Introduction: Hypertension is the cause of 7.5 million deaths, equivalent to 12.8% of total deaths based on WHO data. Trunyan Village currently has limited access to health services, low public awareness of maintaining personal health and environmental health, and no descriptive or analytical data discussing hypertension prevalence and risk factors. Methods: Therefore, this study aims to determine hypertension prevalence and risk factors in Trunyan Village, Bangli. This study used a cross-sectional design, with the subject selection method using simple random sampling and blood pressure status as a dependent variable. The interview was conducted on 55 people, which used a questionnaire. Result: Data analyzed used the chi-square test, and the relationship between variables was considered significant with a p-value <0.05. The prevalence of hypertension in Trunyan Village is 52.7%, with female dominance (65.5%) and age ≤50 years (52.7%). There is a significant relationship between hypertension and age (p<0.01; PR=3.50), the habit of consuming sweet foods (p=0.02; PR=0.54), and family history of hypertension (p<0.01; PR=1.91). Conclusion: It can be concluded that hypertension has a significant relationship with risk factors for age, habits of consuming sweets foods, and a family history of hypertension. Further research needs to be carried out with a larger sample size to obtain more representative results. Keywords: Bali, hypertension, prevalence, risk factors, Trunyan village

Objective: Since an elevation of pulmonary artery pressure (PAP) often precedes clinical worsening of heart failure, early and non-invasive detection of that sign is useful in heart failure care. The purpose of this study was to assess whether a non-invasive technology called cardiac acoustic biomarkers (CABs) to quantify heart sounds can detect the exercise-induced elevation of PAP in patients with heart failure. Design and Methods:Patients with heart failure scheduled to undergo right heart catheterization (RHC) were prospectively enrolled between February 2020 to September 2021. CABs were concurrently recorded with PAP and pulmonary capillary wedge pressure (PCWP) at rest (baseline) and while applying a handgrip (exercise).Results: Forty-nine patients were included in the analysis dataset and their mean PAP significantly increased at exercise compared to baseline (32.45 ± 11.28 mmHg vs 23.52 ± 8.41 mmHg; p < 0.001). Several CABs correlated significantly with mean PAP by absolute values, among which S2 Width (r = 0.354; p < 0.05 and r = 0.363; p < 0.05) and S3 Strength (r = 0.375; p < 0.05 and r = 0.386; p < 0.05) were consistent throughout baseline and exercise. The response of CABs to PAP elevation caused by exercise was divided into two patterns: increasing and decreasing. The frequency of cardiac index less than 2.2 mL/m 2 was significantly higher in the decreasing pattern.Conclusions: CABs related to S2 and S3 can quantify heart sounds which reflect the exercise-induced hemodynamic change in patients with heart failure. It should be noted, however, that their reactions to hemodynamic change can be different depending on the background hemodynamics of individuals.

Introduction:Hypertension is considered the most important risk factor for stroke in the general population, is the most common comorbidity in patients with atrial fibrillation (AF), and is prevalent in approximately 80 to 90% of subjects with AF enrolled in recent clinical trials. Statin drugs have potent anti inflammatory and antioxidant effects that have the potential to prevent AF. Patients who had ischemic stroke complications due to episodes of AF are usually asymptomatic, thus primary prevention of AF in hypertensive patients is very important.Objectives:To determine the effectiveness of statin in reducing the incidence of new onset AF and ischemic stroke complications in hypertensive patients.Methods:We included 180 subjects in this retrospective cohort study using medical records at Sanglah General Hospital from 2018 to 2020. Subjects were divided into hypertensive subjects who were treated with a statin and hypertensive subjects who were not given statins, and we tracked the incidence of new onset AF. Pearson chi square test was used to determine the association of baseline characteristics, comorbidities, and medications, including statin, on the outcome of new onset AF, ischemic stroke, and side effects of statin. The progression of new onset AF between groups was also compared with the Kaplan Meier curve.Results:Our subjects who used statin were 39.4%, the mean age for all was 51.51+12.31 with 28,3% new onset AF, 7,2% ischemic stroke, and 2.2% all cause death. Statin in hypertensive patients significantly reduced the incidence of new onset AF (PR 0.174; 95%CI 0.079–0.38; P < 0.001) with a longer AF free period (19.16 + 2.57 vs 13.68 + 0.67 months; 95%CI 5.01–5.84; P = 0.014) and ischemic stroke free period (23.72 + 0.71 vs 16.57 + 1.06 month; 95%CI 5.01–5.84; P = 0.003), without any significant relationship with the adverse effect of statin. The incidence of AF was significantly high in hypertensive subjects with comorbid heart failure (HF) however, the AF free period remains longer if hypertensive patients with HF are given statin (19.16 + 2.57 vs 13.68 + 0.67 month; 95%CI 5.01–5.84; P = 0.014).Conclusion:Statin administration has the potential to be an effective treatment for primary prevention of the incidence of new onset AF and ischemic stroke in hypertensive patients without significant side effects.

Funding Acknowledgements Type of funding sources: None. Background Although current guidelines recommend the use of direct oral anticoagulants in patients with non-valvular atrial fibrillation (NVAF), the use of vitamin K antagonists (VKA) is still very widespread, especially in low to middle-income countries in Asia. If VKA/Warfarin is used, a target international normalized ratio (INR) range of 2.00-3.00 is recommended. Still, various studies conducted in Asia have found bleeding rates to be higher in this range. Thus, the "sweet spot" of INR targets in the Asian population is still under debate. Purpose This study aimed to compare bleeding and ischemic outcomes between the lower target INR and the standard target INR in an Asian population. Methods We conducted a systematic search in Pubmed, ScienceDirect, Cochrane, SinoMed, CNKI, and Wanfang data for studies conducted in East Asian countries comparing the outcome of standard INR targets (2.00-3.00) with lower INR targets in AF patients on VKA/Warfarin medication. The primary endpoints of interest are thromboembolic events and major bleeding. In addition, we performed a sub-analysis based on the lower INR with homogenized range (1.50-2.00) against the standard INR in primary outcomes. Secondary outcomes in this study were ischemic stroke, hemorrhagic stroke, minor bleeding, all-cause mortality, and treatment adherence. We used Review Manager 5.4 to calculate the result of 95% CI for the outcomes and odds ratios (OR). Results A total of 28 studies consisting of 10,533 patients from Japan, Korea, China, Hong Kong, and Thailand were included in our study. The incidence of thromboembolism was significantly higher in patients with a lower INR [OR 1.34 (95% CI 1.10-1.65; p=0.0005; I²=41%)], but if the lower INR was homogenized at range of 1.50–2.00 in the sub-analysis, there was no significant difference in events [OR 1.19 (95% CI 0.85-1.65; p=0.31; I²=0%)]. Major bleeding events [OR 0.36 (95% CI 0.28-0.46; p&lt;0.00001; I²=0%)], hemorrhagic stroke [OR 0.24 (95% CI 0.14-0.42; p&lt;0.00001; I²=0%)], and minor bleeding [OR 0.29 (95% CI 0.09-0.92; p=0.04; I²=0%)] was found to be significantly lower at the lower INR targets. Although there was no significant difference in all-cause mortality and ischemic stroke, a lower INR targets was associated with better treatment adherence in term of fewer patients discontinuing therapy independently [OR 0.48 (95% CI 0.28-0.48; p=0.007; I² =0%)]. Conclusion The incidence of bleeding was significantly higher in the Asian population treated with the standard target INR. Adjusting the lower target INR to 1.50-2.00 might be the sweet spot for the balance of ischemic and bleeding events to provide better outcomes in the Asian population with AF.