Decrease In Systolic Blood Pressure Research Articles

Immediate implant placement influenced by musical flow: a prospective randomized controlled clinical trial

BackgroundThe purpose of this study was to test how musical flow using baroque (BM) and classical era music (CM) as a non-pharmacological therapy can control anxiety and pain levels among patients undergoing IPI (Immediate post-extraction implants).Methods78 patients who required an IPI were enrolled in this randomized clinical trial. Each patient was assigned to one of the three experimental groups with a simple randomization: Group I (n = 26) listened to BM; Group II (n = 27) listened to CM; and Group III (n = 25) did not listen to music and was the control group (C). The physiological dependent variables analyzed were systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and oxygen saturation (SpO2). The psychological dependent variable analyzed was modified dental anxiety scale (MDAS) and visual analogue scale (VAS), measured before and after surgery. In all cases, the level of statistical significance was set at p < 0.01.ResultsStatistically significant differences were found in the SBP decrease in the CM group (p = 0.001, CI = 1.9716–6.5840) and the BM group (p = 0.003, CI = 1.4450–6.4396). Anxiety levels during the intervention decreased in both groups that listened to music: BM group (p = 0.002, CI = 0.645–2.662) and CM group (p = 0.000, CI = 1.523–3.884).ConclusionsPatients undergoing IPI placement surgery can register lower levels of SBP when listening to BM and CM than patients who were not exposed to the musical flow, improving their anxiety levels.

Effects of a Nonlinear Program on Different Health Parameters in the Elderly.

The aim of this research was to evaluate the impact of a nonlinear training program on visceral adipose tissue (VAT) and systolic (SBP) and diastolic (DBP) blood pressure, as well as the response of biochemical parameters such as fasting plasma glucose (FPG), total cholesterol (TC), high-density cholesterol (HDL-C), low-density cholesterol (LDL-C), and triglycerides (TG). The nonlinear periodized program would produce greater improvements in outcomes than the linear periodized training program. Randomized cross-sectional design. Level 3. Older adults with no previous training experience (10 male and 8 female [age, 64 ± 2.1 years; height, 165.12 ± 7.5 cm; body mass, 72.5 ± 11.4 kg; body max index, 26.5 ± 3.2 kg/m2]) were randomized to linear (n = 9, TT) or undulating (n = 9, UT) periodization. After a 3-week familiarization period, all participants performed 3 sessions of resistance training per week; 8 weeks of training were conducted for each group. Dual x-ray absorptiometry was used to measure VAT, and SBP and DBP were measured using an OMRON M3 digital automatic blood pressure monitor. Blood samples were collected between 8:00 a.m. and 9:30 a.m. after 12-hour overnight fasting. Both interventions significantly (P < 0.05) decreased FPG, TC, LDL-C, and TG. A significant decrease in SBP and DBP was observed only in the UT group (P < 0.05). No significant between-group differences in outcomes were observed (P > 0.5). However, the effect size was marginally more pronounced for all outcomes in the UT group. An undulating periodization program was effective in improving VAT, TC, LDL-C, FPG, HDL-C, TG, and blood glucose levels in older adults. Resistance training can be programmed in an undulating or traditional way in older adults based on improvements in health parameters, considering adherence and individual preferences.

#2049 Prognosis of decreased renal function in patients with arterial hypertension

Abstract Background and Aims Chronic kidney disease and hypertension are closely related in cause and effect. As the glomerular filtration rate decreases, the frequency and severity of arterial hypertension increases. In addition, the risk of morbidity and mortality from cardiovascular diseases increases significantly with comorbidity of arterial hypertension and chronic kidney disease. The purpose of this study was to identify predictors of a decrease in GFR below 60 ml/min in patients with arterial hypertension. Method The cross-sectional study included 43 patients with arterial hypertension (average age 56.7 (10.6) years). Exclusion criteria were age over 80 years, primary kidney disease, diabetes mellitus, cancer, heart failure, stage III arterial hypertension. All patients underwent determination of cystatin C in the blood, the composition of the body was studied using the bioimpedance method and 24-hour blood pressure monitoring. To identify predictors of kidney damage, we used regression analysis with ROC curve estimation using MedCalc software. Results The optimal value (cut-off point) of the content of total adipose tissue, which allows the most accurate prediction of a decrease in GFR &amp;lt; 60 ml/min in patients with hypertension, was 26.1% (sensitivity −100%, specificity—77.8%), and the content of total muscle tissue—35.9% (sensitivity −100%, specificity—44.4%). The optimal value (cut-off point) of cystatin C was 1.13 (sensitivity −100%, specificity—53.9%), AUC—0.73 (0.46; 0.92). At the same time, when this predictor was included once in multiple logistic regression, the statistical significance decreased (p = 0.5). Among individual predictors of decreased renal function, indicators of 24-hour blood pressure monitoring were studied. The optimal value (cut-off point) of the ambulatory arterial stiffness index, which allows the most accurate prediction of a decrease in GFR &amp;lt; 60 ml/min in patients with arterial hypertension, was 0.36 (sensitivity −100%, specificity—71.4%), an indicator of an increase in the rate of increase in diastolic blood pressure. blood pressure—0.27%, AUC 0.74 (0.48; 0.91)) and the rate of increase in nighttime decrease in systolic blood pressure—8.1%, AUC 0.71 (0.47; 0.89). Conclusion Increase in total adipose tissue &amp;gt; 26.1%, decrease in total lean tissue &amp;lt;35.9%, increase in ambulatory arterial stiffness index &amp;gt;0.36, increase in rate of increase in diastolic blood pressure &amp;gt;0.27%, and increased nocturnal decrease in systolic blood pressure &amp;gt; 8.1% were identified as significant predictors of a decrease in GFR below 60 ml/min in hypertension.

#1418 Phase II dose-selection, randomised, controlled trial of ASi BI 690517 with and without EMPA in CKD: subgroup analysis by T2D status

Abstract Background and Aims High aldosterone levels accelerate chronic kidney disease (CKD) progression. BI 690517 is a highly selective aldosterone synthase inhibitor (ASi) in clinical development for CKD treatment. ASi may reduce deleterious haemodynamic, inflammatory, and fibrotic actions of aldosterone. Coadministration of BI 690517 with a sodium-glucose cotransporter-2 inhibitor may also mitigate the risk of hyperkalaemia. This multinational, randomised, dose-finding, Phase II trial (NCT05182840) investigated the efficacy and safety of BI 690517, given either alone or in combination with empagliflozin (EMPA), in people who had CKD with or without type 2 diabetes (T2D) [1, 2]. Here, we present an analysis by T2D status (pooled for background randomizedon to EMPA or placebo [PBOEMPA]). Method Adults with CKD receiving a maximally tolerated dose of a renin-angiotensin system inhibitor were randomized (R1) 1:1 to an 8-week run-in to receive background EMPA 10 mg or PBOEMPA, then randomized again (R2) 1:1:1:1 to receive BI 690517 (3 mg, 10 mg, or 20 mg) or PBOASI for 14 weeks. The primary endpoint was the change from R2 baseline in urine albumin:creatinine ratio (UACR) in the first morning void of urine at Week 14. A secondary endpoint was UACR response (≥30% reduction from R2 baseline in UACR at Week 14). Changes in systolic blood pressure (SBP) and estimated glomerular filtration rate (eGFR) from R2 baseline to Week 14 were also assessed, as were safety outcomes. Results Of 586 people randomized at R2, 414 (70.6%) were reported to have T2D and 172 (29.4%) did not have T2D. Baseline demographics and clinical characteristics were mostly similar between these two groups [1]; however, those with T2D had higher mean BMI (30.6 vs 28.3 kg/m2), SBP (135.3 vs 130.2 mmHg) and eGFR (53.0 vs 49.4 mL/min/1.73 m2), and higher median UACR (444.7 vs 409.2 mg/g) than those without T2D. BI 690517 consistently reduced UACR versus PBOASI in people with and without T2D (p = 0.38, indicating no difference in treatment effect between these groups), with the largest reductions observed in the 10 mg and 20 mg dose groups; however, for the 3 mg dose group, UACR reduction was only observed in people with T2D (Figure). UACR response rates (≥30% reduction) were achieved in more than half of people with and without T2D in the BI 690517 10 mg and 20 mg dose groups, with the highest response rates in those also receiving EMPA (10 mg dose group: with T2D, 74.3%; without T2D, 64.0%). Decreases in SBP and small decreases in eGFR were also observed in people with and without T2D in response to BI 690517 10 mg and 20 mg, and were consistent with the observed changes in the overall population; however, for the 3 mg dose group, eGFR reduction was only observed in people with T2D. Adverse events leading to discontinuation in BI 690517 10 mg and 20 mg dose groups were more common among people with T2D than those without T2D who were receiving the same dose of BI 690517. Conclusion In people who had CKD, with or without T2D, BI 690517 dose-dependently reduced UACR, with high rates of UACR response suggestive of additive beneficial effects when given with EMPA.

#1981 Experience with the use of semaglutide in cardiorenal syndrome patients followed in a cardiorenal unit (CRU)

Abstract Background and Aims GLP-1 receptor agonists are antihyperglycemic drugs that have shown an interesting cardio and nephroprotective effect beyond glycemic control and also induce weight loss, which is likely a facilitating element in the renal and cardioprotection of patients with elevated BMI. Patients with cardiorenal syndrome are often approached as particularly complex cases, which can lead to the underutilization of certain therapeutic groups. We have analyzed the use of semaglutide in patients followed in the CRU of Puerta de Hierro University Hospital to evaluate the drug's efficacy in glycemic and weight control and its safety profile. Method Retrospective real-life analysis performed in patients who received semaglutide while being under follow-up in the CRU, from January 21-December 22. Follow-up time was 6 months. Patients who had previously been on GLP1-AR treatment, on renal replacement therapy, or while waiting for any percutaneous or surgical cardiovascular procedure were excluded from the study. Results 41 patients, 14 on oral semaglutide and 24 on subcutaneous semaglutide were analyzed. Demographic data and main comorbidities are shown in the table and were similar in both formulations. 53% of the patients were on maximum semaglutide dose at the end of follow-up (59.3% sbc and 42.9% oral, p 0.3). Weight loss and decrease in HbA1C% were significant without differences between formulations. We observed a significant decrease in systolic blood pressure of 11.1 (18) p 0.007 also similar in both drug formulations. No significant modifications in renal parameters were observed during follow-up. Adverse events were observed in 9 patients (22%), mainly gastrointestinal intolerance, and were more frequent with oral formulation (50% vs. 7.4%, p 0.004). 6 patients (14%) stopped semaglutide treatment without differences between formulation groups. 3 patients experienced at least one episode of HF decompensation, but no other events, hospitalizations, or deaths were observed. 3 (7.9%) patients experienced an eGFR decrease of&amp;gt; 30% without differences among the formulation groups. Conclusion We conclude that semaglutide in both formulations is an excellent option for glycemic and weight control in CRS patients’ blood pressure, with an additional significant improvement in blood pressure control and a good safety profile in this special population.

#2169 Transplant renal artery stenosis in recipients with resistant arterial hypertension

Abstract Background and Aims Transplant Renal Artery Stenosis (TRAS) is a vascular complication after kidney transplantation. It worsens the prognosis of the graft and the patient's life. The aim was to study the incidence of TRAS as a cause of resistant arterial hypertension in kidney transplant recipients in the Republic of Belarus and the efficiency of its endovascular treatment. Method The study included 187 kidney transplant recipients. Blood pressure of 72 (38.5%) patients was less than 130/80 mmHg without taking antihypertensive drugs. Arterial hypertension was diagnosed in 115 (61.5%) recipients. The study included clinical, laboratory and instrumental methods (24-hour blood pressure monitoring, Doppler ultrasound, graft scintigraphy with captopril). Results 31 (16.6%) recipients needed to take one antihypertensive drug, 43 (23.0%)—2 drugs, 41 (21.9%)—3 or more. 17 (9.1%) recipients did not have target blood pressure correction while taking more than 4 antihypertensive drugs. There was decreased blood flow in the graft artery with a peak systolic velocity &amp;gt; 200 cm/s in 14 (7.5%) cases. These patients were submitted to the graft nephroscintigraphy with caplopril where 8 grafts (4.3%) were diagnosed signs of TRAS. These recipients were submitted to the renal angiography with the injection of 150 (100; 200) ml of contrast agent. 5 (2.7%) recipients were diagnosed with hemodynamically significant TRAS of more than 70 (65; 75) % and received percutaneous transluminal angioplasty and stenting. All these patients had a decrease of glomerular filtration rate and resistant arterial hypertension before operation. The average age of the patients with TRAS was 57.4 ± 11.0 years, the period after transplantation was 11 ± 3 months. Their blood tests did not show dyslipidemia, but 4 out of 5 cases had diabetes mellitus. Their postoperative period had no complications. The patient was placed on dual antiplatelet therapy with aspirin and clopidogrel. There was an increase in glomerular filtration rate by 27 ± 7 ml/min/1.73 m2 and a decrease in systolic blood pressure by 40 (40; 45) mm Hg in the early postoperative period. Graft artery stenting allowed reducing the number of antihypertensive drugs to one tablet in 4 out of 5 patients. Conclusion Transplant Renal Artery Stenosis is a rare but significant complication of the late postoperative period that may cause resistant hypertension in kidney transplant recipients. Timely identification and stenting of the graft artery improves the graft functioning and reduces blood pressure.

Effectiveness of medication self-management, self-monitoring and a lifestyle intervention on hypertension in poorly controlled patients: The MEDICHY randomized trial

BackgroundUncontrolled hypertension is a common problem worldwide, despite the availability of many effective antihypertensive drugs and lifestyle interventions. We assessed the efficacy of a multi-component intervention in individuals with uncontrolled hypertension in a primary care setting.MethodsThis study was a randomized, multicenter, parallel, two-arm, single-blind controlled trial performed in primary healthcare centers in Mallorca (Spain). All participants were 35 to 75-years-old and had poorly controlled hypertension. Patients were randomly assigned in a 1:1 ratio to a control group (usual care) or an intervention group (self-monitoring of blood pressure, self-titration of hypertensive medications, dietary interventions, and physical activity interventions). The primary outcome was decrease in the mean SBP at 6 months relative to baseline.ResultsA total of 153 participants were randomized to an intervention group (77) or a control group (76). After 6 months, the intervention group had a significantly lower systolic blood pressure (135.1 mmHg [±14.8] vs. 142.7 mmHg [±15.0], adjusted mean difference: 8.7 mmHg [95% CI: 3.4, 13.9], p &amp;lt; 0.001) and a significantly lower diastolic blood pressure (83.5 mmHg [±8.8] vs. 87.00 mmHg [±9.0], adjusted mean difference: 5.4 [95% CI: 2.9, 7.8], p &amp;lt; 0.0001). The intervention group also had significantly more patients who achieved successful blood pressure control (&amp;lt;140/90 mmHg; 54.4% vs. 32.9%, p = 0.011).DiscussionSelf-monitoring of blood pressure in combination with self-management of hypertensive medications, diet, and physical activity in a primary care setting leads to significantly lower blood pressure in patients with poorly controlled hypertension.Clinical Trial Registration:ClinicalTrials.gov, identifier ISRCTN14433778.

Impact of Lipoprotein(a) Levels on Cardiovascular Risk Estimation.

A new cardiovascular risk (CVR) calculator that incorporates Lipoprotein(a) [Lp(a)] levels has recently been designed. To estimate CVR using the new score and to identify the reduction in low-density lipoprotein cholesterol (LDL-C) or systolic blood pressure (SBP) necessary to balance the risk attributable to Lp(a). CVR throughout life and at 10 years was estimated with the new score in patients in primary prevention, both considering and not considering the value of Lp(a). When the estimated risk considering Lp(a) levels exceeded the baseline risk, the reduction in LDL-C levels or SBP necessary to balance the risk attributable to Lp(a) was calculated. In total, 671 patients (mean age 54.2 years, 47.2% women) were included. Globally, 22.7% of the population had high Lp(a) values (>50 mg/dL or >125 nmol/L). When calculating CVR throughout life and considering the Lp(a) value, the global risk increased in 66.7% of cases (median 19.3%). Similar results were observed when we assessed the 10-year risk. The risk associated with Lp(a) could be completely compensated by decreasing LDL-C (average 21 mg/dL) or SBP (average 6.3 mmHg) in 79.2% and 74.7% of cases, respectively. When calculating the CVR with the new score, two-thirds and one-third of the population were bidirectionally recategorized as 'up' or 'down,' respectively. The decrease in LDL-C or SBP mitigated the increased risk caused by Lp(a) levels across a substantial proportion of patients.

Vasodilators for acute heart failure. A systematic review of randomized clinical trials with meta-analysis and trial sequential analysis

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Danish Cardiovascular Academy Novo Nordisk Foundation. Background Acute heart failure (AHF) is an increasing public health concern with limited evidence for current treatments, such as vasodilators. Recent studies have shown mixed results regarding the efficacy of vasodilation in AHF, leading to downgraded recommendations in European Society of Cardiology (ESC) 2021 guidelines. Method We conducted a systematic review of randomized clinical trials (RCTs) to assess vasodilator therapy's effectiveness in managing AHF. The search for relevant studies was conducted without restrictions across the major databases: Medline, Embase, Latin American and Caribbean Health Sciences Literature (LILACS), Web of Science, and the Cochrane Central Register of Controlled Trials. The study protocol was published and registered at PROSPERO, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. We included RCTs that compared vasodilators to standard care, placebo, no-intervention, or co-interventions. Our primary outcome was all-cause mortality, while secondary outcomes included serious adverse events (SAEs), tracheal intubation and length of hospital stay. Systolic blood pressure difference was an exploratory outcome. We assessed the risks of bias in individual trials using the Cochrane Collaboration risk of bias tool. Results We included 46 RCTs comprising 28,374 patients with AHF. Meta-analysis and Trial Sequential Analysis showed that vasodilators did not reduce the risk of all-cause mortality (risk ratio (RR) = 0.96, 95% CI: 0.90 to 1.03; I2 = 0%; P = 0.26). However, meta-analysis showed evidence of a beneficial effect of vasodilators in reducing the need for tracheal intubation (RR = 0.82, 95% CI: 0.68 to 0.99; I2 = 55.05%; P = 0.04). No evidence of a difference was seen in the risk of SAEs (RR = 1.01, 95% CI: 0.97 to 1.06; I2 = 0%; P = 0.50) or length of hospital stay (Mean difference (MD) = -0.28, 95% CI: -0.73 to 0.16; I2 = 69.84%; P = 0.28). Finally, a significant decrease in systolic blood pressure (MD = -6.26, 95% CI: -8.06 to -4.46; I2 = 90.51%; P &amp;lt; 0.01) was demonstrated. Conclusion In patients hospitalised with AHF, vasodilator therapy did not result in a reduction of all-cause mortality, SAEs or length of hospital stay. However, the need for tracheal intubations was significantly decreased.Forest plot of all-cause mortalityForest plot of Tracheal intubation

“Advocates for Each Other”: The creation and evaluation of a pragmatic peer navigation program for black patients in primary care with uncontrolled hypertension

BackgroundBlack individuals in the U.S. and in our primary care clinic experience worse control of blood pressure compared to White individuals. ObjectiveTo address this inequity, our objectives were to (1) elicit from patients and community members their ideas for barriers and facilitators to blood pressure control; and (2) use their input to design and pilot a navigator program for Black patients in our clinic to improve blood pressure management. Patient involvementWe conducted three focus groups with 27 individuals and identified two main areas of need that informed the peer navigator program: (1) community-based services and (2) skill development for hypertension self-management. MethodsPeer navigators from the Black community called participants at least monthly for 6–12 months and connected them with medical and social services. Available blood pressure data was used as the primary outcome to measure change pre- to post-peer navigation program. ResultsAmong 499 eligible patients in the clinic, 53 (10.6%) enrolled in the peer navigation program. For those with baseline and follow-up blood pressure data, mean systolic blood pressure decreased from 155.9 to 142.4 mmHg after the program (change of −13.6, 95% CI −24.7 to −2.4) for the enrolled patients (N = 17) and from 139.1 to 137.1 mmHg (change of −2.5, −4.8 to 1.9) for unenrolled, comparison patients (N = 183). DiscussionThis community-informed peer navigation program to support Black patients with uncontrolled hypertension led to a 11.1 mmHg greater decrease in average systolic blood pressure for enrolled patients compared to the comparison group. However, the enrolled group started with a significantly higher systolic blood pressure at baseline with more room for improvement. While this study was conducted during the pandemic years, low uptake of this program needs to be addressed in expansion efforts. Practical valueClinic-based peer navigation for hypertension improved blood pressure control and was highly regarded by the subset of enrolled patients. Increasing uptake and sustainable funding for non-billable clinic roles remain areas of need. FundingGrant from the Pacific Hospital Preservation & Development Authority.

Effects of Acupuncture on Autonomic Nervous System Parameters and Salivary Cortisol Level Among Mental Stress University Students: A Pilot Randomized Controlled Trial

Stress is a common and often unavoidable aspect of daily life that can negatively impact the autonomic nervous system, which controls the functions of internal organs and glands. Chronic stress has been associated with an imbalance in autonomic nervous system function, leading to a range of health conditions. Acupuncture is a medical treatment modality that has been applied to health care in different dimensions including physical, mental, and spiritual. This study aimed to investigate the effect of acupuncture on blood pressure, heart rate, and salivary cortisol level in mild stress university students, a population particularly vulnerable to stress. Twenty-eight university students were recruited and divided into two groups, a real acupuncture group and a sham acupuncture group. Heart rate, blood pressure, and salivary cortisol level were evaluated before and after a 30-minute acupuncture session on the ST36 acupoint. The results showed that the real acupuncture group had a significant decrease in blood pressure and heart rate, whereas the sham acupuncture group showed no change. Both groups had a slightly decrease in salivary cortisol level with no statistically significant. There was a statistically significant difference in the decrease of systolic blood pressure and heart rate after acupuncture between the two groups, but there was no significant difference between the groups in salivary cortisol level after acupuncture. The findings suggest that the acupuncture can be a valuable treatment for restoring balance to the symptoms of the autonomic nervous system in university students experiencing stress. A larger sample size, a non-intervention control, as well as different sources and times of cortisol collection, could contribute to the validation of the findings in this study.

Non-invasive pulse arrival time as a surrogate for oscillometric systolic blood pressure changes during non-pharmacological intervention

Background. Non-invasive continuous blood pressure (BP) monitoring is of longstanding interest in various cardiovascular scenarios. In this context, pulse arrival time (PAT), i.e., a surrogate parameter for systolic BP (change), became very popular recently, especially in the context of cuffless BP measurement and dedicated lifestyle interventions. Nevertheless, there is also understandable doubt on its reliability in uncontrolled and mobile settings. Objective. The aim of this work is therefore the investigation whether PAT follows oscillometric systolic BP readings during moderate interventions by physical or mental activity using a medical grade handheld device for non-invasive PAT assessment. Approach. A study was conducted featuring an experimental group performing a physical and a mental task, and a control group. Oscillometric BP and PAT were assessed at baseline and after each intervention. Interventions were selected randomly but then performed sequentially in a counterbalanced order. Multivariate analyses of variance were used to test within-subject and between-subject effects for the dependent variables, followed by univariate analyses for post-hoc testing. Furthermore, correlation analysis was performed to assess the association of intervention effects between BP and PAT. Main results. The study included 51 subjects (31 females). Multivariate analysis of variances showed that effects in BP, heart rate, PAT and pulse wave parameters were consistent and significantly different between experimental and control groups. After physical activity, heart rate and systolic BP increased significantly whereas PAT decreased significantly. Mental activity leads to a decrease in systolic BP at stable heart rate. Pulse wave parameters follow accordingly by an increase of PAT and mainly unchanged pulse wave analysis features due to constant heart rate. Finally, also the control group behaviour was accurately registered by the PAT method compared to oscillometric cuff. Correlation analyses revealed significant negative associations between changes of systolic BP and changes of PAT from baseline to the physical task (−0.33 [−0.63, 0.01], p < 0.048), and from physical to mental task (−0.51 [−0.77, −0.14], p = 0.001), but not for baseline to mental task (−0.12 [−0,43,0,20], p = 0.50) in the experimental group. Significance. PAT and the used digital, handheld device proved to register changes in BP and heart rate reliably compared to oscillometric measurements during intervention. Therefore, it might add benefit to future mobile health solutions to support BP management by tracking relative, not absolute, BP changes during non-pharmacological interventions.

Blood Pressure and Central Arterial Stiffness before and after a 161-km Ultra-Endurance Race

BACKGROUND: Competing in ultra-endurance running events (&gt;42.2 km) is a tremendous physiological stressor. Training for and competing in these events may be detrimental to cardiovascular (CV) health. However, previous findings on acute changes in key CV health measures like blood pressure (BP) and central arterial stiffness after a race remain equivocal. Therefore, we aimed to characterize the acute CV response to an ultra-endurance race. We hypothesized that BP would decrease while central arterial stiffness would increase following the race. Methods: We measured supine BP with an automated brachial cuff and carotid-to-femoral pulse wave velocity (cfPWV - index of central arterial stiffness) with applanation tonometry (SphygmoCor XCEL, AtCor Medical) among 41 finishers (9F/32M; Age: 44 ± 10 years; BMI: 22.7 ± 1.8 kg/m2) of the 2023 161-km Western States Endurance Run (WSER). Measures were taken 1–3 days before (pre) and ≤1 hour after race completion (post). We present data as mean ± SD after confirming normality using Shapiro-Wilk tests (α ≥ 0.05). We assessed differences between pre- and post- systolic BP (SBP), mean BP (MBP), diastolic BP (DBP), cfPWV, and cfPWV normalized to MBP using paired, two-tailed t-tests (α &lt; 0.05). The magnitude of the difference between time points was represented as Cohen’s d ( d) effect sizes. Results: After the race, there was a significant decrease in SBP (129 ± 9 vs. 122 ± 10 mmHg, P &lt; 0.001, d = 0.78), MBP (94 ± 7 vs. 89 ± 10 mmHg, P &lt; 0.001, d = 0.58), and DBP (77 ± 7 vs. 74 ± 8, P = 0.02, d = 0.38) but no change in cfPWV (6.4 ± 1.0 vs. 6.2 ± 0.8 m/s, P = 0.10, d = 0.26) or cfPWV normalized to MBP (0.07 ± 0.01 vs. 0.07 ± 0.01 (m/s)/mmHg, P = 0.83, d = 0.00). CONCLUSION: We found that systolic, mean, and diastolic pressure were all lower after the 161-km WSER, but cfPWV did not change. These findings suggest that running a 161-km ultra-marathon race acutely lowers BP but does not affect central arterial stiffness. Further research is needed to understand the effect of chronic ultra-endurance training and competition on cardiovascular health. FUNDING INFORMATION: Western States Endurance Run Medical Research Program (GJG), National Institutes of Health K01HL160772 (JCW), American Heart Association 23CDA1037938 (JCW). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Myeloid Specific Hypoxia Inducible Factor 1 Alpha contributes to Immune Metabolic Reprogramming in Human Salt Sensitive Hypertension

Salt-sensitivity of blood pressure (SSBP), acute changes in blood pressure that mirror dietary salt intake, is a major risk factor for cardiovascular disease independent of hypertension. We previously found that oxidative lipid protein modification via NADPH oxidase (NOX2) reactive oxygen species (ROS) production in antigen presenting cells (APCs) contributes to SSBP. Hypoxia Inducible Factor 1 Subunit Alpha (HIF1α) plays a role in metabolic reprogramming and maturation of dendritic cells but its role in the pathogenesis of SSBP is not known. I hypothesize that HIF1α expression specifically in APCs contributes to SSBP by promoting a switch to anaerobic energy production through glycolytic enzyme induction. To test this hypothesis, we performed both bulk and single cell transcriptomic analysis in circulating immune cells following both in vitro and in vivo salt-loading/depletion protocols to phenotype people for SSBP. We found that compared to normal (150 mMol/L), isolated monocytes from women (N =11) treated with high sodium (190 mMol/L) in vitro for 72 hours exhibited a marked increase in expression of HIF1α (16149 ± 6246.1 vs. 42233 ± 20836, p = 2.28E-05). This was associated with increased downstream expression of glycolytic enzymes LdhA (29600 ± 12391 vs. 55998 ± 17118, p = 0.013928), which catalyzes the conversion of pyruvate to lactate under anaerobic conditions, and PDK1 (1422.2 ± 880.80 vs. 2651.3 ± 1216.2, p = 0.0091) which attenuates the conversion of pyruvate to acetyl-CoA through inhibition of pyruvate dehydrogenase, stopping its entry to the citric acid cycle. Moreover monocyte-specific expression of PDK1 correlated with a decrease in systolic blood pressure from salt-loading to salt-depletion (r = 0.6753, p = 0.06608). Our data indicate that HIF1α may play a role the pathogenesis of SSBP by contributing to immune metabolic reprogramming. 1R03HL155041-01 (Kirabo, PI)1R01HL144941-01A1 (Kirabo, PI). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

EVALUATION OF THE EFFICACY AND TOLERABILITY OF A FIXED DOSE COMBINATION OF AMLODIPINE AND INDAPAMIDE IN PATIENTS OLDER THAN 55 YEARS

Objective: There is very limited real-life data on hypertension management in Bangladeshi population. Considering this fact, this study evaluated the effectiveness of treatment with an indapamide/amlodipine single-pill combination (SPC) in Bangladeshi patients over the age of 55 years, in an OPD setting with uncontrolled systolic hypertension in real-life clinical practice. Methods: This was a 3-month, multicenter, observational, open-label study conducted in 3 divisional cities of Bangladesh among patients with grade I or II hypertension who were either uncontrolled on previous antihypertensive treatment or treatment-naïve. The effectiveness of indapamide/amlodipine SPC was assessed by the change in office systolic blood pressure (SBP) and the rate of target SBP (&lt; 140 mmHg) achievement at 2 weeks, 1 month and 3 months, in four age groups: 55-59 years, 60-69 years, 70-79 years, and 80 years or older. Design and method: The COMBINE study recruited 213 patients, of whom 185 took indapamide/amlodipine 1.5/5 mg SPC fora full three-month course of therapy. Mean age was 62.4±7.4 years, 76 men [41.1%] and 109 women [58.9%]. The absolute decrease of SBP during 3 months of taking indapamide/amlodipine single-pill combination (SPC) was 29.3 mm Hg, DBP - 12.9 mm Hg. After 3 months of treatment significant SBP decreases from baseline were observed in each age group: ? 31.8 mmHg (from 156.7 to 124.9), ? 26.4 mmHg (from 152.7 to 126.3), ? 29.5 mmHg (from 152.8 to 123.3), and ? 25.8 mmHg (from 151.7 to 125.9) in the 55-59, 60-69, 70-79, and 80 years and older age groups, respectively. Leg edema was observed in 3 patients (1.62%), electrolyte imbalance was observed in 4 patients (2.16%) and 1 patients observed sudden fall of blood pressure. Conclusion: This COMBINE study results showed that indapamide/amlodipine SPC was associated with significant and rapid reductions in BP even in a different age range of Bangladeshi patients in routine clinical practice. This study result is consistent with already achieved data of this SPC globally.

The Reduction of Blood Pressure in Elderly People with Hypertension Through Morning Walk Therapy

Background: Hypertension in the elderly is a very dangerous disease because without early indications it can cause sudden death. The prevalence of people with hypertension in the Burneh Health Center in 2021 is 15.935 people (11.29%). The proportion of elderly with hypertension is 1,820 elderly men (0.10%) and 1,670 elderly women (0.09%). Purpose: This study aims to analyze the effect of morning walking physical activity on reducing systolic blood pressure in elderly people with hypertension. Method: This study was conducted in the village of Burneh, Bangkalan, East Java, Indonesia from May to June 2022. The research design used a Quasy Experiment with a Pre-test and Post-test approach, the independent variable in this study was physical activity therapy for morning walks and the dependent variable systolic blood pressure in elderly with hypertension. The sample size is 14 elderly with purposive sampling technique. Data analysis used the Paired t-test. Results: The results of the statistical test obtained p-value = 0.041 &lt;0.05 indicating that there was a difference in systolic blood pressure before and after being given physical activity therapy for the morning walk. Most of the respondents (57.14%) experienced a decrease in systolic blood pressure with an average decrease of 8.72 mmHg. Conclusion: Therapeutic physical activity walking in the morning has a significant effect on systolic blood pressure in elderly people with hypertension. Health workers need to provide correct information about the benefits of morning walks for elderly people with hypertension and monitor the consistency of sufferers.

Comparison of the Efficacy and Tolerability of Candesartan Cilexetil between Hypertension patients of Muna and Tolaki Ethnicity

There are differences in the efficacy of a drug between ethnicities. Hypertension Treatment Guidelines of JNC 8 recommend not using angiotensin receptor blockers (ARBs) and ACE inhibitors in the black population for first-line therapy. The Tolaki and Muna ethnicities are two indigenous ethnic groups of the Southeast Sulawesi Province of Indonesia. The very different physical characteristics between these two ethnic groups raise the possibility that there are differences in the body's response to antihypertensive ARBs, including candesartan. The study aimed to compare the efficacy and tolerability of candesartan cilexetil monotherapy for one month in hypertensive patients of the Tolaki and Muna ethnicities. Assessment of therapy efficacy includes the proportion of patients achieving the therapeutic target according to JNC 8 and the reduction of blood pressure. Tolerability is assessed based on side effects and adverse drug reactions (ADR) reported by patients. Patients who met the criteria for this study were those who had recently been diagnosed with essential hypertension or hypertension with type 2 diabetes mellitus, were taking candesartan cilexetil (8 mg orally once a day), and had blood pressure values after one month of treatment. Sixty-eight Tolaki ethnic patients and 51 Muna ethnic patients who met the inclusion criteria were included in this study. The results showed that the decrease in systolic and diastolic blood pressure was greater in the Tolaki than those in the Muna ethnicity. The median value of the systolic decrease was -33 ((-10)–(-60)) mmHg for the Tolaki ethnic group and -10 (0–(-20)) mmHg for the Muna ethnic group. The median value of diastolic decline for the Tolaki and Muna ethnicities was -10 (0–(-37)) mmHg and -5 (5–(-20)) mmHg, respectively. The MAP value of the Tolaki ethnic group is 93.30 (80–110), and that of the Muna ethnic group is 110 (96.69–130). The achievement of the target of reducing blood pressure was also significantly higher for the Tolaki than the Muna ethnicities. Complaints felt by some people in both ethnic groups were dizziness, headaches, and feeling weak. Six people in the Muna ethnic group with diabetes mellitus with type 2 experienced hyperkalemia. There was a significant difference in the efficacy of candesartan for one month between Muna and Tolaki ethnic hypertension patients. There was no difference in tolerability between the two ethnic groups.

The Prevalence of Orthostatic Hypotension in Cancer Patients.

Orthostatic hypotension (OH) is associated with a higher risk of mortality in the general population; however, it has not been studied in the cancer population. This study aimed to assess the prevalence of OH in cancer patients compared to that in the noncancer population. A total of 411 patients (mean age 63.5 ± 10.6 years) were recruited: patients with active cancer (n = 223) and patients hospitalised for other reasons, but without a cancer diagnosis (n = 188). Medical histories were collected and an orthostatic challenge test was performed. OH was defined as a blood pressure (BP) decrease upon standing of ≥20 mmHg for the systolic or ≥10 mmHg for the diastolic BP after 1 or 3 min; or a systolic BP decrease <90 mmHg. The prevalence of OH in the subjects with cancer was significantly higher than in the subjects without cancer (28.7% vs. 16.5%, respectively, p = 0.003). OH was the most common in the lung cancer patients (57.5%). In a single-variable analysis, the predictors of OH were cancer presence, age ≥ 65 years, and body mass index (BMI) ≥ 30 kg/m2. In the multivariable model, the strongest independent predictor of OH was cancer status, which doubled the risk of OH, and BMI ≥ 30 kg/m2 and diabetes. Cancer patients are characterised by a high prevalence of OH. In this population, the recommendation of routine orthostatic challenge tests should be considered.

Combination of retagliptin and henagliflozin as add-on therapy to metformin in patients with type 2 diabetes inadequately controlled with metformin: A multicentre, randomized, double-blind, active-controlled, phase 3 trial.

This study assessed the efficacy and safety of co-administering retagliptin and henagliflozin versus individual agents at corresponding doses in patients with type 2 diabetes mellitus who were inadequately controlled with metformin. This multicentre, phase 3 trial consisted of a 24-week, randomized, double-blind, active-controlled period. Patients with glycated haemoglobin (HbA1c) levels between 7.5% and 10.5% were randomized to receive once-daily retagliptin 100 mg (R100; n = 155), henagliflozin 5 mg (H5; n = 156), henagliflozin 10 mg (H10; n = 156), co-administered R100/H5 (n = 155), or R100/H10 (n = 156). The primary endpoint was the change in HbA1c from baseline to week 24. Based on the primary estimand, the least squares mean reductions in HbA1c at week 24 were significantly greater in the R100/H5 (-1.51%) and R100/H10 (-1.54%) groups compared with those receiving the corresponding doses of individual agents (-0.98% for R100, -0.86% for H5 and -0.95% for H10, respectively; p < .0001 for all pairwise comparisons). Achievement of HbA1c <7.0% at week 24 was observed in 27.1% of patients in the R100 group, 21.2% in the H5 group, 24.4% in the H10 group, 57.4% in the R100/H5 group and 56.4% in the R100/H10 group. Reductions in fasting plasma glucose and 2-h postprandial glucose were also more pronounced in the co-administration groups compared with the individual agents at corresponding doses. Decreases in body weight and systolic blood pressure were greater in the groups containing henagliflozin than in the R100 group. The incidence rates of adverse events were similar across all treatment groups, with no reported episodes of severe hypoglycaemia. For patients with type 2 diabetes mellitus inadequately controlled by metformin monotherapy, the co-administration of retagliptin and henagliflozin yielded more effective glycaemic control through 24 weeks compared with the individual agents at their corresponding doses.

Impact of guideline-directed medical therapy on systolic blood pressure and cardiovascular outcomes in patients with heart failure and low blood pressure: A systematic review and meta-analysis.

Existing research indicates that patients with heart failure (HF) may have restricted access to guideline-directed medical therapy (GDMT) when their blood pressure (BP) is comparatively low. However, recent clinical trials suggest that HF patients with low BP could still benefit from certain HF medications, which have a minimal impact on BP. This systematic review and meta-analysis was conducted to determine whether this applies to all GDMT. A systematic search of MEDLINE and EMBASE was conducted for studies published from inception to 10 January 2024. Randomized controlled trials were selected if they reported on the longitudinal change of systolic BP (SBP) due to GDMT, or the risks of cardiovascular events in HF patients based on SBP categories. Weighted mean difference (WMD), hazard ratio or relative risk, and corresponding 95% confidence intervals (CI) were pooled for meta-analysis where possible. Data from 20 studies, encompassing information on 84 782 individuals, were analysed. Overall, GDMT is associated with lower SBP (WMD, -2.16; 95% CI -2.86 to -1.46), with no significant difference between baseline low and non-low BP subgroups (interaction p = 0.810). However, SBP of the treatment group increased by 5.8 mmHg from baseline in the low SBP subgroup during follow-up, while it decreased by 4.0 mmHg in the baseline non-low SBP subgroup. GDMT demonstrated similar cardiovascular benefits and risk of hypotension between low and non-low SBP subgroups (interaction p = 0.318 and 0.903, respectively). Guideline-directed medical therapy is associated with a negligible decrease in SBP, but can provide similar cardiovascular benefits in both low and non-low SBP HF patients, with no significant interaction with SBP as to hypotension. Therefore, GDMT should be initiated and maintained in HF patients with low BP.