Higher Systolic Blood Pressure Levels Research Articles

PREDIABETES IN NAÏVE GREEK HYPERTENSIVE PATIENTS

Objective: Prediabetes subjects have increased risk for diabetes and cardiovascular disease. Aim of our study was to find the incidence of prediabetes, in naive hypertensives in Greece. Design and method: We studied 688 [304 (44.2%) were men] hypertensives, who were under neither antihypertensive nor lipid-lowering medications, and they were not diabetics. Their median age was 55 (range: 15–82) years. Prediabetes was defined by ADA criteria (fasting glucose: 100–125 mg/dl). Results: Two hundred forty five out of 688 patients (35.6%) met the criteria for prediabetes. It was more prevalent in males than in females (42.4% vs 30.2%, p = 0.001). On the contrary, there was no statistically significant difference in the age between the 2 groups. Subjects with prediabetes had significantly higher body mass index (BMI) (31.5 + 5.8 vs 30.3 + 5.0; p = 0.01) when compared with the rest hypertensives. Hypertensives with prediabetes had significantly higher systolic blood pressure (SBP) levels than the others (158.4 + 18.5 vs 155.2 + 18.6; p < 0.05), while there was no significant difference in diastolic blood pressure levels (95.0 + 11.0 vs 94.7 + 11.3; p = 0.70) between the 2 groups. There was no significant difference in total, high density, and low density cholesterol and triglycerides serum levels between the two groups. On the contrary hypertensives with prediabetes had significantly increased all liver functional tests than those without. Conclusions: Our results suggest that more than one third of naive hypertensives had prediabetes. These subjects had higher SBP levels and they were more obese. They had also increased liver functional tests, without any difference in their lipid profile.

Therapeutic inertia in the management of dyslipidaemia and hypertension in incident type 2 diabetes and the resulting risk factor burden: Real-world evidence from primary care.

To investigate trends in the prevalence of hypertension and dyslipidaemia in incident type 2 diabetes (T2DM), time to antihypertensive (AHT) and lipid-lowering therapy (LLT), and the association with systolic blood pressure (SBP) and lipid control. Using The Health Improvement Network UK primary care database, 254 925 people with incident T2DM and existing dyslipidaemia or hypertension were identified. Among those without atherosclerotic cardiovascular disease (ASCVD) history and not on AHT or LLT at diagnosis, the adjusted median months to initiating an AHT or an LLT, and the probabilities of high SBP or lipid levels over 2 years in people initiating therapy within or after 1 year were evaluated according to high and low ASCVD risk status. At diabetes diagnosis, 66% and 66% had dyslipidaemia and hypertension, respectively. During 2005 to 2016, dyslipidaemia prevalence increased by 10% in people aged <60 years, while hypertension prevalence remained stable in all age groups. Among those with high ASCVD risk status in the age groups 18 to 39, 40 to 49, and 50 to 59 years, the median number of months to initiation of therapy were 20.4 (95% confidence interval [CI] 20.3-20.5), 10.9 (95% CI 10.8-11.0), and 9.5 (95% CI 9.4-9.6) in the dyslipidaemia subcohort, and 28.1 (95% CI 28.0-28.2), 19.2 (95% CI 19.1-19.3), and 19.9 (95% CI 19.8-20.0) in the hypertension subcohort. Among people with high and low ASCVD risk status, respectively, compared to early LLT initiators, those who initiated LLT after 1 year had a 65.3% to 85.3% and a 65.0% to 85.3% significantly higher probability of failing lipid control at 2 years of follow-up, while late AHT initiators had a 46.5% to 57.9% and a 40.0% to 58.7% significantly higher probability of failing SBP control. Significant delay in initiating cardioprotective therapies was observed, and time to first prescription was similar in the primary prevention setting, irrespective of ASCVD risk status across all T2DM diagnosis age groups, resulting in poor risk factor control at 2 years of follow-up.

Blood Pressure Level and Variability During Long-Term Prasugrel or Clopidogrel Medication After Stroke: PRASTRO-I.

High blood pressure increases bleeding risk during treatment with antithrombotic medication. The association between blood pressure levels and the risk of recurrent stroke during long-term secondary stroke prevention with thienopyridines (particularly prasugrel) has not been well studied. This was a post hoc analysis of the randomized, double-blind, multicenter PRASTRO-I trial (Comparison of Prasugrel and Clopidogrel in Japanese Patients With Ischemic Stroke-I). Patients with noncardioembolic stroke were randomly assigned (1:1) to receive prasugrel 3.75 mg/day or clopidogrel 75 mg/day for 96 to 104 weeks. Risks of any ischemic or hemorrhagic stroke, combined ischemic events, and combined bleeding events were determined based on the mean level and visit-to-visit variability, including successive variation, of systolic blood pressure (SBP) throughout the observational period. These risks were also compared between quartiles of mean SBP level and successive variation of SBP. A total of 3747 patients (age 62.1±8.5 years, 797 women), with a median average SBP level during the observational period of 132.5 mm Hg, were studied. All the risks of any stroke (146 events; hazard ratio, 1.318 [95% CI, 1.094-1.583] per 10-mm Hg increase), ischemic stroke (133 events, 1.219 [1.010-1.466]), hemorrhagic stroke (13 events, 3.247 [1.660-6.296]), ischemic events (142 events, 1.219 [1.020-1.466]), and bleeding events (47 events, 1.629 [1.172-2.261]) correlated with increasing mean SBP overall. Similarly, an increased risk of these events correlated with increasing successive variation of SBP (hazard ratio, 3.078 [95% CI, 2.220-4.225] per 10-mm Hg increase; 3.051 [2.179-4.262]; 3.276 [1.172-9.092]; 2.865 [2.042-4.011]; 2.764 [1.524-5.016], respectively). Event rates did not differ between the clopidogrel and prasugrel groups within each quartile of SBP or successive variation of SBP. Both high mean SBP level and high visit-to-visit variability in SBP were significantly associated with the risk of recurrent stroke during long-term medication with either prasugrel or clopidogrel after stroke. Control of hypertension would be important regardless of the type of antiplatelet drugs. Registration: URL: https://www.clinicaltrials.jp; Unique identifier: JapicCTI-111582.

CORRELATION AMONG SLEEP DURATION, BLOOD PRESSURE, AND BLOOD GLUCOSE LEVEL OF MORANGAN PEOPLE, SINDUMARTANI, NGEMPLAK, SLEMAN

Sleep deprivation is a risk factor for cardiovascular and metabolic diseases. There was a high prevalence of high blood pressure and type 2 diabetes in Morangan, Yogyakarta Province. This study aims at studying the correlation between sleep duration, systolic blood pressure and fasting blood glucose levels of people in Morangan. This study was a cross-sectional study conducted in cooperation with a public health care program for people in Morangan. Data collection was done using a questionnaire and health screening procedure during the public health care program. Collected data were covering aspects of systolic blood pressure, fasting blood glucose, sleep duration, and sleep habit. There was a high prevalence of high systolic blood pressure (&gt;130mmHg; 66.04%) and high fasting blood glucose level (&gt;100mg/dL; 39.62%) in Morangan people. There was a significantly positive correlation between sleep duration and systolic blood pressure (p:0.024; r:0.31) but no significant correlation between sleep duration and fasting blood glucose level. The major contributing habits towards sleep deprivation were caffeine consumption and medium pre-sleep routine. The result of this research will provide help in designing an education program for people of Morangan in preventing and treating high blood pressure and type 2 diabetes.

Abstract 13706: Differences in the Distribution of Systolic Blood Pressure by Rural and Urban Residence

Introduction: The incidence of stroke is higher in rural areas. Hypertension is the leading risk factor for stroke, but the difference in systolic blood pressure (SBP) for those living in rural and urban areas is unknown. Hypothesis: We hypothesized that rural residence is associated with higher SBP levels, and this difference is modified by race, sex, and United States (US) division. Methods: We analyzed 26,113 participants enrolled in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, recruited between 2003 and 2007. Participants were grouped based on the Rural-Urban Commuting Area (RUCA) scheme into urban, large-rural, and small-isolated rural groups. Resting SBP was measured during the initial home visit. Differences in percentiles of SBP distribution were compared using multivariate models with adjustment for age, race, sex, and US Census Bureau division. Results: Of the participants, 20,976 (80.3%) were classified as urban, 3,020 (11.6%) as large-rural, and 2,137 (8.2%) as small-isolated rural, reflecting the distribution of the population. The large-rural group had a 0.09 mmHg higher mean SBP compared to the urban group (95% CI, 0.33 to 1.52 mmHg, p = 0.0023), but the difference in SBP at the 95th percentile between these groups was 3.23 mmHg (95% CI, 1.43 to 4.73 mmHg, p = 0.0006). A similar difference was present between the small-isolated rural and urban groups at the highest percentiles. No urban-rural interaction was observed by race, sex, or US division. However, large SBP differences were present between US divisions, especially at the highest percentiles. To illustrate, SBP at the 95th percentile was 9.51 mmHg higher in the East North Central division than in the Pacific (95% CI, 6.41 to 12.61 mmHg, p &lt; 0.0001). Conclusions: Residence in a rural area is associated with higher SBP, with larger differences at the highest percentiles of distribution. SBP differences are present between US divisions, independent of urban-rural status.

Systolic blood pressure mediates the association between body mass index and inhibitory control in children

Here, we examine whether systolic blood pressure (SBP) mediates the relationship between body mass index (BMI) and inhibitory control in children. Twenty children with high blood pressure (HBP) were approximately matched with twenty children with low blood pressure (LBP) by fitness, BMI, somatic maturation, sex and age. Inhibitory control was measured by a cognitive Go/Nogo task, where number of commission errors during Nogo trials and reaction time during Go trials were used as performance. We compared performance between the two groups and conducted a mediation analysis using SBP as mediator of the relationship between BMI and commission errors. Results revealed that HBP children presented higher number of commission errors, compared to LBP children. Moreover, SBP mediated the relation between BMI and number of errors. Thus, early exposure to high levels of SBP can negatively impact inhibitory control and SBP acts as a mediator between BMI and inhibitory functioning in children.

Blood pressure variability in diabetic patients with or without albuminuria

Introduction: Various studies considered albuminuria as one of the first asymptomatic paraclinical manifestation of the micro-vascular damages in type 2 diabetes mellitus (DM). Hypertension (HTN) is common in type 2 DM, which has a correlation with the greater risks of cardiovascular morbidity and death. Objectives: The present research evaluated the relationship between blood pressure (BP) variability in diabetic patients who have or not albuminuria. Patients and Methods: In this analytical-descriptive research, we divided 90 type 2 diabetic patients into two groups of micro-albuminuric (urinary albumin excretion ≥30 mg/d and &lt;300 mg/d) and the normo-albuminuric (urinary albumin excretion &lt;30 mg/d) diabetic patients. We evaluated systolic and diastolic BP and 24-hour Holter monitor BP and heart rate, with respect to their albuminuric states and glomerular filtration rate (GFR) stages. Results: According to the findings, a considerably greater BMI (body mass index) and retinopathy was observed in microalbuminuric group in comparison with the normoalbuminuric group (P&lt;0.05). Additionally, non-dipping pattern was greater in the microalbuminuric patients (P&lt;0.05). In addition, patients were divided into dippers and non-dippers, the mean daytime and nighttime BP and heart rate were compared. Mean arterial BP (MAP) and nighttime BP and substantially in the subgroup of patients with GFR below 60 mL/min, systolic blood pressure (SBP) were considerably greater in the micro-albuminuric patients (P&lt;0.05). Conclusion: In patients with diabetes, the existence of albuminuria is related to the increase in the incidence of non-dipping pattern compared with patients without albuminuria. According to high levels of SBP in albuminuric patients with low GFR, the pattern of HTN and then albuminuria and the subsequent reduction of renal function can be similar to that of type 1 DM patients. Moreover, 24-hour Holter monitoring and BP should be monitored closely in diabetic patients.

Riesgo cardiometabólico en pacientes con hiperaldosteronismo primario y secreción autónoma de cortisol. Estudio de casos y controles

ObjectiveTo analyse the differences in the cardio-metabolic profile of patients with primary aldosteronism (PA) and autonomous cortisol secretion (ACS) matched by age and sex. MethodsCase-control study; cases of PA without associated ACS and as controls patients with ACS (dexamethasone suppression test ≥ 1.8 μg/dL in the absence of specific hypercortisolism clinical data), matched by age and sex. Comorbidities of hypertension, diabetes, obesity, dyslipidaemia, chronic kidney failure, and cardiovascular and cerebrovascular events were analysed, as well as their degree of control. Results57 patients with PA and 57 with ACS were included. On diagnosis, in addition to a higher prevalence of hypertension in the PA patients (100 vs. 52.7%, p < .0001) and higher systolic blood pressure levels (143.2 (2.5) vs. 135.3 (2.6) mmHg, p = .032) than in the ACS patients, no other differences were detected in the prevalence of other cardio-metabolic comorbidities. Nevertheless, the patients with ACS had higher HbA1c levels (p = .028) than the PA patients.After a median follow-up of 2.25 years, the patients with PA presented a greater deterioration in kidney function (Average decrease in glomerular filtration rate (MDRD-4) -17.4 (3.0) vs. -2.3 (4.4) mL/min/1.73 m2, p = .005) and lipid profile (Δtriglycerides of 34.5 (15.8) vs. -6.7 (11.3) mg/dL, p = .038) than the ACS patients. ConclusionsDespite the higher prevalence of hypertension in the patients with PA than in the patients with ACS matched by age and sex, no differences were detected in the prevalence of other cardio-metabolic comorbidities. However, the PA patients showed a greater deterioration in kidney function and lipid profile throughout the follow-up than the ACS patients.

Contemporary Prevalence and risk factors of carotid artery stenosis in asymptomatic low-income Chinese individuals: a population-based study

ABSTRACT Objectives Carotid artery stenosis (CAS) is an established risk factor for cerebrovascular disease. However, the contemporary prevalence and risk factors of CAS in asymptomatic rural Chinese individuals, especially low-income populations, remains unclear. Therefore, we aimed to explore the present prevalence and risk factors of CAS in a low-income Chinese population. Methods A total of 3126 people aged ≥ 45 years without history of stroke or cardiovascular disease were recruited for this study. B-mode ultrasonography was performed to evaluate the presence of CAS. We used multivariate analysis to determine potential risk factors for CAS. Results The overall prevalence of CAS in this population was 6.7%, with a prevalence of 8.8% for men and 5.0% for women. The risk of CAS increased with older age and a higher level of low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), and fasting blood glucose (FBG) (all P < 0.05). Each 1-mmHg increase in SBP increased the risk of CAS by 0.011 times, each 1-mmol/L increase in LDL-C increased the risk of CAS by 0.192 times, and each 1-mmol/L increase in FBG increased the risk of CAS by 0.067 times. In addition, the risk of CAS increased 52.9% in men compared to that in women, increased 100.2% in current drinkers compared to that in never drinkers, and increased 38.9% in patients with diabetes compared to those without diabetes (all P < 0.05). Conclusions These findings suggest that the prevalence of CAS remains high in low-income individuals. Male sex, older age, current drinking, diabetes, and high levels of LDL-C, SBP, and FBG increase the risk of CAS. Thus, to prevent cerebrovascular disease and reduce the severe disease-associated burden for low-income individuals, there is a definitive need to control the risk factors of CAS.

P0155CHARACTERISTICS OF HYPERTENSIVE NEPHROSCLEROSIS DIAGNOSED BY RENAL BIOPSY BASED ON 40-YEAR EXPERIENCE

Abstract Background and Aims Hypertensive nephrosclerosis (HT-N) is known as the second common cause of end stage renal disease (ESRD) in Korea as well as in other countries. However, the HT-N is assumed by clinical findings which are not well correlated to the pathologic findings. Therefore, we report the clinical characteristics of HT-N diagnosed by renal biopsy and compare the prognosis between patients with HT-N and hypertensive patients with focal segmental nephrosclerosis (FSGS) without pathologic HT-N. Method We enrolled 21,617 patients having native kidney biopsy for diagnosis of nephritis between 1979 and 2018, retrospectively. Among them, we selected 267 adult hypertensive patients with only HT-N and 984 hypertensive patients with FSGS without HT-N or other diagnoses (FSGS-HT). The estimated glomerular filtration rate (GFR) was calculated by original MDRD equation. The final outcomes were incidences of end stage renal disease (ESRD) and death. We matched blood pressures and GFR between two groups and analyzed the difference of outcomes within the matched cohort (mHT-N and mFSGS-HTN), also. Results The age of patients with HT-N was 49.5 ± 15.3 years at renal biopsy. There were 175 (65.5 %) men. Systolic blood pressure (SBP) was 139.1 ± 24.0 mmHg and diastolic blood pressure (DBP) was 83.7 ± 15.6 mmHg at renal biopsy. Levels of serum creatinine, GFR, and urine protein to creatinine ratio were 3.17 ± 3.05 mg/dl, 40.7 ± 32.5 ml/min/1.73 m2, and 2.277 ± 2.803 g/g cr, respectively. During follow-up period of 64.1 months (median), there were 52 (22.7%) patients progressed to ESRD and 8 (3.1%) patients were dead. Age, SBP, and hemoglobin were risk factors to mortality by Cox’s hazard proportional model adjusted with related factors to mortality. With increase of 10 mmHg in the level of SBP at renal biopsy, hazard ratio(HR) of mortality was increase by 1.645 folds (95% CI: 1.192-2.270, P=0.002). Presence of diabetes mellitus, serum albumin, and GFR were risk factors to incident ESRD. Compared to patients with FSGS-HT, patients with HT-N showed higher levels of SBP, DBP, and serum creatinine and lower levels of GFR, serum albumin, hemoglobin, and UPCR (all p-values &amp;lt;0.05), however, the risk of incident ESRD and mortality was not different. Therefore, we matched BP and GFR between groups and selected 235 patients in each group. The matched groups were not different in the values of age, SBP, DBP, and GFR. The risk of mortality was not different between groups (p-value =0.502), however, HR of incident ESRD was 1.558-fold higher (95% CI: 1.004-2.419, P=0.048) in mFSGS-HT compared to mHT-N by Cox’s hazard proportional model adjusted by factors related to ESRD. Conclusion Hypertensive nephrosclerosis was diagnosed in more advanced stage of CKD compared to hypertensive FSGS. Considering levels of GFR and SBP as risk factors to hard outcomes, we should consider early pathologic diagnosis for proteinuric and/or azotemic hypertensive patients and control blood pressures and renal dysfunction in more aggressive manners.

Association Between Clinical Manifestations and Prognosis in Patients with COVID-19

PurposeThe purpose of this study was to determine the risk factors associated with pneumonia, acute respiratory distress syndrome (ARDS), and clinical outcome among patients with novel coronavirus disease 2019 (COVID-19). MethodsThis was a cross-sectional multicenter clinical study. A total of 95 patients infected with COVID-19 were enrolled. The COVID-19 diagnostic standard was polymerase chain reaction detection of target genes of 2019 novel coronavirus (2019-nCoV). Clinical, laboratory, and radiologic results, as well as treatment outcome data, were obtained. ARDS was defined as an oxygenation index (arterial partial pressure of oxygen/fraction of inspired oxygen) ≤300 mm Hg. FindingsMultivariate analysis showed that older age (odds ratio [OR], 1.078; p = 0.008) and high body mass index (OR, 1.327; p = 0.024) were independent risk factors associated with patients with pneumonia. For patients with ARDS, multivariate analysis showed that only high systolic blood pressure (OR, 1.046; p = 0.025) and high lactate dehydrogenase level (OR, 1.010; p = 0.021) were independent risk factors associated with ARDS. A total of 70 patients underwent CT imaging repeatedly after treatment. Patients were divided in a disease exacerbation group (n = 19) and a disease relief group (n = 51). High body mass index (OR, 1.285; p = 0.017) and tobacco smoking (OR, 16.13; p = 0.032) were independent risk factors associated with disease exacerbation after treatment. ImplicationsThese study results help in the risk stratification of patients with 2019-nCoV infection. Patients with risk factors should be given timely intervention to avoid disease progression.

Clinical characteristics and quality assessment of the treatment of patients with chronic heart failure with diabetes mellitus

A study of the clinical and instrumental characteristics and quality of treatment of patients with chronic heart failure (CHF) with diabetes mellitus. The study was conducted by using the CHF register method, which is a computer program with remote access, which allows on-line data collection on patients who have been examined and treated in primary care and in hospitals. The study included 8272 patients with CHF IIIV FC (functional class) (New York Heart Association NYHA); among them 62% of patients were treated in hospital. The study showed that the frequency of diabetes was 21%. The main causes of CHF in diabetic patients are coronary artery disease, myocardial infarction (in anamnesis) and hypertension. These patients are more often diagnosed with III and IV CHF FC according to (NYHA) and retained LV (left ventricular) ejection fraction. The reduced ejection fraction was observed in 6.8% of cases, and the frequency of the intermediate LV was significantly higher than among patients with CHF and with diabetes and accounted for 18.9%. At patients with CHF with diabetes in comparison with patients with CHF without diabetes, atherosclerosis of the peripheral arteries, stroke (in anamnesis) and chronic kidney disease of stage III and IV were significantly more common. Under the treatment, patients with CHF with diabetes have higher levels of SBP (systolic blood pressure), lipids and glucose in the blood plasma, indicating a lack of quality of treatment and, accordingly, the doctors are not optimally performing the clinical guidelines on treating this category of patients.

Decrease in Serum HDL-C Level Is Associated with Elevation of Blood Pressure: Correlation Analysis from the Korean National Health and Nutrition Examination Survey 2017.

A low-serum, high-density lipoproteins–cholesterol (HDL-C) level and high blood pressure (BP) are independent risk factors for cardiovascular disease and dementia. In the present study, in order to find putative correlation between low HDL-C and hypertension, 4552 subjects (20–80 years old) were selected from the Korean National Health And Nutrition Examination Survey 2017 (KNHANES VII-2, n = 2017 men, n = 2535 women). They were classified into four levels of blood pressure, ranging from BP1 (normal, below 120/80 mmHg for systolic BP (SBP)/diastolic BP (DBP), BP2 (prehypertension, 120/80 to 139/89 mmHg), BP3 (hypertension stage 1, 140/90–159/99 mmHg), and BP4 (hypertension stage 2, higher than 160/100 mmHg). Generally, in the total population, a higher SBP level and age were associated with a lower HDL-C in both genders. However, DBP was not associated with age in men. In the total population, Pearson’s correlation analysis revealed that SBP (r = −0.188, p < 0.001) and DBP (r = −0.198, p < 0.001) showed negative correlations with percentage of HDL-C in total cholesterol (TC), HDL-C/TC (%). In both genders, HDL-C gradually decreased with age and HDL-C/TC (%) was more accurate in expressing a correlation with BP. Women showed a more distinct decrease in HDL-C with an elevation of BP and age than men. Both elevation of DBP and SBP were associated with a decrease in HDL-C, around 2.3–2.4 mg/dL, between normal range and hypertension 2 stage. Additionally, DBP was significantly associated with HDL-C/TC (%) (men: r = −0.136, p < 0.001; women: r = −0.152, p < 0.001), while HDL-C did not show a significant association with a change in DBP. In conclusion, SBP was positively correlated with age, but DBP did not change significantly with age. The correlation of BP and HDL-C depending on age showed that SBP gradually increased and HDL-C decreased with an increase in age. The percentage of HDL-C in TC was more significantly associated with a change in SBP and DBP in both genders.

Both High and Low Levels of Negative Emotions Are Associated with Higher Blood Pressure: Evidence from Whitehall II Cohort Study.

Previous studies of negative emotions and blood pressure (BP) produced mixed findings. Based on the functionalist and evolutionary perspective on emotions, we hypothesized that the association between negative emotions and BP is U-shaped, i.e., that both very high levels of negative emotions and theabsence thereof are related to high BP. Data from 7479 British civil servants who participated in Phases 1-11 (years 1985-2013) of theWhitehall II cohort study was used. Negative emotions were operationalized as negative affect and depressive and anxiety symptoms. Negative affect was measured at Phases 1 and 2. Anxiety and depressive symptoms were assessed at each phase. BP was measured at every other phase. For each negative emotion measure, an average across all phases was computed and used as a predictor of PB levels throughout the follow-up period using growth curve models. Very high values of anxiety and depressive symptoms, but not negative affect, were associated with higher levels of systolic BP. However, low to moderate levels of all negative emotions were associated with lower blood pressure than the absence of negative emotions. The article offers a theoretical explanation for a previously observed inverse association between negative emotions and blood pressure and underscores that moderate levels of negative emotions that naturally occur in everyday life are not associated with risks of heightened blood pressure.

Взаимосвязь между гемодинамическими реакциями на холодовой стресс и изменениями уровня саливарного кортизола

An experimental study was conducted with the participation of 30 healthy male volunteers (18–20 years) in order to determine the types of hemodynamic reactions to the general cooling of the body and to determine the severity of cold stress from the dynamics of salivary cortisol levels. The experiment included three 10-minute stages: rest t +20 oС; being in a cold chamber t –20 oС; warming t +20 oС. During each stage, blood pressure (BP), heart rate (HR), temperature in the ear canal were determined, and saliva samples were taken for subsequent determination of free cortisol levels. Volunteers were divided into two groups according to the dynamics of changes in salivary cortisol during cooling: with an increase (n = 22) and a decrease (n = 8) in the hormone’s level. It was shown that during cooling the body temperature of the subjects significantly decreased by an average of 2.1–2.3 oС and did not reach the initial values by the end of the warming stage. In both groups of individuals, when cooling, an increase in BP and a decrease in HR occurred, while in the group with an increase in cortisol, significantly higher levels of systolic BP and a slight decrease in HR were detected. During warming, the hemodynamic indices tended to the initial levels, and the change in the salivary cortisol level was similar to that during cooling. Thus, an increase in the level of salivary cortisol during short-term (10 min) cooling of the human body is associated with severe cold arterial hypertension, a lower baroreflex response, and the risk of cold damage to blood vessels. A decrease in salivary cortisol as a reflection of a decrease in the release of free hormone into the cell during cold stress, in combination with moderate cold arterial hypertension, may indicate a successful adaptation of the body to cold with limited development of hypothermia.

Low Level of Vitamin D is a Risk Factor for the Occurrence of Early and Late Onset Pre-Eclampsia in Pregnant Women.

This study was aimed to investigate the relationship between 25-hydroxy vitamin D (25(OH)D) level and the occurrence of pre-eclampsia (PE) and also the risk factors of developing early and late onset PE. A total of 370 pregnant women were included between January 2015 and December 2016 at our hospital. PE was defined as the presence of maternal blood pressure > 140/90 mmHg and 24-hour proteinuria levels > 300 mg or 2 + in a random sample of urine after the 20th week of pregnancy. Controls were pregnant women without hypertension and proteinuria. Assessment of 25(OH)D was performed at 16 - 20 weeks of gestation. Univariate and multivariate analyses were used to evaluate the association of vitamin D with PE. There were 201 patients with PE while 169 pregnant women were controls. Patients with PE had older maternal age (p < 0.001), earlier gestation age (p < 0.001), and higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) (p < 0.001). The level of 25(OH)D in the PE group (17.26 ± 13.95 µg/L) was significantly lower than that in controls (22.15 ± 12.65 µg/L, p = 0.019). Moreover, the proportion of 25(OH)D deficiency in patients with PE was significantly higher than that of controls (27.6% vs. 0.9%, p < 0.001). Older age, high SBP, and low level of 25(OH)D were independent risk factors of both early and late onset PE during pregnancy. Low 25(OH)D level was more likely presented in PE patients and was an independent risk factor of both early and late onset PE.

Association Between Early Hypertension Control and Cardiovascular Disease Incidence in Veterans With Diabetes.

Guidelines for hypertension treatment in patients with diabetes diverge regarding the systolic blood pressure (SBP) threshold at which treatment should be initiated and treatment goal. We examined associations of early SBP treatment with atherosclerotic cardiovascular disease (ASCVD) events in U.S. adults with diabetes. We studied 43,986 patients with diabetes who newly initiated antihypertensive therapy between 2002 and 2007. Patients were classified into categories based on SBP at treatment initiation (130-139 or ≥140 mmHg) and after 2 years of treatment (100-119, 120-129, 130-139, 140-159, and ≥160 mmHg). The primary outcome was composite ASCVD events (fatal and nonfatal myocardial infarction and stroke), estimated using inverse probability of treatment-weighted Poisson regression and multivariable Cox proportional hazards regression. Relative to individuals who initiated treatment when SBP was 130-139 mmHg, those with pretreatment SBP ≥140 mmHg had higher ASCVD risk (hazard ratio 1.10 [95% CI 1.02, 1.19]). Relative to those with pretreatment SBP of 130-139 mmHg and on-treatment SBP of 120-129 mmHg (reference group), ASCVD incidence was higher in those with pretreatment SBP ≥140 mmHg and on-treatment SBP 120-129 mmHg (adjusted incidence rate difference [IRD] 1.0 [-0.2 to 2.1] events/1,000 person-years) and in those who achieved on-treatment SBP 130-139 mmHg (IRD 1.9 [0.6, 3.2] and 1.1 [0.04, 2.2] events/1,000 person-years for those with pretreatment SBP 130-139 mmHg and ≥140 mmHg, respectively). In this observational study, patients with diabetes initiating antihypertensive therapy when SBP was 130-139 mmHg and those achieving on-treatment SBP <130 mmHg had better outcomes than those with higher SBP levels when initiating or after 2 years on treatment.

Clinical characteristics of postprandial hypotension in elderly patients with coronary heart disease

Objective To observe the incidence, clinical characteristics, related factors, adverse events during hospitalization and short-term prognosis of postprandial hypotension (PPH) in elderly patients with coronary heart disease. Methods One hundred and sixty-eight elderly patients with coronary heart disease hospitalized in the Department of Cardiology, Second Hospital of Hebei Medical University from January 2014 to January 2015 were selected as the research subjects.They were monitored by 24 h ambulatory blood pressure monitoring.According to the diagnostic criteria of PPH, they were divided into postprandial hypotension group (PPH group) 34 cases and non-postprandial hypotension group (NPPH group) 134 cases.The clinical characteristics, risk factors related to PPH, occurrence of adverse events and prognosis of all-cause death, cardiovascular and cerebrovascular adverse events were compared between the two groups. Results Among 168 elderly patients with coronary heart disease, thirty-four patients had PPH, and the incidence rate was 20.2%(34/168). The average systolic blood pressure before meals in PPH group was (139.8±18.6) mmHg (1 mmHg=0.133 kPa). The proportion of taking calcium antagonists was 50.0% (17/34) higher than that in NPPH group (127.4±13.2)mmHg, 27.6% (37/134). The difference between the two groups was statistically significant(t=6.463, χ2=6.232, P<0.05). PPH was higher in breakfast and dinner than in lunch; the higher the basal systolic blood pressure level, the higher the incidence of PPH.Logistic regression analysis showed that the basal systolic blood pressure level and age were positively correlated with the occurrence of PPH (r=0.301, r=0.208, P<0.05). Follow-up for 26 months showed that the incidence of all-cause death and cerebrovascular events in PPH group was higher than that in NPPH group (χ2=5.800, 11.560, P<0.05). Conclusion The incidence of PPH in elderly patients with coronary heart disease during hospitalization is 20.2%.Breakfast and dinner at three meals are prone to PPH.Older age and high systolic blood pressure level will increase the incidence of PPH.PPH will increase the incidence of mid-term all-cause death and cerebrovascular events. Key words: Postprandial hypotension; Coronary heart disease; Prognosis

Abstract WP221: Relation Between Blood Pressure and Stroke Mortality in the United States Veteran Population

Introduction: Improved control of hypertension is largely credited for declines in stroke incidence and mortality. Previous studies have reported worse outcomes after ischemic stroke with lower blood pressures prior to the stroke. We investigated the relationship between pre-stroke systolic blood pressure (SBP) and mortality after ischemic stroke among U.S. Veterans. Methods: This longitudinal analysis assessed mortality risk after incident stroke in a national sample of Veterans Health Administration hospitalizations between 2002 and 2007. We included patients who had admission ICD-9 codes for ischemic stroke (433.x1, 434, and 436, excluding 434.x0) and ≥1 outpatient blood pressure measurements 1 to 18 months prior to stroke. We defined 6 categories of average baseline SBP: &lt;120, 120-129, 130-139, 140-149, 150-159, and ≥160 mm Hg. Multivariable Cox analyses were used to relate baseline SBP to all-cause and vascular mortality determined using the National Death Index. Results: There were 29,458 hospitalizations (mean age 67±12 years, 98% male) for incident stroke. During 4.1±3.3 years mean follow-up, there were 15,489 deaths (54%). There were 6,629 vascular deaths (23%). In a fully adjusted model, with high normal pre-stroke SBP (130-139) as the reference, risk of all-cause mortality was increased for patients with very low-to-normal SBP (&lt;120), normal SBP (120-129), and very high SBP (≥160) (Table 1A). The risk of vascular mortality increased with very low (&lt;120) and very high (≥160) SBP levels, but was not increased with normal SBP (120-129) (Table 1B). Conclusions: In U.S. Veterans hospitalized with first-ever stroke, very low and very high pre-stroke systolic blood pressure levels increased risk of all-cause and vascular mortality. Optimal SBP targets after stroke, particularly in patients with low pre-stroke SBP, merit further investigation.

Impact du bruit professionnel sur le développement de l’hypertension artérielle : enquête réalisée au sein d’une centrale de production d’électricité et de gaz en Tunisie

BackgroundNoise pollution is one of the major environmental pollutants that can adversely affect public health. Cardiovascular diseases are the primary out-auditory adverse outcome caused by occupational noise exposure. AimsTo investigate the association between occupational exposure to high level of noise and blood pressure among a group of workers in a company of electricity production in the Centre of Tunisia. Material and methodsA total of 120 occupational noise-exposed workers and 120 non-exposed employees were recruited to conduct a cross-sectional survey exploring the association between occupational noise-exposed and arterial hypertension. Data collection was based on a questionnaire, a clinical exam and biomarkers. Blood pressure was measured using a mercury sphygmomanometer following a standard protocol. The occupational noise level was measured with a portable calibrated sound meter. Multiple logistic regression was used to calculate the odds ratio (OR) and 95 % confidence interval (CI) of noise exposure adjusted by potential confounders. ResultsThe noise level to which our population was exposed ranged from 75dB to 103dB with an average noise level of 89dB. Mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and the prevalence of hypertension were significantly higher in exposed individuals than in non-exposed. In multivariate analysis, elevated SBP in exposed workers was associated with high-salt diet (OR adjusted=1.71, 95% CI adjusted [1.14–1.98]) and occupational seniority more than 8 years (adjusted OR=5.31, 95% CI [2.22–12.72]). The factors associated with high BP in the exposed group were diabetes (OR adjusted to 15.31; 95% adjusted CI [2.61–89.58]), history of hypertension in the family (OR adjusted to 11.46; 95% adjusted CI [5.18–83][1.58–83.05]), mean of age (OR adjusted to 6.65; 95% adjusted CI [1.87–23.59]) and high-salt diet (OR adjusted to 0.29; 95% adjusted CI [0.09–0.95]). ConclusionOccupational chronic noise exposure was associated with higher levels of SBP, DBP, and the risk of hypertension. These findings indicate that effective and feasible measures should be implemented to reduce the risk of hypertension caused by occupational noise exposure in companies of electricity production.