients because it identifies hypertension phenotypes and circadian blood pressure profile that are known to be predictors for target organ damage and increased incidence of future cardiovascular event.

Objectives:
To determine the blood pressure profile and phenotypes of hypertensive and pre-hypertensive health care workers and its association to BP control and dipping status.

Design and Methods:
This is a cross-sectional study of hypertensive employees who underwent 24 hr ambulatory blood pressure monitoring (ABPM).

Results:
181 patients were included with majority from 50–59 years old age group (33.3%), female (70.17%), non-shift workers (61.88%) with the most common comorbidity of obesity (60.22%) and suspected obstructive sleep apnea (60.22%). All the known hypertensives (100%) had uncontrolled blood pressure despite being on antihypertensive medication. The following hypertension phenotypes were identified: Sustained hypertension (64.7%), masked hypertension (13.26%), white coat hypertension (7.18%), and non-dippers (66%).

Conclusion:
There was high prevalence of sustained hypertension among healthcare workers included in this study. All those known hypertensives tested had uncontrolled blood pressure despite being on one or more antihypertensive therapy, while there were also newly diagnosed with masked hypertension.
The overall prevalence of non-dippers and those with elevated mean 24- hour blood pressure levels was high, and there is significant association of working longer hours and nocturnal dipping pattern. However, there was no significant difference on nocturnal dipping status and blood pressure elevation among those with those with shift work, compared to usual office work hours. This study is one of the few local data on 24hr ambulatory blood pressure measurement of Filipino hypertensive and prehypertensive patients and is one of few data on use of ambulatory blood pressure monitoring among Asians. This also highlights the importance of 24-hour ABPM to identify ABPM parameters at high risk for cardiovascular outcomes and finally determine blood pressure control among known hypertensive patients according to the locally available maintenance medications.
PS-P03-10: SETTING UP OF MYWASSH, THE MALAYSIAN SOCIETY FOR WORLD ACTION ON SALT, SUGAR AND HEALTH: PROMOTE SALT REDUCTION IN MALAYSIA
Authors: Chia Yook Chin , Chung Felicia Fei Lei , Ooi Pei Boon , Chew Ming Tsuey , Cheng Daniel Maoung Hui 
Published: January 2023

In response to non-communicable diseases in particular cardiovascular diseases being the leading cause of premature deaths in high as well as middle income countries, the World Health Organisation in 2013, proposed several targets to address this problem. One of the targets set was reduction of salt intake to less than 5gm per day by 2030 - to reduce the prevalence of hypertension.
Salt intake is of particular importance because intake of salt in Asia is high, ranging from 9–17 gm/day. Furthermore, high salt intake is more important in Asia as salt sensitivity is higher in Asians causing a rise greater rise in blood pressure (BP) compared to Caucasians. Furthermore, the impact of BP in Asians is again higher than in Caucasians, making it even more important to reduce BP as much as possible.
Reduction in salt intake needs a multi-prong, multi-sectorial approach. One strategy to help reduce salt intake is public education. We cannot rely only on the government and health authorities alone to ensure the reduction of intake of salt. To this end, a group of interested health care professionals, dietitians, scientists got together to set the society to help educate the public. This society was successfully formed and registered under the Malaysian Registrar of Societies in November 2021 and launched by the Deputy Minister of Health Malaysia in May 2022. A website was also created and language specific educational materials including videos were created by the members themselves.
To strengthen the Society activities and aligned with international organisations, the society sought and was granted affiliated membership with the World Hypertension League and the
International Society of Hypertension. A memorandum of understanding was signed with UK WASSH and Sunway University (SU) as SU is very much committed to UN Sustainable Development Goals - health is one the arms and willing to provide a lot of support for our educational activities. Furthermore, a monetary grant was successfully secured to help defray expenditure related to our educational activities.
We need more salt warriors- i.e., the people who will help educate the public, food vendors, the food manufacturers and lobby public policy as well. The young and enthusiastic members have already embarked educational activities at various sites throughout the country. We believe the efforts of this new Society will have impact and by sharing this, we hope other countries in Asia will also start the battle against a high salt intake.
PS-P04-9: PULSE PRESSURE AND MEAN ARTERIAL PRESSURE IN HYPERTENSIVES WITH MULTI-MORBIDITY: AN ANALYSIS USING GLOBAL DATA FROM MAY MEASUREMENT MONTH (MMM)
Authors: Wang Wei , Janssen Carolina , Schlaich Markus , Schutte Aletta E , Stergiou George , Poulter Neil R , Beaney Thomas 
Published: January 2023

Background:
The increasing prevalence of people living with multimorbidity is an increasing challenge for health systems. Mean arterial pressure (MAP) serves as the steady component in a patient's arteries during one cardiac cycle while pulse pressure (PP) is recognized as the pulsatile component. Along with systolic blood pressure (BP) and diastolic BP, both MAP and PP are established risk factors for the development of major adverse cardiovascular events. The knowledge of how PP and MAP vary among hypertensives according to the presence of one or more long-term conditions (LTCs) is limited. May Measurement Month (MMM) is the largest contemporary global BP screening campaign designed to raise awareness of high BP.

Purpose:
To identify the association between BP parameters and number of LTCs (diabetes, myocardial infarction and stroke) in participants with hypertension.

Design and methods:
MMM is an opportunistic cross-sectional survey with over 4.8 million volunteers aged over 18 years recruited between 2017–2019, and 2021 in 106 countries. Three sitting BP readings were taken for each participant on a single occasion, with data on demographics, lifestyle, hypertension and LTCs collected. Hypertension was defined as systolic BP greater than 140mmHg and/or diastolic BP greater than 90mmHg (average of the second and third readings) and/or taking antihypertensive medication(s). Mixed-effects linear regression models were applied to compare the BP parameters with different numbers of LTCs, assuming random intercepts for country to account for clustering. Multivariable models were adjusted for age and sex (with an interaction term), medication use, current smoking and alcohol consumption.

Findings:
We analysed data from 1,107,432 individuals with hypertension, recorded data on LTCs and with all three BP readings. Overall, 860,376 (77.7%) had no LTCs, 188,306 (17.0%) had one, 40,592 (3.7%) had two, and 18,158 (1.6%) had three LTCs. After adjustment for potential confounders, the average PP of hypertensives without LTCs was 52.9mmHg. Compared to those with no LTCs, the PPs were significantly higher at 54.4mmHg, 54.9mmHg, and 53.6mmHg, in hypertensives with one, two or three LTCs, respectively (all p < 0.001). A strong inverse relationship was seen between MAP and numbers of LTCs, with mean MAPs of 104.1mmHg, 103.8mmHg, and 101.5mmHg in those with one, two or three LTCs respectively, compared to participants without (104.4 mmHg) (all p < 0.001).

Conclusion:
Our study highlights that the presence of one or more LTCs is associated with higher PP and lower MAP. These differences in PP and particularly reduced MAP may have implications for optimal BP management in people with multimorbidity.
PS-P05-2: THE CORRELATION OF HYPERTENSION WITH LENGTH OF STAY OF ADHF IN CVCU OF SAIFUL ANWAR GENERAL HOSPITAL, MALANG, INDONESIA
Authors: Sakti Pradhika Perdana , Anjarwani Setyasih 
Published: January 2023

Background:
Long-term hypertension eventually leads to heart failure (HF), and therefore, most patients with HF have a history of hypertension. Conversely, the absence of hypertension in midlife was associated with a lower risk of new-onset heart failure later in life. Cardiac remodeling with major pressure overload includes diastolic dysfunction and concentric left ventricular (LV) hypertrophy. If pressure overload persists, diastolic dysfunction progresses and concentrically remodeled left ventricular filling decreases, followed by heart failure with preserved ejection fraction.

Objectives:
The aim of this study was to ascertain the correlation of pre-existence hypertension with the length of stay (LOS) of acute decompensated heart failure (ADHF) patients admitted in CVCU of Dr. Saiful Anwar General Hospital, Malang.

Method:
The study was a retrospective analytic in ADHF patients in CVCU of Dr. Saiful Anwar General Hospital Malang in August 2021 to April 2022. The presence of pre-existence hypertension in admission were compared with non-hypertensive group.

Result:
A total of 86 patients met study criteria in August 2021 to April 2022, respectively. The prevalence of hypertensive group ADHF patients was 61.6% (53 of 86), with comparable rates for men (74.4% [64 of 86]) and women (25.6% [22 of 86]). The LOS rate was higher in hypertensive group (11 days in average) than non-hypertensive group ADHF patients (8 days in average).

Conclusion:
The prevalence of hypertension as comorbid of heart failure patients is higher than the non-hypertensive heart failure group in CVCU of Dr. Saiful Anwar Malang in August 2021 to April 2022. Based on admission vital signs, patients with longer LOS have hypertension as pre-exsistence comorbid.
PS-P05-5: CHANGES IN BLOOD PRESSURE CONTROL, TARGET ORGAN DAMAGE AND CARDIOVASCULAR RISK FACTORS IN HYPERTENSIVE SUBJECTS UNDER ANTIHYPERTENSIVES DURING 9 YEARS
Authors: Hayashi Kazusa , Takase Hiroyuki , Kin Fumihiko , Nakano Suguru , Machii Masashi , Takayama Shin , Sugiura Tomonori , Dohi Yasuaki 
Published: January 2023

Objective:
Since an increase in blood pressure is one of the most important risk factors for cardiovascular morbidity and mortality, appropriate blood pressure control is necessary to prevent target organ damages and cardiovascular diseases. We investigated changes in blood pressure control, target organ damage and cardiovascular risk factors of hypertensive subjects under antihypertensive medications from 2010 to 2019.

Design and Methods:
A total of 1679 and 1884 hypertensive subjects under antihypertensive medications (62.8 ± 9.8 and 65.8 ± 9.4 year-old, respectively) who visited our hospital for physical checkup in 2010 and 1019, respectively, were enrolled. Subjects were divided into two groups; controlled (blood pressure < 140/90mmHg) and not-controlled groups (blood pressure > = 140/90mmHg). Target organ damage defined as left ventricular hypertrophy (LVH) on electrocardiogram (Sokolow-Lyon voltage > 3.8 mV and/or Cornell product > 2440 mm ms) or decline of estimated glomerular filtration rate (eGFR; < 60 mL/min per 1.73 m2) and other cardiovascular risk factors were investigated.

Results:
The results are summarized in the table. Blood pressure control was generally improved during the 9 years though the mean age of subjects was increased. The prevalence of impaired kidney function but not LVH and the number of subjects with risk factors were increased during the period. Sub-analysis in 537 subjects who visited in both 2010 and 2019 were performed and similar results were obtained (data not shown).

Conclusions:
Although blood pressure control was improved, total management of hypertensive subjects was not appropriate. Management of risk factors other than hypertension as well as blood pressure control is necessary in hypertensive subjects for extension of healthy life expectancy.
PS-P05-8: CARDIOVASCULAR DISEASES AWARENESS AMONG WOMEN IN NORTHERN JORDAN
Authors: Okour AbdelHakeem , Saadeh Rami 
Published: January 2023

Background:
Womens awareness of chronic diseases, including cardiovascular diseases, is the cornerstone in promoting womens health.

Objectives:
To examine the relationship of awareness levels about cardiovascular diseases and their related risk factors with demographic information of Jordanian women.

Methods:
A cross-sectional study of 18 years and older women. Scores of awareness were computed for each individual and were divided into 4 quartiles. Logistic regression analysis was used to examine the association of demographic information of participants with mean scores of quartiles. ANOVA analysis was used to com-pare between the mean scores of quartiles.

Results:
A total of 514 women completed the questionnaire, with a mean age of 35.46 (±12.53). Current smokers were 6.2%, and 34.6% had a family history of heart disease. The proportion of diabetes, hypertension, hypercholesterolemia, and overweight/obesity were 15.6%, 19.3%, 14.4%, & 21.6% respectively. The mean score for awareness was 12.87 (+ 3.26). Women who had lower income and who were at younger age were more likely to score low in awareness.

Conclusion:
Women illustrated a fair level of awareness of CVD and its related risk factors. Increasing women awareness of CVD through educational programs, targeted toward women at risk, assists in disease prevention and help to improve treatment plans.
PS-P06-3: TREATMENT SEEKING BEHAVIOUR AND TRIGGERS AMONG PATIENTS WITH CHRONIC ILLNESSES DURING COVID-19 PANDEMIC: A QUALITATIVE STUDY
Authors: Gamage Anuji , Gunasekera Therani , Sathasivam Sridharan 
Published: January 2023

Background:
Public health strategies, many of which required restricting movement of people, such as lock-downs and social-distancing measures had to be resorted to world-wide, to reduce the incidence and transmission of COVID-19, leading to a decline in healthcare utilization by non-COVI-19 patients, which is detrimental to people suffering from chronic-illnesses. This study aimed to assess treatment-seeking behavior among patients with chronic illnesses during the pandemic and the new normal.

Methods:
This qualitative study involved in-depth interviews with sixteen patients aged 30 -55 years with chronic diseases. Three focus group sessions were also held. The indepth interviews and focus group discussions were conducted until saturation point was achieved. Purposive sampling was used, and data were analyzed thematically. The study centers were two public hospitals and one general practitioner setting in Sri Lanka.

Findings:
Three main themes were identified. Namely, change of treatment seeking behaviour, difficulties in healthcare access and adherence and high out of pocket expenditure. Majority had diabetes, hypertension or both. Trigger factors for changing the healthcare setting during the pandemic were long waiting times, lack of staff to conduct the clinic, lack of drugs and investigations, and fear and anxiety associated with the pandemic. Treatment access and adherence were found difficult due to lack of high expenditure on transportation, prolonged waiting times, difficulties in buying the drugs, and spending on laboratory investigations. The reasons for high cut-off pocket expenditures were mostly for transportation, drugs, consultations and investigation. Some mentioned that due to difficulties in obtaining the treatment, they resort to adopting a healthy lifestyle, taking indigenous medication, and taking the drugs in a different frequency and regime. Very few agreed that they received the drugs via the postal service but stated that this was not regular, and that not all the drugs were available.

Conclusion:
Healthcare system-related and patient-related factors lead people to change their treatment-seeking behavior. Any health intervention to promote people's treatment-seeking behavior and to continue acess and adherence, especially for a chronic illness, should consider these complex trigger factors of individual needs, goals, and issues.