Effective Blood Pressure Control Research Articles

On the Regulation of Arterial Blood Pressure by an Intracranial Baroreceptor

Introduction: There is significant evidence for the existence of an intracranial baroreceptor mechanism(s) capable of sensing physiological changes in cerebral blood flow (Marina et al., 2020). However, little is known about the sensitivity of this mechanism to changes in brain perfusion and its interaction with inputs from the peripheral (arterial) baroreceptors. The aim of this study was to characterise the cardiovascular responses to physiological changes in cerebral perfusion induced by experimental manipulations of intracranial pressure (ICP). Methods: The experiments were performed in adult Sprague-Dawley rats (250–300 g), anesthetized with urethane (induction: 1.3 g kg−1, i.p.; maintenance: 10–25 mg kg−1 h−1, i.v.). The femoral artery and vein were cannulated for measurement of arterial blood pressure (ABP) and administration of anaesthetic. The trachea was cannulated, and the animal was mechanically ventilated. The lateral cerebral ventricles were cannulated and connected via saline-filled catheters to a pressure transducer to record ICP and to a “water column” to allow controlled manipulation of ICP. The experiments included the denervation of the arterial baroceptors, stimulation of the aortic depressor nerve and recording of renal sympathetic nerve activity. Results: The resting ICP in rats anesthetized with urethane was 6.2 ± 0.7 mmHg (n=8). Following a small craniotomy that reduced ICP to 0 mmHg, ABP decreased by 11.2 mmHg (n=6) within 30 min. Restoring the integrity of the intracranial space increased ABP to the baseline level. Progressive increases in ABP were observed in response to experimentally-induced increases in ICP by 5, 10, 15 and 20 mmHg, revealing a linear relationship between ICP and systemic arterial pressure within the physiological range of ICP changes. In the absence of inputs from the arterial baroceptors (bilateral sino-aortic denervation and vagotomy) the ABP responses to ICP increases were preserved. Analysis of the ABP and heart rate responses to the electrical stimulation of the aortic depressor nerve suggested baroreflex re-setting at raised ICP. Renal nerve recordings demonstrated increased sympathetic activity at raised ICP (172 ± 34.91 % at 20 mmHg ICP (p=0.003; n=7) with markedly enhanced bursts of activity during the inspiratory phase of the respiratory cycle. Conclusion: These data demonstrate that the intracranial baroceptor mechanism is highly sensitive to changes in cerebral perfusion within the physiological range and suggest that cerebral blood flow is an important determinant of systemic ABP. The data suggest that at raised ICP the baroreflex control of sympathetic vasomotor activity is reset and provides effective control of arterial blood pressure at a higher level required to compensate for reduced brain perfusion. Marina, N., Christie, I.N., Korsak, A., Doronin, M., Brazhe, A., Hosford, P.S., Wells, J.A., Sheikhbahaei, S., Humoud, I., Paton, J.F. and Lythgoe, M.F., 2020. Astrocytes monitor cerebral perfusion and control systemic circulation to maintain brain blood flow. Nature Communications, 11(1), 131. This PhD Studentship is funded by the British Heart Foundation. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Analysis of the Effect of Family-Centered Empowerment Model (FCEM) Health Education Through WeChat on Medication Compliance and Blood Pressure of Elderly Hypertensive Patients in Rural Areas

Objective: To validate the effectiveness of a Family-Centered Empowerment Model (FCEM) health education through WeChat on medication compliance and blood pressure among elderly hypertensive patients in rural areas. Methods: One hundred and two rural elderly hypertensive patients aged 65–80 years were selected and randomly divided into an experimental and control group of 51 each. The control group implemented conventional health education, and the experimental group implemented FCEM health education through WeChat platform for 4 consecutive weeks. The Therapeutic Adherence Scale for Hypertensive Patients (TASHP) scores and blood pressure measurements were compared between and within the two groups. Results: After the intervention, there were significant differences in medication compliance and blood pressure between the two groups (P < 0.001). In the control group, before and after the intervention, there was a significant difference in medication compliance (P < 0.001), but no significant difference in blood pressure (P > 0.05). In the experimental group, there were significant differences in medication compliance and blood pressure before and after the intervention (P < 0.001). Conclusion: The FCEM health education through an online social platform significantly improved medication compliance and led to effective blood pressure control in rural elderly hypertensive patients. Therefore, as an effective, safe, and economical model, it is also necessary to explore its effectiveness in improving health problems in other chronic diseases and other age groups.

Adherence to Medications of Hypertension among Hypertensive Patients of Majmaah City of Saudi Arabia

Objectives: To assess engagement in heart-healthy lifestyle practices and adherence to antihypertensive medications with knowledge of hypertension, for more effective blood pressure control. Methodology: It was a cross-sectional study involving adults of more than 18 years diagnosed with hypertension as study participants. Total sample size was 381. Assessment of medication adherence, and responses were calculated using Malaysian Medicine Adherence Score 8 (MALMAS 8) scale. The scoring system utilized in the MALMAS questionnaire, aligned with the MMAS-8, aids in categorizing participants based on their medication adherence levels. Data were collected using a pre-tested, self-administered questionnaire. The data were analysed using the statistical software for social sciences (SPSS26). Results: The prevalence of hypertension among the selected study participants was found to be 71%. High level of adherence was found in 33% of the participants. The medication adherence of the patient was significantly associated with gender (p<0.05). 27% of the study participants belong to the age group of 25-40 years. Around 63% of the females were having high adherence and this association was found to be statistically significant, (p value < 0.05.). There was no statistically significant association between participants’ adherence to the age group they belong, marital status, educational level and their occupation. Conclusion: In conclusion, this cross-sectional study highlights the difficulty in adhering to treatment plans, with forgetfulness and trouble taking medications ranking as the biggest obstacles. Interestingly, adherence was higher in females than in males. Nevertheless, no statistically significant correlation was observed between medication adherence and other demographic variables, including age, income level, occupation, marital status, education, or occupation

Management of hypertension in heart transplant recipients: an ongoing conundrum.

Hypertension remains one of the most common clinical problems leading to significant posttransplant complications. This study reviews the pathophysiology of hypertension in the postcardiac transplant phase and provides an update on currently available antihypertensive therapies for heart transplant patients. The true prevalence of hypertension in the heart transplant population remains unknown. Effective blood pressure (BP) control is key to prevent left ventricular remodeling, diastolic dysfunction and stroke. Calcium channel blockers (CCBs) are the most commonly and preferred agents in the early posttransplant phase and may have renal protective effects. Angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs) can all be used as second line antihypertensive agents and may have a role in preventing other long-term complications such as calcineurin-inhibitor induced nephropathy. Although more data are needed, sodium-glucose co-transporter 2 inhibitors (SGLT2i) appeared to be well tolerated and could be considered especially in the presence of type diabetes and chronic kidney disease. Conversely, angiotensin receptor-neprilysin inhibition (ARNI) have not been studied in the heart transplant population therefore cannot be recommended at this time. Hypertension is very common after heart transplant. Early steroid wean and traditional risk factor modification play an important part in the management of post-heart transplant hypertension. CCB, ACEI, ARB are the preferred antihypertensive agents to improve postcardiac transplant complications. Novel therapies such as SGLT2i appear well tolerated and may have benefits in both BP and glycemic control in heart transplant; however, larger trials are needed.

Pressure control and treatment interact in the deterioration of incidental visuospatial memory in hypertensive patients.

Systemic hypertension (SH) is the main risk factor to cognitive deterioration, whereas visuospatial memory is more vulnerable to ageing. Some antihypertensive agents have a neuroprotector effect, however, such effects could be masked by comorbidities and/or the lack of effective control on the arterial pressure of patients. To assess this, the evaluation of incidental visuospatial memory of SH patients and the relation to the treatment received and the effective control of pressure were made. 80 patients (46 woman) were included grouped by the received medication: angiotensin 2 receptor blockers (ARB) or angiotensin converting enzyme inhibitors (ACEI). A multiple correlation analysis between visuospatial scores and clinical variables was made; also, a mixed model analysis (fixed factors: treatment, pressure control, diabetes comorbidity; aleatory factors: age, schooling, months from SH diagnoses). Half of the patients had a controlled pressure, from them the higher proportion received ARB, and a minor number of patients received ACEI. The normotensive patients receiving ACEI were inefficient whereas the hypertensive patients were more efficient. The systolic pressure was negatively related with the visuospatial scores in spite of no correlations occurred with MoCA and Raven tests. The visuospatial incidental/intentional scores were negatively correlated with systolic pressure. The efficiency in the visuospatial ability depends on the interaction of treatment and effective control of blood pressure. The interaction between treatment and effective pressure control must be taken in count when cognitive deterioration is studied.

Furosemide to lower antenatal severe hypertension: a randomized placebo-controlled trial

BackgroundHypertensive disorders of pregnancy are a leading cause of perinatal morbidity, and timely treatment of severely elevated blood pressure is recommended to prevent serious sequelae. In acute hypertension marked by increased blood volume, it is unknown whether diuretics used as an adjunct to antihypertensive medications leads to more effective blood pressure control. ObjectiveTo evaluate whether the addition of intravenous furosemide to first-line antihypertensive agents reduces systolic blood pressure in acute-onset, severe antenatal hypertension with wide (≥60 mmgHg) pulse pressure. Study DesignIn this double-blinded randomized trial, participants received 40 milligrams of intravenous furosemide or placebo in addition to a first-line antihypertensive agent. The primary outcome was mean systolic blood pressure during the first hour after intervention. Secondary outcomes included corresponding diastolic blood pressure; systolic blood pressure, diastolic blood pressure, and pulse pressure at 2 hours after intervention; total reduction from qualifying blood pressure, duration of blood pressure control, need for additional antihypertensive doses within 1 hour, and electrolytes and urine output. A sample size of 35 subjects per group was planned to detect a 15-mmHg difference in blood pressure. ResultsBetween January 2021 and March 2022, 65 individuals were randomized, 33 to furosemide and 32 to placebo. Baseline characteristics were similar between groups. There was no difference in the primary outcome of mean 1-hour systolic blood pressure (147 [14.8] vs 152 mmHg [13.8], P=.200). We found a reduction in 2-hour systolic blood pressure (139 [18.5] vs 154 mmHg [18.4], P=.007) and a decrease in 2-hour pulse pressure (55 [12.5] vs 67 [15.1], P=.003) in the furosemide group. Subgroup analysis according to hypertension type showed a significant reduction in mean 1-hour systolic blood pressure, 2-hour systolic blood pressure, and 2-hour pulse pressure among patients with new-onset but not pre-existing hypertension. Urine output was greater in the furosemide group with no difference in electrolytes and creatinine before and after intervention. ConclusionIntravenous furosemide in conjunction with a first-line antihypertensive agent did not significantly reduce systolic blood pressure in the first hour after administration. However, both systolic blood pressure and pulse pressure at 2 hours were decreased in the furosemide group. These findings suggest that a one-time dose of intravenous furosemide is a reasonable adjunct to achieve blood pressure control, particularly in patients in whom increased volume is suspected.

A Review of Olmesartan-based Therapy in Targeting Effective Blood Pressure Control and Achieving Blood Pressure Goals.

For >3 decades now, angiotensin receptor blockers (ARB) have been used in the management of hypertension (HTN) and HTN-related cardiovascular (CV) diseases. Olmesartan medoxomil (OLM) is an angiotensin II type 1 (AT1) receptor antagonist (or blocker) that binds tightly to the AT1 receptor with long-lasting efficacy over the 24-hour period and safety demonstrated in several trials. It is well tolerated and effective in reducing blood pressure (BP) in mono and combination therapy with thiazide diuretics or calcium channel blockers across a wide range of patient subgroups. The effectiveness and safety of OLM-based combination therapies have good and tolerable profiles with high adherence in the fixed single-pill formulation. Consistent antihypertensive efficacy and good tolerability when used as monotherapy or as a combined therapy make OLM a valuable treatment option for adults with HTN. In this review, we discuss the important clinical implications of OLM as an optimal choice as monotherapy and combination therapy in managing patients with HTN.

Batteryless implantable device with built-in mechanical clock for automated and precisely timed drug administration.

Adherence to medication plays a crucial role in the effective management of chronic diseases. However, patients often miss their scheduled drug administrations, resulting in suboptimal disease control. Therefore, we propose an implantable device enabled with automated and precisely timed drug administration. Our device incorporates a built-in mechanical clock movement to utilize a clockwork mechanism, i.e., a periodic turn of the hour axis, enabling automatic drug infusion at precise 12-h intervals. The actuation principle relies on the sophisticated design of the device, where the rotational movement of the hour axis is converted into potential mechanical energy and is abruptly released at the exact moment for drug administration. The clock movement can be charged either automatically by mechanical agitations or manually by winding the crown, while the device remains implanted, thereby enabling the device to be used permanently without the need for batteries. When tested using metoprolol, an antihypertensive drug, in a spontaneously hypertensive animal model, the implanted device can deliver drug automatically at precise 12-h intervals without the need for further attention, leading to similarly effective blood pressure control and ultimately, prevention of ventricular hypertrophy as compared with scheduled drug administrations. These findings suggest that our device is a promising alternative to conventional methods for complex drug administration.

Telmisartan Plus Amlodipine as the Preferred Initial Combination in Newly Diagnosed Indian Patients with Hypertension: An Expert Consensus Statements.

Hypertension (HTN) remains one of the most important risk factors for cardiovascular (CV) diseases and a leading cause of mortality worldwide. Despite improvement in detection and treatment, poor blood pressure (BP) control rates are observed globally. The situation in India is alarming with only 22.5% of patients maintaining their BP under control. Initiating early and effective treatment for HTN helps control BP within normal limits and reduces associated health risks. In India, currently, there are no guidelines on the choice of dual combination treatment that can be considered an initial treatment for newly diagnosed HTN patients to achieve effective BP control and reduce CV risks. To provide consensus recommendations for preferred initial combinations in newly diagnosed Indian patients with HTN. A core group of 100 experts with HTN expertise conceptualized and formulated the four key questions based on answerability, effectiveness, potential for translation to clinical practice, novelty, and potential impact on the healthcare burden. A mix of Delphi and Child Health and Nutrition Research Initiative (CHNRI) methods was adopted for acceptance or refusal of recommendations. Likert scale 1-9 was used for scoring. A score of ≥7 was considered "statement accepted," >6.50 "near to acceptance" and <6.50 "not accepted." A vote of ≥7 by at least two-thirds of the experts (66.66%) was mandatory for acceptance of the recommendation. Combination therapy could be necessary for a majority of newly diagnosed Indian patients for effective BP control. It can manage HTN with better clinical outcomes. Based on mean rating scores from experts, telmisartan plus amlodipine can be considered the preferred initial combination in the management of newly diagnosed Indian patients with HTN to achieve better BP control and improve CV outcomes.

The effects of Olmesartan/amlodipine administered in the Morning or At Night on nocturnal blood pressure reduction in Chinese patients with mild-moderate essential hypertension (OMAN Trial): study protocol for a prospective, multicenter, randomized, open-label clinical trial {1}

IntroductionHypertension increases the risk of cardiovascular disease. Uncontrolled nocturnal blood pressure is prevalent in patients taking antihypertensive medication, with an incidence rate of 30–60%. Although chronotherapy with antihypertensive agents may provide a new direction for effective control of nocturnal blood pressure, the clinical evidence base remains controversial. This research is presently underway to compare the effects of morning and bedtime administration of antihypertensive medication on nocturnal reduction and circadian rhythm of blood pressure in patients with hypertension.Methods and analysisThis study is being performed as a randomized, multicenter, open-label, parallel-group, clinical trial in which 720 participants are to undergo 24-h ambulatory blood pressure measurement (ABPM) and office blood pressure measurement (OBPM) at baseline before being randomly assigned to a morning (6–10 am) or a bedtime (6–10 pm) administration group. Each participant receives one 20/5-mg tablet of olmesartan/amlodipine (OA) daily for 4 weeks and is then followed up at 4-week intervals for a total of 12 weeks. During follow-up, the OA dosage is adjusted according to the ABPM and OBPM results. Patients with uncontrolled hypertension at the first follow-up visit will receive an increase in OA dosage to 1.5 tablets/day. For patients with blood pressure that is still uncontrolled after a further 4 weeks, the dosage of OA can be increased to 2 tablets/day. The primary objective is the reduction in mean nocturnal systolic blood pressure between baseline and week 12. The secondary objectives are the reduction in ambulatory blood pressure at weeks 4 and 12 and the blood pressure control rate at weeks 4, 8, and 12.DiscussionAntihypertensive chronotherapy remains controversial. A superiority test hypothesis design has been adopted for this trial, in which all participants will be taking the same antihypertensive medication. We anticipate that our findings will determine if nocturnal blood pressure control in Chinese patients with essential hypertension varies according to whether antihypertensive medication is taken in the morning or at bedtime. This study may provide scientific evidence for the application of chronotherapy in clinical practice.Trial registrationChiCTR2200059719. Registered on 10 May 2022(http://www.chictr.org.cn/edit.aspx?pid=169782&htm=4) {2a,2b}

A nomogram for predicting mild cognitive impairment in older adults with hypertension

BackgroundHyper- and hypotension increase the risk of cognitive dysfunction. As effective control of blood pressure can reduce the risk of mild cognitive impairment (MCI), early risk assessment is necessary to identify MCI in senile hypertension as soon as possible and reduce the risk of developing dementia. No perfect risk-prediction model or nomogram has been developed to evaluate the risk of MCI in older adults with hypertension. We aimed to develop a nomogram model for predicting MCI in older patients with hypertension.MethodsWe selected 345 older patients with hypertension in Xixiangtang District, Nanning City, as the modeling group and divided into the MCI (n = 197) and non-MCI groups (n = 148). Comparing the general conditions, lifestyle, disease factors, psychosocial and other indicators. Logistic regression was used to analyze risk factors for MCI in older hypertensive patients, and R Programming Language was used to draw the nomogram. We selected 146 older patients with hypertension in Qingxiu District, Nanning City, as the verification group. The effectiveness and discrimination ability of the nomogram was evaluated through internal and external verification.ResultsMultivariate logistic regression analysis identified 11 factors, including hypertension grade, education level, complicated diabetes, hypertension years, stress history, smoking, physical exercise, reading, social support, sleep disorders, and medication compliance, as risk factors for MCI in older patients with hypertension. To develop a nomogram model, the validity of the prediction model was evaluated by fitting the curve, which revealed a good fit for both the modeling (P = 0.98) and verification groups (P = 0.96). The discrimination of the nomogram model was evaluated in the modeling group using a receiver operating characteristic curve. The area under the curve was 0.795, and the Hosmer–Lemeshow test yielded P = 0.703. In the validation group, the area under the curve was 0.765, and the Hosmer–Lemeshow test yielded P = 0.234.ConclusionsWe developed a nomogram to help clinicians identify high-risk groups for MCI among older patients with hypertension. This model demonstrated good discrimination and validity, providing a scientific basis for community medical staff to evaluate and identify the risk of MCI in these patients at an early stage.

Elevated blood pressure accelerates white matter brain aging among late middle-aged women: a Mendelian Randomization study in the UK Biobank.

Elevated blood pressure (BP) is a modifiable risk factor associated with cognitive impairment and cerebrovascular diseases. However, the causal effect of BP on white matter brain aging remains unclear. In this study, we focused on N = 228 473 individuals of European ancestry who had genotype data and clinical BP measurements available (103 929 men and 124 544 women, mean age = 56.49, including 16 901 participants with neuroimaging data available) collected from UK Biobank (UKB). We first established a machine learning model to compute the outcome variable brain age gap (BAG) based on white matter microstructure integrity measured by fractional anisotropy derived from diffusion tensor imaging data. We then performed a two-sample Mendelian randomization analysis to estimate the causal effect of BP on white matter BAG in the whole population and subgroups stratified by sex and age brackets using two nonoverlapping data sets. The hypertension group is on average 0.31 years (95% CI = 0.13-0.49; P < 0.0001) older in white matter brain age than the nonhypertension group. Women are on average 0.81 years (95% CI = 0.68-0.95; P < 0.0001) younger in white matter brain age than men. The Mendelian randomization analyses showed an overall significant positive causal effect of DBP on white matter BAG (0.37 years/10 mmHg, 95% CI 0.034-0.71, P = 0.0311). In stratified analysis, the causal effect was found most prominent among women aged 50-59 and aged 60-69. High BP can accelerate white matter brain aging among late middle-aged women, providing insights on planning effective control of BP for women in this age group.

Management of hypertension in non-dialysis and dialysis patients with chronic kidney disease: Chinese expert consensus

Chronic kidney disease (CKD) is a global public health problem that is usually progressive. Hypertension is a risk factor for the progression of CKD, and cardiovascular disease is the most common cause of death in patients with CKD. In Chinese patients with CKD, there is a high prevalence of hypertension and a poor rate of control. Several studies have demonstrated that effective blood pressure control can delay the progression of kidney disease and reduce the risk of cardiovascular events and all-cause mortality. Based on previously published high-quality evidence, guidelines and consensus reports, the Zhongguancun Nephropathy and Blood Purification Innovation Alliance formulated a new consensus. This consensus includes blood pressure measurement; the blood pressure management of non-dialysis patients, dialysis patients and kidney transplantation patients, and the interaction between commonly used drugs and antihypertensive drugs. The consensus aims to further strengthen the standardization and safety of blood pressure management in CKD patients, delay disease progression, reduce disease burden, and comprehensively improve the quality-of-life and prognosis of patients with CKD.

#3484 A NETWORK META-ANALYSIS COMPARING INTENSIVE GLYCEMIC CONTROL AND SGLT-2 INHIBITORS IN PREVENTING RENAL OUTCOMES

Abstract Background and Aims Type 2 diabetes (T2D) is one of the prominent causes for chronic kidney disease (CKD) leading to end-stage renal failure. Traditionally, prevention and retardation of CKD was attempted with effective glycemic and blood pressure control. In recent times sodium glucose co-transporter 2 inhibitors (SGLT-2is), glucagon-like peptide 1 receptor agonists (GLP1-RA), and non-steroidal mineralocorticoid receptor (MRA) inhibitors have proved to be excellent agents in preventing cardio-renal outcomes in patients with T2D, independent of baseline glucose control. SGLT-2is rank the highest in recent network meta-analysis-based scoring. We conducted this network meta-analysis to explore the ranking of intensive glucose therapy in comparison to SGLT-2is, to better understand the present position of the traditional approach and its relevance. Method A database search was conducted using the Cochrane library to identify relevant citations. Analysis was conducted using RStudio (2022.07.1, Build 554). Using progression of macroalbuminuria and end-stage kidney disease (ESKD) as the outcomes of interest, scoring was performed comparing intensive glycemic control (IGC) and SGLT-2is. Using a frequentist approach P-score was conducted and corroborated using the Surface Under the Cumulative Ranking (SUCRA) using Bayesian network meta-analysis. Results A pooled population of 62,742 patients from twelve citations were included for analysis. The Cochrane risk of bias was used to assess quality of the studies. IGC scored higher than SGLT-2is as far as retardation of progression of macroalbuminuria was concerned while using both the P-score (0.99 Vs 0.50) as well as the SUCRA (0.97 Vs 0.52). A similar trend was also observed with ESRD as the end point with both the P-score (0.84 Vs 0.65) and the SUCRA (0.81 Vs 0.68) rankings favoring IGC (Fig. 1). Conclusion The importance of achieving glycemic targets should be emphasized in recommendations in the same footing as the choice of individual reno-protective agents.

RENAL DENERVATION REDUCES RETINAL ARTERIAL REMODELING IN PATIENTS WITH TREATMENT RESISTANT HYPERTENSION AND TYPE 2 DIABETES MELLITUS

Objective: Renal denervation has been shown to be a safe and effective method to lower blood pressure (BP) in patients with uncontrolled treatment resistant hypertension (TRH). Patients with TRH and T2DM typically show hypertrophic arteriolar remodeling, which is associated with the development of early target end-organ damage. By using the retinal vasculature as a mirror of vascular remodeling in the systemic circulation, arteriolar remodeling can be non-invasively assessed with Scanning Laser Doppler Flowmetry (SLDF). In this analysis we assessed the impact of RDN on retinal arteriolar remodeling in patients with TRH and T2DM. Design and method: Retinal arteriolar remodeling was assessed using SLDF together with office and 24-hour ambulatory BP before and 6 as well as 12 months after renal denervation in 22 patients with TRH and T2DM. All patients participated in the investigator initiated study program “Renal Denervation in Treatment Resistant Hypertension” (NCT01687725). SLDF allows confocal measurement of the retinal arteriolar parameters, such as outer (OD) and inner (ID) diameter. Based on ID and OD the following parameters of arteriolar remodeling are derived: retinal arteriolar wall thickness (WT), wall-to-lumen ratio (WLR), and retinal arteriolar crosssectional area (CA). Results: Retinal arteriolar parameters were analysed in 18 male and 4 female patients with 6.5 antihypertensive medications on average. There was a significant reduction of systolic and diastolic 24-hour ambulatory as well office BP 6 as well as 12 months after RDN (table 1). In 77.3% of the patients number of antihypertensive medications was reduced. We found a reduction of hypertrophic retinal arteriolar remodeling and also a reduction of WLR 12 months after RDN (table 1). Of note, no significant changes of retinal arteriolar remodeling were found 6 months after RDN. Conclusions: In very high-risk patients with TRH and T2DM endovascular RDN reduced retinal arteriolar remodeling and retinal wall-to-lumen ratio, a prognostic marker of further end-organ damage. Whereas BP-changes already occurred 6 months after RDN, changes in retinal arteriolar remodelling were observed 12 months after RDN. We conclude that after RDN reversal of arteriolar remodeling happens slowly and requires long-term effective BP control.

Investigation of effective invasive blood pressure control methods to prevent acute exacerbation of acute aortic dissection.

Acute aortic dissection is associated with high mortality and increased risk of complications. Acute exacerbations have a relatively high frequency; however, the contributing factors are unclear. Blood pressure (BP) and heart rate control are important factors, but the ideal BP control strategy to prevent acute exacerbations under invasive arterial pressure monitoring remains unclear. Therefore, in this study, we aimed to determine the relationship between invasive arterial BP and the effects of acute exacerbation of aortic dissection. This single-centre, retrospective, case-control study included 104 patients with a partial diagnosis of acute aortic dissection (Stanford type A or B) who were treated conservatively between September 2013 and September 2022. The patients were divided into exacerbation (acute exacerbation; n = 26) and stable (no acute deterioration) groups. The SBP trend (122.5 ± 13.1 vs. 116.6 ± 10.6 mmHg, respectively; P = 0.024) and mean BP trend (77.8 ± 5.8 vs. 74.4 ± 7.5 mmHg, respectively; P = 0.038) significantly differed between the two groups. The time to target BP was significantly longer in the exacerbation group ( P = 0.036). The exacerbation group did not achieve a mean SBP < 120 mmHg. Moreover, the importance of early BP reduction was demonstrated in the present study.

Management of hypertension in patients supported with continuous flow left ventricular assist devices.

Hypertension remains one of the most common clinical problems leading to devastating postleft ventricular assist device (LVAD) implant complications. This study reviews the pathophysiology of hypertension in the setting of continuous flow LVAD support and provides an update on currently available antihypertensive therapies for LVAD patients. The true prevalence of hypertension in the LVAD population remains unknown. Effective blood pressure (BP) control and standardization of BP measurement are key to prevent suboptimal left ventricular unloading, pump malfunction and worsening aortic regurgitation. Angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), beta blockers and mineralocorticoid receptor antagonists (MRA) are the preferred antihypertensive agents because of their additional potential benefits, including optimization of haemodynamics, prevention of stroke, gastrointestinal bleed and in some patients myocardial recovery. Angiotensin receptor-neprilysin inhibition (ARNI) may be a well tolerated and effective therapy for BP control especially among CF-LVAD patients with resistant hypertension. Similarly, sodium glucose co-transporter 2 inhibitors (SGLT2i) should be considered in the absence of contraindications. Hypertension is very common post-LVAD implant. Heart failure guideline directed medical therapies, including ACEI, ARB, beta blockers and MRA, are the preferred antihypertensive agents to improve post-LVAD outcomes.

Abstract P307: Elevated Blood Pressure Accelerates White Matter Brain Aging in Late Middle-Aged Women: A Mendelian Randomization Study in UK Biobank

Background: Elevated blood pressure (BP) is a modifiable risk factor associated with cognitive impairment and cerebrovascular diseases. However, the causal effect of BP on white matter (WM) brain aging remains unclear. In this study, we hypothesize that increasing BP will accelerate WM brain aging. Methods: In our study, we focused on N=219,968 non-pregnant, family-unrelated individuals of European ancestry who had genotype data and two non-null clinical BP measurements available (99,532 male and 120,436 female, age range: 40-69, 16,901 have neuroimaging data available) collected from UK Biobank (UKBB). In the current study, we adopted a chronological age-adjusted brain age metric, Brain Age Gap (BAG), as the outcome variable to measure the brain aging status. As a first step, we applied machine learning method to establish the model to compute BAG based on fractional anisotropy (FA) measurements derived from structural neuroimaging data among a group of subjects without hypertension (N=7,728). The established model will be applied to calculate WM BAG in other subjects with or without hypertension. We then performed association analysis as well as a two-sample Mendelian Randomization (MR) analysis to estimate the causal effect of BP on WM BAG in the whole population and subgroups stratified by gender and age brackets . In the first sample with genotype and BP data but no WM FA data (N=20,3067), we tested the genetic-exposure association and identified relevant genetic variants as instrumental variables. In the second non-overlapping sample with genotype, BP, and WM FA data, we tested the genetic-outcome association (N=8,822). The causal effect of BP on WM BAG is estimated by using a generalized version of the inverse-variance weighted (IVW) approach. Results: The non-hypertension group and females had younger brains (WM BAG) across all the year cycles than the hypertension group by 0.3098 year and males by 1.2666 years, respectively, both p &lt;0.0001. The association analysis revealed that both Diastolic Blood Pressure (DBP) and Systolic Blood Pressure (SBP) had a stronger significant relationship with WM BAG among females (&amp;#946;SBP=0.0149; &amp;#946;DBP=0.0233), 50-59 aged group (&amp;#946;SBP=0.0163; &amp;#946;DBP=0.0259), and 60-69 aged group (&amp;#946;SBP=0.0086; &amp;#946;DBP=0.0147), all p &lt; 0.0001. The MR analyses showed that DBP had a significant causal effect on WM BAG among females aged 50-59 (&amp;#946;=0.0720, p=0.0243) and females aged 60-69 (&amp;#946;=0.1000, p=0.0085). We only observed SBP had a marginal causal effect (0.05&lt;p&lt;0.1) among males aged 50-59 (&amp;#946;= -0.0458), females aged 40-49 (&amp;#946;= -0.0446) and aged 50-59 (&amp;#946;=0.0326). Conclusion: Hypertension and genetic predisposition to higher BP can accelerate WM brain aging specifically targeting at late middle-aged women, providing insights on planning effective control of BP for women in this age group.

Association of Uncontrolled Hypertension or Diabetes Mellitus With Major Adverse Cardiovascular Events and Mortality in South Korea: Population-Based Cohort Study

Managing hypertension (HT) and diabetes mellitus (DM) is crucial to preventing cardiovascular diseases. Few studies have investigated the incidence and risk of cardiovascular diseases or mortality in uncontrolled HT or DM in the Asian population. Epidemiological studies of cardiovascular disease should be conducted with continuous consideration of the changing disease risk profiles, lifestyles, and socioeconomic status over time. We aimed to examine the association of uncontrolled HT or DM with the incidence of cardiovascular events or deaths from any cause. This population-based retrospective study was conducted using data from the Korean National Health Insurance Service-National Health Screening Cohort, including patients aged 40-79 years who participated in national screening from 2002 to 2003 and were followed up until 2015. The health screening period from 2002 to 2013 was stratified into 6 index periods in 2-year cycles, and the follow-up period from 2004 to 2015 was stratified accordingly into 6 subsequent 2-year periods. The incidence rates and hazard ratio (HR) for major adverse cardiovascular events (MACE) and death from any cause were estimated according to HT or DM control status. Extended Cox models with time-dependent variables updated every 2 years, including sociodemographic characteristics, blood pressure (BP), fasting blood glucose (FBG), medication prescription, and adherence, were used. Among the total cohort of 440,249 patients, 155,765 (35.38%) were in the uncontrolled HT or DM group. More than 60% of the patients with HT or DM who were prescribed medications did not achieve the target BP or FBG. The incidence of MACE was 10.8-15.5 and 9.6-13.3 per 1000 person-years in the uncontrolled DM and uncontrolled HT groups, respectively, and increased with age. In the uncontrolled HT and DM group, the incidence of MACE was high (15.2-17.5 per 1000 person-years) at a relatively young age and showed no age-related trend. Adjusted HR for MACE were 1.28 (95% CI 1.23-1.32) for the uncontrolled DM group, 1.32 (95% CI 1.29-1.35) for the uncontrolled HT group, and 1.54 (95% CI 1.47-1.60) for the uncontrolled HT and DM group. Adjusted HR for death from any cause were 1.05 (95% CI 1.01-1.10) for the uncontrolled DM group, 1.13 (95% CI 1.10-1.16) for the uncontrolled HT group, and 1.17 (95% CI 1.12-1.23) for the uncontrolled HT and DM group. This up-to-date evidence of cardiovascular epidemiology in South Korea serves as the basis for planning public health policies to prevent cardiovascular diseases. The high uncontrolled rates of HT or DM, regardless of medication prescription, have led us to suggest the need for a novel system for effective BP or glycemic control, such as a community-wide management program using mobile health technology.

Antihypertensive Drug Usage and Target Blood Pressure Attainment in Postrenal Transplant: A Prospective Study in Indian Population

Introduction: The etiology of hypertension in post renal transplant patients is multifold and effective control of blood pressure (BP) contributes towards proper graft functioning and reduces risk of cardiovascular diseases. This prospective observational study was undertaken to evaluate the prevalence of antihypertensive drug use, the prescribing pattern and trends of blood pressure control in a cohort of post renal transplant patients from eastern India. Materials and Methods: Patients who had undergone renal transplant in this public hospital were enrolled as per eligibility criteria. All enrolled patients were on antihypertensive from at least 3months prior to transplant and were followed upto one year post-transplant. Antihypertensive drug (AHD) and immunosuppressant intake, BP recordings and occurrence of major adverse cardiac events (MACE), if any were noted at each visit. Results: 56 patients were enrolled with a mean age of 33.04 ± 9.96 years, 87.5% were male. 75% were hypertensive at discharge (2-3 weeks post-transplant). Percentage of patients on AHD at 3, 6, 9 and 12 months post-transplant were 83.9%, 82.1%, 75% and 71.4% respectively. Amlodipine was the most common prescribed AHD. Target BP control (≤130/80 mm of Hg) was achieved in 62.5% patients at 1year post-transplant. There were no major adverse cardiac events (MACE) during the study period. Conclusion: In our study comprising of a relatively young cohort of transplant patients from India, hypertension control was well achieved in majority of the subjects and no MACE were noted. Amlodipine was the most commonly used AHD either as monotherapy or in combination with beta-blocker. Long term follow up of this cohort shall provide further insights into the trends of such control.