BP Levels Research Articles

Connections between serum Trimethylamine N-Oxide (TMAO), a gut-derived metabolite, and vascular biomarkers evaluating arterial stiffness and subclinical atherosclerosis in children with obesity.

Childhood obesity leads to early subclinical atherosclerosis and arterial stiffness. Studying biomarkers like trimethylamine N-oxide (TMAO), linked to cardio-metabolic disorders in adults, is crucial to prevent long-term cardiovascular issues. The study involved 70 children aged 4 to 18 (50 obese, 20 normal-weight). Clinical examination included BMI, waist measurements, puberty stage, the presence of acanthosis nigricans, and irregular menstrual cycles. Subclinical atherosclerosis was assessed by measuring the carotid intima-media thickness (CIMT), and the arterial stiffness was evaluated through surrogate markers like the pulse wave velocity (PWV), augmentation index (AIx), and peripheral and central blood pressures. The blood biomarkers included determining the values of TMAO, HOMA-IR, and other usual biomarkers investigating metabolism. The study detected significantly elevated levels of TMAO in obese children compared to controls. TMAO presented positive correlations to BMI, waist circumference and waist-to-height ratio and was also observed as an independent predictor of all three parameters. Significant correlations were observed between TMAO and vascular markers such as CIMT, PWV, and peripheral BP levels. TMAO independently predicts CIMT, PWV, peripheral BP, and central SBP levels, even after adding BMI, waist circumference, waist-to-height ratio, puberty development and age in the regression model. Obese children with high HOMA-IR presented a greater weight excess and significantly higher vascular markers, but TMAO levels did not differ significantly from the obese with HOMA-IR<cut-offs. TMAO did not correlate to HOMA-IR and insulin levels but presented a negative correlation to fasting glucose levels. An increase in TMAO was shown to be associated with an increase in the probability of the presence of acanthosis nigricans. TMAO levels are not influenced by other blood biomarkers. Our study provides compelling evidence supporting the link between serum TMAO, obesity, and vascular damage in children. These findings highlight the importance of further research to unravel the underlying mechanisms of this connection.

Uncontrolled and masked uncontrolled blood pressure in treated pregnant women with chronic hypertension and risk for preeclampsia/eclampsia.

To analyze the relationship between the level of BP achieved with treatment and the risk for development of preeclampsia/eclampsia (PE), we conducted a historical cohort study on 149 consecutive pregnant women with treated chronic hypertension, evaluated between January 1, 2016, and November 31, 2022. According to office BP readings and ambulatory blood pressure monitoring (ABPM) performed after 20 weeks of gestation, the cohort was classified in controlled hypertension, white-coat uncontrolled hypertension, masked uncontrolled hypertension and sustained hypertension. Risks for the development of PE were estimated using logistic regression. One hundred and twenty-four pregnant women with a control BP evaluation were included in this analysis. The rates of PE were 19.4%, 27.3%, 44.8% and 47.1% for controlled, white-coat uncontrolled, masked uncontrolled and sustained uncontrolled hypertension, respectively. Compared with women with controlled hypertension, the relative risk for PE increased markedly in women with sustained uncontrolled (OR 3.69, 95% CI, 1.19-11.45) and masked uncontrolled (OR 3.38, 95% CI, 1.30-11.45) hypertension, but not in those with white-coat uncontrolled (OR 1.56 95% CI, 0.36-6.70); adjustment for covariates did not modify the results. Each mmHg higher of systolic and diastolic daytime ABPM increased the relative risk for PE ~4% and ~5%, respectively. Each mmHg higher of systolic and diastolic nocturnal BP increased the risk ~5% and ~6%, respectively. When these risks were adjusted for ABPM values in opposite periods of the day, only nocturnal ABPM remained as a significant predictor. In conclusion, masked uncontrolled hypertension implies a substantial risk for the development of PE, comparable to those of sustained uncontrolled. The presence of nocturnal hypertension seems important.

Tunable plasmonic hybrid photonic device based on squared graphene and black phosphorus metamaterials

The yearning to utilize and control the captivating property of two-dimensional carbon materials has attracted plenty of attention in biosensing and optoelectronics. In this paper, we proposed a novel graphene-black phosphorus (BP) hybrid photonic device to exhibit strong absorption of 97.0 % at 12.23 μm in the x-direction and it is 93.3 % at 13.42 μm in the y-direction. Due to the surface plasmon resonance of graphene and distinctive anisotropic effective electron masses of black phosphorus along the armchair and zigzag axes, the electromagnetic coupling achieves an enhanced performance than individual graphene or BP layer. Additionally, by adjusting the Fermi energy of graphene, the doping level of BP, and the geometric parameters, the resonant absorption peaks can be tuned independently in both TE and TM polarization. The advantages of our proposed plasmonic hybrid photonic device include high anisotropic resonance, flexible tunability, great stability, and a simple design. These make it promising for applications in photodetectors, polarizers, and imaging systems.

Association of serum transforming growth factor β1 with left ventricular hypertrophy in children with primary hypertension

The current study was designed to assess the association of serum transforming growth factor β1 (TGF-β1) with left ventricular hypertrophy (LVH) in children with primary hypertension. The present single-center prospective trial examined 182 patients diagnosed with primary hypertension in Children’s Hospital, Capital Institute of Pediatrics, between January 2021 and September 2022. Clinical data were analyzed, and ambulatory blood pressure was assessed for 24 h. LVH, the commonest subclinical cardiac feature of hypertension, was assessed by echocardiography. According to left ventricular geometry, cases were assigned to the LVH (n = 44) and normal geometry (n = 138) groups. Serum TGF-β1 amounts were quantitated by enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristic (ROC) curves were established to analyze various variables for their predictive values in LVH. Among 182 children with primary hypertension, the concentrations of serum TGF-β1 were higher in stage 2 hypertension than in stage 1 (47.3 (38.8, 52.5) vs. 46.0 (38.6, 48.2) ng/L, Z = − 2.376; P = 0.018). Additionally, serum TGF-β1 content showed a positive correlation with BP levels (P < 0.05). TGF-β1 amounts were significantly elevated in the LVH group compared with the normal geometry group (51.7 (46.1, 54.9) vs. 46.1 (38.7, 48.1) ng/L, Z = − 4.324; P = 0.0000). Serum TGF-β1 content was positively associated with LVH (r = 0.321, P = 0.0000). Multivariable logistic regression analysis showed BMI (OR = 1.188, 95% CI 1.082–1.305; P = 0.0000) and elevated serum TGF-β1 content (OR = 1.063, 95% CI 1.016–1.113; P = 0.009) independently predicted LVH. A multivariable logistic regression model considering BMI and TGF-β1 content in LVH prediction was 0.771, with sensitivity and specificity of 72.7% and 70.3%, respectively.Conclusion: These data revealed an association of serum TGF-β1 with BP in children with primary hypertension. Serum TGF-β1 concentration was positively correlated with hypertensive cardiac damage. Serum TGF-β1 might constitute a valuable molecular marker for the prediction of LVH in children with primary hypertension. The combination of BMI and TGF-β1 has a certain diagnostic and predictive value for LVH in children with primary hypertension, which may provide a new reference index for early clinical identification of hypertensive cardiac damage.What is Known:• Experimental and clinical data indicated TGF-β1 is involved in BP elevation.• TGF-β1 is positively correlated with LVMI and hypertrophy in adults.What is New:• Our current study reveals an association of serum TGF-β1 with BP in children with primary hypertension.• Elevated serum TGF-β1 level is positively associated with LVH in children with primary hypertension.• The combination of BMI and TGF-β1 has a certain diagnostic and predictive value for LVH in children with primary hypertension.

Long-term effectiveness of radiofrequency renal denervation in patients with resistant arterial hypertension (10-year follow-up results)

The aim – to determine the long-term efficacy and safety of renal denervation (RDN) at 10-year follow-up.Materials and methods. We selected 1146 patients with resistant arterial hypertension (RAH) who received 3 or more antihypertensive drugs. 16 patients were selected for renal artery denervation. RDN was performed in 8 patients (0.70 %). 8 patients refused the procedure. The age was 52.13 ± 3.88 years (40–66), the duration of hypertension was 16.75 ± 2.17 (12–25) years. The number of antihypertensive drugs was 5.5 ± 0.18. Office SBP/DBP on optimization of therapy in patients was 156.88/95.00 ± 2.98 mm Hg and heart rate – 68.88 ± 3.28 beats/min. 24SBP/DBP was 149.16 ± 5.40/86.98 ± 5.08 mm Hg. 24HR was 70.12 ± 2.94 beats/min. All patients tolerated the procedure well.Results and discussion. The decrease in office SBP/DBP was –12.59/–10.0 mm Hg; –11.17/–2.57 mm Hg; –20.31/–11.71 mm Hg, –27.71/–13.33 mm Hg and –30.21/–16.67 mm Hg, in the dynamics of 1 month, 12 months, 2 years, 5 years and 10 years, respectively, p &lt;0.05 for all values compared to the initial. The office heart rate at the stages of 1 month, 6, 12 months, 2 years, 5 and 10 years decreased, its dynamics were –3.74 bpm, –4.68 bpm, –1.45 bpm, –2.13 bpm, –4.21 bpm, –3.88 bpm, respectively. The decrease in 24SBP/DBP was –14.45/–6.95 mmHg, –8.70/–10.01 mm Hg, –19.45/–12.37 mm Hg, –19.91/–11.24 mm Hg, –29.93/–13.61 mm Hg. and –26.13/–23.35 mm Hg (p&lt;0.05 for all values). 24HR dynamics: –3.16 bpm, – 4.19 bpm, + 1.43 bpm, –1.51 bpm, –4.46 bpm, and –5.49 bpm, respectively. After 2, 5, and 10 years, all patients reached the target blood pressure level both in the office and with ABPM. Patients reduced the number of antihypertensive drugs from 5.50 ± 0.18 to 3.50 ± 0.30 – after 5 years and 3.67 ± 0.18 – after 10 years after RDN. GFR practically did not change over 10 years from 76.10 ± 5.62 to 64.60 ± 1.93 ml/min/1.73m2, p&gt;0.05. One patient died of thyroid cancer 2 years later. All other patients are alive and have not had any cardiovascular event or death during 10 years.Conclusion. Long-term results of renal artery denervation showed no cases of cardiovascular events, development of diabetes or cardiovascular death over 10 years. RDN contributed to a reduction in the number of antihypertensive drugs from 5.5 to 3.67 after 10 years of therapy against the background of 100 % achievement of the target BP level.

Transforming growth factor β1 upregulates 6-phosphofructo-2-kinase/fructose 2,6-bisphosphatase-4 expression in A549 and MCF-10A cells.

Transforming growth factor β1 (TGFβ1) induces a cellular process known as epithelial-mesenchymal transition (EMT) associated with metabolic reprogramming, including enhanced glycolysis. Given the involvement of 6-phosphofructo-2-kinase/fructose 2,6-bisphosphatase (PFKFB) enzymes in glycolysis, we aimed to investigate whether TGFβ1 regulates expressions of PFKFB genes and if PFKFBs are required for TGFβ1-driven phenotypes. A549 and MCF-10A cell lines were used as TGFβ1-driven EMT models. Messenger RNAexpressions of PFKFB and EMT genes were determined by real-time quantitative polymerase chain reaction. A small interfering RNA approach was used to deplete PFKFB4 expression. A Matrigel invasion assay was conducted to assess the effect of PFKFB4 silencing on the TGFβ1-enhanced invasion of A549 cells. F2,6BP levels were analyzed using an enzyme-coupled assay. Glucose and lactate concentrations were determined using colorimetric assays. TGFβ1 robustly induced expression of the fourth isoform of PFKFBs, PFKFB4, in both cell lines. PFKFB4 depletion partially inhibits mesenchymal transdifferentiation caused by TGFβ1 in A549 cells, as assessed by microscopy. Inductions of Snail in MCF-10A cells and Fibronectin in A549 cells and repressions of E-cadherin in both cell lines by TGFβ1 are attenuated by PFKFB4 silencing. PFKFB4 silencing reduces F2,6BP and glycolytic activity, although TGFβ1 alone does not affect these parameters. Finally, PFKFB4 depletion suppresses the TGFβ1-driven invasion of A549 cells through Matrigel. Presented data suggest that TGFβ1 induces the expression of PFKFB4 in A549 and MCF-10 cells, and PFKFB4 may be required for TGFβ1-driven phenotypes such as EMT and invasion in these models.

Ambulatory and home blood pressure monitoring for cardiovascular disease risk evaluation: a systematic review and meta-analysis of prospective cohort studies.

The aim of this work was to systematically review the level of evidence based on prospective cohort studies investigating the role of 24-h ambulatory blood pressure measurement (ABPM) and home blood pressure measurement (HBPM) on cardiovascular disease (CVD) risk prediction. Eight studies were included in the meta-analysis. The Der Simonian and Laird's random-effects model with standard error adjustment using the Knapp-Hartung method was used. SBP from ABPM and HBPM was significantly and positively associated with CVD risk [ combined hazard ratio per 1-SD SBP, 95% confidence interval (95% CI): 1.32, 1.19-1.45, I2 = 35.8%, and 1.30, 95% CI: 1.11-1.49, I2 = 79.1%, respectively], after adjusting for office BP levels and other potential confounders. DBP from both ABPM and HBPM was positively associated with CVD risk ( combined hazard ratio per 1-SD DBP, 95% CI: 1.15, 1.01-1.29, I2 = 73.1% and 1.21, 1.05-1.37, I2 = 84.5%, respectively). BP either from ABPM or HBPM could predict CVD risk. As so, at least one of out-of-office BP measurements have to be taken into account during the evaluation of the hypertensive population.

«СОСУДИСТЫЙ ВОЗРАСТ» И ЕГО ЗНАЧЕНИЕ В КЛИНИЧЕСКОЙ ПРАКТИКЕ

Introduction: The term "vascular age" (VA) was developed to motivate and increase patients' commitment to a healthy lifestyle. This assessment can significantly help in communication between the doctor and the patient. CO is the age of a person who has the same probability of death from cardiovascular diseases as the patient, only without modifiable risk factors. CV can be determined using instrumental methods or risk can be calculated using the modified SCORE scale, the latter method is currently limited due to the modification of the SCORE2 and SCORE-OP scales. The aim of our study was to assess the vascular age in patients with arterial hypertension (AH) using the method of volumetric sphygmography and the relationship of vascular aging with the main clinical and laboratory parameters. Materials and methods: 48 patients with AH were examined, including 21 men (44%) and 27 women (56%), the mean age was 66.9 years and 67.3 years, respectively. The duration of the disease was about 10 years. All patients were receiving antihypertensive therapy at the time of the examination. Vascular age was assessed using the volumetric sphygmography method using the BPLab-Vasotens apparatus (LLC Petr Telegin, Russia). This technique is quite simple, non-invasive, does not require the use of expensive equipment and additional specialists. Statistical processing was carried out using the Microsoft Excel package (Microsoft Office 2011) and Statistica 10.0. Results. Our assessment showed that CO in patients with AH was 69.0 years and did not differ statistically from the passport (67.0 years, р˃0.05). The groups of men and women did not differ from each other in terms of the passport age of the patients (р˃0.05). Correlation analysis showed a positive relationship between passport and vascular age (r=0.88, p&lt;0.001). When analyzing hemodynamic parameters, the patients were divided into 2 groups: group 1 included patients with CO less than or equal to the passport one (n=22), and group 2 included patients with CO greater than the passport one (n=26). In the first group there were more men (14 - 63.6%), and in the second group there were more women (19 - 73.1%), р=0.1. It was found that the indicators of systolic, mean and pulse BP in group 2 were higher: 117.0 [109.0;133.0] and 137.0 [122.0;146.0] mm Hg (p=0.005), 86.5 [84.0;94.0] and 100.5 [92.0;108.0] mm Hg (p=0.006), 44.5 [38.0;64.0] and 70.5 [48.0;74.0] mm Hg (p=0.01), respectively. The groups did not differ from each other in terms of passport age, body mass index, diastolic BP level, length of service, stage of hypertension, lipid profile, creatinine, glomerular filtration rate, incidence of coronary artery disease, history of stroke (р˃0.05). Conclusion. The assessment of vascular age using volumetric sphygmography is simple and improves communication between the doctor and the patient. Vascular age directly correlates with passport age. In the group of patients whose vascular age was higher than the passport one, an increase in systolic, mean and pulse BP was revealed, compared with the group of patients in whom the CO was less than or equal to the passport one. The absence of statistically significant correlations between CO and other generally recognized risk factors indicates the need for an individualized comprehensive assessment of cardiovascular risk using clinical, laboratory and instrumental data.

Comparison of Ambulatory and Home Blood Pressure Variability for Cardiovascular Prognosis and Biomarkers.

Although blood pressure variability (BPV) is reported to be associated with cardiovascular prognoses, it has not been established whether ambulatory BPV (ABPV; ie, short-term 24-hour BPV) or home BPV (HBPV; day-to-day BPV) is a superior clinical marker. We analyzed the associations of ABPV and HBPV with cardiovascular prognoses and biomarkers in 1314 hypertensive outpatients who underwent both home and ambulatory BP measurements in the J-HOP study (Japan Morning-Surge Home Blood Pressure). BPV was evaluated by the SD, coefficient of variation, and average real variability of the patients' 24-hour ambulatory and home systolic BP values. During the median 7.0-year follow-up, 109 cardiovascular events occurred. All SD, coefficient of variation, and average real variability values of the HBPV were significantly associated with cardiovascular risk even after adjusting by average 24-hour ambulatory systolic BP and each ABPV value: 1 SD of hazard ratio (95% CI) for the SD, 1.36 (1.14-1.63); coefficient of variation, 1.38 (1.16-1.66); and average real variability 1.29 (1.10-1.51) of HBPV. The ABPV parameters did not exhibit comparable relationships. The cardiovascular risk spline curves showed a trend toward increased risks with increasing HBPV parameters. There were no differences between ABPV and HBPV in the relationships with B-type natriuretic peptide and the urine albumin-creatine ratio. In this comparative analysis of ambulatory and home BP monitoring values in individuals with hypertension, ABPV was not significantly associated with cardiovascular prognosis adjusted by average BP level, and HBPV was suggested to have modest superiority in predicting cardiovascular prognosis compared with ABPV.

Improving Knowledge of Healthy Lifestyle Using WhatsApp Application and Health Screening of Productive Age Population in Pajimatan Hamlet, Imogiri, Bantul

The prevalence of obesity continuously increase, as are associated comorbidities and healthcare expenses. Early detection, intervention, and effective treatment of obesity are important to improve quality of life and to reduce costs. This Community Practice Program aimed to evaluate health status and provide education about healthy life style of people at productive age in Pajimatan Hamlet, Imogiri, Bantul, Yogyakarta. Participants were 66 adults (26 men, 40 women) aged 19-64 years living in Pajimatan Hamlet. The program was held on November 2021. Education on healthy life style was done using WhatsApp group. Pre- and post-test were given to the participant before and after the education. Health screening was done by measuring height, weight, waist circumference (WC), blood pressure BP), and fasting blood glucose level. Obesity was determined using body mass index (BMI) and WC. There were significant increase scores before and after education in men (p= 0.017) and women (p&lt; 0.001). Health screening indicated that men were significantly taller (p&lt; 0.001) and heavier (p= 0.009) than women, however, there was no difference in BMI, WC, BP, and fasting blood glucose level (p&gt; 0.05). There were no differences in the distribution of BMI obesity between men and women, however, women with central obesity were higher than men (70% women, 30% women, p= 0.021). Men having prehypertension were higher than women (46.2 vs. 15%), on the other hand, women with hypertension I and II seemed to be higher than men (p= 0.043). The prevalence of type-2 diabetes was slightly greater in women (12.5%) compared with 7.7% in men. In conclusion, the Community Service Program found high prevalence of obesity and hypertension in the population. Education on healthy life style program can help to improve knowledge of the target population.

Interleukin-18, Interleukin-18 Gene Polymorphisms and Interleukin18 Binding Protein in Children and Adolescents with Immune Thrombocytopenia

Background Immune thrombocytopenia (ITP) is an autoimmune illness characterized by an aberrant T cell response, which is supported by autoreactive B cell growth and differentiation. IL-18 expression has been linked to a number of autoimmune and inflammatory illnesses. IL18BP is a protein that binds IL-18 with high affinity, suggesting a potential mechanism for regulating IL-18 activity. Corticosteroids may play a significant role in reversing the IL-18- IL18BP ratio by upregulating IL18BP. Objective The aim was to study associations between IL-18 and two associated gene polymorphism sites -607 &amp; -137 with incidence and response to therapy in patients with ITP. Patients and Methods It is a case control study conducted on children and adolescents with ITP.A total of 55 patients with different stages of ITP (25 acute, 18 persistent &amp; 12 chronic patients) were recruited with 30 age matched healthy controls. All patients were subjected to full history and physical examination. Laboratory investigations included serial blood counts, IL-18 and IL-18BP serum levels using enzyme linked immunosorbent assay (ELISA) and IL-18 gene polymorphisms using polymerase chain reaction (PCR). Results At diagnosis the median platelet count was 16× 109/L (range 2-79) &amp; eventually increased to a median of 90× 109/L after treatment. IL-18 level was significantly higher than that of control (P &amp;lt; 0.001) &amp; even after treatment. There was no significant difference between patient and control groups regarding the studied gene polymorphism sites -607 &amp; -137. The mean IL-18 was still significantly elevated in all stages of ITP compared to control group &amp; as well the drop after treatment. This was also observed in IL-18 BP which increased significantly after response to steroid therapy. However, it was observed that the decline in level of IL-18 as well as increment in IL-18 BP was the least in the patients tested during the acute phase. Mean IL-18 &amp; IL-18 BP levels show no significant relation with gender, family history of ITP, mode of treatment or genotype. Conclusion Among the studied IL-18 gene polymorphisms, no significant difference was detected among ITP patients or had a significant correlation with clinical or laboratory markers. Reversed IL-18/IL-18BP ratio is an important modulator in pathogenesis of ITP. Increasing levels of IL-18BP could have a significant role in treatment.

Evaluation of Blood Pressure Status and Mortality in Turkey: Findings from Chronic Diseases and Risk Factors Cohort Study.

Background and objectives: An important Non-Communicable Disease risk factor, hypertension (HT), is highly prevalent and controlled HT rates are not sufficient which increases the risk of developing premature deaths. The purpose of the study is to evaluate differences in all-cause and cardiovascular-related mortality according to HT status by using national data from Chronic Diseases and Risk Factors Survey in Turkey (2011-2017). Materials and Methods: Cox regression models were used to estimate hazard ratios (HR) for predicting the all-cause and cardiovascular system-related mortalities. Median follow-up period was 6.2 years. Results: Among individuals with HT, 41.8% was untreated, 30.1% received treatment and had controlled blood pressure, and 28.1% were under treatment but had uncontrolled BP levels. The hazard for mortality among treated & uncontrolled hypertensive participants was significantly higher for all-cause (HR = 1.32, 95% CI = 1.06-1.65), cardiovascular (HR = 2.11, 95% CI = 1.46-3.06), heart disease (HR = 2.24, 95% CI = 1.46-3.43), and Coronary Heart Disease mortality (HR = 2.66, 95% CI = 1.56-4.53) compared to normotensive participants. Conclusions: Individuals with HT who were treated but do not have controlled blood pressure in Turkey had a significantly increased risk of Cardiovascular Disease and all-cause mortality. Along with studies investigating the causes of uncontrolled blood pressure despite initiation of treatment, support should be provided to patients in cases of non-adherence to antihypertensive medication or life change recommendations.

Primary hyperaldosteronism in Acute Central Serous Chorioretinopathy: a real need for screening?

Central Serous Chorioretinopathy (CSCR) is a prevalent ocular disease classified in the pachychoroidal spectrum with an elevated morbidity. Although the pathogenesis is yet unclear, mineralocorticoid-mediated pathways seem to be implicated. Primary hyperaldosteronism (PA) is a relatively frequent, albeit underdiagnosed, cause of hypertension, and has a specific therapy. A previous study assessed the prevalence of CSCR-like signs in a cohort of patients diagnosed with PA and found signs in seven out of thirteen PA patients. The present study aims to study the contrary, screening for PA in a cohort of acute CSCR patients. Between March 2017 and September 2018 all patients with acute CSCR were systematically referred to Endocrinology Department after complete ophthalmic evaluation was performed with visual acuity, spectral domain optical coherence tomography, fundus autofluorescence, fluorescein and indocyanine green angiography. The method applied for detection of PA was the 2-h 25mg captopril challenge test (CCT). Of the nineteen patients screened, two of them had a CCT positive for PA (2-h plasma aldosterone/renin ratio > 50 and/or an aldosterone level of 130pg/ml or higher), and were treated with mineralocorticoid receptor antagonists (MRA). No ophthalmic pattern was identified in them in terms of time to resolution, recurrences or features of the acute episode. The only differential feature in the fundus of PA patients was pathological arteriovenous crossings (AVC) as well as elevated BP levels. a high incidence of PA was found among acute CSCR patients. This preliminary study suggests a need for screening for PA in hypertensive CSCR patients in real clinical practice.

Associations of cardiovascular risk factors and lifestyle behaviors with neurodegenerative disease: a Mendelian randomization study

Previous observational studies reported that midlife clustering of cardiovascular risk factors and lifestyle behaviors were associated with neurodegenerative disease; however, these findings might be biased by confounding and reverse causality. This study aimed to investigate the causal associations of cardiovascular risk factors and lifestyle behaviors with neurodegenerative disease, using the two-sample Mendelian randomization design. Genetic variants for the modifiable risk factors and neurodegenerative disease were extracted from large-scale genome-wide association studies. The inverse-variance weighted method was used as the main analysis method, and MR-Egger regression and leave-one-out analyses were performed to identify potential violations. Genetically predicted diastolic blood pressure (DBP: OR per 1 mmHg, 0.990 [0.979–1.000]), body mass index (BMI: OR per 1 SD, 0.880 [0.825–0.939]), and educational level (OR per 1 SD, 0.698 [0.602–0.810]) were associated with lower risk of late-onset Alzheimer’s disease (LOAD), while genetically predicted low-density lipoprotein (LDL: OR per 1 SD, 1.302 [1.066–1.590]) might increase LOAD risk. Genetically predicted exposures (including LDL and BMI) applied to familial AD showed the same effect. The association of LDL was also found with Amyotrophic lateral sclerosis (ALS) (LDL: OR per 1 SD, 1.180 [1.080–1.289]). This MR analysis showed that LDL, BMI, BP, and educational level were causally related to AD; a significant association between LDL and ALS risk, as well as the potential effect of sleep duration on PD risk, were also revealed. Targeting these modifiable factors was a promising strategy of neurodegenerative disease prevention.

Serum gamma glutamyl transferase levels in metabolic syndrome in obese south Indian population

Background: Increased waist circumference in metabolic syndrome (MS), which reflects central obesity is associated with an increased risk of type 2 diabetes, dyslipidemia, hypertension and coronary vascular disease. Generation of free radicals in central obesity depletes intracellular glutathione, thereby induces release of gamma glutamyl transferase (GGT) into circulation. Elevated GGT levels could be a marker of high oxidative stress which is known to be associated with central obesity and metabolic syndrome. Hence the aim of this study was to determine the association of GGT levels with components of metabolic syndrome in obese South Indian population. Materials and methods: In this case control study conducted at Master Health Check (MHC) Department, Sri Ramachandra Medical College, study population included 60 obese subjects with metabolic syndrome (cases) and 60 non obese subjects (controls) of South Indian population who were non-smokers and non-alcoholics, between the ages of 30-50 years. Components of metabolic syndrome such as waist circumference, blood pressure, fasting plasma glucose, lipid profiles and GGT measured in both the groups. Data between cases and controls compared with unpaired student t-test. Pearson’s correlation was performed to find the association of GGT levels with other variables in Metabolic syndrome. Results: Serum GGT levels were significantly higher in metabolic syndrome patients (cases) than controls with p &lt; 0.0001. High levels of serum GGT were also associated with increase in BP and atherogenic lipid levels and ratios. Conclusion: Elevated serum GGT levels were significantly associated with components of metabolic syndrome in obese South Indian population.

Correlation Between Body Fat Composition and Blood Pressure Level Among Medical Students in a Tertiary Care Teaching Hospital In Pokhara, Nepal

IntroductionIncrease in body fat is a common finding in young adults due to sedentary lifestyle and unhealthy dietary habits predisposing an individual to increase in blood pressure which is a common cause of cardiovascular morbidity and mortality. This study aimed to determine the association between body fat composition and BP level in young adults.MethodsA cross sectional study was conducted among 350 students of Manipal College of Medical Sciences from January to June, 2020. A structured proforma was used to collect the required information about the subjects and measurement of height, weight, waist and hip circumference, BP was done following standard methods. Body fat percentage was assessed by skinfold thickness.ResultsThe prevalence of were overweight and obesity was found to be 35.14%. Systolic, diastolic and combined hypertension was found in 64.7%, 53.26% and 57.64% respectively, in overweight and obese population. Increase in body fat percentage in boys and increase in waist hip ratio in girls showed no correlation with increase in systolic, diastolic and mean arterial pressure. However, increase in BMI was strongly correlated (p&lt;0.05) with increase in all the measures of blood pressure- systolic, diastolic and mean arterial pressure.ConclusionsBody mass index is a better predictor of increased blood pressure level than body fat percentage and waist hip ratio.

Features of short-term variability of arterial pressure with different types of circadian rhythm in patients with hypertension disease who have suffered myocardial infarction

Abstract. Blood pressure variability is an important prognostic parameter and is an independent predictor of cardiovascular disease and mortality. Aim. To assess short-term blood pressure variability with regard to the type of diurnal blood pressure profile in hypertensive patients with myocardial infarction. Materials and methods. 78 hypertensive men who had a myocardial infarction were examined. The average age was 58.0 (54.0; 67.0) years, the experience of hypertension was 9.0 (5.0; 18.0) years, the period after the myocardial infarction was 24.5 (12.0; 84,0) months. All patients underwent daily monitoring of blood pressure with the study of average day and night pressure levels, the degree of nocturnal decrease in blood pressure, blood pressure variability with STD calculation, pure and new variability indices. The results. Increased BP variability during the day and at night was registered with all types of circadian systolic BP rhythm. The highest values of systolic BP variability (STD) during the day and at night were in patients with a night-picker circadian profile. Achieving the target level of systolic BP as a whole in the group was observed in 34.6 % of patients during the day and 42.3 % at night. Patients with an over-dipper circadian blood pressure profile, despite having the highest percentage of target blood pressure achievement, had the highest values of variability characteristics calculated by STD, pure and new indices per day (p &lt; 0.05). Conclusions. Increased blood pressure variability and pressure level at night are important criteria for assessing the prognosis of hypertensive patients after myocardial infarction. Daily monitoring of blood pressure provides a unique opportunity to objectify these prognostic parameters at different times of the day, which, together with the assessment of reaching the target level of blood pressure, is necessary to control the effectiveness of treatment.

1322-P: Association of Long-Term Blood Pressure Variability and Decrease in GFR on Type 2 Diabetes Mellitus Patients with Hypertension

Introduction: Increased long-term blood pressure variability (BPV), defined as monthly to yearly BPV, has been reported a risk factor of cardiovascular events independent of mean BP level. However, the relationship between long-term BPV and decrease in GFR remains unknown. In this study, we examined the association of Long-Term BPV and decrease in GFR. Methods: We included 214,443 type 2 diabetes mellitus patients with hypertension, registered in the Japan Diabetes Data Management Study Group, whose BP and HbA1c were simultaneously measured at least 4 times per year for 5 years from 2014-2018. BPV was defined as the 5-year coefficient of variation (CV), and the relationship between BPV and eGFR was examined. We also examined the relationship between BPV and the following background factors: (1) age (2) duration of diabetes (3) HbA1c (4) antihypertensive medications. The Ca-antagonist group was patients who took only Ca-antagonists during the 5-year period, and the ARB group was patients who took only ARBs. This study was a retrospective analysis. Data analyses were performed using the SPSS 28.0 software. Results: The group with greater 5-year BPV had lower eGFR than the group with smaller BPV, independent of mean BP (P&amp;lt;0.001). Regarding BPV and patient background, (1) BPV tended to increase with increasing age, and was significantly greater in patients over 50 years of age compared to those in their 30s (P&amp;lt;0.001). (2) The longer diabetic duration, the greater the BPV (P&amp;lt;0.001). Especially in patients more than 20 years’ diabetic duration, BPV was significantly larger than that of less than 5 years (P&amp;lt;0.001). (3) There was no association between HbA1c and BPV. (4) BPV was significantly lower in the Ca antagonist group compared with the ARB group over 5 years (0.069 vs. 0.078 P&amp;lt;0.001). Conclusion: Increased long-term BPV was observed older age and long duration of diabetes, but was not related to HbA1c. Interestingly, Patients with greater BPV had lower eGFR at 5 years. Disclosure M.Sakamoto: None. M.Yuki: None. K.Miyashita: None. T.Yamazaki: None.

The Analysis of Internet Service Provider (ISP) Service Quality to Maintain Customer Loyalty in The B2B Market

The use of an internet network in an organization cannot be divorced from the numerous types of challenges that occur inside it, particularly those connected to network service quality., In addition, the high demand for service users has become a severe issue where people believe that the network needs to be optimally utilized. This research examined the connection between ISP service quality and B2B customer loyalty to business Internet services. This work employs Structural Equation Modeling with Partial Least Square methodology for SEM data analysis (PLS-SEM). The research revealed a favourable and statistically significant correlation between BP trust and BP loyalty. Because BP believes in the quality and service of ISP providers, they are typically loyal to BP. In addition, NQ and SP have a sizeable direct association with client loyalty. Moreover, this research showed that QSTS had a good and substantial effect on BP's level of trust. Meanwhile, CSTS, NQ, and SP have a favourable and significant impact on BP value.

#4747 THE APPLICATION OF MODERN MEDICAL INFORMATION SYSTEMS WITH ARTIFICIAL INTELLIGENCE ELEMENTS FOR PERSONALIZED TREATMENT OF PATIENTS ON HEMODIALYSIS

Abstract Background and Aims The quality of life and survival of patients on hemodialysis significantly depend on modern technology. Treatment requires control of dynamically changing large volume of data, which must be analyzed and interpreted in real time. Achieving the ideal balance between adequate fluid removal, effective dialysis dose, and low risk of adverse events on the hemodialysis procedure is a complex multifactorial problem. The heterogeneity of the dialysis population, comorbid burden, the use of concomitant medications, nutritional status and adherence to diet, patient compliance are a noncomplete list of factors that must be considered when setting the dialysis regimen. Thus, despite significant progress in the technical aspects of the “artificial kidney devices”, personalization of the treatment regimen remains an important and difficult task. Introduction of modern automated medical information systems (MIS) for management of treatment and diagnostic process can provide invaluable assistance in treatment process and improve treatment outcomes. The aim of our study was to improve the prevention and treatment of hemodynamic disorders in hemodialysis patients using a special own program “Maximus”, which collects and analyzes indicators from dialysis machines in real time. Method The study was conducted from May to November 2022. The study included 120 patients on hemodialysis. The average age of the participants was 62.3±25.4 years. All participants underwent bioimpedance testing with a hydration score (InBody S10) compared to the prescribed dry weight at inclusion. A total of 9360 hemodialysis procedures (all HDF) were analyzed. The data of all procedures were collected directly from dialysis machines and analyzed in MIS in real time, identifying deviations from the target values. Episodes of both hypertension (140/90 mm Hg) and hypotension (100/60 mm Hg) were considered. MIS analyzed the actual duration of the procedure, blood flow rate, volume of fluid removal, rate of ultrafiltration and level of Na. In case of deviations from the established normal values, the system actively notified the doctor (via SMS/messengers) about detected deviations and proposed solutions. The medical staff timely corrected dry weight, duration of procedures, UF rate, volume of fluid removal, sodium content and blood pressure. Results In patients with arterial hypertension (63% of patients), mean systolic BP decreased by 12±6 mmHg and diastolic BP by 10±8 mmHg before dialysis procedure. In this group mean systolic BP decreased by 11±10 mmHg and diastolic BP by 9±8 mmHg during the procedure of hemodialysis. In patients with hypotension, due to “dry weight” increase, correction of Na level, stabilization of BP level was achieved, and mean systolic BP increased by 14±5 mmHg, and diastolic BP by 9±5 mmHg before dialysis procedure. Correction of hemodynamically significant parameters led to a decrease in the incidence of both intradialytic hypotension and hypertension during the hemodialysis procedure. Conclusion Correction of treatment, carried out using MIS with SMS notification of medical staff, improved hemodynamic parameters. Modern medical information systems with a Decision Support System can improve the quality and efficiency of treatment, reduce the risk of cardiovascular complications in patients on hemodialysis.