bluuebunny/crossref_metadata_2025_split huggingface dataset:
S-54-4: DIETARY SALT INTAKE ASSESSED BY SPOT URINARY SODIUM EXCRETION FROM CHILD TO ADULTHOOD IN A JAPANESE TOWN
Authors: Nakagawa Naoki , Matsuo Yuka , Hasebe Naoyuki 
Published: January 2023

In clinical practice, a high salt intake is strongly associated with elevation of blood pressure. To prevent and treat hypertension, it is important to restrict salt in one’s diet from child and adolescence. However, data are lacking regarding dietary salt intake from child to adulthood in general population. Therefore, we evaluated the dietary salt intake assessed by spot urinary sodium excretion from child to adulthood in a Japanese town. A total of 534 persons of both sexes, aged from 3 to 91 years were under study. The Tanaka formula was used to estimate 24-h urinary sodium excretion, which reflects salt intake. The average salt intake was 8.0 ± 2.7 g/day (n = 534); that of the men was 8.2 ± 2.8 g/day (n = 206), and that of the women was 7.8 ± 2.6 g/day (n = 249). When we assessed by age group, the average salt intake was 3.8 ± 2.2 g/day in 3 years old (n = 79), 6.8 ± 1.5 g/day in 11 years old (n = 36), 8.0 ± 1.5 g/day in 14 years old (n = 37), 8.6 ± 2.8 g/day in 20 s and 30 s (n = 37), 8.0 ± 1.7 g/day in 40 s (n = 24), 8.9 ± 2.2 g/day in 50 s (n = 32), 8.9 ± 2.1 g/day in 60 s (n = 108), 9.2 ± 1.9 g/day in 70 s (n = 182), and 9.0 ± 2.2 g/day in over 80 s (n = 22). Notably, dietary salt intake was over 6 g/day even in 11 years old. The salt intake was significantly higher in the older age group (P < 0.001 for trend) and was significantly associated with higher systolic and diastolic blood pressure. In conclusion, it is important to educate children, their parents, childcare professionals, and society about proper salt restriction and potassium supplementation, as well as to improve the food environment.
S-54-5: CHANGES IN ESTIMATED SALT AND POTASSIUM INTAKE AND SODIUM-TO-POTASSIUM RATIO USING SPOT URINE MEASUREMENTS: A 10-YEAR FOLLOW-UP OF NIPPON DATA2010
Authors: Kitaoka Kaori , Kadota Aya , Okami Yukiko , Kondo Keiko , Harada Akiko , Yoshita Katsushi , Yano Yuichiro , Ohkubo Takayoshi , Okamura Tomonori , Okayama Akira , Miura Kasuyuki 
Published: January 2023

Background:
Reducing dietary salt (sodium) intake and increasing potassium intake and sodium to potassium ratio (Na/K) are crucial in preventing hypertension. However, these changes by aging have not yet been evaluated in Japanese general population.

Methods:
NIPPON DATA2010 is a cohort study in the participants of the National Health and Nutrition Survey of Japan in 2010, we assessed changes in dietary sodium and potassium intake from 2010 to 2020 using spot urine. Of 2,732 participants in the 2010 survey, 667 participants (mean age 54.8 ± 8.2 years, women 59.1%) underwent spot urine measurements in both 2010 and 2020 survey. Using Tanaka formula, we estimated 24-hour salt intake (g/day) and potassium excretion (mg/day), and calculated sodium to potassium (Na/K) ratio (mmol/mmol) in spot urine for each participant. We assessed these changes from 2010 to 2020 by sex and age groups.

Results:
Change in estimated 24-hour salt intake from 2010 to 2020 was not a statistically significant in all groups (see table). Only estimated 24-hour potassium excretion showed a statistically significant increase in women and men ≧60 years, and the change showed a tendency towards statistical significance in men < 60 years. Na/K ratio was significantly reduced in women and men ≧60 years, not in men < 60 years.

Conclusions:
Potassium intake increased and dietary Na/K ratio decreased by 10-year aging in Japanese men and women, except for relatively younger men.
S-55-3: MINERALOCORTICOID RECEPTOR ANTAGONISTS IMPROVE QUALITY OF LIFE IN PATIENTS WITH PRIMARY ALDOSTERONISM
Authors: Imaishi Nao , Yoshida Yuichi , Shibuta Kanako , Miyamoto Shotaro , Ozeki Yoshinori , Okamoto Mitsuhiro , Gotoh Koro , Masaki Takayuki , Shibata Hirotaka 
Published: January 2023

Objective:
Although primary aldosteronism (PA) worsens quality of life (QOL), there have been no reports on whether treatment with a mineralocorticoid receptor antagonist (MRA) improves QOL in Japanese PA patients. Using the 36-Item Short-Form Health Survey (SF-36), we compared the QOL of PA patients before and after treatment and evaluated whether the effectiveness of MRAs differs by sex and serum potassium level.

Methods:
In 50 patients diagnosed with PA (with or without hypokalemia) and treated with an MRA, the SF-36 scores, blood pressure, and clinical features were assessed before, and 3 and 6 months after treatment. Separate analyses were also conducted for males and females, and for those with and without hypokalemia.

Results:
MRAs decreased systolic blood pressure (140.6 ± 2.4 mmHg and 125.1 ± 1.2 mmHg, p < 0.01) and increased serum potassium (3.8 ± 0.1 mEq/L and 4.2 ± 0.1 mEq/L, p < 0.01) and active renin levels (3.2 ± 0.4 pg/mL and 7.9 ± 1.2 pg/mL, p < 0.01) in PA patients. The normative mean SF-36 score of the healthy subjects was 50. The pre-treatment Role-Physical (RP) (46.7 ± 1.8, p = 0.019), General Health (47.1 ± 1.3, p = 0.042), and Role-Emotional (47.2 ± 1.7, p = 0.045) SF-36 subscale scores of all PA patients were significantly lower than those of healthy subjects but were improved by MRA treatment. Females with PA had a lower RP score (45.1 ± 2.2, p < 0.01), which was not improved by MRA treatment (46.1 ± 2.4, p = 0.036). In addition, PA patients with hypokalemia had a lower Mental Health SF-36 subscale score (43.2 ± 4.4, p = 0.041), which was improved by treatment with an MRA.

Conclusions:
MRAs improved the QOL of Japanese PA patients and were also effective for treating PA patients with hypokalemia, but female PA patients may be more resistant to MRAs.
S-56-4: ESTABLISHING A NEPHROLOGY-LED AMBULATORY BLOOD PRESSURE MONITORING SERVICE IN SINGAPORE
Authors: Khan Umer Farooq , DCosta Matthew Ross , Ngoh Clara Lee Ying 
Published: January 2023

Objective:
The prevalence of hypertension in Singapore is increasing, and 64.3% of patients with hypertension are not able to meet treatment targets. Management of hypertension in patients with chronic kidney disease (CKD) and end stage kidney disease (ESKD) is challenging due to higher risk of resistant and masked hypertension, autonomic dysfunction, and blood pressure fluctuations related to intermittent haemodialysis (HD) treatment. Ambulatory blood pressure monitoring (ABPM) is the gold standard for diagnosis and management of hypertension and can provide better insight into patients blood pressure patterns and response to treatment.
ABPM for a 24-hour period is an established service with the Cardiology department at our hospital. However, access remains limited, and utilizing another departments resources increases costs and may be a burden for our patients. Our aim was to develop a nephrologist-led ABPM service to increase accessibility and utilization of ABPM in our department and provide the option of 48-hour ABPM for patients on haemodialysis to be able to track blood pressure trends on both dialysis and non-dialysis days.

Design & methods:
We procured a Schiller BR-102 ambulatory blood pressure monitor with battery compatibility ensured to be able to run for 48 hours. Other factors in machine selection were portability, and ease of use of machine interface and reporting software. Two cuff sizes were obtained to increase utility for patients of different body habitus. The device underwent a review by hospital operations management team for meeting standards for safety and patient data protection.
Scheduling and nursing workflows were established Nurses were trained in pre and post procedure checks with the aid of a nursing checklist, and a patient log was drafted for listing timing of medications, haemodialysis, and sleep and wake times. A patient information sheet was also created with a phone hotline to call during office hours in the event of complications. The service was then integrated into the electronic health reporting system. Reporting guidelines were adapted from the 2019 HOPE Asia Networks expert panel consensus guidelines for ABPM in Asia (2019).

Results:
Pilot studies were run on two healthy subjects to ensure the process flowed smoothly and that the machine was in working order., Recruiting of patients for ABPM service is ongoing.

Conclusions:
Establishing an ABPM service in our nephrology practice is feasible and will facilitate improved management of hypertension in our complex patient population.
S-57-4: THE ROLE OF ORAL L-TYROSINE, METABOLISED BY THE GUT MICROBIOTA INTO P-CRESOL DERIVED METABOLITES, IN BLOOD PRESSURE REGULATION
Authors: Xu Chudan , Donnell Joanne A O , Dinakis Evany , Xie Liang , Nakai Michael , Barlow Chris , Marques Francine Z 
Published: January 2023

Objective:
Low fibre intake has emerged as an important risk factor for hypertension through changes in the gut microbiota, but the specific metabolites involved in this phenotype are unknown. We identified two novel secondary metabolites, p-Cresol glucuronide (PCG) and p-Cresol sulfate (PCS) that were elevated in plasma samples in mice on a low fibre diet. The precursor of PCG and PCS, p-Cresol, is a microbial metabolite derived from tyrosine fermentation by the gut microbiota. We hypothesized p-cresol-derived metabolites would trigger immune-activation to promote the development of hypertension. We aimed to assess whether oral L-tyrosine increases circulating PCG and PCS levels, leading to a worsened cardiovascular phenotype via immune-dependent mechanisms.

Design and method:
Male C57BL/6 mice (n = 8/group) were infused with saline or angiotensin II (Ang II, 0.5 mg/kg/day) for 4 weeks. Mice were treated with or without L-tyrosine in their drinking water accompanied by a normal chow diet for the duration of the experiment. Blood pressure (BP) was measured using tail-cuff and a targeted metabolomic approach was applied to identify the levels of PCG and PCS in the circulation. Additionally, liver enzymatic activities, immune cell activation and infiltration in the bone marrow, spleen and kidney were examined.

Results:
L-tyrosine treated hypertensive mice had significantly reduced systolic and diastolic BP compared to the control hypertensive mice (-16.4 and -14.2 mmHg, respectively, p < 0.01). Flow cytometric analysis revealed that L-tyrosine did not alter the numbers of the immune cells, including monocytes, neutrophils or T cells in bone marrow, spleen or kidneys in hypertensive or normotensive conditions. Furthermore, immune cell activation and production of cytokines, including TNF-alpha and IL17, did not change. Preliminary data suggests L-tyrosine increased the levels of PCS, but not PCG, in the circulation of both hypertensive and normotensive mice. The expression of the hepatic enzymes responsible for the biotransformation of p-Cresol to PCS and PCG were not differentially expressed, suggesting that conversion of p-Cresol to PCS occurs outside the liver.

Conclusions:
This study provides novel insights into the roles of L-tyrosine and PCS in hypertension. When delivered orally, L-tyrosine is digested by the gut microbiota, and leads to the production of PCS, lowering BP through immune-cell independent mechanisms. However, the role of PCG, a low-fibre driven-metabolite, in BP is still under investigation.
S-57-5: GUT MICROBIOME DIVERSITY AND BRAIN VOLUME AMONG GENERAL JAPANESE MEN
Authors: Ahmed Sabrina , Yano Yuichiro , Hexun Zhang , Okami Yukiko , Azahar Nazar Mohd , Kondo Keiko , Arima Hisatomi , Torii Sayuki , Moniruzzaman Mohammad , Kadota Aya , Andoh Akira , Shiino Akihiko , Ueshima Hirotsugu , Miura Katsuyuki 
Published: January 2023

Objective:
Accumulative evidence links gut microbiome diversity to the central nervous system, cognition, and mental disorders. However, little is known regarding the associations of gut microbiome diversity with brain volumes in human. We assessed the association of within-person gut microbiome diversity and brain volumes in general Japanese men.

Methods:
Healthy Japanese men (n = 623) aged 40–79 years participated in the examination of the Shiga Epidemiological Study of Subclinical Atherosclerosis II (SESSA II) between 2010 and 2015. They underwent assessments of gut microbiota diversity (Shannon Diversity Index and Chao Index) through 16S rRNA sequencing using DNA extracted from stool samples and brain volumes in milliliters (i.e., total brain volume, white matter, gray matter, and hippocampus) and white matter lesion volumes (WMLV, reflecting cerebral small vessel disease) via brain magnetic resonance imaging (MRI). Multivariable linear regression tested the effect of indexes per SD on the outcomes.

Results:
In unadjusted models, higher Shannon Index and Chao Index were associated with lower volumes in hippocampus (see table). After adjustments for age and total intracranial volume, higher Shannon Index and Chao Index showed associations with higher volumes in gray matter but were attenuated after additional adjustments for body mass index, physical activity, smoking, drinking, and hypertension.

Conclusions:
Among general Japanese men, higher within-person gut microbiota diversity was not associated with volumes in total brain volume, white matter, gray matter, hippocampus, and WMLV. Further studies are warranted to identify specific gut microbiome signatures associated with brain volumes in human.
AW-NI-3: EFFECTS OF RENAL DENERVATION ON LEFT AND RIGHT VENTRICULAR FUNCTION IN HYPERTENSIVE RATS WITH HEART FAILURE INDUCED BY VOLUME OVERLOAD
Authors: Miklovic Matus , Gawrys Olga , Kala Peter , Honetschlagerova Zuzana , Jichova Sarka , Vanourkova Zdenka , Huskova Zuzana , Kikerlova Sona , Mracek Tomas , Sedmera David , Maxova Hana , Melenovsky Vojtech 
Published: January 2023

Objective:
Clinical studies showed that renal denervation (RDN) is effective in blood pressure lowering in hypertension. Previously, we found that RDN prolongs survival in a hypertensive rodent model of heart failure due to volume overload from aorto-caval fistula (ACF). Whether it is due to afterload removal, or due to intrinsic effects of RDN on the right (RV) or left (LV) ventricular function, is currently unknown and was the focus of our investigation.

Design and method:
8-week-old Ren-2 transgenic male rats (model of angiotensin II-dependent hypertension) underwent ACF surgery to induce volume overload. After one week, animals underwent bilateral RDN (mechanical and chemical by topical phenol application) from laparotomy. Two weeks after RDN, the functions of both ventricles were measured by simultaneous biventricular pressure-volume analysis, and the animals were examined using echocardiography each week.

Results:
RDN in ACF rats only slightly reduced maximum pressure in RV but did not affect maximum pressure in LV. Yet, RDN in ACF animals significantly reduced hypertrophy and dilatation of both ventricles and decreased lung and liver congestion. RDN in ACF rats improved load-independent measures of contractility of both ventricles (end-systolic elastance and preload recruitable stroke work). RDN in ACF rats reduced renal levels of norepinephrine (NE) but restored depleted NE both in RV and LV. At the gene expression level, RDN in ACF led to favorable remodeling which was reflected as increased transcription of beta-1 adrenergic receptors in LV and beta-2 adrenergic receptors in RV and LV, decreased transcription of natriuretic peptide A gene (NPPA), collagen 1, and monoaminoxidase A (MAOA). These changes were relatively more pronounced in RV than LV. Interestingly, RDN in ACF rats also significantly inhibited the activity of neprilysin in the kidney.

Conclusions:
Besides the effects on pressure, RDN favorably affected load-independent measures of chamber function, markers of myocardial remodeling, and restored myocardial norepinephrine levels. These data indicate that RDN effects extend beyond pressure lowering and could be a promising method in the treatment of both right and left ventricular heart failure.
AW-APSH-1: TARGETING WINDOWS OF PLASTICITY TO PREVENT HYPERTENSION.
Authors: Denton Kate M 
Published: January 2023

Failing lifestyle interventions, there are many classes of anti-hypertensive drugs that are highly effective in most patients if taken appropriately. But multiple agents taken daily may be required to achieve target blood pressure (BP). The problem is that the majority of patients are non-compliant: they do not take their drugs continuously, choose to only take some, or stop taking them completely. It is time to focus on interventions that do not require lifelong daily medications, and this requires understanding and treating the causative factors.
For decades, it has been understood that the kidney, under the influence of both the renin-angiotensin-aldosterone system and sympathetic nerves, has a dominant role in the long-term control of extracellular fluid volume and BP. The kidney is an important target for the treatment of hypertension. Early postnatal life is a period of remarkable plasticity and is a neglected window of opportunity to prevent disease onset.
Our aim is to preserve and protect function of existing nephrons. If born with reduced renal mass (less nephrons), the compensatory response is to increase the filtration rate of each individual nephron so that GFR is maintained. Clinically, the degree of nephron overload is linked to faster age and disease related reduction in renal functional reserve, glomerular damage, albuminuria and hypertension.
By targeting the postnatal period of maturation, our aim is to prevent maladaptive compensatory hypertrophy and hyperfiltration to preserve kidney health-span without the need for lifelong drug therapy. Our studies in a large animal model of congenital renal mass reduction demonstrate the long-term therapeutic potential of a brief period of angiotensin converting enzyme inhibition early in life to alter the trajectory of renal and cardiovascular disease.
ISH-PP-3: INTERNATIONAL SOCIETY OF HYPERTENSION POSITION PAPER: BEDTIME DOSING OF ANTIHYPERTENSIVE MEDICATIONS: SYSTEMATIC REVIEW AND CONSENSUS STATEMENT
Authors: Stergiou George S 
Published: January 2023

Antihypertensive drug therapy is one of the most efficient medical interventions for preventing disability and death globally. Most of the evidence supporting its benefits has been derived from outcome trials with morning dosing of medications. Accumulating evidence suggests an adverse prognosis associated with night-ime hypertension, non-dipping blood pressure (BP) profile and morning BP surge, with increased incidence of cardiovascular events during the first few morning hours. These observations provide justification for complete 24-h BP control as being the primary goal of antihypertensive treatment. Bedtime administration of antihypertensive drugs has also been proposed as a potentially more effective treatment strategy than morning administration. This Position Paper by the International Society of Hypertension reviewed the published evidence on the clinical relevance of the diurnal variation in BP and the timing of antihypertensive drug treatment, aiming to provide consensus recommendations for clinical practice. Eight published outcome hypertension studies involved bedtime dosing of antihypertensive drugs, and all had major methodological and/or other flaws and a high risk of bias in testing the impact of bedtime compared to morning treatment. Three ongoing, well designed, prospective, randomized controlled outcome trials are expected to provide high-quality data on the efficacy and safety of evening or bedtime versus morning drug dosing.
In august 2022 The TIIME study announced results of its first analysis in 12,104 treated hypertensives in UK who were randomized to take their tablets in the morning or the evening for > 5 years. The study showed no difference in preventing heart attacks, strokes, or cardiovascular deaths. Thus, until more information is available, preferred use of bedtime drug dosing of antihypertensive drugs should not be routinely recommended in clinical practice. Complete 24-h control of BP should be targeted using readily available, long-acting antihypertensive medications as monotherapy or combinations administered in a single morning dose.
JS-CME-2: REDUCTION IN CARDIOVASCULAR MORBIDITY AND MORTALITY BY CARDIAC REHABILITATION: WHAT'S THE EVIDENCE?
Authors: Makita Shigeru 
Published: January 2023

The Japanese Society of Cardiac Rehabilitation defines cardiac rehabilitation (CR) as follows. Cardiac rehabilitation refers to a long-term, multifaceted, comprehensive program designed to optimize a cardiac patients physical, psychological, social, and vocational status, in addition to stabilizing, slowing, or even reversing the progression of the underlying atherosclerotic or heart failure processes, thereby reducing recurrence, rehospitalization and mortality and enabling patients to live comfortably and actively. CR programs include medical assessment, prescribed exercise training, coronary risk factor modification, patient education, counseling and optimal medical therapy for individual patients, which are provided by a multi-disciplinary team in a coordinated manner.
Comprehensive CR consists of continuous multidisciplinary team medical care centered on exercise therapy and disease management. Comprehensive CR improves exercise tolerance and physical function in most heart diseases. Improvements in subjective symptoms and QOL are also observed in many heart diseases. Concerning long-term prognostic improvement effect, it is observed in coronary artery disease and heart failure. Reduced readmissions are also observed in heart failure patients.
Mechanisms for improving the long-term prognosis of patients with coronary artery disease and heart failure include: 1) improvement of coronary risk factors, 2) improvement of vascular endothelial function and systemic anti-arteriosclerosis/anti-inflammatory effects via suppression of oxidative stress, 3) improvement of autonomic nerve function, 4) increase in skeletal muscle mass and associated various myokine actions.
Based on the above-mentioned evidence, all clinical guidelines of the Japanese Circulation Society, AHA, and ESC strongly recommend participation in CR as class I (evidence and/or general agreement that a given procedure or treatment is effective and useful) for patients after acute myocardial infarction. In post-CABG patients, American and European guidelines recommend CR as Class I. As for chronic heart failure, exercise therapy is strongly recommended as class I in all heart failure clinical guidelines in Japan, Europe, and the United States.
However, a clinical problem is the low rate of CR participation in patients with heart disease. This tendency is particularly conspicuous in Japan. Furthermore, an increase in the number of elderly heart failure patients with frailty is also a major issue. There is a need to create a system that supports patients through a community network throughout the acute, recovery, and maintenance phases.