Diastolic Hypertension Research Articles

P108 DIFFERENCES IN BLOOD PRESSURE CONTROL BASED ON HYPERTENSION SUBTYPE IN PATIENTS WITH A DE NOVO DIAGNOSIS: A RETROSPECTIVE COHORT STUDY

Background and Objective: Currently, the selection of antihypertensive pharmacological treatment is carried out without considering whether only systolic or diastolic hypertension is present or both pressures are elevated. It is unknown whether the selection of individualized pharmacological treatment according to arterial hypertension (AH) subtype leads to greater blood pressure (BP) control. Therefore, this study aims to evaluate the association between the selection of pharmacological treatment based on AH subtype and BP control. Methods: This was a real-world cohort study that included 1,397 Latin American subjects with a de novo diagnosis of AH who received antihypertensive pharmacological treatment following current guidelines. Retrospectively, patients were classified by AH subtype according to the pattern of systolic or diastolic predominance of AH. Also, appropriateness of the pharmacological treatment was assessed based on AH subtype and the underlying hemodynamics of each subtype. BP control at the follow-up, within the first 12 weeks after diagnosis, was defined as <140/90 mmHg. Results: Among the subjects included in the study (n=1,397), the mean age was 52.4±13.2, and body mass index 28.8±4.9 kg/m2; 56.7% were women and 50.6% achieved BP control. The median time to the follow-up after diagnosis was 55 days (IQR 32-89 days). Regarding hemodynamic variables, the mean heart rate was 76.1±7.4 beats per minute, systolic blood pressure 147±13.9 mmHg, diastolic blood pressure 86.4±11.2, mean arterial pressure 108.0±9.5 mmHg, and pulse pressure 61.1±16.1 mmHg. The most frequent AH subtype was isolated systolic hypertension (47.3%). Initiation of appropriate antihypertensive pharmacological treatment was associated with greater BP control (OR 2.17; 95% CI 1.49 to 3.15; P value <0.001) (Figure). The patients who did not reach BP control presented a higher frequency of divergent systolic-diastolic hypertension subtype, and greater hemodynamic alterations. Conclusions: Appropriate selection of pharmacological treatment based on AH subtype is associated with better BP control in patients with newly diagnosed AH.

Establishment and validation of a nomogram model containing a triglyceride-glucose index and neutrophil-to-high-density lipoprotein ratio for predicting major adverse cardiac events in patients with ST-segment elevation myocardial infarction.

To analyze the predictive value of the triglyceride-glucose (TyG) index and neutrophil-to-high-density lipoprotein ratio (NHR) for in-hospital major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI), and to establish an associated nomogram model. In this retrospective study, we collected data from consecutive STEMI patients who underwent PCI from October 2019 to June 2023 at the Second People's Hospital of Hefei and the Second Affiliated Hospital of Anhui Medical University, as training and validation sets. Stepwise regression and multivariate logistic regression analysis were performed to screen independent risk factors, and a nomogram model was constructed and evaluated for its predictive efficacy. The TyG index, NHR, urea, diastolic blood pressure, hypertension, and left ventricular ejection fraction were independent risk factors for in-hospital MACE after PCI, and were used to construct the nomogram model. The C-index of the training and validation sets were 0.799 and 0.753, respectively, suggesting that the model discriminated well. Calibration and clinical decision curves also demonstrated that the nomogram model had good predictive power. In STEMI patients, increased TyG index and NHR were closely related to the occurrence of in-hospital MACE after PCI. Our constructed nomogram model has some value for predicting the occurrence of in-hospital MACE in STEMI patients.

P167 DIFFERENCES IN PULSE WAVE VELOCITY ESTIMATED USING TOTAL ARTERIAL COMPLIANCE BETWEEN SUBTYPES OF ARTERIAL HYPERTENSION

Background and Objective: Different clinical phenotypes of arterial hypertension (AH) are identified through current oscillometric blood pressure (BP) measurements. Recently, our group described hemodynamic characteristics of AH subtypes utilizing 24-hour ambulatory blood pressure monitoring (24-h ABPM). It remains unclear whether differences in PWV exist among AH subtypes, which could potentially enhance diagnostic accuracy and guide antihypertensive treatment selection. The objective was to assess the relationship between PWV, estimated using Ct, and AH subtypes. Methods: A cross-sectional study was conducted, involving 13,027 untreated patients referred for 24-h ABPM. PWV was estimated using a novel method based on Ct, derived from BP and heart rate measurements obtained during 24-h ABPM. This estimation method was developed based on the relationship between Ct and PWV as described by Vardoulis et al., utilizing the Bramwell-Hill theory and experimental research. The formula used for PWV estimation was PWV = √(36.7/(Ct/(log[age]))). Results: Among the participants, 46.5% were men, with an average age of 50.2±14.1 years and a body mass index of 27.1±4.1 kg/m2. Isolated systolic hypertension (ISH) (3.9%) exhibited the highest arterial stiffness, with the highest PWV (10.2±1.4 m/s) and pulse pressure (PP) (60.0±6.6 mmHg), and the lowest Ct (0.67±0.16 mL/mmHg). In contrast, isolated diastolic hypertension (IDH) (26.3%) showed the lowest PWV (7.9±0.8 m/s) and PP (40.6±3.6 mmHg), and the highest Ct (1.01±0.18 mL/mmHg). As Ct decreased, PWV increased. Thus, PWV based on Ct from 24-hour ABPM showed clear differences between AH subtypes (ANOVA; p value < 0.001) (Figure). Conclusions: PWV is related with AH subtypes, exhibiting a progression from IDH to ISH. Patients with IDH typically have the lowest PWV, whereas those with divergent systolic-diastolic hypertension (D-SDH) and ISH have the highest PWV values. These findings underscore the significance of Ct in determining PWV values and carry diagnostic and prognostic implications concerning arterial function across various AH subtypes.

P004 BODY MASS INDEX IS RELATED TO SUBTYPES OF ARTERIAL HYPERTENSION IN CHILDREN

Background and Objective: Arterial hypertension (AH) subtypes in the pediatric population may represent distinct pathophysiological subsets, potentially allowing for more targeted interventions and improved blood pressure (BP) management. Emerging evidence suggests that various hemodynamic mechanisms may underlie hypertension development across different age groups. Moreover, overweight and obesity, are closely linked to hypertension and other risk factors. Therefore, this study aims to investigate the relationship between body mass index (BMI) and (AH) subtypes in the pediatric population. Methods: A cross-sectional study was conducted, involving 195 records from 189 children referred to an outpatient cardiology center due to suspected BP abnormalities. Each participant underwent 24-hour ambulatory blood pressure monitoring (24-h ABPM) using a device validated. Demographic, clinical, and anthropometric data were collected. The American Heart Association (2022) criteria were utilized to ensure accurate 24-h ABPM recordings and to classify AH subtypes based on average BP, including: i) isolated diastolic hypertension (IDH); ii) non-divergent systolic-diastolic hypertension (ND-SDH) (pulse pressure [PP]<50 mmHg); iii) divergent systolic-diastolic hypertension (D-SDH) (PP>50 mmHg); and iv) isolated systolic hypertension (ISH). BMI Z-Score was calculated using Colombian reference tables, and nutritional status was determined based on World Health Organization recommendations. Results: Among the participants, 46.0% were male, with a distribution of nutritional status showing 3% underweight, 37% normal weight, 30% overweight, and 30% obese. The average age was 12.3±3.0 years (range: 5-17 years). 24-h ABPM records revealed that 34.0% had normotension, 33.0% had IDH, 16.0% had ND-SDH, 13.0% had D-SDH, and 3% had ISH. The ANOVA test indicated significant differences in BMI Z-Score values among AH subtypes (P value <0.001) (Figure). Conclusions: BMI is related with AH subtypes in children. Specifically, BMI tends to be higher in D-SDH and ISH, which could be characterized by a hyperdynamic state marked by increased activity of the sympathetic nervous system. This finding may help to elucidate the pathophysiology of hypertension in obese children.

P165 HEMODYNAMIC PROFILES OF ISOLATED DIASTOLIC HYPERTENSION IN AMBULATORY BLOOD PRESSURE MONITORING

Background and Objective: Isolated diastolic hypertension (IDH) is a prevalent form of high blood pressure (BP), especially among young individuals. Yet, its association with cardiovascular disease risk and the necessity of treatment remain subjects of ongoing debate. Our research endeavors to elucidate hemodynamic profiles using a non-invasive method applied to 24-hour ambulatory blood pressure monitoring (24-h ABPM). However, uncertainty persists regarding whether distinct hemodynamic profiles exist within IDH patients, considering they are characterized by normal total arterial compliance (Ct). This study aims to shed light on potential variations in hemodynamics within the IDH population, providing valuable insights for personalized treatment. Methods: A cross-sectional study was conducted, involving 7,202 patients referred to an outpatient cardiology center for suspected arterial hypertension. These patients underwent 24-h ABPM. The study included individuals over 18 years old without a prior diagnosis of hypertension and not taking antihypertensive medication. Two groups were included: those with IDH, defined as diastolic blood pressure >80 mmHg (24-h ABPM), and those with normotension. Hemodynamic parameters were estimated using a published method to estimate Ct. Silhouette analysis determined the number of underlying groups within the IDH cohort, while cluster analysis classified these subgroups. Results: Among the participants, 59.0% were female, with an average age of 49.0±14.0 years. Of the total patients included, 3,424 (47.5%) had isolated diastolic hypertension (IDH). Silhouette analysis effectively distinguished two groups. Group IDH-1 exhibited normal Ct and systemic vascular resistance (SVR), elevated heart rate (HR), and higher cardiac index (CI) (P value <0.001). Conversely, group IDH-2 demonstrated high Ct and SVR, lower HR, and CI (P value <0.001) (Table). Conclusions: The delineation of two distinct hemodynamic profiles within IDH is significant. The first group demonstrates a cardiogenic hypertension profile, indicated by elevated CI, whereas the second group presents a profile characterized by heightened SVR. These contrasting hemodynamic patterns offer valuable insights for tailoring treatment strategies to individual patient needs. Table. Comparison of hemodynamic variables between normotensives (NT) and two isolated diastolic hypertension (IDH) profile, utilizing ANOVA for statistical analysis.

Differing associations of PM2.5 exposure with systolic and diastolic blood pressures across exposure durations in a predominantly non-Hispanic Black cohort

Environmental health research has suggested that fine particulate matter (PM2.5) exposure can lead to high blood pressures, but it is unclear whether the impacts remain the same for systolic and diastolic blood pressures (SBP and DBP). This study aimed to examine whether the effects of PM2.5 exposure on SBP and DBP differ using data from a predominantly non-Hispanic Black cohort collected between 2013 and 2019 in the US. PM2.5 exposure was assessed based on a satellite-derived model across exposure durations from 1 to 36 months. The average PM2.5 exposure level was between 9.5 and 9.8 μg/m3 from 1 through 36 months. Mixed effects models were used to estimate the association of PM2.5 with SBP, DBP, and related hypertension types, adjusted for potential confounders. A total of 6381 participants were included. PM2.5 exposure was positively associated with both SBP and DBP. The association magnitudes depended on exposure durations. The association with SBP was null at the 1-month duration (β = 0.05, 95% CI: − 0.23, 0.33), strengthened as duration increased, and plateaued at the 24-month duration (β = 1.14, 95% CI: 0.54, 1.73). The association with DBP started with β = 0.29 (95% CI: 0.11, 0.47) at the 1-month duration, and plateaued at the 12-month duration (β = 1.61, 95% CI: 1.23, 1.99). PM2.5 was associated with isolated diastolic hypertension (12-month duration: odds ratio = 1.20, 95% CI: 1.07, 1.34) and systolic–diastolic hypertension (12-month duration: odds ratio = 1.18, 95% CI: 1.10, 1.26), but not with isolated systolic hypertension. The findings suggest DBP is more sensitive to PM2.5 exposure and support differing effects of PM2.5 exposure on SBP and DBP. As elevation of SBP and DBP differentially predict CVD outcomes, this finding is relevant for prevention and treatment.

Twenty four-hour blood pressure and cognitive outcomes in adolescents born extremely preterm and at term.

To explore the impact of blood pressure on cognitive outcomes at 18 years of age in individuals born extremely preterm (<28 weeks' gestation) and at term (≥37 weeks' gestation). Prospective longitudinal cohort comprising 136 young adults born extremely preterm and 120 matched term controls born in Victoria, Australia in 1991 and 1992. Using linear regression, we analysed the relationships between 24-h mean ambulatory blood pressure, systolic and diastolic hypertension with cognitive outcomes. For both birth groups combined, higher 24-h mean ambulatory blood pressure and systolic hypertension were associated with similar or worse cognitive outcomes. The strongest relationships were between higher 24-h mean ambulatory blood pressure and systolic hypertension with poorer general intellect, visual learning and visual memory. We found little evidence that relationships between ambulatory blood pressure and cognitive outcomes differed by birth group. Higher 24-h mean ambulatory blood pressure and systolic hypertension were associated with poorer cognitive outcomes in individuals born extremely preterm and at term, particularly in general intelligence and visual memory.

State of the cardiovascular system in thyroid pathology

The review presents the data on cardiac damage in patients with thyroid dysfunction (hyper- and hypothyroidism). The features of cardiovascular pathology in patients with hyperthyroidism and the possibility of using certain groups of drugs (beta blockers, antiplatelet agents, anticoagulants) are described. The association of hypothyroidism (including subclinical) with atherosclerosis and diastolic arterial hypertension, an increased risk of developing ischemic heart disease and myocardial infarction, heart failure and cardiovascular mortality, regardless of gender, age and previous cardiovascular diseases, has been shown. Available facts indicate the need to determine thyroid hormones in patients with cardiovascular pathology and mandatory assessment of the state of the cardiovascular system in patients with thyroid pathology.

Association of Phenols, Parabens, and Their Mixture with Maternal Blood Pressure Measurements in the PROTECT Cohort.

Phenols and parabens are two classes of high production volume chemicals that are used widely in consumer and personal care products and have been associated with reproductive harm and pregnancy complications, such as preeclampsia and gestational diabetes. However, studies examining their influence on maternal blood pressure and gestational hypertension are limited. We investigated associations between individual phenols, parabens, and their mixture on maternal blood pressure measurements, including systolic and diastolic blood pressure (SBP and DBP) and hypertension during pregnancy (defined as stage 1 or 2 hypertension), among Puerto Rico PROTECT study participants. We examined these relationships cross-sectionally at two time points during pregnancy (16-20 and 24-28 wks gestation) and longitudinally using linear mixed models (LMMs). Finally, we used quantile g-computation to examine the mixture effect on continuous (SBP, DBP) and binary (hypertension during pregnancy) blood pressure outcomes. We observed a trend of higher odds of hypertension during pregnancy with exposure to multiple analytes and the overall mixture [including bisphenol A (BPA), bisphenol S (BPS), triclocarbon (TCC), triclosan (TCS), benzophenone-3 (BP-3), 2,4-dichlorophenol (2,4-DCP), 2,5-dichlorophenol (2,5-DCP), methyl paraben (M-PB), propyl paraben (P-PB), butyl paraben (B-PB), and ethyl paraben (E-PB)], especially at 24-28 wk gestation, with an adjusted mixture (95% CI: 1.03, 2.38). Lower SBP and higher DBP were also associated with individual analytes, with results from LMMs most consistent for methyl paraben (M-PB) or propyl paraben (P-PB) and increased DBP across pregnancy [adjusted M-PB (95% CI: 0.17, 1.38) and adjusted P-PB (95% CI: 0.19, 1.51)] and for BPA, which was associated with decreased SBP (adjusted ; 95% CI: , ). Consistent with other literature, we also found evidence of effect modification by fetal sex, with a strong inverse association observed between the overall exposure mixture and SBP at visit 1 among participants carrying female fetuses only. Our findings indicate that phenol and paraben exposure may collectively increase the risk of stage 1 or 2 hypertension during pregnancy, which has important implications for fetal and maternal health. https://doi.org/10.1289/EHP14008.

Ambulatory isolated diastolic hypertension and risk of left ventricular hypertrophy in children with primary and secondary hypertension

BackgroundPediatric blood pressure (BP) assessment and management is increasingly important. Uncontrolled systolic and combined hypertension leads to hypertension-mediated organ damage. The impact of isolated diastolic hypertension is less clearly understood.MethodsWe analyzed the prevalence of ambulatory isolated diastolic hypertension (IDH) in primary (PH) and secondary (SH) hypertension, and associations with BMI Z-score (BMIz) and left ventricular mass index adjusted to the 95th percentile (aLVMI) in a large, multicenter cohort of hypertensive children. Hypertensive children were divided and analyzed in three ambulatory hypertension subgroups: 24-h, daytime, and nighttime. Specifically, we sought to determine the prevalence of ambulatory 24-h, daytime, or nighttime IDH.ResultsPrevalence of IDH varied based on ambulatory phenotypes, ranging from 6 to 12%, and was highest in children with SH. Children with IDH tended to be more likely female and, in some cases, were leaner than those with isolated systolic hypertension (ISH). Despite previous pediatric studies suggesting no strong association between diastolic blood pressure and left ventricular hypertrophy (LVH), we observed that children with IDH were equally likely to have LVH and had comparable aLVMI to those with ISH and combined systolic-diastolic hypertension.ConclusionsIn summary, ambulatory IDH appears to be a unique phenotype with a female sex, and younger age predilection, but equal risk for LVH in children with either PH or SH.Graphical abstractA higher-resolution version of the Graphical abstract is available as Supplementary information

The association between serum folate and elderly diastolic hypertension: results from the NHANES (2007–2018)

Aim To explore the association between serum folate concentration and the prevalence of elderly diastolic hypertension. This study aims to identify potential relationships that could inform further research into the mechanisms underlying hypertension management. Methods Data from six NHANES cycles (2007–2008, 2009–2010, 2011–2012, 2013–2014, 2015–2016, and 2017–2018) were analysed for individuals aged over 60. Weighted logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup and restricted cubic spline (RCS) regression explored the serum folate concentration and elderly diastolic hypertension relationship. Results This study included 9,419 participants (4,734 females and 4,685 males) with a mean age of 70.0 ± 7.0 years. Among them, 360 were diagnosed with diastolic hypertension. In the fully adjusted model, there was a negative correlation between serum folate concentration and the prevalence of diastolic hypertension (OR 0.65; 95% CI: 0.52–0.82). When serum folate concentration levels were divided into quartiles (in μg/dL), the ORs for diastolic hypertension corresponding to Q2 (1.29–1.98), Q3 (1.99–3.08), and Q4 (3.09–5.56) levels compared to Q1 (0.18–1.28) were 1.41 (95% CI: 0.60–3.33), 0.48(95% CI: 0.20–1.16), and 0.35 (95% CI: 0.16–0.74), respectively, with a P for trend <.05. Restricted cubic spline plots showed a negative correlation between serum folate concentration and the prevalence of diastolic hypertension (non-linearity: p = .495). Subgroup analysis indicated that the negative correlation between serum folate concentration and the prevalence of diastolic hypertension was more significant in female participants (interaction p = .009). Conclusion Higher serum folate concentration is associated with a lower prevalence of diastolic hypertension in the elderly.

Structural And Functional State Of Various Zones Of Skin Microcirculation In Men With Isolated Diastolic Hypertension

The objective of our study was to assess the structural and functional characteristics of various skin microcirculation zones in men with newly diagnosed isolated diastolic hypertension (IDH). Material and Methods — Our study sample included 275 men (aged 30 to 60 years) subjected to the comprehensive medical examination, which included blood tests, videocapillaroscopy (VCS) on the left ring finger, laser Doppler flowmetry (LDF) in the skin of the middle finger tip and forearm at rest, functional tests and photoplethysmography (PPG) on the left forefinger, determination of flow-mediated vasodilation of the brachial artery, echocardiography, ultrasound imaging of extracranial and femoral arteries, and also 24-hour ambulatory blood pressure monitoring (ABPM). According to the ABPM data, an isolated increase in diastolic blood pressure (BP) was noted in 83 subjects who formed the IDH group. The control group (CG) consisted of 90 men with normal BP. Results — VCS and LDF revealed no significant differences between the groups at the scale of capillaries and precapillary arterioles. According to PPG, IDH subjects had significantly higher values of reflection index vs. the CG (35.6% vs. 30.4%, p=0.0013) and lower values of ejection duration (310.5 ms and 319.5 ms, p=0.0159), respectively. Conclusion — The greatest contribution to peripheral vascular resistance in men with IDH most likely comes from large muscle arterioles, in which neurogenic regulation of vascular tone prevails.

Serum vitamin D, blood pressure and hypertension risk in the HUNT study using observational and Mendelian randomization approaches

Limited studies have triangulated the relationship between serum 25-hydroxyvitamin D [25(OH)D] levels and systolic blood pressure (SBP), diastolic blood pressure (DBP) or hypertension risk utilizing both observational and Mendelian randomization (MR) approaches. We employed data from the Norwegian Trøndelag Health Study (HUNT) to conduct cross-sectional (n = 5854) and prospective (n = 3592) analyses, as well as one-sample MR (n = 86,324). We also used largest publicly available data for two-sample MR. Our cross-sectional analyses showed a 25 nmol/L increase in 25(OH)D was associated with a 1.73 mmHg decrease in SBP (95% CI − 2.46 to − 1.01), a 0.91 mmHg decrease in DBP (95% CI − 1.35 to − 0.47) and 19% lower prevalence of hypertension (OR 0.81, 95% CI 0.74 to 0.90) after adjusting for important confounders. However, these associations disappeared in prospective analyses. One-sample and two-sample MR results further suggested no causal relationship between serum vitamin D levels and blood pressure or hypertension risk in the general population.

Kegiatan Skrinning Tekanan Darah Dan Penyakit Hipertensi Pada Populasi Usia Produktif Di Sekolah SMA Kalam Kudus II, Kelurahan Duri Kosambi, Jakarta

Hypertension is a condition where a person's blood pressure exceeds normal limits. In order to detect hypertension and provide health education, this community service activity evaluates the basic characteristics and blood pressure of men and women of productive age at Kalam Kudus II High School, Duri Kosambi Village, Jakarta. A total of 68 respondents participated, consisting of 26 men (38.2%) and 42 women (61.8%), with the majority being in the 18-35 year age group (52.9%). The results showed that 77.9% of respondents had normal systolic blood pressure and 82.4% had normal diastolic blood pressure. However, 22.1% of respondents experienced systolic hypertension and 17.6% experienced diastolic hypertension, with the highest prevalence in the 51-64 year age group. These findings emphasize the importance of early detection and health education about hypertension to prevent serious complications such as stroke and heart disease. Prevention can be done by changing lifestyle, such as exercising, avoiding smoking and alcohol, and consuming foods high in fiber and low in salt. Collaboration with schools and health units is very important for regular monitoring and comprehensive education. This community service activity aims to increase awareness and quality of life for individuals of productive age through prevention and early screening for hypertension.

#2470 Isolated diastolic hypertension in hemodialysis patients

Abstract Background and Aims Isolated diastolic hypertension (IDH) is relatively rare in the general population (prevalence about 6.5%, Front Cardiovasc Med. 2021;8:810105) and of uncertain etiologic implications. The prevalence of this alteration in the hemodialysis (HD) population and the etiologic implications of IDH have not been studied. Method We investigated the prevalence and the risk for all-cause death and cardiovascular events of isolated diastolic hypertension in a population of 534 HD patients enrolled in 7 centres in 3 European countries (the EURECA-m working group). BP was measured by a golden standard method in this population (48 h ABPM) using well-validated instruments (AAMI/ESH/ISO). Along with recommendations by the European Society of Hypertension guidelines, recordings were made at 15-minute intervals during the day and 30 minutes at night. According to a consensus document by the EURECAm working group (Nephrol Dial Transplant. 2019;34:1542-1548), isolated diastolic hypertension was defined as 48 h diastolic BP &amp;gt; 80 mmHg with a systolic BP &amp;lt;130. Results Among 534 HD patients, thirty-one (5.8%) had isolated diastolic HTN, which is very close to the prevalence estimated in the general population (6.5%). During a mean follow-up of 2.6 years, 138 patients died, 188 had at least one CV event, and 249 experienced the combined event. In univariate analyses, diastolic hypertension was associated with death (HR 0.21; 95% CI: 0.05-0.86, P = 0.03) and the combined outcome of death and CV events (HR 0.42, 95% CI: 0.20-0.88, P = 0.02). However, these associations were no longer significant after adjustment for age and sex (all P &amp;gt; 0.45). Additional sensitivity analyses substantially confirmed these findings. No effect modification by age or gender was observed in these associations. Conclusion In a large cohort of HD patients studied by state-of-the-art 48-hour BP monitoring, the prevalence of isolated diastolic hypertension in HD patients (5.8%) is close to that registered in the general population (6.5%). This alteration predicts the risk for clinical outcomes in unadjusted analyses but not after adjustment for age and sex. Isolated diastolic hypertension is as rare as it is in the general population and unlikely to contribute to the high risk of adverse clinical outcomes in the dialysis population.

Madelung’s Disease in a Middle-Aged Nigerian Man: A Case Report

Abstract Madelung’s disease is a rare metabolic disease of surgical importance seldom reported among Africans. This case reports the condition in a middle-aged Nigerian man with Type 1 variety of the condition. In addition, he was overweight and had diastolic hypertension (90 mmHg) with a 30-year history of local alcohol consumption of 30-60 units/day. Diagnosis of Madelung’s disease was made by fine-needle aspiration cytology, ultrasound scan, and x-ray of the fatty deposits on the body. The patient also had an aspartate transaminase-to-alanine transaminase (AST/ALT) ratio of 2.0, indicative of alcoholic fatty liver disease. Management was through counseling to stop alcohol and excision of the neck mass. The case introduces this rare condition, demonstrates the need for evaluation of patients with Madelung’s disease for metabolic complications, and highlights the role of interdisciplinary collaboration in the management of this disease.

#2616 AVF volume blood flow reduction in NYHA III patients—is it too late?

Abstract Background and Aims Heart failure (HF) with preserved / high cardiac output (CO) is a well-known syndrome in patients with high-flow AVF. However, the threshold for classifying an AVF as high-flow is currently undefined. Cardio-fistular recirculation (CFR) is often used as a criterion, with values greater than 25-30% considered cardiotoxic and associated with adverse outcomes. Additionally, CFR is one of the few easily modifiable risk factors through surgical reduction of AVF volume blood flow (Qa). The study aimed to evaluate the extent of involution of heart structural and functional changes following Qa reduction. Method A prospective cohort study included 86 adult HD patients who met the inclusion criteria: HF with preserved / high CO, CFR &amp;gt; 25%, eKt/V &amp;gt; 1.2. Non-inclusion criteria: arrhythmias (except grade I AV block), valvular disease (except mitral regurgitation I-II). Patients were divided into two groups according to the severity of symptoms: NYHA I-II (N = 39) and NYHA III-IV (N = 47). All patients underwent a thorough examination, Qa assessment and ECHO-CG with tissue Doppler on the interdialytic day immediately prior to surgery. Qa reduction was achieved by external PTFE banding, PTFE graft segment placement or aneurysmorrhaphy (in case of coexisting AVF aneurysm). Long-term results were evaluated at 6 months after surgery. As the aim was to evaluate the dynamics, patients who died during follow-up, underwent conversion of KRT, or had a change in vascular access were excluded. Results Table 1 presents the descriptive statistics of the patients prior to surgery. Both groups of patients showed a significant decrease in Qa, CO, cardiac index, end-systolic and end-diastolic volume indices, and LV myocardial mass index, while EF remained unchanged (data not shown). At the same time, there were no significant differences in the dynamics of the above parameters (group*time interaction in the mixed-effects model). Fig. 1 shows that there was a significant group*time interaction: there was a significant difference in CFR before surgery (p = 0.001), but not after (p = 0.958). In both groups, CFR was adjusted to achieve optimal values. The E/A ratio was not different before the surgery (p = 0.209), but it was different after the surgery (p &amp;lt; 0.001). NT-proBNP levels were higher in the NYHA III-IV group both preoperatively (p &amp;lt; 0.001) and postoperatively (p &amp;lt; 0.001). We have observed a similar pattern in the dynamics of the PASP as well (p &amp;lt; 0.001 at both time points). The likelihood of complete weaning from CHF therapy at 6 months after Qa reduction is almost twice as high in the NYHA I-II group (RR = 1.93 [95% CI 1.2; 3.18], p = 0.009). Conclusion Defining AVF as high-flow based solely on Qa value is not accurate. Instead, it is more appropriate to define cardiotoxicity based on both CFR and the severity of clinical symptoms. Patients in NYHA III-IV benefit less from Qa reduction than patients in NYHA I-II and are more likely to retain diastolic dysfunction and pulmonary hypertension. We recommend reducing Qa in the early stages of HF.

Cardiopulmonary phenotype in systemic sclerosis associated pulmonary hypertension

IntroductionPulmonary hypertension (PH) associated with systemic sclerosis (SSc) increases morbidity and mortality. Cardiopulmonary comorbidities, as per the 2021 PH consensus, play a role in the choice of therapy between monotherapy and combination therapy. MethodsA cross-sectional study was conducted in patients with SSc based on the 2013 ACR/EULAR criteria or very early disease (VEDOSS 2011). PH was considered if they met the following criteria: pulmonary artery systolic pressure (PASP)>39mmHg or peak tricuspid regurgitation velocity (PTRV)>3.4m/s, PASP between 33 and 39mmHg or PTRV between 2.9 and 3.4m/s plus two additional findings suggestive of PH. PH was classified as type 2 if LVEF<50% or moderate to severe diastolic dysfunction was present; type 3 if extensive interstitial disease on tomography>20% or forced vital capacity (FVC)<75%; type 4 if abnormalities related to embolism were detected on scintigraphy or tomography. If patients did not meet these criteria, they were classified as type 1 PH. Complete data on cardiopulmonary risk factors and other factors were required. The frequency of these factors in the population and differences between groups based on risk factors were estimated. ResultsA total of 228 patients were selected. Three had type 2 PH, 24 had type 3, and 40 had type 1 PH, with the majority (75%) having at least one cardiopulmonary risk factor, and 47.5% having more than one. Mild diastolic dysfunction (25%) and hypertension (35%) were the most prevalent. In the type 1 PH group, those with risk factors experienced an increase in the number of years with Raynaud's phenomenon, anticentromere antibodies, and gastrointestinal symptoms (p<0.05). ConclusionIn patients with PH, 75% have one, and 45% have two or more risk factors.

PREVALENCE OF HYPERTENSION, OBESITY AND NUTRITIONAL BEHAVIORS IN PRIMARY SCHOOL STUDENTS

Objective: Hypertension and obesity seen in childhood are among the important public health problems while creating risks for diseases in both childhood and adulthood. Nutritional habits are one of the important factors in the development of obesity. This study aimed to determine the frequency of hypertension, obesity and the nutritional behaviors in primary school students. Design and method: This descriptive research was conducted with 210 primary school students aged 6-9. The blood pressure was measured to determine the frequency of hypertension, the Feeding Behavior Scale was used to determine nutritional behaviors, height and weight were measured to identify obesity status. Results: The mean age of the children was 7.21±0.69, the systolic blood pressure was 98.2±8.69, the diastolic blood pressure was 64.30±7.25 and the body mass was 16.66±3.43. The nutritional behavior scale total score was found to be 2.48±4.18. It was detected that 12.4% of primary school students were slightly overweight and 5.2% were obese. Hypertension was detected in 4.8% of the children, isolated systolic hypertension in 2.4%, and isolated diastolic hypertension in 2.4%. It was determined that there was a relationship between body mass index and systolic blood pressure and diastolic blood pressure (p&lt;0.05), but there was no relationship between nutritional behavior score (p&gt;0.05). Conclusions: It was determined that obesity rates were higher in primary school students, and the higher the body mass index, the higher the blood pressure. It can be said that interventional studies are needed to reduce obesity and hypertension in childhood.

THE PREVALENCE, CHARACTERISTICS, AND PREDICTORS OF HYPERTENSION PHENOTYPES IN A CHINESE POPULATION

Objective: Different phenotypes of hypertension are associated with varying degrees of cardiovascular risk. However, there is limited data available regarding the features and predictors of hypertension phenotypes in Chinese populations. This study aimed to evaluate the prevalence, characteristics, and predictors of different patterns of hypertension in a Chinese population. Design and method: In this study, a cross-sectional design was employed, and a total of 13,073 community participants were included. Hypertension phenotypes were defined as isolated systolic hypertension (ISH, systolic blood pressure (SBP) no less than 140 mmHg and diastolic blood pressure (DBP) less than 90 mmHg), isolated diastolic hypertension (IDH, SBP less than 140 mmHg and DBP no less than 90 mmHg), and systolic-diastolic hypertension (SDH, SBP on less than 140 mmHg and DBP no less than 90 mmHg). Univariate and multivariate logistic regression analyses were utilized to investigate the predictors of various hypertension phenotypes. Results: The mean age of participants was 56.1 years, and 8625 (66%) were women. The prevalence rates of normotension, ISH, IDH, and SDH were 77.7%, 15.6%, 1.2%, and 5.6%, respectively. Compared with the normotensive group, participants with ISH were more likely to be older, men, overweight, obese, presenting with abdominal obesity, artery stiffness, and diabetes, as well as having lower levels of serum creatinine. Patients with IDH demonstrated a higher likelihood of being younger, men, presenting with abdominal obesity, and having higher levels of heart rate compared to normotensive individuals. Furthermore, male gender, alcohol consumption, overweight, obesity, abdominal obesity, artery stiffness, and higher levels of heart rate were predictors for SDH compared to normotension. Conclusions: Male gender and abdominal obesity were identified as common risk factors for three phenotypes of hypertension. However, age had a varying effect on the prevalence of distinct patterns of hypertension.