Early Hypertension Research Articles

An Investigation of the Relationship Between Vascular Markers and Cognitive Functions in Early Hypertension

Background/Objectives: Controlling hypertension may reduce the risk of cognitive impairment. A marker for the identification of hypertensive patients who are more likely to suffer cognitive impairment would be of clinical benefit. In our research, 105 patients with newly diagnosed primary hypertension were assessed at the Department of Neurology, the University of Debrecen. Methods: The available data covered detailed medical history and data, the results of different tests, ambulatory blood pressure monitoring, the intima–media thickness, the flow-mediated dilatation, the augmentation index, the pulse wave velocity, and neuropsychological evaluation. Multiple linear regression models were created to evaluate the associations found in simple analyses (Spearman’s rank correlation and Pearson’s chi-squared test). Results: The flow-mediated dilatation showed significant correlations with working memory, attention, learning, and executive functions. The intima–media thickness showed significant correlations with attention and reaction time. The composite flow-mediated dilatation/IMT ratio showed a significant relationship with the overall index of cognitive functions. Based on our results, a flow-mediated dilatation/IMT ratio of 15 represents a cut-off value. The pulse wave velocity showed a significant correlation with working memory and attention. The augmentation index showed significant relationships with reaction time and executive functions. Conclusions: Based on our results, the intima–media thickness, flow-mediated dilatation, and their ratio are suitable for the identification of a particularly vulnerable subgroup of patients for whom a detailed cognitive examination is required for the early detection and treatment of functional disorders. The assessment of attention, executive functions, working memory, and reaction time is required in early hypertension.

A parent and child with Liddle syndrome diagnosed correctly with the child as the proband: a case report with review of literature.

Liddle syndrome (LS) is an autosomal dominant genetic disorder characterized by early onset hypertension, hypokalemia, and low plasma aldosterone or renin concentration. It is caused by mutations in subunits of the epithelial sodium channel (ENaC). The clinical phenotypes of LS are variable and nonspecific, making it prone to both misdiagnosis and missed diagnosis. Genetic analysis is necessary to confirm the diagnosis of LS. Herein, we report the case of a 42-year-old male with LS and a 30-year history of hypertension. He was being treated for possible primary aldosteronism (PA) over the preceding 7 years; however, his hypertension was poorly controlled despite intensive combination therapy. His 13-year-old son served as a proband for a diagnosis of LS, as he had hypertension, hypokalemia, and a significant family history of hypertension. Genetic testing revealed a heterozygous pathological variant in the SCNN1B gene. This led to a diagnosis of LS, as the father was found to harbor the same mutation. Both were treated with ENaC inhibitors and a salt-restricted diet, which improved their symptoms markedly. The son's genetic diagnosis facilitated the subsequent proper diagnosis and treatment of his father. LS causes early onset hypertension; hence, its early diagnosis and treatment can prevent complications. Hereditary hypertension should be considered in cases of early onset hypertension with a significant family history. Patients diagnosed with PA using outdated criteria may have concomitant LS and require careful evaluation of biochemical and endocrine tests according to the current criteria.

Abstract 4131796: Non-Contact Biometric System for Early Detection of Hypertension and Diabetes Using AI and RGB Imaging

Introduction: In recent years, the development of wearable devices and bioinformation analysis applications utilizing smartphone sensors has seen significant advancements. Despite these technological strides, their adoption and sustained use remain limited to health-conscious individuals. The general populace, particularly those indifferent to health management, stands to miss out on the potential benefits of wearable technologies due to a lack of engagement. This disconnect underscores the necessity for more accessible health monitoring solutions. Research Questions and Goals: This study aims to bridge the gap in health monitoring accessibility by introducing a system capable of non-invasive, non-contact acquisition of biometric information. Such a system seeks to democratize the early detection and prevention of diseases across various demographics. Methods and Results: A prospective cohort clinical study was conducted in a hospital setting with approximately 200 consenting patients and healthy controls. Images of the subjects' faces and hands were captured with a high-speed camera, and blood pressure measurements were taken simultaneously for correlation. A machine learning algorithm was developed to analyze skin blood flow and spectral features from these images to identify potential diseases. The study specifically focused on early detection of hypertension and diabetes. Hypertension was categorized for individuals with systolic blood pressure ≥115 mmHg or diastolic blood pressure ≥75 mmHg. Diabetes was identified in subjects with HbA1c levels ≥6.5 or those previously diagnosed. The algorithm's performance in detecting hypertension showed a 94.2% in alignment with the AHA guidelines for stage1 hypertension, based on pulse wave features. For a subset including 40% early hypertension cases, accuracy rates were 86.2% for 30-second data segments and 80.9% for 5-second segments. For diabetes detection, the application of the algorithm to video data achieved a 75.3%, utilizing blood flow patterns as markers. Hypertension and diabetes were analyzed using different features. Conclusions: The integration of AI algorithms with video data analysis of skin and blood vessels demonstrates a promising avenue for the non-contact, early detection of hypertension and diabetes. This approach not only offers a viable non-contact monitoring technology, but also represents a significant leap towards inclusive, accessible health care prevention and management strategies.

Machine Learning-Based Prediction for Incident Hypertension Based on Regular Health Checkup Data: Derivation and Validation in 2 Independent Nationwide Cohorts in South Korea and Japan.

Worldwide, cardiovascular diseases are the primary cause of death, with hypertension as a key contributor. In 2019, cardiovascular diseases led to 17.9 million deaths, predicted to reach 23 million by 2030. This study presents a new method to predict hypertension using demographic data, using 6 machine learning models for enhanced reliability and applicability. The goal is to harness artificial intelligence for early and accurate hypertension diagnosis across diverse populations. Data from 2 national cohort studies, National Health Insurance Service-National Sample Cohort (South Korea, n=244,814), conducted between 2002 and 2013 were used to train and test machine learning models designed to anticipate incident hypertension within 5 years of a health checkup involving those aged ≥20 years, and Japanese Medical Data Center cohort (Japan, n=1,296,649) were used for extra validation. An ensemble from 6 diverse machine learning models was used to identify the 5 most salient features contributing to hypertension by presenting a feature importance analysis to confirm the contribution of each future. The Adaptive Boosting and logistic regression ensemble showed superior balanced accuracy (0.812, sensitivity 0.806, specificity 0.818, and area under the receiver operating characteristic curve 0.901). The 5 key hypertension indicators were age, diastolic blood pressure, BMI, systolic blood pressure, and fasting blood glucose. The Japanese Medical Data Center cohort dataset (extra validation set) corroborated these findings (balanced accuracy 0.741 and area under the receiver operating characteristic curve 0.824). The ensemble model was integrated into a public web portal for predicting hypertension onset based on health checkup data. Comparative evaluation of our machine learning models against classical statistical models across 2 distinct studies emphasized the former's enhanced stability, generalizability, and reproducibility in predicting hypertension onset.

Association between early menarche and hypertension in pre and postmenopausal women: Baependi Heart Study.

Early menarche has been associated with an increased risk of arterial hypertension. Whether the association between early menarche and hypertension is independent of menopausal status is unknown. This study aimed to investigate the association between early menarche and hypertension in pre and postmenopausal women. This cross-sectional study analyzed data from 1406 women aged 18-100. Age at menarche, menopause status, hemodynamic, anthropometric, and biochemical data were collected by using standard protocols. Menarche <12 years was defined as early menarche. Systolic blood pressure ≥140 mmHg and/or diastolic ≥90 mmHg and/or intake of antihypertensive medication, were used as criteria for hypertension. In total, 21.3% of women had early menarche (<12 years), and the frequency of hypertension was 38.7%. Premenopausal women with early menarche had a 58% higher chance of developing hypertension, even after adjusting for age, obesity, and smoking [odds ratio (OR) 1.58; (95% confidence interval, CI 1.016-2.461)]. In postmenopausal women, age, obesity, and diabetes mellitus were predictors of hypertension, while early menarche was not. The odds of hypertension were higher with early menarche, but only in women of reproductive age. In postmenopausal women, the physiological changes inherent to aging and the presence of more comorbidities, such as diabetes, might overlap the influence of early menarche on hypertension.

First-trimester maternal tryptophan metabolites, utero-placental (vascular)development and hypertensive disorders of pregnancy: The Rotterdam periconceptional cohort

BackgroundHypertensive disorders of pregnancy (HDP) are a significant cause of maternal and perinatal mortality and morbidity. Knowledge on the placenta-related pathophysiology of HDP is increasing. Since maternal tryptophan metabolites are involved in placentation, we investigated associations between first-trimester tryptophan metabolites and utero-placental (vascular) development, and the occurrence of HDP. Methods911 women were included from a prospective tertiary hospital cohort. Serum tryptophan metabolites were determined at 8.1 ± 1.4 weeks gestation. Placental volume (PV) and utero-placental vascular volume (uPVV) were determined at 7, 9 and 11 weeks gestation. HDP, including hypertension in early pregnancy, gestational hypertension, and preeclampsia, were retrieved from medical records. Associations with PV- and uPVV-trajectories were assessed using mixed models, and HDP risks were estimated by logistic regression models, adjusted for confounders. A mediation analysis was performed to evaluate whether blood pressure was a mediator in the associations with utero-placental (vascular) development. ResultsA negative association between kynurenine and PV-trajectories was found (β = −0.129, 95%CI = −0.220 to –0.039), which was not mediated by blood pressure. No significant associations between other tryptophan metabolites and PV- and uPVV-trajectories were observed. Higher 5-hydroxytryptophan was associated with hypertension in early pregnancy (OR = 1.405, 95%CI = 1.210–1.681), and with an increased risk of preeclampsia in these women. No associations between tryptophan metabolites and other HDP were found. ConclusionsHigher first-trimester kynurenine concentrations were associated with impaired utero-placental (vascular) development. Higher first-trimester 5-hydroxytryptophan concentrations were associated with early pregnancy hypertension, and an increased risk of preeclampsia, indicating its clinical potential as biomarker for future prediction, prevention and treatment of HDP.

Childhood exposure to air pollution, noise, and surrounding greenness and incident hypertension in early adulthood in a US nationwide cohort–the Growing Up Today Study (GUTS)

Exposure to increased air pollution, noise, and reduced surrounding greenness have been suggested as potential environmental risk factors for hypertension in adults, but limited evidence exists regarding early-life exposure, particularly from prospective studies. We investigated independent and joint associations of childhood exposure to these factors with incident hypertension in early adulthood in a US nationwide cohort. Study participants were from the Growing Up Today Study (GUTS) established in 1996 (GUTSI) and 2004 (GUTSII), who were ages 9−14 (GUTSI) or 10−17 (GUTSII) at enrollment. Incident hypertension was identified by self-report on questionnaires from 2010 to 2021. We estimated residential exposures to air pollution (from spatiotemporal models), noise, and surrounding greenness throughout childhood (10-18y). We applied Cox proportional hazards models adjusted for potential confounders to assess hazard ratios (HRs) and 95% confidence intervals (CIs) associated with each interquartile range (IQR) change in exposure. We performed a quantile g-computation to assess the joint association of simultaneous exposure to the mixture. We considered potential effect modification by sex, maternal history of hypertension, overweight/obese status at age 18, urbanicity, and neighborhood socioeconomic status. Among 17,762 participants, 1530 hypertensive cases occurred during an average follow-up of 12.8 years. HRs for all exposures were small with CIs including unity. A joint HR of 1.03 (95% CI: 0.95, 1.11) was associated with a one-quartile increase across simultaneous exposure to the environmental mixture. The joint associations were stronger among non-obese participants or participants living in less advantaged neighborhoods: HRs of 1.07 (95% CI: 0.97, 1.18) and 1.08 (95% CI: 0.98, 1.18), respectively. In conclusion, we did not identify an independent or joint association between childhood exposure to air pollution, noise, and surrounding greenness and early adulthood hypertension. However, a positive joint association was suggested among non-obese participants or those living in less advantaged neighborhoods.

Effective Ventilation Mode in Early Neonatal Sepsis, Bilateral Pneumonia, and Pulmonary Hypertension in a Very Low Birth Weight Newborn (Case Report)

The aim was to demonstrate an alternative approach to respiratory therapy in respiratory failure complicated by pulmonary hypertension when conventional ventilation and high-frequency oscillatory ventilation are ineffective.Patient and study methods. We analyzed laboratory data, ventilatory parameters and hemodynamic parameters during ventilation in a child with birth weight of 1300 grams and respiratory failure complicated by pulmonary hypertension. Dynamic selection of parameters and modes of pulmonary ventilation with transition to Airway Pressure Release Ventilation (APRV) mode is presented. Chest radiography and echocardiography were used.Results. The use of APRV mode when traditional approaches were ineffective allowed «stabilization» of the lungs by alveolar recruitment without deep sedation and muscle relaxation. On day 20 after birth, the infant was weaned. On day 29, the infant was transferred to the neonatal pathology unit for further management, and on day 49, the infant was discharged in stable condition.Conclusion. In neonates with severe respiratory failure, the use of the APRV mode as an alternative to ineffective conventional ventilation requires further investigation and the development of guidelines for its use.

Paragangliome et grossesse : une histoire mictionnelle palpitante

ObjectivesCarrying out a pregnancy to term in a patient with a paraganglioma or pheochromocytoma (PPGL) results from a multidisciplinary challenge. The objective was to compare our therapeutic attitude with the existing literature and to identify optimal treatment. MethodsDescription of a case of paraganglioma treated during pregnancy at the University Hospital Center of Caen (France) in 2024 and comparison with the literature. ResultsWe describe a patient with a family history of paraganglioma, in whom paravesical PPGL was discovered at 18 weeks of gestation. The symptoms were marked by episodes of palpitations and headaches during urination. The diagnosis was confirmed by a measurement of urinary metanephrines associated with magnetic resonance imaging. After initiation of alpha-blocker treatment, delivery was performed by cesarean section at 36 weeks of gestation. An excision was carried out by laparoscopy 2 months postpartum without intra- and postoperative complications. ConclusionsThe absence of antenatal diagnosis of PPGL is the main risk factor increasing maternal and fetal mortality. Certain criteria such as a family history, the appearance of early or malignant arterial hypertension should suggest the diagnosis of PPGL. The initiation of alpha-blocker treatment upon diagnosis is essential. The curative therapy remains surgical excision. Its timing depends on its size, location, term of pregnancy and route of delivery. It is preferable to postpone it until postpartum in order to reduce the risk of complications.

Sarcoplasmic reticulum calcium ATPase (SERCA) proteolysis by matrix metalloproteinase-2 contributes to vascular dysfunction in early hypertension

AimsHypertension is associated with an increased activity of matrix metalloproteinase (MMP)-2 in the vasculature, which, in turn, proteolyzes extra- and intracellular proteins that lead to vascular dysfunction. The activity of sarcoplasmic reticulum calcium ATPase (SERCA) is decreased in the aortas of hypertensive rats. Increased activity of MMP-2 proteolyzed SERCA in rat heart during ischemia and reperfusion injury, thus impairing cardiac function. Therefore, we examined whether increased activity of MMP-2 in early hypertension contributes to proteolyze SERCA in the aortas, thus leading to maladaptive vascular remodeling and dysfunction. Main methodsMale Sprague-Dawley rats were submitted to two kidney-one clip (2K-1C) or Sham surgery and treated with doxycycline. Systolic blood pressure (SBP) was assessed by tail-cuff plethysmography. After 7 days, aortas were collected for zymography assays, Western blot to SERCA, ATPase activity assay, vascular reactivity, Ki-67 immunofluorescence and hematoxylin/eosin stain. Key findingsSBP was increased in 2K-1C rats and doxycycline did not reduce it, but decreased MMP-2 activity and prevented SERCA proteolysis in aortas. Cross sectional area, media to lumen ratio and Ki-67 were all increased in the aortas of hypertensive rats and doxycycline decreased Ki-67. In 2K-1C rats, arterial relaxation to acetylcholine was impaired and doxycycline ameliorated it. Significancedoxycycline reduced MMP-2 activity in aortas of 2K-1C rats and prevented proteolysis of SERCA and its dysfunction, thus ameliorating hypertension-induced vascular dysfunction.

P014 APPLICATION OF AI IN HYPERTENSION MANAGEMENT: A REVIEW

Background and Objective: The integration of artificial intelligence (AI) in healthcare has revolutionized the management of various diseases, including hypertension. This review explores the potential of AI applications in improving hypertension diagnosis, treatment, and patient outcomes. Methods: A comprehensive literature review was conducted using databases such as PubMed, Scopus, and IEEE Xplore. Studies published between 2010 and 2023 were included, focusing on AI models used for hypertension management, such as machine learning algorithms and predictive analytics. Results: AI has demonstrated significant accuracy in predicting hypertension risk factors, optimizing treatment plans, and monitoring patient adherence. Machine learning models, such as neural networks and decision trees, have shown up to 95% accuracy in early hypertension detection. Furthermore, AI-driven personalized treatment plans have resulted in improved patient outcomes and reduced healthcare costs. Conclusions: AI holds tremendous potential in transforming hypertension management by enhancing diagnostic precision and personalizing treatment strategies. Future research should focus on integrating AI with electronic health records and developing real-time monitoring systems to further improve patient care.

HRP-OG: Online Learning with Generative Feature Replay for Hypertension Risk Prediction in a Nonstationary Environment.

Hypertension is a major risk factor for many serious diseases. With the aging population and lifestyle changes, the incidence of hypertension continues to rise, imposing a significant medical cost burden on patients and severely affecting their quality of life. Early intervention can greatly reduce the prevalence of hypertension. Research on hypertension early warning models based on electronic health records (EHRs) is an important and effective method for achieving early hypertension warning. However, limited by the scarcity and imbalance of multivisit records, and the nonstationary characteristics of hypertension features, it is difficult to predict the probability of hypertension prevalence in a patient effectively. Therefore, this study proposes an online hypertension monitoring model (HRP-OG) based on reinforcement learning and generative feature replay. It transforms the hypertension prediction problem into a sequential decision problem, achieving risk prediction of hypertension for patients using multivisit records. Sensors embedded in medical devices and wearables continuously capture real-time physiological data such as blood pressure, heart rate, and activity levels, which are integrated into the EHR. The fit between the samples generated by the generator and the real visit data is evaluated using maximum likelihood estimation, which can reduce the adversarial discrepancy between the feature space of hypertension and incoming incremental data, and the model is updated online based on real-time data using generative feature replay. The incorporation of sensor data ensures that the model adapts dynamically to changes in the condition of patients, facilitating timely interventions. In this study, the publicly available MIMIC-III data are used for validation, and the experimental results demonstrate that compared to existing advanced methods, HRP-OG can effectively improve the accuracy of hypertension risk prediction for few-shot multivisit record in nonstationary environments.

Intravenous Immunoglobulins for Recurrent Chronic Histiocytic Intervillositis: A Series of Case Studies.

Chronic histiocytic intervillositis (CHI) is a rare inflammatory placental disease characterized by diffuse infiltration of monocytes into the intervillous space and is associated with adverse pregnancy outcomes. No treatment is currently validated and although in some small reports, steroids with hydroxychloroquine have been described. There are no data for other therapies in refractory cases. We here report four cases of patients with a history of CHI treated with immunoglobulins during a subsequent pregnancy. The four patients with recurrent CHI had failed to previous immunomodulatory therapies with steroids and hydroxychloroquine. All patients had at least four pregnancy losses with histopathological confirmation of CHI for at least one pregnancy loss. The usual pregnancy-loss etiology screening and immunological screening were negative for all the patients. For three patients, intravenous immunoglobulins were initiated at the βHCG positivity at 1g/kg every 15 days until delivery. In one case with combined therapy since the beginning of the pregnancy, intravenous immunoglobulins were introduced at 20 WG because of severe growth restriction. Two patients had live births at 36 WG and one patient at 39 WG. One patient, who presented early first-trimester hypertension and severe placental lesions, failed to intravenous immunoglobulins and had a pregnancy loss at 15 WG. This is the first report demonstrating the potential benefit of intravenous immunoglobulins in recurrent chronic intervillositis. Larger studies are needed to confirm this potential benefit for patients presenting severe cases of recurrent CHI.

Metabolic syndrome-associated murine aortic wall stiffening is associated with premature elastic fibers aging.

Type 2 diabetes (T2D) constitutes a major public health problem, and despite prevention efforts, this pandemic disease is one of the deadliest diseases in the world. In 2022, 6.7 million patients with T2D died prematurely from vascular complications. Indeed, diabetes increases the risk of myocardial infarction or stroke eightfold. The identification of the molecular factors involved in the occurrence of cardiovascular complications and their prevention are therefore major axes. Our hypothesis is that factors brought into play during physiological aging appear prematurely with diabetes progression. Our study focused on the aging of the extracellular matrix (ECM), a major element in the maintenance of vascular homeostasis. We characterized the morphological and functional aspects of aorta, with a focus on the collagen and elastic fibers of diabetic mice aged from 6 mo to nondiabetic mice aged 6 mo and 20 mo. The comparison with the two nondiabetic models (young and old) highlighted an exacerbated activity of proteases, which could explain a disturbance in the collagen accumulation and an excessive degradation of elastic fibers. Moreover, the generation of circulating elastin-derived peptides reflects premature aging of the ECM. These extracellular elements contribute to the appearance of vascular rigidity, often the origin of pathologies such as hypertension and atherosclerosis. In conclusion, we show that diabetic mice aged 6 mo present the same characteristics of ECM wear as those observed in mice aged 20 mo. This accelerated aortic wall remodeling could then explain the early onset of cardiovascular diseases and, therefore, the premature death of patients with T2D.NEW & NOTEWORTHY Aortic elastic fibers of young (6-mo old) individuals with diabetes degrade prematurely and exhibit an appearance like that found in aged (20-mo old) nondiabetic mice. Exacerbated elastolysis and elastin-derived peptide production are characteristic elements, contributing to early aortic wall rigidity and hypertension development. Therefore, limiting this early aging could be a judicious therapeutic approach to reduce cardiovascular complications and premature death in patients with diabetes.

A Rare Case of Apparent Mineralocorticoid Excess Presenting as Endocrine Hypertension

A 3-year-old boy presented with polyuria and polydipsia for 18 months, along with growth failure. He was born prematurely, at 34 weeks of gestation, with a low birth weight. On examination, the child was severely underweight and hypertensive. Clinical history and evaluation could not identify any secondary causes of hypertension. There was no significant family history. An endocrine workup was planned, considering hypokalemia and metabolic alkalosis. This demonstrated hyporeninemic hypoaldosteronism and raised the possibility of apparent mineralocorticoid excess (AME) and Liddle syndrome. Clinical exome sequence analysis of HSD11B2 revealed a homozygous mutation in exon 5 (911A&gt;G; p.His304Arg), which resulted in a missense mutation that confirmed the diagnosis of AME. A novel homozygous variant was found in the HSD11B2 gene in a subject with early onset hypertension associated with hypokalemic metabolic alkalosis, establishing the diagnosis of AME.

Risk Factor Analysis for Stroke Incidence in North Sulawesi: Based on the 2018 Indonesia Basic Health Research

Stroke is a serious public health issue and the main cause of disability and death after ischemic heart disease. Every year, 12.2 million individuals worldwide suffer from a stroke, which results in 6.5 million deaths. There has been an increasing incidence of stroke in Indonesia, including in North Sulawesi. This study aims to examine the risk factors for stroke incidence in North Sulawesi in a population aged ≥35 years based on the 2018 Indonesia Basic Health Research data. This quantitative research was an analytical observational study with a cross-sectional design. The Chi-square test and multiple logistic regression were performed during data analysis involving 7,111 respondents. The multivariate analysis results showed that hypertension (p=0.000; AOR 8.739; 95% CI 5.758-13.263), physical activity (p=0.000; AOR 2.771; 95% CI 1.944-3.948), gender (p=0.000; AOR 2.047; 95% CI 1.388-3.017), heart disease (p=0.015; AOR 1.919; 95% CI 1.133-3.250), age (p=0.008; AOR 1.669; 95% CI 1.144-2.434), occupation (p=0.008; AOR 1.693; 95% CI 1.145-2.504), and fatty foods consumption (p=0.023; AOR 0.603; 95% CI 0.390-0.932) had a significant correlation with stroke incidence in this study. The main finding of this study shows that hypertension is the most influential risk factor for stroke incidence in a population aged ≥35 years in North Sulawesi. Regular blood pressure screenings are needed as an early hypertension detection effort to prevent stroke incidence.

Prediction of various insulin resistance indices for the risk of hypertension among military young adults: the CHIEF cohort study, 2014–2020

BackgroundNon-insulin-based insulin resistance (NI-IR) indices have been reported to have an association with prevalent hypertension, however, no cohort studies to date have compared their prediction of hypertension among young adults.MethodsA total of 2,448 military men and women, aged 18–39 years, without baseline hypertension in Taiwan were followed for incident hypertension events from 2014 until the end of 2020. All subjects underwent annual health examinations including measurements of blood pressure (BP) in mmHg. Systolic BP (SBP) 130–139/diastolic BP (DBP) < 80, SBP < 130/DBP 80–89, and SBP 130–139/DBP 80–89 were respectively defined as stage I isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH) and combined hypertension (CH). The cut-off levels of stage II hypertension for SBP and DBP were 140–159 and 90–99, respectively. Four NI-IR indices included the ratio of serum triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C), TyG index defined as ln[TG* fasting glucose (FG)/2], Metabolic Score for IR (METS-IR) defined as ln[(2* FG) + TG)* body mass index (BMI)/(ln(HDL-C))], and ZJU index defined as BMI + FG + TG + 3* alanine transaminase/aspartate transaminase (+ 2 if female). Multivariable Cox regression analysis was performed with adjustments for baseline age, sex, body mass index, BP, substance use, family history for early onset cardiovascular diseases or hypertension, low-density lipoprotein cholesterol, kidney function, serum uric acid and physical activity to determine the associations.ResultsDuring a median follow-up of 6.0 years, there were 920 hypertension events (37.6%). Greater TyG, TG/HDL-C and METS-IR indices were associated with a higher risk of stage I IDH (hazard ratios (HRs) and 95% confidence intervals: 1.376 (1.123–1.687), 1.082 (1.039–1.127) and 3.455 (1.921–6.214), respectively), whereas only greater ZJU index was associated with a higher risk of stage II IDH [HRs: 1.011 (1.001–1.021)]. In addition, greater ZJU index was associated with a higher risk of stage II ISH [HR: 1.013 (1.003–1.023)], and greater TyG index was associated with a higher risk of stage II CH [HR: 2.821 (1.244–6.395)].ConclusionInsulin resistance assessed by various NI-IR indices was associated with a higher risk of hypertension in young adults, while the assessment ability for specific hypertension category may differ by NI-IR indices.

Racial Discrimination and Metabolic Syndrome in Young Black Adults

Metabolic syndrome (MetS) is a common health condition that predisposes individuals to cardiovascular disease (CVD) and disproportionately affects Black and other racially and ethnically minoritized people. Concurrently, Black individuals also report more exposure to racial discrimination compared with White individuals; however, the role of discrimination in the development of MetS over time and associated mediators in these pathways remain underexplored. To evaluate the association between racial discrimination and MetS in rural Black individuals transitioning from late adolescence into early adulthood and to identify potential mediating pathways. This longitudinal cohort study included Black adolescents enrolled in the Strong African American Families Healthy Adults (SHAPE) Project between June 2009 and May 2021. Families resided in rural counties of Georgia, where poverty rates are among the highest in the nation. Analyses included 322 of the 500 participants who originally enrolled in SHAPE and who were eligible to participate. Guardians provided information about socioeconomic disadvantage. Analyses were conducted in April 2023. Youths reported exposure to racial discrimination annually from ages 19 to 21 years. MetS was the main health outcome and was measured at ages 25 and 31 years. MetS was diagnosed according to the International Diabetes Federation guidelines, which requires central adiposity (ie, waist circumference ≥94 cm for males and ≥80 cm for females) and at least 2 of the 4 additional components: signs of early hypertension (ie, systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥85 mm Hg); elevated triglyceride levels (ie, >150 mg/dL); elevated fasting glucose level (ie, ≥100 mg/dL); or lowered high-density lipoprotein levels (ie, <40 mg/dL in men and <50 mg/dL in women). At age 25 years, markers of inflammatory activity (ie, soluble urokinase plasminogen activator receptor [suPAR]) and sleep problems were collected to consider as potential mediators. In 322 participants (210 [65.2%] female) ages 19 to 21 years, more frequent exposure to racial discrimination was associated with higher suPAR levels (b = 0.006; 95% CI, 0.001-0.011; P = .01) and more sleep problems at age 25 years (b = 0.062; 95% CI, 0.028-0.097; P < .001) as well as a 9.5% higher risk of MetS diagnosis at age 31 years (odds ratio [OR], 1.10; 95% CI, 1.01-1.20; P = .03). Both suPAR (b = 0.015; 95% CI, 0.002-0.037) and sleep problems (b = 0.020; 95% CI, 0.002-0.047) at age 25 years were significant indirect pathways. No significant interactions between sex and discrimination emerged. This study suggests that racial discrimination in late adolescence is associated with MetS among Black young adults through biobehavioral pathways. Thus, health interventions for MetS in Black adults will need to contend with sleep behaviors and inflammatory intermediaries as well as address and reduce exposure to racial discrimination to narrow disparities and promote health equity.

Longitudinal Analysis of the Relationship Between Social Isolation and Hypertension in Early Middle Adulthood.

Most studies have used cross-sectional or limited follow-up data to evaluate the relationship between social isolation (SI) and hypertension in older populations. The objective of this analysis was to examine the relationship between longitudinal SI and hypertension in a younger population. The present analysis used data from waves I to V of the National Longitudinal Study of Adolescent to Adult Health (1994-2018) and logistic regression models to describe the association of timing, duration, and transitional patterns of SI with hypertension in early middle adulthood. Models were adjusted for demographic variables and adolescent socioeconomic and health-related confounders. SI was higher across life stages among individuals with hypertension (adolescence: 38% versus 35%, young adulthood: 52% versus 44%, and early middle adulthood: 61% versus 52%). Individuals who were socially isolated in young adulthood or early middle adulthood had greater odds of hypertension in early middle adulthood than those who were not (odds ratio [OR], 1.30 [95% CI, 1.07-1.56]; OR, 1.42 [95% CI, 1.15-1.76], respectively). Early middle adulthood hypertension was significantly associated with persistent SI across all life stages and for those who moved into persistent SI after adolescence (OR, 1.40 [95% CI, 1.02-1.93]; OR, 1.61 [95% CI, 1.18-2.19], respectively). SI in young or early middle adulthood significantly increased the odds of hypertension, as did moving into SI and the accumulation of SI across life stages. Our analysis provides insights regarding timing for effective interventions to reduce hypertension earlier in the life course, which may prevent future adverse cardiovascular-related events.

(1382) - How Much Can the Liver Handle? Management of Early Portal Hypertension in a Pediatric Patient with Fontan Circulatory Failure

(1382) - How Much Can the Liver Handle? Management of Early Portal Hypertension in a Pediatric Patient with Fontan Circulatory Failure