Higher Mean Systolic Blood Pressure Research Articles

Machine Learning-Based Predictive Modeling of Surgical Intervention in Glaucoma Using Systemic Data From Electronic Health Records

To predict the need for surgical intervention in patients with primary open-angle glaucoma (POAG) using systemic data in electronic health records (EHRs). Development and evaluation of machine learning models. Structured EHR data of 385 POAG patients from a single academic institution were incorporated into models using multivariable logistic regression, random forests, and artificial neural networks. Leave-one-out cross-validation was performed. Mean area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, and Youden index were calculated for each model to evaluate performance. Systemic variables driving predictions were identified and interpreted. Multivariable logistic regression was most effective at discriminating patients with progressive disease requiring surgery, with an AUC of 0.67. Higher mean systolic blood pressure was associated with significantly increased odds of needing glaucoma surgery (odds ratio [OR]= 1.09, P < .001). Ophthalmic medications (OR= 0.28, P < .001), non-opioid analgesic medications (OR= 0.21, P= .002), anti-hyperlipidemic medications (OR= 0.39, P= .004), macrolide antibiotics (OR= 0.40, P= .03), and calcium blockers (OR= 0.43, P= .03) were associated with decreased odds of needing glaucoma surgery. Existing systemic data in the EHR has some predictive value in identifying POAG patients at risk of progression to surgical intervention, even in the absence of eye-specific data. Blood pressure-related metrics and certain medication classes emerged as predictors of glaucoma progression. This approach provides an opportunity for future development of automated risk prediction within the EHR based on systemic data to assist with clinical decision-making.

322-OR: Risk Factors for Peripheral and Cardiovascular Autonomic Neuropathy in Type 1 Diabetes: Thirty Years of Follow-Up in DCCT/EDIC

The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study reported that intensive glucose control as assessed by hemoglobin A1c (HbA1c) reduced the risk of diabetic peripheral neuropathy (DPN) and cardiovascular autonomic neuropathy (CAN) in type 1 diabetes (T1D), with long lasting benefits. We evaluated additional clinical parameters and risk factors that could contribute to the development of DPN and CAN in this cohort. DPN was assessed at three different times and defined as a composite of symptoms, signs, and abnormal nerve conduction studies in ≥2 nerves; CAN was assessed seven different times and defined based on R-R variation, Valsalva maneuver, and postural changes in blood pressure. Generalized estimating equation models were used to evaluate the association of DPN and CAN with individual risk factors over repeated time points spanning 30 years. Among 1,441 DCCT/EDIC participants, 32% developed DPN and 44% developed CAN. Higher mean HbA1c was the most significant risk factor for DPN (OR=1.56 per 1%, 95% CI 1.41,1.72). DPN was also associated with older age (1.43 per 5 years, 95% CI 1.31,1.55), longer duration of T1D, higher albuminuria, β-blocker use, higher mean diastolic blood pressure, and higher HbA1c at DCCT eligibility. CAN was associated (in order) with older age (1.51 per 5 years, 95% CI 1.40,1.63), longer duration of T1D (1.07 per 1 year, 95% CI 1.05,1.10), any sustained microalbuminuria (AER ≥30 mg/24 hour on two consecutive visits), higher mean HbA1c, higher mean and current pulse rate (likely as an indirect measure of CAN), higher mean systolic blood pressure, β-blocker use, any eGFR &amp;lt;60 mL/min/1.73 m2, higher HbA1c at DCCT eligibility, and current cigarette smoking. Higher mean HbA1c was the strongest risk factor for DPN, but not of CAN. These findings help identify patient phenotypes and modifiable risk factors for personalized approaches to neuropathy prevention. Disclosure B. Braffett: None. R. Gubitosi-Klug: None. J.W. Albers: Consultant; Self; Eli Lilly and Company. E.L. Feldman: None. C. Martin: None. N.H. White: None. T.J. Orchard: Consultant; Self; Boehringer Ingelheim International GmbH. M.F. Lopes-Virella: None. P. Raskin: Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Gan &amp; Lee Pharmaceuticals, Novo Nordisk A/S. R. Pop-Busui: Consultant; Self; Novo Nordisk A/S. Research Support; Self; AstraZeneca. Other Relationship; Self; American Diabetes Association. Funding Division of Diabetes Endocrinology &amp; Metabolic Diseases (U01DK094176, U01DK094157); National Eye Institute; National Institute of Neurologic Disorders and Stroke; General Clinical Research Centers Program; Clinical Translational Science Center

Associations of various blood pressure parameters with functional outcomes after endovascular thrombectomy in acute ischaemic stroke.

High blood pressure (BP) at presentation is associated with poor outcomes in acute ischaemic stroke, but serial BP measurements may better delineate the clinical implications of BP. The aim was to investigate the association between various BP parameters and functional outcomes in acute ischaemic stroke patients treated with endovascular thrombectomy (EVT). This study reports a retrospective analysis of a prospective registry of a comprehensive stroke centre. Patients treated with EVT due to large vessel occlusion in the anterior circulation were enrolled. BP was measured hourly during the first 24h after admission. Associations of various BP parameters, including BP variability, with functional outcomes at 3months, including good outcomes (modified Rankin Scale score of 0-2), were analysed. Of the 378 enrolled patients (mean age 70±11years, male 54.2%), 313 (82.8%) achieved successful reperfusion after EVT, and 149 (39.4%) had good outcomes at 3months. Higher mean systolic BP [each 10mmHg increase, odds ratio 0.82 (0.69-0.97)] and higher systolic successive variation (SV) [each 10% increase, odds ratio 0.37 (0.18-0.76)] were associated with a reduced likelihood of achieving good outcomes. In addition, reperfusion status after EVT moderated the influence of higher systolic SV on good outcomes (Pint =0.05). The results showed that a higher mean systolic BP and systolic SV during the first 24h of EVT reduced the likelihood of good outcomes at 3months. The effects of these parameters on outcomes are more substantial amongst patients with successful reperfusion after EVT, suggesting that different BP control strategies should be employed according to reperfusion status.

Reader response: Late-life blood pressure association with cerebrovascular and Alzheimer disease pathology.

We read with interest the article by Arvanitakis et al.,1 which found that both higher mean and more rapidly declining late-life systolic blood pressure (SBP) increased the odds of gross and microinfarcts. A relationship between higher mean SBP and neuronal neurofibrillary tangles was also observed. In examining blood pressure (BP) and neuropathology of aging, recent work highlighted that high—but also low BP—and wide fluctuations of BP levels may increase the risk of dementia, including mixed or Alzheimer dementia.2–4 In addition, antihypertensive medications can specifically address the pulsatile component and variability of BP.4,5 Therefore, it would be interesting to explore whether and how BP variability and pulse pressure relate to brain disease. These analyses would be useful to further understand the vascular contribution to cognitive dysfunction and identify potential therapeutic strategies.

Abstract P105: Less Walkable Neighborhoods Are Associated With Worse Cardiovascular Risk Profile

Introduction: There is mounting evidence that neighborhoods that have low levels of walkability have higher burdens of cardiovascular disease (CVD) risk factors such as obesity and hypertension. However, few studies have examined the impact of walkability on overall cardiovascular risk. Hypothesis: We hypothesized that residents living in less walkable communities have a higher burden of cardiovascular risk factors and a greater predicted risk for future CVD events. Methods: We assembled a cross-sectional sample of community dwelling adults aged 40-74 on January 1, 2008 from the CANHEART cohort. We ascertained systolic blood pressure, HDL and total cholesterol, smoking status, and diabetes status using a combination of EMR, clinical laboratory databases, and health administrative databases. The primary outcome was an estimated total 10-year cardiovascular disease risk of ≥ 7.5% using the ACC/AHA Pooled Cohort risk score. Walkability was measured using a validated index and divided into quintiles from lowest (Q1) to highest (Q5). The associations were tested using linear and logistic regression with cluster-robust standard errors, adjusting for confounders. Results: In total, 44,448 individuals were included in the analysis. Individuals living in less walkable areas had a higher predicted 10-year CVD risk than those living in highly walkable areas. The association was non-linear, as individuals living in neighborhoods of mid-range walkability (Q3) were even more likely to have an estimated 10-year CVD risk exceeding 7.5% in comparison to those in Q5 (OR = 1.33, (1.23, 1.45)). Conversely, we observed monotonic associations between decreasing walkability and higher mean systolic blood pressure (Q1 vs. Q5: +2.73 mmHg, 95% CI: +2.11, + 3.35) and odds of diabetes (Q1 vs. Q5: OR = 1.29, 95% CI: 1.13, 1.47). Dose-response associations were also observed between decreasing walkability and lower HDL cholesterol (Q1 vs. Q5: -1.93 mg/dl, 95% CI: -2.32, -1.16) and likelihood of being a current smoker (Q1 vs. Q5: OR = 0.76, 95% CI: 0.67, 0.85). Conclusions: Residents living in less walkable neighborhoods had a higher burden of CVD risk factors and a higher estimated risk of future CVD. Conversely, the likelihood of smoking was higher in more walkable neighborhoods, suggesting this may be an area to focus smoking cessation efforts.

Abstract P4-10-05: High risk for cardiovascular disease in postmenopausal breast cancer survivors

Abstract Background: The majority of women diagnosed with breast cancer are considered to have a good prognosis and can expect to survive the disease. Cardiovascular risk in postmenopausal women treated for breast cancer is higher than in women without cancer. Objective: To evaluate cardiovascular risk factors in postmenopausal breast cancer survivors, in comparison to postmenopausal women without breast cancer. Methods: In this cross-sectional study, 96 postmenopausal breast cancer survivors were compared to 192 postmenopausal women (controls), aged 45 to 75 years. The main group included women with amenorrhea &amp;gt; 12 months, aged ≥45 years, with a histological diagnosis of breast cancer, without metastatic disease and without established cardiovascular disease (CVD). The control group consisted of women with amenorrhea &amp;gt; 12 months, aged ≥45 years, without breast cancer and CVD. Groups were matched by age, time since menopause, and body mass index (BMI) in a ration of 1 case to 2 controls, according to sample calculation, with a minimum of 92 breast cancer survivors. Clinical and anthropometric data (BMI and waist circumference) were collected by interview and physical examination. For biochemical analysis, total cholesterol, HLD, LDL, triglycerides, glucose and insulin levels were measured. Women presenting with three or more of the following criteria were diagnosed with metabolic syndrome (MetS): waist circumference (WC)&amp;gt; 88 cm; TG≥ 150 mg/dL; HDL cholesterol &amp;lt;50 mg/dL; blood pressure ≥ 130/85 mmHg; glucose ≥ 100 mg/dL. For measurement of plasma HSP 60 and 70 concentrations, immunoassays were used (ELISA test). Atherosclerotic disease was determined by intima-media thickness (IMT&amp;gt; 1 mm) of the carotid arteries and / or by the presence of atheromatous plaque, assessed by carotid artery ultrasound (scanner duplex). For statistical analysis, Student's t-test, Gamma Distribution (asymmetric variables), Chi-Square Test and Logistic Regression (odds ratio-OR) were used. Results: Breast cancer survivors had high mean systolic and diastolic blood pressure (p &amp;lt;0.001), and mean blood triglycerides and glucose, above desirable levels (p &amp;lt;0.05). Breast cancer patients had higher HSP60 levels and lower HSP70 levels than controls (p &amp;lt;0.05). Atheromatous plaque occurred more frequently in breast cancer survivors than in controls (19.8% vs. 9.4% respectively) (p &amp;lt;0.05). Analysis of risk adjusted for age, time since menopause and BMI, showed that women treated for breast cancer have a significantly higher risk of MetS (OR = 4.21, 95% CI 2.28-7.76), atheromatous plaque (OR = 2.61, 95% CI 1.19-5.72), diabetes (OR=4.42; 95%CI 1.86- 10.49), hypertriglyceridemia (OR = 2.32, 95% CI 1.33-4.0) and increased waist circumference (OR = 11.22, 95% CI 4.0 - 31.65) than women without breast cancer. Conclusion: Postmenopausal breast cancer survivors are at higher risk for metabolic syndrome, diabetes, atherosclerotic disease, hypertriglyceridemia and abdominal obesity (major risk factors for cardiovascular disease), in comparison to postmenopausal women without breast cancer. Citation Format: Buttros DdAB, Branco MT, Orsatti CL, Nahas-Neto J, Nahas EAP. High risk for cardiovascular disease in postmenopausal breast cancer survivors [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-10-05.

Abstract TP411: Distinct Systolic Blood Pressure Trajectories 72 Hours After Mechanical Thrombectomy Predict Hemorrhagic Transformation and Poor Functional Outcome

Introduction: Current stroke guidelines recommend maintaining systolic blood pressure (SBP) below 180 mmHg after thrombolysis, and this standard has carried over for post-thrombectomy blood pressure (BP) management. However, optimal BP management after mechanical thrombectomy (MT) remains unclear and BP beyond 24 hours after thrombectomy is not well-studied. We investigated how 72-hour SBP trajectories after MT may predict patient outcome. Methods: We retrospectively studied patients with large-vessel occlusion stroke who underwent MT. BP was non-invasively recorded hourly for the first 72 hours. Hemorrhagic transformation (HT) was measured on 24-hour CT scans using ECASS II classification. Functional outcome was assessed using the modified Rankin Scale (mRS). SBP trajectories between groups were compared using generalized estimating equations. All analyses were adjusted for age, admission NIHSS, and recanalization status. Results: Seventy-three patients (mean age 72±14, 40F, mean NIHSS 18) were analyzed. Patients with poor 90-day functional outcome (mRS &gt;3) had higher mean SBP over the first 24 hours compared to those with favorable outcome (136 vs. 128 mmHg, p=0.017) and demonstrated distinct BP trajectories over the first 72 hours (Figure 1A). Patients with poor functional outcome had higher SBP directly after MT (155 vs. 141 mmHg) and their pressures dropped less during the first 12 hours when compared to those with favorable outcomes (p=0.018). Similarly, mean SBP and SBP trajectories of patients with HT were significantly different from those without HT (Figure 1B, p=0.050). By 72 hours, SBP trajectories were similar, regardless of functional outcome or HT. Conclusions: During the first 72 hours after MT, acute ischemic stroke patients show distinct SBP trajectories, which differ in relation to functional outcome and hemorrhagic transformation. The findings may help recognize potential candidates for future blood pressure control trials.

Low Socioeconomic Status but Resilient: Panacea or Double Trouble? John Henryism in the International IMIAS Study of Older Adults.

John Henry (JH) theory provides a framework for understanding the physiological toll exerted on low socioeconomic status (SES) individuals as they overcome psychosocial stressors imposed by their environments. This theory suggests that resilience, a seemingly positive social adaptation, may in fact be physically deleterious. JH theory has been well-described in low-SES rural male African Americans, however it is currently unclear whether validity of this theory extends to women, other races and outside the rural US. We assessed whether, in individuals with low income, there is an association between self-mastery/resilience and either blood pressure or depressive symptoms that is different from the association seen in individuals with higher income. Data were obtained from 1353 older men and women participants of the International Mobility in Aging Study (IMIAS). Across 3 countries and 4 sites, higher self-mastery/resilience was associated with lower depressive symptoms in both low and high income groups. In low income individuals from Saint-Hyacinthe, Québec, higher self-mastery/resilience was associated with both higher mean systolic blood pressure (n = 240, β = 0.135, p ≤ 0.05) and higher mean diastolic blood pressure (n = 240, β = 0.241, p ≤ 0.0001). In the high income group of Saint-Hyacinthe, no such associations were observed. The findings in the Saint-Hyacinthe cohort (but not the other settings), are consistent with the John Henry hypothesis, and demonstrates this effect extends beyond a rural African American population. This finding indicates that in certain populations, the positive psychological effects of resilience come with a cost to physical health.

A common underlying genetic contribution to the co-occurrence of depressive symptoms and lower blood pressure in adolescents

Background: Depression and cardiovascular disease risk factors develop in childhood. The objective of this study was to investigate cross sectional and longitudinal associations between blood pressure, mood scores and tagged SNPs within the Monoamine oxidase A (MAOA) gene in the Western Australian Pregnancy Cohort (Raine) Study. Methods: Data from the five (n=1097), eight (n=1046), ten (n=1026) and fourteen (n=1124) year surveys were used. Blood pressure was measured at all surveys, anxious-depressed scores obtained from the Childhood Behavior Checklist at all surveys and depressive symptom scores from the Beck Depression Inventory for Youth at 14 years. Single nucleotide polymorphisms (SNPs) tagging the MAOA gene were identified from HapMap Phase II (CEU) data and genotyped. Cross sectional and longitudinal analyses were used to examine the association between blood pressure (outcome) and tagged SNPs within the MAOA gene and anxious/depressed scores (outcome) and tagged SNPs within the MAOA gene. Results: At 14 years, boys with the risk allele of SNP rs5905859 and rs3027396 had higher systolic blood pressure (βrs5905859=2.5; 95% CI: 0.743, 4.337 and βrs3027396=2.5; 95% CI: 0.681, 4.383 respectively) and lower mood scores (βrs5905859=-0.1; 95% CI: -0.100, -0.022 and βrs3027396=-0.2; 95% CI: -0.313,-0.045 respectively). Longitudinally, boys with the risk allele of SNPs rs5905859 (β=0.3; 95% CI: 0.026, 0.540) or rs6609257 (β= 0.3; 95% CI: 0.022, 0.521) had a higher mean systolic blood pressure trajectory compared to boys without. Conclusions: Variation within or close to the MAOA gene may explain in part the association between lower depressive symptom scores and higher systolic blood pressure in Caucasian boys within the Raine cohort.

Predictive factors for conservative treatment of liver trauma

Objectives The aim of this study was to evaluate the management of patients with liver injury and the possible predictive factors for conservative treatment. Background Injuries are a major public health problem. The liver is the most commonly injured intra-abdominal organ. Conservative treatment thereby not only decreases the number of nontherapeutic laparotomies, but also achieves a reduction in morbidity and mortality. Patients and methods The present study was conducted on all patients with traumatic liver injury (20 patients) admitted to Menoufia University Hospital and El-Senbellawein General Hospital in the period between April 2015 and April 2016. Liver trauma was classified according to the Hepatic Injury Scale of the American Association for the Surgery of Trauma. To analyze the results, patients were divided into two groups – group A included patients with blunt trauma and group B included patients with penetrating trauma. According to the management plan, patients were further divided into group I (conservative treatment) and group II (operative treatment). Results Patients who were successfully managed conservatively had significantly higher mean systolic blood pressure (P = 0.004), lower mean pulse rate on admission (P = 0.003), and significantly lower American Association for the Surgery of Trauma grade of liver injury than patients who underwent operative management (P = 0.001). There was a significant difference in the number of blood unit transfusions between the types of management plan groups (P = 0.006). Conclusion Conservative management of traumatic liver injuries is safe when the decision is based on careful initial evaluation. During management, we identified possible predictive factors that may influence the management plan and outcome of patients with liver injury: pulse rate, systolic blood pressure at arrival to the hospital, the amount of blood transfused, and the grade of injury.

A17369 Application of Continuous Noninvasive Arterial Pressure Monitor in Patients with Cardiovascular Diseases plus Obstructive Sleep Apnea

Objectives: The hemodynamics of patient with cardiovascular diseases (CVD) plus obstructive sleep apnea (OSA) is changeable and complicated. A new continuous noninvasive arterial pressure monitor (CNAP) has been validated in screening the hemodynamics. The aim of our study is to assess the performance of CNAP in patients with CVD plus OSA. Methods: The hemodynamics of patient with cardiovascular diseases (CVD) plus obstructive sleep apnea (OSA) is changeable and complicated. A new continuous noninvasive arterial pressure monitor (CNAP) has been validated in screening the hemodynamics. The aim of our study is to assess the performance of CNAP in patients with CVD plus OSA. Results: Compared with the values monitored before sleeping, patients had higher mean systolic blood pressure (125.60 ± 17.19mmHg vs. 118.96 ± 17.97mmHg, P < 0.05), lower mean heart rate (66.41 ± 9.19bpm vs. 69.61 ± 12.57bpm, P < 0.05) during sleep apnea events. 10 patients have used continuous positive airway pressure (CPAP) to treat OSA. Compared with the values monitored before treatment by CPAP, patients using CPAP had lower cardiac output (5.41 ± 1.12l/min vs. 5.74 ± 1.19l/min, P < 0.05), cardiac index (2.85 ± 0.40l/min/m^2 vs. 3.02 ± 0.4l/min/m^2, P < 0.05), pulse pressure variation (5.67 ± 1.20% vs. 6.48 ± 1.20%, P < 0.05) and stroke volume variation (7.47 ± 1.60% vs. 11.03 ± 2.78%, P < 0.05). Conclusion: CNAP could be clinically useful to assess hemodynamics of patient with CVD plus OSA. When sleep apnea events happened, patients’ mean systolic blood pressure became higher while mean heart rate became lower. When patients using CPAP, cardiac output, cardiac index, pulse pressure variation and stroke volume variation all became lower.

Abstract P306: Preterm Birth is Associated with Increased Blood Pressure and Increased Urinary Angiotensinogen in Young Adults

Introduction: Cardiovascular disease (CVD) is the leading cause of mortality and hypertension (HTN) is a major risk factor for CVD. Preterm birth is an emerging risk factor for both CVD and HTN, but the underlying mechanisms are poorly described. The renin-angiotensin system (RAS) plays a key role in HTN and CVD, and adolescents born preterm have higher blood pressure (BP) with a shift in the balance of the classical and alternative pathways of the RAS exhibited as increased angiotensin II and reduced angiotensin-(1-7) as compared to term-born adolescents. Although numerous factors influence the expression of angiotensins, the precursor protein angiotensinogen in the kidney is implicated in the development of HTN and CVD and may contribute to higher angiotensin II. As the status of renal angiotensinogen in individuals born preterm is unknown, we hypothesized that urinary angiotensinogen is increased in young adults born preterm as compared to their term-born peers. Methods: We compared urinary excretion of angiotensinogen corrected for urine creatinine and systolic and diastolic BP in 142 young adults (mean age 19.9 years) born preterm with very low birth weight (&lt;1500 g) to 32 young adults born term using Wilcoxon Rank-Sum test and t-test. We used generalized linear models to compare the ln(x) urinary angiotensinogen between the preterm and term groups adjusted for the potentially confounding factors race, maternal hypertensive pregnancy, and maternal smoking during pregnancy. Results: Compared to term, subjects born preterm had higher median urinary angiotensinogen (0.02 μg/g, IQR 0.01 to 0.04 vs. 0.01 μg/g, IQR 0.004 to 0.01, p &lt; 0.001) and higher mean systolic BP (111 mmHg, SD 11 vs. 106 mmHg, SD 10, p = 0.03). On crude and adjusted analyses urinary angiotensinogen was associated positively with preterm birth (crude β : 0.82, 95% CI 0.47 to 1.16; adjusted β : 0.79, 95% CI 0.39 to 1.18). Discussion: In addition to higher BP, young adults born preterm demonstrated increased urinary angiotensinogen as compared to their term-born peers. Preterm birth may induce programming of the renal RAS leading to higher angiotensinogen and a higher angiotensin-to-angiotensin-(1-7) ratio, potentially contributing to the increased risk of HTN in individuals born preterm.

Biological Risk and Infection Profiles of Young Adult Male Mexican American Gang Members.

Little research has examined the long-term health consequences of gang affiliation among Mexican Americans. The objectives of this study were to (1) measure biological indicators of cardiovascular and metabolic risk, as well as prevalence of sexually transmitted infections (STIs), in a sample of Mexican American men aged 25-40 who were affiliated with gangs as adolescents and (2) compare those indicators with a comparable national sample of Latino men. Using bivariate analyses, we compared blood pressure, body mass index, 4 metabolic and cardiovascular indicators, and 4 infections for 179 Mexican American formerly gang-affiliated men in San Antonio, Texas, and 155 Mexican American men from the National Health and Nutrition Examination Survey. We used multivariate models to estimate adjusted risk scores for each sample controlling for age, marital status, and education. Compared with men in the national sample, the unadjusted results showed that men in the gang-affiliated sample had significantly higher mean systolic blood pressure (125.6 vs 120.0 mm Hg, P = .001), diastolic blood pressure (81.4 vs 71.1 mm Hg, P < .001), and C-reactive protein (5.9 vs 3.6 mg/L, P = .04), and a significantly lower mean total cholesterol (164.2 vs 205.5 mg/dL, P < .001) and low-density lipoprotein cholesterol (91.1 vs 120.1 mg/dL, P < .001). Compared with men in the national sample, more men in the gang-affiliated sample had herpes simplex virus type 2 (64/174 [36.8%] vs 18/147 [12.2%], P < .001), chlamydia (10/176 [5.7%] vs 1/135 [0.7%], P = .02), and hepatitis C virus (85/173 [49.1%] vs 0, P < .001). The gang-affiliated sample had a significantly higher adjusted risk score than the national sample (1.5 vs 1.1, P = .003). Gang-affiliated Mexican American men had significant disparities in biological risk indicators and STIs, which can lead to long-term health implications and highlight the need for tailored prevention strategies. Long-term exposure to psychosocial stressors and subsequent systemic inflammation may also increase the risk for physiological and psychological dysregulation and detrimental chronic health conditions in this population.

Long-Term Blood Pressure Level and Variability From Midlife to Later Life and Subsequent Cognitive Change: The ARIC Neurocognitive Study.

BackgroundTo understand how blood pressure (BP) from midlife and beyond is related to cognition in older age, a lifespan approach is needed. We assessed the associations of BP levels and variability from midlife on with subsequent cognitive change.Methods and ResultsThe ARIC (Atherosclerosis Risk in Communities) Study participants underwent 4 clinic BP measurements (visit 1, 2, 3, and 4 BPs) between 1987 and 1998, and their mean levels and average real variability (ARV) were assessed as exposures. A global cognitive z score, estimated from the Delayed Word Recall Test, Digit Symbol Substitution Test, and Word Fluency Test scores, was calculated at 1996 to 1998 (visit 4) and 2011 to 2013 (visit 5). Among 11 408 participants (mean age, 54 years; 56% women; 21% black race), mean systolic BP (SBP)/diastolic BP (DBP) level was 123/72 mm Hg, and ARVSBP/ARVDBP was 11/7 mm Hg. With linear mixed models, 1‐SD increases of ARVSBP (standardized regression coefficient [95% confidence interval], −0.03 [−0.04 to −0.01] points) and ARVDBP (standardized regression coefficient [95% confidence interval], −0.02 [−0.03 to −0.002] points; both P<0.05), but not mean SBP or DBP levels, were associated with lower global cognitive z scores at visit 4. In contrast, mean SBP (standardized regression coefficient [95% confidence interval], −0.04 [−0.06 to −0.02] points) or DBP (standardized regression coefficient [95% confidence interval], 0.04 [0.02–0.06] points; both P<0.001) level, but not ARVSBP or ARVDBP, was associated with change in global cognitive z scores from visits 4 to 5.ConclusionsGreater visit‐to‐visit SBP or DBP variability from midlife on is modestly associated with lower cognitive function, whereas higher mean SBP and lower DBP levels from midlife to later life are modestly associated with cognitive decline in later life.

DO BIOMARKERS VARY BY SOCIAL CLASS, EDUCATION AND REGION AND IS MIGRATION IMPORTANT? EVIDENCE FROM A COHORT OF BRITISH ADULTS.

The aim of this study was to test whether Body Mass Index (BMI), waist circumference, systolic and diastolic blood pressure, Forced Expiratory Volume (FEV1) and Peak Expiratory Flow (PEF) vary in relation to social class at birth and adulthood, educational level and region of residence, and also with inter-generational social, educational and regional mobility/migration. The study used 5702 adults (2894 males and 2718 females) from the longitudinal British National Child Development Study (all children born in England, Scotland and Wales during the first week in March 1958 with follow-up throughout childhood and adulthood, most recently at 55 years of age). In both sexes BMI and waist circumference tended to increase from social classes I+II to IV+V and higher social class was associated with higher mean FEV1 and PEF. Better-educated adults tended to have lower BMI and waist circumference, and higher mean FEV1 and PEF. Women from Wales had the highest mean BMI and waist circumference but the lowest mean PEF, while women in Scotland had the highest mean systolic blood pressure and the lowest mean FEV1. For men only, FEV1 and PEF showed regional variation and the lowest mean FEV1 was in Wales and the lowest PEF in Yorkshire &amp; Humberside. Inter-generational social mobility was not found to be associated with any of the biomarkers, while educational mobility was related only to FEV1 and PEF. In both sexes, in unadjusted regression analysis regional migrant cohort members tended to have a lower mean BMI than sedentes. Regional male migrants also tended to have a lower waist circumference and a higher FEV1 and PEF than sedentes.

An Observational Study: Ambulatory Blood Pressure Monitoring after Percutaneous Transluminal Coronary Angioplasty

Abstract Aim In recent studies, lack of fall in nocturnal blood pressure (BP) has been presented as an independent predictor of poor prognosis. The aim of this study is to investigate the prognostic value of various variables of BP by 24-hour ambulatory blood pressure (ABP) measurement and sex-related differences after percutaneous transluminal coronary angioplasty (PTCA). Methods This study included 100 patients who underwent PTCA in the authors’ institute from June 2017 to January 2018. They were monitored by 24-hour ABP for 1 day in the hospital. Results One hundred patients were recruited in this study with mean age of 61.64 years, with female-to-male ratio of 0.27:1. All demographic, clinical, and laboratory parameters including the ABP parameters were comparable between females and males, except smoking and alcoholism that were more frequent in males.Out of 100 patients, 41 had nocturnal dipping in BP and 59 did not have nocturnal dipping. In this study, the variables among nondippers, 16 (27.1%) were females, 43 (72.8%) were males, 45 (63.3%) had diabetes mellitus (DM), 46 (75.4%) had hypertension (HTN), mean systolic blood pressure (SBP) was 141.7 ± 13.9 mm Hg, mean diastolic blood pressure (DBP) was 86.34 ± 5.64 mm Hg, mean pulse pressure (PP) was 55.39 ± 9.25 mm Hg, and pulse-wave velocity (PWV) was 6.69 ± 2.22 m/s.In females were more nondippers (27.1%) than dippers (12.1%), which was statistically significant (p = 0.05). Nondippers were more among hypertensive patients (77.9% vs. 36.5%; p = 0.00). Higher mean SBP (p = 0.001), higher mean BP (p = 0.032), and higher mean pulse pressure (p = 0.00) were observed in nondippers.However, age, ejection fraction (EF), presence of DM, coronary artery disease (CAD) severity, type of presentation, and PWV were not different in dipper versus nondippers. Conclusion With comparable clinical, laboratory parameters along with BP parameters between females and males, immediate post-percutaneous coronary intervention (PCI) patients, female PCI patients had more nondippers (p = 0.05). Overall nondippers had higher SBP, mean BP, and PP than dippers. Diabetes, severity of CAD, and type of presentation of CAD (as ACS or CSA) did not influence the nocturnal dipping quality of the BP.

Early Cognitive Impairment after Intracerebral Hemorrhage in the INTERACT1 Study

Background: Data on cognitive impairment after acute intracerebral hemorrhage (ICH) are limited. This study is aimed at determining the frequency and predictors of cognitive impairment among participants of the pilot phase, Intensive Blood Pressure (BP) Reduction in Acute Cerebral Hemorrhage Trial (INTERACT1). Methods: INTERACT1 was an open randomized trial of early intensive (target systolic BP <140 mm Hg) compared with contemporaneous guideline-recommended BP lowering in 404 patients with elevated systolic BP (150–220 mm Hg) within 6 h of ICH onset. Cognitive impairment was defined by scores ≤24 on the Mini-Mental State Examination (MMSE) assessed by interview on follow-up at 90 days. Results: A total of 231 (64.5%) of 358 90-day survivors had MMSE scores for analyses, and 75 (32.5%) had cognitive impairment. In multivariable analysis, older age (OR 2.48, 95% CI 1.73–3.56 per 10-year increase; p < 0.001), female sex (OR 2.06, 95% CI 1.00–4.23; p = 0.049), prior ICH (OR 2.87, 95% CI 1.08–7.65; p = 0.035), high baseline National Institute of Health Stroke Scale score (OR 1.06, 95% CI 1.00–1.13; p = 0.044), and high mean systolic BP over the first 24 h post-randomization (OR 1.34, 95% CI 1.07–1.68/10 mm Hg increase; p = 0.011) were independently associated with cognitive impairment. Conclusions: One third of patients have significant cognitive impairment early after ICH, which is more frequent in the elderly, females, those with prior ICH, and more severe initial neurological deficit and with persistently high early systolic BP.

Gender disparities in pulmonary hypertension at a tertiary centre in Cameroon.

Pulmonary hypertension (PH) is a potent cause of heart failure and has been little investigated in the African setting. To investigate the effects of gender on the clinical presentation, echocardiographic features and outcomes of patients with PH in Douala, Cameroon. A prospective cohort study was conducted from March 2012 to December 2013 as part of the Pan African Pulmonary Hypertension Cohort study. PH was diagnosed by echocardiography and defined as a right ventricular systolic pressure >35 mmHg in the absence of acute right heart failure. Patients were followed up for a maximum of 12 months for primary endpoint mortality. In total, 130 patients with PH were recruited; 71 (54.6%) were women. The median age was 59.2 years for men and 58.3 years for women (p=0.76). Active smoking and alcohol use were more frequent in men than women (both p<0.001), but women had greater exposure to indoor cooking fumes than men (p<0.001). Previous tuberculosis infection (11.3% v. 1.7%) and S3 gallop rhythm (30.9% v. 11.9%) were more common in women (both p<0.03). Women had a significantly higher mean systolic blood pressure (134 mmHg v. 125 mmHg; p=0.04) and pulse pressure (53.8 mmHg v. 44.9 mmHg; p=0.01) and a lower mean haemoglobin concentration (10.4 g/dL v. 12.4 g/dL; p<0.05) compared with men. Echocardiographic left ventricular (LV) systolic dysfunction was more frequent in men: mean LV ejection fraction 42.6% v. 51.5% (p=0.01) and mean fractional shortening 21.4% v. 28.6% (p=0.01). The overall mortality rate was 20.3%, and rates were similar in the two groups (Kaplan-Meier log rank 1.1; p=0.30). Despite differences in baseline characteristics including cardiovascular risk factors, mortality rates on follow-up were similar in men and women in this study. However, these different baseline characteristics probably suggest differences in the pathogenesis of PH in men and women in our setting that need further investigation.

PP.06.32] VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY AND ITS CORRELATION WITH DECLINE IN KIDNEY FUNCTION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Objective: Blood pressure variability (BPV) is associated with poorer outcomes in patients with diabetes. Research on the characteristics of visit-to-visit BPV and its prognostic implications is limited. This study aimed to determine the value of BPV, associated factors of systolic BPV and its correlation with decline in kidney function in patients with type 2 diabetes mellitus (T2DM). Design and method: This was a 10-year retrospective cohort study of 333 patients with T2DM at a primary care clinic. Blood pressure (BP) at every follow up visit from 2005 to 2014 were captured. BPV was defined as the standard deviation of the BP readings. Decline in kidney function was expressed as the annual rate of decline in estimated glomerular filtration rate (eGFR). Factors associated with visit-to-visit systolic BPV was determined using Pearson's correlation coefficient and independent t-test. Independent association of decline in annual eGFR rate was determined using multivariate linear regression analysis. Results: This study involved 112 male patients (33.6%) and 221 female patients (66.4%). The mean age of patients at baseline was 57.8 ± 9.5 years old. By the end of study period, the mean duration of years of diabetes was 15.9 ± 6.2 years and 298 (89.5%) of patients had co-morbid hypertension. The mean visit-to-visit systolic BPV was 12.7 ± 3.1 mmHg. Higher systolic BPV was found in patients who were older, females, with co-morbid hypertension, more frequent clinic visits, higher mean systolic BP, higher mean total cholesterol and users of antihypertensive medications. The mean annual decline in eGFR rate in this study was −0.78 ± 1.60 ml/min/1.73m2. Independent factors associated with decline in kidney function were systolic BPV, longer duration of diabetes and use of diuretics. Conclusions: The visit-to-visit standard deviation of BPV in patients with T2DM is 12.7 mmHg. Systolic BPV is an independent risk factor associated with decline in kidney function. Hence visit-to-visit BPV is an important additional target to reduce decline in kidney function in patients with T2DM.

Spontaneous and Reflex Movements of the Brain Death in South-East Province of South Korea

Introduction During the diagnosis of the brain death, remained spontaneous or reflex movements of the patient may cause confusion of status of brain death and many medical staffs are reluctant to diagnose the brain death. In order to analyze multiple movements of brain death patients and provide the helpful basis for diagnosis of brain death, we reviewed our video record checked during patient management. Methods We conducted a regional cohort study of adult patients (≥aged 19 years old) with brain death admitted to the hospital care systems in south-east province of South Korea from January 2013 to December 2016. We divide the patients into two groups: ‘Brain death with spontaneous and reflex movements’ and ‘Brain death without spontaneous and reflex movements’. We described the patterns of spontaneous and reflex movements through video analysis. Demographic and clinical characteristics including the causes of brain death, timing of spontaneous and reflex movement detection, hemodynamic parameters, and arterial blood gas findings were compared between the two groups. Results During the study period, 436 patients met criteria for brain death. Among them, 74 (17.0%, age 49.7±12.6 years, 64.9% males) subjects had spontaneous or reflex movements, which were analyzed in the way of video record. The most common movements were the extensor plantar response and tonic neck reflex. The logistic regression analysis revealed that hypoxic brain injury (OR=2.93, p=0.001), higher mean systolic blood pressure (OR=1.05, p=0.000), and longer the time from diagnosis of brain death (OR=1.04, p=0.016) were significantly correlated with presence of spontaneous or reflex movement in brain death subjects. There were no statistically significant differences in age, sex, height, heart rate, body temperature, blood PH, bicarbonate and partial pressure of oxygen and carbon dioxide levels. Conclusions While diagnosing a brain death especially caused by hypoxic brain injury, higher mean systolic pressure, and longer time from diagnosis of brain death, special attention is necessary not to exclude brain death in such patients with spontaneous and reflex movements. The common movements that appeared on video review were extensor plantar response and tonic neck reflex. As we know through the above results, medical staffs who perform the diagnosis of the brain death need opportunities for sharing diverse experiences and information.