bluuebunny/crossref_metadata_2025_split huggingface dataset:
S-16-6: NATRIURETIC PEPTIDES AND HUMORAL FACTORS IN CARDIORENAL SYNDROME AND RESISTANT HYPERTENSION
Authors: Mukoyama Masashi 
Published: January 2023

Hypertension is one of the strongest and modifiable risk factors for cardiovascular disease, and a variety of antihypertensive agents and treatment modalities have been developed in these 6 decades. In Japan, however, among the patients with hypertension, ∼75% fail to reach an optimal goal of target blood pressure, and 10–15% of the patients are referred to as resistant hypertension. There are a number of factors for resistant hypertension; especially, the prevalence of resistant hypertension is reported to be 2–3 times higher in patients with chronic kidney disease (CKD) than in the general hypertensive population. CKD has become a major challenge to public health all over the world, and one of the reasons for increased morbidity should be the increasing prevalence of cardiometabolic (or metabolic kidney) disease including diabetic kidney disease. Considering them, novel therapeutic strategies are eagerly being sought.
We have studied the roles of vasoactive hormones, such as natriuretic peptides and aldosterone, and local humoral regulators in the pathophysiology of CKD. We have especially focused on metabolic renal disease, including diabetic nephropathy, nephrosclerosis, and renal fibrosis as their common consequence. Using genetically engineered mouse models, we demonstrated the renoprotective role of natriuretic peptides (ANP, BNP) against diabetic nephropathy, immune-mediated renal injury as well as renal fibrosis by subtotal renal ablation. Furthermore, using natriuretic peptide receptor (GC-A)-deficient mice coupled with aldosterone-induced renal injury, we found a renoprotective role of natriuretic peptides on podocytes independent of their antihypertensive action, by inhibiting the local RAS-MAPK-cytokine cascade activation. From recent GWAS analyses, gene polymorphisms related to the natriuretic peptide system are found to be strongly associated with hypertension and cardiovascular disease, suggesting their critical role in cardiovascular homeostasis and blood pressure control. Angiotensin receptor-neprilysin inhibitor (ARNI) is a new class of anti-hypertensive agents characterized by its dual action with renin-angiotensin system blockade and inhibition of natriuretic peptide degradation. In recent clinical trials, ARNI has been shown to have significant cardio-renoprotective effects with a potent antihypertensive property. These findings together could show potential molecular targets, providing a promise for novel therapeutic approaches against CKD with resistant hypertension, metabolic renal disease and related cardiovascular complications.
S-17-5: EFFECT OF MINERALOCORTICOID RECEPTOR BLOCKER, ESAXERENONE, ON HOME BLOOD PRESSURE AND ALBUMINURIA IN JAPANESE HYPERTENSIVE PATIENTS WITH DKD (EX-DKD STUDY)
Authors: Uchida Haruhito A , Nakajima Hirofumi , Hashimoto Masami , Nakamura Akihiko , Nunoue Tomokazu , Murakami Kazuharu , Hosoya Takeshi , Komoto Kiichi , Taguchi Takashi , Akasaka Takaaki , Shiosakai Kazuhito , Sugimoto Kotaro , Wada Jun 
Published: January 2023

Objective:
To investigate the effect of esaxerenone on home blood pressure (BP) and albuminuria in Japanese hypertensive patients with diabetic kidney disease (DKD) who had an inadequate response to BP-lowering treatment with a renin angiotensin system (RAS) inhibitor or a RAS inhibitor plus a calcium channel blocker (CCB).

Design and method:
The EX-DKD study (jRCTs061190027) was a multicenter, open-label study conducted in Japan. The study enrolled hypertensive patients with DKD who had previously received a RAS inhibitor or a RAS inhibitor plus CCB for < 12 weeks, and had sitting office systolic BP (SBP) 130 to < 180 mmHg and/or diastolic BP (DBP) 80 to < 110 mmHg, UACR < 1000 mg/g creatinine, and eGFRcreat 30 to < 60 mL/min/1.73m2 at baseline. Based on baseline UACR, the patients were divided into 3 subcohorts: UACR < 30, 30 to < 300, and 300 to < 1000 mg/g creatinine. Esaxerenone was incrementally dosed for 12 weeks: 1.25, 2.5, and 5 mg/day at the start of treatment, Week4, and Week8, respectively, based on each patient's condition. The primary efficacy endpoint was change in morning home SBP/DBP from baseline to end of treatment (EOT). Secondary endpoints included the proportion of patients achieving target BP at Week12, change in UACR from baseline to EOT, and safety (including serum potassium level).

Results:
The baseline characteristics of the overall study population (n = 109) were mean age, 72.6 years; male, 54.1%; morning home SBP/DBP, 135.6/75.9 mmHg; UACR < 30, 30 to < 300, and 300 to < 1000 mg/g creatinine, 41.3%, 37.6%, and 21.1%, respectively; eGFRcreat, 49.4 mL/min/1.73m2; RAS inhibitor, 33.0%; RAS inhibitor plus CCB, 67.0%. Morning home SBP/DBP decreased significantly from baseline to EOT in the total population (-11.6/-5.2 mmHg, both p < 0.001) and all UACR subcohorts (all p < 0.001). Similar results were obtained for bedtime home and office BP. At Week12, 38.5% of the total population had achieved target morning home BP. UACR improved significantly from baseline to EOT in the total population and UACR subcohorts; the overall percentage change was -50.9% (p < 0.001). Incidences of treatment-emergent adverse events (TEAEs) and drug-related TEAEs were 23.2% and 7.1%, respectively. The percentage of patients with serum potassium <5.5 mEq/L during the study period was 2.7%, and no patients had serum potassium < 6.0 mEq/L.

Conclusions:
Esaxerenone significantly reduced morning home BP as well as bedtime home and office BP and significantly halved albuminuria in Japanese hypertensive patients with DKD. The effects were consistent regardless of their UACR severity without clinically relevant serum potassium elevation.
S-20-4: HYPERTENSION AND CARDIOVASCULAR DISEASE IN ASIA
Authors: Castillo Rafael Ricafranca 
Published: January 2023

Being the most populous continent in the world, consisting of around 60% of the global population, Asia shoulders a big brunt of the hypertension and cardiovascular disease (CVD) burden in the world. Just as it is in the rest of world, hypertension remains a major modifiable risk factor in Asia for stroke, myocardial infarction, heart failure, atrial fibrillation, and peripheral arterial disease; and it is a dominant risk factor implicated for cardiovascular deaths causing premature death in the region. There is generally a stronger association between elevated blood pressure (BP) and stroke than with coronary artery disease (CAD), although CAD is reported as the most dominant cause of CVD deaths in Central, Western, and Southern Asia, while stroke deaths is more common than CAD deaths in Eastern and Southeastern Asia.
Of the estimated 1.13 billion people worldwide with elevated BP, around 66% live in low and middle income countries, which consist the majority of countries in Asia. In Southeast Asia (SEA), the prevalence of hypertension in the adult population is nearing 35%, and to this has been attributed the close to 1.5 million deaths in the region annually.
Hypertension awareness, treatment and control remain a challenge in Asia. Awareness level is less than 50% in most countries in Asia, though it is higher (56 70%) in the higher income countries in the region. Treatment rates are generally 25% to 30% of the hypertensive population, but control rates to BP levels below 140/90 mmHg, are still dismally low.
The comparatively high dietary salt intake in the region, aggravating the salt sensitive phenotype characterizing Asian hypertension is implicated as a significant risk factor leading to poor hypertension control and a relatively increased rates of strokes in the region. Salt intake ranges from 10to17 grams a day, which is 2to3 times higher compared to the 5 grams (approximately 2 grams of sodium) recommended daily salt consumption by the World Health Organization.
Because of the socioeconomic, educational and cultural heterogeneity of the countries comprising Asia, the region appears to be in different transition stages of the CVD epidemic. This highlights the challenge in mapping out a one size fits all strategy in curbing hypertension and CVD in Asia. Individualized prevention and treatment strategies factoring the differing capacities for management, prevalence of unhealthy diet especially increased salt intake, smoking, obesity, hypertension, dyslipidemia, and diabetes, as well as the impact of population aging must be considered.
S-23-4: EFFECTS OF ROTATING NIGHT SHFT ON CIRCADIAN PATTERN OF AMBULATORY BLOOD PRESSURE/HEART RATE, SALIVARY CORTISOL AND SULFATOXY MELATONIN LEVELS
Authors: Anjum B , Verma Narsingh , Tiwari Sandeep , Naz Qulsoom , Singh Ranjana , Mahdi Abbas Ali 
Published: January 2023

Objective:
The present study was aimed to investigate effect of Light exposute at night on 24 hours chronomics of BP/HR in terms of Double amplitude, Acrophase and Hyperbaric index and its relation with circadian rhythm of salivary cortisol and 6 sulfatoxy melatonin in rotating night shift nursing professionals and actual day workers.

Design & Methods:
56 night shift nurses, aged 20 to 40 years, performing day and night shift duties were recruited from the Trauma Center, KGMU, India, and 56 age sex matched actual day workers were also enrolled as controls. BP and HR were recorded by Ambulatory Blood Pressure Monitoring (ABPM) at every 30 min intervals in day time and each hour in night time during shift duties.

Results:
Highly significant difference was found in double amplitude (2DA) of among between night (23.10 ± 14.68) and day shift (34.27 ± 16.44) (p < 0.0005). In night shift, hyperbaric index (HBI) of mean SBP was found to be increased at 00 to 03 am (midnight) while during day shift, peak was found at 06 to 09 am. HBI of mean HR was found to be increased at 18 to 21 pm during night shift while in controls, peak was found at 09 to 12 & again 15 to 18 pm of SBP, DBP & HR. Alterations in Acrophase of BP/HR were very common among night shift workers and Ecphasia was found in few nights shift workers. Difference was found in night cortisol levels among night (4.08 ± 3.28) vs day shift (2.62 ± 2.37), while in comparison to night shift or day shift with controls (1.82 ± 1.18) these difference was significant (p < 0.05).

Conclusion:
Alteration in mean morning melatonin and Increased Night cortisol level were found during night shift. Reverse pattern of Acrophase and HBI of BP & HR along with salivary cortisol during night shift represents desynchronization. It indicates that the circadian rhythm was disrupted during night shift and recovery occurs during day shit.
S-24-1: OLD HABITS DIE HARD. REDUCED-SODIUM SCHOOL LUNCHES IN ELEMENTARY SCHOOLS WILL CREATE A NEW LOW-SODIUM EATING HABIT IN JAPAN
Authors: Kusaka Miho 
Published: January 2023

To prevent future cerebrovascular disorders, the most important lifestyle improvement measure for Japanese people, who have a high prevalence of hypertension and especially high salt intake, is to reduce salt intake by less than 6 g/day, but progress is slow. If this trend continues, medical and nursing care costs are expected to increase further in the future.
However, it is frustrating to verbally instruct patients who have already developed the habit of eating a high-salt diet on how to reduce salt intake, and younger people, who are less health-conscious, are less interested in salt reduction.
Therefore, it is desirable to create a society in which people can reduce salt intake naturally living a normal life. As a first step toward this goal, we need to promote a low-sodium dietary education for children and low-sodium school lunches at elementary schools. This is because high-salt eating habits do not begin in adulthood, but rather are the accumulation of eating habits from childhood, and we think that acquiring the basics of healthy eating habits as a child will be a major prevention of lifestyle-related diseases, including hypertension, throughout life.
In 2012, a group led by the Japanese Society of Hypertension held the “Salt Reduction Summit in Kure 2012’’, combining research with a salt reduction experience event for the public. One of the goals of the summit was to educate on the importance of salt reduction to children through a program involving children, teachers, government officials, and chefs. This led to the start of reduced-sodium school lunches in elementary schools in Kure City.
Initially, the amount of salt per school lunch was 3.1 g, but this was reduced to 2.0 g by 2021. The salt content was gradually reduced every year, so the goal was achieved without any discomfort and there were no leftover meals. With the introduction of low salt school lunches and providing education on salt reduction by school nutrition teachers, children and their parents’ generation are becoming more interested in salt reduction. The Japanese Society of Hypertension also holds various events for children. If reduced-sodium school lunch programs spread not only through Japan but also around the world, by the time children become adults, the public's preference will be for low-sodium foods, and food companies will appreciate benefits of selling low-sodium products and thereby creating a low-sodium society. As a result, we hope that healthy life expectancy will increase.
S-24-2: IMPACT OF FEBUXOSTAT ON VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY: INSIGHTS FROM THE RANDOMIZED PRIZE STUDY
Authors: Saito Yuichi , Tanaka Atsushi , Kobayashi Yoshio , Node Koichi 
Published: January 2023

Objective:
Although uric acid lowering therapies, including xanthine oxidase (XO) inhibition, may reduce the absolute level of blood pressure (BP), the effect of XO inhibition on BP variability is largely unknown. The objective of the present analysis was to evaluate the impact of febuxostat, an XO inhibitor, on BP variability in a randomized trial setting.

Design and method:
This was a sub-analysis of the PRIZE study, a randomized trial to evaluate the potential effect of febuxostat on carotid intima-media thickness progression. Patients with hyperuricemia and carotid plaques were randomly assigned to the febuxostat or control group. During a 24-month period, office BP and pulse rate (PR) were measured 3 times or more. BP and PR variabilities were assessed with standard deviation (SD) and coefficient of variation (CV). The effect of febuxostat on BP and PR variabilities were adjusted with age, sex, and baseline BP or PR, expressed with 95% confidence intervals.

Results:
A total of 472 patients with hyperuricemia and carotid plaques were included into the present analysis. Overall, the median serum uric acid level was 7.6 [7.1, 8.2] mg/dl at baseline, and a history of hypertension was found in 419 (88.8%) patients. Baseline characteristics were well balanced between the febuxostat group (n = 236) and control group (n = 236). During the 24-month follow-up period, the febuxostat group had a significantly lower adjusted mean systolic BP (128.4 [126.8 to 130.0] vs. 130.7 [129.1 to 132.2] mm Hg, p = 0.04) and CV of systolic BP (7.4 [6.7 to 8.0] vs. 8.2 [7.6 to 8.8], p = 0.04) than the control group. Adjusted SD of PR was also lower in the febuxostat group than their counterpart (5.95 [4.93 to 6.97] vs. 7.33 [6.32 to 8.33], p = 0.04).

Conclusions:
XO inhibition with febuxostat was associated with reduced visit-to-visit BP variability as well as reduced PR variability, illustrating the potential therapeutic effect of febuxostat in patients with hyperuricemia and carotid plaques.
S-24-5: REAL WORLD DATA IN HYPERTENSION: DATA FROM JAPAN MEDICAL ASSOCIATION DATABASE OF CLINICAL MEDICINE (J-DOME) STUDY IN KANAGAWA
Authors: Kobayashi Kazuo 
Published: January 2023

Despite the ease of access for the diagnosis of hypertension and the progression of antihypertensive medications, the consultation for hypertension or the control of blood pressure (BP) is not sufficient, and hypertension remains the major cause of death due to cerebrovascular and cardiovascular diseases.
The Japan Medical Association Database of Clinical Medicine (J-DOME) was established in 2018 with the aim of advancing the level of medical care for lifestyle-related diseases (diabetes and hypertension). To compare the results of previous studies and clarify the current problems, Kanagawa Physicians Associations collaborated with J-DOME to conduct the Kanagawa hypertension study 2021 featuring with J-DOME.
We compared three studies: the 2011 study (n = 826); the 2014 study (n = 1098); and the 2021 study featuring with J-DOME (n = 830).
The BP values at office (mmHg) were 132.9 ± 13.2/75.8 ± 9.3 in 2011, 133.1 ± 14.6/77.2 ± 10.7 in 2014, and 136.5 ± 17.4/76.9 ± 11.6 in 2021 study. Significantly high systolic and diastolic BP were observed in the 2021 study (p < 0.001) and the 2014 study (p = 0.02). The BP values at home (mmHg) were 128.6 ± 10.6/75.5 ± 8.7 in 2011, 129.4 ± 10.2/76.2 ± 8.9 in 2014, 128.0 ± 8.1/76.6 ± 8.3 in 2021 study. A significantly higher systolic BP was observed in the 2014 study (p = 0.03).
Among patients whose target BP was < 140/90 mmHg at the office and < 135/85 mmHg at home, the achievement rates (at office/at home) were 72.5% and 75.8% in the 2011 study; 66.0%/68.5% in the 2014 study; and 46.7%/83.3% in the 2021 study. In contrast, among patients whose target BP was < 130/85 mmHg at office and < 125/75 mmHg at home, the achievement rates (at office/at home) were 31.6%/19.7% in 2011, 32.1%/16.9% in 2014, and 30.4%/19.1% in the 2021 study.
Lower utilization of Ca-channel blockers, ARBs, alpha-blockers, and diuretics was observed in the 2021 study (all p < 0.001).
Because JSH recommends that BP at home is given more importance than BP at the office, the improvement in the achievement of target BP by 135/85 mmHg at home is acceptable. However, efforts should be focused on the management of patients requiring strict BP control who showed extremely low achievement rates and did not show any improvement over the last decade. Furthermore, the low frequency of utilization of antihypertensive medications, despite the large number of diabetes patients, is also a major issue that general practitioners should address as soon as possible.
S-25-3: TRENDS IN SOCIOECONOMIC INEQUALITIES IN OBESITY AMONG KOREAN ADOLESCENTS: THE KOREA YOUTH RISK BEHAVIOR WEB-BASED SURVEY (KYRBS) 2006 TO 2020
Authors: Kim Eunji , Kim Hyeon Chang 
Published: January 2023

Objective:
Studies reported the plateau of the rates of adolescent obesity and its masked socioeconomic inequality in developed countries. However, the burden of pediatric obesity continued to increase in Korea and its socioeconomic disparity remains poorly described. This study aims to investigate the recent trends of prevalence and socioeconomic disparity in obesity among Korean adolescents from 2006 to 2020.

Design and method:
We used annual data of self-reported height, weight, and socioeconomic information from the nationwide survey, Korea Youth Risk Behavior Web-based Survey (KYRBS), from 2006 to 2020. Adolescent obesity was defined as a sex-specific BMI for age of 95 percentile or greater among children aged between 12 and 19 years. Obesity prevalence was calculated according to each of four socioeconomic indicators (household income; parental education attainment; urbanicity). Also, socioeconomic inequality in it was quantified and compared using Relative Index of Inequality (RII). Identical analyses were repeated for the subgroups by sex or stage of school along with the total study population. The trend analyses of prevalence and inequalities were conducted using linear regression model with the variable of survey year.

Results:
The analytic sample consisted of 818,210 students, representing approximately 64% of adolescents in Korea. The overall prevalence of obesity continued to increase and doubled during the study period. Male and high school students showed higher absolute figures. Inverse relationships between obesity and socioeconomic status were observed across all subgroups. RIIs in household income and parental education attainments significantly increased with time. These socioeconomic disadvantages exercised greater influence on obesity among female and middle school students.

Conclusions:
This study showed increasing prevalence and widening inequality in obesity among Korean adolescents. These findings highlight parental educational attainments to understand socioeconomic disparities in adolescent obesity, along with household economic status. Relevant policymaking and intervention should focus on not only lowering the absolute figures among boys and high school students but also narrowing the gap among the disadvantaged girls and middle school students.
S-29-4: ASSOCIATION BETWEEN OBESE STATUS AND INCIDENT LEFT VENTRICULAR HYPERTROPHY DIFFERED BY ACHIEVED SYSTOLIC BLOOD PRESSURE LEVEL
Authors: Cai Anping , Liu Lin , Chen Jiyan , Zhou Yingling , Feng Yingqing 
Published: January 2023

Background:
Obesity frequently coexists with hypertension, and both confer additive effects on left ventricular hypertrophy (LVH) development. Little is known whether a more intensive blood pressure (BP) control is needed to mitigate this risk. The primary aim of this study was to evaluate the association between obese status and incident LVH according to achieved systolic BP (SBP) level at follow-up in community hypertensive populations.

Methods:
Hypertensive patients without LVH at baseline (n = 1842; obesity was 19.7%) were included. The China and American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) criteria were used to define LVH. The association between obese status and incident LVH according to achieved SBP level at follow-up (equal to or greater than 140, 130–139 and less than 130 mm Hg) was evaluated using Cox regression model.

Results:
After a median follow-up of 2.90 years, the incidence of LVH in the normal weight, overweight and obese groups were 17.0%, 25.0% and 31.1% (P < 0.001). Obesity was associated with incident LVH, with adjusted hazard ratio (HR) of 3.64 (95% CI 2.39–5.55). When achieved SBP equal to or greater than 140 mm Hg and at 130–139 mm Hg, this association remained significant; when achieved SBP less than130 mm Hg, this association was attenuated (adjusted HR 1.51 and 95% CI 0.89–2.56). When applying the ASE/EVCAI criteria, the results were consistent except for the differences in classification of LV geometry.

Conclusion:
A lower achieved SBP level may be needed to mitigate the additive effects of obesity and hypertension on LVH development. Randomized clinical trials are needed to corroborate these findings.