Changes In SBP Research Articles

Association between heart rate response during orthostatic test and falls in polymorbid patients aged 60 years and older

Background. Orthostatic hypotension is a significant risk factor of falling in older adults. To diagnose the orthostatic hypotension an orthostatic test is used with assessment of heart rate (HR) response, systolic (SBP) and diastolic blood pressure (DBP) at the 3rd minute after the rise. However, according to studies, measurement of SBP and DBP at the 1st minute after rising can be more sensitive to detect older adults at risk of falling than at 3rd minute.Objective. The purpose of this study was to evaluate the role of changes in SBP, DBP and HR at the 1st, 2nd and 3rd minutes when performing an orthostatic test for identification of the elderly at high-risk of falls.Design and methods. This cross-sectional study included 100 adults aged 59+. Among them women comprise 56 % (n = 56). The following procedures were performed: the orthostatic test, anthropometry, medical history, assessment of drug treatment, depression evaluation, dementia and the degree of autonomy decline.Results. HR response at the 1st minute after the transition from horizontal to vertical position is more significant factor of falls risk than SBP and DBP changes during performing of orthostatic test. Absence of HR increasing during the transition from horizontal to vertical position associates with 10‑fold of risk falls among older adults: odds ratio 95 % confidence interval (OR 95 % CI) 10,5 (2,9–37,8). This association remained significant even after adjusting for age, gender, β-blockers use and comorbidity.Conclusion. Absence of HR increasing during the transition from horizontal to vertical position is a high sensitive marker of detecting older adults with polymorbidity in patients with the high risk of falls.

Clinical blood pressure responses to daily ambient temperature exposure in China: An analysis based on a representative nationwide population

BackgroundLimited evidence is available regarding the potential heterogeneity of ambient temperature on blood pressure (BP) in various climate zones. ObjectivesTo explore the effect of daily ambient temperature on BP in various climate zones across 31 provinces in China. MethodsA representative population sample (n = 451,770) were obtained from the China Hypertension Survey study (CHS) from October 2012 to December 2015. Survey seasons were divided into warm and cold seasons. Survey sites were divided into three climate zones as subtropical, temperate monsoon and temperate continental zones. ResultsAfter adjustment for confounders, an overall 10 °C decrease in ambient temperature was statistically associated 0.74 mmHg (95% CI: 0.69, 0.79) and 0.60 mmHg (95% CI: −0.63, −0.57) rise for SBP and DBP, respectively. In the warm season, U-shaped exposure-response curves were observed between ambient temperature and BP in temperate monsoon and continental zones, and liner curves in other zones. A greater SBP change due to a lower temperature was observed in subtropical zones, so did DBP in temperate continental zones, especially for cold season. Female, rural and elderly populations were more susceptible to cold weather than their counterparts. DiscussionThere is a geographical disparity between temperature and BP across different climate zones, which should been taken into consideration when maintaining stable blood pressure levels.

Short- and long-term systolic blood pressure changes have different impacts on major adverse cardiovascular events: Results from a 12.5 years follow-up study

BackgroundSystolic blood pressure increased in middle-aged person contributes significantly to the risk of major adverse cardiovascular events (MACE). Meanwhile, different patterns (short- or long-term change) of SBP increase may result in differential risk and lead to differences in predictive ability. MethodsA total of 19,544 and 22,610 participants in the Fuxin Cardiovascular Cohort Study underwent measurement of SBP at 2 examinations for short- and long-term change study population. Cox proportional hazards models were used to relate future clinical outcomes with change in SBP. ResultsDuring a median follow-up period of 12.5 years, 1064 (772 stroke, 247 myocardial infarction, 528 CVD deaths) and 1316 (958 stroke, 301 myocardial infarction, 660 CVD deaths) MACE were identified during short- and long-terms SBP change, respectively. For SBP increased participants, short-term change in SBP was associated with future MACE (hazard ratio [HR]: 1.241 per 1-SD increase; 95% confidence interval [CI]: 1.146–1.344; P < 0.001), long-term change in SBP (HR: 1.218; 95% CI: 1.123–1.322; P < 0.001). For prehypertension participants, long-term changes conferred a strong impact than short-term. For hypertensive participants, short-term changes conferred a strong impact than long-term. ConclusionsHaving a SBP rise in short- or long-term both confer an increased risk of MACE and its subgroups. Furthermore, short- and long-term SBP increase patterns adds different additional information beyond one single baseline examination. Change in SBP may be a prognostic surrogate marker and future studies are needed to clarify the possible mechanism for predicting MACE.

Deep learning-based automatic blood pressure measurement: evaluation of the effect of deep breathing, talking and arm movement

Objectives: It is clinically important to evaluate the performance of a newly developed blood pressure (BP) measurement method under different measurement conditions. This study aims to evaluate the performance of using deep learning-based method to measure BPs and BP change under non-resting conditions.Materials and methods: Forty healthy subjects were studied. Systolic and diastolic BPs (SBPs and DBPs) were measured under four conditions using deep learning and manual auscultatory method. The agreement between BPs determined by the two methods were analysed under different conditions. The performance of using deep learning-based method to measure BP changes was finally evaluated.Results: There were no significant BPs differences between two methods under all measurement conditions (all p > .1). SBP and DBP measured by deep learning method changed significantly in comparison with the resting condition: decreased by 2.3 and 4.2 mmHg with deeper breathing (both p < .05), increased by 3.6 and 6.4 mmHg with talking, and increased by 5.9 and 5.8 mmHg with arm movement (all p < .05). There were no significant differences in BP changes measured by two methods (all p > .4, except for SBP change with deeper breathing).Conclusion: This study demonstrated that the deep learning method could achieve accurate BP measurement under both resting and non-resting conditions.Key messagesAccurate and reliable blood pressure measurement is clinically important. We evaluated the performance of our developed deep learning-based blood pressure measurement method under resting and non-resting measurement conditions.The deep learning-based method could achieve accurate BP measurement under both resting and non-resting measurement conditions.

The midline approach for endotracheal intubation using GlideScope video laryngoscopy could provide better glottis exposure in adults: a randomized controlled trial

BackgroundPrevious studies have demonstrated that the common laryngoscopic approach (right-sided) and midline approach are both used for endotracheal intubation by direct laryngoscopy. Although the midline approach is commonly recommended for video laryngoscopy (VL) in the clinic, there is a lack of published evidences to support this practice. This study aimed to evaluate the effects of different video laryngoscopic approaches on intubation.MethodsTwo hundred sixty-two patients aged 18 years who underwent elective surgery under general anaesthesia and required endotracheal intubation were included in the present prospective, randomized, controlled study. The participants were randomly and equally allocated to the right approach (Group R) or midline approach (Group M). All the intubations were conducted by experienced anaesthetists using GlideScope video laryngoscopy. The primary outcomes were Cormack-Lehane laryngoscopic views (CLVs) and first-pass success (FPS) rates. The secondary outcomes were the time to glottis exposure, time to tracheal intubation, haemodynamic responses and other adverse events. Comparative analysis was performed between the groups.ResultsFinally, 262 patients completed the study, and all the tracheas were successfully intubated. No significant differences were observed in the patient characteristics and airway assessments (P > 0.05). Compared with Group R, Group M had a better CLV (χ2 = 14.706, P = 0.001) and shorter times to glottis exposure (8.82 ± 2.04 vs 12.38 ± 1.81; t = 14.94; P < 0.001) and tracheal intubation (37.19 ± 5.01 vs 45.23 ± 4.81; t = 13.25; P < 0.001), but no difference was found in the FPS rate (70.2% vs 71.8%; χ2 = 0.074; P = 0.446) and intubation procedure time (29.86 ± 2.56 vs 30.46 ± 2.97, t = 1.75, P = 0.081). Between the groups, the rates of hoarseness or sore throat, minor injury, hypoxemia and changes in SBP and HR showed no significant difference (P > 0.05).ConclusionAlthough the FPS rate did not differ based on the laryngoscopic approach, the midline approach could provide better glottis exposure and shorter times to glottis exposure and intubation. The midline approach should be recommended for teaching in VL-assisted endotracheal intubation.Trial registrationThe study was registered on May 18, 2019 in the Chinese Clinical Trial Registry (ChiCTR1900023252).

Blood pressure changes after renal denervation are more pronounced in women and nondiabetic patients: findings from the Austrian Transcatheter Renal Denervation Registry.

Three recently published sham-controlled studies proved the efficacy of renal denervation (RDN) in hypertensive patients. The study presented here analyzed a nationwide multicentre registry database to clarify which patient subgroups benefit most from radiofrequency RDN. This is a post hoc analysis from the multicentre Austrian Transcatheter Renal Denervation Registry hosted by the Austrian Society of Hypertension. We correlated change of SBP after RDN to sex and presence/absence of comorbidities. Univariable correlation and multiple linear regression analyses were performed. Two hundred and ninety-one patients (43% women, median age 64 years) undergoing RDN between April 2011 and September 2014 were included in this analysis. Mean baseline ambulatory 24 h BP (systolic/diastolic) was 150 ± 18/89 ± 14 mmHg and mean baseline office BP was 170 ± 16/94 ± 14 mmHg.After RDN, mean ambulatory 24 h BP reduction was 9 ± 19/6 ± 16 mmHg. The following features were associated with a good response to RDN: high baseline systolic ambulatory BP, high baseline diastolic office BP, female sex, absence of diabetes mellitus, and absence of peripheral artery disease. Multivariable analysis identified female sex and absence of diabetes mellitus as strongest predictors for ambulatory BP reduction, although those groups had the lowest baseline ambulatory BP. Ambulatory BP reductions after RDN were substantially more pronounced in female and in nondiabetic patients despite lower baseline BP. It is concluded that in terms of efficacy female patients and nondiabetic patients might benefit more from RDN.

Effects of bariatric surgery in different obesity phenotypes: Tehran Obesity Treatment Study (TOTS).

Not all morbid obese patients suffer from metabolic co-morbidities; thus, a sub-group of metabolically healthy morbid obese (MHMO) individuals are identified. However, the role of bariatric surgery is not well understood in this subgroup. A total of 2244 morbid obese individuals aged 18-65 years undergoing bariatric surgery were selected. Patients were considered MHMO according to the joint interim statement (JIS) definition, as having two or less abnormalities in these five parameters: waist circumference (WC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), systolic or diastolic blood pressure (SBP or DBP), and fasting plasma glucose (FPG). Otherwise, they were considered metabolically unhealthy morbid obese (MUMO). Follow-up data were collected at 6, 12, and 24 months post-surgery. Prior to surgery, 36.2% of participants were MHMO and had significantly lower BMI, WC, TG, FPG, SBP, and DBP and higher HDL-C compared to MUMO. Both MHMO and MUMO participants showed a significant decrease in BMI, WC, TG, SBP, DBP, and FPG and increase in HDL-C and the percentage of excess weight loss (%EWL). Two-year post-operative changes (from baseline) of BMI, WC, and %EWL were greater in MHMO subjects and changes of TG, HDL-C, DBP, SBP, and FPG were greater in MUMO subjects. Further multivariate regression analysis for delta (∆) change in these characteristics revealed that only the delta (∆) changes of WC and %EWL were statistically different between the two phenotypes and were greater in MHMO subjects, 2 years after the surgery (- 3.077 cm decrease in WC and + 3.612% higher %EWL compared to MUMO subjects). Bariatric surgery is an effective method for reduction of metabolic abnormalities and weight loss in both MUMO and MHMO phenotypes. Benefits of this intervention are comparable between patients with these two obesity phenotypes.

Property of Melatonin of Acting as an Antihypertensive Agent to Antagonize Nocturnal High Blood Pressure: A Meta-Analysis

Therapy of hypertension persisting in the course of nocturnal sleep has yielded rather disappointing results . Therefore, the research has focused on drugs such as melatonin acting in such a way so as to counteract the lack of fall in blood pressure during night time sleep. A meta-analysis has been planned by gathering only randomized controlled trials( RCTs), where melatonin was administered as a single dose at bedtime and compared with placebo. The efficacy was the "night time variation in systolic blood pressure" and the "night time variation in diastolic blood pressure". Safety endpoint was the possible occurrence of serious adverse events. Seven studies with 221 participants were pooled in the meta-analysis. Melatonin use was a predictor of significant decrease in nocturnal systolic blood pressure[SBP]( difference in means[MD]= -5.74 mm Hg; 95% CI: -6.07 to- 5.41 mm Hg; p&lt;0.00001).This change was generated by the very steep decrease in nocturnal SBP detected in patients treated with controlled-release(CR) melatonin ( MD=-8.42 mm Hg; 95% CI: -8.82 to- 8.02 mm Hg; p&lt;0.00001); whereas the mean change in nocturnal SBP, found in patients taking fast -release (FR)melatonin, was nonsignificant (MD=-0.06 mm Hg; 95% CI: -0.64 to 0.52 mm Hg; p=0.84). Likewise, use of melatonin was associated with a fall in DBP( MD= -0.60 mm Hg; 95% CI=-1.12 to -0.08 mm Hg), driven by the pressure changes attained by the CR melatonin. No major adverse events occurred in the examined trials. Evening administration of CR melatonin has been shown to cause a significant pressure decrease over the nocturnal sleep. Thus, the CR melatonin preparations could find a place in the antihypertensive armamentarium for promoting the physiological fall of blood pressure levels during night time sleep.

1138 Intragastric Balloon on Blood Pressure Reduction in a Gastroenterology Practice in Eastern Northern Carolina: A Retrospective Review

INTRODUCTION: Obesity is a global pandemic and a major health concern contributing to cardiovascular disease (CVD). Cardiovascular disease (CVD) causes nearly 18 million deaths yearly. Amongst the CVD risk factors, hypertension remains the leading cause of excessive premature mortality and morbidity. The consequences of hypertension are of momentous impact on public health. It is estimated that nearly 1.5 billion adults in the world will have hypertension in the decade ahead. If this trend is not reversed, the ramifications do not bode well for the pandemic of CVD. The highest CVD hospitalization rates are clustered primarily in rural Eastern North Carolina (ENC), a pattern similar to that of all CVD death rates. Also, the prevalence of obesity and HTN in ENC are comparable. Bariatric surgery is the most effective weight (wt.) reduction intervention with short- and long-term health improvements. However, little is known about endoscopic bariatric therapy, such as intragastric balloon therapy (IGBT) on HTN improvement. METHODS: Retrospective chart review between January 1, 2016, and January 31, 2019, of adults who received IGBT in a GI practice in ENC. Data collection comprised patient demographics. The primary outcome was wt. reduction, expressed as kilograms lost, and % wt. loss at 3 and 6 months after IGB. The secondary outcome was the impact of weight reduction on hypertension (cut off SBP/DBP: 140/90) post-implantation at 6 months. Logistic regression analyses were performed to determine the association between weight and hypertension at 6- months post-implantation. Statistical analysis was done using STATA 14. RESULTS: See Table 1 for baseline demographics. Wt. was found to be a significant factor in determining SBP given the JNC 8 guidelines (β = 0.0140, P &lt; 0.000). These results indicate that for every increase in wt., the log odds of SBP will increase by 1.4%. These results indicate that for every increase in wt, the log odds of hypertension will increase by 1.2%. No association was shown between wt. and DBP. 11 patients requested early removal (IGB removal in the first two weeks to one-month post-implantation). Of the 11, 10 patients reported intolerable side effects, such as intractable nausea, vomiting, diarrhea, and abdominal pain; and one patient reported a sensation of a foreign body. CONCLUSION: There was a statistically significant wt reduction post-implantation. Statistically significant correlation was found between wt reduction and changes in SBP at 6 months post-implantation.

Associations of blood pressure categories according to the 2017 American College of Cardiology/American Heart Association hypertension guideline and long-term blood pressure change with incident cardiovascular disease in middle-aged and elderly Chinese: the Dongfeng-Tongji cohort study.

To assess the associations of newly defined blood pressure (BP) categories by the 2017 American College of Cardiology/American Heart Association guideline and changes in BP with the risk of cardiovascular disease (CVD) among the middle-aged and older Chinese. Among 29 086 participants aged 61.6 years from the Dongfeng-Tongji (DFTJ) cohort, we estimated the hazard ratio for CVD using Cox proportional hazard models. As BP increased, we found a significant trend for greater risk of incident CVD, coronary heart disease (CHD) or stroke. Compared with the BP <120/<80 mmHg, those having stage 1 hypertension (BP of 130-139/80-89 mmHg) had an increased risk of CVD [hazard ratio of 1.29 (1.18-1.42)], CHD [hazard ratio of 1.27 (1.15-1.41)] and stroke [hazard ratio of 1.36 (1.10-1.70)], respectively. The effect of stroke was only presented in those aged at least 60 years, but not for those aged less than 60 years; whereas no age-specific association for CHD and CVD was found. Particularly, significantly increased risk of CVD (18%), CHD (14%) and stroke (37%) appeared even with elevated BP (120-129/<80 mmHg). Over a 5-year period, compared with individuals with stable BP less than 130/80 mmHg, those who maintained stage 1 hypertension had 43% increased risk for CVD, which was more prominent among those age at least 60 years. Relative to stable BP (-5 to 5 mmHg), a rise in SBP at least 15 mmHg and DBP at least 5 mmHg conferred 15 and 16% higher CVD risk; whereas the risk of CVD and CHD had 25 and 22% reduction with a decrease in SBP greater than15 mmHg, but not with DBP. Newly defined stage 1 hypertension and elevated BP were associated with increased risk of incident CVD, whereas long-term changes of SBP and DBP had effects of varying degree on CVD incidence.

P2641Renal and cardiovascular benefits of treatment with angiotensin receptor blockers in patients with hypertension and chronic kidney disease: A systematic review and meta-analysis

Abstract Background Blood pressure (BP) control is critical in delaying the progression of chronic kidney disease (CKD), which otherwise results in an increased risk of cardiovascular morbidity and mortality. Angiotensin II receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors, are recommended by several guidelines as first-line treatment for patients with hypertension and CKD. Purpose We reviewed and analysed the effect of ARB treatment on BP and renal outcomes (estimated glomerular filtration rate (eGFR), serum creatinine (SCr), creatinine clearance (CrCl) or proteinuria) in patients with hypertension and CKD with or without diabetes, including large clinical trials such as RENAAL and IDNT. Methods MEDLINE, EMBASE, and BIOSIS databases were searched for literature from the earliest available date to July 2017. Randomised (parallel-group) controlled trials of ≥8 weeks assessed the impact of ARBs on systolic/diastolic BP (SBP/DBP), eGFR, SCr, CrCl or proteinuria were included in the analysis. Meta-analysis (post- versus pre-treatment) and meta-regression were conducted in R-statistical software (v3.4.1) using meta- and metafor-packages. Mean difference (MD, generic inverse variance) with 95% confidence intervals (CIs) was used to pool data for an outcome in a single forest plot. The risk of bias (quality) of included studies was assessed by the six items of the Cochrane instrument. Results Of the 165 articles assessed for eligibility, 24 studies were included in the analysis (19 evaluated ARBs as monotherapy, 4 evaluated ARBs in combination with other antihypertensives and 1 evaluated ARBs both as mono- and combination therapy). Treatment with ARBs as monotherapy for ≥8 weeks to &lt;1 year significantly reduced mean office SBP (MD, −12.60 mmHg; 95% CI, −18.53 to −6.67)/DBP (−6.52 mmHg; −11.27 to −1.77) (p&lt;0.01). BP reduction was also significant (p&lt;0.01) with ARB monotherapy for ≥1 year SBP (−14.84 mmHg; −17.82 to −11.85)/DBP (−10.27 mmHg; −12.26 to −8.27). ARBs also significantly reduced SBP/DBP when combined with other antihypertensive treatments for ≥8 weeks to &lt;1 year as well as for ≥1 year (Figure). Moreover, ARBs induced significant reductions (p&lt;0.01) in proteinuria (≥8 weeks to &lt;1 year [MD, −0.6 g/L; 95% CI, −0.93 to −0.26; ≥1 year [−0.9 g/L; −1.22 to −0.59]), but no significant changes in eGFR, CrCl or SCr levels. The beneficial effect of ARBs was maintained overtime with no significant additional impact on SBP change (estimate: 0.025; 95% CI, –0.14 to 0.19) or eGFR (estimate: 0.068; 95% CI, −0.14 to 0.28; p=0.53). The overall risk of bias was judged to be low. Effect of ARBs on blood pressure changes Conclusion Treatment with ARBs effectively and sustainably lowered BP and proteinuria with no significant change in eGFR in patients with hypertension and CKD with or without diabetes.

P4991Effects of the glucagon like peptide-1 receptor analogue, sodium-glucose co-transporter 2 and their combination on myocardial work index and vascular function in diabetes after 3-month treatment

Abstract Glucagon like peptide-1 analogues (GLP-1A) and sodium-glucose co-transporter 2 (SGLT2) are used in the treatment of type 2 diabetes mellitus (T2DM) We investigated whether the effects of treatment with GLP-1A and SGLT2 and their combination on vascular and cardiac function. Methods A hundred twenty, patients with type 2 diabetes were randomized to receive the insulin +/− metformin (n=30), GLP-1A, liraglutide (n=30), the SGLT-2, empagliflozin (n=30) or their combination (GLP-1R+SGLT-2) for 3 months (n=30). We measured at baseline and after treatment a) pulse wave velocity (PWV), central systolic blood pressure (cSBP) b) the perfusion boundary region (PBR-micrometers) of the sublingual arterial microvessels, as a marker of endothelial glycocalyx thickness. c) global LV longitundinal strain (GLS), peak LV untwisting velocity and global myocardial work index (GWI) derived by pressure–myocardial strain loops using speckle tracking imaging and PWV to GLS ratio, as a marker of ventricular-arterial coupling Results All treatment groups had similar vascular and cardiac markers, glucose levels and HbA1 at inclusion (p&gt;0.05). After treatment, all patients had improved GLS, PWV and increased LV twisting-untwisting velocities (p&lt;0.05). Patients under GLP-1R, SGLT-2 and their combination achieved a significant reduction of PBR, PWV, central SBP and a greater increase of GWI (30%, 25% and 50% respectively) and LV untwisting velocities (p&lt;0.05) than those under insulin (15% reduction of GWI), despite a similar reduction of HbA1 (p&lt;0.05). The combination of GLP-1A and SGLT-2 showed a greater improvement of the measured markers than each treatment alone (table, p&lt;0.05). The reduction of PBR (indicating improvement of glycocalyx thickness) was related with the changes in central SBP (r=0.40) and PWV (r=0.35) (p&lt;0.05). N=120 Insulin GLP-1A SGLT-2 GLP-1A + SGLT-2 P 3-months N=30 N=30 N=30 N=30 PBR, μm 2.27±0.3 2.17±0.3 2.17±0.3 1.99±0.2 &lt;0.05 Central SBP, mmHg 136±20 127±16 126±11 124±10 &lt;0.05 PWV, m/sec 11.7±0.5 9.5±0.5 9.3±0.5 9.2±0.5 &lt;0.05 HbA1 7.1±1.5 6.6±0.3 6.7±0.6 6.2±0.6 0.8 Myocardial work index (GWI), mmHg% 1343±394 1579±245 1364±431 1784±593 &lt;0.05 LV untwisting velocity, deg/sec −116±36 −123±36 −122±36 −130±36 &lt;0.05 PWV/GLS ratio −0.77±0.2 −0.57±0.2 −0.66±0.3 −0.55±0.3 &lt;0.05 Conclusion Three-month treatment with GLP-1A, SGLT-2 and their combination showed a greater improvement of vascular markers, ventricular-arterial coupling and effective cardiac work than insulin treatment in type 2 diabetes.

Reducing Hypertension in a Poststroke Black and Hispanic Home Care Population: Results of a Pragmatic Randomized Controlled Trial.

Uncontrolled hypertension (HTN) is a leading modifiable stroke risk factor contributing to global stroke disparities. This study is unique in testing a transitional care model aimed at controlling HTN in black and Hispanic poststroke, home health patients, an understudied group. A 3-arm randomized controlled trial design compared (i) usual home care (UHC), with (ii) UHC plus a 30-day nurse practitioner transitional care program, or (iii) UHC plus nurse practitioner plus a 60-day health coach program. The trial enrolled 495 black and Hispanic, English- and Spanish- speaking adults with uncontrolled systolic blood pressure (SBP ≥ 140 mm Hg) who had experienced a first-time or recurrent stroke or transient ischemic attack. The primary outcome was change in SBP from baseline to 3 and 12 months. Mean participant age was 67; 57.0% were female; 69.7% were black, non-Hispanic; and 30.3% were Hispanic. Three-month follow-up retention was 87%; 12-month retention was 81%. SBP declined 9-10 mm Hg from baseline to 12 months across all groups; the greatest decrease occurred between baseline and 3 months. The interventions demonstrated no relative advantage compared to UHC. The significant across-the-board SBP decreases suggest that UHC nurse/patient/physician interactions were the central component of SBP reduction and that additional efforts to lower recurrent stroke risk should test incremental improvements in usual care, not resource-intensive transitional care interventions. They also suggest the potential value of pragmatic home care programs as part of a broader strategy to overcome HTN treatment barriers and improve secondary stroke prevention globally. Trial Number NCT01918891.

Implications of renin-angiotensin-system blocker discontinuation in acute decompensated heart failure with systolic dysfunction.

BackgroundRenin‐angiotensin‐system blockers (RASB) improve clinical outcomes in patients with chronic heart failure with reduced fraction; however, there remains ambiguity whether RASB therapy should be continued during the treatment of acute decompensated heart failure (ADHF).HypothesisIn comparison to patients with RASB use, RASB discontinuation in ADHF will be associated with worsening renal function, hypotension, and adverse long‐term clinical outcomes.MethodsPatients in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization (ESCAPE) trial were separated into four groups based on RASB use at baseline and discharge: continuation (n = 316), discontinuation (n = 21), initiation (n = 42), and nonuse (n = 23). Post‐discharge outcomes were validated in an independent ADHF cohort admitted to the Cleveland Clinic (n = 253).ResultsRASB discontinuation and nonuse were associated with higher serial creatinine and blood urea nitrogen levels than RASB continuation or initiation (P < .001 for both), but not with serial potassium and systolic blood pressure measurements. No other clinical parameter changes were significant. In comparison to RASB continuation, RASB discontinuation and nonuse was associated with ~75% increased risk of a 180‐day composite of death, transplant, or rehospitalization (HR 1.87, 95% CI 1.09‐3.20, P = 0.02 and HR 1.72, CI 1.04‐2.82, P = .03, respectively). Post‐discharge outcomes were similar in the validation cohort.ConclusionCompared to RASB continuation, RASB discontinuation and nonuse were associated with higher baseline and serial creatinine levels during treatment for ADHF, but not with changes in SBP and potassium levels. Furthermore, RASB discontinuation and nonuse in ADHF were associated with an increased risk of adverse clinical outcomes.

Abstract 047: Mode of Orthostatic Hypotension Assessment and Dizziness in Older Adults

Background: Orthostatic hypotension (OH) is an important predictor of dizziness, falls, and death. However, there is substantial uncertainty regarding the most clinically meaningful way to assess OH. Methods: The Study to Understand Fall Reduction and Vitamin D in You (STURDY) was a randomized trial (2015-2019), comparing the effect of vitamin D dose on fall risk in adults, 70 yrs or older. At baseline, seated blood pressure (BP) was measured after 5 minutes of rest. Then, after standing for 1 minute, a series of 3 BP measurements were performed, each separated by 30 seconds. Participants were asked about dizziness during the seated-to-standing protocol. OH was defined at 3 different times based on the consensus definition (a drop in systolic BP [SBP] of 20 or diastolic BP [DBP] of 10 mm Hg) and by its individual BP components. We used logistic regression to determine the association of OH definitions with dizziness. Results: Among 660 participants (mean age 76.4 ± 5.3 yrs, 44% women, 18% black), 52 (8%) reported dizziness and 19 (3%) had consensus OH. While all 3 assessments of consensus and systolic OH were associated with dizziness, associations based on average measurements were strongest (OR 6.8 [2.4, 19.6] and OR 11.7 [3.7, 36.7], respectively) ( Table ). Only diastolic OH measurements at or after 3 minutes were associated with dizziness. In contrast, the last measurement of postural change in SBP and none of DBP were associated with dizziness. Conclusions: OH based on an average of 3 SBP measurements between 1-5 minutes was the most strongly associated with dizziness, suggesting that precision is more important than timing. These findings are useful for the clinical assessment of dizziness.

Abstract P3050: The Effects of Sacubitril/Valsartan on Blood Pressure: Experiences From a Community-Based Heart Failure Center

Background: The use of sacubitril/valsartan (S/V) in heart failure has shown promising results. Clinical data is lacking regarding antihypertensive effects. We examined systolic and diastolic blood pressure (SBP and DBP) reduction with S/V. Methods: From July 2016 to March 2018, 193 consecutive patients on uninterrupted S/V therapy were identified. Of these, patients who a) had 14 or more days of S/V therapy and b) at least two follow-up visits 7 or more days apart from S/V initiation and from each visit were included in the analyses. Change in SBP from baseline to first visit was the dependent variable. Paired-t and one-way ANOVA tests were performed to identify deltas and associations. Linear regression models were used for continuous variables. Results: In 111 eligible patients, a significant decrease in SBP (123.4 ± 16.8 to 113.7 ± 18.0 mm Hg; p&lt;0.001) and DBP (75.2 ± 12.1 to 69.6 ± 11.8 mm Hg; p&lt;0.001) occurred from baseline to the first clinic visit (mean days of therapy: 38.2 ± 35.3 days). Significance did not persist to the second clinic visit (mean SBP: 121 ± 18.3 mm Hg, p=0.316; mean DBP: 73.9 ± 12.0 mm Hg) with mean 110.2 ±119.2 days. Multiple factors were associated with SBP reduction from baseline to first visit (Table). With multiple linear regression, only higher baseline BNP (R=0.006, p=0.028) and higher baseline SBP (R=0.549, p&lt;0.001) remained significant. Conclusion: The use of S/V was associated with a short-lived reduction in SBP. Hypotheses regarding diuretic effect with subsequent fluid homeostasis could be considered given noted associations. As symptomatic hypotension is a limiting adverse effect, these data may help guide clinicians with patient selection and dosing.

Abstract 003: Early and Late Post-Kidney Transplant Hypertension and Late Renal Allograft Outcome

Background: Association between pattern of blood pressure (BP) change at different period after kidney transplantation (KTx) and renal allograft function is unclear. We examine the association between changes in BP patterns and long-term allograft function. Methods: Kidney transplant recipients were stratified into 4 groups based on presence (+) or absence (-) of systolic hypertension (SHTN; SBP ≥130 mmHg) both at 1 and 6 mo post-KTx (Gr1 (-,-), Gr2 (-,+), Gr3 (+,-), Gr4 (+,+)). Declined allograft function defined by a decrease in eGFR from baseline eGFR at 1-mo post-KTx during 24 mo of follow-up among 4 different groups is examined by multivariable Cox regression analysis. Results: Of all 70 patients, mean±SD age was 52.7±12 yr and 41% was female. Mean SBP at 1- and 6-mo post-KTx were 130.9±18.3 and 136.2±18.2 mmHg, respectively. Baseline mean eGFR at 1-mo post-KTx was 50.86±18.89 ml/min/1.73 m 2 and were not different among all 4 groups. Among 70 patients, 57 patients (81%) had a decrease in eGFR between 1 and 24 mo post-KTx with a median time to outcome of 6.8 mo (IQR 2.8-19.6) and the incidence rate of 0.075 person-mo. The number of patients (% in each group) with declined eGFR in Gr1, 2, 3 and 4 were 15 (88%), 17 (89%), 7 (78%), and 18 (72%) patients, respectively (x 2 2.8830, p 0.410). Compared to Gr1, Gr2 had higher, but Gr 3 and 4 had lower the risk of declining eGFR but no statistical significance (HR(95% CI): Gr2 1.20 (0.60-2.40); Gr3 0.79 (0.32-1.95); Gr4 0.78 (0.39-1.55)). After adjusted for age, gender, race, types of induction immunosuppression, types of KTx, SBP, DBP, and BMI at the time of KTx, Gr3 became higher risk; otherwise, the direction of the association remains the same for Gr2 and Gr4. Conclusion: Changes in SBP from either normotension to HTN or vice versa between 1 and 6 mo post-KTx appears to be associated with poorer allograft function within 24 mo post-KTx; whereas, maintaining SBP pattern both normotension or HTN from 1 to 6 mo post-KTx may be protective for a decline in allograft function. Very early BP levels during 1 mo post-KTx may be the suitable target SBP for kidney transplant recipients and too liberal or tight BP control in normotensive or hypertensive patients after 1 mo post-KTx may associated with greater risk for worsening long-term allograft outcomes.

Abstract P2072: Integrative Network Analysis Of Microbiome-Immune Axis In Metabolic Syndrome Patients During A Fasting Intervention

Fasting can prolong survival and reduce disease burden in rodent models, and possibly in humans. The relationship between diet, gut microbiota, immune system and host (patho)physiology has only recently been explored, and information is lacking on how periodic fasting affects the gut microbiome in patients with metabolic syndrome (MetS). We show a 5-day fast (FAST) in humans, followed by a modified DASH diet is more effective than DASH alone (DASH) at reducing systolic blood pressure (SBP change measured by ABPM, 95% CI; FAST: [-7.053,-1.142], DASH: [-5.880,1.477]), need for antihypertensive medication (FAST: n=15 of n=35, DASH: n=6 of n=36 patients), and body-mass index at three months post intervention. Fasting altered the gut microbiome, impacting bacterial taxa and functional gene modules associated with the production of short-chain fatty acids (e.g. Faecalibacterium prausnitzii , Eubacterium rectale, Coprococcus comes ), previously linked to vascular health and immunity. Immunophenotyping and cross-system analyses revealed that SBP changes correlated with circulating Il-2 + TNFα + mucosa-associated invariant T (MAIT) cells (FDR-corr P(q) =0.044, Spearman’s rho=0.44), Il-17 - IFNγ + MAITs (FDR-corr P(q) =0.022, Spearman’s rho=0.49), and effector CD4 + T cells (FDR-corr P(q)=0.047, Spearman’s rho=0.43). By stratifying the fasting group into BP responders and non-responders, we identified a set of 76 microbial and 99 immune responder-specific features. Machine learning algorithms could predict long-term SBP responsiveness from baseline immunome data, identifying changes in effector CD8 + T cells, Th17 cells and Tregs as discriminators (Single-subject prediction: 71%). This is the first high-resolution multi-omics characterization of fasting in MetS. Fasting induced long-term reduction in body weight and SBP, accompanied by changes in microbiome and immune homeostasis. Our data implicate fasting as a promising non-pharmacological intervention in MetS.

Abstract P3055: Effects of Lactotripeptides on Tele-Monitoring Home Blood Pressure in Prehypertension: A Randomized, Double-Blind, Placebo-Controlled, Crossover Study

Aims: The present randomized, double-blind, placebo-controlled, crossover study was conducted to examine the effect of lactotripeptides on tele-monitoring home blood pressure (homeBP) and also on markers of vascular function and renal damages, which affect the blood pressure elevation, in Japanese subjects with prehyperension. Methods: In 26 subjects with prehypertension, the active products (lactotripeptides tablets) or placebo tables were randamly allocated for 8 weeks each in a cross-over manner. 2 weeks of run-in period and 4 weeks of wash-out period between two sessions were set up. The home BP was monitored by home BP tele-monitoring from the run-in period to the end of the study. The urinary liver-type fatty acid-binding protein-to-creatine ratio (UFABPCR), pulse wave velocity (PWV), and flow-mediated vasodilatation of brachial artery (FMD) were measured at the end of each intervention. Results: While the home BP before each intervention (mean of BP in 7 days just before the start each intervention) were similar, the home BP at the end of taking lactotripeptides were significantly lower than those at the end of taking placebo (mean of BPs in 7 days at the end of each intervention) (127 ± 2 vs. 130 ± 2 mmHg, p&lt;0.05). PWV and FMD were similar between both interventions, but the UFABPCR was significantly lower in at the end of taking lactotripeptides than that at the end of taking placebo (1.9 ± 1.7 vs. 2.4 ± 2.2 microg/g creatinine, p&lt;0.05). The mixed linear model analysis demonstrated a significant difference of the change of home DBP between both intervention was observed (P=0.04), and that difference of the change of home SBP was marginal (p=0.10). Conclusion: The lactotripeptides supplement may provide a beneficial effect on the blood pressure in Japanese subjects with prehypertension. In addition, it seems to have a protective effect against renal damage.

Effect of angiotensin receptor blockers on blood pressure and renal function in patients with concomitant hypertension and chronic kidney disease: a systematic review and meta-analysis

Objective: Angiotensin receptor blockers (ARB) are among the recommended first-line treatment options in patients with hypertension and chronic kidney disease (CKD). This meta-analysis evaluated the effect of ARB on blood pressure (BP) and renal function in patients with concomitant hypertension and CKD with or without diabetes.Methods: Literature search was performed in PubMed/MEDLINE, EMBASE and BIOSIS to identify parallel-group, randomized controlled trials (≥8 weeks) reporting the effects of ARB on office systolic/diastolic BP (SBP/DBP), estimated glomerular filtration rate (eGFR), serum creatinine (SCr), creatinine clearance (CrCl) or proteinuria in adults with hypertension and CKD. Mean difference (MD, generic inverse variance) with 95% confidence intervals (CIs) was used to report an outcome.Results: Among the 24 studies identified, 19 evaluated ARB as monotherapy, 4 evaluated ARB as combination therapy and one evaluated ARB both as monotherapy and combination therapy. Median (range) duration of the studies was 12 (1.84–54.0) months. ARB monotherapy significantly (p < 0.01) reduced BP (treatment ≥1 year: SBP [MD: −14.84 mmHg; 95% CI: −17.82 to −11.85]/DBP [−10.27 mmHg; −12.26 to −8.27]) and proteinuria (≥1 year [−0.90 g/L; −1.22 to −0.59]). Results were consistent for combination therapy. In these studies, non-significant changes were observed for eGFR, CrCl and SCr. The impact of SBP changes on eGFR was not significant; however, studies were of a relatively short duration.Conclusion: ARB had a favorable impact on BP and renal parameters such as proteinuria with monotherapy as well as with combination therapy, highlighting their potential benefits in patients with hypertension and CKD. During the short follow-up of these studies, no significant change in eGFR was observed.