bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS-C33-11: FACTORS RELATED TO DETERIORATED KIDNEY FUNCTION IN RESISTANT HYPERTENSION PATIENTS
Authors: Bezrodna Larysa V , Mishchenko Larysa A , Bezrodny Volodymyr B , Matova Olena O , Kupchynska Olena G , Gulkevych Oxana V , Serbenyuk Kateryna I 
Published: January 2023

Objectives:
To determine the factors associated with renal function deterioration in resistant hypertension (RH) patients

Methods:
The study included 152 patients aged 28 to 79 years with RH. They underwent measurement of office and ambulatory blood pressure monitoring (ABPM). Blood level of potassium, sodium, glucose, creatinine, uric acid, citrulline, C-reactive protein (CRP), matrix metalloproteinase-12 (MMP-12), aldosterone-renin ratio and 24-h excretion of metanephrine and 24-h urinary albumin excretion rate (AER) were determined. Glomerular filtration rate (GFR) was estimated by the CKD-EPI formula.

Results:
Chronic kidney disease (CKD) was diagnosed in 32.3% of patients with RH (gr.1 pts), gr.2 pts - those without CKD. Spearman's correlation analysis showed a negative relationship between GFR and office diastolic BP (DBP) and 24 hours mean DBP (r = -0.233; r = -0.373; P < 0.01, respectively). Significant negative correlation was revealed between GFR and daytime systolic BP variability (r = -0.275; P < 0.01). GFR was inversely related to AER (r = -0.412; P < 0.01), uric acid (r = -0.311; P < 0.05), CRP (r = -0.314; P < 0.05), MMP-12 (r = -0.385; P < 0.01), citrulline (r = -0.375; P < 0.01), sodium (r = -0.284; P < 0.05), aldosterone and urinary metanephrine level (r = -0.225; P < 0.05 and r = - 0.210; P < 0.05). In gr.1pts. level of CRP, MM-12 and citrulline was significantly (P < 0.01) higher than in the gr.2 pts.
Factors independently and most closely related to reduced GFR in RH patients are 24 hours mean DBP (β; = -0.449, P < 0.001), CRP (β; = -0.354, P < 0.01), MMP-12 (β; = -0.248; P < 0.01) and citrulline (β; = -0.232; P < 0.05).

Conclusions:
Revealed associations, in addition to elevated blood pressure, indicate the possible pathogenic role of low-grade systemic inflammation biomarkers in the renal function deterioration in RH patients. Targeting low-grade systemic inflammation may improve BP control in resistant hypertension patients with CKD.
PS-C34-3: EXPERIENCES AND INFLUENCES OF ONLINE HEALTH INFORMATION-SEEKING ABOUT STATIN USE IN PATIENTS WITH HIGH CARDIOVASCULAR RISK: A QUALITATIVE STUDY.
Authors: Lim Hooi Min , Ng Chirk Jenn , Dunn Adam G , Abdullah Adina 
Published: January 2023

Objectives:
Online health information (OHI) about statin use has created debates among healthcare professionals and the public. As a result, online misinformation about statins has led to an increase in the discontinuation of statins. OHI has been shown to influence patients’ health decisions and behaviours. This study explores the views and experiences of OHI-seeking about statins in patients with high cardiovascular risk and how OHI influences patient decision-making and statin adherence.

Designs and method:
This is a qualitative study with semi-structured in-depth interviews of 20 patients with high cardiovascular risk from a primary care clinic in Malaysia. We included participants who were at least 18 years old and had high cardiovascular risk where statin use is indicated as per guideline (i.e. with pre-existing cardiovascular disease (CVD), diabetes mellitus, chronic kidney disease, a 10-year risk for CVD > 20% based on the Framingham General CVD risk score) and have sought OHI about statins. We used an interpretive description approach with thematic analysis.

Results:
The age of the participants ranged from 39–74 years, with 16 (80%) participants having hypertension. 12 (60%) participants took a statin for primary CVD prevention. The duration of statin use ranged from 2 weeks to 30 years. Six themes emerged from the interviews (Figure 1): (1) Participants sought different types of OHI throughout the disease trajectory depending on their information needs, (2) There is a changing paradigm of OHI-seeking behaviour, where passive exposure to OHI appears to have increased relative to active searching, (3) Participants sought a wide range of OHI from hypercholesterolemia, lifestyle modification and complementary alternative medicine, (4) Statin-related OHI was mainly negative and stressed the side effects of statins, (5) OHI triggered emotional reactions that may affect patients’ decision on statin adherence, (6) Doctors’ responses to participants’ OHI-seeking behaviour affected patient-doctor communication and patients’ decision in taking statins.

Conclusions:
This study highlights the changing information needs throughout patient journeys, suggesting the opportunity to provide needs-oriented OHI to patients with high cardiovascular risk. Passive OHI exposure appears to have an influence on patients’ adherence to statins. The quality of patient-doctor communication about OHI-seeking behaviour remains a critical factor in patient decision making. Doctors should discuss patients’ information needs and OHI-seeking behaviour throughout the disease trajectory and provide evidence-based health information to patients. Strategies are needed to address patients’ concerns about statins, acknowledge their emotional reactions toward OHI and support their need for evidence-based OHI.
PS-C36-1: CLINICAL INERTIA IN THE HYPERTENSIVE PATIENTS TREATED BY HYPERTENSION SPECIALISTS
Authors: Arakawa Kimika , Imazu Rina , Morinaga Yuki , Tominaga Mitsuhiro , Tsuchihashi Takuya 
Published: January 2023

Background:
Only about 30% of hypertensive patients in Japan is reported to have properly controlled blood pressure (BP). The clinical inertia (Inertia) seems to be one of the factors behind the inadequate BP control.

Purpose:
We investigate the achievement rate of the BP lowering target in 2020 for outpatients in the division of hypertension, and confirm the prevalence of inertia as a possible factor for the failure to achieve their BP targets.

Methods:
Subjects were 517 outpatients (mean age 68.6 ± 13.2 years, 54% of women) who regularly visited the division of hypertension from March to September 2020 and took antihypertensive drugs prescribed by hypertension specialists. We calculated the average of office BP (OBP) in the two visits during the same period, and the average of home BP (HBP) for the three days before each two visits. In addition, we investigated the antihypertensive drugs taken during that period and complications such as diabetes and chronic kidney disease, and collected blood chemistry and urine test data. From these data, as of December 2021, the attending doctors determined whether each patient achieved the BP target according to the Japanese Society of Hypertension 2019 (JSH2019), and chose one reason from the options in the patients who failed to achieve target BP.

Results:
The target for OBP in all subjects was < 130/80 (48%), < 140/90 (140 group, 15%), < 140/90 mandatory, and < 130/80 if tolerable (37%). The percentage of those who achieved each OBP target was 48% (OBP achievers, N = 246). As a result of investigating the reason for the OBP non-achievement (N = 273) by the attending doctors, 20% answered “judged to be the optimal BP level (Optimal)”, 20% answered “due to the white coat effect ”, and then “Inertia” was the next highest at 14%. Regarding the achievement rate of HBP for OBP achievers, 36% did not measure HBP, 38% achieved < 135/85 or < 130/80 (HBP 135), and 26% (N = 65) did not achieve it. Among the HBP 135 other than the 140 group (N = 66), the unachieved rate of < 125/75 was 58% (N = 38). The reasons for non-achievement of HBP (N = 103 in total), “Optimal” was the most common answer (42%), followed by “Inertia” (27%).

Conclusion:
Inertia existed as a factor explaining insufficient BP control even in the patients treated by hypertension specialists. From now on, in order to increase the rate of achieving the BP target, we should make an effort to overcome inertia.
PS-C36-5: SUPEROXIDE DISMUTASE AS A PROTECTIVE FACTOR FOR EARLY RENAL DAMAGE IN HYPERTENSIVE PATIENTS
Authors: Yu Xiaoqian , Xu Rui 
Published: January 2023

Background:
Hypertension is a primary risk factor for chronic kidney disease (CKD), which is a highly prevalent condition that contributes to a substantial proportion of disease burden globally. However, CKD can be reversed in the early stage of renal damage. As a result, for a better prognosis, early detection and treatment are crucial for a better prognosis. Oxidative stress had been linked to hypertensive renal impairment in previous investigations. Superoxide dismutase (SOD) was a clinically available oxidative stress biomarker that had yet to be linked to early kidney damage in hypertension. The association between SOD and the early renal damage (ERD) of hypertension has not been established. The aim of the study was to investigate the relationship between SOD and ERD, hoping to provide a new direction to prevent and treat hypertension with ERD.

Methods:
This was a retrospective observational study. Clinical data were collected from patients with essential hypertension (EH) in Shandong Provincial Qianfoshan Hospital from January 2017 to December 2018. ERD was defined as urine microablumin/ creatinine ratio (UACR) greater than 30 mg/g but less than 300 mg/g. Patients were divided into hypertension with ERD group and hypertension without early renal damage (NRD) group. Clinical data from patients were collected and compared between the two groups. Spearman and Pearson correlation analysis were used to analyze the correlation between UACR and SOD. Moreover, univariate and multivariate logistic regression analyses were used to screen for the risk factors for ERD.

Results:
According to our analysis, SOD was protective factors (P < 0.05). Multivariate logistic regression analysis showed that SOD was an independent protective factor for hypertension with ERD. Both Spearman and Pearson correlation analysis showed negative correlation between SOD and UACR (P < 0.05).

Conclusion:
SOD was an independent protective factor for early renal damage in hypertensive patients, providing a new direction for the treatment of early renal damage in hypertensive patients.
PS-P12-6: CADMIUM AND HYPERTENSION IN KINGSTON JAMAICA: ANY CORRELATION?
Authors: Hedge Tiffany , Rattray Vaughn , Coleman Novie Younger , Wilks Rainford , Nwokocha Chukwuemeka 
Published: January 2023

Background:
The cadmium burden in Jamaican soil is exceptionally high. Cadmium has been found to induce hypertension in animal models but in humans, the results have been inconsistent.

Objectives:
We sought to Quantify associations of systolic and diastolic blood pressures with blood levels of cadmium in persons living in Kingston and St. Andrew. The distribution of hypertension by gender, age, BMI and other lifestyle categories and Determining the association of blood pressure with blood cadmium concentration.
Methodology: A cross- sectional study was conducted with 287 persons residing in the parishes of Kingston and St. Andrew. Demographic and lifestyle data were captured using closed ended questionnaires. Systolic and Diastolic blood pressure levels were measure using standardized protocol and blood cadmium concentration was measured by atomic absorption spectroscopy.

Results:
More than half of the respondents (58.5%) were hypertensive, with the majority being females (65.5%). There was a statistically significant relationship between hypertension status and age, X2 (3, N = 287) = 51.98, p = 0.001), and hypertension status and BMI (p = 0.008). There was a positive yet small correlation between blood cadmium concentration blood pressure measurements (systolic and diastolic). However, after multivariable adjustments, there was no association between blood cadmium concentration and blood pressure measures. Logistic regression analysis indicated that for every one unit increase in blood cadmium concentration the odds of respondents being hypertensive increase by a factor of 1.035 (95% CI 0.975–1.099) unadjusted and 1.014 (95% CI 0.951–1.808) adjusted. No association was found between dietary patterns and blood cadmium concentration.

Conclusion:
No association was found between blood cadmium concentration and blood pressure measurements (systolic and diastolic measurements) and blood cadmium concentration and dietary patterns. However a positive association was found between hypertension prevalence and blood cadmium concentration. Further studies with increased sample size will be required to improve the statistical significance among the variables of interest.
PS-P15-2: CHANGES IN HOME BLOOD PRESSURE VARIABILITY DURING DOWN-TITRATION OF ANTIHYPERTENSIVE DRUGS IN PATIENT WITH SYSTOLIC HOME BLOOD PRESSURE BELOW 120MMHG
Authors: Lee Yonggu , Shin Jinho , Pyun Wook Bum 
Published: January 2023

Background:
In the guideline recommendation for intensive blood pressure (BP) control, there has been a concern for the J-curve phenomenon so European guidelines recommended down-titration if systolic BP (SBP) lowered below 120 mmHg. But there is no studies for the changes in BP and BP variability with down-titration. Aim of the study is to test the hypothesis that BP variability could be increased with down-titration.

Methods:
In a retrospective study, 82 patients undergone down-titration in whom home BP monitoring (HBPM) before and after were available were analyzed during 2020.09.01∼2022.05.31. During this period, the guideline directed medical therapy was to down-titrate when home SBP was below 120 mmHg. When preclinic SBP below 120 mmHg, down-titration was performed when home SBP was less than 120 mmHg in the next visit or incidental home SBP less than 120 mmHg regardless of clinic SBP level. Minimal and maximal required numbers of readings in HBPM were 8 and 40. Average and standard deviation (SD) were compared before after down-titration.

Results:
Mean age was 66.2(34∼95) years and female readings were 44 (53.7%). Preclinic SBP was 122.4  + /-17.5 mmHg and clinic SBP was 121.9 +/-14.2 mmHg at baseline (BL). Clinic SBP at follow up (FU) was 126.4 +/-15.5 mmHg. History of cardiovascular diseases, diabetes and hyperlipidemia were present in 17%, 32.9%, and 69.5%, respectively. Numbers of AHMS were 1 in 26.8%, 2 in 30.5%, 3 in 32.9%, and 4 in 9.7%. The uses of renin angiotensin blockade, beta blocker, calcium antagonist, and diuretics were 84.1%, 36.5%, 75.6% and 29.3%, respectively. Home SBP was increased significantly (111.6 mmHg BL, 118.8mmHg FU, p < 0.0001). SD of home SBP did not increased significantly (3.5 mmHg BL, 3.4 mmHg FU, p = 0.85). Home diastolic BP (DBP) was also increased significantly (68.7 mmHg BL, 72.8 mmHg FU, p < 0.0001). SD of home DBP did not changed (2.2 mmHg BL, 1.6 mmHg, p = 0.55).

Conclusion:
When antihypertensive drug was down-titrated due to excessive lowering of systolic BP less than 120 mmHg, mean BPs were increased modestly without increase in BP variability. Current guideline directed down-titration should be safe without increasing BP variability.
PS-P15-6: PERIPHERAL OSTEOPONTIN MIGHT BE A POTENTIAL BIO-MARKER FOR PREDICTING ARTERIAL STIFFNESS IN ELDERLY CHINESE
Authors: Fu Guoxiang , Pan Fengfeng , Xu Chanchan 
Published: January 2023

Objective:
Compare the efficiency of pulse wave velocity (PWV) and ankle-brachial Index (ABI) in diabetes patients and healthy participants. Investigate novel bio-markers for aging related arterial stiffness.

JOURNAL/jhype/04.03/00004872-202301001-01307/figure1/v/2023-10-24T163949Z/r/image-jpeg

Design and method:
PWV, ABI, vascular cell adhesion molecule (VCAM), osteopontin (OPN) and glutathione peroxidase (GPX) were evaluated in elderly Chinese from March to June in 2019.

Results:
86 participants were included in the study. There were 69 male participants (80.2%), the mean age is 87.2 ± 0.5 years, the mean BMI is 23.3 ± 0.5. Of the 86 participants, 34 were diagnosed with diabetes mellitus. Compared with non- diabetes mellitus participants, ABI levels declined in left limbs of diabetes mellitus (DM) patients (0.94 ± 0.04 vs 1.02 ± 0.03, P < 0.05, separately). After adjusted by age, SBP, DBP, BMI, FPG, Cholesterol and HCT, serum OPN level was negatively correlated to both L- ABI and R- ABI (r = - 0.317, P = 0.028; r = - 0.362, P = 0.014, separately).

Conclusions:
Differential use of PWV and ABI should be considered in elderly with diabetes. Serum levels of OPN might be an independent bio-marker for predicting arterial stiffness in elderly Chinese.
Less use of rescue morphine when a combined PSP/IPP-block is used for postoperative analgesia in breast cancer surgery
Authors: Ahlberg Hans , Wallgren Daniel , Hultin Magnus , Myrberg Tomi , Johansson Joakim 
Published: January 2023

BACKGROUND
Surgery for breast cancer is common, and intravenous opioids are often used to control postoperative pain. Recently, pectoralis-2 (PECS-2) block has emerged as a promising regional anaesthetic alternative. With nomenclature recently proposed, this block is termed combined PSP/IPP-block (pectoserratus plane block/interpectoral plane block).

OBJECTIVE
We aimed to compare the need for postoperative rescue morphine between the intervention group that received a pre-operative combined PSP/IPP-block and a control group that received peri-operative long-acting opioids for postoperative analgesia.

DESIGN
A randomised controlled study.

SETTING
Operating theatres of two Swedish hospitals. The patients were recruited between May 2017 and October 2020.

PATIENTS
Among the 199 women scheduled to undergo breast cancer surgery (sector resection or radical mastectomy) who were enrolled in the study, 185 were available for follow up.

INTERVENTION
All patients received general anaesthesia. The intervention group received a combined PSP/IPP-block before surgery. The control group received intravenous morphine 30 min before emergence from anaesthesia.

MAIN OUTCOME MEASURE
The primary endpoint was the cumulative need for intravenous rescue morphine to reach a predefined level of pain control (visual analogue scale score <40 mm) during the first 48 h after surgery.

RESULTS
Data from 92 and 93 patients in the intervention and control groups, respectively, were analysed. The amount of rescue morphine administered in the 48 h after surgery was significantly lower in the intervention group than in the control group (median: 2.25 vs 3.0 mg, P = 0.021). The first measured pain score was lower in the intervention group than in the control group (35 vs. 40 mm, P = 0.035). There was no significant difference in the incidence of nausea between the groups (8.7 vs. 12.9%, P = 0.357).

CONCLUSION
The use of a combined PSP/IPP-block block before breast cancer surgery reduces the need for postoperative rescue morphine, even when compared with the use of intra-operative morphine.

TRIAL REGISTRATION
Clinicaltrials.gov identifier: NCT03117894.
Outcome of patients with HCC and liver dysfunction under immunotherapy: a systematic review and meta-analysis
Authors: El Hajra Ismael , Sanduzzi-Zamparelli Marco , Sapena Víctor , Muñoz-Martínez Sergio , Mauro Ezequiel , Llarch Neus , Iserte Gemma , Forner Alejandro , Rios José , Bruix Jordi , Reig María 
Published: January 2023

Background and Aims:
Immunotherapy-based regimes have changed the management of HCC. However, evidence of efficacy in patients with impaired liver function is unknown. This systematic review and meta-analysis assesses survival of HCC patients and liver dysfunction treated with immunotherapy-based regimens.

Methods:
Systematic review and meta-analysis of original articles or abstracts reporting survival of HCC patients treated with immunotherapy according to liver function between 2017 and 2022. Overal survival (OS) according to restricted mean survival time (RMST) and median OS, and hazard ratio (HR) of Child-Pugh B or B/C versus Child-Pugh A were assessed while considering the line of treatment.

Results:
Of the 2218 articles considered, 15 articles recruiting 2311 patients were included. Of these, 639 (27.7%) were Child-Pugh B and 34 (1.5%) C. RMST was 8.36 (95% CI, 6.15–10.57; I
2=93%) months, estimated from 8 studies. The HR was reported in 8 studies for survival between Child-Pugh B versus Child-Pugh A and metanalysis disclosed a 1.65 HR (95% CI,1.45–1.84; I
2=0% heterogeneity; p = 0.45). Treatment line data were available for 47% of the patients and 3 studies included patients treated with atezolizumab-bevacizumab in the first line.

Conclusions:
The high heterogeneity across studies reflects the incapacity of the current evidence to support the indication of immunotherapy in HCC patients with relevant liver dysfunction. It is mandatory to report complementary information to Child-Pugh classification such as prior liver decompensation, use of concomitant medication to control ascites, or signs of clinically significant portal hypertension to allow better patient stratification in future studies.
Outcome of untreated low-level viremia versus antiviral therapy-induced or spontaneous undetectable HBV-DNA in compensated cirrhosis
Authors: Huang Daniel Q. , Tamaki Nobuharu , Lee Hyung Woong , Park Soo Young , Lee Yu Rim , Lee Hye Won , Lim Seng Gee , Lim Tae Seop , Kurosaki Masayuki , Marusawa Hiroyuki , Mashiba Toshie , Kondo Masahiko , Uchida Yasushi , Kobashi Haruhiko , Furuta Koichiro , Izumi Namiki , Kim Beom Kyung , Sinn Dong Hyun 
Published: January 2023

Background:
Comparative outcomes of HBV-infected compensated cirrhosis with low-level viremia (LLV) versus maintained virological response (MVR) are unclear. We conducted a large, multiethnic, multicenter study to examine the natural history of LLV versus MVR in compensated cirrhosis.

Patients and Methods:
We enrolled patients with HBV-infected compensated cirrhosis (n=2316) from 19 hospitals in South Korea, Singapore, and Japan. We defined the LLV group as untreated patients with ≥1 detectable serum HBV-DNA (20–2000 IU/mL), Spontaneous-MVR group as untreated patients with spontaneously achieved MVR, and antiviral therapy (AVT)-MVR group as patients achieving AVT-induced MVR. Study end points were HCC or hepatic decompensation.

Results:
The annual HCC incidence was 2.7/100 person-years (PYs), 2.6/100 PYs, and 3.3/100 PYs for LLV (n=742), Spontaneous-MVR (n=333), and AVT-MVR (n=1241) groups, respectively (p = 0.81 between LLV vs. Spontaneous-MVR groups and p = 0.37 between LLV vs. AVT-MVR groups). Similarly, the annual decompensation incidence was 1.6/100 PYs, 1.9/100 PYs, and 1.6/100 PYs for LLV, Spontaneous-MVR, and AVT-MVR groups, respectively (p = 0.40 between LLV vs. Spontaneous-MVR groups and p = 0.83 between LLV vs. AVT-MVR groups). Multivariable analyses determined that HCC and decompensation risks in the LLV group were comparable to those with Spontaneous-MVR and AVT-MVR groups (all p >0.05). Propensity score matching also reproduced similar results for HCC and decompensation risks (all p>0.05 between LLV vs. Spontaneous-MVR groups and between LLV vs. AVT-MVR groups).

Conclusions:
Untreated LLV in HBV-infected compensated cirrhosis is not associated with increased risk of disease progression compared with Spontaneous-MVR and AVT-MVR. These data have important implications for practice and further research.