Blood Pressure In Group Research Articles

Abstract P117: Hydralazine Prevents the Rupture of Experimental Cerebral Aneurysms in Hypertensive Rats

Introduction: Subarachnoid hemorrhage (SAH) is a catastrophic event with high morbidity and a poor prognosis. While epidemiological studies showed that hypertension is a risk factor for aneurysmal rupture, it remains unclear whether lowering the blood pressure (BP) prevents the rupture of aneurysms. Under the hypothesis that lowering the BP prevents the rupture of experimental cerebral aneurysms, we investigated whether hydralazine reduces the incidence and rupture of aneurysms in our rat model. Methods: In 10-week-old female Sprague-Dawley rats (n=34) we elicited estrogen deficiency, renal hypertension, and hemodynamic stress. Two weeks later, they were divided into 2 groups; group 1 (n=17) was treated perorally with hydralazine (100 mg/kg/day), group 2 (n=17) was the vehicle control. We recorded their death or abnormal behavior in the course of 90 days and inspected ruptured aneurysms. Results: At 2 weeks, both groups manifested an increase in the systolic BP (SBP) (group 1, 205 mmHg; group 2, 207 mmHg). After 30-, 60-, and 90-days, the SBP was lower in group 1 than group 2 (150 vs 210 mmHg, 163 vs 211 mmHg, and 173 vs 210, mmHg, respectively). In the course of 90 days, 9 group 2 (53%) and 8 group 1 rats (47%) developed cerebral aneurysms. The rupture rate was lower in group 1 (3/8, 38%) than group 2 rats (9/9: 100%). While hydralazine did not prevent the development of aneurysms, it prevented their rupture. qRT-PCR performed on day 35 showed the down-regulation of MCP-1 and MMP-9 in the cerebral vascular wall of group 1 rats. Conclusion: Our findings suggest that lowering the SBP may prevent the rupture of cerebral aneurysms via the down-regulation of MCP-1 and MMP-9 in the cerebral vascular wall.

PP.06.18] SEASONAL BLOOD PRESSURE CHANGES IN HIGH NORMAL, NORMAL AND OPTIMAL BLOOD PRESSURE PATIENTS WITHOUT ANTIHYPERTENSIVE MEDICATION

Objective: Many investigators supposed that seasonal blood pressure (BP) changes are one of the reasons of fatal and nonfatal cardiovascular events. These studies included mainly the patients with arterial hypertension and the division of patients into groups with high normal (HNBP) or normal and optimal BP was not done. The aim of study was to estimate the seasonal differences in clinical (CBP) and ambulatory BP (ABP) in patients with HNBP and normal and optimal BP. Design and method: The ambulatory patients from the ABP monitoring database (>2000 patients) were selected according to the following criteria: absence of any antihypertensive treatment, availability of CBP and ABPM records in winter or summer, CBP<140 and 90 mmHg. Standard statistical methods were used. Results: The preliminary data of the on-going study are demonstrated. We selected 355 patients: 206 with HNBP and 149 with normal and optimal BP. The main characteristics of groups and seasonal BP changes are presented in Table. In patients with HNBP only systolic CBP was significantly higher in winter than in summer. We found similar tendency for ABP data in these patients despite relatively small differences. In patients with normal and optimal BP only diastolic ABP was higher in winter; in contrast, nighttime systolic BP was higher in summer. At the same time, average values of CBP and ABP in the normal and optimal BP group did not exceed threshold limits.Conclusions: Some of the ABP parameters in patients with HNBP without antihypertensive medication are increased in winter and exceed normal values. This factor may contribute to the increase of cardiovascular events incidence in winter. The problem should be studied in prospective investigations.

Poor sleep quality is responsible for the nondipper pattern in hypertensive but not in normotensive chronic kidney disease patients.

This study was designed to evaluate the relationship between sleep quality and hypertension and to determine if there was an association between nondipper blood pressure (BP) and sleep quality in chronic kidney disease (CKD) patients. A total of 775 pre-dialysis CKD patients (314 normal BP patients, 461 hypertension patients) defined as dippers or nondippers by ambulatory BP monitoring were recruited for this study. Demographics and clinical correlates were collected, including body mass index, estimated glomerular filtration rate (eGFR) and other measures. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). A total of 185 (58.9%) patients with normal BP and 341 (74.0%) hypertensive patients had a nondipper BP pattern. The hypertension group had a higher prevalence of the nondipper BP pattern, smoking, alcohol intake and diabetes mellitus (DM) and lower eGFR levels and poorer sleep quality than the normal BP group. Patients with the nondipper BP pattern had lower haemoglobin, worse renal function and poorer sleep quality when compared with hypertensive CKD patients with the dipping BP pattern. PSQI scores were significantly associated with the rate of nocturnal BP decline (P < 0.05) in the hypertension group but not in the normal BP group. Poor sleep quality was an independent factor affecting BP pattern in hypertensive CKD patients using multivariate linear and logistic regression analyses. There was no association between sleep quality and hypertension in CKD patients after multivariate logistic regression analyses. Poor sleep quality, which is commonly observed in pre-dialysis CKD patients, is an independent associated factor of the nondipper BP pattern in hypertensive CKD patients. No association was found between poor sleep and nondipper BP in normotensive patients.

Does resting heart rate measured by the physician reflect the patient’s true resting heart rate? White-coat heart rate

ObjectivesIn cardiology, resting heart rate (HR) and blood pressure (BP) are key elements and are used to adapt treatment. However HR measured in consultation may not reflect true resting HR. We hypothesize that there may be a “white-coat” effect like with BP and that there may be an association between HR variations and BP variations. MethodsThis prospective, monocentric, observational, pilot study (January-April 2016) included 57 consecutive ambulatory patients at Poitiers University Hospital, France (58% male, mean age 64 years). Patients’ resting HR and BP were recorded with the same automated blood pressure sphygmomanometer in consultation by the physician then with self-measurement at home. ResultsIn the overall cohort, we found that HR was significantly higher in consultation (70.5bpm±12.6 vs. 68.1bpm±10.1, p=0.034). HR also correlated with diastolic BP (r=0.45, p=0.001).Patients were divided into three groups to look for associations with BP: masked HR, (higher HR at home, 38.6%), white-coat HR, (lower HR at home 52.6%) and iso HR, (no change between HR at home and consultation, 8.8%).Although there was no difference between groups in diastolic BP measured in consultation, home diastolic BP was lower in the white-coat HR group (74.3mmHg±9.8 vs. 77.9mmHg±7.5, p=0.016). ConclusionsOur study brings to light an exciting idea that could have a major therapeutic and maybe prognostic impact in cardiology: resting HR measured by the physician in consultation does not reflect true resting HR. This must be taken into account to adapt treatment.

Corelaţii între hipertensiunea arterială şi evoluţia retinopatiei diabetice la pacienţii cu diabet zaharat tip II

Diabetic retinopathy is a well-known complication of diabetes, a major cause of vision loss worldwide. Purpose. The present study investigates the correlation between hypertension and evolution of diabetic retinopathy in patients with type II diabetes. Materials and methods. We conducted a prospective study between June and December 2016, on 24 patients hospitalized in Ophthalmology Clinic, Emergency University Hospital Bucharest, with AO: diabetic retinopathy and arterial hypertension under medical treatment. Patients were evaluated at baseline, 2 months, 4 months and 6 months through comprehensive eye examination and measuring the value of blood pressure (BP). Comparative data were analyzed in patients with compensated hypertension (BP&lt;150 mmHg) and subcompensated hypertension (BP&gt; = 150 mmHg). Results. Of the 24 patients, 15 had values offset BP (group A) and 9 associated hypertension subcompensated (group B). In group A proportion of patients (at baseline) with diabetic retinopathy absent or nonproliferative was higher than patients in group B (47% vs. 22%, p = 0.052995019518117). Patients in group B had a higher tendency to record an evolution of diabetic retinopathy (in group B, 55.55% of patients had a progression, and in group A, only 26.66%). Conclusions. Incomplete therapeutic control of hypertension may affect the retinal microvasculature impacting the progression of diabetic retinopathy. Maintaining a strict control of systolic BP of permanent value bellow 140 mmHg should be part of the patient management guide of the diabetic patient in order to prevent ophthalmic complications with major risk of vision loss.

Impact of the Management of Type B Aortic Dissection on the Long-Term Blood Pressure

Ambulatory blood pressure (BP) measurement (ABPM) is recommended to assess optimal BP control, and we studied its influence after an acute type B aortic dissection (ATBAD). We retrospectively collected data from 111 patients with ATBAD from January 2004 to September 2014. Controlled BP group was defined according to a 24-hour BP under 130/80mm Hg during chronic phase. The population consisted of 85 men, with a mean age of 61±13years and mean body mass index of 28±6kg/m2. The median delay between ambulatory BP measurement and ATBAD was 2 (0.3 to 4) months. The mean 24-hour BP of the entire population was 124/71±15/8.8mm Hg. BP was not controlled in 41 patients (37%). The treatment score at discharge was 3.9±1.4. The mean glomerular filtration rate was 83±28ml/min/1.73m2, with no difference between groups. Visceral stent implantation in the acute phase (odds ratio [OR] 3.857 [1.199 to 12.406], p= 0.023), higher left ventricular ejection fraction (OR 1.092 [1.005 to 1.187], p= 0.038), and higher platelet count at discharge (OR 1.064 [1.018 to 1.112], p= 0.006) were identified as predictors of good BP control by multivariate analysis. The analysis showed that nighttime systolic BP was associated with aortic events during follow-up (hazard ratio [HR] 5.2 [1.01 to 27.2], p= 0.049), particularly for a threshold of 124mm Hg or more (HR 1.967 [1.052 to 3.678], p= 0.0341). Nighttime pulse pressure showed also its significance (HR 20.1 [1.4 to 282.7], p= 0.026). In conclusion, subclinical renal malperfusion revascularization seems to improve BP control. A greater nighttime systolic BP was associated with the risk of new aortic events during follow-up.

Effect of Aggressive Blood Pressure Control on the Recurrence of Atrial Fibrillation After Catheter Ablation: A Randomized, Open-Label Clinical Trial (SMAC-AF [Substrate Modification With Aggressive Blood Pressure Control]).

Radiofrequency catheter ablation for atrial fibrillation has become an important therapy for AF; however, recurrence rates remain high. We proposed to determine whether aggressive blood pressure (BP) lowering prevents recurrent atrial fibrillation (AF) after catheter ablation in patients with AF and a high symptom burden. We randomly assigned 184 patients with AF and a BP >130/80 mm Hg to aggressive BP (target <120/80 mm Hg) or standard BP (target <140/90 mm Hg) treatment before their scheduled AF catheter ablation. The primary outcome was symptomatic recurrence of AF/atrial tachycardia/atrial flutter lasting >30 seconds, determined 3 months beyond catheter ablation by a blinded end-point evaluation. The median follow-up was 14 months. At 6 months, the mean systolic BP was 123.2±13.2 mm Hg in the aggressive BP treatment group versus 135.4±15.7 mm Hg (P<0.001) in the standard treatment group. The primary outcome occurred in 106 patients, 54 (61.4%) in the aggressive BP treatment group compared with 52 (61.2%) in the standard treatment group (hazard ratio=0.94; 95% confidence interval, 0.65-1.38; P=0.763). In the prespecified subgroup analysis of the influence of age, patients ≥61 years of age had a lower primary outcome event rate with aggressive BP (hazard ratio=0.58; 95% confidence interval, 0.34-0.97; P=0.013). There was a higher rate of hypotension requiring medication adjustment in the aggressive BP group (26% versus 0%). In this study, this duration of aggressive BP treatment did not reduce atrial arrhythmia recurrence after catheter ablation for AF but resulted in more hypotension. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00438113.

Are There Predictable Blood Pressure Patterns After Delivery in Women With Preeclampsia? [20B

INTRODUCTION: There is limited data on blood pressure(BP) patterns after delivery among women diagnosed with preeclampsia. We sought to investigate immediate postpartum BP trajectories and the impact of fluid balance on these patterns. METHODS: Prospective cohort of women with preeclampsia from 2005-2009. Group-based trajectories were created using latent-class models based on all individual BPs from delivery to 48 hours postpartum. Fluid balance was defined as input minus output from admission until 24 hours postpartum. Odd ratios were calculated for association between BP group, fluid balance, mode of delivery, length of labor, and disease severity. RESULTS: 96 women were evaluated. A model identifying four distinct patterns best fit the BP trajectories (class 1 (n=28):initial decrease in BP followed by rise at discharge, class 2(n=11):persistently elevated BPs, class 3(n=25):rising BPs until discharge, class 4(n=32):normal BP control). There was a statistically significant association between maternal age (p=0.0004) and initial weight(p=0.0005), parity(p=0.02), history of hypertension(p=0.035) or preeclampsia(0.024), and gestational age at delivery(p=0.018) with BP group. Women with a fluid balance greater than 500 cc and cesarean delivery after more than 12 hours of labor were more likely to be in group 3 vs 4(OR 3.97, p=0.03; OR 8.4, p=0.001). Severity of disease(p=0.36) was not associated with BP group. CONCLUSION: There are distinct patterns of BP immediately postpartum. Persistent hypertension is associated with age, chronic hypertension, fluid balance, length of labor, and mode of delivery. Future investigations should evaluate whether diuresis, as a modifiable factor, can alter patterns of BP and expedite resolution of hypertension in the postpartum period.

Cardiovascular findings in ponies with equine metabolic syndrome.

OBJECTIVE To determine whether hypertension, high sympathetic tone, resting and exercising arrhythmias, and echocardiographic changes consistent with hypertensive cardiomyopathy were associated with equine metabolic syndrome (EMS) in ponies. DESIGN Prospective case-control study. ANIMALS 19 privately owned ponies with a diagnosis of EMS (history of laminitis, body condition score ≥ 7/9, cresty neck score ≥ 3/5, and abnormal oral sugar test result; cases) and 20 healthy control ponies. PROCEDURES Heart rate (HR), noninvasively measured arterial blood pressure (BP), markers of autonomic tone (splenic volume and HR variability), 24-hour and exercising ECGs, and echocardiograms were compared between cases and controls. RESULTS Compared with controls, cases had a higher mean ± SD HR (44.5 ± 7.5 beats/min vs 38.6 ± 6.8 beats/min) and median mean left ventricular wall thickness (2.0 cm vs 1.8 cm). No differences were identified between groups in BP, splenic volume, HR variability, and number of premature complexes in ECGs. Mean wall thickness was correlated with BP (r = 0.54), high-frequency power (r = -0.71), and ratio of low-to high-frequency power (ϕ = 0.66). Relative wall thickness was correlated with serum insulin concentration (r = 0.71). CONCLUSIONS AND CLINICAL RELEVANCE Ponies with EMS had myocardial hypertrophy that was correlated with insulin response to an oral sugar test, sympathetic and parasympathetic tone, and BP. The heterogeneity and limited sample size of this preliminary study should be considered when drawing conclusions. Cardiovascular changes associated with this syndrome deserve further attention.

Frequency, Predictors, and Implications of Abnormal Blood Pressure Responses During Dobutamine Stress Echocardiography.

It is not known whether abnormal blood pressure (BP) responses during dobutamine stress echocardiography (DSE) are associated with abnormal test results, nor if such results indicate obstructive coronary artery disease (CAD). We sought to define the frequency of abnormal BP responses during DSE and their impact on accuracy of test results. We studied 21 949 patients who underwent DSE at Mayo Clinic, Rochester, MN, grouped by peak systolic BP achieved during the test. We also analyzed a subgroup who underwent coronary angiography within 30 days after positive DSE. The positive predictive value of DSE was calculated for each BP group. Patients with hypertensive response (n=1905; 9%) were more likely to have positive DSE than those with normal (n=19 770; 90%) or hypotensive (n=274; 1%) BP responses (32% versus 21% versus 23%, respectively; P<0.0001). Angiography, performed in 1126 patients, showed obstructive CAD (≥50% stenosis) in 814 patients and severe CAD (≥70% stenosis) in 708 patients. Positive predictive value of DSE was similar for patients who had hypertensive and normal BP responses (69% versus 73%; P=0.3), considering 50% stenosis cut point. The proportion of severe CAD (≥70% stenosis) was lower in patients who had hypertensive response compared with those who had normal BP response (54% versus 65%; P=0.005). Patients with hypertensive response during DSE are more likely to have stress-induced myocardial ischemia compared with those with normal or hypotensive BP responses but are not more likely to have false-positive DSE results. They are, however, less likely to have higher grade or multivessel CAD.

High Stroke Volume Variation Is an Independent Predictor for Decreased Blood Pressure During Hemodialysis.

It currently remains unclear whether stroke volume variation (SVV) before hemodialysis (HD) is an independent predictor of decreased blood pressure (BP) during HD. Fifty-two patients were divided into two groups (Decreased BP during HD group: N=10, Non-decreased BP group: N=42). Fractional shortening was lower, and mean arterial pressure (MAP) and SVV were higher in the Decreased BP during HD group. A multiple logistic regression analysis identified low fractional shortening, high MAP, and high SVV as independent predictors of decreased BP during HD. The areas under the ROC curves were as follows: 0.849 for MAP, 0.712 for SVV, and 0.893 for MAP and SVV. Optimal threshold values were 93.0mm Hg for MAP and 17.3% for SVV. A multivariate regression analysis identified anemia and a longer dialysis vintage as independently related factors for higher SVV. Our results suggest that high SVV is an independent predictor for decreased BP during HD.

Blood Pressure Trajectories From Childhood to Young Adulthood Associated With Cardiovascular Risk: Results From the 23-Year Longitudinal Georgia Stress and Heart Study.

The purpose of this study is to identify subgroups of individuals with similar trajectories in blood pressure (BP) from childhood to young adulthood and to determine the relationship of BP trajectories with carotid intima-media thickness (IMT) and left ventricular mass index (LVMI). BP was measured ≤16 times during a 23-year period in 683 participants from childhood to young adulthood. IMT and LVMI were measured in 551 participants and 546 participants, respectively. Using latent class models, 3 trajectory groups in BP from childhood to young adulthood were identified, including high-increasing, moderate-increasing, and low-increasing groups. We found that trajectory of systolic BP was a significant predictor of both IMT and LVMI with increased rate of growth in systolic BP associated with higher levels of IMT and LVMI (Pfor trend <0.001). Similar to the BP trajectory groups from childhood to young adulthood, 3 trajectory groups in BP during childhood (≤18 years) were identified, and participants in the high-increasing group had thicker IMT (P<0.001) and increased LVMI (P=0.043) in comparison with those in the low-increasing group. Results were similar for mid-BP trajectories but not for diastolic BP trajectories. Our results suggested that different BP trajectories exist from childhood to young adulthood, and the trajectories were independently associated with IMT and LVMI. We, for the first time, reported the association between systolic BP trajectories derived from childhood with subclinical cardiovascular risk in young adulthood, indicating that monitoring trajectories of BP from childhood may help identify a high cardiovascular risk population in early life.

Predictors of blood pressure control in patients with resistant hypertension.

Uncontrolled resistant hypertension (RH) defined by the mean 24-hour ambulatory blood pressure (ABPM) represents an independent risk factor in hypertensive patients. Predictors of blood pressure (BP) control in RH are not yet clearly defined. To evaluate the predictors of BP control in RH patients with repeated ABPM measurements. 114 consecutive patients from outpatient cardiology office fulfilling criteria for RH (office BP ≥ 140 and/or 90 mmHg, with treatment of ≥ 3 antihypertensive drugs, including diuretic, or controlled BP with > 3 drugs), with two consecutive ABPM studies were compared in clinical characteristics according to BP control assessed by ABPMRESULTS: After the second ABPM, BP was controlled in 25.4 % of patients; the remaining 74.6 % were classified as uncontrolled. In the uncontrolled BP group, systolic office BP was 140.91±16.71 mmHg, diastolic 81.26 ± 10.92 mmHg. In ABPM, systolic was 145.11 ± 13.65 mmHg, diastolic 81.26 ± 10.92 mmHg. Compared to the controlled BP group, in the uncontrolled group the age was higher 72.32 ±10.89 years (p = 0.047), baseline average real variability of systolic BP was lower 12.66 ± 3.08 vs. 14.52 ± 3.53 (p = 0.013), no significant difference in baseline standard deviation of systolic BP changes was found. Higher office BP, older age, and increased short term BP variability were associated with an uncontrolled hypertension. Stronger association was found with baseline average real variability rather than standard deviation. No significant differences were found in the dipping status and other clinical characteristics (Tab. 6, Fig. 1, Ref. 28).

Heart rate recovery in hypertensive patients: relationship with blood pressure control

Delayed heart rate recovery (HRR) post treadmill exercise testing reflects autonomic dysfunction and is related to worse cardiovascular outcome. The present study compared HRR in normotensive subjects and hypertensive patients taking anti-hypertensive medications with controlled blood pressure (BP) and uncontrolled BP. A total of 279 consecutive patients with (n=140, HP) and without (n=139, N-HP) essential hypertension who were hospitalized in our department during May 2012 to March 2016 were included in this study. All subjects underwent treadmill exercise testing. Hypertensive patients were divided into controlled BP (n=88) and uncontrolled BP (n=52) groups according to their BP prior to treadmill exercise testing. Body mass index, triglyceride level and incidence of diabetes mellitus (DM) were significantly higher in the HP group than in the N-HP group, and HDL-c and HRR were significantly lower. Male gender, higher creatinine value and lower cholesterol and HDL-c were associated with lower HRR in the N-HP group, and higher triglyceride, lower LDL-c, and HDL-c were associated with lower HRR in the HP group. More frequent, ⩾3, antihypertensive drug use, less monotherapy use and high incidence of smokers and lower HRR were found in hypertensive patients with uncontrolled BP compared to hypertensive patients with controlled BP. The present results demonstrate that uncontrolled BP following antihypertensive medication is associated with lower HRR in hypertensive patients.

Prehypertension is associated with early complications of atherosclerosis but not with exercise capacity

BackgroundPrehypertension has a high risk of progression to hypertension, and intensive lifestyle modification including regular exercise is recommended for the management of prehypertensive individuals. However, data on the association between exercise capacity and hypertension status are limited. Therefore, we aimed 1) to define the characteristics of prehypertension, focusing on metabolic aspects and exercise capacity, and 2) to elucidate determinants of exercise capacity in healthy individuals without hypertension. MethodsWe retrospectively identified 741 normotensive healthy subjects (mean age, 52.6±8.8years; 57.9% men) who underwent consecutive cardiopulmonary exercise testing. The participants were categorized into two groups: the optimal blood pressure (BP) (systolic BP<120mmHg and diastolic BP<80mmHg, n=364) and prehypertension (systolic BP 120–139mmHg and/or diastolic BP 80–89mmHg, n=377) groups. Exercise capacity was assessed with peak oxygen consumption. ResultsThe prehypertension group showed metabolic syndrome characteristics, and had increased left ventricular mass index and impaired diastolic function. However, no significant differences in exercise capacity were found between the optimal BP and prehypertension groups (peak VO2, 25.3±7.2 vs. 25.8±7.3mL/kg/min, p=0.327). Age, resting heart rate, and fat percentage were identified as independent determinants of exercise capacity (p<0.001 for all). ConclusionsPrehypertension is associated with metabolic disarrangement and preclinical target organ damage but not with exercise capacity. Exercise capacity is determined by age, resting heart rate, and body composition in relatively healthy individuals who do not have hypertension.

Higher Stroke Risk with Lower Blood Pressure in Hemodynamic Vertebrobasilar Disease: Analysis from the VERiTAS Study

Despite concerns regarding hypoperfusion in patients with large-artery occlusive disease, strict blood pressure (BP) control has become adopted as a safe strategy for risk reduction of stroke. We examined the relationship between BP control, blood flow, and risk of subsequent stroke in the prospective Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke (VERiTAS) study. The VERiTAS study enrolled patients with recent vertebrobasilar (VB) transient ischemic attack or stroke and ≥50% atherosclerotic stenosis or occlusion of vertebral or basilar arteries. Hemodynamic status was designated as low or normal based on quantitative magnetic resonance angiography. Patients underwent standard medical management and follow-up for primary outcome event of VB territory stroke. Mean BP during follow-up (<140/90 versus ≥140/90 mm Hg) and flow status were examined relative to subsequent stroke risk using Cox proportional hazards analysis. The 72 subjects had an average of 3.8 ± 1.2 BP recordings over 20 ± 8 months of follow-up; 39 (54%) had mean BP of<140/90 mm Hg. The BP groups were largely comparable for baseline demographics, risk factors, and stenosis severity. Comparing subgroups stratified by BP and hemodynamic status, we found that patients with both low flow and BP <140/90 mm Hg (n = 10) had the highest risk of subsequent stroke, with hazard ratio of 4.5 (confidence interval 1.3-16.0, P = .02), compared with the other subgroups combined. Among a subgroup of patients with VB disease and low flow, strict BP control (BP <140/90) may increase the risk of subsequent stroke.

Total antihypertensive therapeutic intensity score and its relationship to blood pressure reduction

Predicting blood pressure (BP) response to antihypertensive therapy is challenging. The therapeutic intensity score (TIS) is a summary measure that accounts for the number of medications and the relative doses a patient received, but its relationship to BP change and its utility as a method to project dosing equivalence has not been reported. We conducted a prospective, single center, randomized controlled trial to compare the effects of Joint National Committee (JNC) 7 compliant treatment with more intensive (<120/80 mm Hg) BP goals on left ventricular structure and function in hypertensive patients with echocardiographically determined subclinical heart disease who were treated over a 12-month period. For this preplanned subanalysis, we sought to compare changes in BP over time with changes in TIS. Antihypertensive therapy was open label. TIS and BP were determined at 3-month intervals with titration of medication doses as needed to achieve targeted BP. Mixed linear models defined antihypertensive medication TIS as an independent variable and change in systolic BP as an outcome measure, while controlling for gender, age, baseline BP, and treatment group. A total of 123 patients (mean age 49.4 ± 8.2 years; 66% female; 95.1% African-American) were enrolled and 88 completed the protocol. For each single point increase in total antihypertensive TIS, a 14.5 (95% confidence interval: 11.5, 17.4) mm Hg decrease in systolic BP was noted (15.5 [95% confidence interval: 13.0, 18.0] mm Hg for those who completed the trial). Total TIS is a viable indicator of the anticipated BP-lowering effect associated with antihypertensive therapy.

The influence of resting blood pressure on muscle strength in healthy adults.

Adverse alterations in the skeletal muscle response to exercise have been noted among adults with hypertension. The influence of resting blood pressure (BP) on muscle strength is unknown. We hypothesized that adults with high BP would exhibit lower muscular strength than adults with normal BP. An isokinetic dynamometer tested 21 measures of isometric and isokinetic muscle strength. BP was measured by auscultation. Patients were categorized into having normal (<120 and <80 mmHg) or high (≥120 and/or ≥80 mmHg) BP. Height (cm) and weight (kg) were measured to calculate BMI (kg/m). Analysis of covariance tested differences in muscle strength between BP groups with sex, age, and height as covariates. Patients [420 (49%) men] were middle-aged (44.1±16.1 years) and overweight (26.4±4.8 kg/m) with 187 having normal (107.7±7.3/68.3±6.3 mmHg) and 233 having high (127.8±9.8/80.8±8.1 mmHg) BP. For upper body, three of five extension measures and five of five flexion measures, as well as handgrip, were greater in the high than the normal BP group (P≤0.05). For lower body, five of five extension measures were greater in the high than the normal BP group, whereas there were no differences between BP groups for the five flexion measures (P>0.05). Contrary to our hypothesis, adults with high BP displayed greater muscle strength than adults with normal BP. Reasons for our findings are unclear, but may be because of shifts in muscle fiber type from type I to type IIb/x and oxidative to glycolytic metabolism; alterations may result in a more strength-adapted phenotype among adults with high BP such as we observed.

PS 11-83 ONE-YEAR OUTCOMES OF THE RANDOMIZED OSLO-RDN STUDY

Objective: The blood pressure (BP) lowering effect of renal sympathetic denervation (RDN) in treatment resistant hypertension (TRH) shows variation among the few randomized studies. The duration of antihypertensive effect and long-term effect and safety of RDN require further follow-up. We aimed to report the office and ambulatory (BP) changes and long-term safety at 12-month follow-up. Design and Method: Patients with apparent TRH (n = 65) were referred specifically for RDN and those with secondary and spurious hypertension (n = 26) were excluded. TRH was defined as office systolic BP>140 mmHg despite maximally tolerated doses of at least 3 antihypertensive drugs including a diuretic. Additionally, ambulatory daytime systolic BP > 135 mmHg following witnessed intake of antihypertensive drugs was required, after which 20 patients had normalized BP, indicating poor drug adherence. Patients with true TRH were randomized and underwent RDN with Symplicity catheter (n = 9) versus adjusted drug treatment (n = 10). Results: 24-hour ambulatory systolic and diastolic BPs in the drug adjustment group changed from 151 ± 13/84 ± 7 mmHg (±SD) at baseline to 131 ± 12/75 ± 5 mmHg at 12 months (p < 0.0005 for all), and in the RDN group from 149 ± 9/89 ± 7 to 141 ± 11/83 ± 5 mmHg (p = 0.07 and p = 0.04, respectively). The absolute difference in change between groups in systolic BP was significantly higher in favor of the drug adjustment group (p = 0.01). Office, daytime and nighttime ambulatory BPs changed in parallel to the 24-hour ambulatory BPs. However 2 patients in RDN group considered as a responder since they have sustained reduction of 24-hour ambulatory systolic BP by more than 15 mmHg. There were no significant changes in renal arteries assessed by MRI or CT scans after 12 months follow-up. No deterioration of renal function was found. Conclusions: RDN has inferior BP lowering effects compared to adjusted drug treatment in patients with TRH. However, RDN is safe and this encourages future research to identify characteristics of patients who might respond to RDN.

PP.19.09] APELIN AND VISFATIN PLASMA LEVELS IN HEALTHY INDIVIDUALS WITH HIGH NORMAL BLOOD PRESSURE

Objective: High normal blood pressure (BP)(130–139/85–89 mmHg) seems to be related with increased cardiovascular risk compared to normal BP (120–129/80–84 mmHg) or/and optimal BP (<120/80 mmHg). Low apelin plasma levels have been associated with arterial hypertension and atherosclerosis while high visfatin plasma levels may promote vascular inflammation and atherosclerotic plaque destabilization and have been evaluated as a marker for identifying stages of essential hypertension. We sought to compare the apelin and visfatin plasma levels between subjects with high normal BP and subjects with normal or optimal BP matched for age, gender, smoking, and body mass index (BMI). Design and method: Twenty-five subjects with high normal BP (office BP 136 ± 3/88 ± 2 mmHg, age 57 ± 4 years, 76% males, 32% smokers, BMI 24.0 ± 1.7 kg/m2) and 35 subjects with normal or optimal BP (office BP 118 ± 2/78 ± 2 mmHg, age 55 ± 7 years, 63% males, 29% smokers, BMI 23.2 ± 1.4 kg/m2) were studied. The apelin and visfatin plasma levels were determined with the enzyme-linked immunosorbent assay. Results: Compared to normal or optimal BP subjects, apelin levels were significantly lower (205 ± 108 vs. 325 ± 152 pg/ml, p < 0.001) and visfatin levels significantly higher (11.0 ± 2.0 vs. 7.2 ± 0.9 ng/ml, p = 0.002) in high normal BP subjects. No significant differences were found between the 2 groups (p = NS) regarding the basic clinical characteristics, the glycemic/lipid profile and the renal function parameters. Conclusions: The emerging, from the present study, lower apelin and higher visfatin plasma levels in high normal BP subjects compared to normal or optimal BP individuals may partially explain the higher cardiovascular risk of the high normal BP group.