Changes In Systolic Blood Pressure Research Articles

Changes in vital signs during adrenaline administration for hemostasis in intracordal injection: an observational study with a hypothetical design of endotracheal adrenaline administration in cardiopulmonary arrest

BackgroundThe background is that intravenous adrenaline administration is recommended for advanced cardiovascular life support in adults and endotracheal administration is given low priority. The reason is that the optimal dose of adrenaline in endotracheal administration is unknown, and it is ethically difficult to design studies of endotracheal adrenaline administration with non-cardiopulmonary arrest. We otolaryngologists think so because we administered adrenaline to the vocal folds for hemostasis after intracordal injection under local anesthesia, but have had few cases of vital changes. We hypothesized that examining vital signs before and after adrenaline administration for hemostasis would help determine the optimal dose of endotracheal adrenaline.MethodsWe retrospectively examined the medical records of 79 patients who visited our hospital from January 2018 to December 2020 and received adrenaline in the vocal folds and trachea for hemostasis by intracordal injection under local anesthesia to investigate changes in heart rate and systolic blood pressure before and after the injection.ResultsThe mean heart rates before and after injection were 83.96 ± 18.51 (standard deviation) beats per minute (bpm) and 81.50 ± 15.38 (standard deviation) bpm, respectively. The mean systolic blood pressure before and after the injection were 138.13 ± 25.33 (standard deviation) mmHg and 135.72 ± 22.19 (standard deviation) mmHg, respectively. Heart rate and systolic blood pressure had P-values of 0.136, and 0.450, respectively, indicating no significant differences.ConclusionsAlthough this study was an observational, changes in vital signs were investigated assuming endotracheal adrenaline administration. The current recommended dose of adrenaline in endotracheal administration with cardiopulmonary arrest may not be effective. In some cases of cardiopulmonary arrest, intravenous and intraosseous routes of adrenaline administration may be difficult and the opportunity for resuscitation may be missed. Therefore, it is desirable to have many options for adrenaline administration. Therefore, if the optimal dose and efficacy of endotracheal adrenaline administration can be clarified, early adrenaline administration will be possible, which will improve return of spontaneous circulation (ROSC) and survival discharge rates.

Cardiovascular response to brisk walking on different surfaces in an innovative senior playground: a randomized trial in older adults

ABSTRACT Brisk walking is a simple exercise for older adults. We aimed to assess the cardiovascular response to a short bout of brisk walking on walking loops in an innovative senior playground in Thailand. Twenty older adults were randomly assigned to brisk walking on artificial turf (AT group, n = 10) or an uneven surface (US group, n = 10). We assessed cardiovascular parameters, average walking speed, and rate of perceived exertion. Blood pressure, heart rate, rate-pressure product, and rate perceived exertion were significantly increased, while the mean RR interval of heart rate variability was significantly decreased in both AT and US groups after exercise compared with pre-exercise (p < 0.05). A greater change in systolic blood pressure was observed in the US group than in the AT group (p < 0.05). These data indicated that brisk walking on AT and US increases cardiovascular response. Our findings provide information on planning exercise programs for older adults.

FRI588 Effect Of Covid-19 On Depression In Girls With Obesity And Pcos Or Type 2 Diabetes

Abstract Disclosure: D. Ebedes: None. C.J. Noar: None. J. Benson: None. S. Simon: None. L.D. Gulley: None. L.B. Shomaker: None. L. Pyle: None. M.G. Cree: Consulting Fee; Self; Pollie Inc. Grant Recipient; Self; NIH. Research Investigator; Self; Amino Corp. Objectives: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age and is associated with elevated body mass index (BMI), and depression in adolescent girls. Prior to the COVID epidemic, we demonstrated elevated rates of depressive symptoms in adolescent girls with obesity suffering from PCOS or T2D. Studies examining how the mental health of this at-risk group of adolescents has changed since the start of the COVID-19 pandemic is limited. Methods: Data were collected from 70 new girls with obesity and PCOS or T2D, who presented for care in an obesity complications clinic between 6 to 18 months into the COVID epidemic (7/1/2020-6/30/2021). Patients were included if they had Center for Epidemiologic Studies-Depression (CES-D, 20 items) scores obtained within 6 months of PCOS or T2D diagnosis. A chart review was performed to collect data on demographics, physical exam findings, psychiatric care, and metabolic measures. CES-D scores ≥16, indicate elevated depression symptoms, and CES-D scores ≥24, indicate severe depression symptoms. This post COVID data was compared to already collected pre-COVID data. Data from pre vs post were compared within PCOS or T2D with a t-test or Mann Whitney U, and proportions with Chi-squared tests. Results: The pre-COVID-19 cohort included 91 girls (47 with PCOS, 44 with T2D) age 15±2 years and BMI z-scores (2.2±0.4). The post-COVID-19 cohort included 70 girls (33 with PCOS and 37 with T2D) aged 14.2±2.3 years and BMI z-scores 2.1±0.7. Pre-Covid moderate or severe depressive symptoms were observed in 30% and 23% of girls with PCOS vs 24% and 39% post-covid (p=0.306). In those with T2D, pre-COVID 18% and 14% had moderate or severe depressive symptoms, respectively, whereas post-COVID these rose to 27% and 43% (P=0.002). There was no change pre/post COVID in the mean CESD score in those with PCOS (18.8±11.6 vs 22.1±13.6; p=0.253), whereas there was a significant increase in overall CESD scores in T2D (12.9±10.6 vs 21.8±11.8; p&amp;lt;0.001). Dysglycemia was worse post-COVID in T2D only, HbA1c (Pre 7.25%[6.6,9.5] vs Post 8.6[7.7,11.4] p=0.006) but neither group demonstrated changes in systolic blood pressure, high density lipoprotein or alanine aminotransferase. Rates of home schooling were greatly elevated during COVID (PCOS pre 15% vs post 76% and T2D pre 5% vs post 55%). Both post-Covid groups reported high rates of loss of sports activities, social activity and friendships. Conclusions: Girls with PCOS and obesity had double the prevalence of depressive symptoms compared to youth with T2D prior to COVID. 6-18 months into the COVID epidemic, CESD scores remained unchanged in girls with PCOS, but were significantly worse in girls with T2D. Presentation: Friday, June 16, 2023

Comparison of the Effectiveness of the FemoStop Device and Sandbag Pressure on Hemostasis During Sheath Removal and Reducing Puncture Site Complications Following Transfemoral Coronary Angiography: A Randomized Controlled Trial

Background: Management of common and unpleasant complications following the removal of the arterial sheath is one of the goals and priorities of nursing care in patients undergoing angiography. Objectives: This study aimed to design and manufacture a FemoStop device and compare its effectiveness with sandbag pressure on hemostasis during sheath removal and reducing puncture site complications following transfemoral coronary angiography. Methods: This randomized controlled trial was conducted between 2019 and 2021. Eighty patients undergoing elective transfemoral coronary angiography referred to a Heart and Vascular Hospital in Tehran were recruited by convenience sampling and were randomly assigned to experimental (n = 40) and control (n = 40) groups. FemoStop devices and sandbags were used in the experimental and control groups to control angiography complications, respectively. The patient’s individual characteristics questionnaire, visual analog scale, checklist of complications, and laboratory indicators were used for data collection. Pain intensity, heart rate, respiratory rate, temperature, systolic and diastolic blood pressure, arterial oxygen saturation, and the amount of hematoma and bleeding of patients before, after 15 minutes, 1 h, 2 h, 2.5 h, 3 h, 3.5 h, 4 h, 4.5 h, 5 h, and 6 h were measured after the intervention. Results: The trend of changes in pain intensity (P &lt; 0.001), heart rate (P = 0.036), and systolic blood pressure (P &lt; 0.001) of patients in the experimental and control groups after the intervention was significant, and in patients who had used the FemoStop device, it was less than the control group. However, the changes in respiratory rate (P = 0.308), diastolic blood pressure (P = 0.089), arterial oxygen saturation (P = 0.205), and temperature (P = 0.195) of patients in the 2 groups were not significant. The 2 groups were not significantly different in terms of these variables and the amount of hematoma and bleeding in the 12 stages of measurement. Conclusions: Compared to using a sandbag after transfemoral coronary angiography, the FemoStop device leads to fewer complications, such as pain intensity, lower heart rate, and systolic blood pressure in patients. Therefore, considering fewer complications, it is suggested to conduct more studies to confirm the use of this device to control complications in patients.

Pharmacist-Led Diabetes Control Intervention and Health Outcomes in Hispanic Patients With Diabetes

Among patients with type 2 diabetes (T2D), Hispanic individuals are more likely than non-Hispanic White individuals to develop diabetes-related complications. To examine the association of a pharmacist-led intervention (UCMyRx) with hemoglobin A1c (HbA1c) and systolic blood pressure (SBP) among Hispanic patients with T2D. This quality improvement study used electronic health record data and a difference-in-differences study design to evaluate the association of UCMyRx exposure with changes in HbA1c concentration and SBP among Hispanic patients with T2D, relative to usual care, at University of California, Los Angeles primary care clinics between February and April of 2023. The study population included patients with an International Classification of Diseases, Ninth Revision/International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis of T2D, self-reporting Hispanic ethnicity, age 18 years or older, with 1 or more visits with a UCMyRx pharmacist (treatment) or 2 or more visits, 2 or more years apart, during the study window (comparison). Additionally, patients had to have the following observations during the study window (March 2, 2013-December 31, 2018): (1) a HbA1c 8% or higher, anywhere between 365 days before and 14 days after the index date (date of the first UCMyRx visit or a randomly generated index date) and a follow-up HbA1c measure within 120 to 365 days after the index date (n = 396) and/or (2) a SBP 140 mm Hg or higher between 365 days before and 14 days after the index date, and a follow-up SBP measure within 120 to 450 days after the index date (n = 795). Pharmacists review laboratory results/vital signs, perform medication reconciliation, and develop personally tailored interventions to address adherence barriers and increase guideline-concordant care. Pre- to post-index date changes in HbA1c and SBP. Of the 931 unique patients with T2D analyzed, the mean (SD) age was 64 (14.1) years, and 552 (59.3%) were female. In adjusted analyses, having 1 or more UCMyRx visits was associated with a reduction in HbA1c concentration (β = -0.46%; 95% CI, -0.84% to -0.07%) but no change in SBP (β = -1.71 mm Hg; 95% CI, -4.00 to 0.58 mm Hg). In this quality improvement study of UCMyRx among Hispanic patients with T2D, a negative association was observed between UCMyRx exposure and HbA1c concentration but not SBP. Pharmacist-led intervention may be a strategy for improving outcomes among Hispanic patients with T2D.

Comparison of whole body versus thoracic bioimpedance in relation to ultrafiltration volume and systolic blood pressure during hemodialysis.

In contrast to whole body bioimpedance, which estimates fluid status at a single point in time, thoracic bioimpedance applied by a wearable device could enable continuous measurements. However, clinical experience with thoracic bioimpedance in patients on dialysis is limited. To test the reproducibility of whole body and thoracic bioimpedance measurements and to compare their relationship with hemodynamic changes during hemodialysis, these parameters were measured pre- and end-dialysis in 54 patients during two sessions. The resistance from both bioimpedance techniques was moderately reproducible between two dialysis sessions (intraclass correlations of pre- to end-dialysis whole body and thoracic resistance between session 1 and 2 were 0.711 [0.58-0.8] and 0.723 [0.6-0.81], respectively). There was a very high to high correlation between changes in ultrafiltration volume and changes in whole body thoracic resistance. Changes in systolic blood pressure negatively correlated to both bioimpedance techniques. Although the relationship between changes in ultrafiltration volume and changes in resistance was stronger for whole body bioimpedance, the relationship with changes in blood pressure was at least comparable for thoracic measurements. These results suggest that thoracic bioimpedance, measured by a wearable device, may serve as an interesting alternative to whole body measurements for continuous hemodynamic monitoring during hemodialysis.NEW & NOTEWORTHY We examined the role of whole body and thoracic bioimpedance in hemodynamic changes during hemodialysis. Whole body and thoracic bioimpedance signals were strongly related to ultrafiltration volume and moderately, negatively, to changes in blood pressure. This work supports the further development of a wearable device measuring thoracic bioimpedance longitudinally in patients on hemodialysis. As such, it may serve as an innovative tool for continuous hemodynamic monitoring during hemodialysis in hospital or in a home-based setting.

A-205 Optimized Time Interval for the Measurement of Plasma Lipids for Assessing Cardiovascular Disease Risk

Abstract Background The measurement of plasma lipids are used to predict atherosclerotic cardiovascular disease (ASCVD) risk and for the management of lipid-lowering therapy. The general recommendation is that plasma lipids should be measured at least every 5 years, but the ideal time may vary depending on the baseline risk, which we examined in this study. Methods Using lipid values and other risk factors from the National Health and Nutrition Examination Survey (NHANES) (no diabetes, no lipid medications, n = 9704), which is designed to be representative of the US-general population, we calculated a baseline 10-year ASCVD risk with the pooled cohort risk equations (PCE). Future 10-year risk scores were estimated by chronologically increasing age of the subjects and projecting future systolic blood pressure (SBP) and lipid changes, using the mean-percentile age group change in the NHANES population for SBP (no hypertension medications, n = 17 329) and the Lifelines Cohort study for lipids (no CVD or lipid medications, n = 133 540). Crossing high-risk (&amp;gt;20%/10-years; 25% decison limit) and intermediate risk (&amp;gt;7.5%/10-years; 50% decision limit) PCE thresholds were calculated by baseline age to determine the best time intervals for testing lipids. Results As shown in the figure, the likelihood of crossing the intermediate or high-risk threshold depends on the baseline risk. Individuals that are close to one of the risk thresholds are more likely to cross it in the subsequent years. Based on this analysis, we recommend the following time intervals for lipid testing: Baseline risk &amp;lt; 5%/10-year: 5-years, baseline risk 5–15%/10-year: 3-years, baseline risk 16–20%/10-year: 1–2 years. Conclusions More frequent lipid testing than once every 5 years is desirable, because it would identify at risk patients sooner and allow for earlier therapeutic intervention, which has been shown to increase the effectiveness of statin therapy for reducing ASCVD events.

Dietary sodium restriction reduces blood pressure in patients with treatment resistant hypertension

PurposePatients with treatment resistant hypertension (TRH) are at particular risk of cardiovascular disease. Life style modification, including sodium restriction, is an important part of the treatment of these patients. We aimed to analyse if self-performed dietary sodium restriction could be implemented in patients with TRH and to evaluate the effect of this intervention on blood pressure (BP). Moreover, we aimed to examine if mechanisms involving nitric oxide, body water content and BNP, renal function and handling of sodium were involved in the effect on nocturnal and 24-h BP. Also, measurement of erythrocyte sodium sensitivity was included as a possible predictor for the effect of sodium restriction on BP levels.Patients and methodsTRH patients were included for this interventional four week study: two weeks on usual diet and two weeks on self-performed sodium restricted diet with supplementary handed out sodium-free bread. At the end of each period, 24-h BP and 24-h urine collections (sodium, potassium, ENaC) were performed, blood samples (BNP, NOx, salt blood test) were drawn, and bio impedance measurements were made.ResultsFifteen patients, 11 males, with a mean age of 59 years were included. After sodium restriction, urinary sodium excretion decreased from 186 (70) to 91 [51] mmol/24-h, and all but one reduced sodium excretion. Nocturnal and 24-h systolic BP were significantly reduced (− 8 and − 10 mmHg, respectively, p < 0.05). NOx increased, BNP and extracellular water content decreased, all significantly. Change in NOx correlated to the change in 24-h systolic BP. BP response after sodium restriction was not related to sodium sensitivity examined by salt blood test.ConclusionSelf-performed dietary sodium restriction was feasible in a population of patients with TRH, and BP was significantly reduced. Increased NOx synthesis may be involved in the BP lowering effect of sodium restriction.Trial registrationThe study was registered in Clinical trials with ID: NCT06022133.

Aldosterone Synthase Inhibition With Lorundrostat for Uncontrolled Hypertension

Excess aldosterone production contributes to hypertension in both classical hyperaldosteronism and obesity-associated hypertension. Therapies that reduce aldosterone synthesis may lower blood pressure. To compare the safety and efficacy of lorundrostat, an aldosterone synthase inhibitor, with placebo, and characterize dose-dependent safety and efficacy to inform dose selection in future trials. Randomized, placebo-controlled, dose-ranging trial among adults with uncontrolled hypertension taking 2 or more antihypertensive medications. An initial cohort of 163 participants with suppressed plasma renin (plasma renin activity [PRA] ≤1.0 ng/mL/h) and elevated plasma aldosterone (≥1.0 ng/dL) were enrolled, with subsequent enrollment of 37 participants with PRA greater than 1.0 ng/mL/h. Participants were randomized to placebo or 1 of 5 dosages of lorundrostat in the initial cohort (12.5 mg, 50 mg, or 100 mg once daily or 12.5 mg or 25 mg twice daily). In the second cohort, participants were randomized in a 1:6 ratio to placebo or lorundrostat, 100 mg once daily. The primary end point was change in automated office systolic blood pressure from baseline to study week 8. Between July 2021 and June 2022, 200 participants were randomized, with final follow-up in September 2022. Following 8 weeks of treatment in participants with suppressed PRA, changes in office systolic blood pressure of -14.1, -13.2, -6.9, and -4.1 mm Hg were observed with 100 mg, 50 mg, and 12.5 mg once daily of lorundrostat and placebo, respectively. Observed reductions in systolic blood pressure in individuals receiving twice-daily doses of 25 mg and 12.5 mg of lorundrostat were -10.1 and -13.8 mm Hg, respectively. The least-squares mean difference between placebo and treatment in systolic blood pressure was -9.6 mm Hg (90% CI, -15.8 to -3.4 mm Hg; P = .01) for the 50-mg once-daily dose and -7.8 mm Hg (90% CI, -14.1 to -1.5 mm Hg; P = .04) for 100 mg daily. Among participants without suppressed PRA, 100 mg once daily of lorundrostat decreased systolic blood pressure by 11.4 mm Hg (SD, 2.5 mm Hg), which was similar to blood pressure reduction among participants with suppressed PRA receiving the same dose. Six participants had increases in serum potassium above 6.0 mmol/L that corrected with dose reduction or drug discontinuation. No instances of cortisol insufficiency occurred. Among individuals with uncontrolled hypertension, use of lorundrostat was effective at lowering blood pressure compared with placebo, which will require further confirmatory studies. ClinicalTrials.gov Identifier: NCT05001945.

New data from a subanalysis of the TRICOLOR study: antihypertensive effectiveness of the triple single-pill combination of amlodipine/indapamide/perindopril and predictors of effectiveness and blood pressure control in young patients

Aim. To describe the antihypertensive efficacy of triple fixed­dose combination of amlodipine/indapamide/perindopril and assess the predictors of efficacy in young patients (&lt;50 years).Material and methods. The TRICOLOR study (NCT03722524) is an observational prospective study (n=1247) that demonstrated high antihypertensive effectiveness and good tolerability of the triple single­pill combination (SPC) of amlodipine/ indapamide/perindopril. This subgroup analysis was performed on 199 patients aged &lt;50 years (16% of the total population), and the comparison group consisted of 925 patients (82,3% of the total population) aged 50 years or older.Results. In young patients, during triple therapy with SPC amlodipine/indapa­ mide/perindopril, a positive trend in blood pressure (BP) reduction was observed compared to the baseline: an average decrease in BP after 12 weeks was 32,6 (11,0)/14,8 (8,5) mm Hg (p&lt;0,0001), comparable to patients over 50 years of age in terms of reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP) after 2, 4 and 12 weeks of follow­up. A greater number of young patients achieved a reduction in blood pressure &lt;140/90 mm Hg after 2 weeks of therapy compared to patients 50 years of age and older (49,7% vs 38,8%, p=0,004), and blood pressure &lt;130/80 mm Hg – after 4 and 12 weeks (51,3% vs 43,5% (p=0,041) and 74,9% vs 67,5% (p=0,038), respectively). Left ventricular hypertrophy was a significant negative predictor of SBP reduction by 12 weeks of therapy, and the presence of grade 2 hypertension (HTN) and statin use, on the contrary, were positive predictors of changes in SBP by the end of observation. More adherent younger patients were significantly more likely to have a decrease in DBP by 12 weeks of follow-up. In addition, in young patients, male sex and the presence of dyslipidemia significantly increased the chances of blood pressure control at the end of observation. Waist circumference, body mass index, and grade 2 HTN were negative predictors of achieving the target blood pressure level.Conclusion. Thus, in young patients, good antihypertensive effectiveness of amlodipine/indapamide/perindopril was observed, comparable in the degree of blood pressure reduction with the older age group of 50 years and older.

The effects of canagliflozin in type 2 diabetes in subgroups defined by population-specific body mass index: Insights from the CANVAS Program and CREDENCE trial.

To assess the effects of canagliflozin on clinical outcomes and intermediate markers across population-specific body mass index (BMI) categories in the CANVAS Program and CREDENCE trial. Individual participant data were pooled and analysed in subgroups according to population-specific BMI. The main outcomes of interest were: major adverse cardiovascular events (MACE, a composite of nonfatal myocardial infarction, nonfatal stroke or cardiovascular death); composite renal outcome; and changes in systolic blood pressure (SBP), body weight, albuminuria and estimated glomerular filtration rate (eGFR) slope. Cox proportional hazards models and mixed-effect models were used. A total of 14 520 participants were included, of whom 9378 (65%) had obesity. Overall, canagliflozin reduced the risk of MACE (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.75 to 0.93) with no heterogeneity of treatment effect across BMI subgroups (Pheterogeneity = 0.76). Similarly, canagliflozin reduced composite renal outcomes (HR 0.75, 95% CI 0.66 to 0.84) with no heterogeneity across subgroups observed (Pheterogeneity = 0.72). The effects of canagliflozin on body weight and SBP differed across BMI subgroups (Pheterogeneity <0.01 and 0.04, respectively) but were consistent for albuminuria (Pheterogeneity = 0.60). Chronic eGFR slope with canagliflozin treatment was consistent across subgroups (Pheterogeneity >0.95). The cardiovascular and renal benefits of canagliflozin and its safety profile were consistent across population-specific BMI subgroups for adults in the CANVAS Program and CREDENCE trial.

Abstract 012: Diagnosis Of Salt Sensitivity Of Blood Pressure Using Circulating Monocyte Isolevuglandin-CXCL/CCL Signaling In Response To Elevated Sodium In Vitro

Salt sensitivity of blood pressure (SSBP) is when blood pressure changes parallel to salt loading/ depletion and is an independent risk factor for cardiovascular disease. Despite its importance, there is no feasible diagnosis, which limits investigational studies to identify therapeutic targets. Our studies indicate that changes in production of isolevuglandins (IsoLGs) in antigen presenting cells (APCs) parallel changes in blood pressure following salt-loading and depletion in humans and this is associated with chemokine signaling. We hypothesized that in vivo responses to salt-loading/depletion leading to IsoLG production in APCs are mirrored in vitro . To test this hypothesis, we isolated peripheral blood mononuclear cells from known salt-sensitive and salt-resistant people and treated them with either normal salt (140 mmoL) or high salt (190 mmoL) for 24 hours in vitro . Using flow cytometry, we found that classical monocytes from salt sensitive but not salt resistant people had a significant increase in IsoLGs (25.15 ± 7.41 vs 14.52 ± 8.60, p = 0.0022) after 24 hours of high salt treatment. To determine mechanisms, we also performed bulk RNAseq on in vitro high salt treated monocytes and CITEseq on PBMCs following the salt-loading/depletion protocol. We found that salt-loading/depletion was associated with parallel changes in the expression of various chemokines in the CXCL and CC families both in vitro and in vivo . Specifically, the changes in levels of CXCL8 (p = 0.01553, r = 0.8067) , CXCL16 (p = 0.004697, r = -0.8725), and CCL2 (p = 0.002292, r = -0.9004) correlated with changes in diastolic and systolic blood pressure from salt loading to depletion. Moreover, changes in systolic blood pressure significantly correlated with changes in CCL2 (p= 0.008878, r= -0.6302) and CCL4 (p= 0.03209, r = -0.5367) from salt loading to salt depletion. These data suggest that in vitro responses of IsoLGs and chemokine production to salt treatment could serve as a feasible diagnosis for salt sensitivity of blood pressure in the clinic.

Abstract P339: Association Between Self-monitored Blood Pressure, Heart Rate, And Anxiety Symptoms In A Digital Heart Health Self-management Program

Introduction: Anxiety is a risk factor for hypertension and other cardiovascular (CV) diseases, and this relationship may be mediated by direct biological effects and/or indirectly via behaviors. We aimed to study the association between change in blood pressure (BP), heart rate (HR), and anxiety symptom severity among participants enrolled in a smartphone-based CV risk self-management program. Methods: We retrospectively studied participants with hypertension engaging with digital coaching focused on non-pharmacological lifestyle interventions, and who completed at least two generalized anxiety disorder (GAD-7) questionnaires between April 2020 and March 2023. Change in GAD-7 score was correlated with change in systolic BP, diastolic BP, and HR, controlling for age, gender, number of GAD-7 self-assessments, and initial GAD-7 score. Median BP and HR for the week of each GAD-7 self-assessment was used, and all change scores were converted to rate of change per day to control for variable time between scores. Results: A total of 5079 (age 58 ± 0.15y, 58% female) participants were included. Median days between GAD-7 scores was 148 (IQR 47-330). At baseline, mean GAD-7 was 7 (± 0.001), mean BP was 135/83 (± 0.28/0.18) mm Hg, and mean HR was 75 (± 0.22) bpm. Severe anxiety (GAD-7 &gt; 14) was reported in 605 (12%) participants, and 34.3% were stage 2 hypertensive. By follow up, most of those with severe anxiety at baseline (430, 71%) showed reduced GAD-7 score (mean change = -4.5 ± 0.23). Both SBP (β = 0.03 ± 0.008, t = 3.6) and HR (β = 0.02 ± 0.009, t = 2.3) rate of change were associated with GAD-7 change such that the more participants reduced SBP or HR, the greater the reduction in anxiety symptoms. Initial GAD-7 scores were negatively associated with GAD change (β = -0.2 ± 0.016, t = -12.3). No other variable was statistically significant (all ps &gt; 0.15). Conclusion: In a smartphone-based CV risk self-management program, reduction in systolic BP and HR is associated with improvement in anxiety symptoms, suggesting that digital coaching targeting CV risk factors has the potential to also improve mental health.

Abstract P398: Reduced Expression Of Nfatc1 Protects Against Salt-sensitive Hypertension In Mice

Background: While nuclear factor of activated T cells-cytoplasmic 1 (NFATc1) is a transcription factor that canonically plays a role in the immune response, it is also widely expressed in non-immune cells. A recent trans-ethnic meta-analysis of genome-wide association studies (GWAS) found that the NFATC1 gene in humans was associated with chronic kidney disease. Additionally, renal Nfact1 mRNA expression was decreased during high-salt exposure in a salt-sensitive murine model, suggesting a link between NFATc1 and salt-sensitive hypertension. Methods: Here, young adult heterozygous Nfatc1 knockout mice (Het) and wild-type (WT) male mice on a salt-sensitive 129S6 background were studied. Systolic blood pressure (SBP) measurements were obtained by either tail cuff manometry with at least 2 weeks of training or implanted radiotelemetry with at least 2 weeks of recovery following surgery. SBP was recorded on standard chow (NSD), on a matched high-salt diet (HSD, 6% total NaCl), or on standard chow with 1000 ng/kg/min angiotensin II (AngII) delivered by osmotic minipump. Pressure natriuresis was examined by correlating 24 h SBP from telemetry with 24 h urine sodium collected in metabolic cages before and for 3 days after switching from NSD to HSD. Results: On NSD, there was no difference in SBP between WT and Het mice (127.8±9.9 vs 125.8±8.7 mmHg, n = 9/group). However, while WT mice displayed an expected elevation in SBP after 3 weeks on HSD, Het mice showed no change in SBP, resulting in a statistically significant difference between genotypes (143.4±8.9 vs 125.7±10.6 mmHg, p = 0.0024, n = 9/group). Pressure natriuresis curves were not significantly different between genotypes. SBP was not significantly different on AngII (167.6±22.2 vs 161.8±10.9 mmHg, n = 2/3). Conclusion: Our preliminary data shows that decreased Nfatc1 expression protects against salt-sensitive hypertension. However, this effect is not mediated through a change in pressure natriuresis, suggesting possible involvement of a vascular mechanism. NFATc1 is a potential therapeutic target in salt-sensitive hypertension.

Abstract 116: Safety And Tolerability Of Zilebesiran, An RNA Interference Therapeutic Targeting Hepatic Angiotensinogen Synthesis, In Obese Patients With Hypertension

Introduction: Single subcutaneous (SC) doses of zilebesiran, an investigational RNA interference therapeutic targeting hepatic angiotensinogen (AGT) synthesis, have been shown to reduce serum AGT levels and blood pressure (BP) in patients with mild-moderate hypertension based on results from phase 1 studies. Limited data are available on the safety, pharmacodynamics, and efficacy of multiple dosing or administration of zilebesiran in patients with Class II/III obesity. Methods: Patients with hypertension (mean seated office systolic BP (SBP) of &gt;130 and ≤165 mmHg after washout of antihypertensive medication) and Class II/III obesity (BMI &gt;35 kg/m 2 and ≤50 kg/m 2 ) without diabetes were randomized 2:1 to zilebesiran or irbesartan in a double-blind, double-dummy design. Patients received either sequential doses of zilebesiran 800 mg SC (Day 1 and 85) and daily oral placebo, or sequential SC doses of saline (Day 1 and 85) and daily 150mg oral irbesartan. Key endpoints included safety, change in AGT level from baseline to week 24 (using an enzyme-linked immunosorbent assay), and change in BP from baseline to week 24 (by 24-h ambulatory BP monitoring). Results: Twelve patients were enrolled (zilebesiran, N=8; irbesartan, N=4; median (range) age 56 (46-64) years, 67% female, mean ± SD BMI 40 ± 4 kg/m 2 , baseline 24-h mean ± SD [systolic/diastolic] BP 144 ± 10 / 88 ± 9 mmHg). At least one adverse event (AE) was reported in 6 zilebesiran patients and 4 irbesartan patients, most of which were mild or moderate; one serious AE occurred with zilebesiran and was considered unrelated. There were no episodes of hypotension requiring intervention in either arm. AGT levels did not change with irbesartan but were reduced with zilebesiran by 99% from week 4 to week 24. Change in SBP from baseline to week 24 was -27 ± 8 mmHg with zilebesiran versus -19 ± 6 mmHg with irbesartan. Conclusions: In this Phase 1 study of obese patients with hypertension, administration of two sequential doses of zilebesiran was associated with durable reductions in serum AGT levels and sustained reductions in BP persisting to 24 weeks. Zilebesiran was also generally well tolerated in this patient population. These data suggest that pharmacodynamics, efficacy, and safety of zilebesiran may not be influenced by BMI.

Abstract P407: Increased Secretion Of Glucose Dependent Insulinotropic Polypeptide Is Associated With Postprandial Hypotension In Patients With Parkinson Disease

Postprandial hypotension (PPH) is highly prevalent in Parkinson Disease (PD) and is defined as a sudden and substantial decrease (&gt;20 mm Hg or &gt;10 mm hg) in blood pressure within two hours after ingesting a meal. This condition is associated with syncope and falls. Eating a meal induces significant blood sequestration in the splanchnic circulation through the release of gastrointestinal (GI) hormones. Patients with autonomic dysfunction cannot compensate for these hemodynamic changes, which results in PPH. The purpose of this study is to evaluate if increased secretion of GI hormones, including glucose-dependent insulinotropic polypeptide (GIP), a strong splanchnic vasodilator, contributes to PPH in those with PD. We enrolled 11 PD patients, seven with PPH (PPH+) (age 69±7.65 years old, 72% males, Unified Parkinson’s Disease Rating Scale 29±18.9) and four without PPH (PPH-) (age 67±1.71 years, 75% males, UPDRS 20±15.30). PD PPH+ patients had evidence of autonomic impairment and orthostatic hypotension as defined by a change in systolic blood pressure, (-57±29.23 vs. -7±17.66 mm Hg in PPH). Blood pressure, heart rate, and blood GIP levels were measured before and at 5, 10, 15, 30, 60, 90, 120 min timepoints after 75 gr oral glucose in supine position. There was a time-dependent decrease in blood pressure with a nadir at 30 min (-17±14.30 mmHg vs. -5±17.26 in PPH-). In PD PPH+, peak GIP secretion also occurred at 30 min post-glucose ingestion (315.3±297.9 vs. 69.1±34.8 pmol/L in PPH-). PD PPH+ patients had a greater secretion of C-peptide (2141±1017.81 vs.1540.56±428.77 pmol/L in PPH-) and insulin (1477.78±1572.80 vs. 351.09±141.53 pmol/L in PPH-). These initial results show excessive GIP secretion in PD patients with PPH, suggesting that GIP may contribute to its pathophysiology.

Acute effects of single-bout isometric handgrip exercise on selected cardiovascular parameters in young normotensive adults at a tertiary care center of West Bengal

Abstract Context: Hypertension is currently prevalent along with other lifestyle disorders, which further adds up to cardiovascular morbidity. Young adults especially those of 18–25 years are also affected because of their sedentary lifestyle. Thus, a need for a compliable exercise that can be introduced in daily life is widely sought for. Aims: To record changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR), before and after a single bout isometric handgrip (IHG) exercise. Settings and Design: This interventional study has been conducted at I.P.G.M.E.&amp;R., Kolkata. Materials and Methods: Eighty-four young healthy individuals were selected based on predefined inclusion and exclusion criteria. After a fixed protocol for exercise, their pre and post (after 3 min and 3 h) IHG exercise values of blood pressure (BP) and HR were recorded and analyzed. Statistical Analysis Used: Paired sample t test was done to compare the mean values of each of the parameters. Results: Three-hour post-IHG values of SBP and MAP are reduced significantly (P = 0.000), whereas those of DBP and MAP are reduced but not significantly. The decrease in HR post 3 h of IHG is not statistically meaningful. Conclusions: Single-bout IHG exercise elicits a significant reduction in BP when recorded after 3 h. Thus, if studied further, it promises to be a useful tool in the regular regimen of antihypertensive management with positive clinical outcomes.

Abstract P337: Blood Pressure And Retina Responses Of Malignant Hypertension Patients In The Rice Diet Program

Introduction: The residential Rice Diet Program at Duke (RDP) has been shown to be effective in treating patients with malignant hypertension (MH) using a low salt (5 meq/d), low protein (5% kcal), and low fat (5% kcal) diet with no anti-hypertensive medications. Our team examined the RDP medical records and further clarified the identification of 710 MH patients by limiting the criteria of an averaged systolic blood pressure (SBP)&gt;170 mmHg to be met ±7 and a documented non-diabetic hemorrhrage and/or papilledema to be met ± 30 days of starting RDP, respectively. Methods: Wilcoxon ranked-sum was used to compare baseline and week-4 blood pressures (BPs), weight, and urine chloride (uCl, a measure of low-salt diet adherence). Linear regression was used to examine the association between baseline age, gender, SBP, last weight measure and uCl change with SBP change at week-4. Retina evaluation were compared between baseline and last measure using Chi-Square and Fisher’s Exact tests. Results: Male patients (p=.048) and those with a greater change in uCl (p=.001) had a greater reduction in SBP at week-4 ( Table ). Those with a higher baseline SBP had a lower reduction in SBP (p&lt;.001), while baseline age and last weight measure had no effect. The proportion of MH patients with either hemorrhage alone, papilledema alone or both, reduced during RDP participation (p&lt;.001). Conclusion: The RDP significantly lowered BPs, weight and uCl in MH patients within 4-week of starting RDP. The proportion of patients with documented retinal hemorrhage and/or papilledema also reduced significantly during participation in RDP. The mechanisms of the diet’s impact merit further investigation.

Abstract 118: Effects Of Aprocitentan, A Dual Endothelin Receptor Antagonist, On Blood Pressure In Black/African American Patients With Resistant Hypertension: Results From A Randomized, Controlled Study (PRECISION) Including A Withdrawal Phase

Background: Resistant hypertension is prevalent among Black/African American drug-treated hypertensives and may increase cardiovascular risk. We evaluated aprocitentan (APRO) for BP lowering in Black patients with resistant hypertension. Methods: Patients had sitting unattended automated office systolic BP (SBP) ≥140 mmHg despite use of ≥3 antihypertensives of different classes in the year prior. After 4 weeks of combination therapy (amlodipine, valsartan, hydrochlorothiazide), those still hypertensive could enter a 4-week single-blind placebo (PBO) run-in period, followed by a 4-week double-blind period wherein patients were randomized 1:1:1 to APRO 12.5 mg, 25 mg, or PBO. A 32-week single-blind period on APRO 25 mg followed. Patients were then re-randomized 1:1 to APRO 25 mg or PBO in a 12-week withdrawal period. The primary endpoint was change from baseline to Week 4 in mean trough SBP. Changes in SBP from withdrawal baseline (Week 36) to Week 40 and in 24-hour, daytime (09:00-21:00), and nighttime (01:00-06:00) ambulatory BP monitoring (ABPM) measures at Weeks 4 and 40 were also assessed. Results: Eighty-two of 730 patients (11.2%) were Black (APRO 12.5 mg, n = 28; 25 mg, n&amp;nbsp;= 28; PBO, n = 26). At Week 4, APRO and PBO produced similar office SBP reductions (least squares mean difference from PBO, 12.5 mg: 0.63 mmHg; 25 mg: 0.12 mmHg). However, APRO produced pronounced reductions vs PBO in mean 24-hour (12.5 mg: –3.23 mmHg; 25 mg: –7.85 mmHg), daytime (12.5 mg: –6.16 mmHg; 25 mg: –9.13 mmHg), and nighttime (12.5 mg: –2.63 mmHg; 25 mg: –8.53 mmHg) ambulatory SBP. Four weeks after withdrawal, office SBP increased with PBO vs APRO 25 mg (difference: +9.87 mmHg), which was confirmed with ambulatory SBP (difference, 25 mg; 24-hour: +8.13 mmHg, daytime: +3.39 mmHg, nighttime: +9.70 mmHg). Safety in Black patients was comparable to the overall population, with no new signals. During the double-blind period, treatment-emergent adverse events were reported in 6/28 (21.4%), 9/29 (31.0%), and 4/25 (16.0%) patients with APRO 12.5 mg, APRO 25 mg, and PBO. Edema or fluid retention occurred in 3/29 patients (10.3%) on APRO 25 mg, and no patients on APRO 12.5 mg or PBO. Conclusion: APRO was well tolerated and produced clinically relevant reductions in SBP by ABPM in Black patients.

Abstract 049: The Effect Of Temperate Seasonality On Systolic Blood Pressure Is Amplified In Population Control Rates

Background: Temperate seasonal effects have a significant influence on blood pressure (BP). Changes in average systolic (S)BP have an exaggerated effect on population BP control (BP &lt;140/90) rates, in part due to patients bordering the control target. We assessed the influence of seasonal effects on average SBP, as well as the corresponding effect on control rates across a patient cohort. Methods: A prospective patient cohort was selected from six diverse healthcare organizations engaged in a quality improvement program. Patients with a diagnosis of hypertension (HTN), no medication changes, and at least one visit in each temperate season during the assessment period were included. The seasonal effect on average SBP and control was determined from multivariable mixed effects linear and logistic regression models, respectively. Results: A cohort of 60,676 patients, mean age 62.3±12.0 years, meeting all inclusion criteria was selected. The population had 453,787 qualifying visits, where SBP during winter months averaged 0.47 mmHg higher (95% CI [0.364-0.573]) than the yearly mean, with a significantly lower odds ratio for BP control (OR 0.92, 95% CI [0.91-0.94]). In contrast, average SBP was 0.92 mmHg lower during the summer - with a higher likelihood of BP control (OR 1.10, 95% CI [1.07-1.12]). Conclusion: The seasonal effect on SBP was confirmed in a diverse group of adults with hypertension. The novel observation is the nearly 5% variation in BP control related to seasonal SBP variation of 1.4 mmHg. From a practical perspective, BP control is typically defined by values at the last visit of the calendar year, which occur disproportionately in months with higher SBP and lower control.