bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS-C28-8: CILOSTAZOL CONTRIBUTES TO RISK REDUCTION OF STROKE RECURRENCE WITHOUT LOWERING BLOOD PRESSURE: RESULTS FROM CSPS.COM
Authors: Miwa Kaori , Saita Ryotaro , Omae Katsuhiro , Koga Masatoshi , Yamaguchi Takenori , Toyoda Kazunori 
Published: January 2023

Background:
The Cilostazol Stroke Prevention Study for Antiplatelet Combination (CSPS.com) found that the dual therapy with cilostazol plus aspirin or clopidogrel reduced the risks of recurrent ischemic stroke compared with monotherapy with aspirin or clopidogrel alone in patients with non-cardioembolic ischemic stroke. As its putative mechanisms, cilostazol can serve a role in the inhibition of angiotensin 2-induced endothelial cell apoptosis and vasodilation, which may yield lower systolic blood pressure (SBP). We aimed to determine to what extent the effect on ischemic stroke recurrence was mediated through blood pressure reduction due to cilostazol.

Methods:
In a post hoc analysis of CSPS.com, we defined change in SBP as the change in SBP at the last visit compared with baseline and treated it as a time-dependent mediator. We performed causal mediation analyses to separate the overall effects of the cilostazol on the first recurrence of the symptomatic ischemic stroke into indirect effects (mediated by change in SBP on cilostazol) and direct effects (mediated through pathways other than change in SBP on cilostazol). The effects were summarized by cumulative hazard rate difference.

Results:
In the ITT population, ischemic stroke recurred in 29 (3%) of 932 patients on dual therapy and 64 (7%) of 947 patients on monotherapy during a median 1.4-year follow-up. The estimates for effect of SBP (per 1mmHg increase) on the stroke recurrence at 24-months follow-up was 0.0007 (95% confidence interval [95% CI] 0.00018 to 0.0013). The effect estimates for direct effect and indirect effect of the cilostazol on the stroke recurrence at the same follow-up were -0.045 (95% CI, -0.071 to -0.015) and -0.0007 (95% CI, -0.0023 to 0.00053), respectively. The results of the adjusted model with age were similar.

Conclusions:
Although it was shown that change of SBP was associated with an increased risk of stroke recurrence, there was no evidence that change in SBP mediated the association between cilostazol and ischemic stroke recurrence, indicating that cilostazol contributed to risk reduction of stroke recurrence without through change in SBP.
PS-C29-4: EVALUATION OF HYPERTENSION COMPLICATIONS AFTER THE START OF WEIGHT MANAGEMENT THERAPY IN OBESITY
Authors: Goto Nobuko , Kita Motoko , Irie Junichiro , Itoh Hiroshi 
Published: January 2023

Objective:
We evaluated 86 patients who attended the obesity outpatient clinic continuously for 3 years from their first visit. The assessment items were weight progress and hypertensive complications during this period.

Design and method:
For patients with body mass index (BMI) less than 35, weight loss of 3% or more was considered successful weight loss; for BMI 35 and above, weight loss of 5% or more was considered successful weight loss. The group that regained weight less than 25% of the weight lost after successful weight loss was defined as the weight loss maintenance group. The group that regained weight more than 25% of the weight lost was defined as the weight loss regain group. The group that gained weight less than 3% of BMI < 35 and less than 5% of BMI 35 or greater was defined as the maintenance group. The group with greater weight gain than 3% of BMI < 35 and 5% of BMI 35 or greater without successful weight loss was defined as the gradual weight gain group.

Results:
Patients with an ambulatory blood pressure of 140/90 mmHg or higher or those taking antihypertensive medication were considered to have a hypertension complication. At the initial visit, the percentage of patients with hypertension was 65% in the weight loss maintenance group, 57% in the weight loss regain group, 65% in the maintenance group, and 63% in the gradual weight gain group, with no apparent difference.

Conclusion:
In this report, we describe the status of hypertension complications in the four groups at 6 months, 1 year, 2 years, and 3 years after the start of weight management therapy in obesity.
PS-C29-5: PULMONARY HYPERTENSION AND RIGHT VENTRICULAR REMODELING IN OBSTRUCTIVE SLEEP APNEA
Authors: Takada Yoichiro , Shiina Kazuki , Takahashi Takamichi , Nakano Hiroki , Fujii Masatsune , Matsumoto Chisa , Chikamori Taishiro , Tomiyama Hirofumi 
Published: January 2023

Background and Objective:
Acute pulmonary artery (PA) pressure changes during sleep have been extensively reported in obstructive sleep apnea (OSA). However, the role of OSA as an independent risk factor for the day-time pulmonary hypertension (PH) is not well known. The present study was conducted to examine whether OSA is associated with PH and right ventricular (RV) remodeling.

Methods:
423 OSA patients without chronic obstructive pulmonary disease or left ventricular dysfunction {age: 55 ± 13 years old, mean apnea-hypopnea index (AHI): 41 ± 22 /h} were enrolled in this study. All patients were performed polysomnography, echocardiography and spirometry. Pulmonary artery systolic pressure (PASP) was determined by continuous-wave Doppler using the simplified Bernoulli equation. For this study, PH was defined as an estimated PASP of greater than 30 mmHg. Patients were divided into two groups: mild-moderate OSA group (n = 153) (AHI = 5–30 /h) and severe OSA group (n = 270)(AHI over 30/h).

Results:
The prevalence of PH among all OSA patients was 19%. No significant differences were found in PASP, tricuspid annular velocity and tricuspid annular plane systolic excursion (TAPSE) between mild-moderate OSA group and severe OSA group. However, RV diastolic diameter (28.7 ± 3.4 vs 27.7 ± 3.0 mm, respectively, P < 0.01) and main PA diameter (26.2 ± 3.7 vs 24.8 ± 3.9 mm, respectively, P < 0.05) were significantly higher in severe OSA group than those in mild-moderate OSA group.

Conclusions:
The severity of OSA was significantly associated with RV and PA diameters independently PASP. These results suggested that OSA may directly affects RV and PA remodeling independently PH.
PS-C29-8: EFFECT OF WEIGHT GAIN ON ARTERIAL STIFFNESS AND PRESSURE WAVE REFLECTION: A 9-YEAR LONGITUDINAL STUDY
Authors: Fujii Masatsune , Tomiyama Hirofumi , Takahashi Takamichi , Nakano Hiroki , Matsumoto Chisa , Shiina Kazuki , Chikamori Taishiro , Yamashina Akira 
Published: January 2023

Background and Aim:
Obesity is a causal factor for conventional risk factors for cardiovascular disease (CVD), and these risk factors affect increased arterial stiffness and also abnormal pressure wave reflection in arterial tree. Even so, because of the potent direct influences of these risk factors on arterial stiffness and pressure wave reflection, the direct effect of obesity on these vascular abnormalities has been still controversial. Then, the present study examined the effect of weight gain on those vascular abnormalities.

Methods and Results:
In 4016 middle-aged (43 ± 9 years) healthy Japanese men without CVD at the study baseline, body weight, risk factors for CVD, brachial-ankle pulse wave velocity (baPWV), and radial augmentation index (rAI) were measured at the baseline and end of study period (mean duration of follow-up was 6.3 years). The study subjects were divided into 3 groups by the change of BMI during the study period. While the change of baPWV in the highest tertile range of increase in BMI (57 ± 138 cm/sec) was larger than that in the lowest tertile range of increase in BMI (46 ± 136 cm/sec)(P < 0.05), these differences were not significant after the adjustment of changes of blood pressure. In addition, the change of rAI was similar between both groups.

Conclusions:
Weight gain may affect increase in arterial stiffness rather than abnormal pressure wave reflection, and this effect may be mediated by increase in blood pressure related to weight gain rather than the direct effect of weight gain.
PS-C29-11: IMPACT OF UNDERWEIGHT, OVERWEIGHT, AND OBESITY ON ENDOTHELIAL FUNCTION: FMD-JAPAN REGISTRY
Authors: Kajikawa Masato , Maruhashi Tatsuya , Kishimoto Shinji , Harada Takahiro , Hashimoto Yu , Mizobuchi Aya , Han Yiming , Yusoff Farina Mohamad , Nakashima Ayumu , Higashi Yukihito 
Published: January 2023

Background:
The association of body weight with cardiovascular outcomes is still controversial. The aim of this study was to evaluate the association between body mass index (BMI) and endothelial function.

Methods:
We evaluated endothelial function by measuring flow-mediated vasodilation (FMD) in 7682 men. All participants were divided into four groups by BMI: underweight (< 18.5 kg/m2), normal weight (18.5 to 24.9 kg/m2), overweight (25.0 to 29.9 kg/m2), and obesity (≧ 30.0 kg/m2). We evaluated the cross-sectional associations between endothelial function and BMI.

Results:
After adjustment for various confounders, overweight (OR: 1.30, 95% CI: 1.14–1.47; P < 0.001) and obesity (OR: 1.40, 95% CI: 1.09–1.80; P = 0.009) were associated with endothelial dysfunction. In 5571 younger adults (< 60 years), overweight (OR: 1.34, 95% CI: 1.16–1.55; P < 0.001) and obesity (OR: 1.37, 95% CI: 1.04–1.81; P = 0.03) were associated with endothelial dysfunction, and underweight (OR: 0.56, 95% CI: 0.35–0.89; P = 0.01) was associated with a reduced risk of endothelial dysfunction. In 2111 older adults (≧ 60 years), underweight (OR: 2.16, 95% CI: 1.22–3.80; P = 0.008) was associated with endothelial dysfunction, and overweight and obesity were not associated with endothelial dysfunction.

Conclusions:
Endothelial function was impaired in the overweight and obesity groups compared with that in the normal weight group. The risk for endothelial dysfunction was higher in obese younger adults than in obese older adults. The association of BMI with endothelial function may be different in young and elderly men.
PS-C29-12: EFFECTS OF WEIGHT LOSS ON THE METABOLIC PROFILE AND CENTRAL HEMODYNAMIC PARAMETERS IN OBESE WITH MODERATE-SEVERE OBSTRUCTIVE SLEEP APNEA
Authors: Cardoso Samanta Mattos , Cunha Michelle Rabello , Klein Márcia Torres , Neves Mário Fritsch 
Published: January 2023

Introduction:
Obstructive sleep apnea (OSA) is known to be an independent cardiovascular risk factor. The presence of OSA and obesity may have synergistic effects on the progression of cardiovascular disease.

Objective:
To evaluate the effect of weight loss on vascular disease in obese patients with moderate or severe OSA.

Design and method:
Individuals of both sexes, aged 40 to 70 years, body mass index (BMI) > = 30 and < 40 kg/m2, were submitted to nutritional intervention for 16 weeks with restriction of 800 kcal/day, and assessment of central parameters by oscillometry (Mobil O Graph). The sleep study was conducted using a portable home device (WatchPAT).

Results:
Patients (n = 60) were divided into two groups based on the apnea hypopnea index (AHI): absent mild (AM) group (AHI < 15 events/h, n = 23) with BMI = 35 ± 3 kg/m2 and moderate severe (MS) group (AHI > = 15 events/h, n = 37) with BMI = 34 ± 3 kg/m2. After the intervention, weight loss was similar in both groups (4.80 vs 4.18 kg). Cardiovascular risk was significantly reduced in the AM group [4.7 (3.2;7.4) vs 4.1 (2.7;6.1) %, p = 0.039] and the MS group [8.0 (5.0;15.0) vs 6.7 (4.6;15.0) %, p = 0.003] after intervention. Both groups also showed a significant reduction in BMI, insulin and C-reactive protein. Only the MS group presented a significant decrease in HOMA-beta [227 (147;317) vs 193 (156;278), p = 0.033], uric acid [5.3 (3.9;6.3) vs 5.1 (3.7;6.0) mg/dl, p = 0.042] and vascular age [54 ± 9 vs 52 ± 9 years, p = 0.010]. The AHI decreased in the MS group [26 (18;34) vs 20 (12;25) events/h, p = 0.007] and increased in the AM group [8 (5;11) vs 11 (7;15) events/h, p = 0.011]. The MS group showed a significant reduction in the oxygen desaturation index [14 (9;19) vs 9 (6;14) events/h, p =  < 0.001] and in the Epworth sleepiness scale [10 (6;14) vs 8 (4;11) points, p = 0.004]. Central systolic pressure [114 (103;130) vs 110 (102;118) mmHg, p = 0.004] and pulse wave velocity [PWV) (7.7 (7.0;8.5) vs 7.3 (6.7;8.5) m/s, p = 0.015] were also significantly reduced in the MS group.

Conclusion:
Weight loss resulted in more benefits in moderate to severe OSA obese individuals, reducing AHI and improving functional capacity of pancreatic beta cells, with favorable effects on arterial stiffness and central hemodynamics in this population.
PS-C30-1: URINARY ANGIOTENSINOGEN-MELATONIN RATIO IN GESTATIONAL DIABETES AND PREECLAMPSIA
Authors: Valias Gabriela R , Gomes Patricia RG , Amaral Fernanda G , Alnuaimi Saif , Monteiro Daniela , OSullivan Siobhan , Zangaro Renato , Neto Jose Cipolla , Acuna Juan , Baltatu Ovidiu C , Campos Luciana A 
Published: January 2023

Objective:
A large research portfolio indicates that an activated renal renin-angiotensin system or a deficit on melatonin is associated with several cardiovascular pathologies. In this observational clinical study, we hypothesized that alterations in urinary melatonin or angiotensinogen levels may be altered in two common conditions, preeclampsia and gestational diabetes. Our primary objective was to assess melatonin and angiotensinogen as novel disease biomarkers detectable and quantifiable in the urine of pregnant women with or without pregnancy complications.

Design and Methods:
This was a concurrent cohort study of pregnant women with selected obstetric pathologies (gestational diabetes, preeclampsia, hypertension and obesity with hypertension). A group of healthy controls was also included. Urinary 6-sulfatoxymelatonin and angiotensinogen were measured by sensitive and specific ELISAs in first morning void urine samples. The patients were included in the cohort consecutively, and the diagnosis was blinded at the level of urine collection. Urinary 6-sulfatoxymelatonin and angiotensinogen levels were investigated in the patients included in the cohort.

Results:
Urinary levels of angiotensinogen were significantly higher in the gestational diabetes [angiotensinogen/creatinine ratio median (25th, 75th): 0.11 (0.07, 0.18)] and preeclampsia [0.08 (0.06, 0.18)] groups than in those with healthy pregnancy [0.05(0.04, 0.06]; 6-sulfatoxymelatonin levels were significantly lower in the gestational diabetes [ug/h: median (25th, 75th): 0.12(0.08, 0.17)] and preeclampsia [0.12 (0.09, 0.15)] groups than in those with healthy pregnancy [0.20 (0.15, 0.27]. Neither morning void protein/creatinine ratio nor 24-h urine protein estimate were significantly different between the study groups.

Conclusion:
These results suggest that urinary angiotensinogen levels may indicate an intrarenal RAS activation while melatonin production appears to be defective in gestational diabetes or hypertension. An angiotensinogen/melatonin ratio is suggested as an early biomarker for identification of gestational diabetes or hypertension. This report provides a basis for the potential use of melatonin for the treatment of preeclampsia. A prospective study in a larger number of patients to determine the operative characteristics of these markers as potential diagnostic tests is justified.
PS-C30-2: SHORT STATURE IS ASSOCIATED WITH HIGHER PULSE WAVE VELOCITY IN SUBJECTS WITHOUT OVERT CARDIOVASCULAR DISEASE
Authors: Moon Jeonggeun , Kang Woong Chol 
Published: January 2023

Objective:
Short stature is reportedly associated with cardiovascular disease (CVD). However, the mechanism underlying this intriguing epidemiological finding is unclear. Pulse wave velocity (PWV), a marker of vascular stiffness, is a predictor of future CVD. Therefore, PWV may be affected by height even before overt CVD occurs. Here, we investigated the association between adult height and PWV in subjects without overt CVD.

Design and method:
A total of 1019 subjects (48 ± 12 years old; 509 men, 21 with diabetes mellitus, 209 with hypertension) without overt CVD were enrolled, all of whom underwent brachial-ankle PWV (baPWV) measurements. The subjects were divided into 3 groups by height. A multiple regression model was used to estimate baPWV values among heights after the adjustment for confounders.

Results:
Mean baPWV value was highest in the group with the shortest height for both sexes (both P < .001). Bivariate correlation analysis between height and baPWV showed significant correlations in men (r = -0.131, P = .003) and women (r = -0.180, P < .001). In the multiple regression analysis with adjustment for identified confounders, group height was a predictor of baPWV (P for trend = .003) in younger men (< 50 years old) but not in older men, while group height was correlated with baPWV in older women (50 years old or more, P for trend = .014) but not in younger women.

Conclusions:
Height is inversely correlated with baPWV in subjects without overt CVD, especially in younger men and older women. This may explain the historical epidemiological observation of an inverse relationship between height and CVD.
PS-C30-5: COMPARISON OF INTRAVENOUS LABETALOL WITH ORAL NIFEDIPINE FOR CONTROL OF BLOOD PRESSURE IN SEVERE PREECLAMPSIA
Authors: Thakur Achala , Vashisht Raabiya , Agrawal Ajay 
Published: January 2023

Objective:
The objective was to compare the effect of intravenous labetalol and oral nifedipine in severe preeclampsia in terms of time interval and the dose required to achieve the targeted blood pressure of 150/100 mm Hg.

Design and method:
Pregnant women at or beyond 28 weeks POG with live fetus and severe preeclampsia with blood pressure 160/110mmHg or more were enrolled and randomized into two groups. Women in group A received injection labetalol 20 mg and group B received 10 mg oral nifedipine. Blood pressure was monitored at an interval of 20 minutes. Intravenous labetalol for group A participants was repeated at 20 minutes interval in escalating doses of 40,80,80 and 80 upto maximum of 5 doses adding upto 300 mg until the target blood pressure was reached. In group B participants received oral nifedipine 10 mg orally at 20 minutes interval upto maximum of 5 doses adding upto 50 mg. If blood pressure was still not controlled then crossover of treatment was planned in the same manner after 2 hours of starting initial treatment such that participants receiving group A drug would receive group B and vice versa.

Results:
Total of 104 participants with 52 in each group were enrolled. The mean age of the participants was 24.01 ± 0.7 years. Primigravida were 82(78.8%) and 22(21.2%) were multigravida. The mean POG at enrollment was 36 to 37 weeks in both the groups (p = 0.9). The mean systolic blood pressure was 175.28 mmHg in the labetalol group and 175.23 in the nifedipine group (p = 0.7). The mean diastolic blood pressure was 119.57mmHg in labetalol group and 117.40 in the nifedipine group (p value = 0.8). Among labetalol group, maximum 76.9% participants achieved target blood pressure in 20 minutes after the first dose whereas 36.5% participants took 60 minutes with three doses to achieve target blood pressure in nifedipine group which was statistically significant (p = 0.00). Forty two (80.7%) had vaginal delivery and 10 (19.2%) participants had cesarean section in labetalol group. In nifedipine group 40(76.9%) participants had vaginal delivery and 12(23.1%) had cesarean section (p = 0.8). In both the groups Apgar score of newborn was normal for 82.7% of participants.

Conclusion:
Intravenous labetalol is more efficacious than oral nifedipine in terms of less time and low dose required to control blood pressure in severe preeclampsia.
PS-C31-2: PRELIMINARY STUDY OF ANTIHYPERTENSIVE TREATMENT EFFECT ON EARLY EVENING ELEVATED BLOOD PRESSURE
Authors: MA Zhiyi , Zhang Yuqing , Chen Yingjun , Xu Yang , Wang Tianhao 
Published: January 2023

Objective:
The aim of this study is to retrospectively analyze the intervention effect of routine antihypertensive treatment on early evening elevated blood pressure (EEE) under community health service.

Design and method:
The ambulatory blood pressure monitoring (ABMP) data of hypertension patients was collected from YJY digital intelligence chronic disease monitoring and management platform from Jan 2019 to Nov 2021. The hypertension patients were from seven community health service stations and divided into treated group and untreated group according to their self-report. The age of each patient should be not less than 18 years old. The percentage of successful measurements for ABPM should not be lower than 70%. Only the first ABPM of one patient during this period was included. The EEE was defined as high average blood pressure from 6pm to 10pm (detailed definition and classification seen in Table).

Results:
1. There were 171 pateints in treated group and 251 patients in untreated group. 2. According to EEE definition A, there are 120 EEE patients in treated group and 206 EEE patients in untreated group (X2 = 8.19059, P = 0.00421). 3. According to EEE definition B, there are 87 EEE patients in treated group and 125 EEE patients in untreated group (X2 = 0.04714, P = 0.82812). 4. According to EEE definition C, there are 101 EEE patients in treated group and 141 EEE patients in untreated group (X2 = 0.34705, P = 0.55579). 5. According to EEE definition X, there are 147 EEE patients in treated group and 224 EEE patients in untreated group (X2 = 1.0287, P = 0.21047).

Conclusions:
According to EEE definition A which indicated the absolute value increase of blood pressure, the detection rate of EEE was significantly lower in treated group than in untreated group. However, based on definition B and definition C, which compared EEE with morning blood pressure and afternoon blood pressure respectively, routine antihypertensive treatment provided by community health service didn’t obtain the significant reduction of EEE detection rate. This phenomenon that a considerable proportion of early evening blood pressure under antihypertension treatment was still higher than morning blood pressure or afternoon blood pressure might result in low compliance of hypertension management, dosage increase of antihypertension medication or multiple administration daily.