Changes In Systolic Blood Pressure Research Articles

Determining Optimal Intervals for In-Person Visits during Video-based Telemedicine in Patients with Hypertension: A Cluster Randomized Controlled Trial.

Introducing telemedicine in outpatient treatment may improve patient satisfaction and convenience. However, the optimal in-person visit interval for video-based telemedicine in patients with hypertension remains unreported in Japan. We determined the optimal in-person visit interval for video-based telemedicine in patients with hypertension. Design: This was a cluster randomized controlled noninferiority trial. Participants: The target sites were eight clinics in Japan that had a telemedicine system, and the target patients were individuals with essential hypertension. Among patients receiving video-based telemedicine, those who underwent in-person visits at 6-month intervals were included in the intervention group, and those who underwent in-person visits at 3-month intervals were included in the control group. Main Measures: The follow-up period of the participants was 6 months. The primary endpoint of the study was the change in systolic blood pressure, and the secondary endpoints were the rate of treatment continuation after 6 months, patient satisfaction, health economic evaluation, and safety evaluation. Overall, 64 patients were enrolled. Their mean age was 54.5 ± 10.3 years, and 39 (60.9%) patients were males. For the primary endpoint, the estimated difference in the change in systolic blood pressure between the two groups was 1.18 (90% confidence interval: -3.68 to 6.04). Notably, the criteria for noninferiority were met. Patient satisfaction was higher in the intervention group than in the control group. Furthermore, the indirect costs indicated that lost productivity was significantly less in the intervention group than in the control group. Moreover, the treatment continuation rate did not differ between the intervention and control groups, and there were no adverse events in either group. Blood pressure control status and safety did not differ between the intervention and control groups. In-person visits at 6-month intervals may cause a societal cost reduction and improve patient satisfaction during video-based telemedicine. UMIN000040953.

Renal and blood pressure effects of dapagliflozin in recently hospitalized patients with heart failure with mildly reduced or preserved ejection fraction: Insights from the DELIVER trial.

Patients recently hospitalized for heart failure (HF) often have unstable haemodynamics and experience worsening renal failure, and are at elevated risk for recurrent HF events. In DELIVER, dapagliflozin reduced HF events or cardiovascular death including among patients who were hospitalized or recently hospitalized. We examined the effects of dapagliflozin versus placebo on estimated glomerular filtration rate (eGFR) slope (acute and chronic), 1-month change in systolic blood pressure, and the occurrence of serious hypovolaemic or renal adverse events in patients with and without HF hospitalization within 30 days of randomization. The 654 (90 randomized during hospitalization, 147 1-7 days post-discharge and 417 8-30 days post-discharge) recently hospitalized patients had lower baseline eGFR compared with those without recent HF hospitalization (median [interquartile range] 55 [43, 71] vs. 60 [47, 75] ml/min/1.73 m2 ). Dapagliflozin consistently reduced the risk of all-cause (pinteraction = 0.20), cardiac-related (pinteraction = 0.75), and HF-specific (pinteraction = 0.90) hospitalizations, irrespective of recent HF hospitalization. In those recently hospitalized, acute placebo-corrected eGFR reductions with dapagliflozin were modest and similar to patients without recent hospitalization (-2.0 [-4.1, +0.1] vs. -3.4 [-3.9, -2.9] ml/min/1.73 m2 , pinteraction = 0.12). Dapagliflozin's effect to slow chronic eGFR decline was similar regardless of recent hospitalization (pinteraction = 0.57). Dapagliflozin had a minimal effect on 1-month systolic blood pressure and to a similar degree in patients with and without recent hospitalization (-1.3 vs.-1.8 mmHg, pinteraction = 0.64). There was no treatment-related excess in renal or hypovolaemic serious adverse events, irrespective of recent HF hospitalization. In patients recently hospitalized with HF, initiation of dapagliflozin had minimal effects on blood pressure and did not increase renal or hypovolaemic serious adverse events, yet afforded long-term cardiovascular and kidney protective effects. These data suggest that the benefit to risk ratio favours initiation of dapagliflozin among stabilized patients hospitalized or recently hospitalized for HF. ClinicalTrials.gov NCT03619213.

Incidence, severity and detection of blood pressure and heart rate perturbations in postoperative ward patients after noncardiac surgery

Study objectiveWe sought to determine changes in continuous mean and systolic blood pressure and heart rate in a cohort of non-cardiac surgical patients recovering on the postoperative ward. Furthermore, we estimated the proportion of vital signs changes that would remain undetected with intermittent vital signs checks. DesignRetrospective cohort. SettingPost-operative general ward. Patients14,623 adults recovering from non-cardiac surgical procedures. Interventions & measurementsUsing a wireless, noninvasive monitor, we recorded postoperative blood pressure and heart rate at 15-s intervals and encouraged nursing intervention as clinically indicated. Main results7% of our cohort of 14,623 patients spent >15 sustained minutes with a MAP <65 mmHg, and 23% had MAP <75 mmHg for 15 sustained minutes. Hypertension was more common, with 67% of patients spending at least 60 sustained minutes with MAP >110 mmHg. Systolic pressures <90 mmHg were present for 15 sustained minutes in about a fifth of all patients, and 40% of patients had pressures >160 mmHg sustained for 30 min. 40% of patients were tachycardic with heart rates >100 beats/min for at least continuous 15 min and 15% of patients were bradycardic at a threshold of <50 beats/min for 5 sustained minutes. Conventional vital sign assessments at 4-h intervals would have missed 54% of mean pressure episodes <65 mmHg sustained >15 min, 20% of episodes of mean pressures >130 mmHg sustained >30 min, 36% of episodes of heart rate > 120 beats/min sustained <10 min, and 68% of episodes of heart rate sustained <40 beats per minute for >3 min. ConclusionsSubstantial hemodynamic disturbances persisted despite implementing continuous portable ward monitoring coupled with nursing alarms and interventions. A significant proportion of these changes would have gone undetected using traditional intermittent monitoring. Better understanding of effective responses to alarms and appropriate interventions on hospital wards remains necessary.

Hemodynamic effects of a low versus a high dose of propofol during induction of anesthesia. A randomized trial.

Hypotension is common after anesthesia induction with propofol and is associated with increased morbidity. It is important to examine the effects of the proposed interventions to limit preventable hypotension, as suggested by the reduction in the dose of propofol. Our objective was to investigate whether a high dose of propofol is inferior to a low dose with respect to changes in systolic arterial blood pressure (SAP). This randomized, double-blind, dose-controlled, non-inferiority study included 68 healthy women scheduled for gynecological surgery at the Day Surgery Unit, Haugesund Hospital, Norway. The patients were randomly allocated 1:1 to a low or high dose (1.4 mg/kg total body weight (TBW) versus 2.7 mg/kg TBW of propofol corresponding to maximal effect site concentrations (Ce) of 2.0 μg/mL versus 4.0 μg/mL. The dose of remifentanil was 1.9-2.0 μg/kg TBW, with maximal Ce of 5.0 ng/mL. The patients were observed for 450 s from the start of the infusions. The first 150 s was the sedation period, after which a bolus of propofol and remifentanil was administered. Baseline was defined as 55-5 s before the bolus doses. LiDCOplus was used for invasive beat-to-beat hemodynamic monitoring of changes in SAP, heart rate (HR), cardiac output (CO), stroke volume (SV), and systemic vascular resistance (SVR). A difference of 10 mmHg in the change in SAP was considered to be clinically important. The SAP change difference for low versus high dose was -2.9 mmHg (95% CI -9.0-3.1). The relative changes for low versus high dose were SAP -31% versus -36%, (p < .01); HR -24% versus -20%, (p = .09); SVR -20% versus -31%, (p < .001); SV -16% versus -20%, (p = .04); and CO -35% versus -32%, (p = .33). A high dose of propofol was not inferior to a low dose, and a reduction in the dose of propofol did not result in clinically important attenuation of major hemodynamic changes during induction in healthy women. ClinicalTrials.gov identifier NCT03861364, January 3, 2019.

Long-term cardiometabolic effects of ambient ozone pollution in a large Chinese population

Limited studies investigated the effects of long-term ozone exposure on cardiometabolic health. We aimed to examine the association of long-term ozone exposure with a range of cardiometabolic diseases, as well as the subclinical indicators in Eastern China. The study included 202,042 adults living in 11 prefecture-level areas in Zhejiang Province between 2014 and 2021. Using a satellite-based model with a 1 × 1 km spatial resolution, we estimated residential 5-year average ozone exposures for each subject. Mixed-effects logistic and linear regression models were applied to explore the associations of ozone exposure with cardiometabolic diseases and subclinical indicators, respectively. We found that a 9% [95% confidence interval (95% CI): 7–12%] higher in odds of cardiometabolic disease per 10 μg/m3 increase in ozone exposure. Specifically, we also found higher prevalence of cardiovascular diseases (15%), stroke (19%), hypertension (7%), dyslipidemia (15%), and hypertriglyceridemia (9%) associated with ozone exposure. However, we did not find significant associations between ozone exposure and coronary heart disease, myocardial infarction, or diabetes mellitus. Long-term ozone exposures were also significantly associated with adverse changes in systolic blood pressure, diastolic blood pressure, total serum cholesterol, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, glucose concentration, and body mass index. Our results showed that people with lower education levels, those over 50 years old, and those who were overweight or obese were more susceptible to the effects of ozone on cardiometabolic diseases. Our findings demonstrated the detrimental effects of long-term ozone exposure on cardiometabolic health, emphasizing the need for ozone control strategies to reduce the burden of cardiometabolic diseases.

Effect of a Peer Health Coaching Intervention on Clinical Outcomes Among US Veterans With Cardiovascular Risks

Although cardiovascular disease (CVD) is the leading cause of death in the US, CVD risk factors remain suboptimally controlled. To test the effectiveness of a home-visit, peer health coaching intervention to improve health outcomes for veterans with multiple CVD risks. This 2-group, unblinded randomized clinical trial, called Vet-COACH (Veteran Peer Coaches Optimizing and Advancing Cardiac Health), used a novel geographic-based method to recruit a racially diverse population of veterans with low income. These veterans were enrolled at the Seattle or American Lake Veterans Health Affairs primary care clinics in Washington state. Veterans with a diagnosis of hypertension with at least 1 blood pressure reading of 150/90 mm Hg or higher in the past year, and 1 other CVD risk factor (current smoker, overweight or obesity, and/or hyperlipidemia), who resided in Census tracts with the highest prevalence of hypertension were eligible to participate. Participants were randomized to the intervention group (n = 134) or control group (n = 130). An intention-to-treat analysis was performed from May 2017 to October 2021. Participants in the intervention group received peer health coaching for 12 months with mandatory and optional educational materials, an automatic blood pressure monitor, a scale, a pill organizer, and healthy nutrition tools. Participants in the control group received usual care plus educational materials. The primary outcome was a change in systolic blood pressure (SBP) from baseline to 12-month follow-up. Secondary outcomes included change in health-related quality of life (HRQOL; measured using the 12-item Short Form survey's Mental Component Summary and Physical Component Summary scores), Framingham Risk Score, and overall CVD risk and health care use (hospitalizations, emergency department visits, and outpatient visits). The 264 participants who were randomized (mean [SD] age of 60.6 [9.7] years) were predominantly male (229 [87%]) and 73 (28%) were Black individuals and 103 (44%) reported low annual income (<$40 000 per year). Seven peer health coaches were recruited. No difference was found in change in SBP between the intervention and control groups (-3.32 [95% CI, -6.88 to 0.23] mm Hg vs -0.40 [95% CI, -4.20 to 3.39] mm Hg; adjusted difference in differences, -2.05 [95% CI, -7.00 to 2.55] mm Hg; P = .40). Participants in the intervention vs control group reported greater improvements in mental HRQOL scores (2.19 [95% CI, 0.26-4.12] points vs -1.01 [95% CI, -2.91 to 0.88] points; adjusted difference in differences, 3.64 [95% CI, 0.66-6.63] points; P = .02). No difference was found in physical HRQOL scores, Framingham Risk Scores, and overall CVD risk or health care use. This trial found that, although the peer health coaching program did not significantly decrease SBP, participants who received the intervention reported better mental HRQOL compared with the control group. The results suggest that a peer-support model that is integrated into primary care can create opportunities for well-being improvements beyond blood pressure control. ClinicalTrials.gov Identifier: NCT02697422.

Longitudinal machine learning model for predicting systolic blood pressure in patients with heart failure.

Systolic blood pressure (SBP) strongly indicates the prognosis of heart failure (HF) patients, as it is closely linked to the risk of death and readmission. Hence, maintaining control over blood pressure is a vital factor in the management of these patients. In order to determine significant variables associated with changes in SBP over time and assess the effectiveness of classical and machine learning models in predicting SBP, this study aimed to conduct a comparative analysis between the two. This retrospective cohort study involved the analysis of data from 483 patients with HF who were admitted to Farshchian Heart Center located in Hamadan in the west of Iran, and hospitalized at least two times between October 2015 and July 2019. To predict SBP, we utilized a linear mixed-effects model (LMM) and mixed-effects least-square support vector regression (MLS-SVR). The effectiveness of both models was evaluated based on the mean absolute error and root mean squared error. The LMM analysis revealed that changes in SBP over time were significantly associated with sex, body mass index (BMI), sodium, time, and history of hypertension (P-value < 0.05). Furthermore, according to the MLS-SVR analysis, the four most important variables in predicting SBP were identified as history of hypertension, sodium, BMI, and triglyceride. In both the training and testing datasets, MLS-SVR outperformed LMM in terms of performance. Based on our results, it appears that MLS-SVR has the potential to serve as a viable alternative to classical longitudinal models for predicting SBP in patients with HF.

ABSENT VASOREACTIVE RESPONSE TO HIGH SODIUM INTAKE COINCIDES WITH SALT SENSITIVITY IN CKD PATIENTS

Objective: Chronic kidney disease (CKD) patients are advised to limit salt intake, because of its detrimental effects on blood pressure (BP) and albuminuria. The salt-sensitive BP response in CKD is classically attributed to impaired renal ability to excrete sodium (Na+) resulting in fluid overload. Yet, BP sensitivity to salt is also linked to vasodysfuction, and may even be fluid independent. We aimed to investigate which factor contributes to BP sensitivity to salt in CKD. Design and method: In this randomized crossover study, CKD patients (KDIGO stage G2-3A, proteinuria &gt;0.5 g/d) and healthy controls (HC) followed a 7-day low sodium diet (LSD, &lt;50mmol/d) and high sodium diet (HSD, &gt;200mmol/d), respectively. After each diet, assessment of the hemodynamic profile included daytime BP (Mobil-O-Graph) and cardiac output (CO) measurements (using NexfinTM), by which SVR was calculated accordingly. Extracellular fluid volume (ECV) change was assessed with multi-frequency body impedance spectroscopy (FHCresenius). Results: We included 16 HC (median age 36.0 yrs) and 8 CKD patients (median age 49.5 yrs, and median (IQR) proteinuria 0.6 (0.5-1.1) g/d and plasma creatinine 144 (103 - 167) μmol/l. Dietary salt intervention was successful with median difference in urine Na+ excretion of 242.2 vs 224.6 mmol/day in HC and CKD respectively (p = 0.74). After HSD, the median (IQR) change in systolic BP of patients with CKD was 14 mmHg (4 - 18; p = 0.04), while systolic BP change (4 mmHg (-3 - 8)) in HC was not significant (Fig 1A). After HSD, we observed a significant ECV expansion in both CKD and HC subjects (Fig 1B), but no effect on CO. No associations between HSD-induced BP changes and both ECV and CO were found. Systolic BP increase was correlated with SVR decline in HC, but not in CKD patients (Fig 1C). Conclusions: In contrast to healthy persons, BP salt sensitivity in CKD does not associate with vasodilation. Regarding the absence of differences with ECV and CO between healthy and CKD persons, our data indicate that the incapacity for vasodilation might explain salt sensitivity in CKD.

THE EFFECT OF LOW-CARBOHYDRATE DIET ON HYPERTENSIVE PATIENTS WITH OBESITY

Objective: Non-pharmacological treatment such as a healthy diet, is important for hypertensive patients as it has a effect of lowering blood pressure (BP). We aimed to evaluate the effect of low-carbohydrate diet (LCD) on hypertensive patients with obesity. Design and method: Four electronic databases (KoreaMed, Embase, Medline, and the Cochrane Library) were searched from their inception to June 2021. Randomized clinical trials evaluating LCD (&lt;130 g/day or &lt;26% of the 2000 kcal/day diet) and very low-carbohydrate diet (VLCD) (&lt;20-50 g/day or &lt;10% of the 2000 kcal/day) for at least 8 weeks in adults with hypertension were eligible. Studies in which more than 50% of patients taking antihypertensive drugs, or systolic blood pressure (SBP) of 140 mmHg or more or diastolic blood pressure (DBP) of 90 mmHg or more were included. Primary outcomes were change of SBP and DBP. The comparative diets were diets with calorie restriction equivalent to those of the intervention diets, and most were included in a calorie-restricted diet and a low fat diet. Results: From 18, 151 studies identified in the initial search results, 6 randomized studies were included in the final analysis. Compared to the control diet, decreased SBP (mean difference: -3.25; 95% CI -7.28, 0.77) is observed in LCD for a period of six months or less, with no statistically significant difference in more than six months to one year or less and more than one year (36-52weeks: mean difference -1.30; 95% CI -76.04, 3.44, and &gt; 1year: mean difference -4.51, 95% CI -15.38, 6.37) (Figure). LCD did not effect on DBP compared to control diet. VLCD marginally decreased SBP compared with the control diet, but not lead to a significant difference in DBP. Conclusions: For obese adults with hypertension, LCD had no additional benefit in reducing BP and weight compared to calorie-restricted or low fat diets when maintained for one year or longer. There is insufficient evidence to support the beneficial effect of a LCD in adults with hypertension, and further studies are needed to evaluate the effect of LCD in hypertensive patients.

Magnetoencephalography(MEG) spectral signature of cognitive impairment ‐ A perspective on pathophysiological changes with blood pressure

AbstractBackgroundSpectral ratios (e.g., resting‐state EEG alpha/theta power ratio), which index rhythmic brain activity, have been shown to distinguish early‐onset AD from healthy controls. Magnetoencephalographic (MEG) brain imaging offers advantages over EEG through its unique combination of excellent temporal as well as spatial precision for detecting brain activity. The purpose of this study is to compare MEG spectral activity in cognitively impaired and healthy controls with changes in systolic blood pressure (sbp), specifically focused in the frontal lobe as this region is known to be susceptible to hypertension related white matter degradation.MethodsSixteen cognitively impaired, including 13 possible and 3 probable mild cognitive impairment (MCI), (mean age 65.6 years, males/females: 5/11, Whites/Blacks: 11/5) and sixteen age, sex, and race matched healthy controls (mean age 62.4 years, males/females: 4/12, Whites/Blacks: 11/5) were recruited from an ongoing multiethnic community‐based study to complete six minutes of resting‐state MEG along with a T1w brain MRI. All MEG data underwent standard preprocessing. Resultant whole‐brain maps of spectral activity were filtered into six canonical frequency bands, including delta (2‐4 Hz), theta (5‐7 Hz), alpha (8‐12 Hz), beta (15‐29 Hz), gamma (30‐59 Hz) and high gamma (60‐90 Hz). Relative mean power of each frequency band, and spectral ratios of alpha/theta, beta/delta as well as a spectral slowing index [(alpha+beta+gamma)/(delta+theta)] were computed.ResultMean sbp was 135 mm Hg for both groups. Generalized linear regression models showed cognitive impairment was negatively associated with spectral ratios beta/delta and spectral slowing index. We also found a significant positive association between spectral ratios (beta/delta β = ‐0.0115, p = 0.0015; spectral slowing index β = ‐0.0125, p = 0.0144) and interaction of systolic blood pressure with cognitive impairment. Results are summarized in tables 1‐2.ConclusionLower spectral ratios have previously been demonstrated in individuals with AD. Somewhat surprisingly, our findings indicate that lower blood pressure is associated with lower values on these MEG metrics in cognitively impaired individuals. Interestingly, overtreatment of hypertension in elderly with MCI has been associated with greater cognitive decline. Thus, these results will be examined in a larger cohort and the analysis will be expanded to include anti‐hypertensive medication data to potentially explain the above findings.

CHANGE IN ARTERIAL STIFFNESS AND AMBULATORY BLOOD PRESSURE IN PATIENTS WITH RHEUMATOID ARTHRITIS: THE JOINTHEART STUDY

Objective: Use of disease modifying antirheumatic drugs (DMARDs) has been associated with reduction in blood pressure (BP) and arterial stiffness in clinical trials, but real-word data is lacking. We investigated change in ambulatory BP and arterial stiffness in outpatients with rheumatoid arthritis (RA) eligible for initiation or change in targeted synthetic (ts) or biological (b) DMARDs. Design and method: Eighty-nine consecutive RA patients (age 53±13, 68% women) were examined at initiation of ts/bDMARDs and repeated after 22 months. Ambulatory BP, carotid-femoral-pulse wave velocity (cfPWV) and Disease Activity Score in 28 joints using C-reactive protein (DAS28) were measured at baseline and at follow-up. High cfPWV was defined as cfPWV &gt; 10 m/s in accordance with guidelines. Results: At follow-up, 20% used tsDMARDs, 57% bDMARDs and 67% had achieved remission or low disease activity. DAS28 decreased from 3.9±1.3 at baseline to 2.8±1.2 at follow-up (p&lt;0.001). The ambulatory systolic BP increased (116±11 mmHg vs 120±13 mmHg, p = 0.010), while the ambulatory diastolic BP decreased (76±7 mmHg vs. 73±8 mmHg, p = 0.001) from baseline to follow-up. Body mass index (BMI) increased from 26.5±5.2 kg/m2 to 27.1±4.9 kg/m2, p = 0.009. Changes in ambulatory systolic and diastolic BP were associated with presence of diabetes at baseline, but not DAS28 or use of ts or bDMARDs. Mean cfPWV increased from 7.8±1.6 m/s at baseline to 8.5±1.8 m/s at follow-up (p&lt;0.001). The prevalence of high cfPWV increased from 10.8% to 16.3 %, p = 0.03. DAS28 (beta = 0.32, p = 0.01) and diabetes at baseline (beta = 0.39, p = 0.001) were associated with increase in cfPWV, independent of achieved remission/low disease activity at follow-up, baseline systolic BP, BMI, age, sex and use of antihypertensive drugs. Conclusions: In outpatients with RA, higher disease activity at baseline was associated with an increase in arterial stiffness during follow-up, despite DMARD therapy and significant decrease in disease activity.

EFFECTS OF 2-WEEK DIETARY NITRATE SUPPLEMENTATION AND ANTIBACTERIAL MOUTHWASH TREATMENT ON RESERVOIR-EXCESS PRESSURE PARAMETERS IN HEALTHY OLDER ADULTS

Objective: The nitrate-nitrite-nitric oxide pathway contributes to blood pressure (BP) regulation in humans. However, it is unknown if the pathway alters arterial haemodynamic parameters derived from reservoir-excess pressure analysis. We therefore determined whether an enhancement/disruption of nitrate-nitrite-nitric oxide pathway by dietary nitrate and antibacterial mouthwash, respectively, would alter reservoir-excess pressure parameters in older adults. Design and method: Healthy older adults (n = 30, 71.0 ± 2.6 yrs, 19F, 133 ± 11 mmHg for systolic BP and 70 ± 6 mmHg for diastolic BP) participated in this study. Participants were randomised to either a 2-week active nitrate treatment (BR: ∼12.4 mmol beetroot juice daily as a nitrate source) or 2-week placebo treatment (PL: nitrate-depleted beetroot juice) followed by 2-week washout. They then crossed-over to the alternate treatment which was followed by another 2-week washout. Thereafter, they completed a twice-daily antibacterial mouthwash treatment (MW) for two weeks with the aim of disrupting enterosalivary nitrate circulation. Prior to and following each 2-week treatment, reservoir-excess pressure parameters including reservoir pressure integral, excess pressure integral (INTXSP), systolic rate constant (SRC) and diastolic rate constant were obtained through radial artery tonometry along with brachial systolic and diastolic BP. Aortic pulse wave velocity (aPWV) was estimated as previously described (Hughes et al., Front Physiol 2020;11:550). Results: Circulating plasma nitrate [614 (95%CI: 545, 683) microM] and nitrite [0.51 (95%CI: 0.30, 0.72) microM] increased with BR, and decreased with MW [nitrate, -17.1 (95%CI: -28.1, -6.1) microM; nitrite, -0.03 (95%CI:-0.05, -0.01) microM]. Relative to PL, BR reduced brachial systolic BP [-2.0 (95%CI: -3.9, -0.1) mmHg], INTXSP [-0.4 (95%CI: -0.7, -0.1) mmHg·s], and aPWV [-0.2 (95%CI: -0.4, 0.0) m/s]. MW increased brachial systolic [2.0 (95%CI: 0.0, 3.9) mmHg], diastolic [1.2 (95%CI: 0.4, 2.0) mmHg] BP, and decreased SRC [-0.2 (95%CI: -0.3, 0.0) 1/s] relative to PL. Conclusions: Favourable (INTXSP with BR) and unfavourable (SRC with MW) alterations in reservoir-excess pressure parameters were observed with 2-week dietary nitrate and antibacterial mouthwash treatments, which was accompanied by a small change in brachial systolic BP. These observations may suggest a potential link between enhancing/disrupting nitrate-nitrite-nitric oxide pathway and cardiovascular health in older adults.

Monitoring of the regulatory ability and regulatory state of the autonomic nervous system and its application to the management of hypertensive patients: a study protocol for randomised controlled trials

IntroductionMany causes lead to sympathetic-vagus imbalance, which promotes the development of hypertension and accelerates the process of target organ damage. Many studies have shown that exercise training and heart rate...

EFFECT OF BAROREFLEX ACTIVATION THERAPY ON BLOOD PRESSURE: THE BAT-STUDY – A RANDOMIZED SHAM CLINICAL PILOT TRIAL

Objective: To explore the effects of baroreflex activation therapy (BAT) on blood pressure in individuals with refractory hypertension. Design and method: This investigator-initiated randomized, double-blinded sham-controlled pilot trial included five Finnish patients with refractory hypertension. Participants were found eligible if they were 18 - 70 years old with a daytime systolic ambulatory blood pressure (ABP) of 145 mmHg or higher, and/or a daytime diastolic ABP of 95 mm Hg or higher. Patients were on 3 or more antihypertensive drugs including a diuretic. A witnessed drug intake prior to ABPM was implemented. The Barostim Neo System was implanted for modulation of the autonomic nervous system by direct electrical stimulation of the carotid baroreceptors. After 1 month following implantation, all participants were randomized to either 8 months of baroreflex activation therapy (BAT-system on) or continuous pharmacotherapy (BAT-system off) followed by continuous BAT-therapy for all participants for 8 months. The complete design is outlined in the Figure. 24-hour ABP-measurements were performed per protocol. The primary outcome was defined as a change in ambulatory systolic blood pressure after 8 months of BAT, compared to pharmacotherapy. Results and conclusions: After 8 months of follow-up BAT decreased mean systolic daytime blood pressure by 11.8 mmHg in three participants randomized to BAT, while in the two remaining participants randomized to continuous pharmacotherapy mean systolic daytime blood pressure increased by 8.7 mmHg. When pooling all daytime systolic 24-hour ABP-measurements across the entire follow-up, BAT-therapy was associated with a 9.2 mmHg lower mean blood pressure as compared to continuous pharmacotherapy (143.5 mmHg [95% CI:142.2 - 144.9] vs 152.7 mmHg [151.1 - 154.2], P &lt; 0.0001). In linear mixed models with the BAT-system's status as a fixed effect, day-time systolic blood pressure recordings from 24-hour ABP-measurements at baseline and after 8 months of follow-up were compared between individuals on BAT and continuous pharmacotherapy. Here, BAT-therapy was associated with a reduction in mean systolic day-time blood pressure of -11.7 mmHg (P &lt; 0.0001). In conclusion, BAT-therapy may be a promising tool in lowering systolic blood pressure in individuals with refractory hypertension. Figure. Study design. ABPM = ambulatory blood pressure measurement. Device = Control of Device.

DETERMINANTS OF OFFICE BLOOD PRESSURE VARIABILITY AND INSTABILITY IN CHILDREN, ADOLESCENTS AND YOUNG ADULTS

Objective: To evaluate the determinants of office blood pressure (BP) variability and instability within a single visit in young individuals. Design and method: Apparently healthy individuals aged 6-25 years referred for elevated blood pressure (BP) were subjected to triplicate office BP measurements in a single visit and 24h ambulatory BP monitoring. BP variability and instability were assessed separately for systolic and diastolic BP using: (i) standard deviation (SD) (ii) coefficient of variation (CV) (iii) average real variability (ARV) (iv) maximum office BP (Max) (v) maximum-minimum office BP difference (MMD) (vi) ratio of difference between 1st-3rd measurement to the average office BP (Relative change). White-coat effect was defined as the difference between office and daytime ambulatory BP. Results: 320 individuals were analyzed (mean age 13.6±3.6 years, 66.8% males, BMI z-score 1.12±0.96, average office BP 122.6±16.6/72.6±10.7 mmHg, 24h ambulatory BP 119.3±11.5/67.8±6.8). Based on office and 24h ambulatory BP, 21.3% of the participants had white-coat hypertension, 8.1% masked and 16.6% sustained hypertension. Age was associated with SD (r = 0.23, p&lt;0.001), CV (r = 0.11, p&lt;0.05), Max (r = 0.54, p&lt;0.001) and MMD (r = 0.23, p&lt;0.001) of office systolic BP, and Max (r = 0.29, p&lt;0.001) and ARV (r = 0.12, p&lt;0.05) of diastolic. In multivariable log-linear regression models [(independent variables: age, sex, BMI z-score, heart rate, office BP, white-coat effect (&gt; = 5/6 mmHg systolic/diastolic, 75th centile)], office BP was an independent determinant for indices of systolic BP variability and instability [SD (↓ = 0.01, p&lt;0.001), ARV (↓ = 0.01, p&lt;0.001), Max (↓ = 0.01, p&lt;0.001), MMD (↓ = 0.01, p&lt;0.001) and Relative change (↓ = 0.001, p&lt;0.05)], and for CV (↓ = -0.06, p&lt;0.001) and Max (↓ = 0.01, p&lt;0.001) of diastolic. White-coat effect was a significant determinant for CV of office systolic BP (↓ = 0.15, p&lt;0.05) and Relative change of office diastolic BP (↓ = 0.03, p&lt;0.05). Conclusions: These results suggest that in healthy children, adolescents, and young adults the indices of office BP variability and instability within the first visit seem to be determined by the level of office BP and the magnitude of the white-coat effect.

Clinical outcomes in patients with radioiodine refractory thyroid carcinoma treated with dose-reduced lenvatinib.

e18104 Background: In recent years, well-differentiated thyroid cancer (WDTC) accounted for over 40,000 new cancer diagnoses annually. For patients with metastatic, iodine-131-refractory thyroid cancer, systemic therapy is sometimes warranted. Lenvatinib was FDA approved in this setting at a starting dose of 24 mg orally daily based on the SELECT trial. Many patients required dose reductions on this trial, and the use of full dose (24 mg) lenvatinib is often not feasible in clinical practice. This study characterizes the clinical outcomes of lenvatinib for WDTC in a real-world setting. Methods: This study is a retrospective chart review of all patients over 18 years old diagnosed with radioiodine refractory thyroid carcinoma who received lenvatinib at a large academic center between 05/01/2016 and 01/01/2022. Demographic information, clinical data, and treatment outcomes were obtained. Results of our study were compared to historical controls from the SELECT trial. Results: There were 38 patients included in this study. Twenty-six of 38 patients had a dose reduction prior to start of treatment per judgement of the treating physician. Of the 12 patients who started at 24 mg, 11 required a dose reduction. Starting doses of lenvatinib ranged from 4 mg to 24 mg. The mean starting dose was 17 mg. Median progression free survival and overall survival were 35.2 months and 56.2 months, respectively. Eighteen patients remain on therapy. Overall response rate was 39.5% compared to 64.8% in historical controls. Disease control rate was 63.2%. Any grade weight loss was higher in this cohort versus historical control – 92.1% vs 46.4%, respectively. Systolic ( &gt; 20 mmHg) and diastolic ( &gt; 10 mmHg) blood pressure changes occurred in 13.2% of patients. 16.7% of patients had a peak increase in creatinine &gt; 0.2 mg/dL above their baseline. Conclusions: Many patients were deemed ineligible for full dose lenvatinib by the treating physician. Despite an apparently lower response rate, lower doses of lenvatinib can still provide adequate disease control with an acceptable rate of blood pressure and serum creatinine elevation. Weight loss was an almost universal side effect of lenvatinib in this real-world population and was seen at a higher frequency than the historical population.

NOVEL TARGETED HEALTH PSYCHOLOGY CLINIC REFERRAL IMPROVES BLOOD PRESSURE: PRELIMINARY RESULTS OF A RETROSPECTIVE STUDY

Objective: Despite hypertension medications being widely available, many patients do not have adequately controlled blood pressure. Consequently, alternative interventions are required to support patients. Recently, we have established a novel health psychology clinic to provide additional support to help patients improve blood pressure control. This retrospective study compared outcomes before and after referral to a targeted health psychology clinic. Our aim was to determine the effectiveness of this novel clinic on patient outcomes with a view to improving the service and support rollout in other departments. Design and method: Patient notes referred to the Health Psychology clinic were reviewed from October 2020 to December 2022 (audit number: 11703). Patient data was linked anonymised and details reflecting key outcomes, demographics and specific psychology interventions were extracted. Results: In the preliminary findings, 11 patients were included for analysis. Patient age ranged from 28-79 years, 18% were female and 45% were White. Patients were prescribed a mean of 3.1 hypertension medications. The mean time between the first blood pressure reading and final reading was 44.1±27.8 weeks, with a mean number of 6.6±6 visits to the clinic. Interventions were tailored to each patient's need. Four patients were supported with anxiety management, three used biofeedback and three used breathing techniques. Two patients were supported with weight management, with one patient losing 31.7kg in 6 months. The mean systolic blood pressure (SBP) change was -11.55±17.78 mmHg (P = 0.0568), and diastolic blood pressure (DBP) was -5.80±13.15 mmHg (P = 0.1965). Two patients had increased blood pressure for unknown reasons. When these two cases were removed from analysis, the overall mean changes for SBP were -18.11±11.30 mmHg (P = 0.0013) and -9.88± 11.03mmHg for DBP (P = 0.0690). Of these blood pressure readings, 7 were conducted in the office, 2 at home, and 1 with 24hour ABPM. Conclusions: Our preliminary findings show that targeted psychological support for hypertensive patients experiencing difficulties with anxiety or depression may improve blood pressure. Health psychology interventions may be suitable to support patients where medication alone does not support optimum hypertension management. Further large prospective studies are needed to confirm these findings.

Objective Hemodynamic Cardiovascular Autonomic Abnormalities in Post-Acute Sequelae of COVID-19.

Many COVID-19 patients are left with symptoms several months after resolution of the acute illness; this syndrome is known as post-acute sequalae of COVID-19 (PASC). We aimed to determine the prevalence of objective hemodynamic cardiovascular autonomic abnormalities (CAA), explore sex differences, and assess the prevalence of CAA among hospitalized vs nonhospitalized patients with PASC. Patients with PASC (n= 70; female [F]= 56; 42 years of age; 95% confidence interval [CI], 40-48) completed standard autonomic tests, including an active stand test 399 days (338, 455) after their COVID-19 infection. Clinical autonomic abnormalities were evaluated. Most patients with PASC met the criteria for at least 1 CAA (51; 73%; F= 43). The postural orthostatic tachycardia syndrome hemodynamic (POTSHR) criterion of a heart rate increase of > 30 beats per minute within 5 to 10 minutes of standing was seen in 21 patients (30%; F= 20; P= 0.037 [by sex]). The initial orthostatic hypotension hemodynamic (IOH40) criterion of a transient systolic blood pressure change of > 40 mm Hg in the first 15 seconds of standing was seen in 43 (61%) patients and equally among female and male patients (63% vs 57%; P= 0.7). Only 9 (13%) patients were hospitalized; hospitalized vs nonhospitalized patients had similar frequencies of abnormalities (67% vs 74%; P= 0.7). Patients with PASC have evidence of CAA, most commonly IOH40, which will be missed unless an active stand test is used. Female patients have increased frequency of POTSHR, but IOH40 is equally prevalent between sexes. Finally, even nonhospitalized "mild" infections can result in long-term CAAs.

Pediatric blood pressure category predicts longitudinal blood pressure change in adolescence and early adulthood.

Patterns of blood pressure (BP) change from early adolescence to young adulthood have not been well-described. The objective of this study was to examine the predictive value of pediatric BP classification on BP change and identify subpopulations with large BP increases during adolescence and early adulthood. Baseline data were obtained from medical checkups of Japanese adolescents aged 12-13 years in 2009 or 2010 and subsequent BP values were followed for a 9-year period. Mixed-effects models were used to estimate the effects of baseline factors on subsequent BP changes. Hypertensive and elevated BP group consistently had higher BP values than normal BP group throughout the observation period. Multivariate mixed-effects model analyses revealed group-by-time interactions between systolic BP change and BP category in males and uric acid category in females, and between diastolic BP change and white blood cell count in males and obesity and high-density lipoprotein cholesterol in females; however, these factors had limited effects on the rate of BP increase, indicating that they are not suitable as clinical predictors of BP increase. Pediatric BP category predicted BP values, but there was no factor that identified subpopulations with large BP increases in adolescence and early adulthood. Blood pressure category in the American Academy of Pediatrics clinical practice guideline at age 12-13 years predicted subsequent blood pressure values during adolescence and early adulthood. No baseline factor that identified a subpopulation with large increase in blood pressure during adolescence and early adulthood in clinical practice was found. Our study contributes to the existing literature by demonstrating the usefulness of the American Academy of Pediatrics clinical practice guideline for blood pressure classification in a Japanese population.

Relationship Between High Sodium Chloride Intake and Obesity in Hypertensive Population A Cross-Sectional Study

Background: High Sodium chloride intake and obesity are significant, regarding hypertension in the population which may develop several medical complications. Objective: The aims and objectives of the current study were to introduce lifestyle medicine awareness in people for managing high blood pressure caused by high sodium chloride intake and obesity. Study Design: It was a cross-sectional clinical Study of the management of high blood pressure in a population with the help of nutrition &amp; physical exercise. Place and Duration: The present study was conducted from January to May 2023 and Patients were selected from the community health center and Ghurky Hospital Lahore. Methodology: ToA total of 10 of 0 hypertensive individuals were selected and divided into different groups regarding hypertension, obesity, sodium chloride intake in daily life, and other demographics. People were separated into different groups based on their sodium intake levels and BMI people were separated into different groups. In group- A there was 50 male and female while in group B other 50 male and female were included respectively. Results: Significant (P≤0.05) changes in systolic and diastolic blood pressure were seen in the individuals of both groups regarding NaCl intake. The mean standard deviation levels, BMI, Systolic and Diastolic blood pressure of men in Group-A and Group-B in the beginning (27.03±0.02, 130.01±0.01, 90.01±0.02), (30.01±0.02, 135.01±0.01, 90.01±0.02) after 15 days (27.03±0.02, 125.01±0.01, 83.01±0.01), (30.01±0.02, 140.01±0.01, 90.01±0.02) and after30 days (27.03±0.02, 124.01±0.01, 80.01±0.01), (30.01±0.02, 145.01±0.01, 100.01±0.01) were measured respectively. Similarly the mean standard deviation levels, BMI, Systolic and Diastolic blood pressure of women in Group-A and Group B in the beginning (28.03±0.02, 131.01±0.01, 88.01±0.02), (31.02±0.02, 131.01±0.01, 88.01±0.02) after 15 days (28.03±0.02, 125.01±0.01, 83.01±0.01), (31.02±0.02, 140.01±0.01, 90.01±0.02) and after30 days (28.03±0.02, 120.01±0.01, 84.01±0.01), (31.02±0.02, 150.01±0.01, 92.01±0.01) were calculated. Conclusion: All recommendations suggest limiting dietary salt as one of the tried-and-true ways to lower high blood pressure because there is a well-established link between excessive salt consumption and hypertension. A current study proved that high sodium chloride intake may increase blood pressure in humans. Keywords: Hypertensive, Sodium Chloride, BMI, Systolic and Diastolic blood pressure.