Higher Prevalence Of Hypertension Research Articles

In-hospital outcomes of anterior versus non-anterior st elevation myocardial infarction complicated with complete atrioventricular block

Abstract Background Complete atrioventricular block (CAVB) is an infrequent complication of acute ST-elevation myocardial infarction (STEMI), and information on its outcomes is scarce. We aimed to address the characteristics and in-hospital outcomes of patients with anterior versus non-anterior STEMI complicated with CAVB in a contemporary, nationwide, all-comer registry, in the U.S. Methods Using the National Inpatient Sample (NIS) database, we identified patients who were hospitalized with STEMI, complicated with CAVB between 2016- 2019. Patients with any cardiac implantable electronic device (CIED) in-situ were excluded. Baseline characteristics, in-hospital procedures and outcomes including time to temporary or permanent pacemaker (PPM)/implantable cardioverter defibrillator (ICD) implantation, length of stay and mortality were collected. Results A total of 17470 patients, were hospitalized with a primary diagnosis of STEMI and concomitant diagnosis of CAVB, 2755(15.8%) with Anterior and 14715(84.2%) with non-anterior STEMI. Non-anterior STEMI patients included more women, had higher prevalence of hypertension, dyslipidemia, smoking history and chronic pulmonary disease, while anterior STEMI patients had higher prevalence of chronic kidney disease and ischemic cardiomyopathy. Anterior STEMI patient had significantly higher rate of in hospital death [955 (35%) vs 2220 (15%), p<0.001], CPR, VT/VF, cardiac arrest, acute heart failure, respiratory failure, mechanical ventilation >96 hours and acute kidney injury. In both groups 40% received temporary pacemaker, but mean time to implantation was longer in anterior STEMI patients [1.1±3.3 vs 0.3±1.2 days, p<0.001]. Rate of any permanent CIED implantation was also significantly higher in the anterior STEMI patients with longer time to PPM implantation, [3.3±3.5 vs 2.8±2.8 days, p<0.001]. Use of mechanical circulatory support devices was significantly higher in anterior STEMI patients. Conclusion In STEMI patients complicated with CAVB, in-hospital outcomes of anterior STEMI were worse comparing to non-anterior STEMI, with significantly higher rates of in-hospital death, in-hospital complications and CIED implantations.

#532 Association between blood flow measured within 30 days from AV access creation and the risk of thrombosis

Abstract Background and Aims The use of arteriovenous (AV) access for hemodialysis (HD) is hampered by the risk of dysfunction and thrombosis. Various factors affect the risk of AV access thrombosis, such as age, female sex, hematocrit, vessels’ diameter and anatomy, and patients’ comorbidities (e.g. diabetes mellitus, thrombophilia, chronic inflammatory disease). Previous studies have reported contradictory results on the prognostic value of intraoperative blood flow (Qa) measurements. Finally, only few studies have investigated the association between postoperative Qa measurements and thrombosis risk. Therefore, current guidelines report that there is not enough evidence to suggest routine assessment of AV access Qa for surveillance. This study aimed to analyze the association between Qa, measured at the first post-operative visit (within 30 days from creation), and thrombosis risk, in distal and proximal autologous AV fistulae (dAVF and pAVF), and AV grafts (AVG). Method This retrospective cohort study included all AV accesses created in San Paolo Hospital (Milan, IT) between January 1st 2013 and December 31st 2022, with a post-operative Qa measurement available within 30 days from the date of creation. AV accesses were classified as dAVF, pAVF and AVG. Qa was measured by ultrasound as the product of the cross-sectional area and the time-averaged mean velocity, in the feeding artery. The thrombosis-free survival of dAVF, pAVF and AVG was plotted using the Kaplan Meier method. The association between Qa and the risk of thrombosis was studied by Cox proportional hazard models, adjusted for patient's age and sex. Non-linearity was assessed using natural splines. Results A total of 218 AV accesses (92 dAVF, 76 pAVF, and 50 AVG) were created in 191 patients. At baseline, patients had a median age of 69 years, 70% were male, 42% were already on HD treatment, and overall, they had a high prevalence of hypertension, diabetes mellitus and cardiovascular comorbidities. At first post-operative visit, median Qa was 922 [698, 1278] ml/min, 1260 [917, 1825] ml/min, and 1665 [1195, 2508] ml/min, respectively for dAVF, pAVF, and AVG (p <0.001). During a median follow up time of 1.35 [0.55, 2.62] years, 66 AV access thrombosis occurred. The thrombosis-free survival rates for dAVF, pAVF and AVG were 84%, 97%, and 51% at 1 year, and 63%, 66%, and 19% at 5 years (Fig. 1). For dAVF we found a significant L-shaped association between Qa measured at the first post-operative visit and thrombosis risk, with the lowest risk found at Qa of 1289 ml/min and an exponential risk increase for dAVF with Qa <800 ml/min (Fig. 2). Particularly, for dAVF with Qa < 1289 ml/min, we found a 39% increased risk of thrombosis for every 100 ml/min decrease in Qa (aHR 1.39, 95% CI 1.10-1.75, p 0.006). In pAVF, Qa showed a trend of inverse linear association with the risk of thrombosis, although not reaching statistical significance (aHR 1.06, 95% CI 0.96-1.17, p 0.24, for every 100 ml/min decrease in Qa). In AVG, Qa was not associated with the risk of thrombosis (aHR 1.01, 95% CI 0.97-1.06, p 0.57, for every 100 ml/min decrease in Qa). Conclusion In our cohort we found that Qa, measured at the first post-operative visit, is associated with the risk of thrombosis in dAVF, but not in pAVF and AVG. In particular, in dAVF the association is non-linear with the lowest risk in our cohort found at Qa equal to 1289 ml/min, with an exponentially increasing risk for Qa <800 ml/min. Our findings suggest that post-operative flow assessment may be a useful tool to identify dAVF at higher risk of thrombosis and allow a closer monitoring or possible preventive interventions.

#1920 The impact of kidney function on cardiac diastolic dysfunction trajectories: insights from a longitudinal study

Abstract Background and Aims Although the association between kidney dysfunction and cardiac diastolic dysfunction has been investigated in cross-sectional studies, we currently lack a complete understanding of how the diastolic dysfunction changes over time in individuals with different kidney functions. Exploring the diastolic dysfunction trajectories is crucial as it can provide valuable insights into how kidney function influences cardiac health and which patients are at the highest cardiovascular risk. E/e’ is an echocardiography measure that estimates left ventricular filling pressure and diastolic dysfunction. This study evaluates how kidney function impacts changes in E/e′ over time. Method We identified patients from the Utrecht Patient Oriented Database (UPOD) who visited the outpatient clinic of Utrecht University Medical Center between January 2012 and April 2022. Patients who had received at least three echocardiography reports with a minimum of 12 months between them and had recorded serum creatinine measurements in their electronic health records were included. The estimated glomerular filtration rate (eGFR [mL/min/1.73 m2]) was calculated using the CKD-EPI 2021 creatinine formula without ethnicity and categorized as follows: eGFR ≥ 90, eGFR ≥ 60 - <90, eGFR < 60. Linear mixed-effect models were utilized to determine the impact of kidney function on changes in E/e′ over time. Results A total of 436 patients were included of whom 34.7% were women. The total number of echocardiography examination was 1308. Overall, the median eGFR for all patients was 78.2 mL/min/1.73 m2 [IQR: 61.9, 90.7]. Among them, 26.6%, 51.4%, and 22.0%, had an eGFR ≥ 90, eGFR ≥ 60 - < 90, and eGFR < 60, respectively. Patients with an eGFR < 60 had a higher prevalence of hypertension (64.6%) and cardiovascular disease (84.4%) compared to those with an eGFR ≥ 90, where the prevalence of hypertension and cardiovascular disease was 49.1% and 67.2%, respectively. Additionally, patients with an eGFR < 60 had the lowest mean ejection fraction of 44.9% ± 18.5% and the highest median E/e′ of 12.84 [10.10, 16.16]. The linear mixed model analysis showed that the estimated change in E/e′ per year depended on the level of kidney function. For patients with eGFR ≥ 60 - <90, E/e′ did not significantly change per year (p-value: 0.927). However, for patients with eGFR < 60, a statistically significant (p = 0.014) increase in the E/e′ of 0.45 (0.09, 0.81) was observed per year. Hypertension, diabetes mellitus, and cardiovascular disease were found to affect the change in E/e′, with estimates of 0.95 (0.41, 1.49), 1.82 (0.82, 2.89), and 1.25 (0.54, 1.97), respectively. Conclusion The trajectory of changes in E/e′ over time was significantly affected by varying levels of kidney function. Patients with impaired kidney function (eGFR < 60) have a higher E/e’ compared to those with normal kidney function (eGFR ≥ 90) and presented a significant increase of E/e’ per year.

#1444 Albuminuria and subsequent risk of kidney events in patients with IgA nephropathy: a nationwide cohort study

Abstract Background and Aims KDIGO recommends proteinuria <1 g/d as a treatment target in patients with immunoglobulin A nephropathy (IgAN) because of high-risk of progression to kidney failure. However, long-term kidney outcomes in patients with low-grade proteinuria remain poorly studied. Method We enrolled patients with biopsy-proven primary IgAN from the Swedish Renal Registry and analyzed associations between first-recorded urinary albumin-to-creatinine ratio (uACR, in categories <0.3, 0.3-0.5, 0.5-1.0, 1.0-1.5, 1.5-2.0 and >2.0 g/g) and the occurrence of major adverse kidney events (MAKE, a composite of kidney replacement therapy [KRT] and >30% decline in eGFR). We also explored the risk of MAKE associated with the fold-change in uACR within a year. Results We enrolled 1269 patients with primary IgAN (74% men, median 53 years, mean eGFR 33 mL/min/1.73 m², median uACR 0.7 g/g). Compared to patients with uACR <0.3 g/g, those with higher uACR levels were younger, more often men, had a higher prevalence of hypertension, diabetes, acute kidney injury, lower eGFR and serum albumin level, and were less often prescribed RASi. Over median follow-up of 5.5 [2.8;9.2] years, 667 MAKE and 517 KRT events occurred, and 528 patients experienced > 30% eGFR decline. In multivariable analyses, and compared with uACR <0.3 g/g, any higher uACR category strongly and incrementally associated with the risk of MAKE (Figure), with Hazard Ratios (HR) ranging from 1.56 [95% CI 1.14-2.14] in patients with uACR 0.3-0.5 g/g to 4.53 [3.36-6.11] in patients with uACR>2g/g. Similar graded relationships were observed for KRT (HR ranging from 1.39 to 4.65), and for >30% decline in eGFR (HR ranging from 1.76 to 3.47). In the 785 patients who had repeated uACR measurements within a year, and compared with stable uACR, the risk of kidney events was lower if uACR decreased by 2-fold (HR ranging from 0.47 to 0.49), and higher if uACR increased by 2-fold (HR from 1.18 to 2.56), irrespective of baseline uACR. Conclusion Our findings show substantial risk of adverse kidney outcomes among patients with IgAN and uACR between 0.3 and 1.0 g/g, a population currently considered at low-risk of CKD progression. Reduction in uACR is associated with better kidney outcomes, irrespective of baseline uACR.

#3094 Prevalence and risk factors for progression and mortality in patients with advanced chronic kidney disease

Abstract Background and Aims Chronic kidney disease (CKD) is a growing health concern worldwide. Prevalence and risk factors for its progression are highly relevant, given that Portugal has the highest incidence and prevalence rates of dialysis in Europe. With this study, we aimed to estimate the prevalence of patients with CKD stage 4 and 5 in a tertiary center in Portugal, as well as to evaluate risk factors for progression and mortality. Method We evaluated all patients followed in the Nephrology outpatient clinic at a tertiary center in Portugal during the year 2021, and selected those with CKD stage 4 and stage 5, based on estimated glomerular filtration rate (eGFR) using CKD-EPI formula. Primary endpoints were CKD progression or mortality after 1 year of follow-up. Progression was defined as initiating renal replacement therapy (RRT) or transition from stage 4 to stage 5 CKD. Results We evaluated 4381 patients, of which 1083 (24.7%) were included with CKD stage 4 (n = 856) and CKD stage 5 (n = 227). There was a predominance of males (52.7%), with a mean age of 74.6 ± 12.5 years. We observed a high prevalence of hypertension (94%), diabetes mellitus (46.2%), dyslipidemia (81%), heart failure (34%) and past history of major cardiovascular events (21%). At one year follow-up 108 patients died, 116 lost follow-up, and 256 (26.5%) had CKD progression, of which 179 (18.5%) initiated renal replacement therapy. 33.5% of patients initiating dialysis had a definitive access, mostly in stage 5 CKD (40 vs. 25%, p < 0.05). Risk factors for progression (versus stability) in univariate analysis were male gender (64.5 vs. 50.1, p < 0.001), younger age (68 vs. 75 years, p < 0.001) and lower eGFR (16 vs. 22 mL/min). Progression occurred in 51% of stage 5 CKD vs. 26.5% stage 4. Worse laboratory control of anemia, hyperparathyroidism, acidosis, and albuminuria (urinary albumin/creatinine ratio 1242 vs. 302 mg/g, p < 0.01) were identified risk factors for progression. In multivariate analysis, predictors for CKD progression were younger age (OR: 0.97, CI: 0.95-0.99, p = 0.02), male gender (OR: 2.82, CI: 1.43-5.57, p = 0.003), lower eGFR (OR: 0.80, CI: 0.74-0.86, p < 0.001), lower hemoglobin levels (OR: 0.62, CI: 0.48-0.79, p < 0.001), and proteinuria (OR: 1.44, CI: 1.22-1.53, p 0.003). Regarding mortality, no statically significant differences were observed between CKD stage 4 and 5, and in multivariate analysis the only independent risk factors for death were older age and heart failure, which increased 3.4 times mortality risk (OR: 3.40, CI: 1.48-7.83, p = 0.04). Conclusion Our data show a high prevalence of CKD and traditional risk factors, with an annual progression rate of 26.5%. Anemia and proteinuria were identified as modifiable risk factors for progression. In older patients with heart failure, the mortality risk was found to be higher than progression risk, highlighting the importance of cardiovascular protection and consideration of conservative management in this particular subset of patients.

Is the cardioprotective effect of pre-infarction angina blunted by age?

Abstract Funding Acknowledgements None. Background Pre-infarct angina (PIA) has been demonstrated to reduce infarct size and improve prognosis in ST-elevation myocardial infarction (STEMI). However, the effects of ischemic preconditioning with aging are still controversial. Purpose We aimed at comparing the effect of pre-infarction angina (PIA) on infarct size between two age groups. Methods We retrospectively studied consecutive STEMI patients treated by primary percutaneous coronary intervention (PCI) from January 2008 to December 2017. PIA was diagnosed if a patient had arm, jaw, or chest pain in the preceding eight days. Peak creatine kinase (CK) concentration was used as a surrogate of infarct size. Patients were divided into two groups, based on the median age: ≤62 years and >62 years. Multiple linear regression was used to identify independent predictors for infarct size that included total ischemic time and classic cardiovascular risk factors (hypertension, diabetes, dyslipidaemia, and smoking). Interaction between age and PIA was evaluated by 2-way factorial ANOVA. Results From the 1131 patients included in the study, 590 (52,2%) had ≤62 years and 541 (47,8%) had >62 years. Older patients were more often women (17.2% vs 8.6%, p<0.001) and had longer total ischemic time [4.6(3.0-9.0) vs 3.5(2.3-6.0) hours, p<0.001]. They also had higher prevalence of hypertension (32.8% vs 22.8%, p<0.001), diabetes (30.7% vs 18.7%, p<0.001) and were less likely to be smokers (26.9% vs 71.4%, p<0.001). The prevalence of PIA was similar across age groups (≤62Y 31.2% vs >62Y 32.0%, p=0.668). In older patients, PIA was associated with smaller infarct size [1.29(0.72-2.33) vs. 1.76(0.97-2.91) U/Lx103, p<0.001]. This difference was not observed for younger patients [1.72(0.95-3.40) vs. 1.81(0.94-3.37) U/Lx103, p=0.392]. There was no significant interaction between the existence of PIA and age on peak CK (p=0.280 for interaction) (Figure 1). In multivariate analysis, overall, PIA was associated with reduced peak CK (β=-0,320, p=0.011). On subgroup group analysis, PIA was a predictor of infarct size only in the older patients (β=-0,459, p=0.005), but not in the younger group (β=-0,182, p=0.394). Conclusion Older patients with PIA had significantly lower infarct size compared to patients in the same age group without PIA. After adjustment for risk factors and total ischemic time, PIA was a predictor of lower infarct size only for the older patients. These results suggest that the effect of pre-ischemic conditioning is not blunted by age, indicating that older patients should not be excluded from clinical trials investigation of cardioprotective strategies in STEMI patients.

Serial invasive hemodynamics and clinical characteristics of patients with shock with and without invasive mechanical ventilation

Abstract Funding Acknowledgements None. Background Invasive mechanical ventilation (IMV) is commonly used in the Cardiac Intensive Care Unit (CICU) in patients with cardiogenic shock (CS). IMV causes hemodynamic changes that may impact outcomes based upon a patient’s profile. Our aim is to characterize the clinical profile and detailed serial hemodynamic parameters in the first 24-hours according to the use of IMV in patients with shock admitted to the CICU. Methods Retrospective analysis of consecutive patients with shock admitted to the CICU at Bellevue Hospital, undergoing pulmonary artery catheter (PAC) placement within the first 24 hours of admission, from February 2022 to June 2023. Clinical characteristics, as well as specific hemodynamic parameters collected and curated at times 0, 6, 12, 18 and 24 hours were from PAC placement compared between patients with and without IMV. Results A total of 101 patients were included (95% with cardiogenic shock), 59 receiving IMV (age 64 ± 15, 24% women) and 42 non-intubated (61 ± 13, 33% women). Non-intubated patients had higher prevalence of hypertension, prior coronary artery disease and heart failure with reduced ejection fraction (HFrEF), while acute coronary syndromes (44%) and cardiac arrest (12%) were more common causes of admission in patients undergoing IMV. Mixed shock predominated in IMV patients (51 vs 17%, p <0.001), whereas cardiogenic shock (CS) was more common in non-intubated patients (83 vs 41%, p <0.01). Patients with acute myocardial infarction CS (AMI-CS) were more likely to undergo IMV, while patients with heart failure CS (HF-CS) were more likely to be non-intubated. Patients undergoing IMV were more likely to have mechanical circulatory support (MCS) and ventricular dilatation compared to non-intubated patients (LVEDD 5.7 cm vs 4.9 cm, p 0.002). Patients undergoing IMV had a higher incidence of severe shock compared to the non-intubated group (31% vs 19% SCAI Shock D), higher lactate levels and greater use of vasoactive drugs (figure 1A). Patients undergoing IMV had significant improvements in cardiac power output (CPO), diastolic blood pressure and systemic vascular resistance (SVR) (figure 1B). Shock severity by SCAI SHOCK classification had a more notable improvement at 24 hours in patients with IMV compared to non-intubated patients (figure 1C), with a non-statistically significant improvement in lactate clearance in the first 24 hours (Figure 1D). Conclusions IMV in patients with CS is more commonly seen in patients with AMI-CS and among those with higher baseline shock severity and greater use of vasoactive medications. IMV is associated with significant improvements in shock severity, CPO and SVR at 24 hours when compared to patients with shock who are not intubated, which could be related to higher use of vasopressors. Further investigations are warranted to understand the impact of IMV on outcomes of patients with CS and how they might vary according to hemodynamic profile.

Angiographic Characteristics and Clinical Outcomes in Patients With Chronic Kidney Disease Undergoing Impella-Supported High-Risk Percutaneous Coronary Intervention: Insights From the cVAD PROTECT III Study.

Prior studies have found that patients with chronic kidney disease (CKD) have worse outcomes following percutaneous coronary intervention (PCI). There are no data about patients with advanced CKD undergoing Impella-supported high-risk PCI. We, therefore, aimed to evaluate angiographic characteristics and clinical outcomes in patients with CKD who received Impella-supported high-risk PCI as part of the catheter-based ventricular assist device PROTECT III study (A Prospective, Multi-Center, Randomized Controlled Trial of the IMPELLA RECOVER LP 2.5 System Versus Intra Aortic Balloon Pump [IABP] in Patients Undergoing Non Emergent High Risk PCI). Patients enrolled in the PROTECT III study were analyzed according to their baseline estimated glomerular filtration rate (eGFR). The primary outcome was 90-day major adverse cardiovascular and cerebrovascular events (the composite of all-cause death, myocardial infarction, stroke/transient ischemic attack, and repeat revascularization). Of 1237 enrolled patients, 1052 patients with complete eGFR baseline assessment were evaluated: 586 with eGFR ≥60 mL/min per 1.73 m2, 190 with eGFR ≥45 to <60, 105 with eGFR ≥30 to <45, and 171 with eGFR <30 or on dialysis. Patients with lower eGFR (all groups with eGFR <60) were more frequently females and had a higher prevalence of hypertension, diabetes, anemia, and peripheral artery disease. The baseline Synergy Between PCI With Taxus and Cardiac Surgery score was similar between groups (28.2±12.6 for all groups). Patients with lower eGFR were more likely to have severe coronary calcifications and higher usage of atherectomy. There were no differences in individual PCI-related coronary complications between groups, but the rates of overall PCI complications were less frequent among patients with lower eGFR. Major adverse cardiovascular and cerebrovascular events at 90 days and 1-year mortality were significantly higher among patients with eGFR <30 mL/min per 1.73 m2 or on dialysis. Patients with advanced CKD undergoing Impella-assisted high-risk PCI tend to have higher baseline comorbidities, severe coronary calcification, and higher atherectomy usage, yet CKD was not associated with a higher rate of immediate PCI-related complications. However, 90-day major adverse cardiovascular and cerebrovascular events and 1-year mortality were significantly higher among patients with eGFR<30 mL/min per 1.73 m2 or on dialysis. Future studies of strategies to improve intermediate and long-term outcomes of these high-risk patients are warranted. URL: https://www.clinicaltrials.gov; Unique identifier: NCT04136392.

Sex difference in cardiac autonomic function in African American adults

African American (AA) individuals in the United States have the highest prevalence of hypertension, with an age-adjusted prevalence of 55.8% in AA men and 56.9% in women. Compared to other racial groups, the AA population also has a two- to three-fold higher mortality rate resulting from hypertension-related causes. Furthermore, AA men exhibit a higher mortality rate than AA women. Previous studies have demonstrated sex differences in some biological mechanisms linked to the increased cardiovascular disease risk in the AA population —such as impaired vascular function and elevated oxidative stress. However, it is unknown whether sex differences are present in baroreflex sensitivity (BRS) and heart rate variability (HRV), which are key mechanisms that may contribute to the pathogenesis and clinical outcomes of hypertension. Herein, we tested the hypothesis that young AA men exhibit impaired cardiac autonomic function (spontaneous BRS and HRV) compared to AA women. We studied 26 young normotensive AA adults (13 women) [Age (men: 22 ± 3; and women: 19 ± 1yr; mean ± SD, p = 0.03); BMI (men: 24 ± 3; and women: 24 ± 2 kg/m2; p = 0.92)]. Heart rate (HR; ECG) and beat-to-beat blood pressure (BP; finger plethysmography) were continuously recorded during 10 min of rest to assess HRV and cardiac BRS. Resting HR (men, 61 ± 8; and women: 65 ± 9 bpm; p = 0.18), diastolic BP (men, 66 ± 6; and women: 65 ± 5 mmHg; p = 0.48) and respiratory rate (men, 17 ± 3; and women, 17 ± 3 bpm; p = 0.97) were similar between the groups. Mean BP and systolic BP were higher in AA men, though within the normotensive range for both groups [mean BP (men: 84 ± 5; and women: 76 ± 5 mmHg; p = 0.001); SBP (men: 119 ± 4; and women: 103 ± 7 mmHg; p &lt; 0.001)]. HRV [root mean square of successive differences between normal heartbeats (RMSSD); men, 113 ± 78; and women, 79 ± 43 ms; p = 0.18] and cardiac BRS (overall gain; men, 25 ± 13; and women, 28 ± 12 ms/mmHg; p = 0.66) were not different between groups. These results indicate that BRS and HRV, which are markers of cardiac autonomic regulation, do not differ based on sex among young normotensive African American individuals. Supported by: Kinesiology and Health Education UT Austin Start-up Account 19-2635-91; and TACSM 2023 Student Research Development Award. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Burden of hypertension and associated risk factors among the Nicobarese tribe of Car Nicobar Island, India

Background: Hypertension, a significant risk factor for various non-communicable diseases, poses a preventable threat to mortality and disease burden. However, there remains a lack of data on hypertension within Indian tribes, particularly those residing in impoverished areas. Determining the prevalence of hypertension and identifying associated risk factors among the Nicobarese tribes. A cross-sectional survey was conducted, involving 2600 tribal individuals aged 18 years and above from ten randomly selected villages on Car Nicobar Island. Methods: A structured questionnaire was utilized to gather data on blood pressure (BP), anthropometric measurements, and detailed participant characteristics. Prevalence of hypertension was determined and analyzed in relation to various identified risk factors using chi-square, Karl Pearson coefficient of correlation, and generalized linear models. Prevalence ratio and adjusted risk ratio calculated, along with their corresponding confidence intervals. Results: Prevalence of hypertension was 57.9%. Several factors, including age, male gender, illiteracy, diabetes, smoking, alcohol consumption, and higher body mass index (BMI), were significantly associated with hypertension. Systolic and diastolic BP levels increased significantly with age, socio-economic scores, BMI, and weight. Conclusions: The prevalence of hypertension among the Nicobarese tribes is significantly higher compared to the general population. Adapting preventive strategies based on an understanding of the tribe's specific culture and lifestyle is important for controlling hypertension. However, it is also crucial to consider genetic and environmental influences that may contribute to the high prevalence of hypertension in this tribe.

FACTORS RELATED TO HYPERTENSION CONTROL IN THE ELDERLY AT PUSKESMAS BANTEN GIRANG YEAR 2024

Hypertension is still the most common health problem experienced by the world's population. Hypertension is a condition of a person who has systolic blood pressure ≥140 mmHg and diastolic pressure ≥90 mmHg. The high prevalence of hypertension in the elderly group is caused because with age, resulting in a decrease in physiological functions of the body, so that non-communicable diseases begin to appear. Hypertension control behavior is the main thing to prevent complications, such as stroke, coronary heart disease, and kidney failure. This study aims to determine the factors associated with elderly behavior in controlling hypertension. This type of research is quantitative with a cross sectional design. Independent variables are gender, education level, lifestyle. While the dependent variable is the control behavior of hypertension in the elderly. The population of all hypertensive patients recorded in the Banten Girang Health Center work area in 2023. The sample number of 100 people was selected by purposive random sampling. Statistical test using Chi square test with 95% CI and logistic regression test. The results of statistical tests showed that sex and education variables did not have a significant relationship with hypertension control behavior in the elderly (p &gt; 0.05), while lifestyle variables with p = 0.003 OR = 4,902, and family support variables with p = 0.010 OR = 3,778 which means they have a meaningful relationship with hypertension control behavior in the elderly.

Hypertension Prevalence and Control Among People With and Without HIV - United States, 2022.

People with HIV (PWH) have higher rates of cardiovascular disease than people without HIV. However, limited information exists about hypertension prevalence and associated risk factors in PWH. This cross-sectional study included adult patients in the 2022 IQVIATM Ambulatory Electronic Medical Record - US data. HIV was identified based on ≥2 HIV diagnosis codes or a positive HIV test. Hypertension was identified by diagnosis codes, ≥2 blood pressure (BP) readings ≥130/80 mmHg, or an antihypertensive medication prescription. Among those with hypertension, control was defined as most recent BP <130/80 mmHg. Logistic models using marginal standardization method were used to estimate adjusted prevalence ratios (aPR) of hypertension and hypertension control among all patients and PWH specifically, controlling for covariates. Of 7,533,379 patients, 19,102 (0.3%) had HIV. PWH had higher hypertension prevalence (66% vs 54%, aPR:1.14, 95% CI: 1.13-1.15) compared with people without HIV. Among persons with hypertension, PWH were more likely to have controlled hypertension (aPR: 1.10, 95% CI: 1.07-1.13) compared with people without HIV. Among PWH, those from the South were more likely to have hypertension (aPR: 1.07, 95% CI: 1.02-1.12) than PWH from the Northeast, while Black PWH were less likely to have controlled hypertension (aPR: 0.72, 95% CI: 0.67-0.77) than White PWH. PWH were more likely to have hypertension than people without HIV. Geographic and racial disparities in hypertension prevalence and control were observed among PWH. Optimal care for PWH includes comprehensive strategies to screen for, prevent, and manage hypertension.

Analysis of Graft Survival in Pediatric Patients Undergoing Kidney Transplantation

Introduction: Kidney transplantation is the gold standard therapy for end-stage chronic kidney disease (CKD). However, aspects related to the characteristics of the donor and the recipient, the surgical technique, the immunosuppression protocol and comorbidities can impact graft survival. Objectives: To evaluate factors associated with graft survival in pediatric patients undergoing kidney transplantation. Methods: Descriptive, retrospective cohort study, which included all patients aged 1 to 18 years who underwent kidney transplantation at Unidade Renal Pediátrica of Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Brazil, from January 2017 to December 2021, with a minimum follow-up time of 10 months, totaling 51 patients. The IMIP ethics and research committee approved the study under CAAE: 52023921.1.0000.5201. Results: The median age of patients undergoing kidney transplantation was 12 years(9-13); 27 (52.9%) were male and eight (15.6%) were younger than 5 years of age. The main etiologies of CKD were congenital anomalies of the kidney and urinary tract (n = 25; 49%). As for kidney transplants, 49 (96.1%) were from a deceased donor and the median follow-up time was 32 (14-42) months. After transplantation, 58% of the population were hypertensive, while 80.4% had dyslipidemia. The 5-year graft and patient survival rates, assessed using the Kaplan Meier curve, were 86.3 and 90.2%, respectively. Seven (n = 5) patients lost the graft, the most common cause being renal vein thrombosis. Nonglomerular causes of CKD showed lower graft survival when compared to glomerular causes (log rank p = 0.035). Conclusion: Our sample’s graft and patient survival rates are similar to national and global data. The most frequent causes of graft loss were thromboembolic events. Furthermore, we observed a high prevalence of hypertension and dyslipidemia. These results direct us to establish strategies to improve survival in pediatric kidney transplants.

Investigating the Prevalence and Predictors of Uncontrolled Hypertension: A Cross-Sectional Study in Gujarat, India.

Uncontrolled hypertension is a major public health concern that contributes significantly to cardiovascular morbidity and mortality. Treatment of hypertension prevents and reduces cardiovascular morbidity, notably a 40% reduction in risk of stroke and a 15% reduction in risk of myocardial infarction. Understanding the prevalence and predictors of uncontrolled hypertension is crucial for developing targeted interventions. This study aimed to determine the prevalence of uncontrolled hypertension and identify potential predictors among patients attending the Non-Communicable Disease (NCD) clinic of a tertiary care center in Gujarat, India. A cross-sectional study involving 732 adult patients with hypertension was conducted. Sociodemographic data, lifestyle factors, anthropometric measurements, and comorbidities were assessed. Blood pressure was measured using standardized protocols, and uncontrolled hypertension was defined as a systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg. Univariate and multivariate logistic regression analyses were performed to identify predictors of uncontrolled hypertension. The prevalence of uncontrolled hypertension was 60.2% (95% CI: 56.7%-63.7%). In the multivariate analysis, increasing age (adjusted OR: 1.21, 95% CI: 1.05-1.39), increased body mass index (adjusted OR: 1.49, 95% CI: 1.27-1.75), diabetes (adjusted OR: 1.68, 95% CI: 1.20-2.35), chronic kidney disease (adjusted OR: 2.11, 95% CI: 1.22-3.65), and current smoking status (adjusted OR: 1.83, 95% CI: 1.14-2.93) were identified as independent predictors of uncontrolled hypertension. This study revealed a high prevalence of uncontrolled hypertension in this tertiary care setting. Age, obesity, diabetes, chronic kidney disease, and smoking were identified as significant predictors. Targeted interventions addressing these modifiable risk factors and comorbidities are crucial for improving blood pressure control and reducing the burden of hypertension-related complications.

Health literacy and high blood pressure among Myanmar migrant workers in Northeastern Thailand.

Hypertension, related to serious consequences unless diagnosed and treated, is a global concern, also affecting migrant workers. Due to the high prevalence of hypertension among migrant workers in Thailand, the influences of health literacy and other factors on blood pressure were needed to explore among Myanmar migrant workers in Northeastern Thailand. Hence, this study aimed to identify the prevalence of high blood pressure (HBP), its association with health literacy and other factors among Myanmar migrant workers in Northeastern Thailand. A cross-sectional analytical study was conducted in Northeastern Thailand. A multistage sampling procedure was applied. Data was gathered through interviews utilizing validated and reliable structured questionnaire. Descriptive statistics and inferential statistics with multiple logistic regression were used. Among 406 participants, about 60% were male and about 70% of them were married. The prevalence of overall HBP was 63.3% (95% CI: 58.49-67.86), 52% in females and 71.86% in males. Participants with limited health literacy were 79% more likely to have HBP than those with excellent and adequate health literacy (AOR = 1.79, 95% CI: 1.13-2.84). Other factors substantially linked with having HBP were being male gender (AOR = 4.68, 95% CI: 2.81-7.78), being overweight (AOR = 2.23, 95% CI: 1.18-4.23), being obese (AOR = 5.69, 95% CI: 2.96-10.96), not having health insurance (AOR = 2.01, 95% CI: 1.11-3.66), staying in Thailand for more than 48 months (AOR = 2.4, 95% CI: 1.48-3.9), and having family history of hypertension (AOR = 2.07, 95% CI: 1.28-3.35). In conclusion, more than half of Myanmar migrant workers had HBP. Factors associated with HBP were limited health literacy, male gender, overnutrition, lack of health insurance, longer duration of stay in Thailand and having family history of hypertension. Therefore, there is a need for a multifaceted strategy to prevent hypertension and its consequences by promoting health literacy as well as by enhancing good behavioural practice among this community.

Tolerability of Antihypertensive Medications: The Influence of Age.

Despite high prevalence of hypertension, few studies have analysed the adverse effects (AEs) of antihypertensive medications, especially in older patients. To investigate the prevalence and associated factors of antihypertensive-related AEs, focusing on the influence of age on treatment tolerability. We retrospectively investigated antihypertensive-related AEs in patients evaluated at the Hypertension Clinic of Careggi Hospital, Florence, Italy, between January 2017 and July 2020. Multivariable regression models were generated to analyse variables associated with AEs in the overall sample and in participants ≥75 years. Among 622 subjects (mean age 64.8 years, 51.4% female), the most frequently reported AEs were calcium-channel blockers (CCB)-related ankle swelling (26.8%) and ACEi-induced cough (15.1%). Ankle swelling was more common in older patients (35.7% vs 22.3%, p = 0.001; odds ratio [OR] 1.94, 95%CI 1.289-2.912) and was independently associated with Body Mass Index (BMI, adjOR 1.073) and angiotensin-receptor antagonists (adjOR 1.864). The association with BMI was confirmed in older patients (adjOR 1.134). ACEi-induced cough showed similar prevalence in younger and older patients (13.9% vs 15.6%, p = 0.634), being independently associated with female sex (adjOR 2.118), gastroesophageal reflux disease (GERD, adjOR 2.488) and SNRI therapy (adjOR 8.114). The association with GERD was confirmed in older patients (adjOR 3.238). CCB-related ankle swelling and ACEi-induced cough represent the most common antihypertensive-related AEs, also at old age. Older patients showed a two-fold increased risk of ankle swelling, that was also independently associated with BMI. ACEi-induced cough had similar prevalence at younger and old ages, being independently associated with GERD.

Association between a metabolic score for insulin resistance and hypertension: results from National Health and Nutrition Examination Survey 2007-2016 analyses.

The Metabolic Score for Insulin Resistance (METS-IR) offers a promising and reliable non-insulin-based approach to assess insulin resistance and evaluate cardiometabolic risk. However, evidence for the association between METS-IR and hypertension was still limited. Participants from the National Health and Nutrition Examination Survey (NHANES) database from 2007-2016 were selected for weighted multivariable regression analyses, subgroup analyses and restricted cubic spline (RCS) modeling to assess the association between the METS-IR and hypertension, as well as systolic blood pressure (SBP) and diastolic blood pressure (DBP). This study enrolled 7,721 adults aged ≥20 years, 2,926 (34.03%) of whom was diagnosed as hypertension. After adjusting for all potential covariates, an increased METS-IR (log2 conversion, denoted as log2METS-IR) was independently associated with a higher prevalence of hypertension (odd ratio [OR] 3.99, 95% confidence interval [CI] 3.19~5.01). The OR for hypertension in subjects with the highest quartile of METS-IR was 3.89-fold (OR 3.89, 95% CI 3.06~4.94) higher than that in those with the lowest quartile of METS-IR. This positive correlation became more significant as METS-IR increased (p for trend < 0.001). Log2METS-IR was significantly correlated with increase in SBP (β 6.75, 95% CI 5.65~7.85) and DBP (β 5.59, 95% CI 4.75~6.43) in a fully adjusted model. Consistent results were obtained in subgroup analyses. Hypertension, SBP and DBP all exhibited a non-linear increase with the rise in METS-IR. The minimal threshold for the beneficial association of METS-IR with hypertension, SBP and DBP were all identified to be 46.88. The findings of this study revealed a significant positive association between METS-IR and hypertension among US adults, suggesting METS-IR as a potential tool for assessing hypertension risk.

Evaluating the Effects of Food Deserts and Food Swamps in an Urban Burn Patient Population.

Poverty is a known risk factor for burn injury and is associated with residency in food deserts and food swamps. Our aim was to determine the prevalence of residency in food deserts and food swamps and to investigate the relationship between food environment, comorbidities, and wound healing in burn patients. We performed a retrospective chart review of all burn patients age ≥ 18 seen in the emergency department or admitted to the burn service at an ABA-verified urban academic center between January 2016 and January 2022. Patient GeoIDs were used to classify residency in food deserts and food swamps and comorbidities and demographics were recorded. A subset of patients with less than 20% total body surface area burns who underwent single-operation split-thickness skin grafting was identified for wound healing analysis. A total of 3,063 patients were included, with 206 in the heal-time analysis. 2,490 (81.3%) lived in food swamps and 96 (3.1%) lived in food deserts. Diabetes, hypertension, and tobacco smoking were more prevalent in food swamps than food deserts or good access areas. While there was no significant effect of food environment on wound healing, diabetes was associated with longer heal times. Most burn patients reside in food swamps, which are associated with a higher prevalence of hypertension, diabetes, and smoking. Food environment was not significantly associated with wound healing. Not having diabetes was associated with a shorter time to wound healing.

Comparative Analysis of Vascular Calcification Risk Factors in Pre-Hemodialysis and Prevalent Hemodialysis Adult Patients: Insights into Calcification Biomarker Associations and Implications for Intervention Strategies in Chronic Kidney Disease.

This retrospective study aimed to compare risk factors for vascular calcification (VC) between pre-hemodialysis (HD) and prevalent HD adult patients while investigating associations with calcification biomarkers. Baseline data from 30 pre-HD and 85 HD patients were analyzed, including iPTH, vitamin D, FGF 23, fetuin-A, sclerostin, and VC scores (Adragao method). Prevalence of VC was similar in both groups, but HD patients had more frequent VC scores ≥ 6. Pre-HD patients were older, with higher prevalence of hypertension and less frequent use of calcium phosphate binders. Both groups showed similar patterns of hyperphosphatemia, low vitamin D, and iPTH. Fetuin-A and sclerostin levels were higher in pre-HD, while FGF 23 was elevated in HD patients. Higher VC risk in pre-HD patients was associated with male gender, older age, lower fetuin-A and higher sclerostin, lower ferritin, and no vitamin D treatment, while in HD patients with higher sclerostin, FGF 23 and urea, and lower iPTH. Conclusion: Biomarkers could be measurable indicators of biological processes underlying VC in CKD patients that may serve as a potential guide for considering personalized therapeutic approaches. Further studies are needed to elucidate the underlying pathways.

Nε-carboxymethyl-lysine and inflammatory cytokines, markers and mediators of coronary artery disease progression in diabetes

This editorial refers to the article “Comparative analysis of Nε-carboxymethyl-lysine and inflammatory markers in diabetic and non-diabetic coronary artery disease patients”, published in the recent issue of the World Journal of Diabetes 2023 is based on glucose metabolism, advanced glycation end products (AGEs), inflammation and adiposity on diabetes and coronary artery disease (CAD). This study has included CAD patients who were stratified according to glycosylated hemoglobin higher than 6.5 and sex-matched. A higher prevalence of hypertension, dyslipidemia, and non-vegetarian diet were found in the diabetic group. These risk factors might influence body weight and adiposity and explain the increment of the left atrium. Although this data was not supported by the study. The diet can also explain the non-enzymatic reactions on lipids, proteins, or nucleic acids and consequently an increment of AGEs. These molecules can emit fluorescence. However, one of the non-fluorescent and most abundant AGEs is Nε-carboxymethyl-lysine (CML). Its association with coronary artery stenosis and severity in the diabetic group might suggest its role as a player in CAD progression. Thus, CML, after binding with its receptor (RAGE), can induce calcification cascade through reactive oxygen species and mitogen-activated protein kinase. Moreover, this interaction AGE-RAGE can cause activation of the transcription nuclear factor-kb and induce inflammatory cytokines. It might explain the relationship between CML and pro-inflammatory cytokines in diabetic and CAD patients. Although this is a population from one center, the determination of CML and inflammatory cytokines might improve the diagnosis of severe and progressive CAD. Future and comparative studies among glycosylated hemoglobin, CML, and other AGE levels according to diagnosis and prognosis value might modify the clinical practice. Although these molecules are irreversible, they can act through a specific receptor inducing a signal transduction that might be modu-lated by inhibitors, antibodies, or siRNA. Further mechanistic studies might improve the development of future preventive therapies for diabetic patients.