e458 Abstracts

POSTER

NEUROLOGY_CLINICAL SCIENCE 1 day within the 14 days (2 AM, 3 AM, and 4 AM). We use the average of all
nocturnal home BP values. N-terminal pro-brain natriuretic peptide (NT-proBNP)
P and urine albumin:creatinine ratio (UACR) were used as surrogate markers of
O TOD. The CVD outcomes were incident stroke and coronary heart disease (CHD)
S events.
T PS-C28-1 
EARLY DETECTION OF DEMENTIA AT
E COMMUNITY PHARMACIES USING SIMPLE Results: The prevalence of nocturnal hypertension defined by HBPM was 61.7%
of all study participants with ≧ 65 years. The participants with nocturnal hyper-
R TOUCH PANEL SCREENING CHECK
tension defined by HBPM presented higher levels of log-transformed NT-proBNP
Mamiko Kai1, Koji Tominaga1, Kazutoshi Morita1, Yoshio Soda2, Ei Sejima3, and UACR at baseline compared to those with controlled nocturnal BP group.
Hitomi Dendo4, Ryosuke Yamaguchi5, Makiko Takada6, Hiroshi Akura7, Over a median 4.0-year follow-up (5,453 person-years), 36 stroke events and
Kazuhiko Ono1, Toshinobu Hayashi1, Hitoshi Iida8, Koji Ogomori9, 31 CHD events occurred, respectively. The nocturnal hypertension group had a
Hiroaki Kawasaski8, Takashi Egawa1 1Department of Pharmaceutical and Health higher incidence rate of stroke events compared with the controlled BP group.
Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University, Concerning CHD, the incidence rate of CHD was similar between two groups
Japan, 2Fukuoka City Pharmaceutical Association Pharmacy, Japan, 3Yasashii (Figure). Cox model results suggested that the participants with nocturnal hyper-
Pharmacy Nagao Store, Japan, 4Sejima Pharmacy Yakuin Store, Japan, 5Ryosuke tension had a higher risk of stroke compared to those with controlled nocturnal
Medical and Surgical Clinic, Japan, 6Miyake Internal Clinic, Japan, 7Muscut BP group after adjustments for log-transformed NT-proBNP and UACR levels
Pharmacy Kurashiki Store, Japan, 8Department of Psychiatry, Faculty of Medicine, (adjusted hazard ratio 3.42; 95% confidence interval 1.15–10.19).
Fukuoka University, Japan, 9Department of Occupational Therapy, Fukuoka
International University of Health and Welfare, Japan Conclusions: In this Japanese population with ≧ 65 years, the participants with
nocturnal hypertension defined by HBPM was significantly associated with stroke
Objective:The purpose of this study was to examine whether a simple touch panel
risk, independently of the extent of TOD.
screening check for dementia (TPCD) would be effective for early detection of
dementia at community pharmacies.
Design and Methods: This was a prospective study of adult visitors presenting to
a pharmacy adjacent to a university hospital (Project 1) or to a general physician
clinic (Project 2). Participants were voluntarily recruited in the pharmacies and
were registered after written informed consent. To evaluate the cognitive function
of participants, we scored immediate and recent memories of words, time orienta-
tion, figure recognition using a Forgetfulness Consultation Program MSP-1100
(Nihon Kohden, Tokyo). When the score was or less than 12 out of 15 points,
participants were suspected as having dementia and recommended to visit the psy-
chiatric outpatient clinic of the university hospital (Project 1) or to visit the gen-
eral physician (Project 2). On the next visit to the pharmacy, the participants were
asked whether they had received the consultation of the psychiatric specialists.
Results: [Project 1] TPCD was conducted on 81 individuals (35 men) from Janu-
ary 2019 to January 2020. One was excluded because of agreement withdrawal
and another was excluded because he had already been treated for dementia at
PS-C28-3 
EFFECTS OF THE OLMESARTAN MEDOXOMIL
another clinic. Of 79 participants, 17 (21.5 %, 8 men) were suspected as having
ON CONTROLLING HYPERTENSION AND
dementia and were recommended to visit the psychiatric clinic. Two participant
REHABILITATION OUTCOMES FOR INPATIENTS IN
visited psychiatric specialists and were diagnosed as having mild cognitive im-
THE STROKE CARE UNIT
pairment. Four consulted with their family physicians but have not yet visit the
psychiatric clinic. Eleven refused the consultation. [Project 2] Currently, TPCD Shuji Matsumoto1, Takashi Hoei2, Ryuji Tojo3, Toshihiro Nakamura3 1Tsukuba
was conducted on 30 individuals (8 men) and 10 (33.3 %, 3 men) were suspected University Hospital, Mito-kyodo Hosipital, Japan, 2Kagoshima University
to having dementia from January 2021 to April 2022. The recruitment is now Hospital, Japan, 3Acras Central Hospital, Japan
ongoing.
Objective: Hypertension is the most prevalent risk factor for stroke, based on data
Conclusion: This preliminary analysis suggests that TPCD in pharmacies may be from many studies, and has been reported in about 64% of patients with stroke.
effective for early detection of dementia. It is necessary to strengthen the pass to In patients with severe hypertension, chronic heart failure or history of stroke, the
support the consultation visit to psychiatric specialists. lower limit of cerebral blood flow autoregulation is shifted to a higher blood pres-
sure (BP) than in healthy subjects. Furthermore, in patients with cerebrovascular
PS-C28-2 
STROKE RISK OF THE ELDERLY PATIENTS WITH disease, CBF autoregulation can be disturbed, so that the mean BP necessary to
NOCTURNAL HYPERTENSION DEFINED USING maintain a constant CBF is higher than that in healthy subjects. In the present
HOME BLOOD PRESSURE MONITORING IN study, we assessed the effects of the angiotensin II type 1 receptor antagonist
JAPANESE GENERAL PRACTICE POPULATION olmesartan medoxomil on controlling hypertension and rehabilitation outcomes
for hypertensive post-stroke patients in the stroke care unit.
Takeshi Fujiwara1, Satoshi Hoshide1, Kazuomi Kario1 1Division of Methods: Inpatients of both genders, who were aged between 20 and 75 years and
Cardiovascular Medicine, Department of Medicine, Jichi Medical University had hypertension and a history of a first stroke, were eligible for participation in
School of Medicine, Japan
the present study. In total, 54 patients were enrolled in the study. Research design
Objective: To investigate the association between nocturnal hypertension defined was an open treatment trial with pre-treatment and post-treatment evaluations for
using home blood pressure (BP) monitoring (HBPM) and the prevalence, extent 8 weeks. After screening, the patients were administered olmesartan once daily at
of cardiovascular target organ damage (TOD), and cardiovascular disease (CVD) a dose of 10 mg for the first 4 weeks of the trial. The dose was increased over the
event risks in participants with ≧ 65 years in general clinical practice. next 4 weeks if a 24-hr SBP/DBP of < 135/80mmHg was not achieved, or if re-
ductions in the 24-hr SBP/DBP of > 10/5 mmHg were not realized. The outcome
Design and method: We used the dataset of the Japan Morning Surge-Home BP
measures were the 24-h BP (ABPM), heart rate (HR), and rehabilitation outcomes
(J-HOP) Study that recruited 4,310 participants with cardiovascular risk factors.
(Brunnstrom stage [BRS], Barthel index [BI] and Mini-Mental State Examination
Among them, we assessed the participants with ≧ 65 years who measured noctur-
[MMSE] score).
nal home BP (n = 1,349, mean age 72.0 year, 48.6% men). We define nocturnal
hypertension as nocturnal systolic (SBP) ≧ 120 mmHg or diastolic (DBP) ≧ 70 Results: Olmesartan was well tolerated by all patients, and no complications or
mmHg, using HBPM. Nocturnal home BP was automatically measured at least adverse events (severe or fatal) were observed during the eight weeks of treatment.

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

The SBP and DBP assessed by ABPM, decreased continuously and significantly 83.2 ± 11.2 mmHg respectively, p = 0.05). However, the two groups did not differ
after olmesartan administration. In all subjects, the BRS of recovery from hemi- as regards MSNA levels (42.5 ± 10 vs. 41.6 ± 7.8 bursts per minute respectively,
plegia in the upper limb, finger, and lower limb showed a significant improvement p = 0.5). MSNA levels did not correlate to attended and unattended systolic/dia-
after 8 weeks of treatment. No decreases in BRS were observed in any of the stolic BP in both groups.
patients during the study. Also, the BI and MMSE score significantly improved
Conclusions: In conclusion, sympathetic nervous system activity may not con-
after 8 weeks of treatment.
tribute significantly to the differential BP levels during attended or unattended
Conclusions: Our findings confirmed that olmesartan is an effective antihyper- BP measurements.
tensive drug with good tolerability. Treating hypertensive patients with a history
of stroke for eight consecutive weeks with olmesartan decreased 24-hr BP, and PS-C28-6 
HIGH TESTOSTERONE AND LOW ESTRADIOL
improved rehabilitation outcomes. These findings suggest that olmesartan has SERA LEVELS ARE ASSOCIATED WITH UNSTABLE
beneficial effects for the hypertensive post-stroke patients in the stroke care unit. PLAQUE COMPOSITION IN MEN WITH SEVERE
CAROTID ATHEROSCLEROSIS
PS-C28-4 
IMPACT OF SYSTOLIC BLOOD PRESSURE ON
OUTCOMES IN ACUTE ISCHEMIC STROKE AFTER Karina Gasbarrino1, Edward Daly2, Huaien Zheng1, Stella S Daskalopoulou1
1Vascular Health Unit, Research Institute of McGill University Health Centre,
INTRAVENOUS THROMBOLYSIS: NCVC RT-PA
Canada, 2Clinical Proteomics and Mass Spectrometry, Research Institute of Mc-
REGISTRY
Gill University Health Centre, Canada
Takeshi Yoshimoto1, Shinichi Wada2, Sohei Yoshimura3, Kazunori Toyoda3, Background and Objectives: Ischemic strokes caused by the rupture of unstable
Masafumi Ihara1, Masatoshi Koga3 1Department of Neurology, National atherosclerotic plaques in the carotid arteries, are leading causes of mortality and
Cerebral and Cardiovascular Center, Japan, 2Department of Medical and disability worldwide. Sex differences exist in plaque composition, where men
Health Information Management, National Cerebral and Cardiovascular are more likely to develop unstable plaques than women. Sex hormones affect
Center, Japan, 3Department of Cerebrovascular Medicine, National Cerebral and vascular reactivity and inflammation, but it remains unclear if they are involved
Cardiovascular Center, Japan
in plaque instability and how their role differs in men and women. Herein, we
Background: The optimal management of systolic blood pressure (SBP) in acute investigated the association between circulating endogenous sex hormone levels
ischemic stroke (AIS) patients receiving intravenous thrombolysis (IVT) remains and plaque composition/instability in men and women with severe carotid ath-
unclear. We aimed to clarify the association between SBP parameters, including erosclerosis.
variability and clinical outcomes in AIS patients who received IVT.
Design and method: Pre-operative fasting blood samples and plaque specimens
Methods: Data of AIS patients receiving intravenous alteplase at 0.6 mg/kg were were collected from post-menopausal women and men greater than 55 years old
extracted from the National Cerebral and Cardiovascular Center (NCVC) rt-PA with severe carotid atherosclerosis who underwent a carotid endarterectomy at
Registry. SBP was measured seven times at admission and within 24 hours every McGill-affiliated hospitals in Montreal, Canada. Plaque composition and stability
4 hours after IVT. SBP variabilities included maximum SBP, minimum SBP, mean were examined by experienced vascular pathologists according to gold-standard
SBP, standard deviation, coefficient of variation, and successive variation. Out- histological classifications. Liquid chromatography-tandem mass spectrometry-
comes were defined as modified Rankin Scale score 3–6 at 90 days, representing based methods were developed to quantify endogenous sex hormones, 17ß-es-
unfavorable outcome, and symptomatic intracranial hemorrhage (SICH) within tradiol (E2), testosterone, androstenedione, and dehydroepiandrosterone, in sera
36 hours. samples.
Results: Among 802 patients (303 women; median age, 76 years; median Nation- Results: Subjects (n = 460) had a mean age of 71.0 ± 9.0, were 68.9% male, and
al Institutes of Health Stroke Scale score, 12), 424 (52.9%) AIS patients had unfa- had various comorbidities (hypercholesterolemia [82.6%], hypertension [84.6%],
vorable outcomes and 16 (2.0%) patients had SICH, respectively. In multivariable type 2 diabetes [34.5%]). Clinical characteristics were similar among post-meno-
analyses, maximum (adjusted odds ratio per 10 mmHg 1.13, 95% confidence in- pausal women (n = 143) and men (n = 317) with stable versus unstable plaques.
terval, 1.04–1.24), minimum (1.27, 1.14–1.42), and mean SBP (1.54, 1.35–1.77) Men had a significantly greater proportion of unstable versus stable plaques
were independently associated with unfavorable outcomes. compared to women (men unstable: 61.5%, women unstable: 41.3%; P < 0.001),
characterized predominantly by a large lipid-rich core, hemorrhage, and high
Conclusions: SBP during the initial 24 hours after intravenous low-dose alteplase
presence of inflammatory cell infiltration. Men with unstable plaques had signifi-
was associated with unfavorable outcomes.
cantly higher levels of testosterone than men with stable plaques (P = 0.004). In
men, testosterone levels were inversely associated with fibrosis (P < 0.05), while
PS-C28-5 
ROLE OF SYMPATHETIC NERVOUS SYSTEM IN directly associated with unstable plaque features, including greater lipid core size
ATTENDED AND UNATTENDED BP LEVELS IN (P < 0.05), and a greater presence of foam cells (P < 0.05), neovascularization (P
ESSENTIAL HYPERTENSION < 0.01), and plaque (P < 0.01) and cap inflammation (P < 0.05). No associations
were observed between testosterone levels and plaque features in women. Endog-
Eleni Manta1, Ioannis Andrikou1, Dimitrios Konstantinidis1, Costas Thomopoulos1,
enous E2 levels were inversely associated with neovascularization (P < 0.05) and
Kyriakos Dimitriadis1, Sotirios Drogkaris1, Panagiotis Iliakis1,
plaque and cap inflammation (P < 0.001) in men, while inversely associated with
Emmanouil Mantzouranis1, Dimitrios Polyzos1, Ioannis Zammanis1,
Konstantinos Tsioufis1 1First Department of Cardiolog y, University of Athens fibrosis levels in women (P < 0.05).
Medical School, Hippokration Hospital, Greece Conclusion: Our findings suggest that higher testosterone and lower E2 levels are
Objective: It has been hypothesized that unattended blood pressure (BP) mea- associated with unstable plaque composition in men with carotid atherosclerotic
surement may provide complementary clinical information to conventionally at- disease and may partly explain the higher proportion of unstable plaques observed
tended BP measurement. The role of sympathetic nervous system activation dur- among men than women of similar age and comorbidity status. Instead, in women,
ing attended and unattended BP measurements is largely undetermined. estradiol appears to play a detrimental role in plaque instability by inversely af-
fecting fibrous tissue levels (a key stabilizing feature of plaques).
Design and method: We studied 161 untreated hypertensive patients undergoing
attended and unattended office BP measurements. Patients were divided into two
PS-C28-8 
CILOSTAZOL CONTRIBUTES TO RISK REDUCTION
groups - group A, unattended systolic BP greater than the attended systolic BP (n
OF STROKE RECURRENCE WITHOUT LOWERING
= 79), and group B, unattended systolic BP equal or lower than the attended (n =
BLOOD PRESSURE: RESULTS FROM [Link]
82). All participants underwent muscle sympathetic nerve activity (MSNA) esti-
mation by microneurography. Unattended and attended BP measurements were Kaori Miwa1, Ryotaro Saita2, Katsuhiro Omae2, Masatoshi Koga1,
performed with the same device in a random order for each patient on the day of Takenori Yamaguchi1, Kazunori Toyoda1 1Department of Cerebrovascular
MSNA recording. MSNA levels were compared between the two groups. Medicine, National Cerebral and Cardiovascular Center, Japan, 2Department of
Data Science, National Cerebral and Cardiovascular Center, Japan
Results: We examined 161 hypertensive patients [54% men, mean age 56 ± 12
years, BMI 29 ± 5 kg/m2, mean attended BP 140 ± 17 / 87 ± 13 mmHg, mean Background: The Cilostazol Stroke Prevention Study for Antiplatelet Combina-
unattended BP 141 ± 20 / 85 ± 12 mmHg]. Group A and group B had statistically tion ([Link]) found that the dual therapy with cilostazol plus aspirin or clopi-
significant differences between attended systolic BP (136.7 ± 17.8 vs 143.7 ± dogrel reduced the risks of recurrent ischemic stroke compared with monotherapy
15.7 mmHg respectively, p = 0.009), attended diastolic BP (85.5 ± 14.7 vs 89.7 ± with aspirin or clopidogrel alone in patients with non-cardioembolic ischemic
11.4 mmHg respectively, p = 0.004), unattended systolic BP (145.5 ± 19 vs 135.7 stroke. As its putative mechanisms, cilostazol can serve a role in the inhibition
± 19.9 mmHg respectively, p = 0.002) and unattended diastolic BP (86.9 ± 13 vs of angiotensin 2-induced endothelial cell apoptosis and vasodilation, which may

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