Determinants Of Hypertension In Patients Research Articles

A simple nomogram score for screening patients with type 2 diabetes to detect those with hypertension: A cross-sectional study based on a large community survey in China.

ObjectivesCompared with unaffected individuals, patients with type 2 diabetes (T2DM) have higher risk of hypertension, and diabetes combined with hypertension can lead to server cardiovascular disease. Therefore, the purpose of this study was to establish a simple nomogram model to identify the determinants of hypertension in patients with T2DM and to quickly calculate the probability of hypertension in individuals with T2DM.Materials and methodsA total of 643,439 subjects participating in the national physical examination has been recruited in this cross-sectional study. After excluding unqualified subjects, 30,507 adults with T2DM were included in the final analysis. 21,355 and 9,152 subjects were randomly assigned to the model developing group and validation group, respectively, with a ratio of 7:3. The potential risk factors used in this study to assess hypertension in patients with T2DM included questionnaire investigation and physical measurement variables. We used the least absolute shrinkage and selection operator models to optimize feature selection, and the multivariable logistic regression analysis was for predicting model. Discrimination and calibration were assessed using the receiver operating curve (ROC) and calibration curve.ResultsThe results showed that the major determinants of hypertension in patients with T2DM were age, gender, drinking, exercise, smoking, obesity and atherosclerotic vascular disease. The area under ROC curve of developing group and validation group are both 0.814, indicating that the prediction model owns high disease recognition ability. The p values of the two calibration curves are 0.625 and 0.445, suggesting that the nomogram gives good calibration.ConclusionThe individualized nomogram model can facilitate improved screening and early identification of patients with hypertension in T2DM. This procedure will be useful in developing regions with high epidemiological risk and poor socioeconomic status just like Urumqi, in Northern China.

When exploring patients during exercise makes sense?

This editorial refers to ‘Clinical characteristics and determinants of exercise-induced pulmonary hypertension in patients with preserved left ventricular ejection fraction’, by A. Young Lim et al. doi: 10.1093/ehjci/jew199. Dealing with exertional dyspnoea or unexplained shortness of breath is a common problem in clinical practice. However, the exploration of such symptoms is difficult and does not always lead to definite positive diagnosis and thus appropriate treatment. Moreover, the perception of dyspnoea is subjective and relies on determinants that are often unclear. In these patients, exploring pulmonary pressures and diastolic function during exercise appears to be an interesting way to assess the potential causes triggering their symptoms. In this issue of European Heart Journal - Cardiovascular Imaging , Lim et al. 1 present a remarkable study exploring the value of exercise-induced pulmonary hypertension (EIPH) in patients with preserved left ventricular ejection fraction and complaining about unexplained dyspnoea. This exhaustive work included a large number of patients (1383 were analysed) and enabled a comprehensive description of the clinical aspects and features of EIPH in this population. To date, this population has not been well characterized, so the data published in this issue allow interesting insights in this not-so-well-known clinical entity. EIPH has been explored and demonstrated as clinically interesting in the field of heart valve diseases and in the prognostic assessment of patients diagnosed for a heart failure with preserved ejection fraction.2–4 Notably, larger studies confirming those first results are mandatory to justify a more generalized use of exercise stress echocardiography in our routine clinical practice. The first surprising fact in the study by Lim et al . appears to be the population with …

SAT0410 Determinants of Hypertension in Patients with Psoriatic Arthritis

BackgroundSeveral studies have found a higher rate of hypertension among patients with psoriasis and psoriatic arthritis (PsA) versus the general population. This frequency may be even higher in patients with...

655 Determinants of exercise-induced pulmonary hypertension in patients with heart failure and systolic left ventricular dysfunction

1 1 CHU Sart Tilman, Liege, Belgium Background: Pulmonary hypertension (PHT) and mitral regurgitation (MR) are frequently observed in heart failure patients. Although the role of MR in the genesis of PHT at rest has been described, the determinants of exercise in- duced PHT have not been examined. Methods: To evaluate the resting and exercise covariates associated with exercise induced PHT, 46 patients with left ventricular (LV) dysfunction (ejec- tion fraction: 30±6%) underwent quantitative exercise echocardiographic as- sessment of the LV systolic and diastolic (Early mitral inflow (E) and early annulus velocity) function, transtricuspid pressure gradient (TTPG), MR vol- ume and left atrial volume (LAV). Results: At rest, LV volumes, MR volume, E wave and LAV correlated with TTPG. In multivariate analysis, E wave (p=0.0003) and LAV (p=0.00001) emerged as independent determinants of the TTPG. At exercise, LV vol- umes, MR volume, and the TTPG calculated in resting conditions correlated with the peak TTPG. The TTPG at rest was the sole predictor of the TTPG at exercise (p=0.000001). However, the TTPG at rest did not correlate with the magnitude of increase in the TTPG during the test (r=0.12, p=ns). The rate of exercise dypnea was similar in patients with (40%) and without (44%) significant PHT at baseline (TTPG >40 mm Hg) (p=ns). At exercise, LV vol- umes and ejection fraction, MR volume, and LAV correlated with the peak TTPG. In multivariate analysis, peak ejection fraction (p=0.006) and peak MR volume (p=0.00001) were independently associated with peak TTPG. Patients with a larger exercise induced increase in TTPG (changes in TTPG >20 mm Hg; median value) interrupted more frequently the test for dyspnea as compared with those who had smaller changes (25% of cases vs 69% of cases; p=0.04). A larger rise in MR volume during exercise emerged as the sole independent determinant of exercise induced increases in TTPG. Conclusions: LA volume overload and LV diastolic function correlated with resting pulmonary pressure. Larger exercise induced increases in MR and limited contractile reserve (weaker changes in ejection fraction) strongly af- fected the level of pulmonary pressure at exercise. The magnitude of changes in pulmonary pressure during exercise mainly depends on the dynamic behaviour of MR. 656 Functional capacity is related to contractile reserve in patients with left ventricular dysfunction In patients (pts) with heart failure the reduction of functional capacity is asso- ciated with poor long-term prognosis and the presence of contractile reserve is a favorable sign. In these pts, functional capacity is not strictly related to the baseline left ventricular ejection fraction (LVEF). Cardiopulmonary exercise testing (ET) is commonly utilized in this setting to evaluate functional capac- ity. We hypothesized that in pts with ischemic or nonischemic cardiomyopa- thy and left ventricular (LV) dysfunction, functional capacity measured by car- diopulmonary ET is related to the presence of contractile reserve assessed by

1112-145 Determinants of severe pulmonary hypertension in patients with severe aortic stenosis

1112-145 Determinants of severe pulmonary hypertension in patients with severe aortic stenosis