Higher Systolic Blood Pressure Research Articles

Impaired Peripheral Vascular Function Following Ischemic Stroke in Mice: Potential Insights into Blood Pressure Variations in the Post-Stroke Patient.

High systolic blood pressure and increased blood pressure variability after the onset of ischemic stroke are associated with poor clinical outcomes. One of the key determinants of blood pressure is arteriolar size, determined by vascular smooth muscle tone and vasodilatory and vasoconstrictor substances that are released by the endothelium. The aim of this study is to outline alterations in vasomotor function in isolated peripheral arteries following ischemic stroke. The reactivity of thoracic aortic segments from male C57BL/6 mice to dilators and constrictors was quantified using wire myography. Acetylcholine-induced endothelium-dependent vasodilation was impaired after ischemic stroke (LogIC50 Sham = -7.499, LogIC50 Stroke = -7.350, p = 0.0132, n = 19, 31 respectively). The vasodilatory responses to SNP were identical in the isolated aortas in the sham and stroke groups. Phenylephrine-induced vasoconstriction was impaired in the aortas isolated from the stroke animals in comparison to their sham treatment counterparts (Sham LogEC50= -6.652 vs. Stroke LogEC50 = -6.475, p < 0.001). Our study demonstrates that 24 h post-ischemic stroke, peripheral vascular responses are impaired in remote arteries. The aortas from the stroke animals exhibited reduced vasoconstrictor and endothelium-dependent vasodilator responses, while the endothelium-independent vasodilatory responses were preserved. Since both the vasodilatory and vasoconstrictor responses of peripheral arteries are impaired following ischemic stroke, our findings might explain increased blood pressure variability following ischemic stroke.

P154 GETTING OPTIMAL AND TARGET BLOOD PRESSURE IS MORE CHALLENGING FOR HYPERTENSIVE PATIENTS WITH ANOTHER CARDIOVASCULAR DISEASE

Home blood pressure monitoring (HBPM) compared with office-based monitoring could be better at predicting cardiovascular morbidity and mortality. Patients and Methods: This project aimed to evaluate HBPM in adult pts with AH. It was conducted from April to June 2022 at 178 general physicians practices in Slovakia. Results: 4375 pts with AH were enrolled (2089 women, 51,8%), mean age 61,1 ± 19,1 years. BP values at HBPM decreased over the period of seven days by -2.2/-1.4 mm Hg (p &lt; 0.01). The first treatment goal, office BP ≤ 140/90 mm Hg, was achieved by 67% of patients. The second treatment goal, based on patients’ age was achieved by 35% of patients. The number of patients with CV comorbidities surpassed 48.8%. They were significantly older 67,3± 15,2 years vs 57,1 ± 12,6 years (p&lt;0,01), with a higher BMI of 30,1± 5,2 kg/m2vs 28,7 ± 3,8 kg/m2 (p&lt;0,01) in comparison with patients without CV comorbidities. In HBPM patients with CV comorbidities have higher both systolic BP (SBP) and diastolic BP (DBP) 134,8 ± 11,2/80,3± 7,6 mmHg vs 131,9±8,2/80,4 ±6,4 mmHg (p&lt;0,01). To compare with office blood pressure measurements: higher SBP was in patients with CV comorbidities 137,1 ±18,1 mmHg vs 135,2 ±16,3 mmHg (p 0,516), higher DBP was in patients without CV comorbidities 81,5 ±6,4 mmHg vs 80,3 ± 5,1 mmHg (p&lt;0,01). Dyslipidemia was present in 67% of patients. Women were more likely to have dyslipidemia and hypertension 68,8% vs 65,5% (p=0.03) in men. Conclusions: The results of office and home BPM 2022 demonstrated active involvement of patients in the management of AH can have a significant impact. We need to be more consistent in treating AH, according to 2023 ESH guidelines, mainly in patients with cardiovascular comorbidities. By achieving a 67% success rate in control of AH patients, The Charter 70/2023 is imminent.

P025 GLOBAL, REGIONAL AND NATIONAL BURDEN OF HIGH SYSTOLIC BLOOD PRESSURE, 1990-2021: FINDINGS FROM THE GLOBAL BURDEN OF DISEASE STUDY 2021

High systolic blood pressure (SBP) is the leading preventable global health risk. As part of the Global Burden of Disease Study 2021, we quantify the SBP-associated burden (relative to a theoretical risk exposure level of 105-115 mmHg) among adults over 25, by age and sex, for 204 countries from 1990 to 2021. Standard GBD Bayesian methods were used to estimate SBP mean, standard deviation and corresponding distribution from 1,116 studies. Meta-analyses of 70 randomized controlled trials and cohorts were used to estimate the relative risks for seven outcomes: ischemic heart disease (IHD), stroke, chronic kidney disease (CKD), atrial fibrillation, aortic aneurysm, peripheral arterial disease (PAD) and hypertensive heart disease. Then, the population attributable fraction and SBP attributable burden were computed with 95% uncertainty intervals (UI). In 2021, 10.9 million deaths (9.2-12.5 million) and 225 million (190 - 259 million) disability-adjusted life years (DALYs) were attributable to elevated SBP worldwide, a decrease, since 1990, of 32% and 30% in age-standardized rates, respectively. In 2021, high SBP accounted for 7.8% of total DALYs; 49.9% (40.6 - 58.2%) of DALYs due to IHD; 57.3% (42.7-68.4%) due to stroke; 24.8% (13.0-36.1%) due to CKD; 30.1% (10.7-47.6%) due to atrial fibrillation; 17.1% (12.9-21.4%) due to aortic aneurysm; 13.0% (2.7-23.8%) due to PAD and 100% of the DALYs due to hypertensive heart disease. Globally, the burden attributable to SBP was higher in men than in women (3,162.9 [2,654.8-3,666.4] vs 2,167.3 [1857.4 -2510.9] age-standardized DALYs per 100,000). Age-standardized DALYs attributable to high SBP were highest in Central Asia and Eastern Europe, rates above six thousand per 100,000. The lowest levels were observed in high-income Asia Pacific, Australasia and Western Europe with less than 1000 DALYs per 100,000. Despite a decrease in age-standardized rates since 1990, high SBP remains a major global health risk with considerable regional variations. Targeted interventions are crucial to address these disparities and reduce SBP-related health impacts.

Enhanced machine learning models for predicting one-year mortality in individuals suffering from type A aortic dissection

ObjectiveThe study objective was to develop and validate an interpretable machine learning model to predict 1-year mortality in patients with type A aortic dissection, improving risk classification and aiding clinical decision-making. MethodsWe enrolled 289 patients with type A aortic dissection, dividing them into a training cohort (202 patients) and a validation cohort (87 patients). The Least Absolute Shrinkage and Selection Operator method with 10-fold cross-validation identified 8 key factors related to 1-year mortality. The Treebag model's performance was assessed using accuracy, F1-Score, Brier score, area under the curve, and area under the precision-recall curve with calibration and clinical utility evaluated through decision curves. Shapley Additive Explanations analysis determined the most influential predictors. ResultsThe Treebag model outperformed others, achieving a Brier score of 0.128 and an area under the curve of 0.91. Key risk factors included older age and elevated white blood cell count, whereas higher systolic blood pressure, lymphocyte, carbon dioxide combining power, eosinophil, β-receptor blocker use, and surgical intervention were protective. A web-based application, TAAD One-Year Prognostic Risk Assessment Web, was developed for clinical use (available at https://taad-1year-mortality-predictor.streamlit.app/). This platform allows for the prediction of 1-year mortality in patients with type A aortic dissection based on the identified predictive factors, facilitating clinical decision-making and patient management. ConclusionsThe Treebag machine learning model effectively predicts 1-year mortality in patients with type A aortic dissection, stratifying risk profiles. Key factors for enhancing survival include surgical intervention, β-blocker administration, and management of systolic blood pressure, lymphocyte, carbon dioxide combining power, eosinophil, and white blood cell levels, offering a valuable tool for improving patient outcomes.

Abstract P420: Amino acid and organic acid signature in urine of prepubescents with higher cardiometabolic risk evaluated by waist-to-height ratio

The waist-to-height ratio (WHtR) is a valuable tool for assessing central obesity and cardiometabolic risk, even in non-obese individuals. Childhood obesity is linked to metabolic abnormalities underlying cardiovascular diseases. Amino acids are fundamental in several metabolic processes, such as synthesizing proteins, ATP, and neurotransmitters. Organic acids are products of the metabolism of amino acids, carbohydrates, and fats. We assessed the hypothesis that their levels can serve as biomarkers for exposure, disease progression, and susceptibility, aiding in early intervention strategies. This cross-sectional study assessed amino acids and organic acids profiles in urine from prepubescent children categorized by WHtR. The 110 Brazilian participants aged 9-10 were classified as higher (n=48) or normal (n=62) cardiovascular risk. LC-MS/MS analyzed 47 amino acids and 73 organic acids in 12-hour urine samples, concentration values were adjusted by urinary creatinine. Standard protocols were used to obtain biochemical profiles, cardiovascular and anthropometric parameters. A metabolic signature in the urine of prepubescents at higher cardiometabolic risk was characterized by increased levels of the aromatic amino acids [Tyr ( 131 vs 90, p &lt; 0.01 ), Trp ( 109 vs 95, p =0.02 ) and Phe ( 65 vs 46, p = 0.04 )], Lys ( 212 vs 160, p &lt; 0.01 ), α-aminoadipic acid (61 vs 49, p &lt; 0.01 ), and cystathionine ( 25 vs 21 nmol/mg of creatinine, p = 0.03 ) while the levels of the organic acids p-OH-phenyl lactic (4.82 vs 3.7 ug/mg of creatinine, p = 0.02 ), suberylglycine (0.37 vs 0.18 , p = 0.01 ), and benzoic acid (2.67 vs 1.77 , p = 0.01 ) were found to be reduced. These amino acids were correlated with increased anthropometric measurements, low HDL-C, and hypertriglyceridemia. Also, Lys and Tyr were positively associated with higher systolic blood pressure. The organic acids were negatively correlated with anthropometric measurements and benzoic acid showed a positive correlation with time of exclusive breastfeeding. Findings indicate that children at higher cardiometabolic risk present an amino acid and organic acid signature in urine, this amino acid signature is commonly reported in type 2 diabetes and adults with cardiovascular disease. The organic acid signature in the urine of children in the context of cardiometabolic risk is reported for the first time.

Abstract P228: Kdm6a Regulates Extracellular Matrix Genes During Arterial Stiffening and High Blood Pressure in Female Mice

Arterial stiffness measured by pulse wave velocity (PWV) increases steeply during menopause due to estradiol decline. Longitudinal studies show higher PWV in postmenopausal women compared to age-matched men. Previously, we have demonstrated increased PWV in ovariectomized (OVX) and middle-aged female mice. However, the impact of sex chromosomes on PWV is unknown in female mice. We hypothesize that a decline in estradiol unleashes the female sex chromosomes effect that promotes arterial stiffening. This study used four core genotype mice (n=6-10/group) of XX or XY sex chromosomes left intact or OVX for 8 weeks. Arterial stiffening was assessed with pulse wave Doppler and 24-hour blood pressure by radiotelemetry. Carotid artery passive myography and vascular reactivity of 2 nd order mesenteric artery were assessed by pressure myography. To induce hypertension, XX and XY mice were treated with deoxycorticosterone acetate (DOCA; 50 mg/pellet) for 21 days and 1% saline. In vitro, isolated aortic vascular smooth muscle cells (VSMC) were stretched on collagen matrix or treated with Kdm6a inhibitor GSKJ-1. PWV was significantly increased in OVX than in gonadal intact XX and XY mice (P&lt;0.001). However, an interaction effect was indicated with higher PWV in XX than XY OVX mice (4.9±0.1 vs. 4.2±0.2 m/s; P&lt;0.001), indicating a sex chromosome effect. Carotid artery stress-strain curves showed a leftward shift of XX than XY mice, suggesting increased structural stiffness. Masson’s trichrome staining of the aorta showed increased collagen in the adventitia of XX than XY (30% vs. 26%; P=0.005) mice. Higher systolic blood pressure (SBP) was indicated in XX than in XY mice (Baseline; 123±3 vs. 116±4 mmHg; P=0.02). Aortic RNAseq showed increased X-linked genes, including Kdm6a, in XX compared to XY mice. Stretched aortic VSMC showed increased Col1a1 and decreased Itga4 and Lama2 genes reversed by GSKJ-1. DOCA-induced hypertension blunted the PWV difference between XX and XY mice; however, SBP was higher in XX than in XY mice (Week 1: 135±13 vs.127±3 mmHg; P=0.03), but not weeks 2 and 3. We observed impaired acetylcholine-mediated relaxation in hypertensive XX than XY mice (47% vs. 24%; P=0.03). Our data suggested that OVX mice with XX sex chromosomes promote arterial stiffening and high blood pressure, and Kdm6a regulates extracellular matrix genes in XX female VSMC. DOCA-induced hypertension promotes endothelial dysfunction and blunts PWV in ovariectomized XX and XY mice.

Abstract P195: Vascular MAPK/ERK Activation in sFTL-1-Induced Preeclampsia In Vivo

Vascular endothelial growth factor (VEGF) inhibition is linked to the development of hypertension and proteinuria in preeclampsia. This occurs as anti-angiogenic factors from the placenta contribute to pregnancy-related hypertension disorder. Soluble VEGF receptor fms-like tyrosine kinase-1 (sFLT-1) is an anti-angiogenic factor that counteracts VEGF. Levels of sFLT-1 are three times higher in preeclamptic placentas compared to those from normotensive pregnancies, and plasma sFLT-1 levels increase with the severity of preeclampsia. Infusing sFLT-1 in rodents induces hypertension, proteinuria, and glomerular endotheliosis, resembling the human condition of preeclampsia. Currently, there is no effective pharmacological treatment of preeclampsia, and in severe cases, early delivery is often the only effective treatment. In this study, we aim to determine how sFLT-1 exposure affects the activation of the vascular MAPK/ERK pathway and the contractility of the aorta ex-vivo using wire myography, to assess if the MAPK/ERK pathway can be a therapeutic target in preeclampsia. To this end, we treated pregnant female C57BL/6 mice from embryonic day E7.5 to E18.5 with either sFLT-1 (3.7mg/kg/day) or vehicle (phosphate-buffered saline) delivered by osmotic minipumps (intraperitoneal) and carried out non-invasive tail-cuff blood pressure measurements. After sacrifice, we isolated descending thoracic aorta for isometric tension measurements in a wire myograph. Infusion of sFLT-1 resulted in marked systolic blood pressure (SBP) elevation (D increase of 14 mmHg, P=0.0003) and augmented aortic phosphorylated-ERK activation (2-fold increase, P=0.040) by western blot and displayed impaired acetylcholine-induced endothelial relaxation in thoracic aortic segments (P&lt;0.05), providing in vivo evidence of increased vascular p-ERK activation, accompanied by higher SBP and endothelial dysfunction in sFLT-1 - indued mouse model of preeclampsia. Future experiments are aimed to test the effect of pharmacological ERK inhibition in sFLT-1 infusion in vivo . We hypothesize that sFLT-1-induced rise in SBP and vascular p-ERK could be prevented in vivo by treatment with the pharmacological ERK inhibitor.

Abstract P226: Sex-Dependent Effects of Perivascular Adipose Tissue on Arterial Stiffness in Hypertensive

Dillon McClintock, Department of Mechanical Engineering, Michigan State University, East Lansing, MI Sydney Bush, Department of Mechanical Engineering, Michigan State University, East Lansing, MI Lisa Sather, Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI Nathan Tykocki, Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI Adam Lauver, Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI Stephanie W Watts, Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI Sara Roccabianca, Department of Mechanical Engineering, Michigan State University, East Lansing, MI Perivascular adipose tissue (PVAT) plays a crucial role in arterial mechanics by significantly reducing arterial stiffness in the thoracic aorta in normotensive rats. This study aims to test the hypothesis that impact of PVAT on arterial stiffness is sex-dependent in an adiposity-driven hypertension rat model. Thoracic aorta from male and female Dahl Salt-Sensitive rats were fed control (10% fat-CD) and high-fat (60% fat-HFD) diets over 16 weeks. Uniaxial mechanical tests were then conducted on aorta samples with PVAT (+PVAT) and without PVAT (-PVAT). In -PVAT samples, arterial wall stiffness at 20% stretch (mimicking in vivo conditions), was higher in males compared to females on a HFD but not on a CD. HFD rats also had higher systolic blood pressures, but the increase was significant only in females. +PVAT samples’ stiffness was reduced by a 95% factor in all groups as compared to -PVAT samples. Furthermore, when including PVAT, the sex difference in the HF diet group was absent. These results suggest that PVAT has a beneficial effect that is preserved in this adiposity-driven hypertension animal model after 16 weeks on diet. Furthermore, remodeling of the arterial wall is more pronounced in male versus female rats and the inclusion of PVAT dampens this sex difference.

Association of X-ray disease stage with basic patient data, laboratory values and treatment modalities in patients with seropositive rheumatoid arthritis.

To investigate whether the radiographic progression of rheumatoid arthritis (RA) correlates with inflammatory markers and other laboratory values, and its association with treatment modalities. This observational study included 125 patients with seropositive RA. Data were obtained from patients' medical records from the year of 2022. Inclusion criteria were patients with seropositive RA who had attended follow-up with a rheumatologist. Basic patient data were collected: gender, age, duration of RA, hospital admission, systolic and diastolic blood pressure, and X-ray stage of RA. Stages of RA are defined by the American College of Rheumatology and they ranged from stage 1, which represents no destructive changes on X-ray, up to stage 4 where bony or fibrous ankylosis is present. There were no differences in X-ray stages of RA between genders. Patients with a higher X-ray stage were younger and had a longer duration of illness. Patients in stages III and IV had higher systolic blood pressure (BP), patients in stage IV had higher diastolic BP. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were higher in X-ray stages II-IV compared to stage I. The patients treated with methotrexate had higher radiographic stages. X-ray changes can be associated with CRP and ESR levels, since structural damage is related to RA disease activity and functional disability. The use of newer treatment modalities may be required to stop the radiographic progression of RA.

P221 ANKLE BRACHIAL INDEX AND ASSOCIATION WITH CHRONIC KIDNEY DISEASE IN THE H3 AFRICA KIDNEY DISEASE RESEARCH NETWORK

Background and Objective: Abnormal ankle brachial index (ABI) is common in patients with chronic kidney disease (CKD). We evaluated the association of ABI, a non-invasive tool to evaluate peripheral arterial disease and arterial stiffness, with CKD among West Africans enrolled in the H3Africa Kidney Disease Research Network (H3AKDRN). Methods: We recruited 9206 participants (5356 with CKD), from Ghana and Nigeria in the H3AKDRN, a multinational case-control study. CKD was defined as estimated glomerular filtration rate of &lt;60 ml/min/1.73m2 and/or albuminuria as albumin/creatinine ratio &gt;3.0 mg/mmol (&gt;30 mg/g) for ≥3months. ABI was divided into low (≤0.9), normal (0.91 – 1.3), and high (&gt;1.3). We assessed low ABI, a marker of peripheral artery disease, and high ABI, the marker of arterial stiffness. We determined association of ABI with CKD by multivariate logistic regression. Results: The mean age of participants was 45.8±15.36 years and 56.3% were males. The prevalence of low ABI was higher in CKD group (32%% versus 16% (control), p=0.013). The prevalence of high ABI was also higher in CKD (15% versus 10.9% (control), p = 0.01). Patients with CKD and low ABI have reduced BMI, low haemoglobin, higher systolic BP and increased albuminuria. Male gender, history of hypertension and diabetes were independently associated with CKD. Higher BMI was associated with reduced odds of CKD (p = &lt; 0.03). After adjustment for covariates, low ABI was associated with CKD, with 26% increased odd (aOR 1.26 (CI, 1.01 – 1.56; p = 0.037)), but high ABI was not associated with CKD (aOR 1.45 (0.88 – 2.38, p = 0.147)). Conclusion: The prevalence of abnormal ankle brachial index is high among adult populations of Ghana and Nigeria, with and without CKD. The Marker of peripheral arterial disease, but not marker of arterial stiffness was associated with CKD. A longitudinal study is required to determine the true relationship between ABI and CKD in West Africa.

P219 ASSOCIATION OF 24-HOURS BLOOD PRESSURE VARIABILITY WITH BRAIN MRI REGIONS OF INTEREST FOR ALZHEIMER'S DISEASE

Introduction: Variability in blood pressure (BP) has been associated with Alzheimer's disease (AD). However, it is unclear whether high variability in BP over 24-hours (24-h) is associated with the pre-clinical stage of AD. By examining brain MRI regions that atrophy decades before AD develops, we investigated the association between 24-h BP variability and MRI regions of interest for AD. Methods: We included baseline information of 324 participants aged ≥40 years old from a population-based study who underwent 24-h ambulatory BP monitoring and brain MRI scans. 24-h systolic BP variability was quantified using the average real variability (ARV) index. Brain MRI regions of interest for AD included the superior and middle frontal gyrus, supramarginal, superior, and precuneus gyrus, temporal pole, medial and inferior gyrus, entorhinal cortex, and hippocampus. We performed adjusted linear regression models to evaluate the association between 24-h systolic BP variability and MRI regions of interest for AD. Results: The mean age was 58.8±12.5 and 75.3% (n=244) were women. The mean thickness of MRI regions of interest for AD ranged from 2.12 mm3 to 4.04 mm3. In linear regression models, every +1.85 mmHg increase in 24-h systolic ARV was associated with lower thickness of the superior (adjusted mean mm3, -0.10; 95% confidence interval [CI], -0.21 and -0.01) and middle (adjusted-mean, -0.12 mm3; 95% CI, -0.24 and -0.01) frontal gyrus, medial temporal gyrus (adjusted mean, -0.21 mm3; 95% CI, -0.32 and -0.10), entorhinal cortex (adjusted-mean, 0.11 mm3; 95% CI, -0.21 and -0.01), and hippocampus (adjusted-mean, -0.14 mm3; 95% CI, -0.25 and -0.03); analyses also accounted for the 24-h systolic BP level. High 24-h systolic BP level was associated with lower thickness in 3/10 regions of interest for AD (P≤0.029). Conclusions: Elevated 24-h systolic BP variability is associated with thinning of brain MRI regions of interest for AD. Prospective data are needed to examine whether 24-h BP variability associated with thinning in brain MRI regions will increase the risk of AD.

P111 INTER-ARM DIFFERENCE IN SYSTOLIC BLOOD PRESSURE AMONG YOUNG POPULATION IN ABEOKUTA, NIGERIA

Background and Objective: Inter-arm blood pressure differences (IABPD) are linked to higher cardiovascular mortality and morbidity. Unfortunately, the profile and associated risk factors of IABPD in sub-Saharan Africa, particularly Nigeria are poorly studied. This study aims to determine the profile and associated correlates of systolic IABPD among the participants in the profile of anthropometry and psychosocial issues on campus (TERRACE) study, a cohort of young persons on selected tertiary educational campuses in Abeokuta metropolis aged 16-35years. Methods: This was a cross-sectional study. Basic demographic, anthropometric, and clinical data were collected. Brachial Blood Pressure (BP) were recorded in both arms, using validated electronic devices. Three standard measurements were performed on both arms. The IABPD was defined as the absolute value of the difference in systolic blood pressure(SBP) between the left and right arms of BP averages. Significant IABPD ≥10 mmHg. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 23. The level of statistical significance was set at &lt;0.05. Results: A total of 301 participants with age, 21.8±4.9 years and female proportion of 65.1%. The mean±SD of neck circumference, weight, height, right SBP, left SBP were 26.2 ± 3.6 cm, 58.0 ± 10.0 kg, 164.1 ± 10.4 cm, 112.9± 11.6mmHg and 112.0 ± 11.1 mmHg respectively. The median systolic IABPD was 0.6 mmHg, and the prevalence of significant systolic IABPD is 9.0% (11.4% in males and 7.7% in females, p- value: 0.275). Among our participants, there were 6.0%, 2.3% and 0.7% with a systolic IABPD in the ranges: 10-14.9mmHg, 15-19.9mmHg and ≥ 20mmHg respectively. The proportion with dominantly high right SBP was 54.4% in males compared to females (41.9%), p- value: 0.209. There was a correlation between height and IABPD (r2=0.177, p-value=0.002) Conclusion: Our study found that this young population have high IABPD, suggesting increased cardiovascular risk. Routine measurement in both arms is advised.

Estimating the burden of atrial fibrillation and atrial flutter with projection to 2050 in Iran

Atrial fibrillation (AF)/atrial flutter (AFL) is the most common cardiac tachyarrhythmia, with an increasing trend in its burden in recent years. However, the burden of AF/AFL in Iran remains unclear. This study aimed to estimate the burden of AF/AFL and its attributable risk factors from 1990 to 2019 at national and subnational levels. Using the comparative risk assessment method of the Global Burden of Disease (GBD) Study 2019, we extracted data on AF/AFL incidence, prevalence, deaths, disability-adjusted life years (DALYs), and their age-standardized rates from 1990 to 2019 and analyzed them based on by age, sex, and socio-demographic index (SDI). The percentage contribution of AF/AFL major risk factors was calculated. Moreover, the AF/AFL burden in 2050 was projected using the United Nations world population prospect data. In 2019, there were 339.1 (259.4–433.7) thousand AF/AFL patients in Iran, with 30.2 (23.2–38.5) thousand new cases, 1.7 (1.5–2) thousand deaths and 48 (37.7–60.5) thousand DALYs. Females and 50–69-year-old patients recorded a higher burden for AF/AFL; however, the increasing trend was more pronounced in males and more than 85-year-old patients. High systolic blood pressure and elevated body mass index (BMI) were the predominant attributable risk factors for AF/AFL-related deaths and DALYs. It is estimated that in 2050, the number of AF/AFL patients will increase to 1.1 million people, the incidence of AF/AFL will increase to 91 thousand patients, and the number of AF/AFL-related deaths and DALYs will surge to 7.2 and 170.8 thousand, respectively. Despite advancements in prevention and treatment, AF/AFL remains a major public health problem in Iran. Given its largely preventable and treatable nature, more cost-effective strategies are required to target modifiable risk factors, especially within susceptible age and sex groups.

Distribution and associated factors of keratometry and corneal astigmatism in an elderly population

To determine the distribution of keratometry and corneal astigmatism (CA) and their association with demographic factors, systemic parameters, anthropometric measures, ocular biometric indices, and refractive errors in people aged 60 years and above. In this cross-sectional study, 160 clusters were randomly selected from Tehran city (Iran) using the multi-stage cluster sampling method. All participants underwent optometric examinations including testing uncorrected and best-corrected distance visual acuity, non-cycloplegic autorefraction, and subjective refraction. Pentacam imaging for all participants was carried out using Pentacam AXL. Keratometry and CA were reported based on Pentacam’s data. The average, standard deviation (SD) and 95% confidence interval (CI) of flat keratometry (Kf), steep keratometry (Ks), mean keratometry (mean K), and CA were 44.02 ± 1.58 D (95% CI 43.94–44.1), 44.86 ± 1.67 D (95% CI 44.78–44.94), 44.44 ± 1.58 D (95% CI 44.36–44.52), and 0.84 ± 0.74 D (95% CI 0.81–0.87), respectively. The 95% and 99% percentiles of mean K were 47.1 and 48.6 D, respectively. According to the multiple generalized estimating equation model, the mean K was significantly higher in males, in myopes, and in those with higher systolic blood pressure. Moreover, the mean K was inversely related to the axial length, height, anterior chamber depth (ACD), corneal diameter, and central corneal thickness (CCT). The prevalence of various types of CA based on a cut-off > 0.50 D was as follows; with-the-rule: 32.5% (95% CI 30.6–34.4), against-the-rule: 18.2% (95% CI 16.7–19.7), and oblique: 10.0% (95% CI 9.1–11.0). The present study investigated the normal distribution of keratometry and CA in individuals ≥ 60 years, and results can be used in clinical matters, especially in intraocular lens power calculation. Sex, systolic blood pressure, height, and some biometric components such as ACD, corneal diameter, and CCT were significantly related to keratometry and should be considered.

Sex Differences in Biochemical Analyses, Cardiometabolic Risk Factors and Their Correlation with CRP in Healthy Mexican Individuals.

Few studies have been undertaken to detect the presence of cardiovascular risk factors (CRFs) in healthy populations (individuals auto-reported as healthy). These risk factors include high body mass index (BMI), high waist-to-hip ratio (WHR), high systolic and diastolic blood pressure (SBP, DBP), high uric acid and high Castelli's risk index (CRI); this last is the ratio of total cholesterol to HDL cholesterol (TC/HDL-c). In addition, the correlations between CRFs and the biomarker C-reactive protein (CRP) has not been explored in each sex. Therefore, this study aimed to determine sex differences in the abnormalities in blood and urine analyses, including CRFs and their correlation with CPR in a non-representative sample of healthy Mexican individuals. A total of 238 subjects were included, 123 (51.7%) of whom were women. The main blood alterations detected were high serum lipids, including high total cholesterol, LDL-cholesterol, triglycerides, and the CRI, which were higher in men than in women. The men's samples had a higher frequency of hypertensives and pre-hypertensives than the women's sample. The CRP showed positive significant correlations with the CRFs: BMI, WHR, SBP, DBP, uric acid, and the CRI, with a higher correlation for BMI and WHR, and most of these correlations were higher in women than in men. Additionally, all these factors showed a positive correlation among them. In conclusion, the main alterations observed in blood are related to cardiovascular risk and were reported with a higher frequency in men when compared with women. This finding can be related to the higher values of WHR in this sex; additionally, the inflammatory marker CRP was more correlated with the cardiometabolic risk factors in women than in men, which suggests a different relationship between inflammation and cardiometabolic risk factors in each sex.

Association of Initial Muscle Fitness with Weight Loss and Metabolically Healthy Status in Children and Adolescents with Obesity: A Retrospective Study.

This retrospective study aimed to investigate the association of initial muscular fitness (MF) with weight loss and metabolic health status in 282 children and adolescents with obesity during 3 to 4 weeks of diet- and exercise-based interventions. Metabolically healthy obesity (MHO) definitions established in 2023 and MF standards based on the 2021 Chinese children's grip strength grading were applied. The proportion of metabolically unhealthy obesity (MUO) was higher in the high MF group than in their low MF counterparts at baseline. After the intervention, neither group transitioned from MUO to MHO due to the high frequency of low HDL-C. High MF females showed a higher percentage of high systolic blood pressure (SBP) than low MF females before and after intervention. High MF males exhibited greater improvements in waist circumference, hip circumference, waist-hip ratio, triglycerides, total cholesterol, and LDL-C than low MF males. The benefits of weight loss and blood lipids obtained by males are more evident than those obtained by females under the same MF level. Thus, attention should be paid to females during weight loss regardless of MF levels. Precision therapy should prioritize the management of blood pressure and avoid excessive reduction in HDL-C levels to sustain metabolic health.

Effect of blood pressure control on the risk of proteinuria during bevacizumab treatment in patients with colorectal cancer: a single-center retrospective cohort study

PurposePre-existing hypertension is reportedly a major risk factor for bevacizumab-induced proteinuria. However, few studies have focused on the effects of blood pressure (BP) control on proteinuria during bevacizumab treatment. We report a retrospective study of the association between poor BP control and the risk of developing proteinuria in patients with colorectal cancer (CRC).MethodsData for CRC patients who received bevacizumab between April 2015 and March 2022 were retrospectively collected. Patients were categorized into two groups based on average systolic blood pressure (SBP) during treatment: normal SBP (< 140 mmHg) and high SBP (≥ 140 mmHg). To evaluate the association between average SBP and grade ≥ 2 proteinuria, we used a 3 month landmark analysis and a Cox regression model.ResultsOf the 279 patients analyzed, 109 had high SBP and 170 had normal SBP. The cumulative incidence of grade ≥ 2 and severe proteinuria was significantly higher in the high compared to the normal SBP group (p < 0.001 and p = 0.028, respectively). Landmark analysis indicated significant differences in proteinuria between patients with and without high average SBP during the first 3 months of treatment (p = 0.002 and p = 0.015, respectively). Multivariate analysis showed that average SBP ≥ 140 mmHg was a significant independent risk factor for proteinuria (p = 0.008).ConclusionLandmark analysis showed that BP status during the first 3 months of bevacizumab treatment influences the risk of subsequent proteinuria. Therefore, timely diagnosis and stricter BP control are recommended for at least the first 3 months to avoid severe proteinuria.

Relationship of Subendocardial Perfusion to Myocardial Injury, Cardiac Structure, and Clinical Outcomes Among Patients With Hypertension.

Coronary microvascular dysfunction has been implicated in the development of hypertensive heart disease and heart failure, with subendocardial ischemia identified as a driver of sustained myocardial injury and fibrosis. We aimed to evaluate the relationships of subendocardial perfusion with cardiac injury, structure, and a composite of major adverse cardiovascular and cerebral events consisting of death, heart failure hospitalization, myocardial infarction, and stroke. Layer-specific blood flow and myocardial flow reserve (MFR; stress/rest myocardial blood flow) were assessed by 13N-ammonia perfusion positron emission tomography in consecutive patients with hypertension without flow-limiting coronary artery disease (summed stress score <3) imaged at Brigham and Women's Hospital (Boston, MA) from 2015 to 2021. In this post hoc observational study, biomarkers, echocardiographic parameters, and longitudinal clinical outcomes were compared by tertiles of subendocardial MFR (MFRsubendo). Among 358 patients, the mean age was 70.6±12.0 years, and 53.4% were male. The median MFRsubendo was 2.57 (interquartile range, 2.08-3.10), and lower MFRsubendo was associated with older age, diabetes, lower renal function, greater coronary calcium burden, and higher systolic blood pressure (P<0.05 for all). In cross-sectional multivariable regression analyses, the lowest tertile of MFRsubendo was associated with myocardial injury and with greater left ventricular wall thickness and volumes compared with the highest tertile. Relative to the highest tertile, low MFRsubendo was independently associated with an increased rate of major adverse cardiovascular and cerebral events (adjusted hazard ratio, 2.99 [95% CI, 1.39-6.44]; P=0.005) and heart failure hospitalization (adjusted hazard ratio, 2.76 [95% CI, 1.04-7.32; P=0.042) over 1.1 (interquartile range, 0.6-2.8) years median follow-up. Among patients with hypertension without flow-limiting coronary artery disease, impaired MFRsubendo was associated with cardiovascular risk factors, elevated cardiac biomarkers, cardiac structure, and clinical events.

Intraoperative Systolic Blood Pressure as a Significant Predictor of Postoperative Hematoma Following Facelift: Single Surgeon Experience of 118 Consecutive Facelifts.

While there exists ample evidence on the impact of perioperative blood pressure on hematoma incidence following facelift; the association of elevated or labile intraoperative blood pressure with postoperative hematoma remains to be explored. The authors evaluate the association of elevated or labile intraoperative systolic blood pressure (SBP) with postoperative hematoma, using the senior author's single surgeon experience of 118 consecutive facelifts. A multivariate logistic regression was conducted using complete demographic, procedure-related, blood pressure-related, and outcomes-related data, with the outcome of interest representing postoperative hematoma. One-way ANOVA and linear regression analyses were used to assess for significant associations between a preoperative history of hypertension and a tendency to demonstrate elevated or labile intraoperative SBP. A Fisher's Exact test was subsequently used to assess for specific intraoperative SBP measurement cut-offs significantly associated with postoperative hematoma, including maximum recorded intraoperative SBP, and specific degree of intraoperative SBP fluctuations. Multivariate logistic regression demonstrated no statistically significant patient- or procedure-related demographic predictors of postoperative hematoma. With aggressive treatment of preoperative hypertension, high preoperative SBP was not found to be a significant predictor of postoperative hematoma following facelift, although this approached statistical significance (p=0.05). In contrast, labile intraoperative SBP (maximum recorded intraoperative SBP - minimum recorded intraoperative SBP; p=0.026), as well as high immediate postoperative SBP (p=0.002), were both independent and statistically significant predictors of postoperative hematoma. Patients with a preoperative history of hypertension, and more specifically those with elevated SBP measurements in the preoperative clinic, were more likely to demonstrate labile (p=0.007) or elevated (p=0.005) intraoperative SBP during facelift surgery. Specifically, maximum recorded intraoperative SBP ≥155mmHg (p=0.045), as well as maximum intraoperative SBP fluctuations ≥80mmHg (p=0.036) were found to be significantly associated with hematoma. A multimodal approach is necessary to control perioperative systolic blood pressure within the strict <120mmHg target demonstrated to significantly decrease hematoma incidence. The senior author's preference is for intraoperative SBP to remain within a strict 90-100mmHg range. In contrast to hypertension that is aggressively treated and successfully controlled, hypertension that is difficult to control intraoperatively, may be a predictor of systolic blood pressure that is difficult to control postoperatively, and thus a significant risk factor for postoperative hematoma following facelift.

Novel Insights into Amlodipine-Induced Gingival Enlargement: A Clinical and Molecular Perspective.

This study aimed to identify risk factors for amlodipine-induced gingival enlargement, assess quality of life, and analyze gingival tissue. This cross-sectional study involved hypertensive patients on amlodipine, divided into groups with and without gingival enlargement. Assessments included sociodemographic data, clinical evaluations, and clinical parameters. Quality of life was assessed using OHIP-14 and WB-HRQoL scales. Gingival tissue samples were analyzed for oxidative status and key molecules using RT-PCR and colorimetric assays. The study included 32 patients with no significant sociodemographic differences between groups (p > 0.05). Patients with gingival enlargement had higher systolic blood pressure (139.63 ± 10.743 vs. 128.38 ± 7.249, p = 0.028) and higher OHIP-14 scores. The RT-PCR analysis showed significant differences in IL-6, TNF-α, IL-33, ST2, TGF-β1, FGF-2, CTGF, VEGF-D, and KGF expression. IL-6, TNF-α, ST2, and FGF-2 expression levels were lower in patients taking amlodipine, with and without gingival enlargement. TGF-β1 and CTGF expression levels were highest in patients with amlodipine-induced gingival enlargement. SOD activity was also highest in these patients, whereas MDA levels were higher in patients with gingival enlargement without amlodipine. Our study highlights the impact of amlodipine-induced gingival enlargement on oral health and quality of life, emphasizing fibrosis and oxidative stress, and suggests the need for integrated healthcare approaches and further research.