Blood Pressure Categories Research Articles

Comparison of the Anthropometric Indices to Identify Prehypertension Among Male Medical Students

The state of prehypertension that is often neglected in young adults is not inferior to hypertension in contributing to a higher risk of cardiovascular diseases. Several simple anthropometric indices may be used as prehypertension prognostic tools, including Body Mass Index (BMI), Body Shape Index (ABSI), Waist Circumference (WC), Weight to Height Ratio (WHtr), and Body Roundness Index (BRI). This study aimed to compare several anthropometric examinations for detecting prehypertension in male medical students. The cross-sectional study design was conducted on 107 male medical students. Direct measurements of the respondents were carried out with blood pressure data collection and anthropometric examination. The area under the receiver-operating characteristic curve (AROC) analysis with a 95% confidence interval (CI) was used to assess all anthropometric measures’ discriminatory power to assess the risk of prehypertension in the participants. Participants with prehypertension were relatively older and had less active physical activity than normotensive (p<0.05). The mean BMI, BRI, WC, and WHtR were significantly higher in the prehypertensive group than in the normotensive group. However, ABSI was not showing any relationship with blood pressure. The process with 95% CI of blood pressure classification related to anthropometric measures indicates that BMI showed the highest AROC values for the prehypertensive state (AROC: 0.73, 95% CI: 0.63–0.82), and WC had the lowest AROCs (AROC: 0.63, 95% CI: 0.52–0.63). BMI, BRI, WC, and WHtr may be applied as prognostic assessments for prehypertension states in young adult males.

Evaluation of vascular risk in patients with migraine with and without aura treated with erenumab: Post hoc analysis of pooled long‐term clinical trial data

To assess cardiovascular (CV) safety of erenumab in clinical trial patients associated with degree of CV risk. Hypertension has been considered a theoretical risk associated with the inhibition of the calcitonin gene-related peptide pathway in migraine management, particularly in a patient population with pre-existing CV risk factors. Data pooled from four double-blind, randomized trials were used to assess blood pressure (BP) changes and CV safety in patients grouped based on 10-year risk of cardiac, cerebrovascular, and peripheral artery disease as no-risk-factors, low-risk (>0% to ≤10%), moderate-risk (>10% to ≤20%), and high-risk (>20%) categories. CV safety was assessed as ischemic cardiovascular and cerebrovascular adverse events (ICCAE). There was no apparent difference between placebo- (N=1032) and erenumab-treatment groups (70 mg, N=885; 140 mg, N=504) in clinical worsening of BP category from baseline to Months 1-3 (14% [143/1032] placebo vs. 13% [114/885] and 14% [71/504] for erenumab 70 and 140 mg, respectively) regardless of baseline BP category. The adverse event (AE) profile of erenumab was similar across CV risk categories throughout the long-term analysis. Erenumab-treated patients with high and moderate 10-year CV risk (N=107) did not experience any ICCAEs during the double-blind treatment period; there was a single ICCAE (a cerebral dural venous sinus thrombosis) observed in the low-risk erenumab group (N=273). There were no increases in AEs during the long-term extensions of up to 5 years (N= 2499; 3482 patient-years of exposure to erenumab) with exposure-adjusted incidence rates of cardio/cerebrovascular disorder AEs of 0.4, 0.5, 0.0, and 1.1 (per 100 patient-years) for no risk factor (N= 1805), low (N= 492), moderate (N= 121), and high (N= 81) 10-year CV risk groups, respectively. Ischemic CV and cerebrovascular AEs were uncommon and the incidence rates were similar across the 10-year CV risk categories. This analysis helps provide more detail on the CV safety of erenumab.

Abstract P261: Associations Between Adolescent Social Determinants and Adult Cardiovascular Health in the Add Health Cohort

Introduction: Hypertension is the leading risk factor for cardiovascular disease in the US. Individual social determinants of health (SDoH; e.g., housing and healthy food availability) are associated with hypertension in cross-sectional samples. However, there is a need to better understand how the social environment during youth impacts future hypertension risk to identify targets for primordial prevention and reduce health disparities. Objective: This study aimed to identify whether patterns of SDoH during adolescence were associated with hypertension risk during adulthood in a nationally representative sample. Methods: This analysis utilized public-use data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) waves I and V (n=1,703). Using the Healthy People 2030 Framework, proxy measures for each domain of SDoH were identified from adolescent survey data (Wave I, age range 12-19 years). Blood pressure (BP) from in-home assessments (Wave V, age range age 32-42 years) was categorized as ‘normal’, ‘elevated’, or ‘hypertensive’ by ACC/AHA criteria. K-metoid (PAM) cluster analysis and assessment of silhouette width identified clusters of participants with similar patterns of SDoH during youth. Multinomial logistic regressions with bootstrapping estimated the odds of BP category membership relative to cluster membership. Models controlled for body mass index, smoking, age, sex, race, ethnicity, and medications. Analyses accounted for the complex sampling design, including appropriate Wave V weighting factors. Results: Three clusters were identified with distribution among ‘normal’, ‘elevated’, and ‘hypertensive’ BP categories, respectively, as: Cluster 1 (n=715), 40.3%, 12.3%, and 47.4%, Cluster 2 (n=499) 37.0%, 11.3%, and 51.7%, and Cluster 3 (n=489) 33.7%, 10.9%, and 55.4%. Primary differences among clusters included more frequent history of physical examinations in Cluster 1 vs. 2 and 3, and Cluster 2 vs. 3, greater feelings of safety in school and closeness to people at school in Cluster 2 vs. 1 and 3, and greater perceived prejudice at school in Cluster 1 vs. 2 and Cluster 2 vs. 3 (all p<0.05). In fully adjusted models, participants in Cluster 3 had greater odds of being hypertensive than those in Cluster 1 (OR: 1.45, 95% CI: 1.02, 2.08). Black or African American participants had greater odds of elevated (OR: 2.53, 95% CI: 1.56, 4.12) or hypertensive (OR: 2.22, 95% CI: 1.58, 3.11) BP, relative to whites. Females had lower odds of elevated (OR: 0.56, 95% CI: 0.34, 0.91) or hypertensive (OR: 0.32, 95% CI: 0.23, 0.45) BP, relative to males. Conclusions: SDoH during adolescence, specifically health care access and quality, may be associated with cardiovascular health during adulthood. Future research that includes more direct assessments of each SDoH domain across the lifespan will help to identify interventional targets for primordial prevention.

Morbidity Profile of Traffic Police Personnel of Vidarbha region of Maharashtra

Background: Morbidity is a state of disease, disability, or poor health condition due to any cause; it may be referred to as the existence of a disease that affects the person's health condition. Traffic police personnel are involved in the occupation of controlling traffic in urban areas. The physical and social environment of the workplace contributes a significant role in occupational health, as traffic police personnel spend at least 8 to 10 hours a day at work. That's why health is affected by the working environment to a large extent. The lifestyle and food culture likely contribute to the elevated morbidity pattern. Several studies indicate that police officers have a risk of increasing specific diseases related to their occupation and lifestyle. Objective: To assess the morbidity pattern concerning the occupational health of traffic police personnel. Material and Methods: The present study was conducted during the fieldwork of Ph.D., among the Traffic police personnel of Nagpur and Wardha district of Vidarbha region Maharashtra. The procedures contributing to this work comply with the ethical standard as per the University's Ethical comity. The traffic police personnel were told about the study's objective, and their written consent was obtained. Result: The present study revealed significant differences in Age, Height, Weight, and Systolic and Diastolic blood pressure among males and females (p = 0.001). Out of 277 personnel, more than fifty percent of traffic police personnel suffered from Musculo skeleton disorder, followed by respiratory problems (17 percent), obesity, and eye-related problem (both in 14.1 percent). 7.6 percent of traffic personnel suffered from skin infections, 7.2 percent from diabetes, 5.4 percent from heart problems, and 2.5 percent from hypertension (High blood pressure) reported by the traffic police personnel. 26.02% of personnel are Systolic and 45.37% of personnel were found Diastolic hypertensive blood pressure category according to physiological measurement.

Systolic Blood Pressure Is Associated with Increased Brain Amyloid Load in Mild Cognitively Impaired Participants: Alzheimer’s Disease Neuroimaging Initiatives Study

Background: Cardiovascular disease (CVD), including elevated blood pressure (BP), is known to promote Alzheimer’s disease (AD) risk. Although brain amyloid load is a recognized hallmark of pre-symptomatic AD, its relationship to increased BP is less known. The objective of this study was to examine the relationship of BP to brain estimates of amyloid-β (Aβ) and standard uptake ratio (SUVr). We hypothesized that increased BP is associated with increased SUVr. Methods: Using data from the Alzheimer’s Disease Neuroimaging Initiative (ADNI), we stratified BP according to the Seventh Joint National Committee (JNC) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Classification (JNC VII). Florbetapir (AV-45) SUVr was derived from the averaged frontal, anterior cingulate, precuneus, and parietal cortex relative to the cerebellum. A linear mixed-effects model enabled the elucidation of amyloid SUVr relationships to BP. The model discounted the effects of demographics, biologics, and diagnosis at baseline within APOE genotype groups. The least squares means procedure was used to estimate the fixed-effect means. All analyses were performed using the Statistical Analysis System (SAS). Results: In non-ɛ4 carrier MCI subjects, escalating JNC categories of BP was associated with increasing mean SUVr using JNC-4 as a reference point (low-normal (JNC1) p = 0.018; normal (JNC-1) p = 0.039; JNC-2 p = 0.018 and JNC-3 p = 0.04). A significantly higher brain SUVr was associated with increasing BP despite adjustment for demographics and biological variables in non-ɛ4 carriers but not in ɛ4-carriers. This observation supports the view that CVD risk may promote increased brain amyloid load, and potentially, amyloid-mediated cognitive decline. Conclusion: Increasing levels of JNC classification of BP is dynamically associated with significant changes in brain amyloid burden in non-ɛ4 carriers but not in ɛ4-carrier MCI subjects. Though not statistically significant, amyloid burden tended to decrease with increasing BP in ɛ4 homozygote, perhaps motivated by increased vascular resistance and the need for higher brain perfusion pressure.

Video Based Cocktail Causal Container for Blood Pressure Classification and Blood Glucose Prediction.

With the development of modern cameras, more physiological signals can be obtained from portable devices like smartphone. Some hemodynamically based non-invasive video processing applications have been applied for blood pressure classification and blood glucose prediction objectives for unobtrusive physiological monitoring at home. However, this approach is still under development with very few publications. In this paper, we propose an end-to-end framework, entitled cocktail causal container, to fuse multiple physiological representations and to reconstruct the correlation between frequency and temporal information during multi-task learning. Cocktail causal container processes hematologic reflex information to classify blood pressure and blood glucose. Since the learning of discriminative features from video physiological representations is quite challenging, we propose a token feature fusion block to fuse the multi-view fine-grained representations to a union discrete frequency space. A causal net is used to analyze the fused higher-order information, so that the framework can be enforced to disentangle the latent factors into the related endogenous association that corresponds to down-stream fusion information to improve the semantic interpretation. Moreover, a pair-wise temporal frequency map is developed to provide valuable insights into extraction of salient photoplethysmograph (PPG) information from fingertip videos obtained by a standard smartphone camera. Extensive comparisons have been implemented for the validation of cocktail causal container using a Clinical dataset and PPG-BP benchmark. The root mean square error of 1.329±0.167 for blood glucose prediction and precision of 0.89±0.03 for blood pressure classification are achieved in Clinical dataset.

Blood pressure and 10-year all-cause mortality: Findings from the PERU MIGRANT Study

Background The long-term impact of elevated blood pressure on mortality outcomes has been recently revisited due to proposed changes in cut-offs for hypertension. This study aimed at assessing the association between high blood pressure levels and 10-year mortality using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) and the American College of Cardiology and the American Heart Association (ACC/AHA) 2017 blood pressure guidelines. Methods Data of the PERU MIGRANT Study, a prospective ongoing cohort, was used. The outcome of interest was 10-year all-cause mortality, and exposures were blood pressure categories according to the JNC-7 and ACC/AHA 2017 guidelines. Log-rank test, Kaplan-Meier and Cox regression models were used to assess the associations of interest controlling for confounders. Hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated. Results A total of 976 records, mean age of 60.4 (SD: 11.4), 513 (52.6%) women, were analyzed. Hypertension prevalence at baseline almost doubled from 16.0% (95% CI 13.7%–18.4%) to 31.3% (95% CI 28.4%–34.3%), using the JNC-7 and ACC/AHA 2017 definitions, respectively. Sixty-three (6.4%) participants died during the 10-year follow-up, equating to a mortality rate of 3.6 (95% CI 2.4–4.7) per 1000 person-years. Using JNC-7, and compared to those with normal blood pressure, those with pre-hypertension and hypertension had 2-fold and 3.5-fold increased risk of death, respectively. Similar mortality effect sizes were estimated using ACC/AHA 2017 for stage 1 and stage 2 hypertension. Conclusions Blood pressure levels under two different definitions increased the risk of 10-year all-cause mortality. Hypertension prevalence doubled using ACC/AHA 2017 compared to JNC-7. The choice of blood pressure cut-offs to classify hypertension categories need to be balanced against the patients benefit and the capacities of the health system to adequately handle a large proportion of new patients.

The Burden of Hypertension and Prehypertension in a Community Health Centre of Haryana.

Background Hypertension (HTN) is endemic in India and it is considered a public health challenge in both economically developed and developing nations.Unfortunately,despite its high prevalence, its awareness, treatment,and control status arelow in urban as well as rural Indian populations. Objectives To determine the burden of hypertension and prehypertensionin a Community Health Center (CHC)and to find the associationof hypertensionwith the agegroupand sexofstudy subjects. Methodology A cross-sectional study was carried out among 713 patients of age 20 years and above attendingtheOut Patient Department (OPD)of the Community Health Centre (CHC),Barwalain the Hisardistrict of Haryana.JNC 7 classification of blood pressure was usedto diagnose hypertension.The collected data was analysed using the Statistical Package for Social Sciences (SPSS) version 20.0. Appropriate statistical tests were used. Result Out ofthetotal patientsenrolled, 200(28.1%)were found to be hypertensives. The burden of prehypertension was further observed to be 28.1%. About (61.6%) of OPD patients were female. Among hypertensive patients, nearly half(48.8%) were in the age group of 60-80 years whereas the majority of the hypertensives(56%) werefemales. Conclusion In our study,more than 50 percentof OPD patients were found to have hypertension and pre-hypertension. Health-seekingbehaviorwas more among females.

Blood pressure per the 2017 ACC/AHA and 2018 ESC/ESH guidelines and heart failure risk: the Suita Study.

Hypertension is a significant risk factor for heart failure (HF). Since hypertension definition varies across guidelines, identifying blood pressure (BP) categories that should be targeted to prevent HF is required. We, therefore, investigated the association between hypertension per the 2017 American College of Cardiology/American Heart Association (ACC/AHA) and 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines and HF risk. This prospective cohort study included randomly selected 2809 urban Japanese people from the Suita Study. Cox regression was used to assess HF risk, in the form of hazard ratios (HRs) and 95% confidence intervals (95% CIs), for different BP categories in both guidelines, compared to a reference category defined as systolic BP (SBP) <120 mmHg and diastolic BP (DBP) <80 mmHg. Within 8 years of median follow-up, 339 HF cases were detected. Per the 2017 ACC/AHA guidelines, hypertension I and II and isolated systolic hypertension were associated with increased HF risk: HRs (95% CIs) = 1.81 (1.33-2.47), 1.68 (1.24-2.27), and 1.64 (1.13-2.39), respectively. Per the 2018 ESC/ESH guidelines, high-normal BP, hypertension I, II, and III, and isolated systolic hypertension were associated with increased HF risk: HRs (95% CIs) = 1.88 (1.35-2.62), 1.57 (1.13-2.16), 2.10 (1.34-3.29), 2.57 (1.15-5.77), and 1.51 (1.04-2.19), respectively. In conclusion, hypertension and isolated systolic hypertension per the 2017 ACC/AHA and 2018 ESC/ESH guidelines and high-normal BP per the 2018 ESC/ESH guidelines are risk factors for HF.

S-10-4: THE ASSOCIATION BETWEEN BLOOD PRESSURE PER THE 2019 JSH AND 2017 ACC/AHA GUIDELINES AND HEART FAILURE RISK: THE SUITA STUDY

Objective: Hypertension is a significant risk factor for heart failure (HF). Since hypertension definition varies across guidelines, identifying blood pressure (BP) categories that should be targeted to prevent HF is required. We, therefore, investigated the association between hypertension per the 2019 Japanese Society of Hypertension (JSH) and 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines and HF risk. Design and method: A total of 2,809 urban Japanese people registered in the Suita Study were followed up for incident HF, which was defined as participants with B-type natriuretic peptide levels of equal or higher than100 pg/mL or starting HF medications. Cox regression was used to assess HF risk for different BP categories in both guidelines compared to a reference category defined as systolic BP (SBP) less than120 mmHg and diastolic BP (DBP) less than 80 mmHg. Results: Within 8 years of median follow-up, 339 HF cases were detected. Per the 2019 JSH guidelines, elevated BP (SBP 130 to139 and/or DBP 80 to 89 mmHg), hypertension I (SBP 140 to159 and/or DBP 90 to 99 mmHg), hypertension II (160 to179 and/or DBP 100 to109 mmHg), hypertension III (SBP equal to or higher than180 and/or DBP equal to or higher than110 mmHg), and isolated systolic hypertension (SBP equal to or higher than 140 mmHg and DBP &lt; 90 mmHg) were associated with increased HF risk with HRs (95% CIs): 1.82 (1.34 to 2.49), 1.57 (1.13 to 2.16), 2.10 (1.34 to 3.29), 2.57 (1.15 to 5.77), and 1.51 (1.04 to 2.19), respectively. Per the 2017 ACC/AHA guidelines, hypertension I (SBP 130 to 39 or DBP 80 to 89 mmHg), hypertension II (SBP equal to or higher than140 and/or DBP equal to or higher than 90 mmHg), and isolated systolic hypertension (SBP equal to or higher than 130 and DBP less than 80 mmHg) were associated with increased HF risk with HRs (95% CIs): 1.81 (1.33 to 2.47), 1.68 (1.24 to 2.27), and 1.64 (1.13 to 2.39), respectively. The associations were modestly attenuated among participants with no history of cardiovascular diseases (coronary heart disease or stroke). Hypertension medication dissolved the association between increased BP and HF risk. Conclusions: Increased BP, even without fulfilling the hypertension definition per the 2019 JSH guidelines, can elevate the risk of HF.

PS-BPC11-2: PEDIATRIC BLOOD PRESSURE CATEGORY PREDICTS LONGITUDINAL VARIABILITY IN BLOOD PRESSURE IN YOUTH

Objectives: In order to identify risk factors that cause elevated blood pressure during adolescence, we aimed to evaluate the predictive effect of childhood factors on longitudinal variability of individual blood pressure during youth. Methods: Childhood data were obtained from medical checkups of Japanese male and female junior high school students aged 12–13 years during the period from 2009 to 2010. Childhood measurements were height, body weight, body mass index (BMI), systolic and diastolic blood pressures, complete blood counts, uric acid, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. Childhood blood pressure was categorized as normal, elevated blood pressure, or hypertension according to the American Academy of Pediatrics (AAP) clinical practice guideline. Linear mixed-effects models for repeated measures were used to estimate the effect of baseline childhood factors on longitudinal changes in systolic and diastolic blood pressures. Results: A total of 1304 participants were followed up to the 10th year. At baseline, the mean age was 12.6 years [SD, 0.3] and 26.2% were female. Among male participants, 6.3% were categorized as having elevated blood pressure and 8.8% were categorized as having hypertension, while among female participants 6.1% were categorized as having elevated blood pressure and 8.5% were categorized as having hypertension. Boys in the hypertension category had higher BMI, higher uric acid, and lower HDLC compared with those in the normal blood pressure category, but this trend was not statistically significant in girls. Of each childhood factor, the baseline blood pressure category according to AAP clinical practice guideline fit best with longitudinal changes in both systolic and diastolic blood pressure in the linear mixed-effects models. Conclusion: These results suggest that the AAP pediatric blood pressure category is the strongest predictor of longitudinal variability in individual blood pressure in youth.

Change in blood pressure status defined by 2017 ACC/AHA hypertension guideline and risk of cardiovascular disease: results of over a decade of follow-up of the Iranian population.

Hypertension (HTN) is known to be the leading cause of cardiovascular disease (CVD) and mortality. We aimed to assess the impact of changes in 3 years in different blood pressure (BP) categories on incident CVD. In this study, 3,685 Tehranians aged ≥30 years (42.2% men) free of prevalent CVD with BP level <140/90 mmHg and not on BP-lowering medications were enrolled. Participants were grouped according to baseline BP category using the 2017 ACC/AHA hypertension guideline definition: normal BP (<120/80 mmHg), elevated BP (120-129/<80), and stage 1 HTN (130-139 and/or 80-89). The hazard ratio of incident CVD by changes in the BP category was estimated after adjustment for traditional risk factors using Cox's proportional hazard model, with stable normotension as a reference. During a median follow-up of 11.7 years, 346 CVD events (men = 208) occurred. Compared to the reference group, among participants with normal BP at baseline, only those with BP rising to stage 1 HTN [1.47 (0.99-2.16)], and among those with stage 1 HTN at baseline, regression to elevated BP [1.80 (1.11-2.91)], remaining at stage 1 [1.80 (1.29-2.52)], and progression to stage 2 HTN [1.81 (1.25-2.61)] had a higher risk for CVD; however, regression to normal BP attenuated this risk [1.36 (0.88-2.12)]. Conversion from elevated BP to any other categories had no significant association with CVD risk. Generally, prevalent stage 1 HTN (regardless of changing category) and incident stage 1 HTN were significantly associated with a higher risk of CVD; even regression to elevated BP did not attenuate the risk. Accordingly, these populations are potential candidates for antihypertensive management.

Exploration of plasma adiponectin, leptin, and COMT genotype on blood pressure among women who are post-menopause.

Research suggests that adiponectin, leptin, and genetic polymorphisms such as catechol-O-methyltransferase (COMT) genotype may play an integral role in blood pressure status and thereby cardiovascular health. This is an area especially important for women who are post-menopause; however, the current literature investigating these associations is limited. This study was a cross-sectional secondary analysis of baseline data (N 237) from the Minnesota Green Tea Trial (MGTT). The current study explored the relationships between plasma adiponectin, leptin, and COMT genotype on blood pressure measures. Plasma adiponectin and leptin were obtained after an overnight fast of at least 10 h and were measured by the radioimmunoassay method. The relationships were analysed using multiple linear regression after adjusting for potential confounders. Effect modifications by age, body mass index (BMI) category, blood pressure category, antihypertensive medication use, and COMT genotype were also investigated. The majority of participants were non-Hispanic (97⋅9%) and Caucasian (94⋅9%). Mean (sd) age and BMI were 60⋅7 (5⋅0) years and 28⋅2 (2⋅9) kg/m2, respectively. After adjustment for confounding variables, neither plasma adiponectin, plasma leptin nor COMT genotype was associated with systolic or diastolic blood pressure measures. The results of stratified analyses also did not reveal any significant interactions or associations. Based on the findings of this study, which utilised more rigorous statistical methods than previous research, neither adiponectin, leptin nor COMT genotype play a role in blood pressure measures in women who are post-menopause.

PS-C01-3: ACCURACY OF THE AKTIIA BRACELET IN THE ELDERLY IN DIFFERENT BODY POSITIONS

Objective: Accurate blood pressure (BP) measurement is essential for the correct diagnosis and management of hypertension (HTN) especially in the elderly population, which has the highest prevalence of HTN. Recently cuffless devices have been developed with the hope of facilitating blood pressure measurement. However, validation studies of cuffless are scarce and a universally accepted validation protocol has yet to be published. The objective of the second arm of this study (NCT04027777) was to test the accuracy of the Aktiia bracelet in an elderly population cohort in different body positions. Design and method: We recruited 40 patients aged from 65 to 85 years with different blood pressure categories and without diabetes. BP measures from Aktiia Bracelet were compared to reference double auscultatory measurement in various body positions: sitting, standing and lying (including after aerobic physical activity in supine position) on four separate visits distributed over one month. Results: The average participant's age was 73 ± 6 years with 52.5% female participants. A total of 469 comparison measurements were made, with an overall acceptance rate of 79% (percentage of optical recordings with sufficient quality to be analyzed by the cuffless device). Five participants were excluded either due to failed initialization or to ensure a distribution of blood pressure categories compliant to the requirements of ISO 81060-2. After initialization procedures on day 1, we observed means and standard deviations of differences for systolic BP of 1.23 ± 7.88 mmHg in sitting position, -1.81 ± 11.11 mmHg in the standing and -1.8 ± 9.96 mmHg in the lying position (including after aerobic exercise). Differences for diastolic BP were 0.2 ± 5.55 mmHg, -5.35 ± 7.75 mmHg and -0.94 ± 7.47 mmHg respectively. The acceptance rate for each position was 86%, 69% and 75% respectively. When considering all possible body positions representative of a realistic use of the device, and along the entire monitoring period of one month, systolic and diastolic BP differences were -0.26 ± 9.96 mmHg and -0.75 ± 7.0 mmHg respectively. Figure 1 illustrates the Bland-Altman plots for SBP and DBP for the sitting position. Conclusions: This study demonstrates that the Aktiia bracelet can accurately estimate the BP in an elderly population in the sitting position (according to the requirements of ISO 81060-2) and in other body positions representative of a realistic use of the device. The use of more comfortable, non-invasive and non-occlusive BP monitoring may contribute to better diagnosis and treatment of hypertension in the elderly through patient empowerment.

S-04-4: INCONSISTENT GUIDELINES-BASED CONTROL STATUS OF OFFICE, HOME, AND AMBULATORY BLOOD PRESSURE MEASURED BY AN ALL-IN-ONE BP MONITORING DEVICE

Objective: Inconsistencies between office and out-of-office blood pressure (BP) values (described as white-coat hypertension or masked hypertension) may be attributable in part to differences in the BP monitoring devices used. We studied the inconsistency of the classification of BP control (well-controlled BP vs. uncontrolled BP) among office, home, and ambulatory BPs by using a validated all-in-one BP monitoring device. Design and method: In the nationwide, general practitioner-based multicenter HI-JAMP study, 2,322 hypertensive patients treated with antihypertensive drugs underwent office BP measurements and 24-h ambulatory BP monitoring (ABPM), consecutively followed by 5-day home BP monitoring (HBPM), using the same all-in-one device over a total of seven BP measurement days. Results: Using the thresholds of the JSH2019 and ESC2018 guidelines, the subjects with consistently well-controlled office (&lt;140mmHg) and home systolic BP (SBP) (&lt;135mmHg) (n = 970) also tended to have well-controlled 24-h SBP (&lt;130mmHg) (n = 808, 83.3%). The subjects with consistently uncontrolled office and home SBP (n = 579) also tended to have uncontrolled 24-h SBP (n = 444, 80.9%). Among the subjects with inconsistent classifications of office and home BP control (n = 803), 46.1% had inconsistent ABPM-vs.-HBPM out-of-office BP control status. When the 2017 ACC/AHA thresholds or JSH2019 target BP thresholds were applied as an alternative, the results were essentially the same. Conclusions: The combined assessment of office and home BP is useful in clinical practice. Especially for patients whose office BP classification and home BP classification conflict, the complementary clinical use of both HBPM and ABPM might be recommended.

AW-AD-4: RENOPROTECTIVE EFFECTS OF CANAGLIFLOZIN VIA LESSENING HYPERINSULINEMIA IN DIABETIC PATIENTS WITH HEART FAILURE: A POST-HOC ANALYSIS OF THE CANDLE TRIAL

Objective: The mechanisms by which sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce proteinuria in patients with type 2 diabetes mellitus (T2DM) remain unclarified. We evaluated factors associated with proteinuria regression in patients with T2DM treated with canagliflozin. Design and method: This study was a post-hoc analysis of the CANDLE trial (UMIN000017669), which compared the effect of 24 weeks treatment canagliflozin and glimepiride for changes in NT-proBNP in patients with T2DM and chronic heart failure (CHF). Factors associated with regression of proteinuria at 24 weeks were evaluated with multivariate logistic models. Results: The rate of regression of proteinuria was higher and that of progression was lower in the canagliflozin versus the glimepiride group. There were no differences in the change in systolic and diastolic blood pressure and eGFR category between groups at baseline. Systolic blood pressure and insulin levels significantly decreased in the canagliflozin group but not in the glimepiride group. Insulin level, HOMA-β, HOMA-IR, and estimated plasma volume were decreased at 24 weeks in the proteinuria regression subclass but not in the proteinuria progression subclass, suggesting that regression of proteinuria is associated with the declines in these values in the canagliflozin group. Systolic and diastolic blood pressure did not change significantly in either the proteinuria progression or regression groups in both the canagliflozin and glimepiride groups. Higher insulin level was solely associated with proteinuria regression in the multivariate logistic regression model. Conclusion: In patients with T2DM and CHF, regression of proteinuria with canagliflozin treatment was associated with the pre-treatment insulin level. These results suggest new mechanistic intuitions into the beneficial effects of canagliflozin on renal outcomes and warrant discussion for selecting preferred patient profiles, including pre-treatment insulin levels.

Study of prevalence of prehypertension and hypertension among urban school-going children in Tripura

Introduction: Prehypertension is defined as an independent category of blood pressure (BP) by the seventh joint national committee on prevention, detection, evaluation, and treatments of BP. Systolic BP (SBP) between 120 and 139 mm Hg or diastolic BP between 80 and 89 mm Hg are considered to have prehypertension. BP ≥140/90 mm Hg is considered hypertension. It is to assess the prevalence of prehypertension and hypertension among urban school-going children. Materials and Methods: A cross-sectional study was conducted among 1011 school-going children of both sexes within 12–17 years of age group and each participant was selected using a simple random sampling technique. Pretested predesigned questionnaire was used for data collection. Results: Prevalence of normotensive, prehypertensive, and hypertensive were 73.6%, 19.4%, and 7%, respectively, when both systolic and diastolic components have been taken into account. Conclusion: This study has showed that more than 19% prehypertensive and 7% hypertensive among the school-going children aged between 12 and 17 years when both systolic and diastolic components have been taken into account.

Gramian Angular Field Based Hybrid CNN for Non-Invasive Blood Pressure Classification

Gramian Angular Field Based Hybrid CNN for Non-Invasive Blood Pressure Classification

PS-BPP04-6: DIASTOLIC BLOOD PRESSURE LEVELS AND CARDIOVASCULAR EVENTS: THE JAPAN EPIDEMIOLOGY COLLABORATION ON OCCUPATIONAL HEALTH STUDY

Objective: In Japan, data are sparse as to the association of diastolic blood pressure (DBP) within the elevated blood pressure range (i.e., DBP of 80 to 89 mm Hg) with risk of cardiovascular diseases (CVD) in young to middle-aged adults. We examined this association by using prospective data collected in the Japan Epidemiology Collaboration on Occupational Health (JECOH) Study. Methods: Participants were 81,876 workers (67,150 men and 14,636 women, aged 20 to 64 years) without taking antihypertensive medication who underwent periodic health checkup in 2011 or 2010 (baseline). Blood pressures categories at baseline were used as exposure. Data on fatal and non-fatal cardiovascular events (ICD10: I21 to I25, I46, I48 to I50, I60 to I69, I71 to I72) that occurred between April 2012 and March 2021 were retrieved from a within-study registry. Multivariable-adjusted hazard ratios according to DBP levels were calculated using Cox regression. Results: Over the 9 years of follow-up (0.5 million person years), 319 cardiovascular events (hemorrhage or ischemic stroke [ICD10: I60/I63], 177 cases; myocardial infarction [ICD10: I21], 77 cases) including 74 cardiovascular deaths were documented. Higher levels of DBP were associated with increased risk of cardiovascular events. As compared with DBP of &lt; 80 mm Hg, multivariable adjusted hazard ratios (95% confidence intervals) of cardiovascular events were 1.58 (1.12, 2.22), 2.25 (1.75, 2.91), 2.85 (1.97, 4.11), 2.89 (1.52, 5.48), and 5.60 (2.52, 12.42) for DBP of 80 to 84, 85 to 89, 90 to 99, 100 to 109, and ≧ 110 mm Hg, respectively (P value for trend &lt; 0.001). Risk of CVD mortality was also increased, albeit not significantly, at DBP of 80 to 84 and 85 to 89 mm Hg (19% and 59% increase, respectively). Conclusion: The present data from JECOH Study showed that DBP of 80 to 84 mm Hg was associated with a significantly higher risk of cardiovascular events. Our results support the blood pressure classification in the Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH2019) for CVD prevention.

Adolescent blood pressure classification curves and cardiometabolic risk factors: a comparison of the Brazilian and American references.

The American Academy of Pediatrics (AAP) adolescent blood pressure (BP) percentiles were updated in 2017, and have been used as reference in Brazil since then. However, specific BP percentiles for Brazilian adolescents were recently proposed based on data from the Study of Cardiovascular Risk in Adolescents (ERICA). To compare the prevalence of arterial hypertension according to each reference, as well as to assess the cardiometabolic risk associated with the reclassification by Brazilian BP percentiles. Data from 73 399 adolescents aged 12-17 years who participated in the ERICA study were analyzed. To assess cardiometabolic risk, 6185 adolescents who were reclassified upwards by the Brazilian reference were 1 : 1 matched with adolescents that were normotensive by both references and were of the same age, sex and height percentile. The parameters evaluated were: overweight/obesity, waist circumference, total cholesterol, triglycerides, LDL-c, HDL-c, fasting glucose, HbA1c and HOMA-ir. The classification according to Brazilian BP percentiles resulted in a higher prevalence of arterial hypertension (14%, 95% CI 13.2-14.8), when compared with the AAP percentiles (10.6%, 95% CI 10.0-11.2). The use of the Brazilian reference also resulted in higher prevalence of arterial hypertension in girls, teenagers ranging from 12 to 14 years, and those classified with adequate weight, overweight or obesity. In the case-control analysis, cardiometabolic risk factors were present more often in adolescents reclassified with arterial hypertension by the ERICA reference. The use of the BP percentiles proposed by ERICA is a sensitive method for tracking Brazilian adolescents with hypertension and higher cardiometabolic risk.