Hypertension Clinic Research Articles

Specialist hypertension clinics: an essential pathway but under-resourced.

Specialist hypertension clinics: an essential pathway but under-resourced.

Accuracy and Performance of Triage Blood Pressure Measurements in A Real-World Clinic Setting

ObjectivesTo investigate the agreement and accuracy of triage blood pressure (BP) in a real-world clinic setting, compared with the reference standard. Study designPaired triage and standardized BP measurements from patients 4 through 21 years old evaluated in an obesity-related hypertension clinic were obtained via chart-review. Triage BPs were measured by a medical assistant or nurse, often by automated device. Triplicate manual BPs were obtained by the clinic physician. Bland-Altman analyses determined mean differences between paired triage and mean standardized BPs. GEE-based multivariable relative risk (RR) regression determined the RR of triage BP overestimation by ≥5mmHg. Overall agreement, sensitivity, specificity, positive predictive value, and negative predictive value of triage BP measurements identifying hypertensive BP were determined. Results130 participants with 347 clinic encounters were included. Mean age was 13.3 years (standard deviation 3.94), 76% were Black, and 58% were male. Overall mean systolic and diastolic BP difference was 8.7 mmHg (95% limits on agreement: -16.66, 34.07) and 4.1 mmHg (95% limits on agreement: -18.56, 26.68), respectively. Triage systolic BP was more likely overestimated by ≥5 mmHg when a large adult (RR=1.49; 95%CI: 1.00, 2.21) or thigh cuff (RR=1.94; 95%CI: 1.08, 3.51) was required compared with when a child/adult cuff was required. Overall agreement in identifying hypertensive BP was 57.6%. Sensitivity (52.6%), specificity (63.4%), positive predictive value (60.8%), and negative predictive value (55.3%) were low across all cuffs. ConclusionsThere was poor agreement between usual triage and standardized BP measurements, with potential for significant clinical implications.

Independent Factors Associated with 30-Day In-Hospital Mortality from Acute Spontaneous Intracerebral Hemorrhage

ObjectiveThis study aims to investigate independent factors associated with 30-day mortality in patients with acute spontaneous intracerebral hemorrhage before treatment. MethodsA retrospective analysis was performed on medical records of patients hospitalized with acute spontaneous intracerebral hemorrhage between 2019 and 2021. Data included personal history, hospital stay duration, symptom onset, chief complaint, underlying diseases, medication, and alcohol/smoking habits. Physical examination records comprised baseline blood pressure, Glasgow Coma Scale assessment, and pupil reaction evaluation. Diagnostic imaging, specifically CT brain scans, was examined for hemorrhage details. Multivariable logistic analysis was utilized for data analysis. ResultsAmong 663 cases, 185 (27.9%) experienced mortality. Risk factors for mortality included chronic kidney disease, ischemic heart disease, loss of follow-up in hypertension clinic, and pontine hemorrhage. Conversely, motor response, reactive pupils, and basal cistern persistence significantly decreased the risk of mortality in multivariable analysis. ROC analysis identified a motor response score of 5 as the cutoff for predicting survival. ConclusionChronic kidney disease, ischemic heart disease, loss of hypertension follow-up, motor response, reactive pupils, pontine hemorrhage, and basal cistern persistence were independent variables associated with the 30-day mortality rate in spontaneous intracerebral hemorrhage patients before treatment initiation. A motor response, pupil reaction, and basal cistern persistence serve as predictive tools for assessing mortality in SICH before treatment.

“I only seek treatment when I am ill”: experiences of hypertension and diabetes care among adults living with HIV in urban Tanzania

BackgroundFor adults living with HIV (ALHIV) and comorbidities, access to comprehensive healthcare services is crucial to achieving optimal health outcomes. This study aims to describe lived experiences, challenges, and coping strategies for accessing care for hypertension and/or diabetes (HTN/DM) in HIV care and treatment clinics (CTCs) and other healthcare settings.MethodologyWe conducted a qualitative study that employed a phenomenological approach between January and April 2022 using a semi-structured interview guide in six HIV CTCs in Dar es Salaam, Tanzania. We purposively recruited 33 ALHIV with HTN (n = 16), DM (n = 10), and both (n = 7). Thematic content analysis was guided by the 5As framework of access to care.FindingsThe majority of the participants were females, between the ages of 54–73, and were recruited from regional referral hospitals. HIV CTCs at regional referral hospitals had more consistent provision of HTN screening services compared to those from district hospitals and health centers. Participants sought HTN/DM care at non-CTC health facilities due to the limited availability of such services at HIV CTCs. However, healthcare delivery for these conditions was perceived as unaccommodating and poorly coordinated. The need to attend multiple clinic appointments for the management of HTN/DM in addition to HIV care was perceived as frustrating, time-consuming, and financially burdensome. High costs of care and transportation, limited understanding of comorbidities, and the perceived complexity of HTN/DM care contributed to HTN/DM treatment discontinuity. As a means of coping, participants frequently monitored their own HTN/DM symptoms at home and utilized community pharmacies and dispensaries near their residences to check blood pressure and sugar levels and obtain medications. Participants expressed a preference for non-pharmaceutical approaches to comorbidity management such as lifestyle modification (preferred by young participants) and herbal therapies (preferred by older participants) because of concerns about side effects and perceived ineffectiveness of HTN/DM medications. Participants also preferred integrated care and focused patient education on multimorbidity management at HIV CTCs.ConclusionOur findings highlight significant barriers to accessing HTN/DM care among ALHIV, mostly related to affordability, availability, and accessibility. Integration of NCD care into HIV CTCs, could greatly improve ALHIV health access and outcomes and align with patient preference.

Retrospective evaluation of patients diagnosed with Primary Hyperaldosteronism

Primary hyperaldosteronism (PA), despite being a common disease, is grossly underdiagnosed and undertreated. Though in primary care prevalence of PA is 4–6% in patients with hypertension, it is much higher in specialized hypertensive clinics, especially in resistant hypertension (RH). PA is associated with higher morbidity rates than matched essential hypertension patients. PA is classified as unilateral and bilateral disease, with adrenalectomy considered for unilateral disease and medical management with mineralocorticoid receptor antagonists (MRA) for bilateral disease. There is gross underdiagnosis of PA across the world with very limited literature on PA from India. We wanted to retrospectively evaluate the profile of patients diagnosed with PA from case records, in outpatient settings in a tertiary care hospital. Primary outcomes of the study will be to evaluate the presenting features of PA patients. This includes clinical, biochemical, radiological aspects in different subgroups like unilateral vs bilateral disease, diabetes/ prediabetes vs non-diabetes, and chronic kidney disease (CKD) vs no significant CKD. We also want to evaluate the treatment preferences (both surgical and medical) and follow-up data (for treatment outcomes / effectiveness if relevant records were available). Our main objective is to highlight the current state of PA presentation and management so that we can develop a pragmatic diagnostic approach to improve screening, case detection and empiric management of PA.

Relationship between the behavior change model and salt intake in hypertensive patients: a single non-specialized hypertension clinic prospective observational study.

We investigated whether changes in salt reduction readiness are associated with changes in estimated daily salt intake and blood pressure (BP). We divided 86 hypertensive patients into groups with high and low readiness for salt-reducing behavior [an up (UP) and a down (DN) groups, respectively] based on the transtheoretical model (TTM) over a 12-month observation period. We then investigated the relationships between changes in the TTM stage and changes in daily salt intake and BP over 12 months. The patients in the UP group had significantly increased urine potassium concentrations (from 51.2 ± 23.3 mEq/L at baseline to 56.9 ± 25.5 mEq/L at 12 months; P = 0.048) and significantly decreased estimated 24-h urinary salt excretion (from 9.7 ± 2.9 g/day at baseline to 8.4 ± 2.8 g/day at 12 months; P = 0.045). In addition, they also had significantly lower changes in urine sodium concentration (-13.1 ± 46.1 vs. -6.6 ± 59.7 mEq/L; P = 0.048), significantly increased changes in urine potassium concentration (5.7 ± 20.1 vs. -4.8 ± 28.6 mEq/L; P = 0.030), and significantly decreased changes in estimated 24-h urinary salt excretion (-1.3 ± 2.6 vs. -0.1 ± 2.6 g/day; P = 0.045) compared with patients in the DN group. However, their home BP did not improve over 12 months. The hypertensive patients who increased their readiness or maintained a high readiness for salt reduction over 12 months showed a significant increase in daily potassium intake and significant decrease in daily salt intake.

A Review on Antihypertension Drug on Herbal Plants

The use of alternative therapies, herbs, and supplements occurs at a very high rate among patients attending a variety of health care settings. Such therapy may cause significant interactions or effects on hypertension and other cardiovascular disorders and needs to be considered by clinicians. In this brief review, we highlight several commonly used alternative therapies that may have a clinical impact in the hypertensive patient. Several problems hinder our complete awareness of these effects .These problems include patients not informing physicians about alternative treatment from the herbal use, which may occur the lack of constituents with specific scientific standards for the bioactivity and bioequivalence of many herbals or supplements, and the multiple names that each bioactive substance show a therapeutic effect under a given mechanism of each drug which effect the body with a particular dose. regarding herbals therapies in the hypertension clinic it show the therapeutic effect which may increase the activity. Therefore herbal drugs including garlic, and licorice all may cause important consequences in the hypertensive patient. Added care is needed in monitoring the use and effects of herbal and alternative therapies in the hypertensive population.

A patient with arterial hypertension in an outpatient clinic: how to use preventive tools

A patient with arterial hypertension in an outpatient clinic: how to use preventive tools

The effects of opium consumption on severity of disease on hospitalized COVID-19 patients in East of Iran, a prospective cohort study.

There are few theories and little empirical evidence about the bilateral impact of substance use and coronavirus disease 2019 (COVID-19), so a logical and accurate picture of this area is required. We investigated the effects of opium use on severity of disease on hospitalized COVID-19 patients in east of Iran. Demographic and clinical characteristics, vital signs, laboratory tests, mortality rate, type and duration of opium consumption in hospitalized patients who recovered from COVID-19 in the follow-up after 3 months were evaluated. In this study, 60 (20%) participants were the opium user and 251 (80%) were the non-user patients. Based on clinical symptoms, hypertension and systolic blood pressure in opium user were significantly higher than non-user patients (p < 0.05). In the laboratory tests, only the level of urea was higher in the opium positive group (37 [26.5-48.5] vs. 32 [23-43], respectively) and the percent of lymphocytes were lower in the opium positive (17 [8.2-25.8] vs. 18.7 [13.85-26.35], respectively). The initial therapies of both opium positive and negative infected patients showed not any significant changes (p > 0.05). Among the studied groups, one deceased case with COVID-19 was related to a drug user patient. Although, uses of opium reduced the levels of some risk factors, vital signs at admission and initial therapies during hospitalization in COVID-19 patients but it increased lung and heart diseases. Also, the severity of COVID-19 including hospitalization and mortality were associated with opium consumption.

Determination of hemorrhagic transformation risk in acute ischemic cerebrovascular disease: The relationship between ADC values and GRE hemo sequence microhemorrhage.

<p>To determine the risk of hemorrhagic transformation in patients with acute ischemic cerebrovascular disease, we investigated the relationship between Apparent Diffusion Coefficient Magnetic Resonance Imaging values measured within the infarct area and microbleeds observed on Gradient Echo Sequence Magnetic Resonance Imaging.</p>. <p>A total of 172 patients who were hospitalized to the Neurology Clinic of the Istanbul Provincial Directorate of Health Erenkoy Mental and Nervous Diseases Training and Research Hospital between June 2019 and March 2020 were included in this cross-sectional study. The patients were classified according to their demographic and clinical characteristics, by age, gender, hypertension, diabetes mellitus, smoking, and alcohol use. In the Cranial Magnetic Resonance Imaging taken in the application for the diagnosis of acute ischemic cerebrovascular disease, the infarction area in Apparent Diffusion Coefficient sequences with the Region of Interest value and the relationship between microhemorrhage observed in Gradient Echo hemo-sequence was evaluated in Magnetic Resonance Imaging applied between 3-7 days. While calculating spherical Region of Interest values, 5 Region of Interest values were obtained for lesions larger than 1.5x1.5 cm, and their arithmetic mean was obtained, and single spherical Region of Interest value was taken for smaller ones. Apparent Diffusion Coefficient Magnetic Resonance Imaging Region of Interest mean values were divided into 2 groups as &lt;500x10&ndash;6 mm2 /s and &gt;500x10&ndash;6 mm2/s.&nbsp;</p>. <p>Patients in the group with Apparent Diffusion Coefficient Region of Interest mean values below 500x10-6 mm2/s, had a significantly higher probability for microhemorrhage observes in Gradient Echo Sequence Magnetic Resonance Imaging (p: 0.001) and also more likely to experience microhemorrhage in other areas, which was statistically significant (p: 0.001).The probability of another micro-bleeding observed in patients with microhemorrhage Gradient Echo Sequence Magnetic Resonance Imaging was also statistically significant (p: 0,001). The risk of microbleeding in areas other than ischemia was also found to be significantly higher in patients with microbleeding in the ischemia area in Gradient Echo Sequence Magnetic Resonance Imaging.</p>. <p>In our study, a statistically significant relationship was found between the microhemorrhage in the infarct area and the Apparent Diffusion Coefficient Region of Interest values. When the literature was reviewed, no such study was found to determine the risk of bleeding.</p>.

Uloga lipida u serumu u patogenezi arterijske hipertenzije

Hypertension is a key contributor to the high global burden of cardiovascular morbidity and mortality, due to its increasing prevalence worldwide. In clinical practice, dyslipidemia and hypertension often coexist, possibly because they share similar underlying causes, such as endothelial dysfunction and obesity. Consequently, this review article presents the collective findings on the role of lipid profile parameters in arterial hypertension. Individuals with hypertension often have significantly higher mean serum levels of triglycerides (TG), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C), while exhibiting lower mean serum levels of high-density lipoprotein cholesterol (HDL-C) compared to those without hypertension. TC and HDL-C play an important role in the pathogenesis of arterial hypertension. However, there is a lack of studies explaining the link between TG and LDL-C and arterial hypertension. Future studies are necessary to fully elucidate the exact mechanisms by which the mentioned lipid parameters contribute to arterial hypertension.

A Rapid and Safe Minimally Invasive Procedure for Percutaneous Pedicle Screw Removal: A Case-Control Study and Technical Description.

Percutaneous pedicle screw fixation is a common minimally invasive treatment for traumatic thoracolumbar and lumbar fractures; however, research on hardware removal after successful healing is limited. We aimed to introduce a rapid, safe, minimally invasive, and cost-effective method for percutaneous pedicle screw removal. We conducted a retrospective analysis of demographic (age, sex, body mass index, alcohol use, and current smoking), clinical (hypertension and diabetes mellitus), surgical (affected levels, number of screws, time of surgery, and blood loss), and treatment cost characteristics of 92 patients who had undergone percutaneous pedicle screw removal between May 2016 and February 2023. The first 57 patients underwent the conventional method, and the remaining 35 underwent the modified method. Independent-sample t-tests and chi-square tests were used to compare continuous and categorical variables, respectively, between the two groups. No significant differences were observed in the demographic parameters, complications, or affected levels between the groups. However, the average surgical time (P=0.000) was significantly shorter, and the average blood loss volume (P=0.002) and total cost (P=0.000) were significantly lower in the modified group than in the conventional group. Compared with the conventional method, our modified method can shorten the surgical time, reduce blood loss, and reduce the total cost of treatment. It is a quick and safe minimally invasive method that does not require additional surgical instruments and is suitable for implementation in primary hospitals.

Validation of self-reported hypertension in young adults in the US-based Growing Up Today Study (GUTS).

Self-reporting is often used in large epidemiologic research to identify hypertensive participants, but its validity in young adults has not been sufficiently assessed. We aimed to validate self-reported hypertension diagnosis from questionnaires by using medical records among a sample of young adults aged 22-39 years in the Growing Up Today Study (GUTS), during a time of transition in national hypertension definitions. A sample of 1,000 GUTS participants were asked for permission to access their medical records, to confirm their self-reported hypertension status on questionnaires from 2010 to 2019. Paired self-reported and medical record information was available for 318 participants. Medical records were reviewed by a clinical hypertension specialist. We evaluated agreement, kappa statistic, sensitivity and specificity of self-reporting. We assessed the correlations between blood pressure measurements self-reported on the 2019 questionnaire and those from medical records and compared the measurements using paired t-tests. The selected sample was generally representative of the full GUTS cohort. Agreement, kappa coefficient, sensitivity and specificity of self-reported hypertension were 85.5%, 0.72, 100%, and 75.3%. Although the absolute differences in blood pressure measurements between self-report and medical records were small (e.g., the average difference in typical recent blood pressures was 3.5/1.2 mm Hg), these measures were only moderately correlated. Validity of self-reported hypertension was high in GUTS, ensuring use as an endpoint in future studies with confidence. We demonstrated that young adults likely without formal medical training are able to report hypertension status with reasonable accuracy.

Therapy and guideline adherence at a multidisciplinary hypertension clinic: A prospective, observational study

BackgroundHypertension is highly prevalent and remains one of the most frequent and preventable causes of cardiovascular morbidity and mortality. Yet, suboptimal blood pressure control is common. Hypertension clinics might play an important role in improving target attainment, by targeting drug therapy adherence, improving guideline compliance and by involving pharmacists. ObjectivesWe aimed to characterize patient drug therapy adherence, prescriber guideline compliance and pharmacist interventions at the hypertension clinic. MethodsA prospective observational study was performed at the hypertension clinic of a large, academic hospital. Adult Dutch-speaking patients were eligible for inclusion. Following data were collected: patient demographics, medication use, patient adherence to prescribed antihypertensive drug therapies according to the BAASIS tool and prescriber compliance to the 2018 European Society of Cardiology (ESC) hypertension guidelines. ResultsA cohort of 108 patients was included with 51.9% male and aged 65 (IQR: 52–75) years. In total, 104 patients took at least 1 antihypertensive drug and 46 patients (44.2%) were classified as non-adherent with regard to their antihypertensive treatment; 82 patients (78.8%) had suboptimal blood pressure control. Compliance with the ESC guidelines was 66.3% prior to the consultation at the clinic and significantly increased to 77.9% thereafter (p = 0.0015). The clinical pharmacist performed a medication review for 27 patients with a total of 44 recommendations and an acceptance rate of 59.1%. ConclusionA visit to the multidisciplinary hypertension clinic improved prescriber guideline compliance and the use of single pill combinations. Involvement of a clinical pharmacist could be beneficial to further improve patient drug therapy adherence and guideline compliance.

Effectiveness of the Protection Motivation Theory-based Education Program among People at Risk of Stroke: A Randomized Controlled Trial

Stroke is a serious health issue that causes mortality and disability in the world’s population. People at risk of stroke need to manage the risk factors of stroke and adherence to stroke prevention, which are the key to success in improving clinical outcomes, particularly blood sugar and blood pressure levels. This randomized controlled trial, with a two-arm preand post-test, aimed to investigate the effectiveness of the Protection Motivation Theory-based Education Program on adherence to prevention and clinical outcomes among people at risk of stroke. The sample consisted of 58 adults visiting diabetes and hypertension clinics at a health-promoting hospital in a province in southern Thailand. They were recruited using multi-stage random sampling and randomly assigned into two arms. The experimental arm received the four-week Protection Motivation Theory-based Education Program (n = 29), and the control arm received only usual care (n = 29). Data were collected using a Demographic Data Form, the Morisky Medication Adherence Scale, the Adherence to Preventive Behavior Scale for Thai persons with prehypertension, a mercury sphygmomanometer, and a laboratory test recording form. Data were analyzed using descriptive statistics, Mixed Model ANOVA, and independent t-test. The results showed that after receiving the program, the experimental arm had higher adherence to stroke prevention, lower blood pressure, and lower HbA1C levels than before receiving the program and the control arm after the program completion. The findings indicate the program’s effectiveness in improving adherence to stroke prevention among people at risk of stroke, which results in better clinical outcomes. Thus, nurses can use this program in clinical practice with further testing in other settings with larger groups before it can be widely used.

Budd-Chiari syndrome in children: Radiological intervention and role of shear wave elastography in monitoring response.

Radiological intervention (RI) is the preferred treatment in children with Budd-Chiari syndrome (BCS). We studied the comparative long-term outcome of BCS children, with and without RI and utility of liver and splenic stiffness measurement (LSM, SSM) by 2-dimensional shear wave elastography (2D-SWE) in assessing response. Sixty children (40 boys, median age 10.5 [6.5-15.25] years) with BCS (29 newly diagnosed, 31 follow-up) were evaluated. LSM and SSM by 2D-SWE and vascular patency were monitored pre- and postprocedure (≥ 6 months postprocedure) in those undergoing RI. Medical therapy without anticoagulation and monitoring was done in subjects without RI. The RI and no-RI groups were compared. Ascites (54,90%), hepatomegaly (56,93%) and prominent abdominal-veins (42,70%), were the commonest features. The majority (46,78%) had isolated hepatic vein block. 44 (73%) cases underwent RI, while 16 (27%) were managed conservatively. Both groups were similar at baseline. Post-RI subjects showed significant improvement in clinical findings, liver functions and portal hypertension. LSM [33 (32-34.5) to 19.2 (18-20.67) kPa] and SSM [54.5 (52.3-57.6) to 28.9 (27.6-30.25) kPa] showed a significant decline from baseline value over a follow-up of 12 (6-13) months. Gradual reduction occurred in the LSM and SSM over 1-5 years, with near-normal LSM [10.2 (9.2-11.5) kPa] and SSM [22.3 (20.5-24.3) kPa] values in patients (n-16) with > 5 years follow-up. Patients without RI showed worsening in LSM and SSM. Hepatopulmonary syndrome and hepatocellular carcinoma developed in 4 (8%) and 1 (1.7%) cases respectively. RI leads to clinical recovery and reduction with near normalization of LSM and SSM over long-term follow-up in children with BCS. 2D-SWE is a promising tool to monitor outcomes.

Role of Social, Clinical, and Contextual Factors in Explaining MRI Markers of White Matter Injury and Change in Objectively‐Assessed Cognition by Race/Ethnicity: The Multi‐Ethnic Study of Atherosclerosis

AbstractBackgroundRacial and ethnic disparities in Alzheimer’s disease and related dementias (ADRD) are well documented. The mechanisms through which race and ethnicity as markers of systemic racism are associated with brain health are lacking.MethodWe used data from the Multi‐Ethnic Study of Atherosclerosis (MESA) and a causal mediation framework to determine whether the association between race/ethnicity (measured in Exam 1, 2000‐2002) and brain health is mediated through pathways represented by social (education level, health insurance (yes/no)), clinical (hypertension, diabetes, and depression symptoms), and contextual factors (neighborhood socioeconomic status) measured in Exam 1. Brain health was measured by 3T magnetic resonance imaging (MRI, N = 966) and change in cognitive scores (N = 2002). Participants completed the Cognitive Abilities Screening Instrument (CASI), Digit Symbol Coding (DSC), and Digit Span (DS) cognitive tests in Exams 5 (2010‐2012) and 6 (2016‐2018). Participants underwent MRI in 2018‐2019 to assess white matter (WM) injury assessed by WM hyperintensity volume (WMHV) and fractional anisotropy (FA). All models were adjusted for age, gender, education, marital status, income, and for WMHV models, total intracranial volume.ResultMean (SD) age at baseline was 58 (9) years, 29% participants self‐reported Black, 17% Hispanic, 11% Chinese and 43% White. Black and Hispanic participants experienced a larger decrease in CASI (‐3.3 points (95%CI: ‐4.1, ‐2.5); ‐4.7 (‐5.7, ‐3.7) respectively), DSC (‐2.2 (‐3.6,‐0.8); ‐5.3 (‐7.0,‐3.6)), and DS scores (‐0.4 (‐0.7,‐0.2); ‐1.1 (‐1.4,‐0.8)) from Exam5 to 6 than White participants, after accounting for covariates and baseline cognitive score. Black participants had greater WMHV (21% (1%, 50%)), and lower FA (‐.006 (‐0.01,‐0.002)) than White participants. We observed that the association between race/ethnicity as markers of racism and CASI change was mediated by education (proportion mediated 13% (1%, 21%)), and that the association with DSC change was mediated by health insurance (proportion mediated 9% (4%, 24%)) but not by any other social, clinical or contextual factor. The association between race/ethnicity and WM injury markers and change in DS was not mediated by social, clinical nor contextual factors.ConclusionEducation and health insurance appear as factors that may partially explain the association between race/ethnicity and cognitive decline.

Relationships among gut microbes, the interleukin family, and hypertension: a mediation Mendelian randomization study

PurposeObservational studies have increasingly recognized the influence of gut microbes on blood pressure modulation. Despite these findings, a direct causal link between gut flora and hypertension remains unestablished due to inherent confounders and the challenges of reverse causality in observational research. In this study, we sought to elucidate the causal relationship between specific gut flora and hypertension and its intermediary mediators.MethodsWe employed a two-sample Mendelian randomization (MR) and mediation MR analysis, analyzing 211 species of gut bacteria, with a focus on the interleukin family as potential mediators and hypertension as the primary outcome. The central methodological technique was inverse variance-weighted estimation, supplemented by various other estimators.ResultsOur findings revealed that two bacterial species positively correlated with hypertension risk, while five exhibited a negative association. Further validation was conducted using sensitivity analyses. Notably, our mediation MR results suggest interleukin-1 receptor type 2 (IL-1R2) as a mediator for the effect of the genus Clostridium innocuum group on hypertension, accounting for a mediation proportion of 14.07% [mediation effect: (b = 0.0007, 95%CI: 0.0002–0.0011); proportion mediation = 14.07% (4.26–23.40%)].ConclusionOur research confirms a genetic causal relationship between specific gut microbes and hypertension, emphasizing the potential mediating role of interleukin-1 receptor type 2 (IL-1R2) and offering insights for clinical hypertension interventions.

A cost-analysis of managing secondary and apparent treatment-resistant hypertension in a specialist multidisciplinary hypertension clinic.

A knowledge gap exists around the costs and budget impact of specialist hypertension clinics. This study reports on the cost of providing care in a multidisciplinary hypertension clinic staffed by nephrologist, endocrinologist and cardiologist, which manages patients with suspected secondary hypertension and/or apparent treatment-resistant hypertension. The aim of this study is to provide the evidence required to inform policy and planning care pathways for this patient group. A cost analysis from a healthcare provider perspective using micro-costing techniques was conducted to estimate the direct implementation costs of existing standard practice for the care pathway of patients attending the multidisciplinary hypertension clinic. Sixty-five patients originally recruited for a study of medication adherence in hypertension were included in the sample. The total care-pathway cost per patient, taking into account clinic visits, clinical reviews, investigations and MDT discussion, was estimated to be €3277, on average. For the patient subgroups, the average cost was €5644 for patients diagnosed with primary aldosteronism and €1446 for patients diagnosed with essential hypertension. There is significant cost associated with providing specialized hypertension care for patients with apparent treatment-resistant hypertension. Given the high rates of nonadherence in this population, it is likely that some of this cost could be avoided with better detection and management of medication adherence in this challenging population. Future studies should consider the cost-effectiveness of this or similar models of care by exploring the benefit to patients and the wider healthcare context of providing care of this type.

Abstract 17842: 3D Visualization and Quantitative Assessment of the Pulmonary Arteries on CT Using Deep Learning Segmentation

Introduction: Assessment of the pulmonary arteries (PA) on CT scan is typically qualitative and requires review of hundreds of images. PA segmentation would enable creation of 3D reconstructions that visualize the entire pulmonary arterial tree in a single image, similar to catheter angiography, and also enable quantification of pathophysiologic changes. Manual segmentation is very time-consuming, but deep-learning (DL) can automate the process. Hypothesis: A DL segmentation algorithm can be used to automatically generate 3D reconstructions of the PAs and quantify morphologic changes seen in Chronic Thromboembolic Pulmonary Hypertension (CTEPH) and Pulmonary Arterial Hypertension (PAH). Methods: A DL algorithm based on a 3D U-Net architecture which segments PAs larger than 2 mm was trained and validated on a total of 250 contrast-enhanced CT chest. The study group included 15 CTEPH and 15 PAH patients seen consecutively in pulmonary hypertension (PH) clinic in 2022 with prior CT chest and right heart catheterization, and 10 additional patients with prior CT chest and no evidence of PH on same day echo (normal). After running the DL algorithm on CTs, 3D renderings were created from segmentations and the relative volume of the central, interlobar, and segmental/subsegmental PAs was derived. Results: 3D renderings of PAH and CTEPH patients showed larger central and interlobar PAs compared with those of normal patients, whereas segmental and subsegmental PAs were smaller and pruned in CTEPH patients (Figure). Quantitatively, the volume of the central and interlobar PAs was higher in CTEPH and PAH compared to normal (p &lt; 0.05). The combined volume of segmental/subsegmental PAs was smaller in CTEPH patients relative to normal and PAH patients (p &lt; 0.005). Conclusions: DL segmentation enables intuitive visualization and quantification of the morphologic changes to the PAs seen in conditions causing PH. This method may improve diagnosis and assessment of PH on CT.