Difference In BP Research Articles

Aortic stiffness after living kidney donation: a systematic review and meta-analysis

ObjectivesIncreased aortic stiffness measured with carotid-femoral pulse wave velocity (cf-PWV) has been associated with adverse cardiovascular outcomes. Some studies have reported increased cf-PWV in living kidney donors after nephrectomy. This...

Abstract 4134668: Title: Mandibular advancement device versus CPAP on cardiovascular health and quality of life in OSA a pre-specified 12 months follow up of outcomes

Background: Obstructive sleep apnoea (OSA) is a significant cause of hypertension. ACC/AHA Guidelines recommended screening and treatment of OSA in patients with hypertension; however, evidence comparing mandibular advancement devices (MAD) to continuous positive airway pressure (CPAP) on cardiovascular health is lacking. We present the complete 12 months follow-up data on the comparative effectiveness of MAD versus CPAP in ambulatory BP reduction, QoL, cardiac arrhythmia, and myocardial remodelling. Method: In a randomized, non-inferiority trial (margin 1.5 mmHg), 321 participants, aged over 40, with hypertension and high cardiovascular risk were recruited. Of these, 220 participants with OSA (apnoea–hypopnea index ≥15 events/h) were randomized to either MAD or CPAP (1:1). Pre-specified secondary outcomes include: ambulatory BP, quality of life (QoL) (sleep-specific: ESS, SAQLI, FOSQ; non-sleep-specific: SF-36, EQ-5D), ambulatory ECG monitoring, and cardiac MRI. Results: A total of 89 (80.9% of 110) participants from MAD, and 91 (82.7% of 110) participants from CPAP completed 12 months follow-up. The median daily usage was 5.5 hours for MAD and 4.9 hours for CPAP. The between-group difference in 24h mean BP from baseline to 12 months was - 0.57 mmHg (95% confidence interval: (-2.53 to 1.39, non-inferiority P < 0.001). Compared with the CPAP group, MAD group demonstrated a larger reduction in all the 24h with the most pronounced differences observed in the asleep BP parameters (Table 1). Both the MAD and CPAP improved QoL (Table 2). CPAP had greater improvement in FOSQ from sleep-specific questionnaires (P=0.038), and social QoL in SF-36 from non-sleep-specificl questionnaires (P=0.013). The ambulatory ECG monitoring (MAD: 2.8 ± 1.0 days, CPAP: 2.3 ± 1.1 days) showed no between-group differences in % atrial fibrillation(P=0.209), % ventricular ectopic isolated count (P=0.790) and % supraventricular ectopic isolated count (P= 0.333). The cardiac MRI sub-study (101 participants : MAD= 45, CPAP= 56) showed CPAP had greater improvement in right ventricular stroke volume (P=0.023) and MAD had greater improvement in circumferential strain favours the MAD group (P=0.015) (Table 3). Conclusion: At 12 months , MAD was non-inferior to CPAP for reducing 24h mean arterial BP. MAD showed greater reduction in 24h BPs, especially during asleep. While both the MAD and CPAP are effective in improving QoL, CPAP is more effective in improving FOSQ and social QoL (SF-36).

Occurrence of plant-parasitic nematodes on rice (Oryza sativa) in Kenya with a focus on Hirschmanniella oryzae

Summary Rice ranks as the third most important staple cereal food crop in Kenya, following maize and wheat. The demand for rice has been increasing at a faster rate than most cereals, occasionally requiring imports to meet local needs. In response, the Kenyan government has been implementing a programme to increase rice production by expanding irrigated lowland rice schemes from 32 988 to 171 676 ha, while increasing rain-fed upland production areas four-fold to 42 000 ha by 2030. However, with continued rice monocropping in irrigated lowland fields and intensification in rain-fed upland ecosystems, there is a growing concern that plant-parasitic nematodes may emerge as a significant problem across rice ecosystems. This study characterised the nematode genera associated with rice in Kenya and assessed their diversity and distribution across rice ecosystems, with a focus on Hirschmanniella species. Eleven nematode genera were identified in both ecosystems, indicating a relatively high diversity. These genera, ranked by prominence, included Hirschmanniella, Hoplolaimus, Pratylenchus, Helicotylenchus, Meloidogyne, Ditylenchus, Trichodorus, Xiphinema, Rotylenchus, Longidorus and Paratylenchus. The family Tylenchidae was also found to be an important component of the nematofauna. Both morphological and molecular analyses confirmed the presence of Hirschmanniella oryzae in irrigated lowland and rain-fed upland rice, which represents the first documented report for Kenya. A notably large molecular variation was also observed for these Kenyan populations on the 18S region, with intraspecific variation up to 10 bp difference. Understanding the diversity, distribution, and species composition of nematodes in rice ecosystems is important for raising awareness among plant protection services, farmers, cooperatives and extension agents about plant-parasitic nematodes and their challenges in rice production. Future research should build on this knowledge to support extensive studies on population dynamics and damage threshold, focusing on local rice cultivars to develop effective management strategies, including breeding programmes and other cultural practices.

A sub-study of the POISE-3 randomized trial examined effects of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy on the risk of acute kidney injury

In this pre-specified sub-study of the POISE-3 trial, we examined the effect of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy on the risk of postoperative acute kidney injury (AKI). Altogether, 7307 patients were included from 110 hospitals in 22 countries. Patients were 45 years and older, had or were at risk of atherosclerotic disease, took at least one antihypertensive medication, and were scheduled for noncardiac surgery. Hypotension-avoidance strategy: (i) target intraoperative mean arterial pressure (MAP) 80 mmHg or over, (ii) on day of surgery and for two days after, hold renin-angiotensin-aldosterone system inhibitors and use other antihypertensives in stepwise fashion if systolic blood pressure (SBP) 130 mmHg or more. Hypertension-avoidance strategy: (i) target intraoperative MAP 60 mmHg or more, (ii) continue all antihypertensives before and after surgery. Primary outcome: postoperative AKI, an increase in serum creatinine concentration of either 26.5 μmol/L or more (0.3 mg/dL or more) within 48 hours of randomization or 50% or more within seven days of randomization. The hypotension-avoidance group (3654 patients) used fewer antihypertensive medications than the hypertension-avoidance group (3653 patients); specifically, 6% vs. 38% used an ACEI or ARB on the day of surgery, and 6% vs. 47% and 7% vs. 50% one and two days after surgery, respectively. Patients also spent about half as much intraoperative time with a MAP under 80 mmHg (27 vs. 60 minutes, respectively), but had little difference in average BP before or after surgery. There was no significant difference in AKI risk (15.1% vs. 14.4%). Results were consistent with other definitions of AKI and in patients with preexisting chronic kidney disease. Thus, a hypotension-avoidance strategy targeting a MAP greater than 80 mmHg in the operating room and discontinued blood pressure medication during the perioperative period did not confer a lower risk of AKI compared to a hypertension avoidance strategy. Clinical trial registration number: NCT03505723.

P077 IS THERE A DIFFERENCE IN THE ACCURACY OF AUTOMATED BLOOD PRESSURE DEVICES DESIGNED FOR HOME OR IN-CLINIC USE? A SYSTEMATIC REVIEW AND META-ANALYSIS OF VALIDATION STUDIES

Background and Objective: Advances in technology mean that accurate BP measurements can be automatically performed, allowing widescale use of BP measurement at home. Despite these advances, some health professionals and patients question the accuracy of devices that are designated for use at home compared to in-clinic BP devices. This study sought to determine if there were differences in the accuracy of home BP devices compared with in-clinic BP devices. Methods: A systematic review of BP measurement validation studies of automated, upper-arm devices in adults published between 1987-2023. Intended primary use of each device was extracted from the published validation study. A random effects meta-analysis was performed to estimate pooled mean BP differences across validation studies for home BP and in-clinic BP devices, compared to manual BP. Results: There were 210 home device, and 77 in-clinic device validation studies that met inclusion criteria. In comparison to manual systolic BP, the mean difference for home device systolic BP was 0.11 mmHg (95% CI: 0.09, 0.13), and the mean difference for in-clinic device systolic BP was 0.18 mmHg (95% CI: 0.16, 0.21). There was no significant difference in the accuracy of home vs. in-clinic systolic BP (p=0.88). In comparison to manual diastolic BP, the mean difference for home device diastolic BP was 0.15 mmHg (95% CI: 0.13, 0.17), and the mean difference for in-clinic device diastolic BP was -0.93 mmHg (95% CI: -0.96, -0.90). There was a small difference in the accuracy of home vs. in-clinic device diastolic BP (1.08 mmHg, 95%CI: 0.44, 1.72; p<0.01). Conclusion: There were no meaningful differences in accuracy between home BP devices and in-clinic BP devices, showing that any validated device will yield accurate BP results if used according to standardized measurement principles.

The Effectiveness of Telemedicine in the Management of Chronic Diseases (Diabetes, Hypertension, and Coronary Heart Disease) at Primary Care Facilities in Eastern Trinidad During the COVID-19 Pandemic.

Introduction: During the COVID-19 pandemic, Trinidad and Tobago's government implemented lockdowns and limited the availability of outpatient clinics to curb virus transmission. Subsequently, telemedicine via telephone calls was utilized to address infection control and continuity of care for chronic disease patients. Methods: An observational study was conducted at three primary care facilities in Eastern Trinidad using convenience sampling to review retrospectively telemedicine patients' medical records from October 2019 to February 2020 (before telemedicine) and from March 2020 to September 2020 (during telemedicine) for comparative analysis. Data were analyzed using IBM SPSS Statistics 28.0 software and Microsoft Excel. Results: A total of 199 patient files were analyzed; 57.3% of these were female; 52.3% were 60 years and older. A Wilcoxon signed-rank test demonstrated no statistically significant differences between random blood sugar (RBS) readings (0.355), weight (0.621), or systolic and diastolic blood pressure (BP; 0.239 and 0.232, respectively) before and during the 6-month period of telemedicine consultation. Patients compliant with medication before the use of telemedicine were 14 times more likely to attain target BPs. There was no significant association between compliance with prescribed therapy and BP control (0.335) during the period of telemedicine. Discussion: The findings support the use of telemedicine to manage chronic diseases such as hypertension, diabetes mellitus, and coronary heart disease, as the standard of care was preserved, and no inferiority of recorded outcomes was demonstrated. Although there was an overall decrease in compliance during the telemedicine period compared with before, comparative analysis exhibited no statistically significant differences in BP or RBS readings.

Discovery of the malacopathogenic nematode Pellioditis akhaldaba from the Caucasus in alien slugs in the Main Botanical Garden in Moscow

Summary A member of the genus Pellioditis Dougherty, 1953 (syn. Phasmarhabditis Andrássy, 1976) was detected in three introduced gastropod species in Moscow for the first time. Both the nematode and its gastropod hosts were found to have originated from the Caucasus region. No native gastropod species as well as the alien invasive slug Arion vulgaris were infected by P. akhaldaba. The Moscow strain of P. akhaldaba is very close to P. akhaldaba from Georgia in the ITS rDNA (7 bp difference) but they differ significantly in the sequences of COI mtDNA (50 bp difference). However, phylogenetic analysis of both loci showed that these two strains were the closest relative to all other species and strains of the genus Pellioditis studied.

Association between glycemic control and autonomic dysfunction: A cross-sectional study in type 2 diabetes mellitus patients

Background. Orthostatic hypotension (OH) stands as one of the initial indications of cardiac autonomic dysfunction in diabetic individuals. Our objective is to assess the prevalence of OH across different degrees of diabetes. Materials and methods. This study is a cross-sectional investigation conducted at a tertiary care center. After obtaining ethical committee clearance and informed consent, 150 individuals aged above 50 years were recruited for this study. 50 of them had normal HbA1c levels, 50 with HbA1c levels between 7-8 and another 50 individuals with more than 8 HbA1c values. Results. The duration of diabetes exhibited a strong correlation with HbA1c levels, which was statistically significant (p=0.000). The systolic BP difference in normal, HbA1c 7-8 and HbA1c levels more than 8 were 6.34±1.95, 15.70±8.37 and 17.04±7.74 respectively. The diastolic BP difference in normal, HbA1c 7-8 and HbA1c levels more than 8 were 4.00±1.42, 7.72±5.26 and 12.22±7.77. These results were found to be statistically significant (p=0.000). Conclusion. OH serves as an ominous sign in diabetic patients, indicating a poor prognosis. Individuals with OH are at a heightened risk of falls, which in turn, is associated with increased morbidity and mortality. Therefore, it is crucial to prioritize the early detection of autonomic neuropathy, particularly in diabetic patients.

CENTRAL SYSTOLIC BLOOD PRESSURE AND ARTERIAL STIFFNESS IN PATIENTS WITH HEART FAILURE WITH DIFFERENT EJECTION FRACTION PHENOTYPES

Objective: The aim of this study was to assess changes of central BP (cSBP,cDBP) and parameters of AS in HF with different ejection fraction (EF) phenotypes. Design and method: In 54 patients (61% males, 69.6±10 years, HTN 100%, median (med) EF 51% (IQR 38;55%), NTproBNP 623 (500; 1842) pg/ml; HFrEF 37%, HFmrEF 13%, HFpEF 50%), apart from routine tests, we assessed CBP and AS with applanation tonometry (SphygmoCor). cSBP above individual reference values [Herbert A,2014], central pulse pressure (cPP)>/=50 mmHg, carotid-femoral pulse wave velocity (cfPWV)>10 m/s, cfPWV above individual reference values [Eur Heart J,2010], and AS gradient (cfPWV/crPWV)>/=1 were considered abnormal. The statistical analysis was performed in the groups with EF >/=and<50%. p<0.05 was considered significant. Results: Median office BP was 117(106;130)/70 (68;80) mmHg, bPP 47 (37;56) mmHg; cBP 109.5(96;120.5)/71.5 (68;80) mmHg, cPP 35 (25;43) (p<0.05 compared to brachial measurements). Uncontrolled BP was observed in 26%, hypotension – in 3%. There were no differences in median BP and AS parameters across EF phenotypes. Elevated cSBP was observed in 33% (28.5% in EF >/=50%,38.4% in <50% (p >0.05)): 27.7% with office normotension, in 5.6% with office hypotension and in 66.7% with office HTN. cfPWV>10 ms was observed in 48.1%, cfPWV>individual reference values – in 33.3%, cPP >/=50 mmHg – in 18.5%, AS gradient>/=1–in 70.3% (in 48.1% of patients with normal cfPWV). Elevation of any AS parameter was present in 77.8%: 1–in 20.4%, 2–in 44.4%, 3–in 9.3%. Patients with cSBP elevation had higher uric acid (469.4±104.8vs367.1±126.5 μmol/l, Spearmen correlation coefficient r=0.34,p=0.04) (whole group); more often had CKD (50vs12.5%) (EF<50%); longer duration of HF (med 4.5 vs 1 year), higher BMI (med 39.4 vs 29.4 kg/m2) (EF>/=50%). Patients with cfPWV>10 m/s had higher total cholesterol (med 4.6vs3.7 mmol/l (whole group) and 4.5vs3.6 mmol/l (EF>/=50%)), patients with AS gradient>/=1 had higher triglycerides (1.3.vs0.8 mmol/l) (EF<50%),p<0.05 for trend. Conclusions: Patients with HF had high frequency of cSBP and AS elevation regardless of EF and BP control. The most common marker of AS increase was abnormal AS gradient. Elevation of cSBP may be associated with hyperuricemia.

A novel method of multiplex SNP genotyping assay through variable fragment length allele-specific polymerase chain reaction: Multiplex VFLASP-ARMS

Variable Fragment Length Allele-Specific Polymerase Chain Reaction (VFLASP) and Amplification Refractory Mutation System (ARMS) are reliable methods for detecting allelic variations resulting from single base changes within the genome. Due to their widespread application, allele variations caused by Single Nucleotide Polymorphisms (SNPs) can be readily detected using allele-specific primers. In the context of the current study, VFLASP was combined with ARMS method as a novel strategy to enhance the efficacy of both techniques. Clinically important base variations within SNP regions used in the study were detected by a fragment analysis method. To validate the accuracy of the developed VFLASP-ARMS method, specifically designed synthetic sequences were tested using a capillary electrophoresis system. Allele-specific primers exhibit differences solely at the 3′ end based on the sequence of the SNP. Additionally, to increase the specificity of the primers, a base was intentionally added for incompatibility. Therefore, allele discrimination on fragment analysis has been made possible through the 3–6 bp differences in the amplicons.With the optimization of the system, designed synthetic sequences provided reliable and reproducible results in wild-type, heterozygous, and homozygous genotypes using the VFLASP-ARMS method. Hence, our results demonstrated that VFLASP-ARMS method, offers a novel design methodology that can be included in the content of SNP genotyping assays.

Molecular characterization of Haemoproteus enucleator with emphasis on the host and geographic distribution

Haemoproteus species (Haemosporida, Haemoproteidae) are cosmopolitan and highly diverse blood parasites of birds that have been neglected in avian medicine. However, recent discoveries based on molecular diagnostic markers show that these pathogens often cause marked damage to various internal organs due to exo-erythrocytic development, sometimes resulting in severe and even lethal avian haemoproteosis, including cerebral pathologies. Molecular markers are essential for haemoproteosis diagnostics, but the data is limited, particularly for parasites transmitted in tropical ecosystems. This study combined microscopic and molecular approaches to characterize Haemoproteus enucleator morphologically and molecularly. Blood samples were collected from the African pygmy kingfisher Ispidina picta in Cameroon, and the parasite was identified using morphological characters of gametocytes. The analysis of partial cytochrome b sequences (cytb) identified a new Haemoproteus lineage (hISPIC03), which was linked to the morphospecies H. enucleator. Illustrations of blood stages were provided and the phylogenetic analysis showed that the new lineage clustered with five other closely related lineages belonging to the same morphospecies (hALCLEU01, hALCLEU02, hALCLEU03, hISPIC01, and hALCQUA01), with a maximum genetic distance between these lineages of 1.5 % (7 bp difference) in the 478 bp cytb sequences. DNA haplotype network was developed and identified geographic and host distribution of all lineages belonging to H. enucleator group. These lineages were almost exclusively detected in African kingfishers from Gabon, Cameroon, South Africa, and Botswana. This study developed the molecular characterization of H. enucleator and provides opportunities for diagnostics of this pathogen at all stages of its life cycle, which remains undescribed in all its closely related lineages.

Abstract WP282: Association of Very Short Interval Blood Pressure Variability With Stroke

Background: While blood pressure variability (BPV) is associated with poor cardiovascular outcomes, the relationship between BPV obtained in a very short interval and stroke is unknown. We aim to examine the association between very short interval BPV and a history of stroke. Hypothesis: Higher BPV is associated with the likelihood of having a stroke. Methods: A cross-sectional study using 2017-2020 NHANES included 3 consecutive BP measurements taken 60 seconds apart. The average real variability (ARV) of systolic and diastolic BP (AVR-SBP and AVR-DBP) was assessed as an average of absolute difference in consecutive BP. The association of AVR-SBP and AVR-DBP and the history of stroke was examined by multiple logistic regression. Results: Of 9,693 adult participants, mean±SD age was 50±19 years and 51% were female. Up to 5% (487 patients) had a history of stroke. Mean of the three average SBP and DBP were 120±20 and 72±12 mmHg, respectively. Median (IQR) of ARV-SBP was 3.5 (2, 6) mmHg and of ARV-DBP was 2.4 (1.5, 4) mmHg. Patients with stroke had significantly higher SBP and ARV-SBP, but not DBP and ARV-DBP compared to non-stroke patients (mean difference (95%CI) of SBP 11 (9, 13); ARV-SBP 0.7, (0.4, 1.1); DBP 0.7 (-0.5, 1.9); ARV-DBP 0.1 (-0.2, 0.4)). For every one mmHg increase in ARV-SBP, there was a 4.6% significantly greater odds of stroke (OR (95%CI) 1.05 (1.02, 1.07)), while there were 1.6% greater odds of stroke for every one mmHg increase in ARV-DBP but no statistical significance (OR 1.02 (0.98, 1.05)). After adjusting for age, gender, race, ethnicity, and BMI, the odds of stroke were 2.8% significantly higher for every one mmHg increase in ARV-SBP (OR 1.03 (1.00, 1.05)) and the ARV - stroke association remained non-significant. ARV-SBP was only associated with stroke in patients who were diagnosed with a stroke at an age < 50 years old, while ARV-DBP was not associated with stroke regardless of the age when the stroke was diagnosed. Conclusions: ARV-SBP in a very short interval is associated with prior history of stroke in younger than 50 years old. Impaired cerebral vasculatures may affect autoregulation in younger patients with stroke, which possibly manifests as BPV. Longitudinal cohort studies to determine the association between BPV and stroke are required.

Comparison of cuff inflation and cuff deflation brachial sphygmomanometry with intra-arterial blood pressure as reference.

Conventional sphygmomanometry with cuff deflation is used to calibrate all noninvasive BP (NIBP) instruments and the International Standard makes no mention of calibrating methods specifically for NIBP instruments, which estimate systolic and diastolic pressure during cuff inflation rather than cuff deflation. There is however increasing interest in inflation-based NIBP (iNIBP) instruments on the basis of shorter measurement time, reduction in maximal inflation pressure and improvement in patient comfort and outcomes. However, we have previously demonstrated that SBP estimates based on the occurrence of the first K1 Korotkoff sounds during cuff deflation can underestimate intra-arterial SBP (IA-SBP) by an average of 14 ± 10 mmHg. In this study, we compare the dynamics of intra-arterial blood pressure (IABP) measurements with sequential measurement of Korotkoff sounds during both cuff inflation and cuff deflation in the same individual. In 40 individuals aged 64.1 ± 9.6 years (range 36-86 years), the overall dynamic responses below the cuff were similar, but the underestimation error was significantly larger during inflation than deflation, increasing from 14 ± 10 to 19 ± 12 mmHg ( P < 0.0001). No statistical models were found which could compensate for this error as were found for cuff deflation. The statistically significant BP differences between inflation and deflation protocols reported in this study suggest different behaviour of the arterial and venous vasculature between arterial opening and closing which warrant further investigation, particularly for iNIBP devices reporting estimates during cuff inflation. In addition, measuring Korotkoff sounds during cuff inflation represents significant technical difficulties because of increasing pump motor noise.

Morphological and genetic identification of Halophila species and a new distribution record of Halophila nipponica at the Tanjung Adang Laut shoal, Johor, Malaysia.

The Halophila species exhibit complex characteristics due to their high degree of variation across different bioregions. This study delves into the intricate characteristics of Halophila species in the Tanjung Adang Laut shoal, Johor, Malaysia, and offers valuable insights through morphological and genetic evidence. Employing internal transcribed sequences (ITS), we investigated the phylogeny of Halophila species, revealing distinct clades for H. ovalis, H. major, H. spinulosa, and the newly recorded H. nipponica. Notably, H. nipponica from the Tanjung Adang Laut shoal formed a conspecific relationship with its counterparts from Japan and Korea (98.3-98.5% similarity; 5-11 bp differences). Morphologically, distinguishing features, including the ratio of the half-lamina width (1:4.76-6.13 mm) and cross-vein count (4-7 pairs), supported the identification of H. nipponica. Genetic distance analyses revealed differences between H. nipponica, H. ovalis, and H. major, indicating haplotype diversity. Geographical variations were evident, as H. nipponica presented unique haplotypes (H24) in its clade. The 47 haplotypes network identified significant mutation sites, providing a comprehensive understanding of genetic and morphological distinctions. In conclusion, this study highlights the intricate characteristics and phylogeny of Halophila species in the Tanjung Adang Laut shoal, Johor, and provides valuable insights into their genetic and morphological diversity.

Abstract 13250: Establishing Partition Values and Clinical Phenotype for Heart Failure Patients With Abnormal Left Atrial Function Index: A Cross-Sectional Analytical Study

Introduction: Left atrial function index (LAFI) has recently been validated for global estimation of left atrial (LA) function. LA dysfunction is critical to developing overt heart failure (HF), and getting the best tool for assessing its function is critical to HF prevention. This study attempts to establish cut-off values for LAFI among HF patients and identify which HF phenotype is associated with abnormal LAFI. Hypothesis: Is there any association between abnormal LAFI and changes in LV function? Methods: This cross-sectional study was conducted at the Delta State University Teaching Hospital, Nigeria. We recruited 80 hypertensive HF patients and 40 healthy normotensive controls. LAFI = (LAEF x LVOT-VTI)/LAESVI. (LAEF = left atrial emptying fraction; LAESVI = left atrial end-systolic volume index; LVOT-VTI = left ventricular outflow tract velocity time integral). Relationships between variables were determined using an independent student’s t-test, and a P-value of &lt;0.05 was significant. Results: In the control arm, the LAFI reference range was estimated to be 24.07-76.24. Abnormal LAFI was defined as LAFI &lt; 24 and 77.5% of the individuals with HF were found to have abnormal LAFI. There was no difference in age (61.83±7.48 vs. 63.22±6.75, p=0.46), BMI (28.27±4.47 vs. 29.52±5.91, p=0.33) and systolic BP (127.34±19.28 vs. 120.94±19.94, p=0.22) of hypertensive HF patients with LAFI &lt;24 and LAFI ≥24. Those with abnormal LAFI had lower EF (45.04±11.06 vs. 63.73±14.73, p&lt;0.0001), FS (25.75±8.26 vs 32.49±8.64, p=0.003) and SV (57.16±13.30 vs. 64.99±16.94, p=0.02). However, E/E’ (15.62±5.61 vs. 9.2±3.22, p&lt;0.0001) and LAVI (37.22±5.80 vs. 16.48±5.65, p&lt;0.0001) were higher among patients with lower LAFI. Contrarily, E/A (1.87±0.97 vs. 1.87±0.83, p=0.98) and TAPSE (17.87±3.67 vs. 19.54±2.47, p=0.06) did not show any difference among the groups. Conclusions: This study shows that abnormal LAFI was associated with impaired LV function and it is crucial to deploy this non-invasive modality of cardiac assessment in hypertensive patients. Early identification of abnormal left atrial mechanics is pertinent to preventing overt HF, especially in parts of the world where access to advanced cardiovascular care is limited.

Blood Pressure Variability: Marker or Predictor of Cardiovascular Risk?

Background: Regardless of the mean blood pressure value, short-term and long-term BP variability (BPV) are associated with the development and progression of target organ damage and predictors of cardiovascular complications and mortality. The purpose of the present study was to evaluate the prognostic significance of increased BPV in patients with arterial hypertension (AH). Methods and Results: The study consisted of two stages. In the first stage, a retrospective analysis of 365 ABPM results was carried out. As a result of the analysis, 271 patients aged 56.1±10.0 years with uncontrolled AH Grades 1-3 (ESC/ESH, 2018) were included in this study. Depending on the values of BPV, AH patients were divided into two groups: Group 1 consisted of patients with normal BPV (n=145), and Group 2 consisted of patients with increased BPV (n=126). The second stage included 91 patients with uncontrolled hypertension without permanent antihypertensive therapy who had increased BPV. We found statistically significant differences in BP between the AH patients with normal BPV and increased BPV. Thus, in the group with normal BPV, compared with increased BPV, the parameters of the average 24-h systolic BP (SBP), daytime SBP, and nighttime SBP were statistically lower (141±14.6 vs. 147.2±20.2 mmHg, P&lt;0.004; 142.8±15.1 vs. 148.4±20.7 mmHg, P&lt;0.01; and 136.2±15.5 vs. 143.8±21.4 mmHg, P&lt;0.001; respectively). A statistically significant moderate direct correlation was found between the average 24-h SBP and the average 24-h and daytime SBP variability (SBPV) (rs=0.49 and rs=0.40 respectively, P&lt;0.001 in all cases). A statistically significant moderate to weak direct correlation also was found between the average daytime SBP, and the average 24-h and daytime SBPV (rs=0.45 and rs=0.37, respectively, P&lt;0.001 in all cases). A moderate direct correlation was found between nighttime SBP and 24-hour SBPV (rs=0.52, P&lt;0.001) and between nighttime SBP and daytime SBPV (rs=0.42, P&lt;0.001). Weak direct correlations were found between the average 24-h SBPV and central SBP (SBPc) (rs=0.34, P&lt;0.001), as well as between the average 24-h and daytime SBPV and central pulse pressure (PPc) (rs=0.33 and rs=0.32, respectively, P&lt;0.001 in all cases). A weak direct correlation was found between carotid intima-media thickness (CIMT) and the average 24-h and daytime SBPV (rs=0.37 [P&lt;0.001] and rs=0.3 [P=0.04]). Conclusion: The increased BPV is associated with impaired diurnal blood pressure profile (DBPP) and structural and functional changes in blood vessels, in particular, an increase in SBPc and PP in the aorta, and CIMT thickening, which characterizes increased BPV as a predictor of vascular remodeling in patients with uncontrolled AH.

Abstract P325: Early Insights From A Self-measured Blood Pressure Program In A Socially And Economically Disadvantaged Primary Care Population

Background: Meta-analyses have shown the success of SMBP in BP control. We aim to describe an SMBP QI program at our primary care clinic and assess its impact on BP. The Einstein CPC is a safety net practice that serves a socially and economically disadvantaged population facing many HTN management barriers. Methods: This program utilized a QI approach for BP control and patient-provider connection. Patient demographics, clinical features, and SDOH were assessed at baseline. Patients with uncontrolled HTN (SBP &gt;140 mmHg) were asked to participate. To date, 111 patients enrolled. Patients were given a Bluetooth-enabled BP monitor connected to a mobile health app, HTN education, DASH diet recommendations, and orientation to SMBP protocols. Those reporting social needs or depression were referred to behavioral resources. Health staff continuously telemonitored patient usage, BP, and individualized interventions. We evaluated the difference in BP from baseline BP and estimated the change in time using a linear multilevel model with random intercept and random slope for each patient. We also calculated time in target range defined as time in SBP 100-130 and DBP 70-80 in mmHg. Results: Patient characteristics (Table 1). Those with at least 3 d of BP readings - 93% (103/111) were included in the BP analysis (Figure 1); mean follow-up 69±67 d and BP readings 42±52. Over 90 d, SBP, and DBP decreased by 11 (95% CI: 4-17) and 5 (95% CI: 3-8) mmHg, respectively. Conclusions: A QI-based SMBP program with robust telemonitoring and individualized interventions may effectively promote short-term adherence to remote BP monitoring and BP control in a socially and economically disadvantaged population.

Abstract P419: First-Trimester Maternal Hemodynamics In Patients With Or Without Chronic Hypertension Using USCOM (ultrasound Cardiac Output Monitor), A Non-invasive And Quantitative Method.

Objective: We aim to investigate maternal hemodynamics at 10-14 weeks of gestation among patients with and without chronic hypertension, utilizing USCOM®, a non-invasive cardiac output monitor. Methods: A prospective pilot study was conducted for women with singleton pregnancies. Independent T, Mann-Whitney U, and Chi-square tests&amp;nbsp;were used to analyze cardiovascular parameters via Doppler waveform. Results: Thirteen pregnant women with preexisting hypertension and no other medical comorbidities were selected, and 26 controls were matched based on maternal age, ethnicity, and BMI in a ratio of 1:2. Six patients with chronic hypertension were on anti-hypertensive medications. Tables 1 and 2 present each respective group's basic demographic and hemodynamic characteristics. Conclusion: Despite no differences in BP, our study revealed significant hemodynamic changes in chronic hypertensive patients in the first trimester. Chronic hypertensive patients might have pre-existing pathological cardiovascular adaptation in early pregnancy, potentially compromising perinatal outcomes.

Abstract P375: Association Of Blood Pressure Variability With Kidney Function In Living Kidney Donors

Background: Relationship between BP variability and kidney function in living kidney donors (LKD) is unknown. We aim to examine the association between BP variability and the risk of worsening kidney function post-donation. Methods: A cohort study using OPTN/SRTR includes adult LKD undergoing donation between 6/1972 and 9/2022. Average real variability (ARV) defined as an average of absolute difference in consecutive BP at 6, 12 and 24 months post-donation was used for assessing BP variability and categorized into quartiles (Q) for SBP and DBP (AVR-SBP and AVR-DBP). The risks of ≥35% decrease in post-donation eGFR from pre-donation eGFR among the quartiles of AVR-SBP and AVR-DBP were evaluated by Cox regression. Results: Of 136,984 LKD, mean±SD age was 42±12 years and 6% were female. Mean pre-donation SBP and DBP were 122±13 and 74±9 mmHg, respectively. Median (IQR) ARV-SBP and ARV-DBP were 7 (3, 12) and 5.5 (2, 9.5), respectively. Median pre-donation eGFR was 98.33 (82.94, 116.66; P trend 0.110). Median eGFR at 6-, 12-, and 24-months post-donation were 57.58 (48.43, 68.89), 58.93 (49.53, 70.61), and 61.02 (51.34, 72.78) mmHg, respectively. Compared to Q1 of the ARV-SBP, only Q3 and Q4 had a 4-6% higher risk for declined eGFR (HR Q3 (95%CI) 1.04 (1.00, 1.08) and HR Q4 1.06 (1.02, 1.11)). After adjusting for age, gender, race/ethnicity, U.S. citizenship status, level of education, history of hypertension, pre-donation BMI, SBP, DBP, creatinine, proteinuria and the interaction term between ARV and age (&lt;65 vs. ≥65), only Q4 remained to have significantly greater risk of the event (HR Q4 1.09 (1.03, 1.16)) and older LKD ≥65 years old had lower the risk compared to the younger (HR Q4-Age 0.75 (0.57, 0.98), P interaction 0.037). For ARV-DBP, Q2 and Q3 had 4-5% higher risk of the event compared to the Q1 (HR Q 2 1.04 (1.00, 1.08) and HR HR Q 3 1.05 (1.01, 1.09)) and only Q3 remained significantly having higher the risk after adjusting for confounders (HR Q 3 1.06 (1.00, 1.13); P interaction non-significance). Conclusions: ARV-SBP especially in &lt;65 years old and ARV-DBP are associated with a higher risk for a decline in post-donation kidney function. Pathophysiological alteration with hyperfiltration after unilateral nephrectomy may involve BP variability related to kidney function.

Abstract 048: Clinical Impact Of 3 Versus 5-minute Delay And 30 Versus 60-second Intervals On Automated Office Blood Pressure Measurements

Background: Guidelines advise automated office blood pressure (AOBP) with an initial 5-minute delay and multiple measurements at least 60 seconds apart. Recent studies suggest that AOBP may be accurate with shorter delays or intervals, but evidence in clinical settings is limited. Objective: To evaluate shorter delays and intervals for AOBP accuracy compared to awake-time ambulatory BP measurement (ABPM). Methods: Patients referred to one hypertension (HTN) center underwent ABPM and one of four non-randomized, unattended AOBP protocols: a 3 or 5-minute delay with a 30 or 60-second interval, i.e., 3m/30s/30s, 3m/60s/60s, 5m/30s/30s and 5m/60s/60s. HTN was defined as SBP≥140 or DBP≥90 mmHg. We compared differences in mean BP and HTN classification between average AOBP and awake-time ABPM by t-tests and Fisher’s exact test. Results: Among 195 participants (mean 59±16 years, 63% women, 25% Black), overall AOBP average was 133.9±15.7/78.5±11.2. Differences between average AOBP and awake ABPM were: 1.3±14.8 mmHg (5m/60s/60s; P for difference=0.46), 7.0±16.7 mmHg (3m/60s/60s; P =0.004), 6.7±12.1 mmHg (5m/30s/30s; P &lt;0.001), and 5.0±12.9 mmHg (3m/30s/30s; P =0.06) ( Figure ). The proportion with HTN was statistically equivalent to ABPM for the 60s arms, but significantly different for the 30s arms (both P -values for difference = 0.01). Conclusion: In this quality-improvement study, 5m/60s/60s was most similar to the awake-time ABPM average. While shorter protocols may improve AOBP adoption in clinical practice, the potential loss in accuracy should be evaluated in a larger, randomized trial.