Blood Pressure In Group Research Articles

Quantifying carotid stiffness in a pre-hypertensive population with ultrafast ultrasound imaging.

The aim of this study was to assess carotid stiffening in a pre-hypertensive (PHT) population using ultrafast pulse wave velocity (ufPWV). This study retrospectively enrolled 626 individuals who underwent clinical interviews, serum tests, and assessments of the systolic blood pressure (SBP), diastolic blood pressure (DBP), carotid intima-media thickness (cIMT), pulse wave velocity-beginning of systole (PWV-BS), and pulse wave velocity-end of systole (PWV-ES) between January 2017 and December 2021. The patients were divided into three groups according to their blood pressure (BP)-normal BP (NBP): SBP <130 mmHg and DBP <80 mmHg (n=215); PHT: 130 mmHg≤SBP<140 mmHg and/or 80 mmHg≤DBP<90 mmHg (n=119); hypertensive (HT): SBP ≥140 mmHg and/or DBP ≥90 mmHg (n=292). Correlation analyses and comparisons were performed among the groups and in the cIMT subgroups (cIMT ≥0.050 cm and <0.050 cm). cIMT and PWV-ES significantly differed among the BP groups (P<0.05). The BP groups had similar PWV-BS when cIMT <0.050 cm or cIMT ≥0.050 cm (all P>0.05). However, the NBP group had a notably lower PWV-ES than the PHT (P<0.001 and P=0.024) and HT (all P<0.001) groups in both cIMT categories, while the PWV-ES in the PHT group were not significantly lower than in the HT group (all P>0.05). Carotid morphological and biomechanical properties in the PHT group differed from those in the NBP group. ufPWV could be used for an early evaluation of carotid stiffening linked to pre-hypertension.

Blood Pressure Trajectories From Childhood to Youth and Arterial Stiffness in Adulthood: A 30-Year Longitudinal Follow-Up Study.

BackgroundThis study aimed to identify the subgroups of individuals sharing similar blood pressure (BP) trajectories from childhood to youth and explore the associations of these trajectories with arterial stiffness in adulthood.MethodsA group-based trajectory model was used to identify BP trajectories among 2,082 individuals in the Hanzhong adolescent hypertension cohort by using BP values repeatedly measured at four visits from childhood (6–15 years) to youth (14–23 years). The brachial–ankle pulse wave velocity (baPWV) was examined 30 years after the baseline survey. Mixed linear regression models were used to examine the associations of these trajectories with adult baPWV.ResultsAmong the 2,082 individuals, three trajectory groups of systolic BP were identified as follows: the low-level group (n = 889), medium-level group (n = 1,021), and high-level group (n = 172). The baPWV in adulthood was higher in medium-level and high-level groups compared with the low-level group (1271.4 ± 224.7 cm/s, 1366.1 ± 249.8 cm/s vs. 1190.1 ± 220.3 cm/s, all p < 0.001). After adjustment for potential confounding factors, the association between baPWV and systolic BP trajectories was statistically significant (adjusted β = 49.4 cm/s; p < 0.001 for the medium-level group and β = 107.6 cm/s; p < 0.001 for the high-level group compared with the low-level group). Similar results were obtained for the association of baPWV with the trajectories of diastolic BP and mean arterial pressure (MAP), except for pulse pressure.ConclusionOur investigation demonstrates different BP trajectories from childhood to youth and shows the trajectories of systolic BP, diastolic BP, and MAP are significant predictors of arterial stiffness in adulthood.

Clinical benefit of systolic blood pressure within the target range among patients with or without diabetes mellitus: a propensity score-matched analysis of two randomized clinical trials

BackgroundRecent guidelines recommended a systolic blood pressure (SBP) target of < 130 mmHg for patients with or without diabetes but without providing a lower bound. Our study aimed to explore whether additional clinical benefits remain at achieved blood pressure (BP) levels below the recommended target.MethodsWe performed a secondary analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) among the non-diabetic population and the Action to Control Cardiovascular Risk in Diabetes BP (ACCORD-BP) trial among diabetic subjects. We used the propensity score method to match patients from the intensive BP group to those from the standard group in each trial. Individuals with different achieved BP levels from the intensive BP group were used as “reference.” For each stratum, the trial-specific primary outcome (i.e., composite outcome of myocardial infarction (MI), acute coronary syndrome not resulting in MI, stroke, acute decompensated heart failure (HF), or cardiovascular death for SPRINT; non-fatal MI, non-fatal stroke, or cardiovascular death for ACCORD-BP) was compared by Cox regression.ResultsA non-linear association was observed between the mean achieved BP and incidence of composite cardiovascular events, regardless of treatment allocation. The significant treatment benefit for primary outcome remained at SBP 110–120 mmHg (hazard ratio, 0.59 [95% CI, 0.46, 0.76] for SPRINT; 0.67 [0.52, 0.88] for ACCORD-BP) and SBP 120–130 mmHg for SPRINT (0.47 [0.34, 0.63]) but not for ACCORD-BP (0.93 [0.70, 1.23]). The results were similar for the secondary outcomes including all-cause mortality, cardiovascular mortality, MI, stroke, and HF. Intensive BP treatment benefits existed among patients maintaining a diastolic BP of 60–70 mmHg but were less distinct.ConclusionsThe treatment benefit persists at as low as SBP 110–120 mmHg irrespective of diabetes status. Achieved very low BP levels appeared to increase cardiovascular events and all-cause mortality.

Effects of Blood Pressure According to Age on End-Stage Renal Disease Development in Patients With Diabetes: A Nationwide Population-Based Cohort Study.

Background:Recent hypertension guidelines have recommended lower blood pressure (BP) targets in high-risk patients. However, there are no specific guidelines based on age or systolic and diastolic blood pressure (SBP and DBP, respectively). We aimed to assess the effects of age-related BP on development of end-stage renal disease (ESRD) in patients with diabetes.Methods:A total of 2 563 870 patients with diabetes aged >20 years were selected from the Korean National Health Screening Program from 2009 to 2012 and followed up until the end of 2019. Participants were categorized into age and BP groups, and the hazard ratios for ESRD were calculated.Results:During a median follow-up of 7.15 years, the incidence rates of ESRD increased with increasing SBP and DBP. The hazard ratio for ESRD was the highest in patients younger than 40 years of age with DBP≥100 mm Hg. The effect of SBP and DBP on ESRD development was attenuated with age (interaction P was <0.0001 for age and SBP, and 0.0022 for age and DBP). The subgroup analysis for sex, antihypertension medication, and history of chronic kidney disease showed higher hazard ratios for ESRD among males, younger than 40 years, not taking antihypertension medications and chronic kidney disease compared to those among females, older than 40 years, antihypertension medication, and nonchronic kidney disease groups.Conclusions:Higher SBP and DBP increase the risk of developing ESRD in patients with diabetes, and in particular, younger individuals face greater risk. Therefore, intensive BP management is warranted in younger patients to prevent ESRD.

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.

Model development to improve primary care services using an innovative network of homecare providers (WinCare) to promote blood pressure control among elderly patients with noncommunicable diseases in Thailand: a prospective cohort study

BackgroundThailand has been rapidly approaching an aging society in conjunction with an increase in noncommunicable diseases (NCDs) especially hypertension and type 2 diabetes. Demographics and epidemiologic transitions create several challenges to the health system in Thailand in the case of long term care policies, in particular, modality to support home care. Therefore, the model development to facilitate primary care home services for elderly patients with NCDs using an innovative network of homecare providers (WinCare) was established. The study aimed to evaluate the effectiveness of WinCare to improve blood pressure (BP) control as well as health-related quality of life (HRQoL) among elderly patients with NCDs.MethodsA prospective cohort study was conducted between July 2019 and January 2020 in a suburban area, Chiang Mai Province, Thailand. The intervention included WinCare providers and WinCare application. WinCare provided check-in visits to measure subjects blood pressure and body weight (once weekly), played the roles of other home caregivers for the patients and recorded measurements and activities in the WinCare app for 6 months. The primary outcomes of the study were differences in systolic BP, diastolic BP, and controlled BP (systolic BP < 140 mmHg and diastolic BP < 90 mmHg) at 6-month follow-up between the intervention and control groups, adjusting for age, sex, marital status, comorbidities, alcohol consumption and smoking status.ResultsA total of 104 subjects were initially recruited. Of the remaining 98 individuals, 52 were allocated to the intervention group and 46 to the control group. After adjusting baseline characteristics, no association existed between decreasing average systolic BP and intervention groups. However, diastolic BP of patients in the intervention group was on average 5.19 mmHg (95% CI -8.22, − 2.17) lower compared than that of the control group at 6-month follow-up. Furthermore, compared with patients in the control group, those in the intervention group were more likely to control BP, (AOR 3.03; 95% CI 1.02–9.01) at 6-month follow-up.ConclusionEstablishing a network of homecare providers (WinCare) was feasible in a community setting. This innovative network was able to facilitate elderly patients with NCDs residing in a suburban community to improve BP control at least at 6-month follow-up.Trial registrationTrial identification number was TCTR20200312007, First submitted date:12/03/2020.

Abstract P116: Hypertension Severity As Quantified By Hypertension Daily Dose (HDD) And Blood Pressure And Risk Of Stroke In The REGARDS Study

Background: Hypertension is a modifiable stroke risk factor, but hypertension severity isn't completely captured by blood pressure (BP) alone. Prior studies have shown that among adults with similar systolic BP, those taking a greater number of antihypertensive medications have greater stroke risk. However, count of antihypertension medications does not consider relative dose across classes and incompletely characterizes hypertension medical therapy. The recently described Hypertension Daily Dose (HDD) metric quantifies total dose of BP-lowering medications across multiple classes. The association between HDD and BP with stroke risk is unknown. Objective: Determine stroke risk by HDD and BP levels. Methods: We included Black and White adults from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study without prevalent stroke at visit 2 (2013-2017; treated as baseline) with follow-up data and full BP assessment. We classified systolic BP using JNC7 groupings and HDD by no BP medications and tertiles among those on BP medications. Cox proportional hazards models estimated hazard ratios (HR) for incident stroke by HDD group and BP group. Results: Of 13,265 participants included (mean age 72 [SD 8.5], 36% Black race, 56% women), 344 incident stroke events occurred during a median follow-up of 5.5 years. The stroke rate was higher among Black than White participants (5.6 vs. 5.0/1000 person-years). Relative to no BP medications and normotension, those with systolic BP ≥140 mm Hg and HDD in tertiles ≥2 had a 2.3x to 3.7x greater risk of incident stroke ( Table ). Those with systolic BP &lt;140 mm Hg had similar stroke risk across HDD groupings. Conclusion: Among Black and White US adults without prevalent stroke, higher HDD was associated with greater risk of incident stroke in those with systolic BP ≥140 mm Hg, possibly reflecting greater disease severity and treatment resistance. These findings support aggressive BP control with antihypertensive medications to lower stroke risk among adults with hypertension.

Blood pressure categorization and subclinical left ventricular dysfunction in antihypertensive medication-naive subjects.

AimsThe impact of blood pressure (BP) levels on subclinical left ventricular (LV) dysfunction and possible sex‐specific difference remains unclarified. This study investigated the relationship between BP categories given in the new 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline and subclinical LV dysfunction in subjects free of cardiac disease.Methods and resultsWe examined antihypertensive medication‐naive 858 individuals who underwent extensive cardiovascular health check‐up. LV global longitudinal (LVGLS) and circumferential strain (LVGCS) were assessed by two‐dimensional speckle‐tracking echocardiography. Participants were categorized into four groups: normal BP, elevated BP, isolated diastolic hypertension (IDH), and systolic hypertension (SH). Among the 858 participants, 422 individuals had normal BP, 113 had elevated BP, 160 had IDH, and 163 had SH. Prevalence of abnormal LVGLS (>−18.6%) was greatest in SH (19.0%), followed by IDH (17.5%), elevated BP (14.2%), and normal BP (7.1%, P < 0.001); no significant differences were observed for LVGCS (P = 0.671). In the multivariable analyses, IDH and SH were associated with impaired LVGLS [adjusted odds ratio (OR) 2.69 and 2.66, P < 0.001], and borderline significance was observed for elevated BP (adjusted OR 1.90, P = 0.060); there was no significant association between any of the BP groups and LVGCS. In sex‐stratified analysis, IDH and SH carried the significant risk of abnormal LVGLS in both sexes, while elevated BP was associated with LVGLS only in women.ConclusionsIsolated diastolic hypertension and SH redefined by ACC/AHA guideline carried significant risk for LVGLS, but not LVGCS. Elevated BP was associated with LVGLS only in women. Our findings provide information on cardiac correlates of the newly established BP categories.

Retinal Oxygen Delivery and Extraction in Ophthalmologically Healthy Subjects With Different Blood Pressure Status.

PurposeTo compare retinal oxygen delivery (DO2) and oxygen extraction (VO2) in ophthalmologically healthy subjects with different blood pressure (BP) status.MethodsIn this case-control study, we prospectively included 93 eyes of 93 subjects (aged 50–65 years) from a Dutch cohort (n = 167,000) and allocated them to four groups (low BP, normal BP [controls], treated arterial hypertension [AHT], untreated AHT). We estimated vascular calibers from fundus images and fractal dimension from optical coherence tomography angiography scans. We combined calibers, fractal dimension, BP, and intraocular pressure measurements in a proxy of retinal blood flow (RBF), using a Poiseuille-based model. We measured arterial and venous oxygen saturations (SaO2, SvO2) with a scanning laser ophthalmoscope. We calculated the DO2 and VO2 from the RBF, SaO2, and SvO2. We compared the DO2 and VO2 between groups and investigated the DO2–VO2 association.ResultsDO2 and VO2 were different between groups (P = 0.009, P = 0.036, respectively). In a post hoc analysis, the low BP group had lower DO2 than the untreated AHT group (P = 4.9 × 10−4). The low BP group and the treated AHT group had a lower VO2 than the untreated AHT group (P = 0.021 and P = 0.034, respectively). There was a significant DO2–VO2 correlation (Robs = 0.65, bobs = 0.51, P = 2.4 × 10−12). After correcting for shared measurement error, the slope was not significant.ConclusionsThe DO2 and VO2 were altered in ophthalmologically healthy subjects with different BP status. Future studies could elucidate whether these changes can explain the increased risk of ophthalmic pathologies in those subjects.Translational RelevanceUnderstanding the baseline interplay between BP, retinal perfusion, and oxygenation allows for improved evaluation of retinal disease manifestation.

Efficacy and Safety of Chinese Herbal Medicine Compared With Losartan for Mild Essential Hypertension: A Randomized, Multicenter, Double-Blind, Noninferiority Trial.

Hypertension is one of the most challenging public health problems worldwide. Previous studies suggested that the Songling Xuemaikang capsule (SXC)-a Chinese herbal formula-was effective for essential hypertension. However, the efficacy of SXC monotherapy for hypertension remains unclear. We aimed to compare the blood pressure (BP)-lowering efficacy and safety of SXC versus losartan in patients with essential hypertension. In this multicenter, randomized, double-blind, noninferiority trial in China, patients 18 to 65 years of age with mild essential hypertension were randomly allocated to receive either SXC or losartan for 8 weeks. The primary outcome was the change in sitting diastolic BP from baseline to 8 weeks, with a predefined noninferiority margin of -2.5 mm Hg. Of the 755 patients who entered a 2-week run-in period, 628 patients (327 women and 301 men; mean [SD] age, 52.6 [9.2] years) were randomly assigned to the SXC (n=314) or losartan (n=314) group. The primary analysis based on the intention-to-treat principle showed that the change in diastolic BP from baseline to 8 weeks was similar between the SXC and losartan groups (-7.9 [8.0] versus -8.1 [7.9]). The lower boundary of 95% CI (mean difference, -0.24 [95% CI, -1.51 to 1.03]) was above the margin of -2.5 mm Hg, showing noninferiority. Results were consistent with per-protocol analysis. SXC produced greater improvements in total hypertension symptom score (-5.7 [4.2] versus -5.0 [4.0]; P=0.020) and total cholesterol (-0.1 [1.0] versus 0.1 [1.2]; P=0.025). There were no differences between groups in the other BP and patient-reported outcomes. Incidence and severity of adverse events were similar between groups. SXC was well tolerated and demonstrated noninferior to losartan in BP lowering in patients with mild hypertension. SXC might be an alternative for mild hypertension, particularly for patients with a preference for natural medicine. URL: www.chictr.org.cn; Unique identifier: ChiCTR-IPR-16008108.

High-intensity interval training reduces blood pressure in older adults: A systematic review and meta-analysis.

The current systematic review and meta-analysis evaluated the effects of High-Intensity Interval Training (HIIT) on blood pressure (BP) in older adults and compared the efficacy of HIIT versus moderate-intensity continuous training (MICT). Search was conducted using the databases at PubMed, Scopus, Cochrane Library and EMBASE, for randomized trials comparing the chronic effects (≥4weeks) of HIIT versus MICT or control group (non-exercise) on BP in older adults (≥60years) with or without hypertension. A total of 10 articles (n=266 participants) were included in this meta-analysis. HIIT were associated with reductions in systolic BP (MD -7.36; 95%CI -11.80 to -2.92; P<0.01; I2=24%) and diastolic BP (MD -5.48; 95%CI -8.71 to -2.25; P<0.01; I2=40%) versus control group. No differences were found between HIIT and MICT in systolic BP (MD -2.09; 95%CI -9.76 to 5.58; P=0.59; I2=0%) and diastolic BP (MD -1.00; 95%CI -6.01 to 4.01; P=0.69; I2=0%). HIIT reduces BP in older adults. Additionally, HIIT and MICT provided comparable reductions on BP in this population.

Randomized Trial of Perfusion-Based Circulatory Management in Infants of Very Low Birth Weight

To establish the superiority of blood flow (BF)-based circulatory management over conventional blood pressure (BP)-based management strategies used for preventing intraventricular hemorrhage (IVH) in infants of very low birth weight (VLBW). We conducted a nonblinded, single-centered randomized trial with the aim to prevent IVH by managing BF. Infants with VLBW were assigned randomly to a BF-based group or BP-based (BP group) circulatory management group. The incidence of IVH was the outcome of interest. The IVH also data were compared among healthy patients and patients responsive and unresponsive to the intervention. A total of 219 and 220 infants with VLBW were assigned to the BF and BP groups, respectively. The IVH incidence rate was lower in the BF group, but the difference was not statistically significant (BF group, 6.8% vs BP group, 10.9%; P=.14). In 21% of patients of the BP group and 20% of the BF group, the intervention failed. In BF group, the IVH incidence rate was significantly greater in infants with unsuccessful intervention when compared with healthy individuals (6% vs 23%, P=.001). Multivariate logistic regression analysis revealed a correlation between low blood flow and IVH (aOR 3.24; 95% CI 1.49-7.08, P=.003) but not between low BP and IVH (P=.73). The BF management protocol did not significantly decrease the incidence of IVH. However, after further optimization, we speculate the treatment strategy holds promise in decreasing the incidence of IVH. Trial registration UMIN-CTR: UMIN000013296.

Abstract 11410: One Drop’s Multicondition Program is Associated with Blood Pressure Reduction in Employees with High Blood Pressure and Maintenance for Employees with Blood Pressure in Range

Background: Studies of mobile apps to reduce and manage blood pressure (BP) show mixed results. One Drop’s (OD) multicondition program incorporates a mobile app, health predictions and insights, in-app coaching, connected devices (glucometer, blood pressure cuff, scale) and integration with thousands of apps &amp; devices to support management of pre-diabetes, diabetes and hypertension. This study evaluated BP outcomes for employees in a large healthcare organization. Methods: Participants were employees identified as having hypertension, enrolled and participated in an OD hypertension program for 30+ days and had at least two systolic/diastolic BP measurements (SBP, DBP; via manual entry or Bluetooth cuff). For employees starting with high BP (Stage 1: SBP 130-139 mmHg, Stage 2: SBP 140-179 mmHg), Wilcoxon signed rank and t-tests evaluated BP change, and ANCOVA assessed program engagement level and duration effects. For in range (SBP &lt; 130 mmHg) and high BP groups, McNemar’s test evaluated risk change. Results: Participants (N = 94) tended to be male, in their 40’s, white and non-hispanic. For the high BP group (N = 45), baseline SBP/DBP was 144.6±11.3/87.8±10.7 mmHg. OD yielded significant reduction in SBP (-16.5±13.2 mmHg, p &lt; .01), DBP (-9.3±12.3 mmHg, p &lt;.01), SBP risk category (p = .01) and marginal reduction in DBP risk category (p = .06). The greatest reduction was within Stage 2 (N = 27; SBP -21.4±13.2, p &lt; .01; DBP -12.2±13.8, p &lt; .01). SBP/DBP change did not vary by engagement level (p = .63/.86) or duration (p = .10/.57), suggesting BP outcomes may be achieved for individuals through varied strategies and timelines. For the in range BP group (N = 49), baseline SBP/DBP was 117.6±9.5/77.7±8.5 mmHg. Of those starting in range, 81.6% stayed in SBP range at follow-up (73.2% for DBP). Of those starting with high BP, 57.8% moved in range at follow-up (43.4% for DBP). Conclusions: For employees with high BP, One Drop’s multicondition program is associated with -16.5/-9.3 mmHg SBP/DBP reduction, and -21.4/-12.2 mmHg reduction for those at Stage 2 hypertension. Employees with hypertension and BP in range were 4.4 times more likely to stay in range. Future studies should validate BP reduction results and explore patterns of engagement and outcomes in additional populations.

Abstract 9916: Relationship Between Blood Pressure Categorization and Subclinical Left Ventricular Dysfunction in Antihypertensive Medication-Naive Individuals

Background: The impact of blood pressure (BP) levels on subclinical left ventricular (LV) dysfunction and possible sex-specific difference remains unclarified. This study aimed to investigate the relationship between BP categories given in the new 2017 ACC/AHA hypertension guideline and subclinical LV dysfunction in subjects free of cardiac disease. Methods: We examined antihypertensive medication-naive 858 individuals who underwent extensive cardiovascular health check-up. LV global longitudinal (GLS) and circumferential strain (GCS) were assessed by 2-dimensional speckle-tracking echocardiography. Participants were categorized into 4 groups according to the BP levels: normal BP, elevated BP, isolated diastolic hypertension (IDH) and systolic hypertension (SH). Results: Among the 858 participants (61±11 years, 459 men), 422 individuals had normal BP, 113 had elevated BP, 160 had IDH, and 163 had SH. Prevalence of abnormal LVGLS (&gt;-18.6%) was greatest in SH group (19.0%), followed by IDH (17.5%), elevated BP (14.2%) and normal BP (7.1%, p&lt;0.001; Figure); no significant differences were observed for LVGCS (p=0.671). In the multivariable analyses, IDH and SH were associated with impaired LVGLS (adjusted odds ratio [OR] 2.69 and 2.66, p&lt;0.001) and borderline significance was observed for elevated BP (adjusted OR 1.90, p=0.060); there was no significant association between any of the BP groups and LVGCS. In sex-stratified analysis, IDH and SH carried the significant risk of abnormal LVGLS in both sexes, while elevated BP was associated with LVGLS only in women. Conclusion: IDH and SH redefined by ACC/AHA guideline carried a significant risk for LVGLS, but not LVGCS. Elevated BP was associated with LVGLS only in women. Our findings provide information on cardiac correlates of the newly established BP categories.

Blood Pressure Levels and Risks of Dementia: a Nationwide Study of 4.5 Million People

There are inconsistent results on the impacts of controlling blood pressure (BP) on the risk of dementia. We investigated the association between BP and risk of dementia subtypes by antihypertensive treatment and comorbidities. Using the Korean National Health Insurance Service-Health Screening Database from 2009 to 2012, a total of 4 522 447 adults aged 60+ years without a history of dementia were analyzed and followed up for a mean of 5.4 years. Individuals were classified according to their baseline systolic BP (SBP) and diastolic BP; SBP 130 to <140 mm Hg and diastolic BP 80 to <90 mm Hg were used as reference groups. The risk of overall dementia and probable Alzheimer disease was significantly higher in the SBP≥160 and lower SBP groups. These U-shaped associations were consistent regardless of antihypertensive use or comorbidities. The risk of probable vascular dementia (VaD) was not higher among lower SBP groups and increased gradually as SBP increased. Although there was a linear association between SBP and the risk of probable VaD in individuals not taking antihypertensives or without comorbidities, there was a U-shaped association in individuals taking antihypertensives or with comorbidities. Patterns of association between diastolic BP and risk of probable Alzheimer disease or probable VaD were similar to those with SBP, except for the risk of probable VaD in individuals taking antihypertensives. In conclusion, risks of probable Alzheimer disease and probable VaD were different among lower BP groups. Although the risk of dementia appears higher in people with lower BP receiving antihypertensives, this finding may be affected by comorbidities.

Different hypertension thresholds and cognitive decline: a pooled analysis of three ageing cohorts

BackgroundThe 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for high blood pressure (BP) in adults came up with a new definition of hypertension with a threshold BP level of 130/80 mmHg. But the 2018 European Society of Cardiology (ESC)/European Society of Hypertension (ESH) guidelines adhered to a conventional hypertension definition as BP ≥ 140/90 mmHg. We aimed to compare the trajectories of cognitive decline between participants with BP < 130/80 mmHg in all BP measurement waves and others with all BP < 140/90 mmHg.MethodsThis pooled analysis involved middle-aged and older participants from three nationally representative ageing cohorts, including the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA), and the China Health Retirement Longitudinal Study (CHARLS). Participants were divided into the Normal (BP < 130/80 mmHg on all occasions throughout the study), the Borderline (BP < 140/90 mmHg on all occasions throughout the study but not in the Normal group), and the High (the rest of participants) BP groups. Global cognitive Z score was calculated from tests on memory, executive function, and orientation.ResultsA total of 17,590 participants (HRS 6964, median follow-ups 12 years; ELSA 5334, median follow-ups 16 years; CHARLS 5292, median follow-ups 7 years) were included. No significant difference in global cognitive decline rate was detected between the Normal and the borderline groups (men, pooled β = − 0.006 standard deviation [SD]/year; 95% confidence interval [CI], − 0.020 to 0.008; P = 0.377; women, pooled β = 0.006 SD/year; 95% CI − 0.005 to 0.018; P = 0.269). Participants in the High group had a significantly faster cognitive decline (men, pooled β = − 0.011 SD/year; 95% CI − 0.020 to − 0.002; P = 0.013; women, pooled β = − 0.017 SD/year; 95% CI − 0.026 to − 0.008; P < 0.001) than that in the Borderline group.ConclusionsIndividuals in the Borderline group did not experience significantly faster cognitive decline compared with those in the Normal group. It might not be necessary for individuals with borderline BP (between 130/80 and 140/90 mmHg) to initiate antihypertension therapy in consideration of cognitive decline.

Dermatoglyphic markers as predictors of high blood pressure in young soccer players

Abstract Background Finger dermatoglyphics has been used as a genetic marker that contributes to the detection of sports talents and the establishment of predisposition to develop physical capacities. Additionally, it has begun to venture as a strategy in the early detection of risk factors for the development of chronic non-communicable diseases (CNCD), with arterial hypertension being one of the least studied factors in athletes; since its prevalence is &amp;lt; 3%, and it has been associated primarily with lifestyle. Therefore, the objective of this study was to know the correlation between the dermatoglyphic characteristics and the increase in blood pressure (BP) in young soccer players. Methods Analytical study. The sample was 86 male soccer players between 18 and 26 years of age; the case definition was soccer players with high blood pressure according to the AHA classification. Controls were those with normal blood pressure. The dermatoglyphic profile was scanned according to the Cummins and Midlo protocol on the 10 fingers of the hands. Statistical analyzes were processed in SPSS 25.0, at a significance level of p ≤ 0.05. The quantitative variables were evaluated with the Shapiro-Wilk test, the non-parametric with Mann-Whitney and the qualitative with the chi-square test. Results The Shapiro-Wilk test detected an abnormal distribution of the crests of the fingers index and atrial of the right hand (RH); of the index and middle fingers of the left hand (LH), and the summation of crests - SQTL of LH. In addition, a significant intergroup difference in all fingerprint patterns (arches, loops and whorls). Finally, a substantial difference for the fifth finger LH; fourth and fifth finger RH, and ulnar loops is more frequent in atrial LH, in annular and atrial RH in the high BP group. Conclusions Dermatoglyphics are suggested as a marker for the early diagnosis of elevated BP in young athletes. Key messages Dermatoglyphic patterns are a marker for the detection of high BP in young soccer players. Early detection of risk factors reduces the incidence of CNCD.

Prevalence of target organ damage in subjects with high-normal blood pressure without known cardiovascular and kidney disease

Abstract Background Heterogeneous results have been obtained regarding the presence of Target Organe Damage (TOD) in subjects with high-normal Blood Pressure (BP) value (sistoly 130–139, diastolic 85–89 mmHg). Purpose Aim of our study was to assess the prevalence of TOD in healthy subjects with high-normal BP comparing them with subjects with BP values that are considered normal (&amp;lt;130/85 mmHg) or indicative of hypertension (≥140/90 mmHg). Methods 755 otherwise healthy subjects participated at the present analysis. TOD was evaluated as Pulse Wave Velocity (PWV), Left Ventricular Mass Index (LVMI) and carotid Intima-Media Thickness (IMT) and plaque. Results When subjects were classified according to BP levels we found that high-normal BP group showed intermediate values of PWV and LMVI with higher value of IMT. This corresponds to intermediate prevalence of arterial stiffness (PWV&amp;gt;10 m/s: 3.4% vs 2.3% for normal and 9.6% for high BP groups, p=0.0014), Left Ventricular Hypertrophy – LVH (32.4% vs 25.7% for normal and 46.6% for high BP groups, p=0.0001) while there were no differences for IMT&amp;gt;0.9 or carotid plaque. At multivariable analysis the odds of having a PWV&amp;gt;10 m/s (OR=1.75, 95% C.I. 0.59–5.16), an IMT&amp;gt;0.9 mm (OR=1.81, 95% C.I. 0.60–5.00) or a LVH (OR=1.1, 95% C.I. 0.72–1.67) in the high-normal group resulted not different to the normal group. Conclusions In our otherwise healthy population, high-normal BP values were not related to aortic, carotid or cardiac TOD. Funding Acknowledgement Type of funding sources: None.

Lower systolic blood pressure levels in early pregnancy are associated with a decreased risk of early-onset superimposed preeclampsia in women with chronic hypertension: a multicenter retrospective study.

To clarify the impact of blood pressure (BP) management ranges on pregnancy outcomes, we conducted a multicenter retrospective analysis of 215 women with singleton pregnancies diagnosed with essential hypertension either before or within 14 weeks of gestation. Patients were classified according to systolic BP (sBP; <130, 130-139, 140-159, and ≥160 mmHg) or diastolic BP (dBP; <80, 80-89, 90-109, and ≥110 mmHg) at 8-11, 12-15, and 16-19 weeks of gestation. The risk of early-onset superimposed preeclampsia and small-for-gestational-age neonates was assessed in each BP group. Moreover, a subgroup analysis was performed in 144 eligible patients whose BP was measured at both 12-13 and 14-15 weeks of gestation. At 16-19 weeks of gestation, higher sBP significantly increased the incidence of early-onset superimposed preeclampsia (13.3%, 24.6%, 32.2% and 75.0%, respectively) and small-for-gestational-age neonates (6.0%, 13.1%, 16.9% and 50.0%, respectively). Multivariate logistic regression analyses showed that women with sBP < 130 mmHg at 16-19 weeks of gestation had a significantly lower risk of early-onset superimposed preeclampsia than women with sBP of 140-159 mmHg. Subgroup analyses also showed that even at 14-15 weeks of gestation, sBP < 130 mmHg was associated with a significantly lower risk of early-onset superimposed preeclampsia than an sBP of 140-159 mmHg. In conclusion, sBP < 130 mmHg within 14 weeks of gestation reduced the risk of developing early-onset superimposed preeclampsia in women with chronic hypertension.

Tobacco cigarette smoking accelerates impairment of aortic elastic properties in middle-aged patients with high normal blood pressure

Abstract Background The impact of smoking on atherosclerosis progression is greater in patients with arterial hypertension. High blood pressure (BP) is a major determinant of increased aortic stiffness which is an independent predictor of cardiovascular events. Aim of this study was to examine whether there are differences between office BP categorization and aortic stiffness on the basis of smoking status. Methods We measured carotid-femoral pulse wave (PWV) in 185 men (mean age: 55±10 years) who were not receiving antihypertensive medications and they had no history of diabetes and cardiovascular disease. The cohort was divided into three groups according to office systolic BP (SBP) and diastolic BP (DBP): normal (SBP &amp;lt;130 and DBP &amp;lt;85 mmHg, n=79), high normal (130≤SBP&amp;lt;140 or DBP 85≤DBP&amp;lt;90mmHg, n=42), and hypertension (SBP≥140 or DBP≥90mmHg, n=64). Results The three groups had similar age and metabolic parameters (body mass index, fasting blood glucose and LDL-C). PWV progressively increased from normotensive to high normal BP, and to hypertensive patients (7.8±1.4 vs 8.2±1.4 vs 8.6±1.6 m/s, respectively, overall P&amp;lt;0.01). Then we subdivided the three office BP groups into subgroups according to smoking status. Figure shows PWV of the three groups stratified by smoking status. The three subgroups of smokers had similar tobacco exposure (40 pack-years). There were not statistically significant differences between smokers and non smokers in each office BP category with regard to age and metabolic parameters. In separate analysis, among individuals with either normal BP the association of smoking status with PWV level was not significant. However, in hypertensive patients but also in patients with high normal BP, smoking status was significantly correlated with PWV (all P&amp;lt;0.01). Furthermore, the differences in mean PWV between smokers with high normal BP and patients with hypertension were not statistically significant reflecting a detrimental effect of smoking on aortic stiffness among males with high normal BP. Conclusion Smoking has an unfavorable effect on aortic elastic properties in men with high normal BP. The smokers with high normal BP have PWV comparable to that of hypertensive patients. This finding imply that smoking cessation should be a premising non pharmacological intervention in men with high-normal BP and increased aortic stiffness who are considered to be at a higher cardiovascular risk. Funding Acknowledgement Type of funding sources: None. Smoking, BP categories and PWV