Greater Blood Pressure Reduction Research Articles

Characteristics associated with responsiveness to isometric handgrip training in medicated hypertensive patients: secondary data analysis.

Isometric handgrip training (IHT) has been shown to reduce blood pressure (BP) in hypertensive patients. However, factors that predict responsiveness to IHT are largely unknown. The aim of this study was to investigate the patient characteristics associated with the antihypertensive response to IHT using a recommended statistical approach for evaluating interindividual responses. Data from four randomized controlled trials were joined, totaling 81 patients undergoing IHT (48.8% women; 60 ± 11 years) and 90 control patients (45.6% women; 62 ± 12 years). IHT consisted of 4 × 2 min isometric contractions at 30% of maximal voluntary contraction, performed three times/week for 8-12 weeks. BP was measured at baseline and following IHT and control interventions. The interindividual variation was assessed by the standard deviation of the individual responses (SDir), and linear regression analyses were conducted to explore response predictors. IHT significantly decreased both SBP (-5.4; 95% confidence interval (CI) -9.5 to -1.3 mmHg) and DBP (-2.8; 95% CI -5.1 to -0.6 mmHg). The interindividual variation of BP change was moderate for systolic (SDir = 5.2 mmHg, 0.30 standardized units) and low for diastolic (SDir = 1.7 mmHg, 0.15 standardized units). Sex, age, and BMI were not associated with the antihypertensive effect of IHT. However, a higher baseline SBP (b = -0.467, P < 0.001) and absence of dihydropyridine calcium channel blockers use (b = 0.340, P = 0.001) were associated with greater BP reductions. IHT reduced BP in medicated hypertensive patients regardless of age, sex, and BMI. Patients with a higher baseline SBP and those not prescribed dihydropyridine calcium channel blockers were more responsive to IHT.

Effect of intelligent hypertension management system on blood pressure: protocol for a randomised controlled multicentre trial

IntroductionHypertension is one of the most serious global health problems, and its prevention and treatment mainly rely on lifestyle intervention and medication. However, the current situation of hypertension control in...

Reversal of arterial stiffness in medically and surgically treated unilateral primary aldosteronism.

Hyperaldosteronism has adverse effects on cardiovascular structure and function. Laparoscopic adrenalectomy is the gold standard for patients with unilateral primary aldosteronism. For unilateral primary aldosteronism patients unable or unwilling to undergo surgery, the effects of mineralocorticoid receptor antagonists (MRAs) on the reversibility of arterial stiffness and other clinical data remain unclear. We aimed to compare the reversibility of arterial stiffness using pulse wave velocity (PWV) and other clinical parameters between surgically and medically treated unilateral primary aldosteronism patients. We prospectively enrolled 306 unilateral primary aldosteronism patients, of whom 247 received adrenalectomy and 59 received medical treatment with MRAs. Detailed medical history, basic biochemistry and PWV data were collected in both groups before treatment and 1 year after treatment. After propensity score matching (PSM) for age, sex, SBP and DBPs, 149 patients receiving adrenalectomy and 54 patients receiving MRAs were included for further analysis. After PSM, the patients receiving adrenalectomy had a greater reduction in blood pressure, increase in serum potassium, and change in PWV (ΔPWV, -53 ± 113 vs. -10 ± 140 cm/s, P = 0.028) than those receiving MRAs 1 year after treatment. Multivariable regression analysis further identified that surgery (compared with MRA treatment), baseline PWV, baseline DBP, the change in DBP and the use of diuretics were independently correlated with ΔPWV. Adrenalectomy is superior to MRA treatment with regards to vascular remodeling when treating unilateral primary aldosteronism patients.

Association of work-related psychosocial factors and day-to-day home blood pressure variation: the Finn-Home study.

Stress, and particularly job strain, has been found to associate with ambulatory blood pressure (BP). Moreover, BP is known to vary between days. One potential over-looked factor underlying this day-to-day BP variation could be work-related psychosocial factors. Thus, we aimed to study the association between job strain, job demands, job control and day-to-day BP variation. The home BP of 754 regularly working participants (mean age 50.9 ± 4.8, women 51%) of the Finn-Home Study was measured twice in the morning and twice in the evening over seven days. Average SBP and DBP were calculated for each day. Work-related psychosocial factors were measured with survey. Multivariable-adjusted generalized linear models were used for statistical analysis. We found a greater SBP/DBP decrease between weekdays and weekend among participants with high job strain (-1.8 [95% confidence interval, 95% CI, -2.7 to -0.8]/-1.7 [95% CI, -2.3 to -1.1] mmHg) compared to participants with low job strain (-0.7 [95% CI, -1.1 to -0.2]/-0.7 [95% CI, -1.0 to -0.4] mmHg). The participants with high job demands showed a higher BP decrease between weekdays and weekend (-1.4 [95% CI, -2.0 to -0.8]/-1.3 [95% CI, -1.6 to -0.9] mmHg) than the participants with low job demands (-0.5 [95% CI, -1.1 to 0.0]/-0.6 [95% CI, -1.0 to -0.3] mmHg). We did not find BP differences regarding job control. High job strain and high job demands were associated with a greater BP reduction from weekdays to the weekend. Work-related psychosocial factors should be considered when assessing day-to-day BP variation.

Abstract 13463: Effect of an Intervention to Reduce Sedentary Behavior on Blood Pressure in Desk Workers: The RESET BP Randomized Clinical Trial (RCT)

Introduction: High sedentary behavior (SB) is associated with cardiovascular (CV) risk in cohort studies, yet definitive data from RCTs of SB reduction on CV risk factors is lacking. Hypothesis: A 3-month SB reduction intervention would decrease blood pressure (BP) and pulse wave velocity (PWV) in sedentary adults. Methods: We recruited desk workers with systolic BP (SBP) 120-159 mmHg or diastolic BP (DBP) 80-99 mmHg, not on antihypertensives, and reporting low physical activity. Participants were randomized 1:1 to a 3-month SB reduction intervention or control. The intervention targeted replacing sitting with standing and stepping via health coaching, a wrist-worn activity prompter, and a height-adjustable workstation. All day and work-specific SB, standing, stepping, and steps were measured by a thigh-worn triaxial accelerometer. Protocolized office SBP (primary outcome), DBP, and HR were measured in duplicate on two occasions at each baseline and 3 months; 24-hr ambulatory BP and carotid-femoral PWV via tonometry were also measured. Changes in outcomes were compared across groups using analysis of covariance and mixed models. Results: Participants (n=271) had mean age 45 y and BP 129/83 mmHg; 60% were female and 82% were non-Hispanic White. Retention was 97%. Intervention participants reduced SB during work (-1.3 hr/day) and across all waking hours (-1.1 hr/day) compared to controls (both p&lt;0.001). Intervention participants increased work-specific standing (1.2 hr/day), stepping (5 min/day) and steps (398/day) and all day standing (1.0 hr/day), stepping (7 min/day) and steps (528/day) compared to control (all p&lt;0.05). Yet, the intervention did not yield a greater reduction in BP or PWV vs. controls (all p&gt;0.05). Differences in changes were office SBP -0.24 mmHg (p=0.793), DBP 0.08 mmHg (p=0.894), and heart rate -2.75 (p=0.190). Findings were similar for 24-hr, daytime, and nighttime ambulatory BP averages (all &lt;1.2 mmHg; p&gt;0.05). Differences in PWV were higher (opposite from the hypothesized direction) in intervention vs. control and approached significance (0.18 m/s, p=0.07). Conclusions: In sedentary desk workers with mild-moderate untreated BP, this 3-month intervention reduced daily SB by about one hour but did not improve BP or PWV.

The Effect of Ambon Banana Juice (Musa paradisiaca var. Sapientum Linn) and Sweet Starfruit Juice (Averrhoa carambola L) on Changes in Blood Pressure in the Elderly Men in the Community Health Center Work Area Tarus, Kupang Regency

Background: Hypertension is a health problem that often occurs in society. Uncontrolled hypertension can trigger degenerative diseases such as heart disease and kidney failure. One of the therapies used to lower blood pressure is Ambon banana and sweet star fruit therapy. Subjects and Method: Research on elderly men suffering from hypertension in the Tarus Community Health Center working area used a Quasi-Experimental pretest–posttest with a Control Group research design. The number of samples in this study was 20 elderly men using a simple random sampling method. The dependent variable in this study was blood pressure, while the independent variable was the administration of Ambon banana juice, sweet star fruit juice, and a combination of Ambon banana juice and sweet star fruit juice. The measuring instrument used in this research is a questionnaire. The data analysis used in this research is Anova and Post hoc. Results: The average blood pressure in the elderly decreased after being given Ambon Banana Juice, Sweet Starfruit Juice, and a combination of Juices. The greatest reduction in blood pressure occurred in the group given Ambon banana juice (Mean= 140 mmHg; p=0.002), compared to sweet starfruit juice (Mean= 148 mmHg; p= 0.036), and these results were statistically significant. The juice combination also reduced the average blood pressure, but the results were not statistically significant (Mean= 156 mmHg; p= 0.454). Conclusion: The average blood pressure in the elderly decreased after being given Ambon Banana Juice, Sweet Starfruit Juice, and a combination of Juices. Keywords: hypertension, Ambon banana juice, sweet star fruit juice Correspondence: Nusthen Aries Manek. Universitas Negri Nusa Cendana Kupang. Jl. Adisucipto Penfui, Kupang, Nusa Tenggara Timur. Email: Nusthen2503@gmail.com. Mobile: 082144927619.

Abstract 039: B-arrestin Defficiency In The Subfornical Organ Alters Blood Pressure Regulation

The activation of the angiotensin type 1 receptor (AT 1 R) in the brain through the canonical Gαq-mediated signaling results in dipsogenic and pressor responses to angiotensin (AngII). Non-canonical or β-arrestin-mediated signaling of AT 1 R activation is hypothesized to counterbalance maladaptive G protein signaling during disease. Recently, we found that global genetic deletion of β-arrestin2 (ARRB2) resulted in an exacerbated increases in blood pressure (BP) in response to deoxycorticosterone acetate-salt treatment, suggesting a protective role for ARRB2 in hypertension. We hypothesized that ARRB2 activation specifically within the brain contributes to BP regulation. First, global male and female ARRB2-deficient (ARRB2-KO) mice were used to evaluate acute BP responses to intracerebroventricular (ICV) infusion of AngII (1μg). Although no differences at baseline BP were observed, ARRB2-KO mice exhibited greater maximal BP after AngII (144±17 vs. 177±24 mmHg; n=14 and 19, p&lt;0.05). Next, we examined the role of ARRB2 within the brain via ICV injection of adeno-associated virus (AAV)-CRE into ARRB2 FLOX mice. Infection with ICV AAV-CRE primarily targeted the subfornical organ with minimal off-targets. In preliminary studies, these mice exhibited higher BP in response to AngII (179±5 vs. 187±6 mmHg; n=4 p=0.09). Thus, deletion of ARRB2 within the subfornical organ exacerbates the pressor response to Ang II. Finally, we evaluated BP responses to ICV infusion of a β-arrestin biased agonist specific for the AT 1 R (TRV120027 0.5 ug/h) in spontaneously hypertensive BPH/2J and normotensive BPN/3J mice. BPH/2J mice exhibited significantly higher baseline BP compared to BPN/3J (124±5 vs. 153±3 mmHg; n=4 p&lt;0.05), and greater reductions in BP with ICV infusion of TRV120027 (-4±3 vs. -9±1 mmHg; n=4 p&lt;0.05), suggesting that the beneficial BP-lowering effects of β-arrestin activation are more robust during hypertension. Overall, these data indicate that ARRB2 in the subfornical organ is protective against increases in BP. Stimulation of the AT 1 R β-arrestin axis in the brain may represent a novel strategy to treat hypertension.

Sex differences in weight gain, blood pressure control, and responses to melanocortin-4 receptor antagonism in offspring from lean and obese parents.

We examined potential sex differences in appetite and blood pressure (BP) responses to melanocortin-4 receptor (MC4R) blockade in offspring from lean and obese parents. Offspring from normal (N) diet-fed parents were fed N (NN) or high-fat (H) diets (NH) from weaning until adulthood. Offspring from obese H diet-fed parents were also fed N (HN) or H diets (HH). Adult male and female offspring were implanted with BP telemetry probes and intracerebroventricular cannulas to infuse MC4R antagonist or vehicle. Infusion of the MC4R antagonist SHU-9119 (1 nmol/h) for 7 days caused larger increases in calorie intake and body weight in obese compared with lean offspring. In male offspring, HH and HN groups exhibited higher baseline BP compared with NN and NH, and HH showed a greater reduction in BP during SHU-9119 infusion. In female offspring, HH also showed higher baseline BP and greater reduction in BP during MC4R blockade. SHU-9119 reduced heart rate in all groups, but reductions were more pronounced in offspring from lean parents. Combined α and β-adrenergic blockade reduced BP more in male HH offspring compared with NN controls. Losartan reduced BP more in male NH, HN, and HH offspring compared with NN controls. Losartan and α- and β-adrenergic blockade reduced BP similarly in all female groups. These results suggest that endogenous MC4R activity contributes to elevated BP in obese offspring from obese parents. Our findings also indicate important sex differences in the mechanisms of BP control in male and female offspring of obese parents.

Effect of Home Blood Pressure Telemonitoring Plus Additional Support on Blood Pressure Control: A Randomized Clinical Trial*

ObjectiveCurrent clinical evidence on the effects of home blood pressure telemonitoring (HBPT) on improving blood pressure control comes entirely from developed countries. Thus, we performed this randomized controlled trial to evaluate whether HBPT plus support (patient education and clinician remote hypertension management) improves blood pressure control more than usual care (UC) in the Chinese population. MethodsThis single-center, randomized controlled study was conducted in Beijing, China. Patients aged 30–75 years were eligible for enrolment if they had blood pressure [systolic (SBP) ≥ 140 mmHg and/or diastolic (DBP) ≥ 90 mmHg; or SBP ≥ 130 mmHg and/or DBP ≥ 80 mmHg with diabetes]. We recruited 190 patients randomized to either the HBPT or the UC groups for 12 weeks. The primary endpoints were blood pressure reduction and the proportion of patients achieving the target blood pressure. ResultsTotally, 172 patients completed the study, the HBPT plus support group (n = 84), and the UC group (n = 88). Patients in the plus support group showed a greater reduction in mean ambulatory blood pressure than those in the UC group. The plus support group had a significantly higher proportion of patients who achieved the target blood pressure and maintained a dipper blood pressure pattern at the 12th week of follow-up. Additionally, the patients in the plus support group showed lower blood pressure variability and higher drug adherence than those in the UC group. ConclusionHBPT plus additional support results in greater blood pressure reduction, better blood pressure control, a higher proportion of dipper blood pressure patterns, lower blood pressure variability, and higher drug adherence than UC. The development of telemedicine may be the cornerstone of hypertension management in primary care.

#4375 LANOSTEROL SYNTHASE RS2254524 POLYMORPHISM MODULATES SALT SENSITIVITY AND RENAL EXPRESSION IN A NOVEL MICE MODEL, LSSV643L/V643L

Abstract Background and Aims The blood pressure (BP) response to different salt intakes (salt sensitivity-SS), shows variability among individuals, with more frequency in hypertensives compared to the general population. Elevated levels of the Endogenous Ouabain (EO) have been associated with hypertension (HT) and SS. We characterized the missense variation rs2254524 (Val642Leu; C&amp;gt;A) of the Lanosterol Synthase gene (LSS) coding for an enzyme in steroid biosynthesis, since AA patients on a low-salt diet showed a greater reduction in BP compared to the LSS CC, with only CC having an increase in plasma EO. Moreover, AKI incidence following cardiovascular surgery was greater among those with the LSS rs2254524 AA genotype than in those with the CC genotype. We aim at dissecting the functional correlation between LSS polymorphism, EO, SS-HT, and renal function. Method We generated by CRISPR-Cas9 a knock-in mouse model carrying the Lss V643L (LssV643L/V643L), homologous to V642L to dissect the functional correlation between LSS polymorphism, EO and salt-sensitive hypertension, and kidney expression. Male mice were fed with a normal-salt diet (0.5% NaCl), high-salt diet (4% NaCl), or low-salt diet (&amp;lt;0.03% Na) and BP was measured every two days by the tail-cuff system. Results LssV643L/V643L mice were viable, healthy, and undistinguishable phenotypically from WT. At baseline, the Lss AA affected kidney weight that was significantly enlarged at 3 (p = 0.02) and 12 months of age, compared to WT (kidney p = 0.04; liver p = 0.003). The Lss V643L mutation did not affect EO and SBP at 3 and 12 months, per se, but affects SBP responsiveness to salt intake. Indeed, we observed an increased SBP upon a high-salt diet only in LssV643L/V643L mice 12 months old compared to the control diet (p = 0.01). Moreover, the 12-month-old LssV643L/V643L mice in high-salt diet showed cardiac hypertrophy and showed a higher incidence of heart fibrosis. At 12 months, in the adrenal gland of LssV643L/V643L mice, Lss mRNA level was reduced upon high-salt diet (p = 0.03), while RNA-seq analysis of renal differentially expressed genes revealed a different regulation of multiple Slc genes, both in control and high-salt diet, but also of Cbr2, and Arhgap26. Conclusion The new LssV643L/V643L mouse model resembles the SS-HT phenotype together with EO non-responsiveness observed in HT patients, thus providing a good model of SS-HT. Our results reveal a role of Lss gene in the regulation of BP upon salt stimulus, and its influence at renal level at 3 and 12 months of age.

Initial treatment with a single capsule containing half-dose quadruple therapy vs standard-dose dual therapy in hypertensive patients (QUADUAL): Study protocol for a randomized, blinded, crossover trial

Combined antihypertensive therapy has obvious advantages over single drug therapy. Hypertension guidelines fully affirm the efficacy of dual combination in initial antihypertensive therapy. Recent studies have also pointed out that the quadruple combination of very low-dose antihypertensive drugs is superior to single drugs. However, whether low-dose quadruple therapy is better than dual combination is unknown. To evaluate and compare the efficacy and safety of half-dose quadruple therapy vs standard-dose dual therapy in the initial treatment of hypertensive patients with systolic/diastolic blood pressure 140-179/90-109 mm Hg. A randomized double-blind crossover clinical trial will be conducted to compare the efficacy and safety of low-dose quadruple antihypertensives (irbesartan 75 mg+metoprolol 23.75 mg+amlodipine 2.5 mg+indapamide 1.25 mg) with standard-dose dual antihypertensives (irbesartan 150 mg+amlodipine 5 mg) in the initial treatment of patients with mild to moderate hypertension (140-179/90-109 mm Hg). Ninety patients are required and will be recruited and randomly assigned in a 1:1 ratio to 2 crossover groups. Two groups will receive a different combination therapy for 4 weeks, then switch to the other combination therapy for 4 weeks, with a 2-week wash-out. The patients will be followed up for 4 weeks to compare the antihypertensive effects and related adverse effects of the 2 antihypertensive combination treatments. We present the rationale for the design of the QUADUAL trial. The trial started in July 2022 and is expected to be completed by August 2023. The study aims to evaluate if an initial treatment regimen of quadruple combination of half-dose blood pressure medications will result in greater reduction in blood pressure and fewer side effects compared to standard dose dual therapy. www. gov (NCT05377203).

SALT SENSITIVITY IS MODULATED BY LANOSTEROL SYNTHASE RS2254524 POLYMORPHISM

Objective: The blood pressure (BP) response to different salt intakes (salt sensitivity-SS), shows variability among individuals, with more frequency in hypertensives compared to the general population. Elevated levels of the Endogenous Ouabain (EO) have been associated with hypertension (HT) and SS. We characterized the missense variation rs2254524 (Val642Leu; C&gt;A) of the Lanosterol Synthase gene (LSS) coding for an enzyme in steroid biosynthesis, since AA patients on a low-salt diet showed a greater reduction in BP compared to the LSS CC, with only CC having an increase in plasma EO. We aim at dissecting the functional correlation between LSS polymorphism, EO and SS-HT. Design and method: We generated by CRISPR-Cas9 a knock-in mouse model carrying the Lss V643L (LssV643L/V643L), homologous to V642L. Male mice were fed with a normal-salt diet (0.5% NaCl), high-salt diet (4% NaCl), or low-salt diet (&lt;0.03% Na) and BP was measured every two days by the tail-cuff system. Results: LssV643L/V643L mice were viable, healthy, and undistinguishable phenotypically from WT. At baseline, the Lss AA affected kidney weight that was significantly enlarged at 3 and 12 months of age, compared to WT. The Lss V643L mutation did not affect EO and SBP at 3 and 12 months, per se, but affects SBP responsiveness to salt stimulus. We observed a decreased SBP after 10 days of a low-salt diet and increased SBP upon a high-salt diet only in LssV643L/V643L mice compared to the control diet at 3 and 12 months, respectively. Moreover, 12-month-old mice in high-salt diet showed cardiac hypertrophy, and LssV643L/V643L showed a higher incidence of heart fibrosis. In the adrenal gland of LssV643L/V643L mice, Lss mRNA level was reduced upon high-salt diet. At 12 months, RNASeq analysis of renal differentially expressed genes revealed a different regulation of multiple Slc genes, both in control and high-salt diet, but also of Cbr2, and Arhgap26. Conclusions: The new LssV643L/V643L mouse model resembles the SS-HT phenotype together with EO non-responsiveness observed in HT patients, thus providing a good model of SS-HT. Our results reveal a role of Lss gene in the regulation of BP upon salt stimulus.

Effects of Covid-19 on the autonomic nervous system in elite athletes assessed by heart rate variability

IntroductionCovid-19 is a viral airway and systemic infection which can negatively affect the function of the autonomic nervous system. Cardiovascular autonomic function is essential for peak athletic performance. The aim of this study was to assess the effects of a Covid-19 disease on the autonomic nervous system of German elite athletes using heart rate variability (HRV).Methods60 elite athletes (aged 22.88 ± 4.71 years) were recruited, 30 of whom had undergone a Covid-19 disease. Heart rate (HR), blood pressure (BP) and heart rate variability (HRV) were measured during rest and during an orthostatic challenge.ResultsAt rest and after orthostatic stress blood pressure and the root mean square of successive differences (RMSDD) were significantly lower in Covid-19 athletes (COV) than in control athletes (CON) (p = 0.002 and p = 0.004, respectively); heart rate was significantly higher (p = 0.001). COV showed a significantly greater reduction in blood pressure and elevation of heart rate than CON, but the change in RMSSD did not differ significantly during the orthostatic challenge.ConclusionThese results show a change in cardiac parasympathetic activity and cardiovascular autonomic function in German elite athletes after Covid-19. These findings further the understanding of effects of the Covid-19 disease on the cardiovascular physiology in athletes. Heart rate variability may be a helpful tool in the return-to-play assessment of elite athletes.

Abstract P146: The Effects of Lifestyle Interventions on Blood Pressure in Postpartum Women: A Systematic Review

Introduction: One in 3 parous individuals has a pregnancy complication that indicates increased risk for future hypertension, diabetes, or heart disease. Lifestyle modification is recommended to reduce chronic disease risk after complicated pregnancies. However, little is known about the effect of lifestyle interventions on blood pressure in postpartum women. Thus, our objective was to evaluate the effects of postpartum lifestyle interventions on blood pressure. We hypothesized that postpartum lifestyle interventions would be associated with a decrease in blood pressure. Methods: We conducted a systematic literature review of six databases (Google, Google Scholar, Embase, Clinical Trials.gov, Cochrane Central, and PubMed) for relevant articles published through May 12, 2022. We considered for inclusion any randomized controlled trial or quasi-experimental, cohort, or case-control study that evaluated a postpartum lifestyle intervention and included blood pressure as an outcome. We excluded non-English publications and articles published before 2010. Two researchers independently identified eligible publications via title and abstract screening followed by full-text review, then extracted relevant data; a third researcher resolved any discrepancies. Due to the heterogeneity of the included studies, we were not able to conduct statistical testing. Results: In total 2,564 unique publications underwent title and abstract screening, of which 32 underwent full-text review, and eight met the inclusion criteria. Six of the included studies were randomized controlled trials, and five had relatively small sample sizes (&lt;100). In studies that reported race, nearly all participants identified as White (82%-100%). Seven of the studies required participants to have a history of a pregnancy complication, most often preeclampsia. Interventions usually involved diet and exercise counseling; only two included supervised exercise. Mean blood pressure declined from baseline to follow-up in all of the studies, however in none was there a statistically significant difference in blood pressure change between the intervention and control groups. While not statistically significant, the interventions that included supervised exercise appeared to be associated with greater blood pressure reductions when compared with control, than were the unsupervised interventions. Conclusions: In conclusion, we found no statistically significant effects of postpartum lifestyle interventions on blood pressure. Supervised exercise interventions appeared most promising. The evidence is limited to a handful of published studies (n=8) characterized by small sample sizes and a lack of racial diversity. Additional research with more diverse populations and supervised exercise interventions are warranted.

The Effect of Renal Denervation on T Cells in Patients with Resistant Hypertension.

(1) Background: Sympathetic overactivity is a major contributor to resistant hypertension (RH). According to animal studies, sympathetic overactivity increases immune responses, thereby aggravating hypertension and cardiovascular outcomes. Renal denervation (RDN) reduces sympathetic nerve activity in RH. Here, we investigate the effect of RDN on T-cell signatures in RH. (2) Methods: Systemic inflammation and T-cell subsets were analyzed in 17 healthy individuals and 30 patients with RH at baseline and 6 months after RDN. (3) Results: The patients with RH demonstrated higher levels of pro-inflammatory cytokines and higher frequencies of CD4+ effector memory (TEM), CD4+ effector memory residential (TEMRA) and CD8+ central memory (TCM) cells than the controls. After RDN, systolic automated office blood pressure (BP) decreased by -17.6 ± 18.9 mmHg. Greater BP reductions were associated with higher CD4+ TEM (r -0.421, p = 0.02) and CD8+ TCM (r -0.424, p = 0.02) frequencies at baseline. The RDN responders, that is, the patients with ≥10mmHg systolic BP reduction, showed reduced pro-inflammatory cytokine levels, whereas the non-responders had unchanged inflammatory activity and higher CD8+ TEMRA frequencies with increased cellular cytokine production. (4) Conclusions: The pro-inflammatory state of patients with RH is characterized by altered T-cell signatures, especially in non-responders. A detailed analysis of T cells might be useful in selecting patients for RDN.

S-09-2: POLYPILLS FOR HYPERTENSION CONTROL IN ASIANS

The number of cardiovascular disease (CVD) cases and deaths have continued to rise in Asian population. These unfavorable trends are expected to continue, particularly in low-income and middle-income countries.Raised blood pressure and LDL-cholesterol are among the leading modifiable risk factors for this problem. From the year 1990–2019, the prevalence of hypertension in many low-income and middle-income countries in Asia remained unchanged or increased. Most of the increase was in those without a previous diagnosis. However, the hypertension treatment and control were not improved in many countries since 1990. A meta-analysis concluded that combination anti-hypertensive therapies results in a greater reduction in blood pressure compared with increasing the dose of a single drug, regardless of the class of drugs used in combination. In term of safety, two-drug combinations have been shown to be safe and well tolerated with only a small increase in the risk of hypotension. The 2019 Thai hypertension Guidelines recommend using statin in high risk hypertensive patients. Adding a statin together with a combination of antihypertensive drug can further reduce the risk of future CVD. Such Polypill may offer many advantages and potential to solve many challenges and barriers in management of hypertension and CVD control in many, if not all, Asian Countries.

PS-C19-10: SEASONAL VARIATION IN THE EFFECT OF ANTIHYPERTENSIVE TREATMENT WITH THE IRBESARTAN/HYDROCHLOROTHIAZIDE COMBINATION

Objective: There is increasing awareness of seasonal variation in blood pressure. In the present analysis, we investigated seasonal variation in antihypertensive treatment effect of the irbesartan/hydrochlorothiazide combination in patients with stage 2 and 3 hypertension. Design and Methods: The study participants were hypertensive patients enrolled in a 12-week therapeutic study. Antihypertensive treatment was initiated with the irbesartan/hydrochlorothiazide 150/12.5 mg/day, with the possible up-titration to 300/12.5 mg/day and 300/25 mg/day at 4 and 8 weeks of follow-up. The month of treatment commencement was classified as spring/summer (May to August) and autumn/winter (September to December). Results: Of the 501 enrolled patients, 313 and 188 commenced antihypertensive treatment in spring/summer and autumn/winter, respectively. The mean changes in systolic/diastolic blood pressure at 8 and 12 weeks of follow-up were greater in patients who commenced treatment in autumn/winter (-32.3/-16.5 and -34.2/-16.7 mmHg, respectively) than those in spring/summer (-28.4/-13.9 and -27.1/-12.8 mmHg, respectively), with a between-season difference of 3.9 (95% confidence interval [CI], 1.4–6.4, P = 0.002)/2.6 (95% CI, 0.9–4.2, P = 0.002) mmHg and 7.0 (95% CI, 4.7–9.3, P &lt; 0.0001)/3.9 (95% CI, 2.4–5.4, P &lt; 0.0001) mmHg, respectively. Further subgroup analyses showed a greater between-season difference in the changes in systolic blood pressure in patients aged 55 years and older (n = 255) than those &lt; 55 years (n = 246, 12.6 vs. 6.9 mmHg, P = 0.02), and in patients with chronic kidney disease (n = 175) than those with normal renal function (n = 326, 12.1 vs. 7.4 mmHg, P = 0.06). Conclusions: There is indeed seasonality in antihypertensive treatment effect, with a greater blood pressure reduction in patients who commenced treatment in cold than warm seasons.

The Effects of Forest Therapy on the Blood Pressure and Salivary Cortisol Levels of Urban Residents: A Meta-Analysis.

Urban residents have a higher risk of hypertension and psychological stress than rural residents. Aside from medical interventions, understanding how to control hypertension and alleviate the stress of urban populations has become a public concern. As an alternative medical measure, forest therapy has shown the effects of normalizing blood pressure (BP) and reducing stress increasingly in recent literature, but this is still inconclusive. In order to systematically verify forest therapy’s effects on the BP and mental stress of urban residents, we conducted meta-analyses to assess the changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and salivary cortisol concentration (SCC; a stress biomarker) between the forest therapy group and urban control group. We searched 4 online databases, and 21 studies on BP involving 2270 participants and 13 studies on SCC involving 1786 participants were included. Through the meta-analysis, the mean difference and confidence interval (CI) estimates indicated that forest therapy significantly reduced participants’ SBP −3.44 (95% CI −5.74, −1.14), DBP −3.07 (95% CI −5.59, −0.54), and SCC −0.07 (95% CI −0.10, −0.04), as compared with urban control. Yet, there was substantial heterogeneity (I2 = 72.87−88.59%) among these studies. We also found that each prediction interval (PI) for SBP (95% PI −13.30, 6.42), DBP (95% PI −15.54, 9.41), and SCC (95% PI −0.18, 0.05) were all much wider than the CIs and contained values above 0. This means that forest therapy may reduce SBP, DBP, and SCC on average, but may not exclude adverse results. Meta-regression analyses showed that participants’ age and baseline SBP levels determined the heterogeneity among SBP studies. After forest therapy, older participants and those with higher baseline SBP levels had greater SBP-lowering effects. Among DBP studies, the primary source of heterogeneity was participants’ baseline DBP levels; participants with higher baseline DBP levels had greater DBP reduction. In subgroup analyses, we discovered that longer-term forest therapy programs (≥20 min) resulted in a greater reduction in BP and SCC than shorter-term forest therapy programs (<20 min). Additionally, seated viewing, walking, or multi-session programs in forests were observed to have similar effects on reducing BP and SCC. Despite extensive analyses, the study did not identify any sources of heterogeneity among forest therapy programs for lowering SCC levels. Overall, we conclude that forest therapy programs have beneficial therapeutic effects on urban residents’ physio-psychological health through lowering BP and relieving stress (reducing SCC). This finding provides solid evidence of the contribution of forest therapy to urban residents’ health and wellbeing.

Health football beats them all: subgroup analysis of the 3F (Fit&Fun with Football) study on white-coat hypertension, sustained hypertension, dippers, nondippers, and on pharmacologically un(treated) arterial hypertension.

The 3F study (Fit&Fun with Football) demonstrated a significant reduction in blood pressure, antihypertensive medication, body weight, stress and depression through health football. Health football could be a popular tool to unleash the full preventive potential of physical activity. This work analyses the effect of health football on hypertensive subgroups: dipper, nondipper, white-coat hypertension (WCH), sustained hypertension, (un)treated hypertensive patients (UH, TH). A prospective interventional study with 1-year follow-up. Football group (FG): n = 103, 'health'-football training (1×/week, 90 min) led by licensed football coaches. Physical inactive, hypertensive patients older than 45 years were compared with a control group (CG) ( n = 105). Subgroups were divided by ambulatory blood pressure monitoring (ABPM), casual blood pressure (CBP), medication schedule and compared by blood pressure (BP), laboratory results and weight. In all three subgroups (WCH vs. sustained hypertension, TH vs. UH, D vs. ND), health football reduced BP and weight significantly compared with the CG, and compared with the admission. An even greater effect in CBP was found in people with WCH than in sustained hypertension (FG: WCH: 141-127 mmHg, sustained Hypertension (SH): 142-132 mmHg; CG: WCH: 141-143 mmHg, SH: 140-141 mmHg). In contrast, the significant reduction in CBP and ABPM was comparable in treated and untreated patients, although antihypertensive drugs were reduced significantly more frequently in FG than in CG. BP reduction in nondippers and dippers was also comparable. In the nondipper group, nocturnal BP was significantly reduced in the FB (122.0-111.5 mmHg), but not in the CG or the dippers. All evaluated football subgroups achieved a significant BP reduction (compared with CG). This applied to dipper, nondipper, (un)treated hypertension, WCH and SH. All mentioned subgroups displayed a clear benefit. The even greater reduction in BP in WCH demonstrates the importance of physical activity before the additional prescription of antihypertensive medications, underscoring the recommendations of the ESC and ISH in WCH.

Seasonal variation in the effect of antihypertensive treatment with the irbesartan/hydrochlorothiazide combination.

There is increasing awareness of seasonal variation in blood pressure (BP). In the present analysis, we investigated seasonal variation in the antihypertensive treatment effect of the irbesartan/hydrochlorothiazide combination in patients with stage 2 and 3 hypertension. The study participants were hypertensive patients enrolled in a 12-week therapeutic study. Antihypertensive treatment was initiated with irbesartan/hydrochlorothiazide 150/12.5 mg/day, with possible uptitration to 300/12.5 mg/day and 300/25 mg/day at 4 and 8 weeks of follow-up, respectively. The month of treatment commencement was classified as spring/summer (May to August) and autumn/winter (September to December). Of the 501 enrolled patients, 313 and 188 commenced antihypertensive treatment in spring/summer and autumn/winter, respectively. The mean changes in systolic/diastolic BP at 8 and 12 weeks of follow-up were greater in patients who commenced treatment in autumn/winter (-32.3/-16.5 and -34.2/-16.7 mmHg, respectively) than those who commenced treatment in spring/summer (-28.4/-13.9 and -27.1/-12.8 mmHg, respectively), with a between-season difference of 3.9 (95% confidence interval [CI], 1.4-6.4, P = 0.002)/2.6 (95% CI, 0.9-4.2, P = 0.002) mmHg and 7.0 (95% CI, 4.7-9.3, P < 0.0001)/3.9 (95% CI, 2.4-5.4, P < 0.0001) mmHg, respectively. Further subgroup analyses according to several baseline characteristics showed a greater between-season difference in the changes in systolic BP in patients aged ≥55 years than in those <55 years (n = 255, 12.6 mmHg vs. n = 246, 6.9 mmHg, P = 0.02), especially in patients who did not use antihypertensive medication at baseline (n = 94, 15.4 mmHg vs. n = 132, 5.4 mmHg, P = 0.006). In conclusion, there is indeed seasonality in the antihypertensive treatment effect, with a greater BP reduction in patients who commenced treatment in cold than warm seasons.