bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS-P15-1: EFFECT OF GARLIC EXTRACT SUPPLEMENTATION ON BLOOD PRESSURE CONTROL IN PATIENTS WITH CHRONIC HEMODIALYSIS
Authors: Akbar Kiagus Muhammad Yusuf Arief , Fathurrachman Alif , Mulia Deddy Primadona , Wangsa Syahpri Putra , Kartika Herleni , Effendi Ian , Ali Zulkhair , Suhaimi Novadian , Slamet Suprapti , Saleh Irsan , Riyadi Ichram 
Published: January 2023

Objective:
Studies have reported intradialytic hypertension and inadequate antihypertension drugs in hemodialysis patients. Garlic and its components like Allicin have biological activities in lowering blood pressure by induction of endothelin nitric oxide synthase (eNOS) to hydrogen sulfide (H2S), which leads to calcium channel closure and relaxation, which leads to vasodilation of vessels. This study aims to analyze the effect of garlic extract supplementation on lowering blood pressure in chronic hemodialysis patients at Moh Hoesin General Hospital, Palembang, Indonesia.

Design and method:
This study was a crossover randomized, placebo-controlled, double-blind trial. The subjects were 40 CKD stage 5 patients with chronic hemodialysis, randomly divided into 2 groups, namely the group that received 1000 mg of garlic extract per day (2x500 mg) for 6 weeks and the group that received a placebo, which was then carried out during a washing period for 2 weeks, and then the two groups were crossover. Each group measured the blood pressure before and after treatment.

Results:
The wilcoxon test revealed that systolic blood pressure before and after garlic extract administration was 144,5 ± 12,1 mmHg and 140 (125–164) mmHg with p = 0,037, respectively (vs placebo, p = 0,55). Diastolic blood pressure before and after garlic extract administration was 80 (70–100) mmHg and 80 (70–100) mmHg, with p = 0,703 (vs placebo, p = 0,9).

Conclusion:
There was an effect of garlic extract on lowering systolic blood pressure in patients with chronic HD at Moh Hoesin Hospital, Palembang, Indonesia.
PS-P15-3: PATIENTS WITH GLOMERULONEPHRITIS IN REMISSION HAVE DECREASED ARTERIAL STIFFNESS COMPARED TO CKD PATIENTS
Authors: Korman Avital Angel , Glasswin Erick , Ishay Rotem Tal-Ben , Amital Mor , Kukuy Olga , Leiba Adi 
Published: January 2023

Background:
Arterial stiffness is the hallmark of the vascular aging process, in which a disruption in collagen to elastin balance in the large arteries with decreased compliance of the central vasculature leads to excess cardiovascular morbidity.
Carotid- Femoral Pulse wave velocity (PWV) is the preferred non-invasive way to quantify arterial stiffness. Apart from age, blood pressure, presence of long standing hypertension, diabetes or kidney impairment, inflammation has been quoted as an harbinger of arterial stiffness. However, in a prior work of our group we found Familial Mediterrenean Fever (FMF) patients to have a decreased PWV, possibly relaed to the relapsing-remitting type of the disease and a possible ptotective role of colchicine.

Objective:
To compare the PWV of patients with Glomerulonephritis (GN) in clinical remission to patients with non inflammatory CKD (either eGFR < 60 or uACR above 30 mg/gram), mostly related to hypertension and diabetes.

Methods:
We prospectively collected data on 58 patients from our Nephrology and Hypertension Center, which either had non inflammatory CKD (30 patients) or a glomerular disease in partial or complete remission (28 patients).
central (aortic) blood pressure and Pulse wave velocity (PWV) were measured using validated Sphygmocor XCEL ® device.

Results:
In a multivariate regession analysis adjusting for age, presence of hypertension, history of diabetes and creatinine values, having glomerular disease in remission was associated with a significant decrease in PWV (B- 3.262) indicating better arterial elasticity compared to CKD patients.

Conclusion:
Patients with glomerulonephritis in remission have better arterial elasticity compared to CKD patients, possibly similar to the general age and blood pressure matched population. This is in accordance with our findings in FMF patients, who were adherent to colchicine treatment and in clinical remission.
It is possible that prior treatment with anti-inflammatory and immunomodulatory drugs carry a beneficial effect on vascular health.
PS-P15-4: THE ROLE OF CARDIOPULMONARY EXERCISE TESTING IN OBESE HYPERTENSIVE PATIENTS: A STEP FORWARD IN DETERMINATION OF OPTIMAL TREATMENT
Authors: Ostojic Marina , Nedeljkovic Ivana 
Published: January 2023

Introduction:
Obesity is a global problem. Morbid obesity (MO) represents a population with a body-mass index (BMI) of more than 40 kg/m2 eligible for surgical treatment (bariatric surgery). During the preoperative evaluation program, every patient must have a cardiopulmonary exercise test (CPET) for cardiopulmonary risk assessment. Also, in the morbid obese population, arterial hypertension (AH) is the most common comorbidity.

Objectives:
We aimed to compare the results of CPET in obese patients with and without AH treatment.

Methods:
We investigated 84 patients (40 males, age 40.50 ± 10.38) scheduled for surgical treatment of morbid obesity. Patients were divided into two groups according to the presence of AH, adjusted for sex and age. All patients underwent CPET for the preoperative risk assessment and determination of cardiopulmonary function.
Result: The mean BMI was 45.37 ± 9.75 kg/m2. There was a significant difference in resting sistolic and diastolic blood pressure between the 2 groups (AH group, sistolic 144.33 ± 13–05 vs. 133 ± 11.26 mmHg, p = 0.001, diastolic AH group, 88.0 ± 7.36 mmHg vs. 84.10 ± 6.36 mmHg, respectively, p = 0.039) as well as at maximal effort (AH group, sistolic 182.13 ± 18.72 mmHg vs. 170.00 ± 13.00 mmHg p = 0.004; diastolic 101.67 ± 9.13 mmHg vs. 96.14 ± 9.16 mmHg, p = 0.018). There was no difference in peak oxygen consumption in AH patients compared to patients without AH (peakVO2 25.542.07 ml/kg/min vs. 26.78 ± 2.92 ml/kg/min, p = 0,147), and for VO2 at anaerobic threshold (VO2AT 14.153.11 ml/kg/min vs. 14.29 ± 3.62 ml/kg/min, P = 0–859). There was a significant difference in ventilatory response among those two groups of patients. Minute ventilation/carbon dioxide production (VE/VCO2) slope among the AH group was 24.89 ± 3.29, vs. 27.22 ± 3.97, p = 0.013, possibly due to demarcation of left ventricular diastolic dysfunction among the hypertensive group during exercise.

Conclusions:
CPET showed significant ventilatory impairment in MO patients with AH. Thus, individualized antihypertensive therapy should be the focus of preoperative programs for morbidly obese patients with AH.
PS-P16-5: ATHEROSCLEROTIC CARDIOVASCULAR DISEASE (ASCVD) RISK STRATIFICATION OF HYPERTENSIVE ADULTS AT A TERTIARY HOSPITAL
Authors: Gnilo Mariean Rocielle , Gonzales Eddieson 
Published: January 2023

Background:
Most hypertensive patients have cardiometabolic risk factors, which raises the likelihood of developing atherosclerotic cardiovascular events. As a result, international professional societies have recommended the use of ASCVD risk assessment in the diagnosis and treatment of hypertension. However implementation of this recommendation remains a challenge in local practice.

Objective:
To determine the atherosclerotic cardiovascular risk stratification of adult patients with hypertension using a Cardiovascular Specialty Organization's Risk Factor Counting method at a tertiary hospital Outpatient Department

Methodology:
The research study employed a descriptive, cross-sectional study design of 122 hypertensive adults between November 2020 to October 2021. Data gathered were a clinicodemographic profile, family history, smoking status, body mass index, and diagnostic tests including 12 lead electrocardiogram, urinalysis, lipid profile, and fasting blood sugar or Hba1c. Statistical analysis was done using the SPSS version 26.

Results:
The majority of the 122 enrolled patients were aged 51 to 60 (37.7%) and 61 to 70 years old (23.0%) Results revealed that the majority of hypertensive adults in a tertiary hospital were high risk at 79.51% and 20.49% were low to intermediate risk. There was a significant difference in the risk classification distribution of patients based on their age, diabetes, dyslipidemia, BMI, and microalbuminuria or proteinuria. Diabetic and dyslipidemic patients were 35.6 and 5.52 times more likely, to be ASCVD high risk respectively. Obese I and Obese II were 6.96 and 5.24 times more likely to be at a high risk of ASCVD as well.

Conclusions:
In conclusion, the majority of hypertensive adults were at high risk for cardiovascular complications. Among the risk factors studied, diabetes, dyslipidemia, and body mass index, when compared to other risk variables, were significantly associated with high ASCVD risk.
PS-P16-8: DIAGNOSIS AND TREATMENT OF HYPERTENSION BY COMMUNITY HEALTH WORKERS IN RURAL NEPAL: MAIN RESULTS OF THE MUTU TRIAL
Authors: Neupane Dinesh , Koirala Sweta , Hu Xiao , Appel Lawrence J , Vaidya Abhinav , Matsushita Kunihiro 
Published: January 2023

Objective:
To evaluate the effectiveness and safety of a community health worker intervention for diagnosing and managing hypertension (HTN) in rural Nepal.

Design & Methods:
We conducted a quasi-experimental study in two rural municipalities in Nepal, assigning one as an active site (7 communities) and the other as a comparison site (8 communities, which received enhanced usual care). The intervention in the active site involved three home visits for blood pressure (BP) monitoring and counseling by trained community-based community health workers (Female Community Health Volunteers) and treatment of HTN by trained community health workers based in government Health Posts under physician supervision using a simplified protocol with amlodipine. The comparison site received one home visit by Female Community Health Volunteers. A total of 1428 adults with untreated HTN (systolic BP of 140–179 and/or diastolic BP of 90–119 mm Hg) were enrolled. The primary outcome was a reduction in systolic BP at 12 months (measured in 94% of enrolled participants), and the secondary outcome was HTN control rate defined as BP < 140/90 mm Hg.

Results:
The mean baseline systolic BP was 145.4 mm Hg in the active site (n = 576, 46% women) and 146.9 mm Hg in the comparison site (n = 760, 46% women). At 12 months, while BP was lower in both sites, mean SBP fell more in the active site [net mean difference of -11.0 mm Hg, (95% CI: -12.5 to -9.6; P < 0.001)] (Table). The corresponding net difference in DBP was -6.0 mm Hg (95% CI: -6.8 to -5.1; P < 0.001). HTN control and medication treatment were both higher in the active site compared to the comparison site (Table). There were four deaths unrelated to the intervention (2 in the comparison site and 2 in the active site).

Conclusion:
In rural communities of Nepal, a health system intervention with trained community health workers diagnosing and treating hypertension, supervised by a physician, substantially lowered BP and achieved higher control rates compared to usual care. The success of this intervention provides strong support of enhanced roles for community health workers to diagnose and treat HTN. Scaling up such interventions could potentially address the major workforce gaps that lead to low HTN control rates, particularly in rural communities of low and middle-income countries.
PS-R06-5: CASE REPORT OF INCREASED ARTERIAL STIFFNESS IN MOYAMOYA DISEASE IN A YOUNG CHINESE PATIENT PRESENTING AS RECURRENT STROKE IN SINGAPORE
Authors: Sule Ashish Anil , Cangco Noe M , Cesar Benedict A 
Published: January 2023

Introduction:
Moyamoya disease (MMD) is characterised by progressive stenosis of distal ICA and the resulting hazy network of basal collateral vessels. Increase arterial stiffness in MMD is not well described.

Case report:
We describe a young patient ML, a 42-year-old Chinese female, presented to hospital in June 2015 with headaches, on a background of known hypertension diagnosed at the age of 28 years.
Her systemic examination was normal. Investigations were unremarkable. She was followed in General Medicine (GM) clinic from 2015, which ruled out secondary causes of hypertension, including renovascular disease, renal artery stenosis, phaeochromocytoma and hyperthyroidism. ML was treated for presumptive essential hypertension. Over time, her BP remained stable on candesartan 16 mg and bisoprolol 2.5 mg once daily. She continued to have intermittent headaches. Recurrent ischaemic strokes and diagnosis of Moyamoya disease
ML presented with intermittent right-sided facial numbness in February 2017. A magnetic resonance imaging (MRI) brain done showed no acute infarct or hemorrhage, but moderately severe narrowing of the left terminal internal carotid artery (ICA), associated with poor flow signals in both the A1 segment of the left anterior cerebral artery (ACA) and the M1 segment of the left middle cerebral artery (MCA). She was started on clopidogrel 75 mg and atorvastatin 40 mg daily. The second stroke occurred in March 2019, when ML presented with acute right upper and lower limb weakness, and right facial, upper and lower limb numbness. Magnetic resonance angiography (MRA) demonstrated severe stenosis at the left terminal ICA, also involving the left M1 and A1 segments; collateral flow was observed. The third stroke happened in April 2019, presenting with acute right-sided facial and upper limb weakness, with BP of 201/86mmHg. MRI and MRA of the brain revealed new acute infarcts scattered in the territories of the left MCA and ACA. A CT angiogram re-demonstrated severe steno-occlusive disease involving the left ICA T-junction and left M1 and A1 segments, with extensive basal collaterals. In light of these findings, Moyamoya disease (MMD) was diagnosed.
ML underwent a left external carotid-internal carotid bypass in June 2019. An arterial stiffness study by syphgmoCor in June 2020 using markedly increased arterial stiffness.

Conclusion:
We present first and very rare case of hypertension in a young patient with MMD associated with increased arterial stiffness. Systemic vascular affection in MMD may be the cause of increased arterial stiffness.
PS-R06-6: CEREBRAL AMYLOID ANGIOPATHY-RELATED INFLAMMATION PRESENTING WITH POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME
Authors: Yoo Bong Goo 
Published: January 2023

Background:
Cerebral amyloid angiopathy related inflammation (CAAri) is a rare CAA variant, characterized by headaches, seizures, acute or subacute encephalopathy, or focal neurological deficits. Radiologically, CAAri presents with widespread white matter lesions on brain MRI in addition to the hemorrhagic imaging features of CAA. We report a patient with CAAri who showed posterior reversible encephalopathy syndrome.

Case Report:
A 77 year old man presented with generalized tonic clonic seizure that persisted for 30 minutes and decreased in consciousness level. He had past medical history of dementia, diabetes and hypertension. His initial blood pressure was 170/90 mmHg and pulse rates were 144/minute. On neurological examination, his consciousness level was stupor and there are no lateralizing signs. Cerebrospinal fluid analysis was unremarkable except elevated protein level of 75 mg/dL. Diffusion weighted images (DWI) and fluid attenuated inversion recovery (FLAIR) images showed diffuse hyperintensities involving the bilateral temporoparietooccipital lobes. Gradient echo images revealed multiple microbleeds in bilateral cortical and subcortical regions as can be seen in CAA. A diagnosis of CAAri was considered, and the patient was started on steroids and valproic acid with clinical improvement. Nine days after admission, follow up DWI and FLAIR images demonstrated improvement of previously shown lesions.

Conclusions:
Aside from the most common subacute presentations, CAAri can have a PRES like presentation. It is hypothesised that in this form, CAAri causes altered vascular autoregulation and impaired blood brain barrier integrity in the face of precipitating factors such as hypertension.
PS-R06-7: CAUDAL REGRESSION SYNDROME AS A CAUSE OF SECONDARY HYPERTENSION
Authors: Renna Nicolás Federico , Ramirez Jesica Magalí 
Published: January 2023

Hypertension (HT) is a disease with a mainly multifactorial etiology. Although monogenic, embryological, epigenetic causes are rare and the interdisciplinary approach is essential to arrive at the diagnosis. We present the case of a 22-year-old patient with a history of congenital myelomeningocele and daughter of non-consanguineous parents, hospitalized for a hypertensive crisis (220/112 mmHg). It is referred to rule out genetic causes of hypertension.
The genealogy shows a history of hypertension and ischaemic heart disease in both parental lines, in two previous generations. Physical examination revealed bilateral pes cavus in the lower limbs, edema, and overlapping of the second toe over the first toe on the left foot. She presented calf atrophy and incontinence, with the use of a bladder catheter and a continent stoma, as post-surgical sequelae.
As a relevant finding, elevated aldosterone and plasma renin activity. Normal blood and urine catecholamines, VMA and normetanephrines. MRI of the abdomen and pelvis revealed a double left renal artery corroborated by CT angiography, a right extrarenal pelvis and a bicornuate uterus of normal size. Doppler of renal arteries showed no signs of significant stenosis. Right renal artery 43 cm/s and left renal artery 103 cm/s. The patient presents diagnostic criteria compatible with a caudal regression syndrome, a spectrum of clinical phenotypes with malformations in the lower hemibody that involve the 3 embryonic layers.
It is postulated that, in this case, the hypertension is secondary to the embryological defect. The patient continues to be medicated with perindopril/indapamide 10/2.5 mg with adequate blood pressure control.

JOURNAL/jhype/04.03/00004872-202301001-01322/figure1/v/2023-10-24T163949Z/r/image-jpeg
PS-R07-1: CASE OF PSEUDOHYPERALDOSTERONISM WITH IMPROVEMENT OF HYPERTENSION AND HYPOKALEMIC WEAKNESS BY DISCONTINUATION OF PEONY AND LICORICE FORMULA.
Authors: Gotoh Shuji , Shimizu Hideaki , Kasahara Rika , Kishima Yukari , Nagashima Ai , Matsuoka Hiroki , Hayakawa Takuto , Naruse Yuki , Kawada Kyogo 
Published: January 2023

Case:
An 80-year-old woman was admitted to our hospital with lower extremity weakness. She was treated for hypertension (HT), type 2 diabetes, and Alzheimer's disease.
Her medications included brotizolam 0.25 mg, rivastigmine tape 18 mg, celecoxib 200 mg, sofarcon 50 mg, losartan 50 mg, hydrochlorothiazide 12.5 mg, rosuvastatin 2.5 mg, propiverine 10 mg, empagliflozin 10 mg, linagliptin 5 mg, esomeprazole 20 mg, peony and licorice formula (PLF) 7.5 grams, and olopatadine 5 mg.
On admission her blood pressure (BP) was 191/73 mmHg.
Manual muscles testing (MMT) for the upper limbs was 4/5 bilaterally throughout. Lower limb MMT included iliopsoas 1/5, quadriceps 1/5, hamstrings 1/5, anterior tibialis 4/5, gastrocnemius 4/5 bilaterally, respectively.
Basic blood tests revealed serum K + 2.0 mEq/L, urinary K + 21.0 mEq/L, creatinine kinase 1,488 U/L, renin activity 0.8 ng/mL/hr, and aldosterone 4.0 pg/mL (CLEIA method).
During admission to the intensive care unit, frequent blood sampling was performed to correct the serum K + level. A calcium channel blocker (CCB) was commenced for HT on admission day. Spironolactone was commenced on post-admission day (PAD) 1. The serum K+ level stabilized, and potassium chloride administration was terminated PAD 6. BP also improved over time, and the CCB was discontinued on PAD 23. On the same day, she was discharged from the hospital with continuation of spironolactone.
In this case, there were a total of 11 prescription drugs including PLF from three clinics. We diagnosed HT and lower extremity weakness due to pseudohyperaldosteronism (PHA). The HT improved after discontinuation of PLF.
Licorice is found in about 70% of Chinese herbal medicines. Risk factors for PHA include short stature and weight, elderly and female, renal dysfunction, and diuretic administration. As Japan has entered a super-aging society, the number of patients using geriatric healthcare facilities and chronic care wards is increasing. The frequency of blood sampling is particularly low in such facilities, so it is difficult to notice hypokalemia among such patients. PHA and hypokalemic myopathy due to licorice should be considered in the case of lower limb weakness in elderly patients.
In conclusion, it is important to identify PHA caused by licorice-containing Chinese herbal medicines in elderly patients with HT. In addition, healthcare facilities for the elderly it is advised that serum K+ is checked in patients with worsening HT, weakness and polypharmacy.
PS-R07-8: A CASE OF PRIMARY ALDOSTERONISM CAUSED BY BILATERAL ALDOSTERONE-PRODUCING MICROTUMORS WITH A UNILATERAL ADRENAL MASS
Authors: Mizumoto Teruhiko , Kakizoe Yutaka , Date Ryosuke , Itai Yohei , Izumi Yuichiro , Adachi Masataka , Kuwabara Takashige , Mukotyama Masashi 
Published: January 2023

Introduction:
Primary aldosteronism (PA) is defined as a disease in which overproduction of aldosterone causes various complications such as hypertension, cardiovascular disorder and kidney disease. We herein report a case of PA caused by bilateral aldosterone-producing microtumors with a unilateral adrenal mass.

Case presentation:
A 54-year-old man was referred to our hospital with a clinical suspicion of PA. He had a history of hypertension and chronic kidney disease for 10 years and had experienced paresthesia that was caused by putaminal hemorrhage in the past. In the initial examination, he exhibited hypertension (150/90 mmHg), high aldosterone (pg/mL)-to-renin (ng/mL/h) ratio (1,744), and overt hypokalemia (K, 2.9 mEq/L). The serum creatinine level was 1.89 mg/dL. The captopril challenge test showed no changes in his blood pressure or plasma aldosterone concentration. These results led to a clinical diagnosis of PA. Computed tomography (CT) revealed the presence of left adrenal mass, so that we suspected that the mass should be responsible for overproduction of aldosterone. We performed adrenal venous sampling. Unexpectedly, the adrenal venous sampling highly suggested the presence of aldosterone-producing microtumors in bilateral adrenal glands (lateralized ratio, 1.3; left contralateral ratio, 0.2). After evaluation, we decided that there was no indication for the removal of left adrenal mass. Then, a low dose of a mineralocorticoid receptor (MR) antagonist was started. Although the dose of an MR antagonist could not be increased sufficiently due to poor renal function, he exhibited an improved control of blood pressure and was followed up thereafter.

Discussion and Conclusion:
Although PA is one of the most common causes of secondary hypertension, making an accurate diagnosis and appropriate treatment is sometimes problematic due to the difficulty in assessing the site of aldosterone overproduction. The Japanese Endocrine Society clinical guideline states that PA with unilateral adrenal tumor in young patients may not require adrenal venous sampling. From the current case, however, we should always consider the possibility of bilateral microtumors or hyperplasia even in the presence of a unilateral adrenal mass.