Blood Pressure Components Research Articles

Relationship between Uric Acid to High Density Lipoprotein Cholesterol Ratio and Nonalcoholic Fatty Liver Disease in Nonoverweight/Obese Patients with Type 2 Diabetes.

To investigate the relationship between uric acid to high-density lipoprotein cholesterol ratio (UHR) levels and nonalcoholic fatty liver disease (NAFLD) in nonoverweight/obese patients with type 2 diabetes. A retrospective study was designed including a total of 343 inpatients with type 2 diabetes whose BMI<24 kg/m2. The population was divided into three groups as the UHR tertiles. Logistic regression analysis was performed to estimate odds ratios (ORs) of UHR for NAFLD. ROC curve analysis was used to estimate the diagnostic value of UHR for NAFLD. The prevalence rat of NAFLD enhanced progressively from the tertile 1 to tertile 3 of UHR (30.70% vs. 56.52% vs. 73.68%). Logistic regression analysis showed that participants in the higher UHR groups, compared with those in the first tertile group, had higher occurrence risks for NAFLD. The positive association between UHR and NAFLD was independent of age, BMI, blood pressure, hepatic enzymes, and other components of metabolic disorders. ROC curve analysis showed that the area under curve (AUC), sensitivity, and specificity for UHR were 0.697, 0.761, and 0.553, respectively. In type 2 diabetic patients without overweight or obesity, UHR is significantly associated with NAFLD and can be used as a novel and useful predictor for NAFLD onset.

Influence of blood pressure variations during hemodialysis on the prognosis of dialysis patients

ABSTRACT The prognosis of dialysis patients is poorer than that of the general population. The relationship between dialysis patients’ blood pressure (BP) and mortality is controversial. We investigated the relationships between mortality and (i) pre-dialysis BP and (ii) BP variation during hemodialysis in maintenance dialysis patients. We retroactively analyzed the cases of the 284 patients on hemodialysis (mean age 68 ± 13 years old) who had been regularly followed at Kokura Daiichi Hospital, Japan in 2018. We assessed the relationship between the patients’ BP components and risk of mortality over a 40-month follow-up. The patients’ average systolic/diastolic BP values before dialysis in 2018 were 145 ± 18/77 ± 11, and those after dialysis were 129 ± 17/71 ± 10 mmHg. The prevalence of intradialytic hypotension was 46.8%. During an average follow-up of 35 months, 72 patients died, including from infectious diseases (n = 41), cardiovascular diseases (n = 9), malignancies (n = 5), and others (n = 17). The mortality rate was 32.7% in the pre-dialysis SBP < 140 mmHg group, 20.6% in the 140–159 mmHg group, and 22.2% in ≥ 160 mmHg group. In a multivariable-adjusted analysis, the hazard ratio for mortality in the pre-dialysis SBP < 140 mmHg group with intradialytic hypotension was significantly higher than that in the 140–159 mmHg group. In dialysis patients, pre-dialysis SBP < 140 mmHg and intradialytic hypotension posed a significantly higher risk for mortality. Our findings suggest that not only lower pre-dialysis BP, but also intradialytic hypotension is associated with poor prognosis in dialysis patients.

Interpretation of Ambulatory Blood Pressure Monitoring for Risk Stratification in Hypertensive Patients: The 'Ambulatory Does Prediction Valid (ADPV)' Approach.

Several outcome-based prospective investigations have provided solid data which support the prognostic value of 24 h ambulatory blood pressure over and beyond cardiovascular traditional risk factors. Average 24 h, daytime, and nighttime blood pressures are the principal components of the ambulatory blood pressure profile that have improved cardiovascular risk stratification beyond traditional risk factors. Furthermore, several additional ambulatory blood pressure measures have been investigated. The correct interpretation in clinical practice of ambulatory blood pressure monitoring needs a standardization of methods. Several algorithms for its clinical use have been proposed. Implementation of the results of ambulatory blood pressure monitoring in the management of individual subjects with the aim of improving risk stratification is challenging. We suggest that clinicians should focus attention on ambulatory blood pressure components which have been proven to act as the main independent predictors of outcome (average 24 h, daytime, and nighttime blood pressure, pulse pressure, dipping status, BP variability).

Progression of blood pressure components and correlation with anthropometric and laboratory measurements in young adults

Introducción: La presencia de hipertensión arterial en población joven aumenta el riesgo de eventos cardiovasculares en la mediana edad y como consecuencia una morbimortalidad prematura. El propósito de este estudio es evaluar la progresión de los componentes de la presión arterial y la correlación con las medidas antropométricas y laboratoriales en estudiantes de la Universidad Nacional de Asunción- Paraguay.

Critical assessment of the metabolic syndrome definitions in the adult general population of the United States - the Multi-Ethnic Study of Atherosclerosis (MESA).

Metabolic syndrome (MetS) consists of a cluster of cardiometabolic risk factors and is an important determining factor for cardiovascular diseases (CVDs). We intended to use latent class analysis to classify the study population into several clusters. The baseline information of 6,814 participants of the Multi-Ethnic Study of Atherosclerosis (MESA) aged 45-84 years in 2000-2002 was used. The latent class analysis was conducted to extract different patterns of components. SAS 9.2 and Stata 12 software were used for analysis. The components of MetS tend to accumulate, hence it would be feasible to categorize the population into three classes: [1] Non-Metabolic Syndrome Latent Class (NonMetS-LC), [2] Low Risk Latent Class (LowR-LC), and [3] Metabolic Syndrome Latent Class (MetS-LC). In women, adding high-density lipoprotein (HDL) component to the two-component combinations of NonMetS-LC will transfer the individual to MetS-LC, and it was found in 100% of combinations of MetS-LC. However, in men, blood pressure (BP) played such a similar role, which was found in 97.36% of combinations of MetS-LC. Results showed that clinical value of each MetS component is different by gender. The main component in men was elevated BP; while low HDL and elevated fasting blood sugar (FBS) were in next ranks. However, the main component in women was low HDL; while elevated BP and FBS were in next ranks. Special attention should be paid to BP and HDL components, because these can be useful for clinicians and health policy-makers in diagnosis and screening. In conclusion, this study showed that revisions might be needed for the MetS definitions.

Muscarinic cholinergic modulation of cardiovascular variables in spinal cord injured rats

Spinal cord injury (SCI) leads not only to major impairments in sensorimotor control but also to dramatic dysregulation of autonomic functions including major cardiovascular disturbances. Consequently, individuals with SCI endure daily episodic hypo/hypertension and are at increased risk for cardiovascular disease. Several studies have suggested that an intrinsic spinal coupling mechanism between motor and sympathetic neuronal networks exist and that propriospinal cholinergic neurons may be responsible for a synchronized activation of both somatic and sympathetic outputs. We therefore investigated in the present study, the effect of cholinergic muscarinic agonists on cardiovascular parameters in freely moving adult rats after SCI. Female Sprague-Dawley rats were implanted with radiotelemetry sensors for long-term in vivo monitoring of blood pressure (BP). From BP signal, we calculated heart rate (HR) and respiratory frequency. We first characterized the physiological changes occurring after a SCI performed at the T3-T4 level in our experimental model system. We then investigated the effects on BP, HR and respiration, of the muscarinic agonist oxotremorine using one variant that crossed the blood brain barrier (Oxo-S) and one that does not (Oxo-M) in both Pre- and Post-SCI animals. After SCI, both HR and respiratory frequency increased. BP values exhibited an immediate profound drop before progressively increasing over the three-week post-lesion period but remained below control values. A spectral analysis of BP signal revealed the disappearance of the low frequency component of BP (0.3-0.6Hz) referred to as Mayer waves after SCI. In Post-SCI animals, central effects mediated by Oxo-S led to an increase in HR and MAP, a slowdown in respiratory frequency and to an increased power in the 0.3-0.6Hz frequency band. This study unravels some of the mechanisms by which muscarinic activation of spinal neurons could contribute to partial restoration of BP after SCI.

Abstract 62: Life’s Essential 8 and Mortality Risk: Associations of an Enhanced Cardiovascular Health Construct With All-Cause, Cardiovascular, and Cancer Mortality in US Adults From the 2011-2018 National Health and Nutrition Examination Survey

Introduction: Cardiovascular health (CVH), measured using the AHA’s Life’s Simple 7, is linked to mortality. Associations of AHA’s Life’s Essential 8 (LE8), an enhanced approach to defining CVH, with mortality risk have not yet been evaluated in a nationally representative sample of US adults. Hypothesis: Lower CVH will be associated with higher risk for all-cause, CVD, and cancer mortality. Methods: We included 21,164 adults (mean age: 48y, 51% female, 11% Black, 15% Hispanic, 65% White) from the 2011-2018 NHANES whose mortality through 2019 was determined via linkage to the National Death Index. The CVH score (range: 0-100, high: 80-100, moderate: 50-79, low: 0-49) and component scores were computed consistent with the LE8 framework. The Kaplan-Maier method and multivariable Cox proportional hazards models were used to evaluate the CVH score and its component scores in relation to all-cause mortality (primary outcome) as well as CVD and cancer mortality (secondary outcomes), accounting for the complex stratified survey design of NHANES. Results: During a median follow-up of 5y, there were 1,397 deaths, including 414 and 329 deaths from CVD and cancer, respectively. Low vs. high CVH was related to 3-fold higher risk for all-cause mortality and &gt;3-fold higher risk of CVD and cancer mortality, and a linear trend across CVH categories was detected (Figure). Lower scores for the diet, physical activity, nicotine exposure, sleep health, BMI, blood glucose, and blood pressure components predicted 25% to 2-fold higher mortality risk, and a gradient in risk was observed. Associations did not vary by sex, but there were differences by race and ethnicity (p-interaction&lt;0.05); the magnitude of associations was strongest among Whites, while no relation was observed among Hispanics. Conclusions: CVH measured using the enhanced LE8 is a strong predictor of all-cause, CVD, and cancer mortality in US adults, with evidence of a dose-response relationship. Improving CVH could result in substantial population-level reductions in mortality.

Association of systolic, diastolic, mean, and pulse pressure with morbidity and mortality in septic ICU patients: a nationwide observational study

BackgroundIntensivists target different blood pressure component values to manage intensive care unit (ICU) patients with sepsis. We aimed to evaluate the relationship between individual blood pressure components and organ dysfunction in critically ill septic patients.MethodsIn this retrospective observational study, we evaluated 77,328 septic patients in 364 ICUs in the eICU Research Institute database. Primary exposure was the lowest cumulative value of each component; mean, systolic, diastolic, and pulse pressure, sustained for at least 120 min during ICU stay. Primary outcome was ICU mortality and secondary outcomes were composite outcomes of acute kidney injury or death and myocardial injury or death during ICU stay. Multivariable logistic regression spline and threshold regression adjusting for potential confounders were conducted to evaluate associations between exposures and outcomes. Sensitivity analysis was conducted in 4211 patients with septic shock.ResultsLower values of all blood pressures components were associated with a higher risk of ICU mortality. Estimated change-points for the risk of ICU mortality were 69 mmHg for mean, 100 mmHg for systolic, 60 mmHg for diastolic, and 57 mmHg for pulse pressure. The strength of association between blood pressure components and ICU mortality as determined by slopes of threshold regression were mean (− 0.13), systolic (− 0.11), diastolic (− 0.09), and pulse pressure (− 0.05). Equivalent non-linear associations between blood pressure components and ICU mortality were confirmed in septic shock patients. We observed a similar relationship between blood pressure components and secondary outcomes.ConclusionBlood pressure component association with ICU mortality is the strongest for mean followed by systolic, diastolic, and weakest for pulse pressure. Critical care teams should continue to follow MAP-based resuscitation, though exploratory analysis focusing on blood pressure components in different sepsis phenotypes in critically ill ICU patients is needed.

Gender-specific effect of outdoor temperature and seasonal variation on blood pressure components: a cross-sectional study on Iranian adults from 2015 to 2018.

Blood pressure (BP) is influenced by both individual and environmental factors such as ambient temperature. However, the gender-stratified and component-specific impact of temperature on BP is not well understood. Herein, we examined the temperature and seasonal effects on four main BP components, namely systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP), in both genders. A total of 8990 (3954 men) Tehranian adults during 2015-2018 were included. Linear regression models for analyzing data in three models including unadjusted, age-adjusted, and further adjusted for known sociodemographic and cardiovascular confounders were conducted. Among women, each 10°C increment was associated with a significant decrease of - 0.48mmHg (95% confidence interval (CI): - 0.86, - 0.19) and - 0.65mmHg (- 0.76, - 0.41) in SBP and MAP, respectively. In men, the corresponding value for SBP was - 0.46 (- 0.82, - 0.16) mmHg (P = 0.058). Gender-specific analysis in each season showed that among women, PP increased in autumn and winter with each 10°C decrease (P < 0.05). The mean increase in SBP (3.4 and 2.06mmHg in women and men, respectively), DBP (1.66 and 1.19mmHg), and MAP (2.71 and 1.12mmHg) was observed during winter compared to summer (all P < 0.05). PP showed seasonality only in women (1.46mmHg, P-value = 0.003). In both genders, SBP in age > 60years was more susceptible to variation compared to younger ages. Furthermore, obese women had more SBP changes compared to their non-obese counterparts (all P for interaction < 0.05). In conclusion, there was a sex difference in BP response to the outdoor temperature, with higher vulnerability among women. The reverse relation between temperature and BP occurred particularly among elderly and obese individuals. Careful monitoring of BP in cold seasons, specifically in the mentioned subgroups, could potentially attenuate cardiovascular risks.

Abstract WP138: Intracranial Artery Stenosis In Relation To Blood Pressure Components

Introduction: Vascular aging is characterized by structural and functional changes in blood vessels that lead to reduced perfusion pressure to distal organs and high blood pressure (BP). Cerebrovascular aging is strongly associated with high BP, however, systemic BP is constituted by the steady and pulsatile components. We aimed this study to investigate the association of intracranial artery stenosis in relation to the steady and pulsatile components of the systemic BP - such association remains undocumented. Methods: We used cross-sectional data from 292 participants from the Maracaibo Aging Study who underwent ambulatory BP monitoring, magnetic resonance angiography, and MRI between 2011 to 2016. The stenosis of eleven intracranial arteries was measured using magnetic resonance angiography scans and encompassed the right and left sides of the anterior (ACA), middle (MCA), posterior (PCA) cerebral arteries, and internal carotid arteries (ICA), vertebral arteries, and the basilar artery. The steady BP component included the 24-hour mean arterial pressure (MAP) while the pulsatile component included the 24-hour pulse pressure (PP). We performed multivariable logistic regression models to assess the association between intracranial artery stenosis and BP components. Models were accounted for age, sex, head circumference, years of education, body mass index, total and high-density cholesterol ratio, creatinine, diabetes mellitus, and antihypertensive treatments. Results: Mean age was 57.5±11 years, 75% women. After adjustment for confounders, 24-hour pulse pressure was associated (P≤ 0.020) with the stenosis of ICA (Odds ratios [OR], 2.00 per every 5 mmHg of PP; 95% confidence interval [CI], 1.49-2.69), ACA (OR, 1.50; 95% CI, 1.23-1.84), MCA (OR, 1.46; 95%, CI, 1.21-1.77), PCA (OR, 1.55; 95% CI, 1.26-1.91), basilar artery (OR, 1.28; 95% CI, 1.03-1.59) and vertebral arteries (OR, 1.42; 95% CI, 1.14-1.78). The ORs of ICA, ACA, MCA, PCA, basilar artery, and vertebral arteries in relation to high 24-hour MAP levels (P≤ 0.040) ranged from 1.27 (95% CI, 1.00-1.61) to 1.48 (95% CI, 1.15 - 1.91). Conclusion: Elevated levels in the steady and pulsatile components of the systemic BP are associated with intracranial artery stenosis.

Distinct components of cardiovascular health are linked with age-related differences in cognitive abilities

Cardiovascular ageing contributes to cognitive impairment. However, the unique and synergistic contributions of multiple cardiovascular factors to cognitive function remain unclear because they are often condensed into a single composite score or examined in isolation. We hypothesized that vascular risk factors, electrocardiographic features and blood pressure indices reveal multiple latent vascular factors, with independent contributions to cognition. In a population-based deep-phenotyping study (n = 708, age 18–88), path analysis revealed three latent vascular factors dissociating the autonomic nervous system response from two components of blood pressure. These three factors made unique and additive contributions to the variability in crystallized and fluid intelligence. The discrepancy in fluid relative to crystallized intelligence, indicative of cognitive decline, was associated with a latent vascular factor predominantly expressing pulse pressure. This suggests that higher pulse pressure is associated with cognitive decline from expected performance. The effect was stronger in older adults. Controlling pulse pressure may help to preserve cognition, particularly in older adults. Our findings highlight the need to better understand the multifactorial nature of vascular aging.

Metabolic Syndrome and Its Components are Associated with In-Hospital Complications after Thoracic Endovascular Aortic Repair for Acute Type B Aortic Dissection

This study aimed to explore whether and to what extent metabolic syndrome (MetS) and its components are associated with in-hospital complications in patients with acute type B aortic dissection after thoracic endovascular aortic repair (TEVAR). We retrospectively enrolled 684 patients who had undergone TEVAR. Demographic and clinical data were collected and subgroup analysis, mixed-model regression analysis, scoring systems, and receiver operating characteristic (ROC) curve analyses were performed. Overall, 684 inpatients were assigned to the poor outcome (n=90) or no complications (n=594) group. Compared to the no complications group, the poor outcome group had a higher incidence of MetS (44 [48.9%] vs. 120 [20.2%], P<0.05). In the subgroup analysis, in-hospital complications were present in 3.1%, 6.6%, 11.9%, 20.7%, 40.0%, and 62.5% of patients in the 6 groups who met the 0, 1, 2, 3, 4, and 5 MetS diagnostic criteria, respectively. On multivariable logistic regression, hypertension (odds ratio [OR]: 2.680; 95% confidence interval [CI]: 1.571-4.570), type 2 diabetes (OR: 2.135; 95% CI: 1.192-3.824), quartiles of body mass index (OR: 1.801; 95% CI: 1.415-2.291), high-density lipoprotein cholesterol (OR: 0.763; 95% CI: 0.611-0.953), and systolic blood pressure (OR: 1.894; 95% CI: 1.486-2.413) were independent factors for in-hospital complications after adjustment for other risk factors. After adjusting for potential confounding factors, MetS was an independent risk factor for in-hospital complications. We established a scoring system for each component and the area under the ROC curve was 0.664 (95% CI: 0.618-0.710) in all patients, 0.672 (95% CI: 0.595-0.749) in patients with MetS, and 0.610 (95% CI: 0.552-0.667) in patients without MetS, as determined by ROC analysis. MetS, especially the blood pressure component, confers a greater risk of in-hospital complications in patients with acute type B aortic dissection after TEVAR.

Optimal or standard control of systolic and diastolic blood pressure across risk factor categories in patients with chronic coronary syndromes.

Guidelines have lowered blood pressure (BP) targets to <130/80 mmHg. We examined the benefit of intensive control for each BP component, vs. the burden of other modifiable risk factors, in patients with chronic coronary syndromes (CCS). The CLARIFY registry (ISRCTN43070564) enrolled 32 703 patients with CCS, from 2009 to 2010, with a 5-year follow-up. Patients with either BP component below European guideline safety boundaries (120/70 mmHg) were excluded, leaving 19 167 patients (mean age: 63.8 ± 10.1 years, 78% men) in the present analysis. A multivariable-adjusted Cox proportional hazards model showed a gradual increase in cardiovascular risk (cardiovascular death, myocardial infarction, or stroke) when the number of uncontrolled risk factors (active smoking, no physical activity, low-density lipoprotein cholesterol ≥100 mg/dL, and diabetes with glycated haemoglobin ≥7%) increased [adjusted hazard ratio (HR): 1.34; 95% confidence interval (CI): 1.17-1.52, 1.65 (1.40-1.94), and 2.47 (1.90-3.21) for 1, 2, and 3 or 4 uncontrolled risk factors, respectively, vs. 0], without significant interaction with BP. Although uncontrolled systolic (≥140 mmHg) and diastolic (≥90 mmHg) BP were both associated with higher risk than standard BP, standard BP was associated with higher risk than optimal control for only the diastolic component (adjusted HR: 1.08; 95% CI: 0.94-1.25 for systolic BP 130-139 vs. 120-129 mmHg and 1.43; 95% CI: 1.27-1.62 for diastolic BP 80-89 vs. 70-79 mmHg). Our results suggest that the optimal BP target in CCS may be ≤139/79 mmHg and that optimizing the burden of other risk factors should be prioritized over the further reduction of systolic BP.

PS-C32-6: ASSOCIATION BETWEEN BLOOD PRESSURE COMPONENTS AND RENAL HISTOLOGIC FINDINGS IN PATIENTS WITH IGA NEPHROPATHY

Objective: The diverse histological findings in IgA nephropathy are often evaluated using the Oxford classification for glomerular, tubular/interstitial, and vascular lesions. Patients with IgA nephropathy are prone to hypertension, but the relationship between the histological findings and blood pressure (BP) is not well known. In addition to systolic BP (SBP) and diastolic BP (DBP), mean arterial pressure (MAP) as a steady component and pulse pressure (PP) as a pulsatile component are also important BP components. Therefore, we investigated the detailed relationship between these BP components and renal histological findings. Design and method: Among 340 patients with IgA nephropathy diagnosed by renal biopsy between June 1996 and December 2008, 230 patients aged 15–65 years who were not taking antihypertensive medications other than renin-angiotensin-aldosterone system (RAAS) inhibitors and had serum creatinine levels &lt; 2.0 mg/dL were included in this cross-sectional analysis. Multiple logistic regression analysis was used to examine the association between four BP components and pathological factors. Pathological factors were evaluated using parameters included in the Oxford classification: mesangial hypercellularity (mesangial score &gt; 0.5 or ≦ 0.5), segmental glomerulosclerosis (yes/no), endocapillary hypercellularity (yes/no), global glomerulosclerosis (≦ 13.6% of the total number of glomeruli, which indicates the highest quartile of the total population, or &lt; 13.6%), tubular atrophy/interstitial fibrosis (&gt; 10% of cortical area, or ≦ 10%), cellular/fibrocellular crescents (yes/no), and arteriosclerosis (yes/no). Results: The prevalence of mesangial hypercellularity, segmental glomerulosclerosis, endocapillary hypercellularity, tubular atrophy/interstitial fibrosis, cellular/fibrocellular crescents and arteriosclerosis were 47.8%, 84.8%, 37.4%, 20.9%, 33.9%, and 32.2%, respectively. After adjustment for age, sex, smoking status, alcohol status, and use of RAAS inhibitors, global glomerulosclerosis and tubular atrophy/interstitial fibrosis were significantly associated with DBP, and arteriosclerosis was associated with SBP, DBP, and MAP, whereas mesangial hypercellularity, segmental glomerulosclerosis, endocapillary hypercellularity, and cellular/fibrocellular crescents were not associated with any BP component. The multiple-adjusted odds ratio of global glomerulosclerosis for DBP per 10 mmHg was 1.67 (95% CI 1.09–2.55), and that of tubular atrophy/interstitial fibrosis for DBP per 10 mmHg was 1.66 (95% CI 1.06–2.60). The multiple-adjusted odds ratios of arteriosclerosis were 1.58 (95% CI 1.16–2.15), 1.89 (95% CI 1.26–2.83), and 1.62 (95% CI 1.15–2.29) for SBP, DBP, and MAP per 10 mmHg, respectively. Conclusions: In the cross-sectional study of patients with IgA nephropathy, global glomerulosclerosis, tubular atrophy/interstitial fibrosis, and arteriosclerosis were associated with DBP, and arteriosclerosis was also associated with SBP and MAP. On the other hand, segmental glomerulosclerosis, endocapillary hypercellularity, and cellular/fibrocellular crescents had no association with any BP component.

Systolic Pressure, not the Diastolic Pressure Expresses Better the Relationship between Age and Blood Pressure Changes in a Community Sample of Adults

Context: Hypertension is an important cause of the cardiovascular disease (CVD). Blood pressure (BP) elevations and the associated complications are influenced by age. Aim: To evaluate age-related variations in systolic BP, diastolic BP, and the derived pulse pressure (PP), mean arterial pressure (MAP), as well as pulse rate (PR) in a community sample of adults in Sokoto. Settings and Design: Adult individuals, predominantly non-hypertensive, non-diabetic that attended a free medical screening in a Sokoto community, Northwestern Nigeria were evaluated. Materials and Methods: Blood pressure, anthropometry, and random blood glucose were measured. Statistical Analysis Used: Database storage and analysis were carried out using IBM SPSS, version 23.0. Results: Systolic BP correlates with age increases beyond other BP parameters (standardized β-coefficient of systolic BP = 0.4071, R2 = 0.0933, Diastolic BP = 0.1485, R2 = 0.0409, PP = 0.2587, R2 = 0.0661, MAP = 0.2347, R2 = 0.0757, PR = -0.0087, R2 = 0.0001). The same trend was observed when age-dependent variations in the BP parameters were assessed independent of body weights (Fcrit = 2.398, F = 151.911, df = 4, P = 0.000) and independent of the steady state pressure, MAP (Fcrit = 2.637, F = 795.975, P = 0.000). However, when the population is considered by age categories of ≤50 years or &gt;50 years separately, diastolic BP rather than the systolic BP better explain the relationship in the ≤50 years category. Conclusion: Although all the components of BP should be monitored when treating hypertension in adults, systolic BP and its derivative PP be given more attention.

PS-B10-1: DIFFERENT MECHANISMS OF BLOOD PRESSURE REDUCTION INDUCED BY CHRONIC PERORAL OR INTRACEREBROVENTRICULAR CLONIDINE ADMINISTRATION IN SALT-DEPENDENT OR ANGIOTENSIN II-DEPENDENT HYPERTENSION

Objective: The agonists of alpha2-adrenergic receptors are known to lower blood pressure (BP) through a reduction of brain sympathetic outflow but their chronic antihypertensive effects in rats with low-renin or high-renin forms of experimental hypertension were not studied yet. Moreover, there is no comparison of mechanisms underlying BP reduction elicited by chronic peroral (PO) or intracerebroventricular (ICV) clonidine treatment. Design and Methods: Adult male Dahl S rats fed 4% NaCl diet and Ren-2 transgenic rats were treated with clonidine administered either in the drinking fluid (0.5 mg/kg/day PO) or via the infusion into the lateral brain ventricle (0.1 mg/kg/day ICV) for 4 weeks. Basal BP as well as the contributions of renin-angiotensin system or sympathetic nervous system (acute BP responses to intravenous injection of either captopril 10 mg/kg or pentolinium 5 mg/kg) to BP maintenance were determined in conscious cannulated rats at the end of the study. Results: Both peroral and intracerebroventricular clonidine treatment lowered BP to the same extent in either rat model. However, in both models chronic clonidine treatment reduced sympathetic BP component only in rats treated intracerebroventricularly but not perorally treated animals. In contrast, peroral clonidine treatment reduced angiotensin-dependent vasoconstriction in Ren- transgenic rats, whereas it lowered residual BP in Dahl rats. Conclusions: Our results indicate different mechanisms of antihypertensive action of clonidine depending on the route of its administration - central or systemical

PS-BPP02-7: DEFINING THE OPTIMAL CUT-OFF POINTS OF BLOOD PRESSURE COMPONENTS TO PREDICT THE PROGRESSION OF CHRONIC KIDNEY DISEASE IN TOYOOKA CITY

Objective: Early control of blood pressure is critical to delaying the progression of chronic kidney disease (CKD) and preventing future cardiovascular events and mortality. The primary objective of the study is to assess the optimal cut-off points of blood pressure components for predicting the worsening of proteinuria or renal function. Design and method: Retrospective longitudinal data from 2013–2017 specific health surveys among participants of National Health Insurance in Toyooka City were analyzed (n = 5,169 at baseline). Association of blood pressure at baseline and worsening of dip-stick proteinuria or estimated glomerular filtration rate (eGFR) during follow-up were determined with Cox proportional hazard analysis. The optimal cut-off points were determined with time-dependent receiver operating characteristic curves (ROC). Results: Survival analysis revealed that worsening of proteinuria during follow-up was significantly associated with baseline systolic and diastolic blood pressure levels independently of age, gender, or HbA1c levels. Time-dependent ROC curves for detecting worsening of proteinuria during follow-up revealed that the optimal cut-off points of systolic and diastolic blood pressure were 126 mmHg (sensitivity 0.62, specificity 0.45) and 81 mmHg (sensitivity 0.38, specificity 0.70), respectively. When the whole population was categorized with the systolic blood pressure levels of &lt; 126, 126–139, or &gt; = 140 mmHg, the age, gender, and HbA1c-adjusted risks for worsening proteinuria in the highest and intermediate systolic blood pressure groups were 1.5-fold (p = 0.002) and 1.3-fold (p = 0.014) higher than that in the lowest group, respectively. In addition, the risks for more than a 15%-decrease in eGFR during follow-up in the highest and intermediate groups were 2.0-fold (p &lt; 0.001) and 1.6-fold (p = 0.009) higher than that in the lowest group, respectively. When the whole population was categorized with the diastolic blood pressure levels of &lt; 81, 81–89, or &gt; = 90 mmHg, the risks for worsening proteinuria in the highest and intermediate diastolic blood pressure groups were 1.5-fold (p = 0.004) and 1.2-fold (p = 0.056) higher than that in the lowest group, respectively. Furthermore, the time-dependent ROC curve for detecting more than a 15%-decrease in eGFR during follow-up revealed that the optimal cut-off point of pulse pressure was 52 mmHg (sensitivity 0.48, specificity 0.58). In subjects with a baseline pulse pressure of &gt; = 52 mmHg, the adjusted odds ratio for detecting more than a 15%-decrease in eGFR during follow-up was 1.5-fold higher than in those with a baseline pulse pressure of &lt; 52 mmHg (p = 0.005). Conclusions: Data from specific health surveys revealed regional blood pressure-related risks associated with worsening of CKD among participants of National Health Insurance.

The influence of Olmesartan on the Renin-angiotensin-aldosterone System of Rats with Thyroid Dysfunction

Background : The thyroid gland and its hormones participate and have a critical part in the development and function of different parts of the body like the kidney, which is the most important site of renin synthesis and release which is followed by angiotensin and aldosterone formation. As needs are; any abnormality in this gland’s function can harm the Renin-Angiotensin -Aldosterone System. We aimed to discover the effects of using an Angiotensin Receptor Blocker (Olmesartan) on the Renin-Angiotensin-Aldosterone System (RAAS) in rats with abnormal thyroid functions. Methods : Thirty rats were used and three groups were formed. 6 rats (First group) were the control. 12 rats (Second group) was the hypothyroid group (6 rats control, 6 rats given Olmesartan). 12 rats (the Third group) was the hyperthyroid group (6 rats control, 6 rats given Olmesartan). L-Thyroxine and Propylthiouracil (PTU) were given orally daily for induction of hyperthyroidism and hypothyroidism respectively. Blood pressure measurement was done on days 1 and 40th day of the study. The rats were sacrificed on day 40th of the study. Results : In hyperthyroid rats, T4 was raised and the use of Olmesartan on these rats caused a lowering of this parameter. Renin levels increased in hyperthyroid rats treated with Olmesartan. Angiotensin I increased in hyperthyroid rats. Systolic BP increased in hyperthyroid rats and the use of Olmesartan on these rats caused a lowering of this parameter. Diastolic BP and Mean BP both increased in the hyperthyroid rats. T3 and T4 levels dropped and TSH increased in hypothyroid and hypothyroid treated with Olmesartan rats. The level of Renin decreased in hypothyroid rats and increased in Olmesartan-treated rats. Angiotensin I decreased in hypothyroid and Olmesartan-treated hypothyroid rats. Blood Pressure components decreased in both hypothyroid and hypothyroid treated with Olmesartan rats. Conclusions : Olmesartan was able to decrease T4 level along with Systolic BP in hyperthyroid rats. It also decreased Angiotensin I and Blood Pressure components in hypothyroid rats.

The Effect of Age on Non-Invasive Hemodynamics in Chronic Heart Failure Patients on Left-Ventricular Assist Device Support: A Pilot Study.

Background: Implantation of continuous flow left ventricular assist devices (LVAD’s) has been increasingly used in patients with advanced heart failure (HF). Little is known about the non-invasive hemodynamics and the relationship with adverse events in this specific group of patients. We aimed to identify any differences in non-invasive hemodynamics in patients with an LVAD in different age categories and to investigate if there is an association with major adverse events. Methods: In this observational cross-sectional study, HF patients with a continuous flow LVAD were included. Non-invasive hemodynamic parameters were measured with a validated, automated oscillometric blood pressure monitor. The occurrences of adverse events were registered by reviewing the medical records of the patients. An independent-samples T-test and Chi-square test were used to compare different groups of patients. Results: Forty-seven patients were included; of these, only 12 (25.6%) had a successful measurement. Heart rate, heart rate-adjusted augmentation index, and pulse wave velocity were higher in the ≥55 years of age LVAD group compared to the <55 years of age LVAD group (all p < 0.05). Stroke volume was significantly lower in the ≥55 years of age LVAD group compared to the <55 years of age LVAD group (p = 0.015). Patients with adverse events such as cardiovascular events, GI-bleeding, or admission to a hospital had lower central pulse pressure (cPP) than patients without any adverse event. Conclusion: Older LVAD patients have a significantly higher heart rate, heart rate-adjusted augmentation index, and pulse wave velocity and a significantly lower stroke volume compared to participants aged < 55 years. The pulsatile component of blood pressure was decreased in patients with adverse events.

Blood Pressure Responses During Exercise: Physiological Correlates and Clinical Implications.

Abnormal blood pressure (BP) responses to exercise can predict adverse cardiovascular outcomes, but their optimal measurement and definitions are poorly understood. We combined frequently sampled BP during cardiopulmonary exercise testing with vascular stiffness assessment to parse cardiac and vascular components of exercise BP. Cardiopulmonary exercise testing with BP measured every two minutes and resting vascular tonometry were performed in 2858 Framingham Heart Study participants. Linear regression was used to analyze sex-specific exercise BP patterns as a function of arterial stiffness (carotid-femoral pulse wave velocity) and cardiac-peripheral performance (defined by peak O2 pulse). Our sample was balanced by sex (52% women) with mean age 54±9 years and 47% with hypertension. We observed variability in carotid-femoral pulse wave velocity and peak O2 pulse across individuals with clinically defined exercise hypertension (peak systolic BP [SBP] in men ≥210 mm Hg; in women ≥190 mm Hg). Despite similar resting SBP and cardiometabolic profiles, individuals with higher peak O2 pulse displayed higher peak SBP (P≤0.017) alongside higher fitness levels (P<0.001), suggesting that high peak exercise SBP in the context of high peak O2 pulse may in fact be favorable. Although both higher (favorable) O2 pulse and higher (adverse) arterial stiffness were associated with greater peak SBP (P<0.0001 for both), the magnitude of association of carotid-femoral pulse wave velocity with peak SBP was higher in women (sex-carotid-femoral pulse wave velocity interaction P<0.0001). In sex-specific models, exercise SBP measures accounting for workload (eg, SBP during unloaded exercise, SBP at 75 watts, and SBP/workload slope) were directly associated with the adverse features of greater arterial stiffness and lower peak O2 pulse. Higher peak exercise SBP reflects a complex trade-off between arterial stiffness and cardiac-peripheral performance that differs by sex. Studies of BP responses to exercise accounting for vascular and cardiac physiology may illuminate mechanisms of hypertension and clarify clinical interpretation of exercise BP.