Difference In BP Research Articles

Mitochondrial phylogeny within the Yellow Chat (Epthianura crocea) does not support subspecific designation of endangered Alligator Rivers population.

The delineation of subspecies is important in the evaluation and protection of biodiversity. Subspecies delineation is hampered by inconsistently applied criteria and a lack of agreement and shifting standards on how a subspecies should be defined. The Australian endemic Yellow Chat (Epthianura crocea) is split into three subspecies (E. c. crocea, E. c. tunneyi, and E. c. macgregori) based on minor plumage differences and geographical isolation. Both E. c. tunneyi (Endangered) and E. c. macgregori (Critically Endangered) are recognized under Australian legislation as threatened and are the subject of significant conservation effort. We used mitochondrial DNA to evaluate the phylogeny of the Yellow Chat and determine how much genetic variation is present in each of the three subspecies. We found no significant difference in the cytochrome b sequences (833 base pairs) of E. c. crocea and E. c. tunneyi, but approximately 0.70% or 5.83 bp difference between E. c macgregori and both E. c. crocea and E. c. tunneyi. This analysis supports the delineation of E. c. macgregori as a valid subspecies but does not support separation of E. c. crocea from E. c. tunneyi. We also found very low levels of genetic variation within the Yellow Chat, suggesting it may be vulnerable to environmental change. Our results cast doubt upon the geographic isolation of E. c. crocea from E. c. tunneyi, but more advanced genetic sequencing and a robust comparison of plumage are needed to fully resolve taxonomy.

THE SIZE OF BLOOD PRESSURE MEASUREMENT REDUCTION IN THE UNATTENDED AUTOMATED BLOOD PRESSURE MEASUREMENTS IS CORRELATED WITH THE LEVEL OF ANXIETY

Objective: Accurate and precise measurement of blood pressure [BP] is critical for both diagnostics and guiding clinical decisions in arterial hypertension. Unattended automated blood pressure measurement [UABPM] can simplify the measurement process, reducing human error and minimizing the white coat effect. The purpose of this study was to analyze the differences in BP between office attended [oABPM] and UABPM and examine their relation with the level of anxiety. Design and method: We conducted a prospective study in the group of 124 hypertensive outpatients (56 % female, mean age 55,3 ± 12,3 years). Each patient had been asked to fill out a health questionnaire and perform the State-Trait Anxiety Inventory, a standardized psychological questionnaire measuring level of anxiety. Afterward, BP was measured using two methods with random order: oABPM – after 5 minutes of rest 3 measurements in 1-minute intervals were taken by a doctor UABPM – after programming the device by a doctor, patient was left alone, after 5 minutes the device performed 3 measurements in 1-minute intervals. Differences in BP were compared using paired sample t-test. Correlation between differences and level of anxiety was nalysed using Pearson correlation coefficient. Results: In UABPM both systolic and diastolic BP values were significantly lower than in oABPM (4,19 ± 6,48 mmHg, p < 0,001 and 2,04 ± 3,34 mmHg, p < 0,001, respectively). These differences t were more pronounced in the group that had attended measurements taken first (5,98 ± 6,57 mmHg, p < 0,001 for systolic and 3,11 ± 3,52 mmHg, p < 0,001 for diastolic). In this group, significant correlation between systolic BP and level of anxiety was found (r = 0,27, p = 0,047). In multiple regression female sex (B = -4,62, p < 0,001 for systolic and -1,19, p = 0,042 for diastolic) and order of measurements (B = 3,63, p < 0,001 for systolic and 2,06, p < 0,001) for diastolic) were most significantly influencing BP differences between compared methods. Conclusions: Routine clinic measurements can overestimate BP values and the difference in oABPM and UABPM partly depends on the level of anxiety. Accurate BP measurement has important implications for treatment decisions like dose and/or drug escalation.

ORTHOSTATIC HYPERREACTIVITY AND THE CARDIOVASCULAR RISK IN JUVENILE AND MIDDLE-AGE HYPERTENSION

Objective: The prognostic significance of orthostatic hypertension (BP) in young individuals is still controversial. This study aims to evaluate the association of hyperreactivity to standing with major adverse cardiovascular and renal events (MACE) in a cohort of young-to-middle-age subjects. Design and method: This investigation was performed in 1207 untreated stage 1 hypertensive subjects with a mean age of 33.1 ± 8.6 years. Supine and standing BPs were measured during two visits performed two weeks apart. At each visit, three supine BP measurements and three orthostatic measurements were taken at 1-minute intervals. The orthostatic BP response to standing was calculated as the average of the standing-lying BP differences obtained during the two visits. Hyperreactors to standing were defined people with a standing-supine systolic BP difference in the top decile (>6.5 mmHg). The mean difference in the whole group was -2.5 ± 7.3/4.6 ± 5.4 mmHg. In 630 participants 24 h urinary epinephrine was measured. Results: Hyperreactors to standing were more frequently smokers (p = 0.003) and coffee drinkers (p = 0.05), and had higher 24 h urinary epinephrine (118.4 ± 185.6 versus 77.0 ± 90.1 nmol/mol, p = 0.005). Hyperreactors also had a greater orthostatic response of diastolic BP (p < 0.001). Ambulatory hypertension evaluated with 24-hour recordings was more common in Hyperreactors than Normoreactors (90.8% versus 76.4%, p = 0.001). During a 17.2-year follow-up, 105 MACE were accrued. In multivariate Cox analysis adjusted for age, gender, parental history of cardiovascular disease, smoking, alcohol drinking, coffee use, physical activity habits, body mass index, office systolic and diastolic BP, postural diastolic BP change, office heart rate, serum glucose, and total cholesterol, Hyperreactors to standing had an almost doubled risk of MACE compared to Normoreactors with a hazard ratio of 1.97 (95%CI, 1.10–3.52). Hyperreactivity remained an independent predictor of MACE even when ambulatory BP data and incident hypertension during follow-up were included in the Cox model (hazard ratio: 1.94; 95%CI, 1.10–3.44). Conclusions: Our data indicate that in young-to-middle-age hypertensive subjects an exaggerated systolic BP response to standing is associated with sympatho-adrenergic hyperreactivity and is an independent predictor of MACE. Orthostatic BP assessment gives the advantage of simple acquisition and future guidelines should encourage measurement of BP on standing in young individuals.

COMPARISON OF AMBULATORY AND HOME BLOOD PRESSURE TELEMONITORING WITH PHYSICAL INACTIVITY MONITORING

Objective: Combined use of office BP (OBP) and out-of-office BP evaluation (ABPM or HBPM) is recommended according to recent guidelines. Aim of the study was to compare the results of BP measurement (BPM) by these methods while improving reliability of HBPTM by the physical activity monitoring. Design and method: BP monitor For a P30Plus was used both for office BP and 3 months home BP telemonitoring (HBPTM) study in triplets on each occasion. Frequency of ABPM (SEIVA TonoTrack) measurement was 15 min during day and 30 min during night. Patients were given preconfigured sets for HBPTM containing For a P30Plus, mobile phone and Xiaomi MiBand 2 smart wristband. 144 treated essential hypertensives aged 24–85 years, 60% males, were referred by their physicians as well controlled. Their therapy was not changed during this study. BP and HR values were accessible to patients and their physicians on a secured server. The demanded 5 minutes of physical inactivity before and during BPM were checked in informed patients by smart wristbands to increase the reliability of HBPTM. Undesired physical activity before and during BP measuring process was shown as the footmark symbol near to BP value in HBPTM logbook. Data were evaluated using a linear mixed model adjusted for gender, age, and BMI. Results: There was no significant difference in mean systolic BP (SBP) of both HBPT week cycle (132.6 ± 10.6 vs. 131.3 ± 9.9 mmHg) and daytime ABPM (135.8 ± 11.5 vs. 134.0 ± 10.6 mmHg) during the time period, respectively. Mean SBP of daytime ABPM was significantly higher (p < 0.001) compared to mean SBP of HBPTM both at entry (135.8 ± 11.5 vs. 132.6 ± 10.6 mmHg) and exit (134.0 ± 10.6 vs. 131.3 ± 9.9 mmHg). Conclusions: Mean SBP of both HBPTM and daytime ABPM were consistent during the study. Daytime ABPM was consistently significantly higher by approximately 3 mmHg compared to HBPTM with the checked 5 min rest before BPM by smart wristbands. Our results suggest, that both methods are comparable.

Characterization and the Genetic Diversity in Pummelo Using Fruit Traits and SSR Markers

Pummelo is one of the basic citrus species of horticultural importance for human health and nutrition security. It has wide genetic diversity due to its breeding behavior during the domestication process. The present research was performed to study the fruits traits and characterization of the studied 21 pummelo genotypes with morphological, fruit quality parameters, and SSR markers. Principal component analysis (PCA) was done to get PC individual plot and clustering the genotypes in five main clusters based on 17 morphological traits. The highest number (08) of genotypes was grouped in cluster V and the lowest (01) in cluster III. Genotypes resided with the highest genetic distance in the individual biplots are promising for suitable parents. Again, molecular characterization or cluster analysis was performed with 5 SSR markers. The PIC values ranged from a low of 0.66 (CAC23) to a high of 0.8787 (TAA41) and averaged 0.78. TAA41 presented the second largest (47 bp) difference among allele size range and the largest (11) number of alleles with the highest gene diversity value (0.88). The average genetic distance among the 21 pummelo genotypes were 0.8362. The NJ cluster analysis led to the grouping of the pummelo genotypes in three major clusters (I, II, and III). The genotypes resided in the similar cluster should be avoided for pummelo improvement. The findings of this research would be useful to select desirable parents for future pummelo breeding program.

MO087: Ambulatory Blood Pressure Trajectories and Blood Pressure Variability in Kidney Transplant Recipients: A Comparative Study Against Hemodialysis Patients

Abstract BACKGROUND AND AIMS Hypertension is the most prevalent cardiovascular risk factor in kidney transplant recipients (KTRs). Preliminary data suggest similar ambulatory blood pressure (ΒP) levels in KTRs and hemodialysis (HD) patients. This is the first study evaluating in comparison the full ambulatory BP profile and short-term BP variability (BPV) in KTRs versus HD patients. METHOD Two hundred four KTRs were matched (2:1 ratio) with 102 HD patients for age and gender. BP levels, BP trajectories and BPV indices over a 24-h ambulatory BP monitoring (ABPM) in KTRs were compared against both the first and second 24-h period of a standard 48-h ABPM in HD. To evaluate the effect of renal replacement treatment and time on ambulatory BP levels, two-way-ANOVA for repeated-measurements was performed. RESULTS KTRs had significantly lower SBP and pulse-pressure (PP) levels compared with HD during all periods studied (24-h SBP: KTR: 126.5 ± 12.1 mmHg; HD first 24-h: 132.0 ± 18.1 mmHg, P = 0.006; second 24-h: 134.3 ± 17.7 mmHg, P < 0.001); no significant differences were noted for DBP levels with the exception of second nighttime. Repeated-measurements-ANOVA showed a significant effect of RRT modality and time on ambulatory SBP levels during all periods studied, and a significant interaction between-them; the greatest between-group difference in BP (KTRs—HD in mmHg) was observed at the end of the second 24-h (−13.9 mmHg, 95%CI: −21.5 to −6.2, P < 0.001). Ambulatory systolic and diastolic BPV indices were significantly lower in KTRs than in HD during all periods studied (24-h SBP-ARV: KTRs: 9.6 ± 2.3 mmHg; HD first 24-h: 10.3 ± 3.0 mmHg, P = 0.032; second 24-h: 11.5 ± 3.0 mmHg, P < 0.001). No differences were noted in dipping pattern between the two groups. CONCLUSION SBP and PP levels and trajectories, and BPV were significantly lower in KTRs compared to age- and gender-matched HD patients during all periods studied. These findings suggest a more favorable ambulatory BP profile in KTRs, in contrast with previous observations.

Dietary nitrate supplementation attenuates the mechanoflex in older women with early menopause: A pilot study

Women who reached early menopause (EM, 40‐44 yrs) have a greater risk for cardiovascular disease than women with normal menopause (NM, 50‐54 yrs), which may be attributed to a longer duration of estrogen loss and a greater reduction in nitric oxide bioavailability in both the peripherals and center. Previous studies have shown that dietary nitrate supplementation improves cardiovascular function in older women, but how autonomic neural control changes in daily living, such as during exercise, has been involved is unclear. We examined the hypothesis that 2wks continuous use of dietary nitrate supplements would attenuate the exercise pressor reflex in older women with EM.Six EM (65±4 [SD] yrs) and 8 NM (64±2 yrs) women participated in this randomized, placebo‐controlled, double‐blind, cross‐over pilot study. All subjects underwent 2 wks of beetroot juice (BRJ; 140 ml containing ~800 mg nitrate per day) or placebo (140 ml nitrate‐depleted BRJ, daily) intervention with ≥14 days of wash‐out. Before and after each intervention period, subjects performed SHG using the dominant hand at 40% of maximum voluntary contraction (MVC) until fatigue, followed by 2 min of PECA with an upper arm cuff inflated to 250 mmHg. Heart rate (HR; ECG), blood pressure (BP; finger photoplethysmography), muscle sympathetic nerve activity (MSNA; microneurography), and respiration (capnography) were continuously measured. In addition, 24‐h ambulatory BP standard deviation (SD) was monitored before and after each intervention (an indication of BP variability).There were no differences in baseline HR, BP and MSNA, MVC, and the time to fatigue between the EM and NM groups before and after intervention (all p>0.05). At the first 30 s of SHG, the EM group showed significant decreases in MSNA burst frequency (DBF; ‐4.5±6.5 in EM vs. 2.5±6.2 bursts/min in NM, p=0.065) and burst incidence (DBI; ‐10.6±12.6 vs. 2.6±8.4 bursts/100 heartbeats, p=0.037) after BRJ intervention compared with the NM group (Figure1A and B). However, there were no differences between groups at fatiguing exercise and during PECA after the intervention. The interventional changes in 24‐h diastolic BP SD had a positive correlation with ΔMSNA BF (r=0.55, p=0.053) and BI (r=0.58, p=0.036) at the first 30 s of SHG in all subjects and EM individuals were in the left‐lower area (Figure2 A and B).These results suggest that dietary nitrate supplementation may attenuate and mechanoreflex, but not the metaboreflex, in older women with EM during static hand grip, which has a relation with BP variability during ambulation. Certainly, these preliminary observations need to be verified in more older women in future studies.

P048 A young girl with myocardial infarction

Abstract Background/Aims Takayasu arteritis is a chronic granulomatous inflammatory disease of the aorta and its major branches. It is commonly seen in young women but has been reported in children as young as 6 months. Acute myocardial infarction due to coronary artery involvement is a rare presentation in Takayasu’s arteritis. Methods A previously healthy 13-year-old girl presented with a history of five episodes of short lasting exertional tightening type chest pain with adrenergic symptoms over a week which was relieved by rest. She didn't have any history of shortness of breath, limb claudication or constitutional symptoms. However, on two of the occasions she felt faint. She denied any recreational drug use. There was no family history of cardiovascular disease, connective tissue diseases or sudden cardiac death. On examination she was of average build with no peripheral stigmata of connective tissue diseases or hypercholesterolemia. Apart from a tachycardia of 110 bpm, her cardiovascular examination was normal. There was no BP difference between the arms and no audible bruits. All her peripheral pulses were felt. Results Her ECG showed ST segment depressions in V1-V5. High sensitivity Troponin I was strongly positive. An urgent CT coronary angiogram revealed aortitis involving the ascending and arch of the aorta extending to the left subclavian artery with both coronary arteries showing smooth short segment narrowing at the origin. Doppler USS abdomen showed wall thickening of proximal and mid abdominal aorta. Blood investigations showed a leucocytosis of 14,100/µl and thrombocytosis of 532000/µl. Her ESR was raised at 31 mm/hr and CRP was 5 mg/l. While further awaiting investigations she was started on treatment as for non-ST elevation myocardial infarction according to standard guidelines. Screening for tuberculosis and VDRL were negative . A CT aortic angiogram showed wall thickening involving the aortic root, coronary arteries, ascending aorta and the abdominal aorta with involvement of the origins of coeliac axis and the superior mesenteric artery. Appearance were suggestive of Takayasu arteritis Type v. She was pulsed with intravenous methylprednisolone 30 mg/kg for 3 days followed by oral prednisolone 2 mg/kg. As a steroid sparing agent methotrexate was added. Despite treatment, while in hospital she developed chest pain with ECG showing new onset ST elevation in aVR. An urgent coronary angiogram done showed severe LMCA disease for which stenting was done. At this stage Tocilizumab was initiated. A year later she remains well controlled in terms of her disease activity. Conclusion Though rare, Takayasu’s arteritis should be considered in any adolescent female presenting with ischemic type symptoms and positive inflammatory response. High index of suspicion can lead to early imaging and aggressive immunosuppression that will reduce the morbidity and mortality of this disease. Disclosure S. Janagan: None. M.P.M.L. Gunathilaka: None. L. Rajagopala: None. J.D. Jagoda: None.

Treatment of male and female spontaneously hypertensive rats with TNF-\u03b1 inhibitor etanercept increases markers of renal injury independent of an effect on blood pressure

Hypertension remains the leading risk factor for cardiovascular disease. Young females tend to be protected from hypertension compared with age-matched males. Although it has become increasingly clear that the immune system plays a key role in the development of hypertension in both sexes, few studies have examined how cytokines mediate hypertension in males versus females. We previously published that there are sex differences in the levels of the cytokine tumor necrosis factor (TNF)-α in spontaneously hypertensive rats (SHR). The goal of this study was to test the hypothesis that TNF-α inhibition with etanercept will lower BP in male and female SHR. However, as male SHR have a more pro-inflammatory status than female SHR, we further hypothesize that males will have a greater decrease in BP with TNF-α inhibition than females. Young adult male and female SHR were administered increasing doses of the TNF-α inhibitor etanercept or vehicle twice weekly for 31 days and BP was continuously measured via telemetry. Following treatment, kidneys and urine were collected and analyzed for markers of inflammation and injury. Despite significantly decreasing renal TNF-α levels, renal phospho-NFκB and urinary MCP-1 excretion, etanercept did not alter BP in either male or female SHR. Interestingly, treatment with etanercept increased urinary excretion of protein, creatinine and KIM-1 in both sexes. These results indicate that TNF-α does not contribute to sex differences in BP in SHR but may be vital in the maintenance of renal health.

The Effect of Circadian Blood Pressure in The Development of Lacunar Infarcts, Together with Other Possible Factors

This study was carried out in Amasya University S.S.R.E. Hospital Department of Neurology and Cardiology between 2021 and 2022. Total number of 58 patients (29 lacunar infarct patients and 29 control subjects, 42 females and 16 males) over the age of 45 (mean age 57.1+-6.8) were recruited to the study. All patients underwent 24-hour blood pressure monitoring. The patients with a history of stroke, malignancy, renal or endocrinal disease were excluded from the study. According to the systolic blood pressure measurements, twenty-seven patients were ‘non-Dipper’ and thirty-one patients were ‘Dipper’. Diastolic blood pressure measurements revealed that twenty-one patients were ‘non-Dipper’ and thirty-seven patients were ‘Dipper’.Mean daytime and night-time systolic blood pressure values were higher in patients with lacunar infarction (p:0.02). There was no difference in the diastolic BP and variability (p > 0,05). The clinical importance of the alteration in the reduction of blood pressure is still controversial. Understanding the alterations in blood pressure rhythmicity will be helpful to prevent and treat the lacunar infarctions.

Effect of Amlodipine/Nebivolol combination therapy on central BP and PWV compared to Amlodipine/Valsartan combination therapy

BackgroundPulse wave velocity (PWV) and central blood pressure (CBP) have been intoduced into managment of hypertensive patients. PWV is positively correlated with arterial wall stiffness while central aortic pressure becomes better predictor of cardiovascular outcome than peripheral pressure. Reduction in CBP provides protective properties against subclinical organ damage. This work aims to investigate the effect of a new combination therapy of Amlodipine/Nebivolol (A/N) on central BP, peripheral BP and PWV. The results of using this combination will be compared to the well-established fixed-dose combination of Amlodipine/Valsartan (A/V). The study conducted between October 2018 and August 2020. One hundred and two hypertensive patients were assigned for Amlodipine 10 mg/Valsartan 160 mg combination therapy (A/V, n = 52) or Amlodipine 10 mg/Nebivolol 5 mg combination therapy (A/N, n = 50) by simple 1:1 randomization. Office, central blood pressure and PWV were measured on first (0 week), second (4–8 weeks) and third visit (10–12). Difference in BP (in each arm and between arms) was calculated along all visits.ResultsNo statistical significant difference was found between A/V and A/N regarding age, gender, BMI and CV history. OBP, CBP and PWV were significantly reduced in each arm, but no differences were found when comparing both arm results to each other. Recorded side effects were insignificant.ConclusionsThe new combination therapy Amlodipine/Nebivolol (A/N) affords a significant reduction in CBP, PBP and PWV with minor and tolerable side effects. It has provided comparable results to Amlodipine/Valsartan (A/V) combination therapy.

Automated Office Blood Pressure and the Impact of Attendance and Rest on Diagnostic Accuracy.

Automated office blood pressure (AOBP) using 3-5 measurements taken with an oscillometric device with or without an attendant in the room may decrease "white coat" effect. We evaluated the impact of the presence or absence of the attendant and rest on BP and diagnosis of hypertension. We randomly assigned 133 adults aged 18-85 with high BP at baseline (≥140/90 mm Hg), no hypertensive diagnosis and no antihypertensive medications to either attended AOBP first, unattended second, or unattended AOBP first, attended second. Outcomes included within-person BP difference for attended vs. unattended measurements; 5 vs. 15 minutes of rest; and the diagnostic performance of AOBP compared with daytime automated blood pressure measurement (ABPM). We found no significant differences between attended and unattended AOBP (mean difference attended - unattended [95% confidence interval, CI], systolic 0.14 mm Hg [-0.78, 1.06]; diastolic 0.16 mm Hg [-0.45, 0.78]) or by rest time (mean difference 15 - 5 minutes [95% CI], systolic -0.45 mm Hg [-1.36, 0.47]; diastolic 0.61 mm Hg [-1.23, 0.003]). AOBP was lower than mean daytime ABPM, regardless of attendance or rest (after 5 minutes rest systolic -3.6 and diastolic -2.55 mm Hg, P = 0.001 for both comparisons). Using daytime ABPM of ≥135/85 mm Hg as the diagnostic threshold, AOBP sensitivity and specificity after 5 minutes of rest were 71.0% and 54.1%, respectively. The presence or absence of a clinic attendant during AOBP measurement and the amount of rest time before AOBP measurements had no effects on BP. AOBP measurements have low sensitivity and specificity for making a new diagnosis of hypertension.

What is the impact of blood pressure on neurological symptoms and the risk of ESKD in primary and secondary thrombotic microangiopathies based on clinical presentation: a retrospective study

BackgroundThe impact of blood pressure on neurological symptoms and risk of end-stage kidney disease (ESKD) is unknown in primary and secondary thrombotic microangiopathies (TMAs).MethodsWe measured baseline systolic (SBP) and diastolic (DBP) BP in consecutive 563 patients with adjudicated primary and secondary TMAs, and assessed its association with the risk of ESKD.ResultsNormal BP, grade 1, 2 and 3 hypertension were present in 243 (43.1%), 132 (23.4%), 101 (17.9%) and 88 (15.6%), respectively.Significant BP differences were noted in relation to the cause of TMA: highest BP values were found in patients with atypical hemolytic-uremic syndrome (aHUS), pregnancy, transplantation and auto-immune-related TMAs. Normal BP or grade 1 hypertension was found in 17/18 (94.4%) patients with thrombotic thrombocytopenic patients (only 1/18 (5.6%) had a SBP value>150 mmHg). In contrast, BP values could not differentiate isolated “essential” malignant hypertension (MH) from MH associated with aHUS (isolated MH (n=15): BP (median (IQR)): 220 (182-249)/132 (101-150) mmHg; MH with aHUS (n=5): BP: 223 (196-245)/131 (111-144) mmHg).The risk of vigilance disturbances (6.9%, 15.0%, 25.0%, respectively), epileptic seizures (1.5%, 4.0%, 12.5%, respectively) and posterior reversible encephalopathy syndrome (0.76%, 2.97%, 6.82%, respectively) increased with increasing baseline BP values from grade 1 to grade 3 hypertension.ESKD occurred in 35/563 (6.2%) patients (1.23%, 2.27%, 11.9% and 19.3% of patients with normal BP, grade 1, 2 and 3 hypertension, respectively). As compared to patients with normal BP (<120/139 mmHg), grade 1, grade 2 and grade 3 hypertension were associated with a greater risk of ESKD in univariate (OR: 1.91 [0.83-4.40], 13.2 [3.56-48.9] and 34.8 [9.31-130], respectively) and multivariate (OR: 0.89 [0.30-2.69], 7.00 [1.57-31.3] and 19.7 [4.53-85.2], respectively) analyses. The association between BP and the risk of ESRD was unchanged after adjustment on eculizumab use (OR: 3.46 [1.41-8.49], 17.7 [4.44-70.0] and 70.6 [8.61-579], respectively). Patients with MH, regardless of its cause, had a greater risk of ESKD (OR: 26.4 [10.0-69.8] vs other patients).ConclusionsBaseline BP differs in primary and secondary TMAs. High BP reduces the neurological tolerance of TMAs and is a powerful independent risk factor of ESKD, even after adjustment on TMA’s cause.

Antihypertensive Medication Use and Its Effects on Blood Pressure and Haemodynamics in a Tri-ethnic Population Cohort: Southall and Brent Revisited (SABRE).

Objectives:We characterised differences in BP control and use of antihypertensive medications in European (EA), South Asian (SA) and African-Caribbean (AC) people with hypertension and investigated the potential role of type 2 diabetes (T2DM), reduced arterial compliance (Ca), and antihypertensive medication use in any differences.Methods:Analysis was restricted to individuals with hypertension [age range 59–85 years; N = 852 (EA = 328, SA = 356, and AC =168)]. Questionnaires, anthropometry, BP measurements, echocardiography, and fasting blood assays were performed. BP control was classified according to UK guidelines operating at the time of the study. Data were analysed using generalised structural equation models, multivariable regression and treatment effect models.Results:SA and AC people were more likely to receive treatment for high BP and received a greater average number of antihypertensive agents, but despite this a smaller proportion of SA and AC achieved control of BP to target [age and sex adjusted odds ratio (95% confidence interval) = 0.52 (0.38, 0.72) and 0.64 (0.43, 0.96), respectively]. Differences in BP control were partially attenuated by controlling for the higher prevalence of T2DM and reduced Ca in SA and AC. There was little difference in choice of antihypertensive agent by ethnicity and no evidence that differences in efficacy of antihypertensive regimens contributed to ethnic differences in BP control.Conclusions:T2DM and more adverse arterial stiffness are important factors in the poorer BP control in SA and AC people. More effort is required to achieve better control of BP, particularly in UK ethnic minorities.

Comparison of automated office blood pressure measurement with 24-hour ambulatory blood pressure measurement

Purpose Although 24-hour ambulatory blood pressure measurement (24-h ABPM) is the most important method to establish true hypertension, in clinical practice often repeated automated office blood pressure (AOBP) measurements are used because of convenience and lower costs. We aimed to assess the agreement rate between a 30 and 60 min AOBP and 24-h ABPM. Materials and methods Patients with known hypertension (cohort 1) and patients visiting the neurology outpatient clinic after minor stroke or transient ischaemic attack (cohort 2) were selected. We performed AOBP for 30–60 min at 5-min intervals followed by 24-h ABPM and calculated average values of both measurements. Agreement between the two methods was studied with McNemar and Bland–Altman plots with a clinically relevant limit of agreement of ≤10 mm Hg difference in systolic BP. Results Our final cohort consisted of 135 patients from cohort 1 and 72 patients from cohort 2. We found relatively low agreement based on the clinical relevant cut-off value; 64.7% of the measurements were within the limits of agreement for 24-h systolic and 50.2% for 24-h diastolic. This was 61.4% for daytime systolic and 56.6% for daytime diastolic. In 73.5% of the patients, both methods led to the same diagnosis of either being hypertensive or non-hypertensive. This resulted in a significant difference between the methods to determine the diagnosis of hypertension (p < 0.0001). Conclusion We conclude that 30–60 min AOBP measurements cannot replace a 24-h ABPM and propose to perform 24-h ABPM at least on a yearly basis to confirm AOBP measurements.

Estimation of Blood Pressure on Postprandial Breakfast, Meal and Dinner among Vegetarians

Background: Blood pressure is the pressure of the blood within the arteries. Based on the circadian rhythm the BP can change. DBP can change according to age. Processed foods, canned soups, snack foods, and condiments may increase BP. The main aim of this study is to estimate the difference in postprandial BP responses during breakfast, lunch and dinner.&#x0D; Materials and Methods: A total of 26 healthy volunteers were randomly selected, men and women aged 17-20 for the study. Systolic blood pressure, Diastolic blood pressure, Heart rate were measured with ambulatory Blood Pressure devices every 10 min before until 90 min after each meal. The measurements were taken to identify the difference in postprandial Blood pressure responses between breakfast, lunch and dinner. Before starting the study, informed consent was taken. Data were collected and analyzed using SPSS software, independent sample T test.&#x0D; Results: In the present study, there was a mild increase observed before and after breakfast, lunch and dinner. There is a difference in BP before and postprandial during breakfast, lunch and dinner. In the present study, there was a mild increase observed before and after breakfast, lunch and dinner. In the morning the body releases hormones such as adrenaline and noradrenaline. These hormones boost energy which raises the BP. So there is decrease in BP before and postprandial during breakfast&#x0D; Conclusion: From this study only a significant difference was observed in SBP, DBP, HR of dinner. There was no significant change seen in breakfast.

The Persistence of Staphylococcus aureus in Pressure Ulcers: A Colonising Role.

Decubitus pressure ulcers (PU) are a major complication of immobilised patients. Staphylococcus aureus is one of the most frequently detected microorganisms in PU samples; however, its persistence and role in the evolution of these wounds is unknown. In this study, we analysed S. aureus strains isolated from PU biopsies at inclusion and day 28. Eleven S. aureus (21.1%) were detected in 52 patients at inclusion. Only six PUs (11.5%) continued to harbour this bacterium at day 28. Using a whole genome sequencing approach (Miseq®, Illumina), we confirmed that these six S. aureus samples isolated at D28 were the same strain as that isolated at inclusion, with less than 83 bp difference. Phenotypical studies evaluating the growth profiles (Infinite M Mano, Tecan®) and biofilm formation (Biofilm Ring Test®) did not detect any significant difference in the fitness of the pairs of S. aureus. However, using the Caenorhabditis elegans killing assay, a clear decrease of virulence was observed between strains isolated at D28 compared with those isolated at inclusion, regardless of the clinical evolution of the PU. Moreover, all strains at inclusion were less virulent than a control S. aureus strain, i.e., NSA739. An analysis of polymicrobial communities of PU (by metabarcoding approach), in which S. aureus persisted, demonstrated no impact of Staphylococcus genus on PU evolution. Our study suggested that S. aureus presented a colonising profile on PU with no influence on wound evolution.

Abstract 12778: A High Physiological Stress Response is Dependent on Call Type in Firefighters

Introduction: CVD and impaired cardiovascular health is noticeably more prevalent in firefighters (FF) than the general population, with over 50% of line-of-duty deaths being cardiovascular related. Many FF have hypertension but less than 25% have their BP under control. The BP and HR response to different calls and job activity in FF is unknown. Thus, we aimed to evaluate and quantify the physiological stress resulting from different types of calls and job activity (fire, medical, riding apparatus) through ambulatory blood pressure (ABP) monitoring. Hypothesis: We hypothesize that fire calls will result in the largest BP surge in FF compared to other types of calls and work conditions. Methods: FF (n=41; 37M, 4F) wore an ABP monitor for at least 12-hours while working. BP was measured every 30 min during daytime and 60 min during nighttime, if worn overnight. Data was analyzed when &gt; 70% of readings were captured. FF were instructed to force an ABP reading when the pager sounded and whenever they felt they entered a stressful situation. Activity and call type were documented on a log sheet for each measurement. Results: The FF were experienced (16.9 ± 11.9 yrs as FF), overweight (BMI: 30.3 + 4.6 kg/m 2 ), middle aged (41.2 ± 13.1 yrs), and hypertensive with average ABP over the 12 hr shift at 131 ± 13.4 / 79.3 ± 8.8 mmHg and HR 75.7 ± 8.8 bpm. Systolic BP surged 19.2 ± 12.2 with fire calls and 18.7 ± 8.1 mmHg with medical calls. Diastolic BP surged 10.5 ± 9.9 with fire and 16.5 ± 10.5 mmHg with medical calls. There were no differences in BP, HR, or BP surge levels ( P &gt;0.05 for all) between the types of measurements (fire, medical, apparatus, alarms). Compared to average ABP values, the response was higher with fire calls (143.9/85.5 mmHg, 85.5 bpm) than medical calls (139.0/87.0 mmHg, 90.5 bpm). Physiological responses were also high when FF rode apparatus (139.8/83.7 mmHg, 81.9 bpm) and received false alarms (137.6/82.6 mmHg, 83.4 bpm). Conclusion: Fire and medical calls resulted in the greatest CV response. On average, fire calls resulted in a 9% increase in systolic BP and medical calls a 9% increase in diastolic BP and a 16% increase in HR. Further investigation in a larger population is warranted to substantiate these results as well as study other variables that may affect BP and HR responses in FF.

Abstract 10636: Inter-Arm Difference in Systolic Blood Pressure: Prevalence and Associated Factors in an African Population

Background: Systolic inter-arm blood pressure differences (IABPD) is associated with increased cardiovascular mortality and morbidity. However, almost all data are issued from western countries, and the epidemiology and associated risk factors of IABPD in sub-Saharan Africa is unknown. Objectives: This study aims to determine the descriptive epidemiology of IABPD in a rural community of Benin. Methods: A cross-sectional study was conducted among participants of the TAnve HEalth Study (TAHES), a prospective population-based cohort conducted in Benin since 2015. All inhabitants of two villages (Tanve and Dékanme), aged 25 years and over were included. Pregnant woman and participants unable to answer the questions were excluded from the study. Data were collected from February to March, 2020 using the WHO STEPS adapted questionnaire in a systematic door-to-door survey. Brachial BP were recorded at rest on both arm with an electronic device. Three series of BP measures were collected sequentially. On each arm the average of the two last measurements was used for analysis. High IABPD was defined as the absolute value of the difference in systolic BP between the left and right arms ≥ 10 mmHg. A multivariate logistic regression models identified factors associated with IABPD. Results: A total of 1,505 participants (median age 40 [32-54] years, 59.3% women) were included in this study. The prevalence of systolic IABPD was 19% (95%CI: 17-21). The prevalence was 19.0% (95%CI: 16-22) in men and 20% (95%CI: 17-22) in women. In the final multivariable model, the probability for systolic IABPD ≥ 10 mmHg increased significantly with age (adjusted OR (aOR) = 1.10 (95%CI: 1.02-1.20) per 10-years), hypertension (aOR = 2.21; 95%CI: 1.68- 2.91) and diabetes (aOR = 1.69; 95%CI: 1.09-2.63). Conclusion: Almost one out of 5 native Africans have an IABPD ≥ 10 mmHg, with an increased risk with older age and presence of hypertension and diabetes. The clinical implication of our finding is in the importance of bilateral brachial blood pressure measurement in this setting.

Low testosterone accelerates vascular damage in hypertensive smokers with more than a 20-pack-year smoking history

Abstract Purpose Testosterone deficiency and cigarette smoking are both associated with increased cardiovascular (CV) mortality risk. Aim of the study is to investigate the impact of low testosterone level on vascular function and structure changes related to cumulative tobacco smoke exposure in patients with arterial hypertension. Methods Indices of vascular function and structure including carotid-femoral pulse wave velocity (PWV) and carotid intima media thickness (cIMT) were measured in 263 hypertensive males divided into 4 age-matched groups according to pack-years of smoking as never smokers (0.0 pack-years), light smokers (0.1–20.0 pack-years), moderate smokers (20.1–40.0 pack-years), and heavy smokers (&amp;gt;40 pack-years). Plasma total testosterone (TT) levels were measured in all patients. Results PWV and cIMT progressively increased from never smokers and light smokers to moderate and heavy smokers (overall P&amp;lt;0.001 and P&amp;lt;0.01 respectively). The hypertensive males of each smoking group were further classified according to measured low or normal TT levels (low TT&amp;lt;3.5 ng/ml). Figure shows mean PWV and cIMT of the smoking/TT groups. Systolic and diastolic BP was higher in patients with TD compared to subjects with normal TT in moderate and severe heavy smokers (all P&amp;lt;0.05) and similar in light and never smokers. LDL-C levels were comparable between men with TD and normal TT across the four smoking groups. The difference in aortic PWV between TD and normal TT shows a progressive increase from light to moderate and heavy smokers. Similarly, the difference in cIMT between TD and normal TT is also positively correlated with cumulative tobacco exposure. All associations remained statistically significant even after adjustment for BP differences. Conclusions The deficiency in TT levels accelerates vascular wall damage of large arteries among hypertensive smokers with more than 20 pack-years tobacco exposure. Considering the predictive value of vascular biomarkers, the findings of this study imply the possibility that the measurement of baseline testosterone level could be an unfavourable marker of smoking-related cardiovascular risk among moderate and heavy smokers with arterial hypertension. Funding Acknowledgement Type of funding sources: None. TT, tobacco smoke exposure, PWV and IMT