Absence Of Hypertension Research Articles

Prevalence and predictors of mitral annular disjunction and ventricular ectopy in mitral valve prolapse

BackgroundMitral annular disjunction (MAD) is associated with ventricular arrhythmia in mitral valve prolapse (MVP). The proportional risk from MAD and other predictors of ventricular arrhythmia in MVP has not been well characterized. ObjectiveThis study aimed to identify predictors of complex or frequent ventricular ectopy (cfVE) in MVP and to quantify risk of cfVE and mortality in MVP with MAD. MethodsWe studied 632 adult patients with MVP on transthoracic echocardiography at the University of North Carolina Medical Center from 2016 to 2019 (median age, 64 [interquartile range, 52–74] years; 52.7% female; 16.3% African American). Resting and ambulatory electrocardiograms were used to identify cfVE. ResultsMAD was present in 94 (14.9%) patients. Independent associations of MAD were bileaflet prolapse (odds ratio [95% CI], 4.25 [2.47–7.33]; P < .0001), myxomatous valve (2.17 [1.27–3.71]; P = .005), absence of hypertension (2.00 [1.21–3.32]; P = .007), electrocardiogram inferior or lateral lead T-wave inversion (2.07 [1.23–3.48]; P = .006), and female sex (1.99 [1.21–3.25]; P = .006). cfVE was frequent with MAD (39 [41.5%] vs 93 [17.3%] without; P < .0001). Independent cfVE predictors were MAD (hazard ratio [95% CI], 2.23 [1.47–3.36]; P = .0001), bileaflet prolapse (1.86 [1.25–2.76]; P = .002), heart failure (1.79 [1.16–2.77]; P = .009), lower left ventricular ejection fraction (0.14 [0.03–0.61]; P = .009), coronary artery disease (1.60 [1.05–2.43]; P = .03), and inferior or lateral lead T-wave inversion (1.51 [1.03–2.22]; P = .03). After a median of 40 (33–48) months, there was increased mortality with MAD (P = .04). ConclusionMAD in MVP is associated with bileaflet or myxomatous MVP, absence of hypertension, T-wave inversion, and female sex. There is increased cfVE and mortality with MAD, highlighting the need for closer follow-up of these patients.

An Overview of Diabetic Cardiomyopathy.

Diabetic cardiomyopathy (DCM) is a myocardial disorder that is characterised by structural and functional abnormalities of the heart muscle in the absence of hypertension, valvular heart disease, congenital heart defects, or coronary artery disease (CAD). After witnessing a particular form of cardiomyopathy in diabetic individuals, Rubler et al. came up with the moniker diabetic cardiomyopathy in 1972. Four stages of DCM are documented, and the American College of Cardiology/American Heart Association Stage and New York Heart Association Class for HF have some overlap. Diabetes is linked to several distinct forms of heart failure. Around 40% of people with heart failure with preserved ejection fraction (HFpEF) have diabetes, which is thought to be closely associated with the pathophysiology of HFpEF. Diabetes and HF are uniquely associated in a bidirectional manner. When compared to the general population without diabetes, those with diabetes have a risk of heart failure that is up to four times higher. A biomarker is a trait that is reliably measured and assessed as a predictor of healthy biological activities, pathological processes, or pharmacologic responses to a clinical treatment. Several biomarker values have been discovered to be greater in patients with diabetes than in control subjects among those who have recently developed heart failure. Myocardial fibrosis and hypertrophy are the primary characteristics of DCM, and structural alterations in the diabetic myocardium are often examined by non-invasive, reliable, and reproducible procedures. An invasive method called endomyocardial biopsy (EMB) is most often used to diagnose many cardiac illnesses.

Predictors of aneurysm occlusion after treatment with flow diverters: a systematic literature review

BackgroundFlow diverters (FDs) have become an integral part of treatment for brain aneurysms.AimTo summarize available evidence of factors associated with aneurysm occlusion (AO) after treatment with a FD.MethodsReferences were identified...

Safety and clinical efficacy of immune checkpoint inhibitors in advanced gastric cancer in the real world.

To evaluate the clinical efficacy and safety of immune checkpoint inhibitors in patients with advanced gastric cancer in the real world. The retrospective analysis was conducted on the clinical records of 402 patients with advanced gastric cancer who were admitted to the Nanjing Drum Tower Hospital between December 2017 and April 2022 and who had received immunotherapy. Observation target: drug use, treatment, adverse reaction type and grade, objective response rate (ORR), disease control rate (DCR), progression free survival (PFS), and overall survival (OS). By retrospectively analyzing the data of patients with advanced gastric cancer treated with ICIs previously admitted to our medical center, we found some clinical characteristic factors associated with the occurrence of irAEs as well as the efficacy and prognosis: the presence or absence of hypertension, whether or not to receive targeted therapies can predict the occurrence of immune-related adverse events (irAEs), and the more the presence of irAEs, the better the prognosis. These can help clinicians in clinical drug selection. The results of this paper show that the occurrence of irAEs is associated with patients' OS. irAEs occurrence can prolong patients' OS. irAEs occurrence may serve as a surrogate marker for ICIs.

Hospital Readmissions for Fluid Overload among Individuals with Diabetes and Diabetic Kidney Disease: Risk Factors and Multivariable Prediction Models

Aims: Hospital readmissions due to recurrent fluid overload in diabetes and diabetic kidney disease can be avoided with evidence-based interventions. We aimed to identify at-risk patients who can benefit from these interventions by developing risk prediction models for readmissions for fluid overload in people living with diabetes and diabetic kidney disease. Methods: This was a single-center retrospective cohort study of 1,531 adults with diabetes and diabetic kidney disease hospitalized for fluid overload, congestive heart failure, pulmonary edema, and generalized edema between 2015 and 2017. The multivariable regression models for 30-day and 90-day readmission for fluid overload were compared with the LACE score for discrimination, calibration, sensitivity, specificity, and net reclassification index (NRI). Results: Readmissions for fluid overload within 30 days and 90 days occurred in 8.6% and 17.2% of patients with diabetes, and 8.2% and 18.3% of patients with diabetic kidney disease, respectively. After adjusting for demographics, comorbidities, clinical parameters, and medications, a history of alcoholism (HR 3.85, 95% CI: 1.41–10.55) and prior hospitalization for fluid overload (HR 2.50, 95% CI: 1.26–4.96) were independently associated with 30-day readmission in patients with diabetic kidney disease, as well as in individuals with diabetes. Additionally, current smoking, absence of hypertension, and high-dose intravenous furosemide were also associated with 30-day readmission in individuals with diabetes. Prior hospitalization for fluid overload (HR 2.43, 95% CI: 1.50–3.94), cardiovascular disease (HR 1.44, 95% CI: 1.03–2.02), eGFR ≤45 mL/min/1.73 m2 (HR 1.39, 95% CI: 1.003–1.93) was independently associated with 90-day readmissions in individuals with diabetic kidney disease. Additionally, thiazide prescription at discharge reduced 90-day readmission in diabetic kidney disease, while the need for high-dose intravenous furosemide predicted 90-day readmission in diabetes. The clinical and clinico-psychological models for 90-day readmission in individuals with diabetes and diabetic kidney disease had better discrimination and calibration than the LACE score. The NRI for the clinico-psychosocial models to predict 30- and 90-day readmissions in diabetes was 22.4% and 28.9%, respectively. The NRI for the clinico-psychosocial models to predict 30- and 90-day readmissions in diabetic kidney disease was 5.6% and 38.9%, respectively. Conclusion: The risk models can potentially be used to identify patients at risk of readmission for fluid overload for evidence-based interventions, such as patient education or transitional care programs to reduce preventable hospitalizations.

Factors Predictive of the Level Of Physical Activity (PA) in Patients with Gonarthrosis in Sub-Saharan Africa

Background: Our aim was to determine the predictive factors of the level of physical activity (PA) in patients with gonarthrosis in the city of Ouagadougou (Burkina Faso). Methods: This was a cross-sectional, descriptive and analytical study based on clinical records, conducted from January 9 to 27, 2023. Using the International Physical Activity Questionnaire (IPAQ), we assessed the level of PA in patients followed at CHU-Bogodogo for gonarthrosis. The significance threshold p&lt;0.05 was retained. Results: Sixty-seven patients were included. Fifty-six were women (83.58%). The mean age was 59.87± 12.53 years. Hypertension was noted in 34 patients (50.75%), diabetes in 16 (23.88%). The mean BMI was 28.70kg/m2± 6.73. Gonarthrosis was bilateral in 49 patients (73.13%). Gonarthrosis patients had a moderate level of PA, with a mean IPAQ score equal to 635.24±135 MET-minutes/week. 45 patients (67.16%) had a low level of physical activity (˂ 600 MET-minutes/week). In bivariate analysis, low PA was associated with age over 65 [OR=5.62, (CI=1.45-21.73), p&lt;0.001], hypertension [OR=2.83, (CI=1.27-6.31), p&lt;0.001], diabetes [OR=2.14, (CI=1.13-5.89), p&lt;0.031], and overweight [OR=2.43, (CI=1.17-6.12), p&lt;0.026]. Moderate PA was associated with age under 65 [OR=1.71, (CI=1.25-2.34), p&lt;0.005] and absence of hypertension [OR=1.86, (CI=1.19-2.89), p&lt;0.012]. Conclusion : Gonarthrosis patients have a moderate level of PA. Factors associated with low PA were advanced age and sedentary comorbidities. Key words: Gonarthrosis, physical activity, Ouagadougou/Burkina Faso

Coexistence of periodic limb movements during sleep with restless legs syndrome and its association with hypertension in Japanese patients

BackgroundCaucasian patients with restless legs syndrome (RLS) frequently exhibit periodic limb movements during sleep (PLMS), which may increase the risk of hypertension. We evaluated the positivity rate of PLMS and factors associated with positivity in Japanese patients with RLS, and tested whether the complications of PLMS are associated with the presence of hypertension. MethodsWe retrospectively investigated polysomnographic data and the presence or absence of hypertension in patients with RLS. Patients with systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg or those taking antihypertensive medication were categorized as the group with hypertension. ResultsAmong 468 patients, 200 (42.7%) had periodic limb movement index (PLMI) values ≥ 15/h and 108 (23.1%) met the criteria of positivity for hypertension. Multiple logistic regression analysis revealed that only higher age was significantly associated with PLMI values ≥ 15/h. Multiple linear regression analyses of factors associated with an increased PLMI also showed that increased PLMI was significantly correlated with higher age and male sex, but not with the international restless legs scale scores. Multiple logistic regression analysis also revealed that higher age and body mass index, not PLMI values ≥ 15/h, were significantly associated with the presence of hypertension. ConclusionThe PLMS-positivity rate may be lower in Japanese patients with RLS than in Caucasian patients, and it increases with age and male sex, but not with the severity of the disorder. Furthermore, PLMS complications were not associated with the risk of hypertension in Japanese patients with RLS.

Local and systemic factors associated with quantitative stiffness of carotid plaque.

Plaque stiffness in carotid artery stenosis is a clinically important factor involved in the development of stroke and surgical complications. The purpose of this study was to clarify which local and systemic factors are associated with the quantitatively measured stiffness of plaque. The subjects were 104 consecutive patients who underwent carotid endarterectomy at our institution. To measure quantitative stiffness of plaque, we used an industrial hard meter in the operating room within 1h after removal of plaque. Local factors related to carotid plaque hardness were evaluated, including maximum intima-media thickness (max IMT), degree of stenosis using the European Carotid Surgery Trial (ECST), presence of ulceration or calcification, and echo brightness on preoperative carotid ultrasound. The degree of stenosis was also evaluated using the North American Symptomatic Carotid Endarterectomy Trial method in digital subtraction angiography. Age, sex, and presence or absence of hypertension, diabetes, and dyslipidemia (low-density lipoprotein cholesterol and triglyceride [TG] levels) served as systemic factors and were compared with the quantitative stiffness of carotid plaque. In multivariate analysis, ECST stenosis degree, calcification, and IMT max as local factors affected plaque stiffness. As a systemic factor, plaque stiffness was statistically significantly negatively correlated with TG values in multivariate analysis (p < 0.05). The quantitative stiffness of the plaque was negatively correlated with TG levels as a systemic factor in addition to local factors. This might suggest that reducing high TG levels is associated with plaque stabilization.

Differences in the impact of newly diagnosed type 2 diabetes on cardiovascular mortality between normotensive and hypertensive individuals.

We investigated the interrelationship between hyperglycemia and hypertension on cardiovascular mortality in the middle-aged and elderly people. In this retrospective cohort study that used data from the Hiroshima Study on Glucose Metabolism and Cardiovascular Diseases, we included 16,564 participants without cardiovascular disease (mean age: 65.8 years; 6179 normoglycemic people, 3017 people with newly diagnosed type 2 diabetes, and 7368 people with prediabetes per the 75-g oral glucose tolerance test). Hypertension was defined as the use of antihypertensive medications and/or having a systolic/diastolic blood pressure of at least 140/90 mm Hg. During a median follow-up period of 12.4 years, a total of 1513 cardiovascular death occurred. Cardiovascular death rates per 1000 participant-years were 4.01, 4.98, 8.33, 8.22, 8.81, and 11.1 among normotensive participants with normal glycemia, prediabetes, and diabetes and hypertensive participants with normal glycemia, prediabetes, and diabetes, respectively. Prediabetes was significantly associated with a high risk of cardiovascular mortality in normotensive individuals [hazard ratio: 1.24, 95% confidence interval (95% CI): 1.02-1.50] but not in hypertensive individuals. Type 2 diabetes was associated with a high risk of cardiovascular mortality in both normotensive (hazard ratio: 1.94, 95% CI: 1.55-2.43) and hypertensive individuals (hazard ratio: 1.35, 95% CI: 1.13-1.62). Stratified analyses revealed no significant impact of type 2 diabetes on cardiovascular mortality in hypertensive individuals aged at least 65 years. The effect of hyperglycemia on cardiovascular death differed with age and the presence or absence of hypertension, demonstrating the clinical importance of case-specific risk assessments.

Risk Factors Analysis and Nomogram Model Establishment of Hidden Blood Loss in Overweight and Obese Elderly Patients After Total Hip Arthroplasty.

Total hip arthroplasty (THA) has become the first-choice treatment for elderly patients with end-stage hip disease. The high amount of hidden blood loss (HBL) in overweight and obese patients after THA not only affects rapid recovery, but also results in a greater economic burden. We aimed to identify risk factors that contribute to elevated HBL in overweight and obese patients after THA by retrospective analysis, and establish a nomogram prediction model for massive HBL in overweight and obese patients after THA. A total of 505 overweight and obese patients treated with THA were included and randomly divided into modeling and validation sets according to a 7:3 ratio. The demographic and relevant clinical data of the patients were collected. The independent risk factors affecting HBL after THA in overweight and obese patients were obtained by Pearson, independent sample T-test, and multiple linear regression analyses. R software was used to establish a nomogram prediction model for postoperative HBL, as well as a receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). HBL was 911±438 mL, accounting for 79.5±13.1% of the total perioperative blood loss (1104±468 mL). A multiple linear regression analysis showed that HBL was associated with necrosis of the femoral head, absence of hypertension, longer operative time, higher preoperative erythrocytes, and higher preoperative D-dimer levels. The areas under the ROC curve (AUC) for the modeling and validation sets were 0.751 and 0.736, respectively, while the slope of the calibration curve was close to 1. The DCA curve demonstrated a better net benefit at a risk of HBL ≥1000 ml in both the training and validation groups. HBL was an important component of total blood loss (TBL) after THA in overweight and obese patients. Necrosis of the femoral head, absence of hypertension, longer operative time, higher preoperative erythrocytes, and higher preoperative D-dimer levels were independent risk factors for postoperative HBL in these patients. The predictive model constructed based these data had better discriminatory power and accuracy, and could result in better net benefit for patients.

Correlation between obesity-related indices and hypertension.

To explore the correlation between obesity-related indices and hypertension, as well as their predictive ability for hypertension, to provide new insights for the prevention and treatment of the disease. This retrospective study included participants aged over 18 years from Chongqing General Hospital, spanning January 2023 to January 2024. Based on the presence or absence of hypertension, 160 participants were divided into two groups: an observation group (with hypertension, n=83) and a control group (without hypertension, n=77). Demographic and obesity-related indices were collected to assess their correlation with hypertension. The mean waist circumference (WC) was significantly higher in the observation group 82.46 (78.87-84.35) compared to the control group 82.64 (78.00-84.87), albeit with a typographical error in reporting (P=0.012). The mean A Body Shape Index (ABSI) was significantly higher in the observation group 0.778 (0.078-0.081) compared to the control group 0.076 (0.083-0.087) (P=0.004). The mean body roundness index (BRI) was also significantly higher in the observation group 3.38 (3.07-3.84) than in the control group 3.40 (2.98-3.87) (P=0.02). Logistic regression revealed ABSI (OR=1.15, 95% CI 1.06-1.28, P=0.014), BRI (OR=1.14, 95% CI 1.03-1.23, P=0.048), and WC/BRI (OR=1.13, 95% CI 1.04-1.34, P=0.031) as statistically significant risk factors. The area under the curve values for ABSI, BRI, WC/BRI, and their combination were 0.572, 0.629, 0.652, and 0.731, respectively. ABSI, BRI, and WC/BRI may serve as independent risk factors for hypertension. These indices, individually or combined, could aid in predicting the risk of hypertension.

Transition in metabolic health phenotypes across general adiposity categories and association with the risk of depression: a prospective analysis.

The association between obesity and depression may partly depend on the contextual metabolic health. The effect of change in metabolic health status over time on subsequent depression risk remains unclear. We aimed to assess the prospective association between metabolic health and its change over time and the risk of depression across body mass index (BMI) categories. Based on a nationally representative cohort, we included participants enrolled at the wave 2 (2004-2005) of the English Longitudinal Study of Ageing and with follow-up for depression at wave 8 (2016-2017). Participants were cross-classified by BMI categories and metabolic health (defined by the absence of hypertension, diabetes, and hypercholesterolemia) at baseline or its change over time (during waves 3-6). Logistic regression model was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the risk of depression at follow-up stratified by BMI category and metabolic health status with adjustment for potential confounders. The risk of depression was increased for participants with metabolically healthy obesity compared with healthy nonobese participants, and the risk was highest for those with metabolically unhealthy obesity (OR 1.62, 95% CI 1.18-2.20). Particularly hypertension and diabetes contribute most to the increased risk. The majority of metabolically healthy participants converted to unhealthy metabolic phenotype (50.1% of those with obesity over 8years), which was associated with an increased risk of depression. Participants who maintained metabolically healthy obesity were still at higher risk (1.99, 1.33-2.72), with the highest risk observed for those with stable unhealthy metabolic phenotypes. Obesity remains a risk factor for depression, independent of whether other metabolic risk factors are present or whether participants convert to unhealthy metabolic phenotypes over time. Long-term maintenance of metabolic health and healthy body weight may be beneficial for the population mental well-being.

Atypical eclampsia at primary health care in a remote area: A case report

BACKGROUND Eclampsia is a generalized tonic-clonic seizure induced by pregnancy. It contributes to a high rate of maternal and neonatal morbidity and mortality worldwide. Eclampsia is characterised by classic signs such as elevated blood pressure, proteinuria, and seizures. However, it may occur in the absence of hypertension and/or proteinuria. The uncommon appearance of eclampsia makes it difficult to immediately assess and treat it. In addition, the occurrence of this case in a remote area makes it more challenging to handle. The objective of this case report is to increase awareness of uncommon manifestations of eclampsia, particularly in limited-resource settings. CASE SUMMARY A young primigravida experienced a generalised seizure without hypertension and/or proteinuria. Sudden hearing loss, blurred vision, and vomiting were complained about before the seizure attack. The patient was diagnosed with eclampsia. A loading dose of magnesium sulphate was administered immediately. The patient was referred from community healthcare to a hospital and discharged without any complications. CONCLUSION Atypical eclampsia may be a diagnostic challenge. However, other symptoms may be beneficial, such as awareness of eclampsia signs.

Dietary Potassium Supplementation Reduces Chronic Kidney Lesions Independent of Blood Pressure in Deoxycorticosterone-Acetate and High Sodium Chloride-Treated Mice

We have previously shown that an excess of deoxycorticosterone acetate and high sodium chloride intake (DOCA/salt) in one-renin gene mice induces a high urinary Na/K ratio, hypokalemia, and cardiac and renal hypertrophy in the absence of hypertension. Dietary potassium supplementation prevents DOCA/salt-induced pathological processes. In the present study, we further study whether DOCA/salt-treated mice progressively develop chronic inflammation and fibrosis in the kidney and whether dietary potassium supplementation can reduce the DOCA/salt-induced renal pathological process. Results showed that (1) long-term DOCA/salt-treated one-renin gene mice developed severe kidney injuries including tubular/vascular hypertrophy, mesangial/interstitial/perivascular fibrosis, inflammation (lymphocyte’s immigration), proteinuria, and high serum creatinine in the absence of hypertension; (2) there were over-expressed mRNAs of plasminogen activator inhibitor-1 (PAI-1), fibronectin, collagen type I and III, interferon-inducible protein-10 (IP-10), monocyte chemotactic protein-1 (MCP1), transforming growth factor-β (TGF-β), tumor necrosis factor-alpha (TNF-α), osteopontin, Nuclear factor kappa B (NF-κB)/P65, and intercellular adhesion molecule (ICAM)-1; and (3) dietary potassium supplementation normalized urinary Na/K ratio, hypokalemia, proteinuria, and serum creatinine, reduced renal hypertrophy, inflammations, and fibrosis, and down-regulated mRNA expression of fibronectin, Col-I and III, TGF-β, TNF-α, osteopontin, and ICAM without changes in the blood pressure. The results provide new evidence that potassium and sodium may modulate proinflammatory and fibrotic genes, leading to chronic renal lesions independent of blood pressure.

Long-term functional outcome and quality of life 2.5 years after thrombolysis in acute ischemic stroke

BackgroundEvaluation of outcome after stroke is largely based on assessment of gross function 3 months after stroke onset using scales such as mRS. Cognitive or social functions, level of symptom burden or emotional health are not usually assessed, nor are data available on long-term functional outcomes years after stroke.MethodsAnalysis of 1141 patients with AIS treated with IVT from two major German university hospitals between 2017 and 2020. Patient characteristics and short-term outcome were analysed from patient records. Long-term outcome of 228 patients with prior written informed consent was assessed via telephone survey using mRS and PROMs (EQ-5D-5L, EQ-VAS) 2.5 years after stroke.ResultsPredictors of excellent to good long-term outcome were younger age, event to door time ≤ 2 h, NIHSS ≤ 6 on admission and NIHSS ≤ 6 after IVT. Stroke recurrence was a negative predictor. Predictors of excellent quality of life at 2.5 years included age < 73 years, lower NIHSS after IVT, absence of hypertension. Quality of life was rated in all dimensions with a medium score of 1 and a medium EQ-VAS of 70, representing the good general health status of this stroke population.ConclusionMain predictors of an excellent to good long-term outcome and excellent QoL 2.5 years after stroke are younger age, lower NIHSS, and event to door time ≤ 2 h. Research on long-term outcome after disease and treatment is of utmost importance, as it has the ability to reveal the patient true functional outcome and quality of life and to provide information on the status of independence and self-esteem.

Abstract 14027: The Use of Anthropometric Indices as Indicators of Hypertension in Patients With Diabetes Types 2: A Large-Scale Cross-Sectional Study

Introduction: Obesity is associated with hypertension and diabetes mellitus (DM), increasing cardiovascular disease risk and mortality. While body mass index (BMI) is widely used to measure obesity, it has several limitations. Therefore, alternative anthropometric indices such as waist circumference (WC), waist-to-height ratio (WHtR), body roundness index (BRI), and a body shape index (ABSI) have been suggested. Hypothesis: This study aims to identify the most effective anthropometric index for predicting hypertension in patients with type 2 DM. Methods: In this cross-sectional study, patients with type 2 DM were included and classified into two groups based on the presence or absence of hypertension. Demographic and clinical data were collected and anthropometric measurements were taken. Multivariate logistic regression analysis was used to identify factors associated with hypertension. Receiver operating characteristic (ROC) curves were performed to determine the diagnostic performance of various anthropometric indices, with a subgroup analysis based on the status of patients DM. Results: The study population included 977 male and 1454 female patients with DM, among whom 50.3% and 67.1% had hypertension. Both male and female patients with hypertension were older, had a longer duration of DM, and had higher anthropometric measurements, blood pressure, and lipid profiles. ROC curve analysis revealed that although all indices could significantly predict hypertension (0.55-0.76 in men and 0.68-74 in women), WHtR and BRI had the highest ability to identify patients with hypertension in men irrespective of DM status being controlled or not. (WHtR: 0.76, 95% confidence interval (CI): 0.73-0.79, BRI: 0.76, 95% CI: 0.73-0.79). WC had the highest diagnostic performance in all female patients and female patients with uncontrolled DM (0.75, 95% CI: 0.72-0.75 and 0.75, 95% CI: 0.72-78, respectively). All indices remained significant in the logistic regression after adjusting for potential confounders. Conclusions: While WHtR and BRI were better predictors of hypertension in men with DM, WC had a better diagnostic performance in women with DM.

Abstract 11310: T Helper 1 Lymphocytes Promote Diastolic Dysfunction and Fibrosis in a Non-Hypertensive Angiotensin II Mouse Model of Heart Failure

Introduction: Angiotensin (Ang) II induces cardiac fibrosis and diastolic dysfunction, also in absence of hypertension (HTN). We found that a non-HTN AngII infusion fails to induce dysfunction and fibrosis in T cell receptor α deficient mice ( Tcrα -/- , bereft of T cells). Hypothesis: Since T helper 1 (Th1) lymphocytes promote adverse remodeling in models of heart failure (HF), we hypothesized that Th1 cells are sufficient to induce diastolic dysfunction and fibrosis in a non-HTN AngII model. Methods: Naïve CD4+ cells were isolated from wild type (WT) mice lymph nodes (LNs) and spleens (MACS columns) and differentiated into Th1 cells over 7 days using plates coated with anti-CD3 antibody (5 μg/ml) plus IL-12 (10 ng/ml) and anti-IL-4 (1 μg/ml) and from day 4, IL-2 (20 ng/ml). Adoptive transfer (AT) of 10 7 Th1 cells/500 μl PBS, naïve CD4+ cells, or PBS alone was performed into Tcrα -/- mice (3-11 months old, N=8-16/group) implanted with AngII (0.2 μg/kg/day) osmotic pumps for 4 wks. AT was repeated two weeks later. LV dimensions, ejection fraction (EF), and diastolic function (isovolumetric relaxation time - IRT) were measured with Doppler echocardiography. LV end-diastolic pressure (EDP) and peak systolic pressure (PSP) were measured with a Millar catheter. Heart slides were stained with picrosirius red to measure interstitial fibrosis. Results: All groups had similar LV dimensions, EF, and PSP (not shown). AT of naïve CD4+ cells or PBS did not increase the IRT vs baseline (7.3±0.9 vs 7.6±0.6 and 9.9±0.7 vs 8.8±0.7 ms). AT of Th1 cells significantly increased the IRT (15.6±0.9 vs 9.0±0.7 ms, all p&lt;0.0001). EDP was significantly higher in Th1 mice (11.5±0.8 mmHg) vs naïve CD4+ mice (4.6±0.8 mmHg) or PBS (5.2±0.6 mmHg) (all p&lt;0.0001). Interstitial fibrosis in Th1 mice (1.4±0.2%) was significantly higher than in naïve CD4+ mice (0.7±0.1%) or PBS (0.8±0.1%) (all p&lt;0.001). Conclusions: Th1 cells are sufficient to induce diastolic dysfunction and fibrosis in a non-HTN AngII HF mouse model.

78 The Effects of Hypertension and Obstructive Sleep Apnea on Auditory Learning and Memory in Veterans with PTSD Symptomology

Objective:Obstructive sleep apnea (OSA) has been associated with cognitive deficits as evidenced by neuropsychological testing in the domains of attention/working memory, verbal memory, processing speed, and executive function. OSA is often comorbid with hypertension and has been considered a risk factor for hypertension (Kareem et al., 2018; Tietjens et al., 2019). Both hypertension and OSA have been shown to be independent predictors of memory (Kinoshita et al., 2012). OSA and posttraumatic stress disorder (PTSD) are also frequently co-occurring, especially among veterans. In a group of veterans with a history of PTSD, we seek to explore the effects of sleep apnea and hypertension on cognitive functioning, particularly auditory learning/memory.Participants and Methods:One hundred and three male and female participants with comorbid OSA and PTSD symptomology were screened as part of a larger VA Palo Alto Health Care System study. Participants (age: x=56.3, a=13.8, 24-81 years; education: x=14.6, a=2.3, 8-20 years; 9.6% female, 89.6% male) completed a neuropsychological battery, including the CVLT-II and WMS-IV Logical Memory. Presence or absence of hypertension was dichotomously coded and AHI severity was categorically coded. An auditory learning/memory composite variable was created using the z-score transformation method (Dodge et al., 2020). Variables and covariates were entered into a hierarchical regression.Results:The initial regression model revealed hypertension and OSA severity to be independent predictors of performance on auditory learning/memory (hypertension: ß= -0.71, p&lt;0.01; OSA: ß= -0.42, p&lt;0.01), where presence of hypertension or increased severity of OSA resulted in worse performance on the auditory learning/memory composite.Conclusions:Results suggest that hypertension and OSA may independently and negatively affect performance on measures of auditory learning/memory in veterans with PTSD symptomology and OSA. Such findings underscore the importance of assessing and treating both hypertension and OSA among veterans with PTSD to improve not only physical health, but also cognitive health. Further research demonstrating similar findings is recommended along with studies investigating whether or not the treatment of hypertension and OSA can improve auditory learning/memory.

FACTORS IMPACTING MYOCARDIAL INFARCTION IN YOUNG POPULATION; AN INSTITUTION BASED EXPERIENCE

ABSTRACT&#x0D; Objective: To determine the frequency of contributing factors in Myocardial Infarction in young population&#x0D; Study design: Descriptive, Cross-sectional study&#x0D; Study was conducted over a period of six months in Medical Unit-II of Services Hospital, Lahore.&#x0D; Materials &amp; Methods: A total population of 149 young patients irrespective of their gender with age range from 15 to 45 years and suffering from myocardial infarction were included in this study. Relevant information comprising of presence or absence of Hypertension, Diabetes, Smoking, Dyslipidemia, Obesity, Hyperuricemia, and Family history of these selected cases were recorded in the data collection proforma and patients’ confidentiality was ensured.&#x0D; Results: Out of 149 patients, 101 (67.79%) were males and 48 (32.21%) were females with male to female ratio of 2.1:1. Age range in this study was from 15 to 45 years with mean age of 34.68 ± 6.93 years. Majority of the patients; 80 (53.69%) were between 30 to 45 years of age. Hypertension was reported in 57 (38.26%), Diabetes Mellitus in 28 (18.79%), smoking in 61 (40.94%), dyslipidemia in 80 (53.69%), obesity in 20 (13.42%), hyperuricemia in 21 (14.09%) and positive family history was seen in 30 (20.13%) patients.&#x0D; Conclusion: This study concluded that Hypertension, Diabetes, Smoking and Dyslipidemia constitute the common and most important contributing factors of Myocardial Infarction(MI) in young patients aged between 15 to 45 years.&#x0D; Keywords: Myocardial Infarction, young patients, factors.

Non-adherence to non-insulin glucose-lowering drugs: Prevalence, predictors and impact on glycemic control and insulin initiation. A longitudinal cohort study in a large primary care database in Spain

BackgroundA better understanding of patient non-adherence to type 2 diabetes medication is needed to design effective interventions to address this issue.Objectives(1) To estimate the prevalence of non-adherence to diabetes medication; (2) to examine its impact on glycemic control and insulin initiation; (3) to develop and validate a prediction model of non-adherence.MethodsWe conducted a longitudinal cohort study based on data from electronic health records. We included adult patients registered within the Health Service of the Balearic Islands (Spain) starting a new prescription of a non-insulin glucose-lowering drug between January 2016 and December 2018. We calculated non-adherence at 12 months follow-up, defined as medication possession ratio (MPR) ≤ 80%. We fitted multivariable regression models to examine the association between non-adherence and glycemic control and insulin initiation and identified predictors of non-adherence.ResultsOf 18,119 patients identified, after 12 months follow-up, 5,740 (31.68%) were non-adherent. Compared with non-adherent, adherent patients presented lower HbA1c levels (mean difference = −0.32%; 95%CI = −0.38%; −0.27%) and were less likely to initiate insulin (aOR = 0.77; 95%CI = 0.63; 0.94). A predictive model explained 22.3% of the variation and presented a satisfactory performance (AUC = 0.721; Brier score = 0.177). The most important predictors of non-adherence were: non-Spanish nationality, currently working, low adherence to previous drugs, taking biguanides, smoker and absence of hypertension.ConclusionAround one-third of the patients do not adhere to their non-insulin glucose-lowering drugs. More research is needed to optimise the performance of the predicting model before considering its implementation in routine clinical practice.