Blood Pressure In Control Group Research Articles

Effects of intensive blood pressure control on cognitive function in patients with cerebral small vessel disease

ObjectiveThis study aimed to investigate the effects of intensive blood pressure control on cognitive function in elderly patients with cerebral small vessel disease (CSVD). MethodsFrom May 2020 to June 2022, 140 outpatients and inpatients with CSVD and hypertension in the Department of Neurology of Beijing Shijingshan Hospital were selected. They were randomly divided into the standard and intensive blood pressure control groups, and the dosage of antihypertensive drugs was adjusted to reduce the blood pressure to the target level. The patients were followed up for 2 years. The medical records or data at “enrollment” and “2-year follow-up” were analyzed and evaluated. The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to evaluate cognitive function. Cranial magnetic resonance imaging was performed to evaluate lacunar infarctions (LIs) and white matter hyperintensity (WMH). Multiple linear regression was used to analyze the correlation between MMSE scores and blood pressure, WMH, and LIs. Results(1) The MMSE and MoCA scores in the standard group were significantly lower than those at enrollment. The WMH score in the standard group was significantly higher than that at enrollment. (2) After the 2-year follow-up, the 24-h systolic blood pressure (SBP), 24-h diastolic blood pressure (DBP), daytime mean SBP, daytime mean DBP, and nighttime mean SBP in the two groups significantly decreased, which had significant statistical significance (P < 0.05). (3) The correlation between blood pressure and MMSE score was analyzed using multiple linear regression analysis. The WMH score, LIs, 24-h SBP, and 24-h DBP were independently correlated with MMSE scores. ConclusionIn elderly patients with hypertension, a decrease in SBP to 126 mmHg, compared with 134 mmHg, can delay cognitive impairment as well as reduce LIs and cerebral WMH lesions in patients with CSVD.

UNCONTROLLED BLOOD PRESSURE BEFORE COVID-19 IS ASSOCIATED WITH ELEVATED SERUM IL-17 AND LONG-COVID SEQUELAE IN HEMODIALYSIS PATIENTS

Objective: Hypertension, a nearly ubiquitous complication in hemodialysis (HD) patients, has been identified as a risk factor for COVID -19 and its associated adverse outcomes. In turn, both hypertensive and COVID-19-infected patients with long- COVID sequelae have been reported to have elevated serum interleukin-17 (IL-17) levels. Although HD patients belong to the high-risk group for long COVID sequelae, the association between pre-infection blood pressure (BP) control, serum IL-17 levels, and long COVID sequelae has never been investigated in this cohort. Design and method: A total of 80 HD patients aged 56 (44-63.2) years with a dialysis vintage of 40 (23-74) months who had experienced COVID-19 before enrollment were included in this cross-sectional cohort study. Controlled BP was defined as a 3-month average pre-dialysis BP &lt; 140/90 mmHg and post-dialysis &lt; 130/80 mmHg. IL-17 was measured at least 5 months after acute COVID-19 by ELISA assay. Data were expressed as proportion or median (Me) and interquartile ranges (Q25-Q75) and compared with the Chi-squared test or the Mann-Whitney test as appropriate. Results: Of the 80 patients included, 46 (57.5%) had uncontrolled BP and 34 (42.5%) had controlled BP before infection with COVID -19. Long-term COVID sequelae were observed in 26/46 (56.5%) patients with uncontrolled BP and 11/34 (32.4%) of the BP -controlled group (⇙2 = 4.6, p = 0.03). Serum levels of IL-17 ranged from 0.01 to 15.14 pg/ml and were significantly higher in patients with uncontrolled BP than in the controlled BP group [0.34 (0.08-0.98) vs 0.06 (0.03-0.14) pg/mL, p = 0.001]. In addition, IL-17 was also higher in patients with long-COVID sequelae than in fully recovered patients [0.43 (0.07-1.58) vs 0.08 (0.02-0.16) pg/mL, p = 0.0003], while those with long-COVID sequelae and preinfection uncontrolled BP had the highest value IL-17 (p = 0.04) (Fig. 1). Conclusions: Uncontrolled BP before COVID-19 is associated with increased serum IL-17 levels and long-COVID sequelae in HD patients. Further studies are needed to understand the role of IL-17 in BP control and long-term COVID sequelae in HD patients.

Influence of Internet-Based Health Management on Control of Clinical Parameters in Patients With Hypertension: Four-Year Longitudinal Study

In recent years, more and more studies have shown that internet-based health management can help patients with hypertension control their blood pressure. However, there is a lack of similar research in China. We designed this study to clarify the impact of long-term internet-based health management on the control of clinical parameters in patients with hypertension. These results are also expected to identify the relevant factors affecting the control of clinical parameters in hypertension more accurately toward developing more targeted health management strategies. This was a longitudinal study of internet-based health management in the five provinces of northwest China. The inclusion criteria were aged ≥18 years and no serious cognitive disease or mental disorder. After collecting the physical examination data of 8567 people in the five northwest provinces in 2013, we conducted online health management (including diet, exercise, and behavior) and follow-up. In the physical examination in 2013, 1008 new patients with hypertension were identified, who were divided into a good blood pressure control group and poor blood pressure control group. Physical examination and a questionnaire survey were conducted every 2 years to understand the changes of health management on the subjects' health-related behaviors. We then analyzed the changes of clinical indicators related to hypertension and the influencing factors related to blood pressure control in patients with hypertension. All statistical analyses were performed using R software (version 4.1.2) and a P value <.05 was considered statistically significant. A total of 8567 people met the inclusion criteria and underwent health management. Self-comparison showed that after 4 years of health management, the smoking cessation rate and amount of exercise significantly increased (both P<.001). The low-density lipoprotein-cholesterol levels also increased (P=.005), whereas the high-density lipoprotein-cholesterol levels decreased (P=.007). The newly discovered patients with hypertension in 2013 were further screened. After 4 years of health management, their smoking cessation rate increased significantly (P=.03) and the amount of exercise increased but not significantly (P=.08). In terms of clinical indicators, the diastolic blood pressure considerably decreased (P<.001) and the systolic blood pressure slightly decreased (P=.13). The correlation analysis of blood pressure control in patients with new-onset hypertension showed that gender (female) and changing relevant factors according to health management behaviors (BMI; cereals and potatoes intake; fish, livestock meat, and eggs intake; fruit intake; and physical activity) were the protective factors of blood pressure control. Internet-based health management has a significant and long-term effect on blood pressure control in patients with hypertension.

Intensive Blood Pressure Control and Diabetes Mellitus Incidence for Patients with Impaired Fasting Glucose: A Secondary Analysis of SPRINT.

Previous studies indicated that intensive blood pressure (BP) control (systolic BP < 120 mm·Hg) compared with standard BP control (<140 mm·Hg) was associated with an increased risk of type 2 diabetes (T2D) and impaired fasting glucose (IFG) among hypertensive patients with normoglycemia. However, the impact of intensive BP control on the incidence of T2D for those with IFG is still unknown. This was a secondary analysis of the SPRINT (Systolic Blood Pressure Intervention Trial) of the study. We included participants with IFG at randomization, which was defined as fasting blood glucose (FBG) between 100 and 125 mg/dL. The primary outcome was incident T2D, defined as events of reaching FBG ≥ 126 mg/dL, participant self-report T2D at annual examination, or a record of hypoglycemic medications at follow-up. The secondary outcome was incident IFG reversion (IFGR), defined as the time to first FBG back to normoglycemia (<100 mg/dl) among participants without incident T2D. Cox proportional hazards models were used to compare the cumulative incidence of outcomes between the two BP control groups. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. A total of 3310 participants were included in our primary outcome analysis (median age 67 years, 29% female). There were 293 participants who developed T2D among the intensive BP control group and 256 participants who developed T2D among the standard BP control group, resulting in 56.87 (50.36-63.39) versus 49.33 (43.29-55.37) events per 1000 person-years of treatment (HR 1.18 [95% CI, 1.00-1.40], P=0.052). After excluding 549 participants who developed T2D, 2761 participants were included in our secondary outcome analysis with 559 participants who developed IFGR among the intensive BP control group and 632 participants who developed IFGR among the standard BP control group, resulting in 141.20 (129.50-152.91) versus 158.20 (145.86,170.53) events per 1000 person-years of treatment (HR 0.9 [95% CI, 0.8-1.01], P=0.067). Our study found that in comparison to the standard BP control for hypertensive patients with IFG, intensive BP control was associated with a small increased risk of new-onset T2D, though it did not reach statistical significance. This kind of impact should be considered when implementing the strategy, especially for those with high risks of developing T2D. This trial is registered with NCT01206062.

Analysis of Physical Condition of First-Year Military Higher Education Institution Cadets

The purpose of the study was to determine the dynamics of anthropometric and functional indicators of the physical condition of first-year cadets over three years (from 2019 to 2021). Materials and methods. 152 cadets from Ivan Kozhedub Air Force National University were involved in the experiment. The age of participants was from 17 to 22 years. All cadets were informed about the experiment and gave their consent. Anthropometric (measurement of anthropometric data) and medical-biological (rhythm inversion, electromanometry) methods of investigation were used to determine the assessment of the cadets’ physical condition. A highly informative method – the assessment of O. Pirogova index was used for analysis of the cadets’ physical condition. Pirogova physical condition index is a complex indicator based on the heart rate, systolic and diastolic blood pressure, age, body weight, and body height. Statistical analysis of the results was carried out using the EXCEL tables. The data was analyzed using Student’s test, p less than 0.05 was considered the level of significance. Results and discussion. The results of the study showed that the mean values of the anthropometric and functional indicators of the first-year cadets have not been changed statistically significant over three years. The exception is the difference in the average value of systolic blood pressure of control group 1 and control group 3 representatives, which is statistically reliable (p &lt;0.05). Current anthropometric indicators of cadets obtained during the experiment confirmed the data available in the scientific and methodological literature about the anthropometric indicators of candidates for training in higher military educational institutions of Ukraine. The Pirogova physical condition index calculating showed the following average values of the Pirogova physical condition index: control group 1 – 0.704 points, control group 2 – 0.688 points, control group 3 – 0.671 points. However, the results of the study show a statistically significant deterioration of the Pirogova physical condition index of the 2021 recruitment cadets by 4.7% compared to the representatives of 2019. The comparative analysis of the first-year cadets' physical condition assessments demonstrates a gradual, significant decrease in the number of “high” physical condition ratings: 12% among control group 1 cadets (2019 year of recruitment); 9% among control group 2 representatives (2020 year of recruitment) and only 3% among control group 3 cadets (2021 year of recruitment). However, over three years, the percentage of representatives with physical condition assessment rating “Lower than average” has increased significantly: 1% among cadets of control group 1 (2019 year of recruitment); 7% among cadets of control group 2 (2020 year of recruitment); 7% among representatives of control group 3 (2021 year of recruitment). Conclusion. Over the last 3 years, there has been a deterioration of the general physical condition of higher military educational institution cadets

PS-C28-2: STROKE RISK OF THE ELDERLY PATIENTS WITH NOCTURNAL HYPERTENSION DEFINED USING HOME BLOOD PRESSURE MONITORING IN JAPANESE GENERAL PRACTICE POPULATION

Objective: To investigate the association between nocturnal hypertension defined using home blood pressure (BP) monitoring (HBPM) and the prevalence, extent of cardiovascular target organ damage (TOD), and cardiovascular disease (CVD) event risks in participants with ≧ 65 years in general clinical practice. Design and method: We used the dataset of the Japan Morning Surge-Home BP (J-HOP) Study that recruited 4,310 participants with cardiovascular risk factors. Among them, we assessed the participants with ≧ 65 years who measured nocturnal home BP (n = 1,349, mean age 72.0 year, 48.6% men). We define nocturnal hypertension as nocturnal systolic (SBP) ≧ 120 mmHg or diastolic (DBP) ≧ 70 mmHg, using HBPM. Nocturnal home BP was automatically measured at least 1 day within the 14 days (2 AM, 3 AM, and 4 AM). We use the average of all nocturnal home BP values. N-terminal pro-brain natriuretic peptide (NT-proBNP) and urine albumin: creatinine ratio (UACR) were used as surrogate markers of TOD. The CVD outcomes were incident stroke and coronary heart disease (CHD) events. Results: The prevalence of nocturnal hypertension defined by HBPM was 61.7% of all study participants with ≧ 65 years. The participants with nocturnal hypertension defined by HBPM presented higher levels of log-transformed NT-proBNP and UACR at baseline compared to those with controlled nocturnal BP group. Over a median 4.0-year follow-up (5,453 person-years), 36 stroke events and 31 CHD events occurred, respectively. The nocturnal hypertension group had a higher incidence rate of stroke events compared with the controlled BP group. Concerning CHD, the incidence rate of CHD was similar between two groups (Figure). Cox model results suggested that the participants with nocturnal hypertension had a higher risk of stroke compared to those with controlled nocturnal BP group after adjustments for log-transformed NT-proBNP and UACR levels (adjusted hazard ratio 3.42; 95% confidence interval 1.15–10.19). Conclusions: In this Japanese population with ≧ 65 years, the participants with nocturnal hypertension defined by HBPM was significantly associated with stroke risk, independently of the extent of TOD.

Impact of sustained hypertension on new cardiovascular events in patients with type 2 diabetes: KAMOGAWA-HBP study.

We have previously shown that masked hypertension (MH) and sustained hypertension (SH) contribute to the progression of diabetic nephropathy. Although the risk of target organ damage and cardiovascular events in MH and SH is significantly higher than that in normotension and white coat hypertension, the role of MH or SH in cardiovascular events has never been reported in studies specific to diabetic patients. Therefore, in this study, we aimed to determine whether blood pressure control status contributes to the development of new cardiovascular events. A longitudinal study of 1082 patients with type 2 diabetes mellitus and no history of cardiovascular events was conducted. Patients were instructed to have their blood pressure measured three times, every morning and evening, for 14 consecutive days. Hypertension status was classified into four groups based on the systolic blood pressure measurements in the clinic and at home. The primary endpoint was the first cardiovascular event. After a median follow-up of 7.0 (interquartile range, 4.0-9.0) years, 119 patients developed cardiovascular events. The hazard ratio (95% confidence interval) for the risk of developing cardiovascular events was significantly higher in the SH group than in the controlled blood pressure group (1.63 [1.02-2.59]). SH is a useful predictor of cardiovascular events. Both at home and in the clinic, blood pressure monitoring should be assessed in routine clinical practice to predict future cardiovascular events in patients with type 2 diabetes.

Analysis of Perioperative Nursing Intervention Effect of Cerebrovascular Intervention Patients Based on Intelligent Internet of Things.

The postoperative results of cerebrovascular surgery patients have been successfully used in medical practice using the Internet. The results obtained through data analysis were used in the study. So far, 120 patients who underwent cerebrovascular surgery from February 2018 to December 2018 have been enrolled. The selected class was divided into two groups: 60 psychiatric patients, a control group and an observation group. The former is medical treatment and the latter is postoperative treatment. Results: The results showed that the blood pressure of control group was lower than that of control group, and the incidence of adverse events was lower than that of control group (P < 0.05). Meanwhile, the average hospitalization rate of cerebrovascular disease patients in control group was lower than that in control group (P < 0.05). Conclusion: For patients with cerebrovascular disease, postoperative nursing can reduce the incidence of postoperative complications, reduce the risk of surgery, and improve the effect of surgery. Acute ischemic stroke refers to a kind of clinical syndrome caused by abnormal blood supply in the brain, resulting in ischemia, hypoxic brain tissue necrosis, and focal or comprehensive neurological deficiency. Among them, progressive cerebral infarction accounted for about 20~35%, and most occurred in the early stage of the disease (48~72)h.

Moderate physical activity against effects of short-term PM2.5 exposure on BP via myokines-induced inflammation

Exposure to PM2.5 increases blood pressure (BP) and cardiovascular morbidity and mortality. We conducted a randomized controlled panel study in Shijiazhuang, China among 55 healthy college students randomly assigned to either the control (CON) or SPORTS group with intervention of 2000 m jogging in 20 min for 3 times in 4 days, and 3-round health examinations from November 15, 2020 to December 6, 2020. We aimed to evaluate whether moderate physical activity (PA) protected BP health against PM2.5 exposure and explore potential mechanisms through myokines and inflammation. Individual PM2.5 exposure was calculated based on outdoor and indoor PM2.5 concentration monitoring data as well as time-activity diary of each subject. In the CON group, the exposure-response curve for SBP was linear with a threshold concentration of approximately 31 μg/m3, while an increment of SBP level was 4.38 mm Hg (95%CI: 0.17 mm Hg, 8.59 mm Hg) at lag03 for each 10-μg/m3 increase in PM2.5, using linear mixed-effect models. For inflammatory indicators, PM2.5 exposure was associated with significant increases in eosinophil counts and proportion in CON group, but decreases in MCP-1 and TNF-α in SPORTS group. Meanwhile, higher myokines including CLU and IL-6 were observed in SPORTS group compared to the CON group. Further mediation analyses revealed that eosinophil counts mediated the elevated BP in CON group, whereas MCP-1 and TNF-α were also crucial mediating cytokines for the SPORTS group, as well as CLU and IL-6 acted as mediators on BP and inflammation indicators in SPORTS group. This study suggests that moderate PA could counteract the elevated BP induced by PM2.5 exposure via myokines-suppressed inflammation pathways.

Plasma Renin-guided Therapy in Patients of Primary Hypertension on Antihypertensives: A Prospective Cohort Study.

Most guidelines for hypertension overlook the underlying pathophysiologic basis in deciding antihypertensives. Based on renin levels, hypertension may be classified as high-renin hypertension (HRH), low-renin hypertension (LRH), and normal-renin hypertension (NRH). The study examined the renin levels in a hypertensive population and assessed the effect of renin-guided antihypertensive management on blood pressure (BP) control. This study was a single-center prospective cohort study. Subjects with primary hypertension (aged 20-60 years) on antihypertensives were included in the study. Initial BP was recorded and subsequently, all antihypertensives were discontinued. After 2 weeks, second BP was recorded and plasma renin assay (PRA) sample was collected. All patients were restarted on the previous antihypertensives and further modification of medication was performed based on their PRA. Anti V drugs, such as diuretics and calcium channel blockers (CCBs) were used in LRH while beta-blockers and antirenin drugs (Anti R drugs) were used in HRH. The study included 918 patients with hypertension and 896 cases were finally analyzed. Of these patients, 287 (32.03%) had LRH (&lt;0.51 ng/mL/hr), 412 (45.98%) had HRH (&gt;2.64 ng/mL/hr), while 197 (21.99%) had NRH (0.51-2.64 ng/mL/hr). Renin-guided management caused significant BP reduction. In controlled BP group, the systolic BP (SBP)/diastolic BP (DBP) before and after modification were 133.83 ± 3.36/84.77 ± 3.12 and 123.87 ± 10.59/84.05 ± 1.84, respectively (p-value &lt; 0.05). In uncontrolled BP group, the corresponding SBP/DBP were 152.17 ± 2.95/90.36 ± 5.02 and 138 ± 1.23/87.78 ± 0.84, respectively (p-value &lt; 0.05). The number of hypertensives used in patients also reduced with reduction in patients on two, three, or four drugs. Renin-guided therapy is useful for improving BP control in both controlled and uncontrolled hypertensive patients and in reducing the number of antihypertensive drugs.

Estimation of Serum Calcium Level in the Patients of Hypertension

Background: Hypertension is one of the leading progressive cause of mortality and morbidity in developed as well as developing countries all over the world. Intracellular and extracellular ions of the body regulate the hemostasis of blood pressure. Objective: To estimate the serum calcium level in the patients of newly diagnosed cases of hypertension with normotensive set of subjects. Methodology: This case comparative study was conducted at the medical OPD of Bilawal Medical College and LUMHS Hospital Hyderabad and Jamshoro. 100 subjects were chosen and divided into two groups: 50 normotensive as a control group and 50 hypertensive as a case study group. Selection of samples was done on the basis of the non-probability technique. A sphygmomanometer was used to measure blood pressure, and a kit method was used to measure serum calcium levels. The statistical analysis of the data was carried out by SPSS version 22 by applying the student t test. Results: The mean age of control group subjects was 44 ± 6 years and control group was 42 ± 7 years. The mean systolic Blood pressure of control group was 110 ± 5 mmHg, while in case study group it was 140 ± 10 mmHg. The mean Diastolic blood pressure of control group was 80 ± 5 mmHg, while in case study group it was 105 ± 5 mmHg. The mean serum calcium level in control group was 9.82 ± 0.68 mg/dl and in case study group it was 8.45 ± 0.47 mg/dl. There was significant (p &lt;0.05) difference of serum calcium level was observed in case study group (hypertensive subjects group). Conclusion: This study concluded that disturbance in intracellular calcium levels can be one of contributory factor in the pathogenesis of essential hypertension. Keywords: Essential Hypertension, Serum Calcium, Intracellular Calcium, Blood Pressure.

KOMBINASI SLOW DEEP BREATHING DAN RELAKSASI AUTOGENIK TERHADAP TEKANAN DARAH PENDERITA HIPERTENSI USIA PRODUKTIF

Introduction: High blood pressure might be a trigger for a variety of diseases, including stroke and heart disease, which can reduce quality of life, primarily for individuals of productive age. This research aims to determine the influence of combination of slow deep breathing and autogenic relaxation to blood pressure in hypertension patients with productive age. Method: The research design used Quasi Experimental with Pretest and Posttest Control Group Design approach. The study population were 114 people and sample obtained 36 respondents with hypertension through purposive sampling technique. The intervention was given once a day for 3 consecutive days with a meeting duration around 25-35 minutes. Data were analyzed by Wilcoxon test and Mann Whitney test. Result and analysis: Based on the Wilcoxon test results, it was known that there was an influence of combination of slow deep breathing and autogenic relaxation to blood pressure in the treatment group perlakuan (Systolic pv = 0.000 &lt; α 0.05 and Diastolic pv= 0.001 &lt; α 0.05) and there was no change on blood pressure in control group (Systolic pv= 0.060 &gt; α 0.05, Diastolic pv = 0.180 &gt; α 0.05). The results of the Mann Whitney test showed that there were difference changes in systolic and diastolic blood pressure between the treatment group and the control group (Systolic pv= 0.000 &lt; α 0.05, Diastolic pv= 0.000 &lt; α 0.05). Discussion: The decrease in systolic and diastolic blood pressure occurs due to process of increasing endorphins secretion and stimulating parasympathetic system, resulting in vascular vasodilation. It is recommended for hypertension patients with productive age to able to apply this combination therapy independently with duration 25-30 minutes every day as an effort to lower blood pressure.

The association between office blood pressure and fluid status using bioimpedance spectroscopy in stable continuous ambulatory peritoneal dialysis patients

BackgroundHypertension is common in continuous ambulatory peritoneal dialysis (CAPD) patients. It remains to be determined the extent to which fluid overload contributes to uncontrolled blood pressure (BP) in this population. The aim was to determine the association between fluid status as measured using bioimpedance spectroscopy (BIS) and BP in CAPD patients.MethodsA cross-sectional study was performed involving 50 stable CAPD patients at a single center in Cape Town, South Africa. All participants were known to have hypertension and were divided into two groups based on office BP measurements: an uncontrolled BP group (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) and a controlled BP group. Fluid status was determined using BIS (Body Composition Monitor®, Fresenius Medical Care, Bad Homburg, Germany).ResultsThere was a statistically significant difference in overhydration (OH) between the uncontrolled BP group and the controlled BP group (3.0 ± 2.3 L vs. 1.4 ± 1.6 L, respectively, P = 0.01). The uncontrolled BP group was older (37.7 ± 9.5 years vs. 32.0 ± 8.0 years, P = 0.04) and had a shorter dialysis vintage (15 [IQR, 7–22] months vs. 31 [IQR, 12–39] months, P = 0.02). Significant correlations were found between OH and the extracellular water (ECW) (r = 0.557, P < 0.01) and ECW to total body water (TBW) ratio (r = 0.474, P < 0.01). Mixed ancestry, presence of residual kidney function, ECW, and ECW to TBW ratio were identified as predictors of OH on multivariable linear regression.ConclusionsWe found that stable CAPD patients with uncontrolled BP had higher OH compared to patients whose BP was controlled.

Intensive or standard blood pressure control in patients with a history of ischemic stroke: RESPECT post hoc analysis.

The Recurrent Stroke Prevention Clinical Outcome (RESPECT) Study and its pooled analysis showed that intensive blood pressure (BP) lowering reduced recurrent stroke risk by 22% in patients with a history of stroke. Here, we report the effect of intensive BP lowering on the risk of recurrent stroke subtypes in patients with a history of ischemic stroke. RESPECT was a randomized clinical trial among 1280 people with a history of cerebral infarction or intracerebral hemorrhage. Participants were assigned to the intensive blood pressure control group (blood pressure < 120/80 mmHg) or standard blood pressure control group (blood pressure < 140/90 mmHg). In this post hoc analysis, we analyzed 1074 patients with a history of cerebral infarction. The mean BP at baseline was 140.7/81.4 mmHg. Throughout the follow-up period, the mean BP was 133.4/77.5 (95% CI, 132.7-134.1/76.9-78.2) mmHg in the standard group and 126.7/74.1 (95% CI, 126.0-127.4/73.5-74.8) mmHg in the intensive group. During a mean follow-up of 3.9 years, 78 first recurrent strokes occurred. Intensive treatment tended to reduce overall annual stroke recurrence (1.74% in intensive vs. 2.17% in standard; P = 0.351 by log-rank test) and did not change the risk of ischemic stroke (1.74% vs. 1.75%, P = 0.999) but markedly reduced the risk of hemorrhagic stroke (0.00% vs. 0.39%, P = 0.005). Beneficial effects of intensive BP control were observed for the risk of hemorrhagic stroke in patients with a history of ischemic stroke. The findings of this study indicate the benefit of intensive BP control for patients with a history of ischemic stroke at high risk of hemorrhagic stroke.

Nursing Intervention in Decrease of Blood Cholesterol and Blood Pressure in The Lansia Group Provided Cupping Therapy in The Village of Wedomartani Sleman

Background: Much alternative therapy such as cupping therapy in the community as one of the cheap treatment efforts without side effects makes the challenge and the goal for nursing staff improve nursing services. The unfinished scientific verification of cupping therapy's alternative therapy makes nurses need to prove decreased blood pressure and cholesterol levels in the elderly. Objective: Scientific proof of cholesterol and blood pressure decrease after Cupping Therapy in an elderly group in Wedomartani Village, Sleman Yogyakarta Indonesia. Method: quantitative type with pseudo experimental research design. Pre-test and Post-test nonequivalent control group. The treatment group was given wet cupping therapy, while the control group was given dry cupping. Respondents were selected using a purposive sampling technique. Blood pressure measurement uses a digital tensimeter and cholesterol measurement using a digital blood cholesterol level measuring device. Results: The elderly blood cholesterol levels after the average therapy decreased 42.89 mg/dl, whereas blood cholesterol levels in the control group decreased an average of 20.95 mg/dl. The blood pressure of the elderly systole in the intervention group after the average therapy decreased 10.74 mmHg, whereas the control group's systole blood pressure decreased an average of 1.58 mmHg. Diastole blood pressure in the treatment group decreased 3,48 mmHg, in the diastole blood pressure control group increased 5,26 mmHg. Conclusions: Wet and dry cupping are both significantly associated with decreased blood cholesterol and blood pressure levels, but wet cupping lowers blood cholesterol levels by a mean difference of 21.95 mg/dl and mean systole blood pressure of 3.74 mmHg and pressure diastole blood difference of mean 9.1 mmHg. Keyword: Blood Pressure. Cupping Therapy, Cholesterol, Elderly

Nursing Intervention in Decrease of Blood Cholesterol and Blood Pressure in The Lansia Group Provided Cupping Therapy in The Village of Wedomartani Sleman

Background: Much alternative therapy such as cupping therapy in the community as one of the cheap treatment efforts without side effects makes the challenge and the goal for nursing staff improve nursing services. The unfinished scientific verification of cupping therapy's alternative therapy makes nurses need to prove decreased blood pressure and cholesterol levels in the elderly. Objective: Scientific proof of cholesterol and blood pressure decrease after Cupping Therapy in an elderly group in Wedomartani Village, Sleman Yogyakarta Indonesia. Method: quantitative type with pseudo experimental research design. Pre-test and Post-test nonequivalent control group. The treatment group was given wet cupping therapy, while the control group was given dry cupping. Respondents were selected using a purposive sampling technique. Blood pressure measurement uses a digital tensimeter and cholesterol measurement using a digital blood cholesterol level measuring device. Results: The elderly blood cholesterol levels after the average therapy decreased 42.89 mg/dl, whereas blood cholesterol levels in the control group decreased an average of 20.95 mg/dl. The blood pressure of the elderly systole in the intervention group after the average therapy decreased 10.74 mmHg, whereas the control group's systole blood pressure decreased an average of 1.58 mmHg. Diastole blood pressure in the treatment group decreased 3,48 mmHg, in the diastole blood pressure control group increased 5,26 mmHg. Conclusions: Wet and dry cupping are both significantly associated with decreased blood cholesterol and blood pressure levels, but wet cupping lowers blood cholesterol levels by a mean difference of 21.95 mg/dl and mean systole blood pressure of 3.74 mmHg and pressure diastole blood difference of mean 9.1 mmHg. Keyword: Blood Pressure. Cupping Therapy, Cholesterol, Elderly

Abstract 068: Hypertension And Longitudinal Changes In Cardiac Structure And Function In The Hispanic Community Health Study/Study Of Latinos: Echocardiographic Study Of Latinos (Echo-SOL) Ancillary Study

Introduction: Hypertension, one of the most modifiable risk factors of heart disease, induces cardiac remodeling and worsens myocardial function prior to the development of clinical symptoms. Using a comprehensive cohort of Hispanic/Latino adults, we assessed cardiac structure and function, in relation to hypertension, and the longitudinal impact of blood pressure control. Hypothesis: If baseline hypertensive adults are stratified by longitudinal blood pressure (BP) control, there will be differences in the progression of cardiac structure and function parameters. Methods: The Echo-SOL Ancillary Study provided serial comprehensive echocardiographic assessments of Hispanic adults aged 45-74 years. They were arranged into two groups based on the presence of baseline hypertension (&gt;140/90mmHg). Linear regression models were used to estimate the association between baseline BP properties and the longitudinal change in echocardiogram parameters. We then subdivided each group based on whether the they maintained BP control (&lt;140/90mmHg) on follow up and used linear regression models to test for significance among the mean longitudinal change of echocardiogram parameters. All analyses accounted for the complex sampling design of HCHS/SOL and Echo-SOL. Results: There was a total of 1818 adults at baseline, with 1643 obtaining serial echocardiograms an average of 4.3 years later, mean age of approximately 56 years. Among all adults, baseline pulse pressure was significantly associated with a longitudinal increase in left ventricular (LV) end diastolic volume (β=0.13, p=0.02), whereas the change in LV mass index longitudinally decreased with baseline diastolic BP (β=-0.14, p&lt;0.01). When isolating the subgroup defined as hypertensive at baseline, the adults who had uncontrolled BP on follow up had a greater absolute increase in the average E/E’ ratio and greater decrease in average E’ velocity, 0.95±0.08 and -0.96±0.06 respectively, compared to the adults with controlled BP 0.04±0.07 and -0.74± 0.04 respectively (p&lt;0.01). In addition, the controlled BP group had a greater absolute reduction in LV end-diastolic volume of 6.94mL than those with uncontrolled BP, 4.60mL (p&lt;0.01). Conclusions: Our study is the first to study the association of longitudinal impact of blood pressure control with cardiac structure and function in Hispanic/Latino adults. We found that higher baseline brachial BP properties were associated with reduced in LV mass index and increased LV end diastolic volumes. Among the baseline hypertensive adults, there was a significantly higher progression in diastolic dysfunction among the participants who had poor BP control, but those with controlled BP on follow up had greater LV enlargement. Despite these differences, both subgroups ultimately showed a collective progression in diastolic dysfunction and a decrease in end-diastolic volume over time.

Home blood pressure during COVID-19 related lockdown in patients with hypertension

Funding AcknowledgementsType of funding sources: None.COVID-19 pandemic has induced governments to promote strict containment measures which inevitably altered patients’ lifestyle with potential effects on blood pressure (BP) control. We aimed to evaluate the changes in home BP (HBP) during the COVID-19 related lockdown in a cohort of hypertensive patients.Consecutive adult patients with arterial hypertension and stable medical treatment were recruited. HBP values were recorded before and after lockdown in March 2020. An additional set of HBP measurements, recorded one year before the pre-lockdown period, were also considered as reference because of similar environmental temperature.A total of 126 patients were included: 47% males, mean age 66 [58-72], reference HBP 124.78 (9.90)/76.19 (8.10) mmHg. In the whole group, patients during lockdown exhibited lower systolic and diastolic HBP values compared to the pre-lockdown period [123.23 vs 125.05 mmHg, p = 0.008 and 74.45 vs 75.28 mmHg, p = 0.023, respectively]. Patients with uncontrolled HBP showed the most consistent drop of systolic HBP [136.06 (8.36) and 138.0 (2.08) vs 130 (9.35) p = 0.001 and p < 0.001] and diastolic [81.30 (6.75) and 84.9 (1.85) vs 78.78 (9.25), p = 0.018 and p = 0.002] from pre-lockdown to lockdown and when considering reference values taken one year before, respectively. (Figure 1: Mean values at baseline, pre-lockdown and during lockdown in the 3 groups for systolic (A) and diastolic (B) blood pressure (dotted line = uncontrolled BP group, solid line = unstable BP control, dashed line = controlled BP group). *p<.001 (one year before lockdown vs lockdown SBP), #p = 0.001 (pre-lockdown vs lockdown SBP), $p = 0.002 (one year before lockdown vs lockdown DBP), §p = 0.018 (pre-lockdown vs lockdown DBP). Grey box refers to the lockdown period. SBP = systolic blood pressure, DBP = diastolic blood pressure.) In conclusion, this study reports for the first time the occurrence of no changes or even a reduction in home BP of treated hypertensive patients during lockdown due to COVID-19. These results may have implications for the management of patients with high blood pressure not only during the current pandemic but also in case of future lockdown conditions. Figure 1

Changes in Home Blood Pressure Monitored Among Elderly Patients With Hypertension During the COVID-19 Outbreak: A Longitudinal Study in China Leveraging a Smartphone-Based Application.

The coronavirus disease 2019 (COVID-19) pandemic has impacted clinical care worldwide. Evidence of how this health crisis affected common conditions like blood pressure (BP) control is uncertain. We used longitudinal BP data from an ongoing randomized clinical trial to examine variations in home BP monitored via a smartphone-based application (app) in a total of 7394 elderly patients with hypertension aged 60 to 80 years stratified by their location in Wuhan (n=283) compared with other provinces of China (n=7111). Change in morning systolic BP (SBP) was analyzed for 5 30-day phases during the pandemic, including preepidemic (October 21 to November 20, 2019), incubation (November 21 to December 20, 2019), developing (December 21, 2019 to January 20, 2020), outbreak (January 21 to February 20, 2020), and plateau (February 21 to March 21, 2020). Compared with non-Wuhan areas of China, average morning SBP (adjusted for age, sex, body mass index) in Wuhan patients was significantly higher during the epidemic growth phases, which returned to normal at the plateau. Between-group differences in ΔSBP were +2.5, +3.0, and +2.1 mm Hg at the incubation, developing, and outbreak phases of COVID-19 (P<0.001), respectively. Sensitivity analysis showed a similar trend in trajectory pattern of SBP in both the intensive and standard BP control groups of the trial. Patients in Wuhan also had an increased regimen change in antihypertensive drugs during the outbreak compared with non-Wuhan patients. Expectedly, Wuhan patients were more likely to check their BP via the app, while doctors were less likely to monitor the app for BP control during the pandemic. Our data demonstrate that the COVID-19 pandemic was associated with a short-term increase in morning SBP among elderly patients with hypertension in Wuhan but not other parts of China. Further study will be needed to understand if these findings extended to other parts of the world substantially affected by the virus. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03015311.

Effects of Angiotensin II type I receptor shRNA on blood pressure and left ventricular remodeling in spontaneously hypertensive rats.

This study was designed to investigate the effects of the Angiotensin II type I receptor (AT1R) shRNA on blood pressure and left ventricular remodeling in spontaneously hypertensive rats. Ten Wistar Kyoto (WKY) rats were used as a normal blood pressure control group, and 20 spontaneously hypertensive rats (SHR) were randomly divided into the experimental and hypertension control groups. The rats in the experimental group were injected with AT1R shRNA recombinant adenovirus (Ad5-AT1R-shRNA) via a tail vein, and the rats in the other two groups were injected with recombinant adenovirus (Ad5-EGFP). The systolic blood pressure (SBP) at rat arteria caudalis was measured before and after the injection, and the heart, kidney, aorta, and adrenal tissues were obtained two days after repeated injection to observe the distribution of Ad5-AT1R-shRNA under a fluorescence microscope. Before the injection of Ad5-AT1R-shRNA, the blood pressure of the experimental group and the hypertension control group was significantly higher than that of the normal blood pressure control group (P<0.01). After two injections, the blood pressure in the experimental group decreased significantly, and the duration of blood pressure reduction reached 19 days. In the experimental group, the kidney, heart, aorta, and adrenal gland tissues showed vigorous fluorescence expression under the fluorescence microscope. Repeated administration of Ad5-AT1R-shRNA has a long-lasting hypotensive effect on SHR and can significantly improve ventricular remodeling.