Blood Pressure In Group Research Articles

A clinical comparison between a non–invasive blood pressure monitor using high definition oscillometry (Memodiagnostic MD 15/90 Pro) and invasive arterial blood pressure measurement in anaesthetized dogs

ObjectiveTo compare high definition oscillometry (HDO) to invasive blood pressure measurement in anaesthetized dogs. Study designProspective, clinical trial. AnimalsFifty dogs weighing 1.95–79 kg (mean 23.5 kg). Materials and methodsAnaesthetic and peri–anaesthetic management was chosen according to each dog's physical status and anaesthetist's preference. Direct arterial blood pressure measurements were performed using a catheter placed in the dorsal pedal artery and an electronic pressure transducer connected to a multiparameter monitor. Non–invasive blood pressure measurements were performed using an appropriately sized cuff placed around the tail base. Comparisons between the two methods were made using Bland and Altman plots. The data are reported as mean bias (lower, upper limits of agreement). Further analysis was performed after separating the data into the following categories based on invasive mean arterial blood pressure (MAP): high (MAP > 100 mmHg), medium (70 mmHg < MAP < 100 mmHg) and low (MAP < 70 mmHg) blood pressure (BP). The two methods were compared as used clinically. ResultsEight hundred measurement pairs for invasive and HDO BP readings were compared. Overall, the HDO measured lower values for SAP and DAP but higher for MAP than the invasive method. The lowest bias (upper, lower limits of agreement) were obtained for MAP, −1 (−22, 19) mmHg. The biggest discrepancy between the methods was reflected by a large bias (limits of agreement) 5 (−34, 45) mmHg, was for SAP. The results for DAP were between those for SAP and MAP with a bias (limits of agreement) of 3 (−20, 27) mmHg. When the values were separated into the pressure range categories the HDO measured higher in the high, medium and low BP groups, with the exception of SAP in the low BP group. ConclusionsWhen considering the mean bias, the accuracy of HDO compared well with direct arterial blood pressure, but the precision was poor, as determined by wide limits of agreement. Clinical relevanceUsing trends and serial measurements rather than a single measurement for clinical decision making is recommended with both methods, when used as reported here.

Parathyroid hormone has an important role in blood pressure regulation in vitamin D–insufficient individuals

ObjectiveThe aim of the present study was to evaluate whether vitamin D status is related to blood pressure (BP) in adults. MethodsWe evaluated the relationship between vitamin D status, intact parathyroid hormone (iPTH) and BP in 332 adults. Anthropometric measurements, BP, and a fasting blood sample was obtained. Participants were stratified into the following BP categories: 1) normal BP; 2) high BP; 3) normal BP through medication. Vitamin D insufficiency was defined as 25-hydroxvitamin D ≤ 75 nmol/L; high iPTH as > 65 pg/mL. The relationships between vitamin D status, iPTH and BP were adjusted for body mass index, waist circumference, blood lipids, physical activity, and sunscreen use. ResultsNo differences in prevalences of vitamin D insufficiency and high iPTH were observed among BP groups. No significant association was observed between BP and vitamin D status. Positive correlations were observed between iPTH and systolic BP (r = 0.168; P = 0.002) and between iPTH and diastolic BP (r = 0.168; P = 0.002). iPTH remained correlated with BP even with adjustments. ConclusionsThe present study contributes to the understanding of calcemic hormones and BP regulation.

Efficacy and safety of ivabradine in patients with chronic systolic heart failure and low blood pressure in the shift trial

Background and objective: Recommended pharmacological agents used in chronic heart failure (HF) usually reduce blood pressure (BP) limiting their application and/or dose in a substantial number of patients. In the SHIFT trial in 61% of participants systolic BP was lower than 130 mmHg. Ivabradine reduces heart rate without impact on BP or myocardial function and improves major HF outcomes, as shown by the SHIFT trial. We investigated 1) the clinical profile and outcomes of the SHIFT population by baseline blood pressure tertiles, and 2) the efficacy and safety of ivabradine in these different BP groups. Methods and results: 6505 patients with chronic HF and LVSD (EF ≤35%) and a HF hospitalization during the previous year, in sinus rhythm, with heart rate ≥70 bpm, randomized to placebo or ivabradine (2.5 to 7.5 mg bid), were divided into tertiles according to baseline systolic BP (SBP): low <115 mmHg (n=2010), intermediate 115-130 mmHg (n=1968), and high SBP≥130 mmHg (n=2427). Multivariate Cox model analyses were performed to assess outcomes in the placebo groups and the treatment effect of ivabradine in the SBP tertiles. Low SBP patients were younger, had CAD less often, higher heart rate, and higher cardiovascular risk profile than the other 2 tertiles. Rate of beta-blocker prescription was similar in all groups, although the doses were lower in patients with low SBP (45% of patients received ≥50% of the target dose vs 63% of patients with SBP≥130 mmHg, P<0.001). ACE inhibitors were less prescribed in low SBP patients (76% vs 81% in patients with SBP≥130 mmHg; P<0.001). In the placebo arm the primary end point and its two components, CV death and HF hospitalization, were more frequent in the low SBP subgroup than in the high SBP subgroup (hazard ratio for primary end point: 1.54, P<0.001; CV death: 1.90, P<0.001; HF hospitalization: 1.60, P<0.001) but all these endpoints were reduced similarly by ivabradine in low SBP (RRR: 16%; 11%; 22%), intermediate SBP (RRR: 14%; 4%; 26%), and high SBP (RRR: 23%; 9%; 29%) tertiles (P interaction=0.68; 0.91; 0.79). The overall occurrence of adverse events was similar in the 3 subgroups. As expected, symptomatic or asymptomatic bradycardia and phosphenes occurred more frequently with ivabradine. Conclusions: SHIFT data confirm that the clinical profile and outcomes in HF patients are influenced by baseline blood pressure. However, the benefits and tolerability of ivabradine are similar irrespective of pre-treatment blood pressure.

Long-term follow up after adrenalectomy for primary hyperaldosteronism

Purpose: Primary hyperaldosteronism sub-types have a radically different management: adrenalectomy for adrenal aldosterone unilateral secretion and medical therapy for bilateral secretion. Our aim was to prove higher long term postoperative blood pressure (BP) in patients with histological defined hyperplasia compared to patients with histological adenoma. Methods: We retrospectively included patients with biological primary hyperaldosteronism, an unilateral nodule on computed tomography (CT) and who underwent adrenalectomy between 2005 to 2009. This was the period before using routinely adrenal venous sampling in our institution. We compared long-term postoperative BP between pre-operative suspected patients of unilateral secretion but with final histological diagnosis of adenoma (group 1) and those with hyperplasia (group 2). Results: 41 patients underwent adrenalectomy (mean age 53.9±12.2). Mean peripheral aldosterone/renin ratio was 229.4. 6 patients (15%) had adrenal hyperplasia as post-operative histological diagnosis (group 2). No difference was observed pre-operatively between the two groups in term of clinical and biological characteristics (mean BP group 1: 136.7±15.8 / 81.8±12.1 mmHg vs group 2: 137.5±9.6 / 85±5.8 mmHg; mean kalemia group 1: 2.9±0.5 mmol/l vs group 2: 3.0±0.5 mmol/l; p=NS). Nodule size on CT was higher in group 1 (18.9mm ±8.7; n=35) than in group 2 (11.7mm ±1.5; n=6) (p=0.05). Post-operative mean follow-up was 4.6 years. Long-term postoperative mean BP was higher in group 2 (137.0±14.8 / 87.0±17.2 mmHg) than in group 1 (127.2±7.4 / 76.1±7.8 mmHg) (p=0.03). Postoperative mean antihypertensive drug score was 0.6±0.7 in group 1 and 2.2±2.4 in group 2 (p=0.002). Long-term mean kalemia was similar in the two groups (group 1: 4.4±0.4 mmol/l vs group 2: 4.0±0.4 mmol/l; p=NS). Conclusions: Long term follow-up after adrenalectomy shows higher BP and antihypertensive drug score in patients with hyperplasia than patients with adenoma. This data confirm that nowadays adrenal venous sampling is essential before adrenal surgery whatever nodule size on CT to prove unilateral secretion.

Comparison of invasive versus noninvasive blood pressure measurements before and after hemorrhage in anesthetized greyhounds using theSurgivetV9203

To determine the agreement between blood pressure obtained with a noninvasive technique and direct technique using the Surgivet V9203 at varying blood pressure levels created using a canine hemorrhage model. Experimental study. University Teaching Hospital. Twenty-nine greyhounds with an average weight of 30 kg. Approval from the Murdoch University Animal Ethics Committee was obtained (R228609). Arterial blood pressure (BP) was measured noninvasively (NIBP) via a cuff placed over the dorsal metatarsal artery and via a catheter in the contralateral dorsal metatarsal artery (IBP). Retrospectively the blood pressure measurements recorded were divided into various BP categories. A total of 84 paired readings were obtained. The data were further analyzed with respect to heart rate [<120/min and >120/min]. Comparison of the measurements was performed using the Bland-Altman method. For all categories, BP measurements were generally lower when recorded using the oscillometric technique [Systolic (Sys) bias 4.20 kPa (31.54 mm Hg), mean bias 0.52 kPa (3.93 mm Hg), and diastolic bias 1.04 kPa (7.83 mm Hg)]. Mean arterial BP had the least bias and greatest precision in the hypotensive group (bias 0.174 kPa (1.3063 mm Hg), precision 0.79 kPa (5.89 mm Hg)), low BP group (bias 0.62 kPa (4.67mm Hg) and precision 0.89 kPa (6.67mm Hg)) and normotensive group [bias 0.76 kPa (5.71 mm Hg) and precision 1.16 kPa (8.73 mmHg)]. The results demonstrate that the agreement between NIBP measurements and IBP, are within the limits of agreement recommended by the American College of Veterinary Internal Medicine Hypertension Consensus Panel for all pressures except Sys BP. This suggests that mean and diastolic NIBP using the Surgivet V9203 are a clinically acceptable alternative of IBP in hypovolemic hypotensive dogs.

Masked hypertension in renal transplant recipients

Purpose: Arterial hypertension is a risk factor affecting graft function in renal transplant recipients (RTRs). In pediatric RTRs, high prevalence of masked and nocturnal hypertension was reported. Most of the RTRs had a history of hypertension and some of them were normotensive at outpatient visits whereas home blood pressure (BP) levels were higher. Masked hypertension (MHT) is defined as a normal office BP but an elevated ambulatory BP. Previous reports have demonstrated the detrimental role of MHT in clinical outcomes in hypertensive patients. However, the true prevalence of MHT in RTRs is yet to be defined. Methods: A total of 113 RTRs (mean age 44 ± 16 years, 72 males, 41 females) with normal office BP (< 140/90 mmHg) were enrolled to the study from the outpatient renal transplantation clinic. Ambulatory BP monitoring (ABPM) was performed in all participants for a 24-h period. Average daytime BP values above 135 mmHg systolic and 85 mmHg diastolic were defined as MHT. Results: The prevalence of MHT in our cohort was 39% (n = 45). Fasting glucose and C-reactive protein levels were higher in patients with MHT compared with normal BP group (p = 0.02 and p = 0.04, respectively). RTRs with deceased donor type had higher prevalence of MHT than RTRs with living donor (40% vs 19%, p = 0.003). In multivariate analysis, deceased donor type could predict the MHT independent of age, gender, office systolic BP level, diabetes mellitus, serum creatinine, C-reactive protein, and glucose levels (OR = 3.62, 95% CI 1.16–11.31, p = 0.03). Conclusion: We demonstrated an increased prevalence of MHT in a typical renal transplant cohort. In addition, transplantation from a deceased donor may be a predictor of MHT. The prevalence of MHT may help to explain high rate of cardiovascular events in RTRs. Therefore, routine application of ABPM in RTRs may be plausible, particularly in RTRs with deceased donor type.

Post-Procedural Hypertension Following Transcatheter Aortic Valve Implantation: Incidence and Clinical Significance

This study sought to investigate the blood pressure (BP) response after transcatheter aortic valve implantation (TAVI) and its correlation with short- and mid-term clinical outcomes. TAVI is an emerging therapy for aortic stenosis patients at high surgical risk. The acute hemodynamic sequelae of this procedure and their clinical relevance are yet unclear. Consecutive patients who underwent TAVI in a single center were prospectively monitored for BP response during 5 post-procedural days. Clinical parameters, adverse events, and medical treatment were recorded during hospitalization, at 30 days, and at 12 months after the procedure. Patients were divided according to their post-procedural BP response into 2 groups: increased BP and stable BP. One hundred and five patients were analyzed. Overall, systolic BP increased immediately after TAVI in the entire cohort by an average of 15 ± 31 mm Hg. This rise was sustained and led to intensification of antihypertensive treatment in 53 patients (51%); these patients were designated as the increased BP group. The increase in systolic BP after TAVI was associated with an increase in stroke volume and cardiac output and was not related to age, baseline cardiac function, or procedural outcomes. Patients with increased BP after TAVI had a significantly better prognosis with fewer adverse events in the hospital (21% vs. 62%, p < 0.01), after 30 days (30% vs. 71%, p < 0.01), and after 12 months (53% vs. 83%, p < 0.01) as compared with patients with stable BP. After TAVI, a substantial number of patients have a significant rise in systolic BP necessitating long-term treatment. This increase in BP is associated with an increase in cardiac output and predicts a better clinical outcome.

Abstract 83: Long-Term Blood Pressure Trajectories and Stroke Risk

Background— Previous studies have used blood pressure (BP) measurements at a single point in time to predict future CVD outcomes. We hypothesize that long-term BP trajectories are associated with stroke risk. Methods— Data from 4 diverse cohorts were pooled. Each had 3+ exams where BP was ascertained and adjudicated stroke events. BP was classified into 5 categories: [1] ideal BP (&lt;120/&lt;80, no meds); [2] elevated BP (120-139/80-89, no meds); [3] controlled hypertension (&lt;140/&lt;90, treated); [4] uncontrolled hypertension (≥140/≥90, treated); and [5] untreated hypertension (≥140/≥90, no meds). BP trajectories were identified using group-based trajectory modeling. A cox proportional hazards model was used to assess BP trajectories as predictors of stroke occurrence adjusted for sex, race and cohort. Results— This study included 13,028 participants (52% female, 93% White, avg baseline age 53.5 yrs). Six unique BP trajectories were identified (see figure). The ideal BP trajectory (group 1) included 19.4% of the population, 18.4% experienced modest age-related increases in BP (group 2), 36.7% developed hypertension but it remained under control (group 3), 14.2% experienced an early period of uncontrolled hypertension but later maintained control (group 4), 5.9% developed hypertension early in middle-age which remained untreated until later in life (group 5), and 5.3% developed hypertension later in life but it remained untreated (group 6 ). BP trajectory was significantly associated with risk for stroke even after adjustment for demographic characteristics. As compared to the ideal BP trajectory, groups 3, 4, 5 and 6 had elevated risk for stroke, HR (95% CI) 1.55 (1.33-1.81), 3.00 (2.45-3.69), 2.99 (2.39-3.75) and 2.18 (1.76-2.71), respectively. Discussion— Long-term trends in BP are associated with the risk for stroke. Risk prediction algorithms should take long-term BP trajectories into account in order to identify individuals at high risk for stroke.

High-normal blood pressure is associated with increased resting sympathetic activity but normal responses to stress tests

Objective. High-normal blood pressure (BP) increases the risk of cardiovascular (CV) disease. The mechanisms underlying this increased risk are not clear. Sympathetic activation appears to be a potential mechanism linking high-normal BP to CV disease. This study examined whether high-normal BP compared with optimal BP is linked to sympathoexcitation at rest and/or during laboratory stressors. Methods. Heart rate (HR), BP and muscle sympathetic nerve activity (MSNA) were obtained at rest and during stress tests (sustained handgrip and mental stress) in 18 subjects (15 males and three females) with high-normal BP (systolic BP of 130–139 mmHg, diastolic BP of 85–89 mmHg, or both) and in 12 subjects (10 males and two females) with optimal BP (< 120/80 mmHg) matched for age (34 ± 3 years in both groups) and body mass index (25 ± 2 kg/m2 in both groups). Results. Despite the higher resting BP levels, MSNA was higher in subjects with high-normal BP than in the optimal BP group (26 ± 3 vs 18 ± 2 bursts/min, p< 0.05). During sustained handgrip, MSNA increased by 37 ± 14% in high-normal BP group compared with an increase of 49 ± 15% in optimal BP group (p = 0.55). Changes during mental stress were 50 ± 28% and 37 ± 12%, respectively (p = 0.73). There were no significant differences in SBP responses to handgrip and mental stress between the high-normal and optimal BP groups. Baseline HR and chronotropic responses to stress tests were comparable between the two groups. Conclusion. In comparison with optimal BP, high-normal BP is associated with increased resting MSNA, but normal neural and circulatory responses to stress tests. These findings suggest that tonic activation of the sympathetic nervous system may precede overt arterial hypertension and contribute to an excess risk of CV disease in subjects with high-normal BP.

Effects of androgen on vascular and inflammatory biomarkers in a female hypertensive population

Background: Androgen is a steroid hormone associated with high blood pressure (BP). The effect of androgen on BP in females is unknown.Methods: Androgen, vascular endothelial growth factor (VEGF), interleukin (IL)-6 and matrix metalloproteinase (MMP)-9 were evaluated in females with menstruation disorders (n = 135, 28 ± 5 years old) and normal BP, pre-hypertension, stage 1 hypertension, and stage 2 hypertension.Results: Normal-BP (n = 57), pre-hypertension (n = 44), stage-1-hypertension (n = 21), and stage-2-hypertension (n = 13) females had similar androgen (3.3 ± 1.5, 2.7 ± 1.2, 3.1 ± 1.4, and 3.5 ± 1.3 ng/ml, p > 0.05) and IL-6 levels (1.7 ± 2.2, 1.9 ± 2.6, 1.3 ± 1.2 and 2.4 ± 3.3 pg/ml, p > 0.05). However, normal BP females had lower MMP-9 (609 ± 307 versus 891 ± 385 ng/ml, p < 0.05) than stage-1-hypertension females. In addition, normal BP females had lower VEGF (166 ± 103 versus 255 ± 139, 272 ± 128 and 301 ± 216 pg/ml, p < 0.05) than the other three groups. In normal-androgen females, VEGF levels were similar among the four groups. However, in high-androgen females, normal BP groups had lower VEGF levels than pre-hypertension, stage-1, and stage-2 hypertension groups (166 ± 94 versus 294 ± 153, 281 ± 160 and 357 ± 253 p < 0.05).Conclusions: Androgen can modulate growth factors and extracellular matrix proteins, which may contribute to the pathophysiology of hypertension in young females.

Preventive role of exercise training in autonomic, hemodynamic, and metabolic parameters in rats under high risk of metabolic syndrome development

High fructose consumption contributes to metabolic syndrome incidence, whereas exercise training promotes several beneficial adaptations. In this study, we demonstrated the preventive role of exercise training in the metabolic syndrome derangements in a rat model. Wistar rats receiving fructose overload in drinking water (100 g/l) were concomitantly trained on a treadmill (FT) or kept sedentary (F) for 10 wk. Control rats treated with normal water were also submitted to exercise training (CT) or sedentarism (C). Metabolic evaluations consisted of the Lee index and glycemia and insulin tolerance test (kITT). Blood pressure (BP) was directly measured, whereas heart rate (HR) and BP variabilities were evaluated in time and frequency domains. Renal sympathetic nerve activity was also recorded. F rats presented significant alterations compared with all the other groups in insulin resistance (in mg · dl(-1) · min(-1): F: 3.4 ± 0.2; C: 4.7 ± 0.2; CT: 5.0 ± 0.5 FT: 4.6 ± 0.4), mean BP (in mmHG: F: 117 ± 2; C: 100 ± 2; CT: 98 ± 2; FT: 105 ± 2), and Lee index (in g/mm: F = 0.31 ± 0.001; C = 0.29 ± 0.001; CT = 0.27 ± 0.002; FT = 0.28 ± 0.002), confirming the metabolic syndrome diagnosis. Exercise training blunted all these derangements. Additionally, FS group presented autonomic dysfunction in relation to the others, as seen by an ≈ 50% decrease in baroreflex sensitivity and 24% in HR variability, and increases in sympathovagal balance (140%) and in renal sympathetic nerve activity (45%). These impairments were not observed in FT group, as well as in C and CT. Correlation analysis showed that both Lee index and kITT were associated with vagal impairment caused by fructose. Therefore, exercise training plays a preventive role in both autonomic and hemodynamic alterations related to the excessive fructose consumption.

Comparison of body shape and physical activity among adolescents with normotensive and elevated blood pressure in Shandong, China

Background: Several studies have provided ample evidence that hypertension in adults has its onset in childhood; children and adolescents with elevated blood pressure (BP) are more likely to become hypertensive adults. Shandong province is one of the areas of China with higher prevalence of hypertension. However, no studies on the relationship between physique and BP have been reported in Shandong Province, China.Aim: The present study examined the difference in body shape and physical activity (PA) between adolescents with normotensive and elevated BP in Shandong, China.Subjects and methods: Data for this study were obtained from a large cross-sectional survey of schoolchildren carried out in 2010.A total of 28 039 students (14 084 boys and 13 955 girls) aged 10–17 years participated in this study. Height, weight, waist circumference (WC), BP, triceps and subscapular skinfolds of all subjects were measured and the sum of triceps and subscapular skinfold thickness was applied. Body mass index (BMI) of adolescents was calculated from their height and weight and the prevalence of overweight and obesity were obtained according to the International Obesity Task Force (IOTF) cut-offs. Elevated BP was defined as systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥ 95th percentile for age and gender. PA attitudes and behaviours were assessed by a standardized questionnaire.Results: The mean values of BMI, WC and SFT for both boys and girls were all significantly higher in the elevated BP group than in the normal BP group in all age categories (p < 0.01). More adolescents with elevated BP were overweight or obese compared with normal BP subjects. Significant differences in PA were observed between the elevated and normal BP group, adolescents with elevated BP had poor PA attitudes and behaviours compared with normal BP subjects.Conclusion: Adolescents with elevated BP had high levels of BMI, WC, SFT and poor PA attitudes and behaviours. These findings reinforce the importance of preventing overweight and obesity and improving their attitudes towards physical activity.

479: Late preterm neonatal morbidity in high-risk hypertensive versus normotensive women

479 Late preterm neonatal morbidity in high-risk hypertensive versus normotensive women Cynthia Gyamfi-Bannerman, Victoria Fratto, Cande Ananth Columbia University Medical Center, Dept of Obstetrics and Gynecology, New York, NY OBJECTIVE: Late preterm (LP, 34 0/7 to 36 6/7 weeks) neonatal morbidity is now well-described. We previously reported the associations of neonatal respiratory morbidity in relation to mild and severe elevations in blood pressure (BP) in low-risk women. We now hypothesized that elevated BP will be associated with increased risk of late preterm neonatal morbidity in women with history of chronic hypertension, preeclampsia (PEC), or insulin-dependent diabetes in the current pregnancy (the “high-risk” cohort). STUDY DESIGN: This is a secondary analysis of a Maternal-Fetal Medicine Units Network study of aspirin to prevent preeclampsia in highrisk women (defined above). Women that delivered non-anomalous singleton births at 34 weeks were divided into 3 groups: normotensive, mild PEC or gestational hypertension (GH), and severe PEC/GH. The primary outcomes included respiratory (respiratory distress syndrome (RDS) or intubation) and non-respiratory (bronchopulmonary dysplasia, intraventricular hemorrhage, retinopathy of prematurity, SGA 10%, NICU admission, perinatal death, pulmonary hypertension, seizures, and 5 min Apgar 5) morbidity. We also analyzed these associations within sub-groups of women with a history of chronic hypertension, preeclampsia, or insulin-dependent diabetes in the current pregnancy. Analyses were adjusted for a variety of confounding factors. RESULTS: Of the 1542 women that met the inclusion criteria, 18.9% (n 256) and 14.3% (n 184) were diagnosed with mild or severe hypertension respectively. When compared to normotensive women, LP delivery rates were higher in women with mild PEC/GH (31.3% versus 15.8%; P 0.001) and in women with severe PEC/GH (42.4% versus 15.8%; P 0.001). The associations of respiratory morbidity in relation to hypertension groups are shown in the Table. CONCLUSION: In this cohort of high-risk women, the increased risk of late preterm neonatal morbidity in women that develop severe PEC/GH is evident only among infants that have morbidity that are non-respiratory in etiology. 480 The risks of neonatal sepsis and respiratory morbidity in fetuses exposed to corticosteroids after preterm PROM Cynthia Gyamfi-Bannerman, Chia-Ling Nhan-Chang, Cande Ananth Columbia University Medical Center, Dept of Obstetrics and Gynecology, New York, NY OBJECTIVE: Controversy exists regarding administration of antenatal corticosteroids (ACS) among women with preterm premature rupture of membranes (PPROM) after 30-32 weeks gestation. Reasons cited include (i) increased risk of neonatal sepsis; and (ii) increased fetal stress after PPROM causing endogenous steroid production and negating possible benefit. We sought to assess the risk of neonatal sepsis and respiratory distress syndrome (RDS) in a cohort of women with PPROM from 30 0/7 to 36 6/7 weeks of gestation. STUDY DESIGN: This is a secondary analysis of a Maternal-Fetal Medicine Units Network multicenter, observational study regarding mode of delivery after prior uterine surgery. Women with singleton gestations delivering from 30 0/7 to 36 6/7 weeks exposed to ACS were compared to women delivering at the same gestational ages who were unexposed. Associations between steroid exposure and risks of neonatal sepsis and RDS were estimated through a propensity score (PS) analysis based on log-linear regression models. These models were weighted based on the inverse probability of treatment weight. RESULTS: We identified 1743 women with PPROM who met inclusion criteria; of those 48% (n 836) received ACS. The mean gestational age was, on average, 2 weeks lower in women exposed to ACS than those unexposed (32.5 versus 34.7 weeks, P 0.001). In the unadjusted analyses, the risks of both RDS and sepsis were 40% and 60% higher in the ACS-exposed than in the unexposed groups. However, when these risks were adjusted for confounders at baseline (age, nulliparity, race, single marital status) and gestational age at delivery through a PS-based analysis, prenatal exposure to corticosteroid exposure was no longer associated with increased risks of both RDS and sepsis. CONCLUSION: In a cohort of women with PPROM, ACS exposure was not associated with increased risks of respiratory morbidity or neonatal sepsis. The PS method safeguards against treatment (steroid) selection bias in this observational cohort study. Odds of neonatal morbidity by blood pressure group Risk of neonatal morbidity by BP group in high-risk women www.AJOG.org Doppler Assess, Fetus, Prematurity, U/S, Med-Surg-Diseases Poster Session III

Relationship between prehypertension and chronic kidney disease in middle-aged people in Korea: the Korean genome and epidemiology study

BackgroundElevated blood pressure (BP) is a major risk factor for the progression of chronic kidney disease (CKD). However, little is known about the influence of prehypertension on CKD. In this study, we investigated the relationship between prehypertension and CKD in a middle-aged Korean population. Furthermore, we prospectively evaluated the effect of active BP control on deterioration of kidney function during the two-year follow-up.MethodsThe Korean Genome and Epidemiology Study is a community-based prospective cohort study started in 2001, with a follow-up survey conducted every two years. A total of 9509 participants aged 40–69 years were included in a baseline study. BP was classified according to the Seventh Report of the Joint National Committee on High BP (JNC-7) categories and CKD was defined as the presence of proteinuria or eGFR< 60mL/min/1.73m2. A multivariable logistic regression model was used to identify associations between BP and CKD.ResultsThe overall prevalence of CKD was 13.2%, and significantly increased with BP level. The multivariable-adjusted odds ratio of CKD was 1.59 for prehypertension and 2.27 for hypertension, compared with a normal BP. At the two-year follow-up, among the participants with prehypertension, subjects whose BP was poorly controlled had a significantly higher risk of eGFR drop (OR, 1.37; 95% CI, 1.13-1.67), as compared to controls. The prevalence of eGFR drop was 57.8% in the controlled BP group and 66.0% in the poorly-controlled BP group.ConclusionsPrehypertension, as well as hypertension, is significantly associated with CKD among middle-aged Koreans. Our results indicate that active control of the blood-pressure of prehypertensive individuals is needed to prevent deterioration of kidney function.

252 BLOOD PRESSURE RELATED RISKS IN JAPANESE BOYS REVEALED BY HEALTH EXAMINATION FOR FOOD EDUCATION

Objective: We conducted the health examination for food education (HEFE) for junior and senior high school students since 2007, and investigated the relationships between the risk of blood pressure (BP) and the result of HEFE in high school boys. Methods: Our HEFE for measuring anthropological indices, checking BP in sitting position after 5 minutes at rest by using an automated BP system, sampling blood, asking questionnaires about birth weight and dietary custom, and collecting 24-hour urine (24U) samples was carried out in 152 healthy Japanese school boys aged 16–18. Fasting blood samples were analyzed for total cholesterol, high density lipoprotein cholesterol (HDL), triglycerides (TG), glucose (Gu) and homocysteine (Hcy). Results: The prevalence of increased BP (≥130/85mmHg), overweight (BMI≥25 kg/m2), dyslipidemia (TG ≥150 mg/dl and/or HDL< 40 mg/dl) and hyperglycosemia (Gu≥100 mg/dl) were 15.8%, 6.6%, 12.6% and 39.1%, respectively. Salt intakes (g/day) estimated by 24U was 9.3 ± 3.5 and 24U Na/K was 4.2 ± 1.5. The results of HEFE were compared in increases BP and normal BP groups. The former showed significantly greater abdominal circumference (p< 0.0001), greater heart rate (p< 0.01), higher Hcy (p< 0.05), lower birth weight (p< 0.05) and greater salt intake (p< 0.05) than the letter. There were significant correlations of Hcy with both systolic and diastolic BP. Conclusion: Even in young school boys higher BP was proven to be related with risks such as abdominal obesity, higher Hcy, higher salt intake and lower birth weight.

Blood pressure targets in patients with coronary artery disease: observations from traditional and Bayesian random effects meta-analysis of randomised trials

ContextMost guidelines for treatment of hypertension including the Joint National Committee-7 recommend a blood pressure (BP) goal of <140/90 mm Hg for hypertensive patients and a more aggressive goal of...

Correlation between obesity index and blood pressure in Kazak childhood from Yili, Xinjiang

To investigate the correlations between obesity index such as waist circumference, hip circumference, skin-fold thickness, body mass index, waist to hip ratio, waist to height ratio etc, and blood pressure among Kazak children living in Yili of Xinjiang. In May-June 2009, 2438 Kazak children aged 7 to 14 at primary schools in Yili of Xinjiang, were investigated. Waist circumference, hip circumference, skin-fold thickness, systolic and diastolic blood pressure were measured to calculate the body mass index, waist to hip ratio and waist to height ratio. Analysis on the differences in age and gender, blood pressure (BP) between hypertensive or normal BP group under the standard set for children. SPSS 17.0 software was used for statistical analysis on its correlation. The total prevalence of hypertension was 5.7% in Kazak ethnic school-age children in Yili, with 4.4% in the boys and 7.0% in girls. Data from waist circumference, hip circumference, waist-height-ratio, waist-hip ratio, systolic and diastolic blood pressure showed gender and age differences (P = 0.000). Average systolic blood pressure was correlated to waist circumference, hip circumference, skin-fold thickness, body mass index and waist to hip ratio (P = 0.000), with hip circumference the most (man: r = 0.618, female: r = 0.655). The average diastolic blood pressure was correlated to waist circumference, hip circumference, skin-fold thickness, body mass index and waist to hip ratio (P = 0.000), with hip having the strongest relation (r = 0.489 for male and r = 0.548 for females). Significant differences were seen between Hypertension group and normal blood pressure group on waist circumference, hip circumference, skin-fold thickness, body mass index and waist-hip ratio (P < 0.05). In Yili of Xinjiang, the prevalence of hypertension was at the low level in Kazak ethnic school-aged children when comparing to data from national and foreign standards. Indicators related to obesity as waist circumference, hip circumference, body mass index and waist to hip ratio were positively correlated with blood pressure, with hip in particular.

Application and effect assessment of " Knowing-Trusting-Acting" model in health education for hypertensive patients

Objective To investigate the application of Knowing-Trusting-Acting model in health education for hypertensive patients.Methods 100 hypertensive patient were divided into control group and experiment group,each with 50 patients.Control group received traditional health education while experiment group was guided in Knowing-Trusting-Acting mode.Questionnaire was used to investigate 2 groups,one with patients who were hospitalized in 24 hours and one with patients who were discharged from hospital for 6 months,of their knowledge toward the disease,their compliance and blood pressure controlling.Results The difference between the two groups' knowledge toward the disease before experiment was not statistically significant ( P ＞0.05 ),while after the experiment,the experiment group' s score of knowledge toward the disease was (67.4±4.3),higher than that of the control group (51.2 ± 3.8 ),and the difference was statistically significant ( t =19.90,P ＜0.01 ).The difference between the two groups' compliance before experiment was not statistically significant ( P ＞ 0.05 ),while after the experiment,the experiment group' s compliance,such as quitting smoking,restraining alcohol,disciplinary work and rest,proper exercise,emotional control,healthy diet,medicine use and regular examination,was better than the control group,and the differences were statistically significant ( x2 =5.828,5.482,7.294,4.320,6.139,6.775,24.731,respectively; P ＜ 0.05 ).The difference between the two groups' blood pressure controlling rate before experiment was not statistically significant (P ＞ 0.05),while after the experiment,the experiment group's blood pressure controlling rate was 92.0％,higher than that of the control group (64.0％),and the difference was statistically significant ( x2 =11.422,P =0.001 ).Conclusions The Knowing-Trusting-Acting model of health education can enhance the knowledge of the disease and the compliance,thus to improve the clinical treatment effect and patients' life quality. Key words: Hypertension; Knowing-Trusting-Acting model; Health education; Compliance

Blood Pressure and Obesity Exert Independent Influences on Pulse Wave Velocity in Youth

The objective was to analyze pulse wave velocity (PWV) in normotensive, high-normal, and hypertensive youths by using aortic-derived parameters from peripheral recordings. The impact of obesity on vascular phenotypes was also analyzed. A total of 501 whites from 8 to 18 years of age were included. The subjects were divided according to BP criteria: 424 (85%) were normotensive, 56 (11%) high-normal, and 21 (4%) hypertensive. Obesity was present in 284 (56%) and overweight in 138 (28%). Pulse wave analysis using a SphygmoCor device was performed to determine central blood pressure (BP), augmentation index, and measurement of PWV. Among the BP groups, differences appeared in age, sex, and height but not in body mass index. Significant differences in peripheral and central systolic and diastolic BPs and pulse pressures were observed within groups. A graded increase in PWV was present across the BP strata without differences in augmentation index. Using a multiple regression analysis, age, BP groups, and obesity status were independently associated with PWV. Older and hypertensive subjects had the highest PWV, whereas, from normal weight status to obesity, PWV decreased. Likewise, PWV was positively related to peripheral or central systolic BP and negatively related to body mass index z score. For 1 SD of peripheral systolic BP, PWV increased 0.329 m/s, and for 1 SD of body mass index z score PWV decreased 0.129 m/s. In conclusion, PWV is increased in hypertensive and even in high-normal children and adolescents. Furthermore, obesity, the factor most frequently related to essential hypertension in adolescents, blunted the expected increment in PWV of hypertensive and high-normal subjects.

PP058. The additive effect of plasma levels of sFlt-1/PLGF ratio following the risk classification using both blood pressure levels and uterine artery blood flow impedance in the second trimester on the later occurrence of preeclampsia

The multivariate model including circulating levels of soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratios, maternal factors, blood pressure (BP) levels and uterine artery (UtA) doppler in the first to second trimester has been reported to be clinically useful to predict PE more accurately. However, the effects of levels of sFlt-1/PlGF ratio after the stratification of women using two major risk factors for PE, BP levels and UtA blood flow imdedance (BFI) have not been evaluated. Our aim was to evaluate the additive effect of plasma levels of sFlt-1/PlGF ratio following the risk classification using both mean blood pressure (MBP) levels and the combination of two UtABFI, mean pulsatility index (mPI) and mean notch depth index (mNDI), on the later occurrence of PE. 1161 women were recruited into a prospective cohort study during 2004 and 2008. Clinical BPs were measured twice during 16 and 23 weeks, UtA doppler was performed twice during 16 and 23 weeks, and the mPI and mNDI was measured. Plasma samples were drawn once at 20-23weeks, and were stored at -20°C until use. The levels of sFlt-1/PlGF ratio were measured by automated electrochemiluminescent immunoassay (Roche Diagnostics K.K.). The cutoff value of mean BP (MBP) was determined as 91.3mmHg using ROC curve, and that of sFlt-1/PlGF ratio was 13.0, the 97.5th percentile of log10(sFlt-1/PlGF) at 20-23 weeks in normal pregnant women. If the mPI was <90th percentile of the gestational-age specific reference range of mPI, or the mNDI was <90th percentile of the gestational-age specific reference range of mNDI, we defined that the UtABFI was low; if the mPI was ⩾90th percentile and the mNDI was ⩾90th percentile, we defined that the UtABFI was high. When women were stratified to 4 groups: low BP and low UtABFI, high BP but low UtABFI, high UtABFI but low BP, high BP and high UtABFI, the PPVs were 0.7%, 6.9%, 6.2% and 39.1%, respectively. In women with low BP and low UtABFI, the high sFlt-1/PlGF changed the PPV to 11.1%; the interval from the sampling to the onset of PE in women with high sFlt-1/PlGF ratio was significantly shorter than in those with low sFlt-1/PlGF ratio (mean±SD [weeks]: 5.9±1.5 vs. 16.5±2.1, p<0.01). In women with high BP but low UtABFI, the high sFlt-1/PlGF changed the PPV to 18.2%; the interval from the sampling to the onset of PE in women with high sFlt-1/PlGF ratio was significantly shorter than in those with low sFlt-1/PlGF ratio (8.0±5.7 vs. 12.6±3.7, p<0.05). Although these effects of sFlt-1/PlGF ratio on the occurrence of PE were not confirmed in women with high BP and high UtABFI, PE occurred in all women with three risk factors (5/5), and the interval from the sampling to the onset of PE was6.8±4.1 weeks. Women with both high BP and high UtABFI, especially those with additional risk of high sFlt-1/PlGF ratio, were the highest risk of PE. In the lowest risk group of low BP and low UtABFI, the addition of sFlt-1/PlGF ratio improved the PPV and the interval from the sampling to the onset of PE. These results clearly indicated the clinical importance of measuring sFlt-1/PlGF ratio in addition to BP levels and UtABFI in all pregnant women in the second trimester.