Blood Pressure Burden Research Articles

Abstract P374: Systolic blood pressure burden better predicts tau accumulation than a one-time measurement

In our past work, our group identified a significant relationship between uncontrolled hypertension and greater accumulations of total-tau and phospho-tau181 in cerebrospinal fluid over time. Here, we tested whether blood pressure is related to brain tau deposition assessed using MK-6240 PET. Blood pressure is dynamic in nature, making it difficult to draw conclusions about their risk from a single measurement. To address this issue, different measurement methods have surfaced to better utilize blood pressure as a predictor of disease pathology. Previous studies have found cumulative diastolic blood pressure to increase cardiovascular disease stratification beyond that of a single diastolic blood pressure measurement. In this project, we studied another method of quantifying blood pressure. We examined whether systolic blood pressure (SBP) burden was better related to tau accumulation than a one-time BP measurement taken at the time of PET scan. SBP load was defined as the percentage of SBP values >=140 mmHg taken in the period spanning from 6 months before tau imaging to 6 months after. SUVR (standardized uptake value ratio) was created using the cerebellar gray matter as the reference region. We assessed SUVR in Braak regions 1-6. Pearson correlation was used to test the associations between the variables of interest. We studied cognitively healthy subjects from a brain aging research center (n=72, 40% women, 60% with hypertension). Medians of our group were 72 years of age (interquartile range (IQR) 10.6), education of 18 years (IQR 2), and 8 BP measurements (IQR 14). While one-time SBP measurements and tau were not related, SBP load was progressively correlated with SUVR across Braak stages. In the entire group, the correlations ranged from -0.18 (p = 0.133) in Braak region 1 to 0.19 (p = 0.114) in Braak region 3 to 0.24 (p = 0.042) in Braak region 6. In the hypertensive group, these correlations were stronger and ranged from -0.06 (p = 0.713) in Braak region 1 to 0.38 (p = 0.012) in Braak region 3 to 0.50 (p < 0.001) in Braak region 6. We show that SBP load instead of singular SBP measurements is a stronger predictor of tau accumulation. Furthermore, stronger associations with brain regions known to be affected in more advanced stages suggest that blood pressure control is more critical to tau progression than initial deposition.

P070 ROLE OF NOVEL BLOOD PRESSURE METRICS IN EARLY BLOOD PRESSURE CONTROL ASSESSMENT: INSIGHTS FROM THE SPRINT TRIAL

Objective: Innovative blood pressure (BP) metrics is pivotal to expedite the BP management among individuals with hypertension. Methods and Findings: This is a post-hoc analysis of the SPRINT (Systolic Blood Pressure Intervention Trial). A total of 8369 participants, who had comprehensive BP records and experienced no adverse events during the initial 90-day follow-up, were included. Two novel BP metrics, systolic blood pressure (SBP) burden and Time-in-Target-Range (TTR), were calculated by employing three-month SBP recordings from follow-up data. SBP Burden were derived as the proportion of area under curve (AUC) over a specific SBP threshold (SBP values >130 mmHg) in a short-term exposure period (from the first month to third month). SBP TTR was estimated by the proportion of time in a specified SBP target range (110 to 140mmHg) in the same exposure period. Major adverse cardiovascular events (MACE), as the primary outcome of this analysis, was a composite endpoint including myocardial infarction, stroke, heart failure, and cardiovascular death. Secondary outcomes included individual components of the primary outcome, as well as all-cause mortality. The relationship of novel BP metrics and study endpoints was accessed by using adjusted Cox proportional hazards regression models. Over a median follow-up period of 3.90 [3.88-3.94] years, 559 MACEs occurred. Both SBP burden (Hazard Ratio [HR]: 1.126 [1.039-1.221]) and SBP TTR (HR: 0.862[0.783-0.949]) were independently correlated with MACEs according to adjusted Cox models. Evaluation using C-statistic and Net Reclassification Indexes (NRI) revealed that both two novel SBP metrics outperformed mean SBP and SBP standard deviation (SD) in predicting MACEs. Furthermore, the predictive value of SBP burden and TTR was consistent across MACE(P=0.383) and secondary endpoints (all P value > 0.05) in this analysis. Conclusions: Among non-diabetic patients with hypertension, both the cumulative SBP burden and TTR independently predict MACEs, surpassing the predictive power of mean SBP and SBP SD. This study substantiates the application of innovative BP measurements for early-stage assessment of BP control.

High Blood Pressure and Its Associated Factors Among Aksum University Students, Northern Ethiopia, 2019: A Cross-Sectional Study.

This study aimed to assess the burden of high blood pressure and its associated factors among students at Aksum University. A total of 240 participants were included; participants were selected through simple random sampling from May 2019 to July 2019. Logistic regression analysis was performed, with statistical significance set at a p-value <0.05 and a 95% confidence level. This study found that 17.9% of the participants had high blood pressure, with higher rates observed in males (62.79%) than in females (37.21%). Several factors were identified as associated with high blood pressure, including a family history of high blood pressure [AOR 1.72, 95% CI (1. 75-4.04)], regular physical exercise [AOR 0.64, 95% CI (0.30-0.94)], alcohol consumption [AOR 2.16, 95% CI (1.07-4.62)], tobacco smoking [AOR 5.46, 95% CI (1.98-15.07)], and central obesity [AOR 2.72, 95% CI (1.12-6.58)]. This study reveals that one out of six students had high blood pressure. Factors such as a family history of high blood pressure, physical inactivity, tobacco smoking, and central obesity were associated with this condition.

Deviation From Personalized Blood Pressure Targets Correlates With Worse Outcome After Successful Recanalization.

Personalized blood pressure (BP) management for patients with acute ischemic stroke after successful endovascular thrombectomy lacks evidence. We aimed to investigate whether the deviation of BP from cerebral autoregulation limits is associated with worse outcomes. We determined autoregulation by measuring mean velocity index and calculated the percentage of time and the burden (defined as the time-BP area) with BP outside the autoregulatory limits of each subject within 48 hours after endovascular thrombectomy. In total, 91 patients with large vessel occlusion stroke who had achieved successful recanalization were prospectively enrolled between May 2020 and February 2022. The burden with BP outside the autoregulatory limits was associated with poor outcome (modified Rankin Scale score 3-6) at 90 days (adjusted odds ratio, 1.28 [95% CI, 1.03-1.59]). The percentage of time with BP out of the autoregulatory limits was correlated with early neurological deterioration (National Institute of Health Stroke Scale scores increased ≥2 at 7 days) (adjusted odds ratio, 1.38 [95% CI, 1.04-1.83]). The burden of BP that decreased below the autoregulatory lower limit was associated with significant infarct growth (volume of infarct growth >11.6 mL) at 7 days (adjusted odds ratio, 1.21 [95% CI, 1.01-1.44]). The percentage of time that BP exceeded the autoregulatory upper limit was associated with symptomatic intracranial hemorrhage within 48 hours (adjusted odds ratio, 1.55 [95% CI, 1.02-2.34]). Both the percentage of time and the burden of BP that deviates from the autoregulation-preserved range are associated with unfavorable clinical outcomes. This study highlights the potential benefits of autoregulation-guided BP management strategy after successful recanalization.

Incidence of hypertension and its risk factors: a systematic review

Hypertension is a persistent, metabolic condition indicated by elevated blood pressure levels. Since hypertension comes with no warning signs, mostly people are not aware of it. The aim of the study was to assess the change in the prevalence of hypertension among adults of Punjab and Haryana and to investigate its risk factors. Medline, Web of Science and Scopus databases from 2009 to 2023 were searched for ‘prevalence, burden, awareness, and control of blood pressure (BP) or hypertension (≥140 SBP and or ≥90 DBP) among Indian adults’ (≥18 years). The incidence of hypertension varied from 32.4 to 88.2 percent in male subjects and 30 to 84.7 percent in female subjects. Hypertension was more prevalent among males of Punjab and Haryana. Whereas females were more hypertensive in different districts of Haryana. The considerable upward trend has been observed over the time, among males and females in both Punjab and Haryana, yet awareness and control rates are comparatively low. Various researchers have discovered that younger the age of beginning of hypertension, the higher the decline in life expectancy if raised blood pressure is not managed.

Abstract TP41: Racial Differences in Cumulative Blood Pressure Exposure and Hippocampal Subvolumes

Introduction: We previously showed that a higher cumulative systolic blood pressure (cSBP) burden from young adulthood to midlife was associated with lower hippocampal volumes in Black but not White individuals independent of other vascular risk factors (VRF). And this difference was particularly evident in those with highest cSBP. In this study, we further explored these relationships by examining the impact of cSBP exposure on different hippocampal subvolumes. Methods: Thirty-four participants (18 black, 16 white) in the highest quartile of cSBP and longitudinal VRF exposure over 30 years with available brain MRI at the year 30 visit of the Coronary Artery Risk Development in Young Adults (CARDIA) cohort were used for this analysis. We measured the hippocampal subvolumes (CA1, CA2/3, and CA4) standardized as a percentage of total intracranial volume. T1 MRI images were processed using FreeSurfer (7.3.2) recon-all and the hippocampal sub-regions were segmented based on the computational atlas available in FreeSurfer. Results: Among the three regions, cSBP was only associated with CA1 subvolume in Black but not White participants. Racial differences were most evident in the CA1 hippocampal subvolume (p=0.099) and this difference remained even when other VRF were accounted for. Conclusion: Blacks with higher cSBP exposure over young adulthood to midlife, have smaller hippocampal CA1 subvolumes, which parallels the disparities in cSBP we previously reported. Our findings further highlight the anatomic vulnerability of the CA1 region to cSBP exposure and underscore the importance of early blood pressure control, particularly in minority populations where early screening for VRF may be limited.

Time-weighted blood pressure with cardiovascular risk among patients with or without diabetes.

Usual measures of blood pressure (BP) do not account for both the magnitude and duration of exposure to elevated BP over time. We aimed to demonstrate the effect of a novel time-weighted BP on cardiovascular outcomes using a post hoc analysis of two published randomized trials. Time-weighted blood pressure is associated with cardiovascular risk among patients with or without diabetes. The limited-access ACCORD and SPRINT data sets were used for the current study. Time-weighted BP is obtained by dividing cumulative BP by the total follow-up time. Time-weighted BP burden above a threshold is also determined after deriving the time-weighted BP by re-zeroing the interpolated pressure values at two different hypertension thresholds (>140/90 and >130/80 mmHg). Eighteen thousand five hundred forty-one patients from the two clinical trials were enrolled in this study. A J-curve relation was observed between time-weighted BP and major cardiovascular events (MACE). The systolic blood pressure(SBP) burden independently predicted MACE across the two trials at different thresholds (ACCORD: SBP > 130 mmHg, HR = 1.05 [1.03-1.06]; SBP > 140 mmHg, HR = 1.06 [1.04-1.08]; SPRINT: SBP > 130 mmHg, HR = 1.04 [1.03-1.05]; SBP > 140 mmHg, HR = 1.05 [1.04-1.07]). Consistent results were found for diastolic blood pressure (DBP) burden (ACCORD: DBP > 80 mmHg, HR = 1.10 [1.06-1.15]; DBP > 90 mmHg, HR = 1.20 [1.11-1.30]. DBP > 80 mmHg, HR = 1.06 [1.02-1.09]; DBP > 90 mmHg, HR = 1.12 [1.06-1.18]). Significant associations were also observed for stroke, myocardial infarction, cardiovascular death, and all-cause mortality. Both time-weighted SBP and DBP independently influenced the risk of adverse cardiovascular events among patients with and without diabetes, regardless of the definition of hypertension (130/80 or <140/90 mmHg).

Adherence Monitoring Package (AMoPac) in patients suspected of non-response to antihypertensive treatment: perceived usefulness by general practitioners

BackgroundNon-adherence to antihypertensive agents is common, mainly because of the low perceived burden of high blood pressure. General practitioners (GPs) are unable to predict whether patients are adhering to a...

Cumulative Diastolic Blood Pressure Burden in Normal Systolic Blood Pressure and Cardiovascular Disease.

The clinical significance of isolated diastolic hypertension defined by the 2017 American College of Cardiology/American Heart Association blood pressure (BP) guidelines remains inconsistent. We examined whether long-term diastolic burden predicts the first major adverse cardiovascular event in participants with sustained and untreated normal systolic BP. The Mass General Brigham Biobank is a New England health care-based cohort recruited between 2010 and 2021. A total of 15 979 participants aged 18 to 64 years and without prior cardiovascular disease, antihypertensives, or high systolic BP were studied. The cumulative diastolic burden was determined as the area under the curve for diastolic BP (DBP) ≥80 mm Hg over 5 years before enrollment. Major adverse cardiovascular event was defined as a composite of first incident ischemic heart disease, stroke, heart failure, or all-cause death. Of the 15 979 participants, mean (SD) age at enrollment was 47.6 (14.3) years, 11 950 (74.8%) were women, and the mean (SD) systolic BP and DBP were 118.0 (12.9) and 72.2 (9.3) mm Hg, respectively. Over a median (interquartile range) follow-up of 3.5 (1.8-5.4) years, 2467 (15.4%) major adverse cardiovascular events occurred. Using Cox proportional hazards regression, each SD increase in cumulative DBP was independently associated with a hazard ratio (95% CI) of 1.06 (1.02-1.10) without effect modification by sex (P=0.65), age (P=0.46), or race/ethnicity (P=0.24). In addition to traditional risk factors, cumulative DBP modestly improved the discrimination C index (95% CI) from 0.74 (0.72-0.75) to 0.75 (0.74-0.76; likelihood ratio test, P=0.037). Among individuals with normal systolic BP, cumulative DBP may augment cardiovascular disease risk stratification beyond a single DBP measure and traditional risk factors.

Male patients with first diagnosed and never treated essential hypertension accompanied by organ damage are at high risk for non-alcoholic fatty liver disease indicated by Hepatic steatosis index

Abstract Background Non-alcoholic fatty liver disease (NAFLD) is closely related to the metabolic syndrome as well as to arterial hypertension and overall cardiovascular (CV) disease. We aimed to investigate if those first diagnosed and never treated patients with essential hypertension at high risk for NAFLD, measured by the Hepatic Steatosis Index (HSI), already have an impaired CV risk profile estimated by increased blood pressure burden and accompanied by the presence of hypertension-mediated organ damage (HMOD). Methods We studied 300 non-diabetic, first diagnosed and never-treated young hypertensive patients [mean age=51+11 years, 60% males, 32% smokers]. Ambulatory blood pressure monitoring (24h ABPM), CV risk factors [smoking, obesity (BMI), hyperlipidemia and HMOD [aortic stiffness (PWV), left ventricular diastolic dysfunction (EEa), cardiac hypertrophy (LVMI), coronary arteries microcirculation (CFR), carotid intima-media thickness (cIMT) and endothelial dysfunction (PBR5-25)] were estimated in each patient before treatment initiation. HIS was calculated as 8 times (ALT/AST ratio) +BMI (+2, if female; +2, if diabetes mellitus). Increased HIS levels predispose for augmented risk for NAFLD. Results The whole hypertensive population was divided regarding HSI median value=39.5 in two groups, Group A (higher risk for NAFLD group, n=150, age=50+10, 59% males, 33% smokers) and Group B (lower risk for NAFLD group, n=150, age=51+11, 60% males, 31% smokers). Group A patients had increased BMI (32+5 vs. 27+3, p&amp;lt;0.001), systolic night-time ABPM (127+15 vs. 124+11, p=0.05), office systolic (152+19 vs. 145+17 mmHg, p=0.004) and diastolic BP (94+11 vs. 90+11 mmHg, p=0.002), central systolic BP (146+20 vs. 137+15, p=0.006), Chol (216+39 vs. 206+35, p=0.02), LDL (138+35 vs.130=33 mg/dl, p=0.04) and Trigl (139+75 vs. 112+63, p=0.001), E/Ea (7+2 vs. 6+2, p=0.01) and LVMI (83+18 vs. 79+17, p=0.03) compared to Group B. All other studied demographic, laboratory, ABPM and HMOD parameters (PWV, MAU, CFR and cIMT) were similar between groups. HSI was related to BMI (p&amp;lt;0.001) and office BP, both systolic (p=0.001) and diastolic (p=0.008) in total population as well as to LVMI (r=0.17, p=0.02) in males. Finally, in multiple regression analysis, we found that HSI was independently associated with LVMI (beta=0.14, p=0.05) only in male hypertensives. Conclusions Patients first diagnosed arterial hypertension and augmented CV risk (smoking, obesity, hyperlipidemia, BP burden and HMOD) are also at high risk for NAFLD. As successful antihypertensive treatment may lead to HMOD regression, probably there is still time for those patients to be treated for hypertension disease and hyperlipidemia and quit smoking, in order to reduce future CV risk.LVMI and HSI in male hypertensives

Cumulative burden and trajectories of body mass index and blood pressure from childhood and carotid intima-media thickness in young adulthood

There are significant gaps in understanding of the association between levels and rate of change of body mass index (BMI) and blood pressure (BP) at different ages during childhood and carotid intima-media thickness (CIMT) in adulthood. We investigated the association between trajectories of BMI and BP from childhood to adulthood and adult CIMT among Iranian participants in the Tehran Lipid and Glucose Study (TLGS) cohort. A total of 1334 participants (692 men), from the TLGS cohort (1999–2018) with repeated measurements of BMI and BP (2–6 times) from childhood (3–18 years) to young adulthood (20–40 years) were selected. Trajectory parameters included levels and linear slopes of BMI and BP growth curve models, and cumulative burden defined as the area under those curves (AUC). After adjusting for confounders, AUC of BMI and diastolic blood pressure (DBP) were significantly associated with high CIMT in adulthood, with the standardized odds ratios (OR) and 95% confidence interval (95% CI) of 1.35 (1.12–1.62) and 1.27 (1.01–1.60), respectively. Associations between level-independent slopes of BMI and adult CIMT were significantly positive (ORs: 1.27 to 1.26) during childhood ages (3–18 years). Further, levels of BMI (ORs: 1.23 to 1.29) and DBP (ORs: 1.25 to 1.33) during the ages of 13–18 and 11–17 years, respectively, were significantly associated with CIMT in adulthood (all P < 0.05). The cumulative burden of BMI and DBP was associated with CIMT in adulthood. Adolescence is a crucial period for high CIMT, which has implications for early prevention of atherosclerosis.

Burden of Hypertensive Heart Disease and High Systolic Blood Pressure in Australia from 1990 to 2019: Results From the Global Burden of Diseases Study.

There is a dearth of comprehensive studies examining the burden and trends of hypertensive heart disease (HHD) and high systolic blood pressure (SBP) among the Australian population. We aimed to explore the burden of HHD and high SBP, and how they changed over time from 1990 to2019 in Australia. We analysed data from the Global Burden of Disease study in Australia. We assessed the prevalence, mortality, disability-adjusted life-years (DALY), years lived with disability (YLD) and years of life lost(YLL) attributable to HHD and high SBP. Data were presented as point estimates with 95% uncertainty intervals (UI). We compared the burden of HHD and high SBP in Australia with World Bank defined high-income countries and six other comparator countries with similar sociodemographic characteristics and economies. From 1990 to 2019, the burden of HHD and high SBP in Australia reduced. Age standardised prevalence rate of HHD was 119.3 cases per 100,000 people (95% UI 86.6-161.0) in 1990, compared to 80.1 cases (95% UI 57.4-108.1) in 2019. Deaths due to HDD were 3.4 cases per 100,000 population (95% UI 2.6-3.8) in 1990, compared to 2.5 (95% UI 1.9-3.0) in 2019. HHD contributed to 57.2 (95% UI 46.6-64.7) DALYs per 100,000 population in 1990 compared to 38.4 (95% UI 32.0-45.2) in 2019. Death rates per 100,000 population attributable to high SBP declined significantly over time for both sexes from 1990 (155.6 cases; 95% UI 131.2-177.0) to approximately one third in 2019 (53.8 cases; 95% UI 43.4-64.4). Compared to six other countries in 2019, the prevalence of HHD was highest in the USA (274.3%) and lowest in the UK (52.6%), with Australia displaying the third highest prevalence. Australia ranked second in term of lowest rates of deaths and third for lowest DALYs respectively due to high SBP. From 1990-2019, Australia ranked third best for reductions in deaths and DALYs due to HHD and first for reductions in deaths and DALYs due to high SBP. Over the past three decades, the burden of HHD in Australia has reduced, but its prevalence remains relatively high. The contribution of high SBP to deaths, DALYs and YLLs also reduced over the three decades.

Hypertension prevalence, coding and control in an urban primary care setting in the UK between 2014 and 2021.

Hypertension is a leading preventable cause of mortality, yet high rates of undiagnosed and uncontrolled hypertension continue. The burden falls most heavily on some ethnic minorities and the socially deprived, with the COVID-19 pandemic having further widened inequalities. We sought to determine the prevalence and predictors of unmeasured blood pressure (BP), uncoded elevated BP and uncontrolled hypertension in primary care across 2014-2021. A population-based cohort study using data from all 41 general practices in a socioeconomically diverse inner-city borough. BP measurements, sociodemographic, lifestyle and clinical factors were extracted from anonymized primary care data. Hypertension and BP control were defined using NICE guidelines. Associations between patient characteristics and hypertension outcomes were identified using logistical regression modelling. Of 549 082 patients, 39.5% had unmeasured BP; predictors included male sex [AOR 2.40, 95% confidence interval (95% CI) 2.26-2.43] and registration in the pandemic years. Of 71 970 adults with elevated BP, 36.0% were uncoded; predictors included obesity (AOR 2.51, 95% CI 2.42-2.60) and increasing age. Of 44 648 adults on the hypertension register, 46.8% had uncontrolled hypertension; predictors included black ethnicity compared to white (AOR 1.54, 95% CI 1.41-1.68) and cardiovascular co-morbidities (AOR 1.23, 95% CI 1.21-1.25). Social deprivation was only weakly or not significantly associated with hypertension outcomes. The burden of uncoded elevated BP and uncontrolled hypertension is high. Obesity and male sex were associated with uncoded elevated BP and uncontrolled hypertension. Black ethnicity was associated with uncontrolled hypertension. Initiatives are needed to optimize hypertension coding and control, with an emphasis on specific population subgroups.

Prevalence and factors associated with suboptimal blood pressure among ambulatory patients with diabetic kidney disease attending a tertiary hospital in Uganda.

Kidney failure prevalence is increasing among diabetic kidney disease (DKD) patients in low-income countries. Suboptimal blood pressure (BP) drives kidney failure and mortality. The burden of suboptimal BP and its associated factors among these patients are not well documented. To determine the prevalence of suboptimal BP and associated factors among those with DKD attending Kiruddu National Referral Hospital. In this cross-sectional study, recruited participants were screened for DKD using urine dipsticks from 6th May 2020 to 15th July 2020. A pretested questionnaire was administered, BP, height and weight were measured. Suboptimal BP was defined as systolic BP > 130mmHg and or diastolic BP > 80mmHg. A Poisson regression model analysed the associated factors. 250 participants with DKD, mean age of 52(11) years were included of whom 199 (79.6%) were female. Suboptimal BP prevalence was 84.4%, associated with past (p = 0.04) and current (p < 0.001) alcohol use, overweight (p < 0.001) and obesity (p < 0.001), wage earning (p < 0.001) and professionals (p = 0.048). The prevalence of suboptimal BP was high among the overweight, obese, unemployed and alcohol users. Thus, there is a need for better BP control interventions.

Editors' Commentary on the 2023 ESH Management of Arterial Hypertension Guidelines.

Clinical practice guidelines are ideally suited to the provision of advice on the prevention, diagnosis, evaluation, and management of high blood pressure (BP). The recently published European Society of Hypertension (ESH) 2023 ESH Guidelines for the management of arterial hypertension is the latest in a long series of high BP clinical practice guidelines. It closely resembles the 2018 European Society of Cardiology/ESH guidelines, with incremental rather than major changes. Although the ESH guidelines are primarily written for European clinicians and public health workers, there is a high degree of concordance between its recommendations and those in the other major BP guidelines. Despite the large number of national and international BP guidelines around the world, general population surveys demonstrate that BP guidelines are not being well implemented in any part of the world. The level of BP, which is the basis for diagnosis and management, continues to be poorly measured in routine clinical practice and control of hypertension remains suboptimal, even to a conservative BP target such as a systolic/diastolic BP <140/90 mm Hg. BP guidelines need to focus much more on implementation of recommendations for accurate diagnosis and strategies for improved control in those being treated for hypertension. An evolving body of implementation science can assist in meeting this goal. Given the enormous health, social, and financial burden of high BP, better diagnosis and management should be an imperative for clinicians, government, and others responsible for the provision of health care services. Hopefully, the 2023 ESH will help enable this.

Spatial Patterns in the Distribution of Hypertension among Men and Women in India and Its Relationship with Health Insurance Coverage.

The present study explores district-level data associated with health insurance coverage (%) and the prevalence of hypertension (mildly, moderately, and severely elevated) observed across men and women as per NFHS 5. Coastal districts in the peninsular region of India and districts in parts of northeastern India have the highest prevalence of elevated blood pressure. Jammu and Kashmir, parts of Gujarat and parts of Rajasthan have a lower prevalence of elevated blood pressure. Intrastate heterogeneity in spatial patterns of elevated blood pressure is mainly seen in central India. The highest burden of elevated blood pressure is in the state of Kerala. Rajasthan is among the states with higher health insurance coverage and a lower prevalence of elevated blood pressure. There is a relatively low positive relationship between health insurance coverage and the prevalence of elevated blood pressure. Health insurance in India generally covers the cost of inpatient care to the exclusion of outpatient care. This might mean that health insurance has limited impact in improving the diagnosis of hypertension. Access to public health centers raises the probability of adults with hypertension receiving treatment with antihypertensives. Access to public health centers has been seen to be especially significant at the poorer end of the economic spectrum. The health and wellness center initiative under Ayushman Bharat will play a crucial role in hypertension control in India.

Sex differences in impact of cumulative systolic blood pressure from childhood to adulthood on albuminuria in midlife: a 30-year prospective cohort study

Background and objectivesAlbuminuria is recognized as being a predictor of cardiovascular and renal disease. We aimed to identify the impact of the long-term burden and trends of systolic blood pressure on albuminuria in midlife, as well as to explore sex differences concerning this relationship.MethodsThis longitudinal study consisted of 1,683 adults who had been examined 4 or more times for blood pressure starting in childhood, with a follow-up time period of 30 years. The cumulative effect and longitudinal trend of blood pressure were identified by using the area under the curve (AUC) of individual systolic blood pressure measurement with a growth curve random effects model.ResultsOver 30 years of follow-up, 190 people developed albuminuria, including 53.2% males and 46.8% females (aged 43.39 ± 3.13 years in the latest follow-up). The urine albumin-to-creatinine ratio (uACR) values increased as the total and incremental AUC values increased. Additionally, women had a higher albuminuria incidence in the higher SBP AUC groups than men do (13.3% for men vs. 33.7% for women). Logistic regression showed that the ORs of albuminuria for males and females in the high total AUC group were 1.34 (0.70–2.60) and 2.94 (1.50–5.74), respectively. Similar associations were found in the incremental AUC groups.ConclusionsHigher cumulative SBP was correlated with higher uACR levels and a risk of albuminuria in middle age, especially in women. The identification and control of cumulative SBP levels from an early age may assist in reducing the incidences of renal and cardiovascular disease for individuals in later life.

Cardiovascular and cerebral vascular health in females with postacute sequelae of COVID-19.

Many individuals who had coronavirus disease 2019 (COVID-19) develop detrimental persistent symptoms, a condition known as postacute sequelae of COVID-19 (PASC). Despite the elevated risk of cardiovascular disease following COVID-19, limited studies have examined vascular function in PASC with equivocal results reported. Moreover, the role of PASC symptom burden on vascular health has not been examined. We tested the hypothesis that peripheral and cerebral vascular function would be blunted and central arterial stiffness would be elevated in patients with PASC compared with age-matched controls. Furthermore, we hypothesized that impairments in vascular health would be greater in those with higher PASC symptom burden. Resting blood pressure (BP; brachial and central), brachial artery flow-mediated dilation (FMD), forearm reactive hyperemia, carotid-femoral pulse wave velocity (PWV), and cerebral vasodilator function were measured in 12 females with PASC and 11 age-matched female controls without PASC. The severity of persistent symptoms in those with PASC was reported on a scale of 1-10 (higher score: greater severity). Brachial BP (e.g., systolic BP, 126 ± 19 vs.109 ± 8 mmHg; P = 0.010), central BP (P < 0.050), and PWV (7.1 ± 1.2 vs. 6.0 ± 0.8 m/s; P = 0.015) were higher in PASC group compared with controls. However, FMD, reactive hyperemia, and cerebral vasodilator function were not different between groups (P > 0.050 for all). Total symptom burden was not correlated with any measure of cardiovascular health (P > 0.050 for all). Collectively, these findings indicate that BP and central arterial stiffness are elevated in females with PASC, whereas peripheral and cerebral vascular function appear to be unaffected, effects that appear independent of symptom burden.NEW & NOTEWORTHY We demonstrate for the first time that resting blood pressure (BP) and central arterial stiffness are higher in females with PASC compared with controls. In contrast, peripheral and cerebral vascular functions appear unaffected. Moreover, there was no relationship between total PASC symptom burden and measures of BP, arterial stiffness, or vascular function. Collectively, these findings suggest that females with PASC could be at greater risk of developing hypertension, which appears independent of symptom burden.

Evening home blood pressure and pulse rate: age-specific associations with nocturia severity.

Previous studies have reported a significant relationship between hypertension and nocturia. However, the underlying pathophysiology associated with pulse rate (PR) remains unclear. In the Japan Morning Surge-Home Blood Pressure Study, a self-administered nocturia questionnaire and evening home blood pressure (BP) and PR measurements (taken on a mean of 11.2 days) were performed on 4310 patients with one or more cardiovascular risk factors (mean: 64.9 years old; 47% male). According to the number of nighttime voids, the study population was divided into three groups (no voids: n = 2382; 1 void: n = 847; ≥2 voids per night: n = 1082). In the multinomial logistic regression analysis adjusted for confounders, diuretic use (OR, 1.23; 95%CI, 1.01-1.50; p < 0.05) was significantly associated with one nocturnal void, whereas evening home systolic BP (SBP) (OR per 1 SD, 1.14; 95%CI, 1.05-1.24; p < 0.01) and evening home PR (OR per 1 SD, 1.12; 95%CI: 1.02-1.24; p < 0.05) were significantly associated with multiple nocturnal voids. In the younger group (<65 years), only evening home PR was significantly related to multiple nighttime voids (p < 0.01), whereas in the older group (≥65 years), only evening home SBP was significantly related to multiple nighttime voids (p = 0.02). In this study, both higher evening home PR and higher evening home SBP were associated with multiple nighttime voids, with the former playing a greater role in the younger participants, and the latter more often associating the older group. An age-stratified approach to reduce the burden of BP or PR might be important to improve sleep quality.

PS-BPP05-1: ASSOCIATIONS OF ENVIRONMENTAL TEMPERATURES AND HOME BLOOD PRESSURE: THE MASUDA STUDY

Objective: The prevalence of elevated blood pressure (BP) remains high, with the greatest absolute burden of elevated BP particularly in the East Asian and Pacific regions. Temperature and BP are closely related; however, few studies have examined the association of out-of-office BP with indoor or outdoor temperature. The effect of the difference between indoor and outdoor temperatures on BP also remains unknown. we examined the association of indoor and outdoor temperatures, and their difference with self-measured BP at home. Design and method: Using 2-year data on temperature and self-measured home BP in healthy 352 participants (mean age, 49.8 years; 46.0% women) from a population-based cohort. We measured home BP and indoor temperature at the same time in the morning and evening every day. Outdoor temperature at the same time period of the home BP measurements in Masuda City was based on the national data from the Japan Meteorological Agency. A linear mixed model was used for analyzing the association between home BP and indoor or outdoor temperature as fixed effects and each participant as a random effect adjusted for age, sex, smoking status, alcohol drinking, obesity, physical activity, diabetes mellitus, and antihypertensive medication use. Results: We observed BP measurements of 82,900 in the morning and of 66,420 in the evening. After adjustment for age, sex, and possible confounders, indoor temperature was inversely associated with systolic and diastolic BP in the morning and evening. A 1 °C increase in the indoor temperature reduced systolic/diastolic BP by 0.37/0.22 mmHg, respectively, in the morning and 0.45/0.30 mmHg, respectively, in the evening (all P-values &lt; 0.001). The magnitude of associations was stronger for indoor than outdoor temperature. Similarly, a 1 °C increase in the indoor temperature above outdoor temperature decreased systolic/diastolic BP by 0.33/0.12 mmHg, respectively, in the morning and 0.45/0.26 mmHg, respectively, in the evening independent of outdoor temperature (all P-values &lt; 0.001). Conclusions: Our findings highlight the importance of indoor temperature for influencing home BP levels. The control of indoor temperature is considered an easy approach for the general population to tackle. It is necessary to control the rise in home BP by controlling indoor temperature in order to reduce high BP, possibly leading to reduced mortality and morbidity from CVD.