Scientific Program

Day 1 :

  • Hypertension | Antihypertensive drugs | Non-pharmacologic Intervention | Hypertension in patients with Comorbidities
Location: Toronto, Canada

Session Introduction

Zahra Saadat

Cardiovascular Research Center Shahid Beheshti University of Medical Sciences, Iran

Title: Adherence to Antihypertensives in Patients with Comorbid Condition
Speaker
Biography:

Zahra Saadat, M. D., completed her medical degree at Shahid Beheshti University of Medical Siences, Tehran, Iran. She is working at Omidvar Ewaz hospital, Emergency room as a general physician. She has her expertise in managing patients with lifethreatening conditions, such as heart attak, trauma, poisoning and etc. She is also cooperating with Shahid Beheshti Cardiovascular Research Center in Cardiology field and has published some articles since she was a medical student. 

Abstract:

Comorbidity has been noted as a potential barrier to proper adherence to antihypertensive medications. We decided to investigate whether comorbidity could significantly affect adherence of Iranian patients with hypertension to their medication regimen. 
Two hundred and eighty consecutive hypertensive patients were interviewed in 4 cities of Iran. The 8-item Morisky medication adherence scale (MMAS-8) (validated in Persian) was used to assess medication adherence. This scale determines adherence by scores as lower than 6 (low adherence), 6 or 7 (moderate adherence), and 8 (high adherence). Comorbidity was considered as any concomitant medical condition, which necessitates the patient to take medicine for a minimum of 6 months prior to the interviews. 
The most common comorbid conditions were ischemic heart disease (65 patients, 23.2%), diabetes mellitus (55 patients, 19.6%), and dyslipidemia (51 patients, 18.2%). Mean (± SD) MMAS-8 score in comorbid group was 5.68 (± 1.85) and in non-comorbid hypertensive patients, it was 5.83 (± 1.91) (P = 0.631). Mean (± SD) number of comorbidities was 1.53 (± 0.75) in low adherence group compared to 1.54 (± 0.77) in moderate/high adherers (P = 0.98). With increasing the number of comorbid diseases, the proportion of patients with high adherence decreased successively from 20% in those with no comorbid disease to 14.1% in those with one or two comorbid conditions, and finally 11.1% in those with 3 to 5 comorbid conditions. 
With increasing the number of comorbid conditions, the proportion of patients with high adherence decreases. In our opinion, this finding is a useful clinical note for healthcare providers when managing patients with hypertension who have other medical problems at the same time. 
 
 

Speaker
Biography:

Dedy Arisjulyanto is one of the postgraduate students of Public Health Universitas Gadjah Mada, he has expertise in overcoming non-communicable diseases with complementary therapy, this research was conducted directly in the community and analyzed it by the quantitative way and various theoretical references, this research became a very good recommendation in overcoming hypertension problem in the world.

Abstract:

Purpose: Hypertension is one of the leading causes of mortality in Indonesia, there is a significantly increasing trend in annual hypertension prevalence in Indonesia. Hypertension is one of the most common diseases in NTB, the prevalence of hypertension measured based on blood pressure in NTB is 1,523,574 (32.4%), it is higher than the national rate (1,255,537 (26.7%) of 4,702,389 people). The highest prevalence of hypertension in Mataram City is in Cakranegara Primary Care, there are 724 people with hypertension in this primary care working area. The purpose of this study is to determine the average number of the patient’s hypertension rate at Cakranegara Primary Care before and after given muscle relaxation techniques.

Method: This study uses "Quasi-Experiment Design" with the control group as comparison. The population in this study are 724 hypertension patients and 27 patients as sample based on inclusion and exclusion criteria.

Results: The results of this study indicate that the T-test calculation using Quasi-Experiment Design shows the difference in the average of hypertension rate before and after given progressive muscle relaxation technique. It is 10,306 mmHg in the intervention group and 1,425 mmHg in the control group. The p-value in the intervention group is 0.000 that is smaller than α = 0.05 and the p-value of the control group is 0.431 that is greater than α = 0.05.

Conclusion: From this study, we can conclude that there is a difference in hypertension rate between the intervention and control group. We hope this progressive muscle relaxation technique can be used as an appropriate alternative or complementing treatment to control Hypertension rate.

Speaker
Biography:

Abstract:

Background: This review focuses on urban and rural parts of central Thailand, north Thailand, east Thailand, west Thailand, south Thailand and northeast of Thailand. A Literature Review of the prevalence, awareness, control of hypertension and risk factors among Thailand patients. 
Methods: This literature review was guided by the Joanna Briggs Institute of Australia for Systematic Review and Meta-Analysis. The following databases were search from multiple electronic databases and manual searches of journals were written in English and published in journals from 2005 to 2015, databases were queried using keywords for prevalence, awareness, control of blood pressure (BP) or hypertension (≥140 SBP and or ≥90 DBP) and risk factors among Thailand adults (≥18 years). A total of 62 articles were identified, of which 18 articles were found to be relevant for this study. 
Results: Overall there is a prevalence of hypertension in Thailand. Significant differences in hypertension were noted between rural and urban parts of Thailand. Significant differences were also noted in the rural and urban Thailand  for awareness about how to control hypertension. The risk factors associated with hypertension among Thailand patients include age, alcohol, smoking and chewing tobacco, BMI, central obesity, consumption of low vegetables/ fruits, high consumption of dietary fat and salt, and sedentary activity. 
Conclusion: The rural areas had lesser prevalence of hypertension are compared to urban areas. The differences in hypertension is due to  socioeconomic conditions, risk factors and quality of life. The higher prevalence of hypertension in urban areas is leading to a rapid increase in cardiovascular disease risk factors among the urban poor and middle class in Thailand. 

  • Hypertension and Nephrology | Hypertension and Diabetes | Cardiovascular Diseases | Cerebrovascular Diseases
Location: Toronto, Canada
Speaker
Biography:

Professor Dr. Punit Gupta is MBBS, MD (Medicine), DM (Nephrology) and PhD. He is the Honorary Nephrologists to the Governor of Chhattisgarh State since 2009. He is Chairman and Members of many important academic and management committees of various Government Medical Institutions in the country and the Pt. Deen Dayal Upadhyay Health Sciences University, Raipur.He has guided over 100 Postgraduate & Technologist student for their thesis & Project in Nephrology & Research and also severed as an examiner for the university examinations.A man of researches and publication, he has presented more than 160 research papers and abstracts on Kidney Diseases in Tribal populations at Renowned National and International Conferences. He was felicitated for being the only research scholar who had presented 29 abstracts in Indian Society of Nephrology conference, Pune and 11 research papers at Asia Pacific congress of Nephrology, 2008 in Malaysia on tribal kidney diseases.His Oral Paper was awarded first prize in ISNCON 2007, New Delhi. He was awarded internationally prestigious APCN Developmental awards in Malaysia  2008 and a Follow Scholarship by International Society of Peritoneal Dialysis in Turkey 2008. His paper was recognized as a best Paper in API 2014, Bhilai. He was awarded Certificate of Excellence awards by the Times of India groups 2016. His work was appreciated with certificate of appreciation by Indian Dietician association 2016. He was felicitated by Agrasen Agrawal Samaj for his excellent work in Tribal Population 2016. He was honoured with excellence award by ‘Z’ TV Chhattisgarh for this distinguish work in kidney disease in rural population of Chhattisgarh in 2017. He has developed a concept of Teledialysis, first of its kind in Asia.He has developed Portable dialysis Machine (MAKE-D) for 60 billion kidney patients in world who require dialysis many times in a week. He has developed an abdominal Pressure Measurement Scale, which is very useful of Continuous Ambulatory Peritoneal Dialysis Patients (type of dialysis). He has developed and economic, efficient and effective walkie talkie system for consultation and directions to the hospital staff and doctors. He has been awarded Dr. B. C. Roy National Award for his research to give Aid or Assistance to Research Project for the year 2016.

Abstract:

Introduction: Gastroenteritis is an important cause of acute Kidney Injury. It was reported that gastroenteritis as a cause of Acute Kidney Injury in 22-44.5% of the cases. The severity of illness was assessed using Glassgow Coma Scale (GCS), Sequential Organ Failure Assessment (SOFA) score;Multiorgan dysfunction scores (MODS). These scales and scores help in assessing prognosis and outcome of the patients in study.

 

Method: The study was conducted in the Department of Nephrology, Pt. J.N.M. Medical College and Dr. B.R.A.M.Hospital, Raipur. 50 patients of Acute Kidney Injury were included for the purpose of study suffering from Acute Gastroenteritis admitted in Nephrology Unit, Pt.J.N.M.Medical College Raipur from was studied by MODS,SOFA and CGS SCORE in Acute Kidney Injury All patients were subjected to routine investigations.

 

Results:

  • Acute Gastroenteritis associated AKI includes 87.5% males, 12.5% Females.
  • AKI most commonly seen in people of age group 41-50 (62.5%).
  • 68.75% patients presented with features of AKI in first 3 days.
  • CGS score deranged in 50% patients affected by AGE with AKI.   
  • MODS score is deranged in 100% of patients suffering fromAGE with AKI.
  • SOFA score is deranged in 100% of patients suffering fromAGE with AKI.
  • Survival rate among patients suffering from AKI associated with AGE is 81.25% while mortality is 18.75%.
  • 50% had Multiorgan dysfunction and among them the mortality was 25% .
  • Mortality is 100% in patients having CGS score 7-11 & 11-13 & no mortality reported in <7 OR >13 GCS score groups suffering from AGE with AKI
  • Mortality rate of patients having MOD score 9-16 & 5-8 is 100% & 20% respectively and No mortality reported in 0-4 suffering from AGE with AKI.
  • Mortality rate of patients having SOFA score 9-16 & 5-8 is 100% & 16.67% respectively and No mortality reported in 0-4 suffering from AGE with AKI.
  • 43.75% required No.of dialysis is 2 ,more than 4 times dialysis required in 18.75% mean dialysis requirement is 2.75±1.5.
  • 12.5% patients require ventilatory support.
  • Mean days of hospitalization was 9.9±3.6 days.

Conclusion:

  • AGE with Acute Kidney injury was more common in male as compared to female.
  • AKI most commonly seen in people of age group 41-50.
  • Maximum number of patients presented with features of AKI in first 3 days
  • MODS score is deranged in all patients suffering from AGE with AKI.
  • SOFA score is deranged in all of patients suffering from AGE with AKI.
  • Multi-organ dysfunction seen in half of the patient suffering from AGE with AKI
  • Mortality of patient having MOD is 25%
  • 100% mortality seen with CGS 7-11 and 11-13
  • Maximum dialysis sessions required was 4.
  • 90% survival for AKI with AGE on hemodialysis

G.P.R. Manmathan

Royal Free Hospital, London

Title: Hypertension in HIV
Speaker
Biography:

Cardiology Specialty Registrar interested in interventional cardiology and devices. Looking to start a PhD in Oct 2017.

Abstract:

Background:

Combination antiretroviral therapy (ART) has dramatically changed the prognosis of HIV infection with survival nearing that of uninfected people when treatment is available. People living with HIV (PLWH), however, experience significant comorbidities associated with HIV infection as they are growing older, with a substantial proportion of them now aged 50 years and above. ART-treated patients are at an increased cardio-vascular risk with some studies quoting a 1.5 to 2 fold relative risk compared to their peers, controversially this was not validated by Q-Risk3.

Hypertension is among the leading risk factors for cardiovascular disease and accounts for 6% of adult deaths worldwide. It is estimated that hypertension is responsible for at least 45% of deaths due to heart disease and 51% of deaths due to stroke.

Recently the American College of Cardiology (ACC) updated their guidance stating high blood pressure (BP) should be treated earlier with lifestyle changes and medication – at 130/80mmHg rather than 140/90mmHg. This is the 1st reclassification of hypertension in over 20 years, NICE are due to address this in 2019.

Methods:

At the Royal Free Hospital, London we have a HIV Centre offering a walk-in service for various clinics and drop-ins for PLWH. We have an average of 140 PLWH using the service on a weekly basis, we opted to exclude those PLWH who were coming for a drop-in visit as their anxiety levels may have led to an elevated BP, thus we only we used patients who were attending for clinic and measured their blood pressure.

Retrospectively we collected data on HTN, HTN meds, their ART regime, creatinine, cholesterol, urine PCR.      

Rasulova

Toshev B.B. Republican Specialized Scientific and Practical Medical Center Therapy And Medical Rehabilitation, Tashkent, Uzbekistan

Title: Influence of lyzinoprile and losartan on the indicators of the functional state of kidneys in patients with chronic heart failure depending on the degree of dysfunction of kidneys
Speaker
Biography:

Rasulova Z.D. has completed his Ph.D. at the age of 30 years from Tashkent Medical Academy. She is the Senior Researcher of the Republican Specialized Scientific and Practical Center for Therapy and Medical Rehabilitation. He has published more than 30 papers in reputed journals.    

Abstract:

 Purpose. To study the effect of lisinopril and losartan on the functional state of the kidneys of patients with I-III functional class (FC) of chronic heart failure (CHF), depending on the degree of renal dysfunction (RD).

Research methods. A total of 223 patients with ischemic heart disease with I-III FC of CHF were examined, initially and after 6 months of treatment. The first group (I) consisted of 118 patients taking lisinopril as part of standard therapy; the second group (II) - 105 patients taking losartan. Also, all patients were divided into 2 groups depending on the estimated rate of the glomerular filtration (eGFR): 30 < eGFR ≤60 ml/min/1.73 m2 - 67 patients (29 patients in the I group, 38 - in the II group), and eGFR > 60 ml/min/1.73m2 -156 patients (89 patients in group 1, 67 patients in group 2).

Results. The nephroprotective effect of standard therapy with the inclusion of lisinopril or losartan was noted, with a significant decrease in the level of enzymes in the urine, as a sign of dysfunction of the tubular kidney apparatus, a decrease in creatinine, and an increase in GFR. In patients with CHF with a preserved RSKF>60 ml/min/1.73 m2 and moderate DP with eGFR = 59-45 ml/min/1.73 m2, the use of standard lisinopril or losartan showed reliable nephroprotection. In patients with CHF with kidney dysfunction with 30>eGFR<45 ml/min/1.73 m2, a significant improvement in renal dysfunction was observed in the group of patients taking standard therapy - losartan.

Conclusion. The results of our study showed the nephroprotective effect of the standard therapy with the inclusion - lisinopril and losartan, with a significant decrease in the level of enzymes in the urine, as a sign of dysfunction of the tubular kidney apparatus, a decrease in creatinine and an increase in GFR, a more pronounced effect was observed in patients taking losartan. 

  • High Blood Pressure in Adults | Stress Management in Adults | Clinical Evaluation | Etiology and Risk Management
Location: Toronto, Canada
Speaker
Biography:

Anum Salman has completed her MSc at the age of 24 years from Liaquat National Hospital in neuromusculoskeletal rehabilitation. She is working as a physiotherapist in Memon Medical Institute Hospital and has more than 3 years of clinical experience

Abstract:

Background:  Hypertension is the leading cardiovascular problem worldwide. Hypertension persists in the patient for a long time without any symptom which results in weakening of coronary vessels. Hypertension is a major risk factor for stroke, neuropathy and coronary artery disease. Increase blood pressure and lack of exercise is strongly associated with each other.

Aims and objective: The purpose of this study was to explore the effectiveness of lower limb (cycling) and upper limb exercises (arm stretch trainer) in reducing blood pressure in hypertensive patients.

Method: Case-control study was performed on  80 participants with the age between  40 - 60 years. Participants taken for the study were divided into two groups. Group A with 40 participants was receiving upper limb exercises and the Group B with 40 participants were receiving lower limb exercises. Total 10 sessions of both types of exercises were administered.

  Result: A statistically significant difference was found in systolic and diastolic pressure before and after the exercises. Systolic blood pressure was reduced to 133.95±4.187 after lower limb exercise and 171.800±5.616 after upper limb exercise. Whereas, diastolic blood pressure was reduced to 84.500±2.83 by using lower limb cycling exercise and 92.27±3.40 by using upper limb exercise. t-test result shows a p-value less than 0.005 of both systolic and diastolic blood pressure.

Conclusion: Both the exercise have impact in reducing blood pressure but patients who want quick recovery should go for lower limb exercises.

Speaker
Biography:

As a Biochemist doctorate along with post graduate in dietetics and food management have passion in challenging research projects based on nutrigenetics. Worked on many genetic association studies in coronary artery disease and diabetic patients. Many research publication in toxigenomics area too.Working on nanoformulations of statins and drug delivery systems to improve the bioavalabilty.

Abstract:

Genetic polymorphisms in glutathione S-transferase (GSTs) genes may modulate the risk of cardiovascular diseases. The objective of present study was to investigate the potential association between the polymorphisms of GSTM1/T1 and P1 genes and their influence on diverse clinical parameters and oxidative stress biomarkers in coronary artery disease (CAD) patients in Asian Indians. Present study includes 562 angiographically confirmed CAD patients and 564 healthy control subjects from north Indian population. Anthropometric and clinical measurements were done in all the participants. The oxidative stress biomarkers including malondialdehyde (MDA) and total antioxidant capacity (TAC) were also measured. The genotyping of GSTM1/T1 and P1 genes was carried out using multiplex-PCR and PCR-RFLP methods. The CAD patients exhibit significantly high values of waist circumference (WC), waist to hip ratio (WHR), Body fat(%), glucose, triglycerides and low-density lipoprotein (LDL), and reduced HDL levels were observed in CAD patients compared to control subjects (p<0.001). MDA levels were significantly enhanced and TAC was reduced in CAD patients compared to controls (p<0.001). However, no significant difference in BMI and total cholesterol levels was observed in CAD patients and control subjects. The frequencies of the GSTM1 and GSTM1/T1 null genotypes in the CAD patients were significantly higher than the control subjects. In contrast, GSTT1(-) genotype frequencies were significantly lower in CAD patients than the controls. Logistic regression analysis of the data revealed null genotype of GSTM1 and GG genotype of GSTP1 (313A/G) gene were associated with 2-fold enhanced risk of developing CAD whereas GSTT1(-) plays a defensive role against CAD development in north Indians. Upon stratification of data according to the genotypes of GSTM1/T1 and P1 genes, we did not find significant difference amongst the various metabolic traits in CAD patients and controls. Our results suggest that oxidative damage induced by lipid peroxidation with reduced antioxidant capacity and genetic variants in GST genes (GSTM1/T1 and P1) may modify the risk of CAD development in Asian Indian population.

Speaker
Biography:

As a Biochemist doctorate along with post graduate in dietetics and food management have passion in challenging research projects based on nutrigenetics. Worked on many genetic association studies in coronary artery disease and diabetic patients. Many research publication in toxigenomics area too.Working on nanoformulations of statins and drug delivery systems to improve the bioavalabilty.

Abstract:

Genetic polymorphisms in glutathione S-transferase (GSTs) genes may modulate the risk of cardiovascular diseases. The objective of present study was to investigate the potential association between the polymorphisms of GSTM1/T1 and P1 genes and their influence on diverse clinical parameters and oxidative stress biomarkers in coronary artery disease (CAD) patients in Asian Indians. Present study includes 562 angiographically confirmed CAD patients and 564 healthy control subjects from north Indian population. Anthropometric and clinical measurements were done in all the participants. The oxidative stress biomarkers including malondialdehyde (MDA) and total antioxidant capacity (TAC) were also measured. The genotyping of GSTM1/T1 and P1 genes was carried out using multiplex-PCR and PCR-RFLP methods. The CAD patients exhibit significantly high values of waist circumference (WC), waist to hip ratio (WHR), Body fat(%), glucose, triglycerides and low-density lipoprotein (LDL), and reduced HDL levels were observed in CAD patients compared to control subjects (p<0.001). MDA levels were significantly enhanced and TAC was reduced in CAD patients compared to controls (p<0.001). However, no significant difference in BMI and total cholesterol levels was observed in CAD patients and control subjects. The frequencies of the GSTM1 and GSTM1/T1 null genotypes in the CAD patients were significantly higher than the control subjects. In contrast, GSTT1(-) genotype frequencies were significantly lower in CAD patients than the controls. Logistic regression analysis of the data revealed null genotype of GSTM1 and GG genotype of GSTP1 (313A/G) gene were associated with 2-fold enhanced risk of developing CAD whereas GSTT1(-) plays a defensive role against CAD development in north Indians. Upon stratification of data according to the genotypes of GSTM1/T1 and P1 genes, we did not find significant difference amongst the various metabolic traits in CAD patients and controls. Our results suggest that oxidative damage induced by lipid peroxidation with reduced antioxidant capacity and genetic variants in GST genes (GSTM1/T1 and P1) may modify the risk of CAD development in Asian Indian population.

 

 

Speaker
Biography:

Dr. Bhatti is an Assistant Professor having teaching and research experience of >10 years. Recently he finished his post doc fellowship at Texas Tech University Health Sciences Center, Lubbock TX USA under the scheme of Raman Fellowship funded by University Grants Commission Govt. of India. He identified a link between the type 2 diabetes and development of Alzheimer’s dises using a genetic model of type 2 diabetes, TallyHO. He is actively engaged in investigating the genes associated with the risk of developing type 2 diabetes and coronary artery disease (CAD) in Asian Indians. He has published 25 research papers in reputed international journals and presented his findings in various national and international conferences. He is an expertise in the area of gene based personalized medicine. He has identified various life style related risk factors and susceptibility genes in diabetes, CAD and metabolic syndrome.  

Abstract:

Statement of the Problem: Coronary artery disease (CAD) is a multifactorial syndrome that is deemed to be an outcome of the association between genetic and environmental factors. Vitamin D receptor (VDR) is a probable candidate gene for the development of CAD. The purpose of present study was planned to examine the role of single nucleotide polymorphisms (SNPs) in VDR gene and CAD risk in Asian Indians. Methodology: A total of 410 CAD patients and 414 controls were included. Three SNPs in VDR gene (BsmI, TaqI and FokI) were examined using PCR-RFLP method. In addition, the anthropometric and biochemical characteristics were done in all the subjects. Findings: The CAD patients shows pronounced abdominal adiposity reflected by their significantly higher waist circumference, waist to hip ratio, even at the normal BMI values suggested for Asian Indians. Dyslipidemia, represented by high levels of TC and TG, and reduced HDL was an established risk factor for development of CAD. The genotyping data revealed that BsmI-bb genotype might be associated with 2.2-fold increased risk (OR=2.19; 95% C.I. = 1.48-3.19; p=<0.001) whereas FokI-TT homozygotes had a 3.5 fold increased risk for the development of CAD (OR = 3.53; 95% C.I. = 2.33-5.36; p=<0.001). Furthermore, no significant relationship of TaqI polymorphism with CAD risk was observed (OR; 1.35, 95% C.I.; 0.91-1.99, p = 0.161). Conclusion & Significance: The present study demonstrated a significant association of BsmI and FokI variants of VDR gene with augmented possibility of CAD development in Asian Indian population. The conventional risk factors such as age, abdominal obesity and dyslipidemia were independently linked with the amplified risk of CAD. However, metabolic characteristics are not very affected by VDR gene polymorphisms in Asian Indians.  Finding variations in the susceptibility genes that makes people more susceptible to diseases help us in improved therapeutic strategies.