Essential Hypertensive Patients Research Articles

Mediating effect of the NLR on the relationship between HbA1c and left atrial stiffness in overweight patients with hypertension.

We aimed to investigate the association between hemoglobin A1c (HbA1c) and left atrial (LA) stiffness in patients with hypertension and to explore the mediating effect of the neutrophil/lymphocyte ratio (NLR) on this association. Essential hypertensive patients (n=292) aged 18 to 83 years were enrolled and divided into two groups based on the LA stiffness index (LASI): Group I (LASI≤0.32, n=146) and Group II (LASI>0.32, n=146). The LASI was defined as the ratio of early diastolic transmitral flow velocity/lateral mitral annulus myocardial velocity (E/e') to LA reservoir strain. Multivariate linear regression analysis was performed to determine the independent predictors of the LASI. Age, BMI, SBP, HbA1c, CRP and the NLR were significantly greater in Group II than in Group I (P<0.05). Additionally, Group II had a greater LA volume index (LAVI), left ventricular mass index (LVMI), and E/e' and lower LA reservoir, conduit and booster pump strains than Group I (P<0.001). Univariate and multivariate linear regression models revealed that age, SBP, HbA1c, and the NLR were independently associated with the LASI. Further mediation analysis was performed to determine the mediating effect of the NLR on the association between HbA1c and the LASI and revealed that the NLR had a mediating role only in overweight hypertensive patients, and the proportion of the mediating effect was 21.9%. The NLR was independently correlated with the LASI and played a mediating role in the relationship between HbA1c and the LASI in overweight hypertensive patients.

A Comprehensive Insight on Pharmacological Properties of Cilnidipine: A Fourth-generation Calcium Channel Blocker

Abstract: Preventing the development of cardiovascular problems is a key objective of antihypertensive drugs. Many of the non-pressure related coronary risk factors for hypertension are thought to be connected to an increase in sympathetic activity. The sympathetic systems have N-type calcium channels at the nerve terminals that control neurotransmitter release. Cilnidipine is a unique fourth-generation calcium channel blocker with blocking action on both L-/N- type calcium channels. Several L-type calcium channel blockers (Nilvadipine, amlodipine, azelnidipine, nifedipine, etc.) have been used to treat hypertensive patients. Cilnidipine is a novel drug that exerts a hypotensive effect through vasodilation action via blocking L-type calcium channels and potent antisympathetic activity via blocking N-type calcium channels. Inhibiting N-type calcium channels might be a new approach to treating cardiovascular disorders. Therefore, it is expected that cilnidipine may respond well to complicated hypertension. The present review aims to describe the management mechanism of hypertension, and other pharmacological and physicochemical properties of cilnidipine. Cilnidipine has various other beneficial effects such as lipid-lowering effect, reduced white coat effect, improves insulin sensitivity in essential hypertensive patients, ameliorates osteoporosis in ovariectomized hypertensive rats, reduced arterial stiffness, reduced the risk of pedal edema, antinociceptive effects, neuroprotective and renal protective effect, probably through inhibition of N-type calcium channels. Cilnidipine distinguishes itself from other calcium channel blockers due to its wide range of beneficial pharmacological effects. In conclusion, cilnidipine may be more advantageous than other dihydropyridines, such as nisoldipine, amlodipine, azelnidipine, and other antihypertensive drugs.

Auto-Immune Cardiac Degeneration as a Complication of Essential Hypertension

Essential hypertension is persistent high blood pressure in the systemic arteries with no identifiable secondary cause. The study was designed to assess auto-immune cardiac degeneration in essential hypertensive patients in Ekiti State. The study included 40 subjects with no history of hypertension (control), 40 hypertensive subjects undergoing treatment and 40 hypertensive subjects without treatment. Body Mass Index (BMI) was calculated, systolic and diastolic blood pressure (SBP and DBP) readings were taken using digital sphygmomanometer, Aspartate Aminotransferase (AST) was measured using spectrophotometer, Cardiac Troponin (CTnI) and Anti-mitochondrial antibody M7 (AMA-M7) were estimated using ELISA. Results obtained were expressed as mean ± SD and statistical analysis was done using SPSS. Values were statistically significant at p&lt;0.05. The results obtained showed that BMI and DBP of treated hypertensive patient was insignificant when compared with control subjects (p&gt;0.05), whereas SBP, AST, AMA-M7 and CTnI were significantly higher (p&lt;0.05) in treated hypertensive patients compared with the control subjects. Similarly, BMI, SBP, DBP, AMA-M7, AST and CTnI of untreated hypertensive patient were significantly higher (p&lt;0.05) compared with non-hypertensive subjects (control). Furthermore, BMI, SBP, DBP, AMA-M7, AST and CTnI were significantly lower (p&lt;0.05) in treated hypertensive patient compared with untreated hypertensive subjects. In conclusion, AMA-M7 is more sensitive marker in detecting auto-immune cardiac degeneration faster than the routine serum AST and Cardiac Troponin I in indicating the functional state of the heart. Therefore, early detection of auto-immune cardiac degeneration in hypertension subjects is important as there is a link between autoimmunity and hypertension.

Causal associations between gastroesophageal reflux disease and essential hypertension: A bidirectional Mendelian randomization study.

Clinical studies have reported that patients with gastroesophageal reflux disease (GERD) have a higher prevalence of hypertension. To performed a bidirectional Mendelian randomization (MR) analysis to investigate the causal link between GERD and essential hypertension. Eligible single nucleotide polymorphisms (SNPs) were selected, and weighted median, inverse variance weighted (IVW) as well as MR egger (MR-Egger) regression were used to examine the potential causal association between GERD and hypertension. The MR-Pleiotropy RESidual Sum and Outlier analysis was used to detect and attempt to reduce horizontal pleiotropy by removing outliers SNPs. The MR-Egger intercept test, Cochran's Q test and "leave-one-out" sensitivity analysis were performed to evaluate the horizontal pleiotropy, heterogeneities, and stability of single instrumental variable. IVW analysis exhibited an increased risk of hypertension (OR = 1.46, 95%CI: 1.33-1.59, P = 2.14E-16) in GERD patients. And the same result was obtained in replication practice (OR = 1.002, 95%CI: 1.0008-1.003, P = 0.000498). Meanwhile, the IVW analysis showed an increased risk of systolic blood pressure (β = 0.78, 95%CI: 0.11-1.44, P = 0.021) and hypertensive heart disease (OR = 1.68, 95%CI: 1.36-2.08, P = 0.0000016) in GERD patients. Moreover, we found an decreased risk of Barrett's esophagus (OR = 0.91, 95%CI: 0.83-0.99, P = 0.043) in essential hypertension patients. We found that GERD would increase the risk of essential hypertension, which provided a novel prevent and therapeutic perspectives of essential hypertension.

Retrospective evaluation of patients diagnosed with Primary Hyperaldosteronism

Primary hyperaldosteronism (PA), despite being a common disease, is grossly underdiagnosed and undertreated. Though in primary care prevalence of PA is 4–6% in patients with hypertension, it is much higher in specialized hypertensive clinics, especially in resistant hypertension (RH). PA is associated with higher morbidity rates than matched essential hypertension patients. PA is classified as unilateral and bilateral disease, with adrenalectomy considered for unilateral disease and medical management with mineralocorticoid receptor antagonists (MRA) for bilateral disease. There is gross underdiagnosis of PA across the world with very limited literature on PA from India. We wanted to retrospectively evaluate the profile of patients diagnosed with PA from case records, in outpatient settings in a tertiary care hospital. Primary outcomes of the study will be to evaluate the presenting features of PA patients. This includes clinical, biochemical, radiological aspects in different subgroups like unilateral vs bilateral disease, diabetes/ prediabetes vs non-diabetes, and chronic kidney disease (CKD) vs no significant CKD. We also want to evaluate the treatment preferences (both surgical and medical) and follow-up data (for treatment outcomes / effectiveness if relevant records were available). Our main objective is to highlight the current state of PA presentation and management so that we can develop a pragmatic diagnostic approach to improve screening, case detection and empiric management of PA.

Intima–Media Thickness in Primary Aldosteronism Compared with Essential Hypertension: A Meta-analysis

AIM: This study was comparison of the intima–media thickness in the primary aldosteronism (PA) patients versus essential hypertension (EH) patients. METHODS: We searched on PubMed for studies about intima–media thickness in PA and found 317 articles. After the title and abstract reading, we excluded 291 studies because they did not fit in our criteria. After the final assessment of the 26 articles, seven of them were chosen as final studies to be included in the meta-analysis. RESULTS: In this study, we included seven studies with a total of participants of 534 patients. The main outcome was a comparison of intima–media thickness between patients with PA, EHs and healthy controls. The result shows a thicker intima media in PA patients in comparison with EH patients and more over with healthy controls, but this was not statistically significant. CONCLUSION: PA predisposes to a thicker intima media in comparison to EH, but we need for larger studies to have significant results.

Prevalence of Primary Aldosteronism and Complications in Type 2 Diabetes Mellitus Patients with Resistant Hypertension: A Prospective Observational Single Centre Study Protocol

Primary hyperaldosteronism (PA) has been thought to be an uncommon cause of hypertension, with an estimated prevalence of 2% among the general hypertensive population but is much higher, especially in resistant hypertension (RH) patients. Recent studies, however, have suggested that the prevalence of PA may be as high as 30% in RH populations. PA is associated with higher morbidity rates than matched essential hypertension patients. RH is more common in type 2 diabetes mellitus (T2DM). PA is generally remediable by treatment with an aldosterone antagonist or, in the case of adrenal adenoma, by adrenalectomy, knowing the true prevalence of PA is important for early diagnosis and treatment. Aim: This study aims to evaluate the prevalence of PA and cardiovascular (CVD) and renal complications in T2DM mellitus patients with resistant hypertension . Method: Prospective observational single centre study, in outpatient (OPD) settings in a tertiary care hospital. The primary outcome of the study is to estimate the prevalence of primary aldosteronism in T2DM patients with resistant hypertension. The secondary outcome is to evaluate the difference in prevalence of complications / comorbidities like CVD, left ventricle hypertrophy(LVH) , atrial fibrillation (AF), chronic kidney disease (CKD) in T2DM patients with and without PA hyperaldosteronism . T2DM patients aged more than 18 years with RH will be included in the study. Patients with type 1 diabetes mellitus or secondary causes of diabetes mellitus, acute diabetic complications, severe underlying systemic diseases, chronic kidney disease stage ≥4 , known secondary causes of hypertension, pregnancy and lactation and on medications like oral contraceptives, spironolactone, eplerenone, amiloride, triamterene will be excluded. Study subjects with plasma aldosterone to renin ratio of value ≥ 1.6 ng/dl/μIU/ml and plasma aldosterone concentration (PAC) of value ≥ 10 ng/dl with suppressed renin, will be considered to be positive on a screening test. Patients, those positive on a screening test will undergo seated saline suppression test (SST). Repeat plasma aldosterone concentration (PAC) with value ≥ 6 ng/dl will be confirmatory test for PA. Conclusion: RH specially in T2DM high-risk phenotype, which may be further aggravated by underlying PA . Thus we want to estimate the prevalence of PA in T2DM patients with RH. We also want to highlight any difference in prevalence of CV and renal complications due to in T2DM patients with and without PA, which may support early screening and diagnosis of PA and targeted treatment of PA to prevent its aggravating effects on chronic diabetes complications.

Changes in the indicators of stiffness and remodeling of magistral arteries in young patients at the early stage of essential hypertension under conditions of syntropy with obesity.

Aim: The study and analysis of indicators of remodeling and rigidity of magistral vessels in young essential hypertension patients with abdominal obesity and determination of the detected changes as a possible criterion for their remodeling.. Materials and Methods: 98 young people with essential hypertension and obesity were included in the study. The structure of the carotid artery and its stiffness were assessed using the ultrasound method, and the level of abdominal fat was determined using dual-energy X-ray absorptiometry. Results: Carotid Intima-Media Thickness in patients with essential hypertension reliably exceeded the corresponding indicator of the control group. We observed a significant increase in arterial stiffness indicators, which is explained by the increased stiffness of blood vessels in patients with obesity. During the correlation analysis, it was established that the relationship between the level of abdominal fat and the elasticity of the vascular wall was positive and strong, which indicated the dominant role of the abdominal type of obesity in the remodeling of the vascular wall in young patients with essential hypertension in combination with obesity. Conclusions: In young patients at the early stage of the formation of essential hypertension, there are signs of a decrease in resilient-elastic properties and remodeling of magistral vessels, whose severity is significantly stronger in combination with abdominal obesity.

Correlations of GGT, Hcy and ABI with carotid atherosclerosis in essential hypertension patients.

This study was to explore the correlations of glutamyltransferase (GGT), homocysteine (Hcy) and ankle-brachial index (ABI) with the onset of cervical atherosclerosis (CAS) in essential hypertension (EH) patients. For this purpose, a total of 280 EH patients who were admitted to this hospital or visited the clinic of this hospital were enrolled into the EH group and received the color Doppler ultrasound for carotid artery and biochemical test for blood, and according to the plaques, they were divided into three groups: non-plaque group (n = 113), stable plaque group (n = 102) and non-stable plaque group (n = 65). Simultaneously, 80 healthy subjects who underwent the physical examination were enrolled in the control group. Correlations of GGT, Hcy and ABI with the onset of CAS were analyzed. The results indicated that in the EH group, the prevalence of CAS and Hcy levels were all higher than those in the control group (all P<0.05). As compared to the non-plaque group, patients with stable or non-stable plaques had higher levels of GGT and Hcy in serum but lower levels of ABI (all P<0.05). Logistic regression analysis revealed that CAS plaques were in positive correlation with the levels of GGT and Hcy in serum, but in negative correlation with ABI (P<0.05). In conclusion, ABI is the protective factor of CAS in EH patients, while Hcy and GGT are the negative factors.

Cholecalciferol, serum calcium and left ventricular hypertrophy in essential hypertension.

Objective: To assess the correlation of vitamin cholecalciferol and serum calcium with left ventricular hypertrophy (LVH) in essential hypertension patients presenting at a tertiary care hospital. Study Design: Cross Sectional Comparative study. Setting: Department of Cardiology and Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh. Period: July 2019 to January 2021. Material &amp; Methods: 100 diagnosed LVH+ Essential Hypertenison cases and 100 diagnosed essential hypertension (controls) were selected through non- probability purposive sampling. Echocardiography, serum cholecalciferol, calcium, phosphate, parathyroid hormone (PTH), alkaline phosphatase (ALP), urea and creatinine were measured form sera. Devereux’s formula measured the LV thickness LVH. SPSS ver. 21.0 analyzed the descriptive statistics and compared the variables at 95% Confidence interval (P≤0.05). Results: Serum calcium, phosphate and parathyroid hormone were found elevated in LVH cases compared to control (P=0.0001). Cholecalciferol in LVH cases was low noted as 27.3±7.84 ng/dl compared to 39.5±0.43 ng/dl in controls (P=0.0001). Cholecalciferol in mild, moderate and severe LVH cases was descending order as 30.67±7.84, 24.76±7.72 and 14.96±6.12 mm respectively (P-0.0001). Serum cholecalciferol proves inverse association (r= -0.180) with LVH (p=0.003). Conclusion: The present study reports vitamin cholecalciferol deficiency increases the chances of left ventricular hypertrophy through increased secretion of parathyroid hormone that induces de – novo protein synthesis of ventricular myocardium.

Association of insertion /deletion polymorphism of ace gene with essential hypertension in patients of Khyber Pakhtunkhwa.

The exact cause of hypertension is unknown in about 90 to 95% patients, known as essential hypertension. Genes may play a crucial role in the pathology of essential hypertension. Gene for angiotensin converting enzyme (ACE) is found on long arm of chromosome 17q23, where 287 base pair insertion or deletion (I/D) polymorphism may occur. This study was aimed to assess the association of I/D polymorphism of ACE gene with blood pressure (BP) in Patients of Khyber Pakhtunkhwa (KPK). This Descriptive Cross-sectional study was conducted from 1st June 2021 to 30th September 2021 at Kuwait Teaching Hospital, Peshawar. The genomic DNA was extracted from lymphocytes and PCR was performed for identification of ACE I/D polymorphism. Total 181 individuals (121 Hypertensive and 60 normal) were enrolled in the study. The measured systolic and diastolic BP in cases were 153.91mmHg±12.65 and 92.94mmHg±5.72, respectively while in control were 118.20±17.13 and 74.12mmHg±7.58, respectively. The Deletion Homozygous (DD), Insertion Homozygous (II) and Deletion and Insertion Heterozygous (DI) genotypes in hypertensive patients were 47 (38.84%), 17 (14.04%) and 57 (47.10%) respectively while in Control group the DD, II and DI were 4 (6.66%), 25 (41.66%) and 31 (51.66%) respectively. This study showed association of DD genotypes of the ACE gene with hypertension as compared to healthy individuals. Individuals with DD genotype may have association with hypertension. polymorphism of ACE gene was proved to be an important genetic marker for essential hypertension in Patients of KPK.

Relationship between β1-AA and AT1-AA and Cardiac Function in Patients with Hypertension Complicated with Left Ventricular Diastolic Function Limitation.

To investigate the association between β1 adrenergic receptor autoantibodies (β1-AA) and angiotensin II type-1 receptor autoantibodies (AT1-AA) and cardiac function in patients with hypertension complicated with left ventricular diastolic function limitation. A total of 120 patients with essential hypertension who were not taking drug treatment and were hospitalised in the Department of Cardiology at the authors' hospital from April 2018 to December 2018 were enrolled in this study and divided into a diastolic dysfunction group (65 cases) and a normal diastolic group (55 cases) according to their left ventricular diastolic function. The levels of cardiac parameters, β1-AA, AT1-AA, and other indicators were compared. Logistic regression analysis was used to analyse the related factors affecting left ventricular diastolic dysfunction (LVDD). The diagnostic efficacy of related factors in the diagnosis of diastolic dysfunction was evaluated. Univariate analysis demonstrated that the left ventricular posterior wall diameter (10.29 ± 1.23 vs. 9.12 ± 1.53), left ventricular systolic dysfunction (10.56 ± 1.37 vs. 9.43 ± 1.44), systolic blood pressure (152.37 ± 10.24 vs. 140.33 ± 5.99), diastolic blood pressure (95.66 ± 6.34 vs. 87.33 ± 7.28), β1-AA (33 vs. 9 cases), and AT1-AA (35 cases vs. 12 cases) were higher in the dysfunction group than in the control group (all P < 0.05). Multivariate regression analysis showed that β1-AA (odds ratio (OR) = 1.96, 95% confidence interval (CI): 1.369-4.345) and AT1-AA (OR = 2.02, 95% CI: 1.332-6.720) were independent risk factors for cardiac diastolic dysfunction (P < 0.05). Both autoimmune antibodies had a certain predictive value, and the combined prediction value of the two was the highest, with an area under the curve of 0.942 (95% CI: 0.881~0.985). The positive rate of β1-AA and AT1-AA in essential hypertension patients with LVDD was higher than that in the normal group. Both β1-AA and AT1-AA could be used as early markers of LVDD in essential hypertension patients.

Additional Impact of Aortic Regurgitation on Left Ventricular Strain and Remodeling in Essential Hypertension Patients Evaluated Using MRI

BackgroundUnderstanding the impact of aortic regurgitation (AR) on hypertensive patients' hearts is important.PurposeTo assess left ventricular (LV) strain and structure in hypertensive patients and investigate the relationship with AR severity.Study TypeRetrospective.Population263 hypertensive patients (99 with AR) and 62 controls, with cardiac MRI data.Field Strength/SequenceBalanced steady‐state free precession (bSSFP) sequence at 3.0T.AssessmentAR was classified as mild, moderate, or severe based on echocardiographic findings. LV geometry was classified as normal, concentric remodeling, eccentric hypertrophy, or concentric hypertrophy based on MRI assessment of LV mass/volume ratio and LV Mass index (LVMI). LV global radial peak strain (GRPS), global circumferential peak strain (GCPS), and global longitudinal peak strain (GLPS) were obtained by post‐processing bSSFP cine datasets using commercial software.Statistical TestsANOVA, Kruskal–Wallis test, Spearman's correlation coefficients (r), chi‐square test, and multivariable linear regression analysis. A P value &lt;0.05 was considered statistically significant.ResultsHypertensive patients with AR had significantly lower LV myocardial strain and higher LVMI than the group without AR (GRPS 26.25 ± 12.23 vs. 34.53 ± 9.85, GCPS −17.4 ± 5.84 vs. −20.57 ± 3.57, GLPS −9.86 ± 4.08 vs. −12.95 ± 2.94, LVMI 90.56 ± 38.56 vs.58.84 ± 17.55). Of the 99 patients with AR, 56 had mild AR, 26 had moderate AR and 17 had severe AR. The degree of AR was significantly negatively correlated to the absolute values of LV GRPS, GCPS and GLPS (r = −0.284 – −0.416). LV eccentric hypertrophy increased significantly with AR severity (no AR 21.3%, mild AR 42.9%, moderate AR 73.1%, severe AR 82.4%). In multivariable analysis, the degree of AR was an independent factor affecting LV global strain and LVMI even after considering confounding factors (β values for global myocardial strain were −0.431 to −0.484, for LVMI was 0.646).Data ConclusionIncreasing AR severity leads to decreased cardiac function and worse ventricular geometric phenotypes in hypertensive patients.Level of Evidence4Technical EfficacyStage 3

Platelet Cyclic GMP Levels Are Reduced in Patients with Primary Aldosteronism.

Nitric oxide inhibits platelet aggregation by increasing the second messenger cyclic guanosine-3',5'-monophosphate (cGMP) through the activation of soluble guanylyl cyclase in target cells. Within this context, the oxidative stress associated with the aldosterone excess impairs the nitric oxide availability. Thus, the aim of the present study was to assess the impact of chronic aldosterone excess on the platelet nitric oxide/cGMP pathway in humans. The levels of cGMP were evaluated in platelets of male patients, 12 with primary aldosteronism (PA) and 32 with uncomplicated essential hypertension (EH), matched for age and blood pressure (BP) values. PA and EH patients were 52.8 ± 3 years old and 51.6 ± 1.6 years old, respectively. Systolic and diastolic BP were 158 ± 5.0 mmHg and 105.9 ± 2.3 mmHg in PA and did not differ compared to EH patients (156.6 ± 2.4 mmHg and 104.7 ± 1.2 mmHg). Mean aldosterone levels were significantly higher in PA (25.5 ± 8.8 ng/dL) compared toEH (8.11 ± 0.73 ng/dL), whereas potassium was significantly lower in PA (3.52 ± 0.18 mEq/L) compared to EH (4.08 ± 0.04 mEq/L). Aldosterone and potassium were inversely related (r = -0.49, p = 0.0006) in the whole study population (n = 44). Platelet cGMP was significantly lower in PA (5.1 ± 0.36 pM/109 cells) than in EH (7.1 ± 0.53 pM/109 cells), and in the entire study cohort, it was directly related to plasma potassium (r = 0.43, p = 0.0321). These results show an impairment of nitric oxide/cGMP signaling in platelets of PA patients. This effect is likely related to the potassium-depleting effect of chronic aldosterone excess. Future studies are needed to understand whether the platelet nitric oxide/cGMP system is involved in the atherothrombotic events in these patients.

Analysis of the controlled essential hypertension’s pharmacotherapy in general practice

BACKGROUND: Arterial hypertension is a common cardiovascular disease that requires constant monitoring by a doctor of drug therapy to achieve the target blood pressure level.&#x0D; AIM: To analyze pharmacotherapy of essential hypertension in patients, who have achieved a controlled course of the disease.&#x0D; MATERIALS AND METHODS: In this study 274 patients with controlled course of stage 2 arterial hypertension and no comorbidities were recruited. Blood pressure indicators, anthropometric data, results of laboratory and instrumental studies, the volume of drug therapy for hypertension were analyzed.&#x0D; RESULTS: We analyzed 543 drug prescriptions for 274 patients with stage II hypertension. In 97 (35.3%) patients only one drug was prescribed, in 112 (40.7%) two drugs, in 46 (16.7%) three drugs from various pharmacological groups, among which monodrugs were in the lead: angiotensin-converting-enzyme inhibitors 31.86%, cardioselective -blockers 23%, angiotensin 2 receptor blockers 9.3%. Combined drugs were present in 18.4% of general doctors prescriptions. Fixed forms of combined antihypertensive drugs were taken by only 50 (18.4%) patients. To prevent cardiovascular complications of arterial hypertension, 75 (26%) patients were prescribed statins (atorvastatin or rosuvastatin) and 56 (19.5%) antiplatelet monotherapy with Cardiomagnyl, Thrombo ACC or clopidogrel.&#x0D; CONCLUSIONS: To achieve the target blood pressure level and control arterial hypertension in patients with stage II hypertension, general practitioners used all main

Practical recommendations for antihypertensive therapy during the primary aldosteronism screening test.

The aldosterone-to-renin activity ratio (ARR) is recommended as a screening test for primary aldosteronism (PA). The use of antihypertensive medication is one of the most important factors to take into account when interpreting the ARR. The goal of this study was to compare the effect of various antihypertensive drug classes on biochemical testing and provide practical recommendations for antihypertensive medication regimens in patients suspected of having PA. We retrospectively investigated 4218 hypertensive patients who underwent PA detection between January 2020 and February 2023. Finally, 25 patients with essential hypertension (EH) and 39 with PA were involved. The enrolled EH patients were selected from EH patients with at least two screening tests with interfering medication changes for at least 4 weeks. A total of 2/18 (11.1%) EH patients had opposite screening results after angiotensin II receptor blockers (ARBs), angiotensin-converting enzyme inhibitors (ACEIs), dihydropyridine-calcium channel blockers (DHP-CCBs) and diuretics were withdrawn. A total of 3/3 (100%) of the patients were initially screened as positive but had results that tested negative after β-blockers withdrawal. A total of 3/39 (7.7%) PA patients were misdiagnosed with EH with drug effects. Only plasma renin activity was markedly reduced after antihypertensive medication washout (P = 0.0173). Not every patient receiving β-blockers, ACEIs, ARBs and DHP-CCBs with negative reports needed withdrawal or switching antihypertensive drugs. We recommend that patients be left on a regimen that includes β-blockers, ACEIs, ARBs, DHP-CCBs and spironolactone when determining the ARR during the initial test.

Correlation Between Monocyte to High-Density Lipoprotein Cholesterol Ratio, Blood Flow-Mediated Dilation, and Arteriosclerosis in Young and Middle-Aged Patients With Essential Hypertension

Abstract OBJECTIVE To investigate the relationship between monocyte to high-density lipoprotein cholesterol ratio (MHR), flow-mediated dilation (FMD), and arteriosclerosis in young and middle-aged patients with essential hypertension (EH). METHODS A total of 188 young and middle-aged patients with EH admitted to the Department of Cardiovascular Medicine of the First Affiliated Hospital of Anhui Medical University from August 2020 to August 2022 were enrolled. The clinical data, laboratory results, and brachial ankle pulse wave velocity (baPWV) and FMD of all patients were collected. According to baPWV, patients were divided into non-arteriosclerosis group (baPWV &amp;lt;1,400 cm/s, n = 43), mild arteriosclerosis group (baPWV 1,400 to &amp;lt;1,700 cm/s, n = 100), and moderate to severe atherosclerosis group (baPWV 1,700 to &amp;lt;2,000 cm/s, baPWV ≥2,000 cm/s, n = 45). The differences of body mass index, fasting blood glucose, blood lipid, FMD, MHR, hypersensitive C-reactive protein (hsCRP), systolic blood pressure, diastolic blood pressure, monocyte, and other indicators were compared. Spearman correlation analysis was used to analyze the correlation between all variables and baPWV. Multivariate logistic regression analysis was used to analyze the influencing factors of arteriosclerosis in young and middle-aged patients with EH. RESULTS MHR of non-atherosclerosis, mild, and moderate to severe atherosclerosis groups were 0.29 (0.22–0.42), 0.36 (0.27–0.49), and 0.52 (0.43–0.62) 109/mmol, respectively. The difference was statistically significant (H = 33.803, P &amp;lt; 0.05). The FMD of non-atherosclerosis, mild, and moderate to severe atherosclerosis groups were (6.0 ± 1.9)%, (4.9 ± 1.6)%, and (3.5 ± 1.8)%, respectively. The difference was statistically significant (F = 24.239, P &amp;lt; 0.05). Spearman correlation analysis showed that MHR was positively correlated with baPWV (r = 0.39, P &amp;lt; 0.001), and FMD was negatively correlated with baPWV (r = −0.47, P &amp;lt; 0.001). Multivariate logistic regression analysis showed that MHR, FMD, systolic blood pressure, and age were independent influencing factors for arteriosclerosis in in young and middle-aged EH patients, odds ratio (95% CI) was 45.874 (2.140–983.243), 0.763 (0.587–0.991), 1.068 (1.016–1.123), and 1.075 (1.038–1.113), respectively; all P &amp;lt; 0.05. CONCLUSIONS MHR is positively correlated with the occurrence of arteriosclerosis in young and middle-aged patients with EH, and FMD is negatively correlated with the occurrence of arteriosclerosis, and both are independent influencing factors for arteriosclerosis.

Mediating effect of cumulative lipid profile burden on the effect of diet and obesity on hypertension incidence: a cohort study of people aged 35-65 in rural China.

Cumulative lipid profile burden is designed to dynamically measure lipid accumulation, and its effect on hypertension has been poorly studied. Our main purpose was to investigate the effect of cumulative lipid profile burden on the incidence of essential hypertension (EH) and to investigate whether cumulative lipid burden mediates the pathogenesis of the effects of diet and obesity on EH. A total of 1295 participants were included in the study, which started in 2017. The average follow-up time was 2.98 years. A total of 240 EH patients occurred during the follow-up period. The HR (95% CI) of the highest quartile in cumulative Total cholesterol (TC), triglyceride (TG) and high density lipoprotein (HDL) burden were 1.747 (1.145 - 2.664), 1.502 (1.038 - 2.173), 0.615 (0.413 - 0.917) for incidence of EH respectively, compared to the respective reference groups. Participants with EH consumed more red meat and refined grains, and red meat was positively associated with cumulative TC burden. BMI and Waist-To-Height Ratio (WHtR) increased the incidence of EH, and obesity was positively correlated with cumulative TG burden. Mediating analysis showed that cumulative TG had a partial mediating effect in the causal relationship between obesity and EH, and Mendelian randomization (MR) also proved this result. Diet was not found to influence EHn through cumulative lipid profile burden. The cumulative TG burden partially mediates the effect of obesity on EH.

Cortisol secretion and abnormalities of glucose metabolism in nondiabetic patients with hypertension.

Glycometabolic changes are associated with hypercortisolism in Cushing's syndrome. Because impaired glucose tolerance (IGT) and insulin resistance are frequently detected in patients with essential hypertension, we hypothesized that in these patients, early glycometabolic abnormalities might be related to differences in regulation of cortisol secretion. In a cross-sectional study, we included 155 nondiabetic, essential hypertensive patients who were free of organ complications. The homeostasis model assessment (HOMA) index and the area under the curve of plasma glucose (AUC-glucose) and insulin (AUC-insulin) concentration following an oral glucose tolerance test were measured, together with daily plasma cortisol (8 a.m., 3 p.m. and 12 a.m.; AUC-cortisol) and 8 a.m. cortisol after 1 mg overnight dexamethasone suppression test (DST). IGT was present in 27% of patients who were older and had higher BMI, plasma triglycerides and uric acid, AUC-cortisol and DST-cortisol, and lower HDL-cholesterol. Frequency of IGT increased progressively across tertiles of DST-cortisol, together with levels of glycated hemoglobin, fasting insulin and C-peptide, HOMA-index, AUC-glucose, and AUC-insulin. AUC-cortisol and DST-cortisol were directly correlated with insulin, C-peptide, HOMA-index, AUC-glucose, and AUC-insulin. Multivariate regression analysis showed that DST-cortisol was directly and independently correlated with HOMA index, AUC-glucose, and AUC-insulin. In a logistic regression model, both AUC-cortisol and DST-cortisol independently predicted IGT. Daily cortisol and cortisol response to DST are independent determinants of IGT and insulin resistance in nondiabetic patients with hypertension, suggesting that even subtle differences in regulation of cortisol secretion might increase the risk of these patients to develop diabetes.

THU595 New Screening Cutoff Values For Detection Of Aldosterone Producing Adenoma Examined By LC-MS/MS And Newly Developed Non-competitive Cleia

Abstract Disclosure: F. Satoh: None. Y. Ono: None. K. Omata: None. Y. Tezuka: None. Y. Yamazaki: None. H. Sasano: None. S. Kojima: None. Objective: Thinking of the poor accuracy of conventional CLEIA measurements of aldosterone, liquid chromatography-tandem mass spectrometry (LC-MS/MS) is the ideal method but it is costly, labor intensive and time consuming. A novel non-competitive chemiluminescent enzyme immunoassay (sandwich assay) (NC-CLEIA) for measuring aldosterone was recently developed. We validated the accuracy and diagnostic ability of the NC-CLEIA and compared the results obtained with those by LC-MS/MS and also determined the new screen cutoffs by both measurements, respectively, detecting aldosterone-producing adenoma (APA) in hypertensive patients. Design and Method: We measured plasma renin activity by enzyme assay and plasma aldosterone concentrations (PAC) using LC-MS/MS and NC-CLEIA in 133 APA, 100 bilateral hyperaldosteronism and 111 essential hypertension patients to examine the accuracy of the values of PAC measured by this new NC--CLEIA as compared with those by LC-MS/MS, and determine the new screen cutoff values by both measurements to detect APA, respectively. Results: Passing-Bablok analysis revealed that NC-CLEIA (regression slope, intercept and correlation coefficient were 0.962, -0.043, and 0.994, respectively), was significantly correlated and equivalent to LC-MS/MS than RIA. Bland-Altman plot analysis of NC-CLEIA by LC-MS/MS also demonstrated much smaller systemic errors (a bias of -0.348 ng/dL with limits of agreement of -4.390 and 3.694 and 95% confidence interval). The receiver-operating characteristics analysis demonstrated that cut-off values of aldosterone/renin activity ratio obtained by LC-MS/MS and NC-CLEIA were 31.2 and 31.5 (ng/dL per ng/mL/hr) with a sensitivity of 91.0% and 90.2%, and a specificity of 75.4% and 76.8%, respectively, in terms of discriminating APA from non-APA. Therefore, we can recommend an ARR &amp;gt; 30.0 ng/dL per ng/mL/hr as a screening cut-off by both LC-MS/MS and NC-CLEIA, which would discriminate APA with a sensitivity of 91.7% in both assays, and with a specificity of 73.0% and 73.9 %, respectively. Conclusions: This novel NC-CLEIA assay for PAC could serve as a clinically reliable alternative to LC-MS/MS to detect APA among hypertensive patients with more accuracy than the conventional methods. Presentation: Thursday, June 15, 2023