Effects Of Antihypertensive Medications Research Articles

Abstract WP397: Effect of Anti-Hypertensive Medications on Hemorrhagic Transformation in Ischemic Stroke

Introduction: Ischemic Stroke is one of the leading causes of mortality and morbidity in the US. Hemorrhagic Transformation (HT) is one the most feared complications of ischemic stroke increasing its mortality and disability, especially in the setting of administration of TPA (tissue plasminogen activator) and intervention with thrombectomy. The objective of this study is to understand the effect of anti-hypertensive medications (AHMs) on hemorrhagic transformation in ischemic stroke patients. Methods: This is a retrospective study in patients who underwent TPA and/or thrombectomy from 2016 to 2017 at a tertiary referral center. . Primary outcome measure was HT at 24 hours in the setting of use of AHMs. Subject stratification was done based on patient’s age, sex, stroke side and location, blood pressure, anti-hypertensive medications (AHMs), admission type (direct emergency room admission versus outside hospital transfer), and lab values on admission. Results: 140 patients were included in this study. Use of AHMs was done in 53 (37.8%) patients. With regards to individual AHMs used, nicardepine was used in 35 (25.00%), labetolol in 50 (35.71%), hydralazine in 15 (10.7%), esmolol in 19 (13.57%) and others in 3 (2.14%) of these patients. Logistic regression model including only admission type and use of any antihypertensive medication as predicting variables was performed, and the use of any anti-hypertensive medications was statistically significant in predicting the odds of HT. Subjects in whom no AHMs were used were found to have 121% higher odds for HT relative to those who were given any AHMs(OR=2.210, 95% C.I. 1.031-4.740, p=0.0416). Individual AHMs nicardepine, labetolol, hydralazine, esmolol or others and admission type did not differ significantly in predicting the odds of HT. Conclusion: Our study shows the use of AHMs to be associated with decreased risk of hemorrhagic transformation in patients who received TPA, thrombectomy or both. There was no statistical significance in relation to specific antihypertensive medications used with regards to hemorrhagic transformation.

Effect of antihypertensive medications on thrombolysis therapy and outcomes in acute ischemic stroke patients.

There are concerns that specific risk factors may alter the benefits of thrombolysis in stroke patients with controlled contraindications including hypertension. The objective of this study was to evaluate the association between clinical risk factors and outcomes in ischemic stroke patients that received thrombolysis therapy pretreated with antihypertensive medications. Using data obtained from a stroke registry, a non-randomized retrospective data analysis was conducted on patients with the primary diagnosis of acute ischemic stroke with hypertension pretreated with antihypertensive medications. The association between clinical risk factors and functional ambulatory outcome was determined using logistic regression while odd ratios (OR) were used to predict the odds of achieving improved ambulatory outcome in thrombolysis treatment status. Improved or poor functional ambulatory outcome was considered as the end point in our analysis. A total of 4665 acute ischemic stroke patients were identified, of whom 1446 (31.0%) were eligible for thrombolysis, while 3219 were not, and 595 received rtPA, of whom 288 were on antihypertensive medications, while 233 were not. In the rtPA group with antihypertensive (anti-HTN) medication, only NIHSS score (OR=1.094, 95% CI, 1.094-1.000, P=0.005) was associated with improved functional outcome while patients with congestive heart failure (OR=0.385, 95% CI, 0.385-0.159, P=0.035) and patients with a history of previous TIA (OR=0.302, 95% CI, 0.302-0.113, P=0.017) were more likely to be associated with poor functional outcomes. Congestive heart failure and TIA are independent predictors of functional outcomes in stroke patients pretreated with antihypertensive medications prior to thrombolysis therapy.

Assessment of Heart Rate Variability in Young Patients with Primary Hypertension

Objective: this study aimed to determine the association between HRV and hypertension young adult patients, the effect of antihypertensive medications on HRV parameters was also studied. Subjects and Methods: 70 subjects under age of 40 years were classified into two groups: A- Patients’ group, It included 50 subjected they were classified according to type of antihypertensive medications into 3 subgroups; 1): 20 patients on ACE-I, (2): 15 patients on BB, 3): 15 patients on CCB. B)- Control group included 20 healthy subjects. Pulse rate, BP, ECG, and 24h Holter monitor were used to measure heart rate variability (HRV). Results: high statistical significant difference was found between patients and control according to SDNN rMSSD, pNN50 and LF/HF ratio ( P < 0.001). HRV parameters showed improvement in patient treated by BB and ACE-I, whereas no improvement was seen in patients treated by CCB. Conclusion: disturbed cardiac autonomic function was found in young hypertensive patients, treating such patients with either BB or ACE-I was associated with improvement of such autonomic imbalance.

Effect of Antihypertensive Medication on Cerebral Small Vessel Disease: A Systematic Review and Meta-Analysis.

Hypertension is an important risk factor for cerebral small vessel disease. We aimed to study the effect of antihypertensive medication (AHM) on the progression of cerebral small vessel disease. We performed a systematic literature search of electronic databases up to January 30, 2017, for randomized controlled trials on the effect of AHM on ≥1 cerebral small vessel disease magnetic resonance imaging markers (ie, white matter hyperintensities, lacunes, microbleeds, enlarged perivascular spaces, acute small subcortical infarcts, and brain atrophy) after ≥1 year. We performed a random-effects meta-analysis using standardized mean difference. We included 4 trials, including patients with stroke, with diabetes mellitus, and people ≥70 years of age. Patients in the AHM group had less progression of white matter hyperintensity during 28 to 47 months (standardized mean difference, -0.19; 95% confidence interval, -0.32 to -0.06; I2=20%; n=1369). Two trials reported on progression of brain atrophy with conflicting results. None of the trials reported on other cerebral small vessel disease markers. AHM has a protective effect on the progression of white matter hyperintensities, but no effect on brain atrophy. There are no trials on the effect of AHM on lacunes, microbleeds, enlarged perivascular spaces, or acute small subcortical infarcts.

Musical auditory stimulus acutely influences heart rate dynamic responses to medication in subjects with well-controlled hypertension

Music can improve the efficiency of medical treatment when correctly associated with drug action, reducing risk factors involving deteriorating cardiac function. We evaluated the effect of musical auditory stimulus associated with anti-hypertensive medication on heart rate (HR) autonomic control in hypertensive subjects. We evaluated 37 well-controlled hypertensive patients designated for anti-hypertensive medication. Heart rate variability (HRV) was calculated from the HR monitor recordings of two different, randomly sorted protocols (control and music) on two separate days. Patients were examined in a resting condition 10 minutes before medication and 20 minutes, 40 minutes and 60 minutes after oral medication. Music was played throughout the 60 minutes after medication with the same intensity for all subjects in the music protocol. We noted analogous response of systolic and diastolic arterial pressure in both protocols. HR decreased 60 minutes after medication in the music protocol while it remained unchanged in the control protocol. The effects of anti-hypertensive medication on SDNN (Standard deviation of all normal RR intervals), LF (low frequency, nu), HF (high frequency, nu) and alpha-1 scale were more intense in the music protocol. In conclusion, musical auditory stimulus increased HR autonomic responses to anti-hypertensive medication in well-controlled hypertensive subjects.

Pharmacologic Treatment of Hypertensive Urgency in the Outpatient Setting: A Systematic Review

BackgroundHypertensive urgency (HU), defined as acute severe uncontrolled hypertension without end-organ damage, is a common condition. Despite its association with long-term morbidity and mortality, guidance regarding immediate management is sparse. Our objective was to summarize the evidence examining the effects of antihypertensive medications to treat.MethodsWe searched the PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Database of s of Reviews of Effects (DARE), Cochrane Database of Systematic Reviews, Web of Science, Google Scholar, and Embase through May 2016. Study selection: We evaluated prospective controlled clinical trials, case–control studies, and cohort studies of HU in emergency room (ER) or clinic settings. We initially identified 11,223 published articles. We reviewed 10,748 titles and abstracts and identified 538 eligible articles. We assessed the full text for eligibility and included 31 articles written in English that were clinical trials or cohort studies and provided blood pressure data within 48 h of treatment. Studies were appraised for risk of bias using components recommended by the Cochrane Collaboration. The main outcome measured was blood pressure change with antihypertensive medications. Since studies were too diverse both clinically and methodologically to combine in a meta-analysis, tabular data and a narrative synthesis of studies are presented.ResultsWe identified only 20 double-blind randomized controlled trials and 12 cohort studies, with 262 participants in prospective controlled trials. However, we could not pool the results of studies. In addition, comorbidities and their potential contribution to long-term treatment of these subjects were not adequately addressed in any of the reviewed studies.ConclusionsLongitudinal studies are still needed to determine how best to lower blood pressure in patients with HU. Longer-term management of individuals who have experienced HU continues to be an area requiring further study, especially as applicable to care from the generalist.

The effect of antihypertensive medication and exercise training on functional status in hypertensive older adults

The effect of antihypertensive medication and exercise training on functional status in hypertensive older adults

Total sleep time does not influence the effectiveness of antihypertensive medications in obstructive sleep apnoea

Total sleep time does not influence the effectiveness of antihypertensive medications in obstructive sleep apnoea

Abstract 096: Comparing Strategies to Improve Systolic Blood Pressure Over 10 Years: A Simulation Study Using the Blood Pressure Control Model

Background: Uncontrolled hypertension increases patients’ risk for cardiovascular and kidney disease. This study compared strategies to improve systolic blood pressure (SBP) among 1000 simulated patients with uncontrolled hypertension (SBP &gt;=140 mmHg) from the National Health and Nutrition Examination Survey (NHANES). Methods: The Blood Pressure Control Model (BPCM) is a microsimulation, health state transition model that predicts the weekly SBP of patients receiving usual care. In the BPCM, patient SBPs are estimated using office visit frequency, measured SBP accuracy and variability, probability of treatment intensification with uncontrolled SBP, effect of antihypertensive medications, and adherence. BPCM inputs are derived from national survey data, meta-analyses, and other published literature. The effects of usual care on SBP were compared to 10% and 50% increases in global strategies for SBP control (i.e., visit frequency, treatment intensification, and/or adherence) over 10 years. SBP outcomes were validated against published literature values of 44-46% prior to implementation (i.e., usual care) and 74-80% 8-10 years after implementation of aggressive hypertension management programs in large health systems. Results: In the simulated NHANES population, the mean (SD) age was 61.1 (14.6), 52% were male, and mean baseline SBP was 153.2 (13.6) mmHg. Under usual care, the BPCM estimated a mean SBP of 140.1 (16.4) mmHg and 49% of patients achieving SBP &lt;140 mmHg after 10 years. Compared to usual care, 50% improvements in global strategies resulted in more rapid reductions in SBP and earlier achievement of SBP control. Simultaneously improving all global strategies by 50% resulted in an estimated mean SBP of 132.4 (15.5) mmHg with 71% achieving control after 10 years. Conclusions: Usual care and intervention BPCM predictions are consistent with hypertension control rates observed in contemporary national surveys and the observed results of recent systematic hypertension control improvement programs. These results show the BPCM may be used by health system planners to project the impact of implementing hypertension control strategies.

Understanding untreated hypertension from patients’ point of view: A qualitative study in rural Yogyakarta province, Indonesia

Objectives This study aimed to explore perspectives about hypertension from patients who do not take anti-hypertensive medications. Factors that shape their perspectives as well as patients' expectations were also canvassed. Method Individual, face-to-face interviews were conducted with 30 people (≥45 years old) living in rural villages, diagnosed with hypertension, who had not taken any anti-hypertensive medications for at least one year. Interviews were audiotaped, transcribed verbatim and thematically analysed. Results Four themes emerged: (1) alternative medicines for managing high blood pressure; (2) accessing health care services; (3) the need for anti-hypertensive medications; and (4) existing support and patients' expectations. Reluctance to take anti-hypertensive medications was influenced by patients' beliefs in personal health threats and the effectiveness of anti-hypertensive medications, high self-efficacy for taking alternative medicines, the lack of recommendation regarding hypertension treatment, and barriers to accessing supplies of medicines. Conclusion Despite their awareness of being diagnosed with hypertension, patients undervalued visiting a health professional to control their high blood pressure. Health strategies need to consider patients' beliefs, concerns and expectations. Providing an accessible, affordable and adequate supply of hypertension medication is also key to any programs designed to optimise hypertension management.

PS 01-15] REDUCED DNA METHYLATION THE HUMAN KIDNEY IS ASSOCIATED WITH INCREASED BLOOD PRESSURE

Background and aims: There is increasing evidence that epigenetic modifications such as DNA methylation (addition of a methyl group to DNA (5mC) that leads to altered gene expression) is important to the development of common complex cardiovascular diseases. A recent study found that DNA methylation of blood cells is associated with blood pressure (BP). So far there has been no studies of epigenetic changes in the kidney, which is a key organ in BP regulation and the development of hypertension. The aim of this study was to examine associations between BP and the global methylation profiles of the kidney and blood. Methods and results: We used 93 human renal tissue samples from the TRANScriptome of RenaL HumAN TissueE (TRANSLATE) Study. All samples were collected from healthy, unaffected by cancer pole of the kidney after elective unilateral nephrectomies. DNA was extracted using the DNeasy Qiagen kit according to the protocol from blood and kidney samples. Global methylation was measured by ELISA assay to determine the percentage of 5mC in all DNA samples. A significant negative relationship was found between renal 5mC percentages and systolic (SBP) and diastolic (DBP) blood pressure (SBP r = -0.25, P = 0.018, DBP r = -0.32, P = 0.002). This correlation was also evident when BP is corrected for effects of antihypertensive medications (adjusted SBP P = 0.046, adjusted DBP P = 0.009). Comparatively, there was no significant relationship between 5mC percentage and BP in DNA extracted from peripheral blood leukocytes. Conclusions: We found a significant negative correlation between the percentage of 5mC and BP in the renal DNA samples indicating that reduced DNA methylation leads to increased blood pressure. No such relationship was established in the leukocyte DNA, indicating that blood may not be a good template for analysis of epigenetic modifications in the hypertensive population.

Antihypertensive Therapy in Females: A Clinical Review Across the Lifespan.

Hypertension affects one-third of all females in the United States, with the prevalence increasing over a female's lifespan. The approach to treating females with hypertension varies depending on a female's age, race, comorbidities, and whether she is of child-bearing age or pregnant. It is important to factor in the safety and effectiveness of antihypertensive medications across these populations of females. Blood pressure target goals are the same in females as in males regardless of comorbidities or stage of life, with the exception of those females who are pregnant. Recommendations for antihypertensive medication do not differ between females and males based on disease state or stage of life, with the exception of females who are pregnant, breastfeeding, or of child-bearing age. Multiple guidelines recommend avoiding renin-angiotensin system blockers during pregnancy and suggest balancing the risk versus benefit in females of child-bearing age. Further, multiple guidelines provide race-based therapy recommendations for the use of calcium channel blockers and thiazide diuretics in black versus nonblack patients, irrespective of sex. Future research is needed to evaluate whether there are sex differences relative to blood pressure and cardiovascular event-lowering relative to specific antihypertensive medications with a focus on pharmacogenomic differences.

The Effect of Antihypertensive Medications on the Brachial and Central Aortic Blood Pressures in Dialysis Patients in the Outpatient Setting

The Effect of Antihypertensive Medications on the Brachial and Central Aortic Blood Pressures in Dialysis Patients in the Outpatient Setting

Abstract P024: Pharmacological Treatment of Hypertension and Lv Dysfunction Predictors in ESRD Patients With AV Fistula

Background: Effects of anti-hypertensive medications on left ventricular dimensions and systolic function in patients with arterio-venous (AV) fistulas have not been well investigated. Material and Methods: Medical charts and echocardiograms of 346 patients with AV fistula were reviewed. Of 346, 149 patients had TTE prior to the AV fistula surgery, 197 had TTE after the AV fistula surgery, and 76 patients had TTE before and after the AV fistula surgery. Data on medication use was available in 314 patients. ANOVA, chi-square, and logistic regression tests were employed. Results: In patients scheduled for AV fistula placement, 20% (31/149) patients had systolic dysfunction and 15% (22/142) had increased LV end-diastolic dimensions (LVEDD). Moderate systolic LV dysfunction was observed in 6% (9/149) and additional 8% (12/149) had severe LV dysfunction. Increased LVEDD with some LV dysfunction was noted in 27% (38/142).Following the AV fistula placement, 18% (36/197) of patients had systolic dysfunction and 12% (22/187) had increased LV end-diastolic dimensions (LVEDD). Moderate or severe systolic LV dysfunction was observed in 6% (5/197). LV systolic dysfunction or dilatation was noted in 23% (43/187). Of 314 patients, 63% were on beta-blockers (BB), 25% were on ACE inhibitor or an ARB , 43% on calcium-channel blocker , and 15% on alpha-antagonist . BB, ACEi-ARB, or AA were not associated with increased LVEDD or systolic dysfunction before or after the AV fistula placement. Prior to AV fistula, CCB treatment was not related to LV dilatation (36% in each group, p=0.981) Post AV fistula, CCB treatment was associated with increased LV dimensions (71% vs. 46%, p=0.029) but not LV systolic dysfunction (49% in LV dysfunction vs. 38% in the rest, p=0.446) . This association persisted after adjustment for co-morbidities and demographic parameters. Conclusions: LV systolic dysfunction and/or dilatation are common in patients undergoing AV fistula surgery. Despite decreased use of Ca-channel blockers in patients with LV dysfunction prior to AV fistula, Ca-channel blockers are associated with increased LV dimensions post AV fistula, and probably should be avoided in this vulnerable patient population.

Effect of hypertension and antihypertensive medications on residual renal function in children treated with chronic peritoneal dialysis

PurposeTo evaluate the effect of hypertension (HTN) and antihypertensive medications (AHM) on residual renal function (RRF) in children on CAPD and APD. Material/methodsWe retrospectively evaluated underlying kidney disease, systolic and diastolic blood pressure (SBP/DBP), presence and control of HTN (SBP/DBP≥95th percentile), AHM, RRF (daily diuresis, residual glomerular filtration rate [rGFR]), biochemical parameters, BMI Z-score, and dialysis parameters during 12-month follow-up in 87 children (38 CAPD, 49 APD) aged 10.22±4.31 years. The rate of RRF loss was expressed as absolute and relative [%] reduction. ResultsAt baseline, HTN was found in 74.7% patients (CAPD/APD: 84.2%/67.3%, P=0.06), most commonly in HUS and least frequently in CAKUT. The proportion of CAPD/APD patients with poorly controlled HTN was 70.0%/63.3% (P=0.50). Relative daily diuresis loss in children with uncontrolled HTN was higher (P=0.017) compared to children with SBP/DBP <95th percentile. No effect of AHM on the rate of RRF loss was found. In multivariate analysis, absolute daily diuresis loss was related to baseline diuresis (β=−0.30, P<0.001) and proteinuria (β=−0.31, P=0.004); absolute rGFR loss to baseline rGFR (β=−0.73, P<0.001) and glucose load after 12 months (β=−0.36, P=0.02); relative daily diuresis loss to mean BMI Z-score (β=−0.44, P=0.04); and relative rGFR to baseline rGFR (β=−0.37, P<0.001) and SBP percentile (β=−0.21, P=0.045). Conclusions1.Maintaining blood pressure <95th percentile helps preserve RRF in children with ESRD treated with peritoneal dialysis.2.Risk factors for rapid RRF loss in children on CAPD/APD include elevated SBP, high baseline diuresis/rGFR, proteinuria, and high glucose load in the dialysis fluid.

Profile of interdialytic ambulatory blood pressure in a cohort of Chinese patients.

Management of hypertension is one of the fundamental interventions in dialysis patients. However, the profile of interdialytic blood pressure (BP) in Chinese dialysis patients remains elusive. We aim to investigate this issue as well as the effect of antihypertensive medication in this population. We performed 44-h ambulatory BP in 90 patients on maintenance hemodialysis. Patients were classified as 'dipping', 'non-dipping' or 'reverse-dipping' based on night/day ratio (N/D) of systolic BP on nondialysis day. The prevalence of blunted circadian BP pattern was strikingly high (92.2%), with more than half of the patients (55.6%) classified as reverse-dipping. There was a close association between high erythropoietin (EPO) dose used and deteriorated circadian rhythm. Patients in the dipping group also displayed a dipping state for heart rate (HR) compared with the other two groups (N/D of HR: 81.5 ± 6.6 vs 92.1 ± 6.0 and 91.3 ± 10.7, P=0.02). Only 26.7% patients had a controlled nocturnal BP. Patients with bedtime dosing had lower N/D of systolic BP compared with patients without (100.1 ± 7.0 vs 105.2 ± 7.1, P=0.01). Non-dipping and reverse-dipping are highly prevalent in Chinese patients. EPO use and autonomic dysfunction may contribute to the blunted circadian rhythm. More tightly control of nighttime BP is an urgent need and bedtime dosing may be beneficial.

IMPROVING THE METHODOLOGY OF CONTINUOUS MEDICAL EDUCATION IN THE CONTEXT OF ARTERIAL HYPERTENSION TREATMENT

Aim. To assess the role of the algorithm-based selection of antihypertensive therapy (AHT) and the continuous medical education in the treatment of arterial hypertension (AH).Material and methods. Based on the autopsy data, we analysed the prevalence of AH and the structure of its complications and comorbidities among 3239 patients of a multidisciplinary Moscow City hospital. We also analysed the practices of preceding ambulatory AHT and conducted the survey on the quality of continuous medical education lectures delivered to internal medicine specialists working at polyclinics.Results. Among patients who died from cardiovascular disease, a high prevalence of AH (96,1%) was combined with prevalent target organ damage (TOD), a strong association between blood pressure (BP) levels and the risk of major cardiovascular events, and a wide range of comorbidities and AH complications. There was a lack of universal AHT schemes and regimens for patients of similar age, gender, and nature and severity of comorbidities.Conclusion. Achievement of target BP levels failed to prevent major cardiovascular events which resulted in fatal outcomes. AHT was administered without adequate consideration of organo-protective and pleiotropic effects of antihypertensive medications. The development of an algorithm which considered age, gender, TOD presence, and previous major cardiovascular events in the selection of AHT had improved the doctors’ understanding of the lecture information.

Can Antihypertensive Medication Interfere with the Vicious Cycle Between Hypertension and Vascular Calcification?

Vascular calcification is a phenomenon of disturbed calcium deposition, as part of the calcium that is supposed to be deposited to our bones, is lodged to our vessels. There are two forms of vascular calcification, each with a distinct anatomical distribution and clinical relevance, namely the intimal and medial calcification. Studies have demonstrated that hypertension may cause vascular calcification but also that both types of calcification, especially medial, promote arterial rigidity and hence hypertension. Implications of this two-way road are largely unknown as there is no consensus yet on their exact clinical value. However, several antihypertensive medications seem to be able to interfere with the cycle of high blood pressure and vascular calcium deposits. The present review summarizes the up-to-date data regarding the effect of antihypertensive medication on vascular calcification.

615: Impact of intrapartum antihypertensives on electronic fetal heart rate (EFM) patterns in labor

fetal heart rate (EFM) patterns in labor Alison Cahill, Anthony Odibo, Kimberly Roehl, George Macones Washington University in St. Louis, Obstetrics and Gynecology, St. Louis, MO OBJECTIVE: The effect of antihypertensive medications on EFM patterns has been poorly studied despite their frequent use. We aimed to estimate the impact of intravenous antihypertensive medications given in labor on EFM patterns in term infants STUDY DESIGN: We performed a retrospective cohort study of all term ( 37 weeks) deliveries from the second stage of labor. Known anomalies and multiple gestations were excluded. The 30 minutes of EFM prior to delivery was extracted by trained obstetric research nurses using the NICHD criteria, blind to clinic and outcome data. Detailed patient data was collected, including medical history, labor and delivery course, medication exposure, and outcomes. For this analysis, EFM patterns of women given intravenous hydralazine or labetalol (antiHTN) were compared to 2 comparison group: women with hypertensive disorders who did not receive any antihypertensives, and women without hypertensive disorders. Relative risks (RR) and attributable risks (AR) were calculated. Logistic regression was used to adjust for confounding factors including labor induction, race, epidural, and magnesium exposure RESULTS: Of 5,388 women, 4,945 had no hypertensive disorders, 408 had hypertension requiring no medications, and 35 received antiHTN. Attributable to their medication exposure, women who received antiHTN were 15% less likely to have accelerations compared to women without HTN (20.0 v. 35.2%, AR 0.15, 95%CI 0.29, 0.02), and 14% less likely compared to women with HTN who did not receive meds (20.0% v. 34.4%, AR 0.14, 95%CI 0.28, 0.02). There was no effect on EFM baseline, variability, or decelerations. CONCLUSION: Decreased frequency of accelerations is seen after exposure to hydralazine or labetalol, but there is no additional effect on other parameters of the fetal heart rate pattern. 616 Maternal plasma concentration of sST2 and angiogenic/ anti-angiogenic factors at the time of diagnosis of preeclampsia: a link between the immune system and angiogenesis Tamara Stampalija, Amol Malshe, Tinnakorn Chaiworapongsa, Piya Chaemsaithong, Steven Korzeniewski, Alyse Schwartz, Zhong Dong, Sonia Hassan, Roberto Romero NICHD/NIH/DHHS, Perinatology Research Branch, Detroit, MI, Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, MI OBJECTIVE: Angiogenic/anti-angiogenic factors have emerged as one of the most promising biomarkers for preeclampsia (PE). Since not all patients with PE can be identified by these biomarkers, the search for additional biomarkers continues. Recently, the soluble form of ST2 (sST2), a protein capable of binding to interleukin-33 and contributing to a Th1 biased immune response, has been reported to be increased in PE. The aims of this study were: 1) to determine if there is a difference in the maternal plasma concentration of sST2 between PE and normal pregnancy at the time of diagnosis of PE; and 2) to examine the relationships between sST2 and angiogenic/anti-angiogenic factors. STUDY DESIGN: This cross-sectional study included women with PE (n 106) and normal pregnant women (n 131). Plasma concentrations of sST2, soluble vascular endothelial growth factor receptor (sVEGFR)-1, soluble endoglin (sEng), and placental growth factor (PlGF) were determined by ELISA. RESULTS: 1) The mean plasma concentration of sST2 was higher in PE than in normal pregnancy (Figure; each p 0.05); 2) the area under receiver-operating characteristic curve (AUC) for sST2 for the identification of PE was 0.83; 3) each angiogenic/anti-angiogenic factor had a significantly larger AUC than sST2 (sVEGFR-1, 0.95, sEng 0.94, PlGF 0.92; compared to AUC of 0.83 for sST2; each p 0.001); and 4) there was a moderate correlation between sST2 and sVEFGR-1 or sEng (Spearman Rho 0.5 and 0.3, respectively; each p 0.005), but not between sST2 and PlGF (p 0.5). CONCLUSION: 1) Preeclampsia is associated with an elevation of plasma sST2 concentration; 2) there is a mild to moderate correlation between sST2 and anti-angiogenic factors; and 3) each angiogenic/antiangiogenic factor outperforms sST2 in the identification of preeclampsia. The diagnostic performance of sST2 combined with angiogenic/anti-angiogenic factors prior to the diagnosis of preeclampsia remains to be determined. Poster Session IV Academic Issues, Antepartum Fetal, Clinical Ob, Fetus, Genetics, Hypertension, Med-Surg-Diseases, Operative Ob, U/S www.AJOG.org

081 The Relationship Between Hypertension and Hypoalgesia in Individuals At Risk of Cardiovascular Diseases

BACKGROUND: The present study sought to examine the relationship between hypertension and hypoalgesia in people at risk for cardiovascular diseases. It is well established in both animals and in human research that organisms with higher blood pressure (BP) report less pain and/or tolerate pain for a longer duration of time (hypoalgesia). This relationship is also evident in individuals that are currently normotensive but who at risk due to a family history of hypertension. The cause of this relationship is unknown. The effect of anti-hypertensive medications on this relationship has not yet been determined. METHODS: Three hundred and three participants were recruited through the website of the Heart and Stroke Foundation of Ontario as part of a clinical trial in e-counseling. The age range was 45-74 years, 58% were females; 72% used anti-hypertensive medications. Participants were diagnosed with hypertension either in stage 1 (systolic/diastolic BP of 140/90-159/99 mmHg) or stage 2 (systolic/diastolic BP of 160/100-180/110 mmHg). Participants underwent a venipuncture for the purpose of blood sampling. Pain intensity and quality were measured by the Short Form McGill Pain Questionnaire (SF-MPQ). RESULTS: A Pearson correlation coefficient revealed a significant negative correlation between systolic BP and pain ratings on the Visual Analogue Scale (VAS) of the MPQ, r 0.166, p 0.027. Other pain ratings failed to show significant correlation with systolic BP. An independent t-test indicated that participants who took anti-hypertensive medications reported more pain on the MPQ-sensory subscale than those who did not take medications, t(133.13) 2.247, p 0.026. CONCLUSIONS: Support for the relationship between hypertension and hypoalgesia was found in our sample, but only with one pain measure, possibly due to the pain stimulus used which was only mild-to-moderate in severity. The present study found that hypertensive patients may be at risk for under-reporting pain symptoms of cardiovascular diseases, in comparison to normtensive individuals. Antihypertensive drugs may moderate this relationship. 082 PREVALENCE, INCIDENCE AND MORTALITY OF HYPERTENSION IN QUEBEC: PERSPECTIVE FROM ADMINISTRATIVE AND SURVEY DATA