Higher Rates Of Hypertension Research Articles

Fecal microbiota transplantation attenuates hypertension in a female mouse model of systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a prototypic multisystem autoimmune disorder that disproportionately affects women. SLE is characterized by a breach of immunological self-tolerance and the expansion of autoreactive T and B lymphocytes, leading to the production of autoantibodies. Autoantibody production leads to downstream chronic inflammation resulting in high rates of hypertension, renal injury, and cardiovascular disease. Alterations in the gut microbiota, or gut dysbiosis, is associated with many autoimmune diseases, including SLE. In the present study, we hypothesized that gut dysbiosis in SLE may play a role in the development of immune system dysfunction and hypertension in an experimental model of SLE, and that fecal microbiota transplantation (FMT) with microbes from control mice may improve these parameters. To test this hypothesis, we treated 26-week-old female control (NZW, n=19) and SLE (NZBWF1, n=19) mice with broad spectrum antibiotics (0.4 g/L ampicillin, 0.4 g/L neomycin sulfate, 0.4 g/L metronidazole, and 0.2 g/L vancomycin) in drinking water for one week to deplete the existing microbiota. Subsequently, mice were given 0.1 mL of fecal microbes via oral gavage two times per week for four weeks in the following groups (n=9-10 mice/group): Control-vehicle, Control-SLE microbes, SLE-vehicle, SLE-Control microbes. Changes in the gut microbiome before and after FMT were assessed by 16S rRNA analysis of the microbiome. Mean arterial pressure (MAP, mmHg), measured in conscious mice by carotid artery catheter was higher in SLE mice that received SLE microbes (Control: 112±3 vs. SLE: 140 ±2 mmHg, p<0.0001). SLE mice that received FMT with control microbes had lower blood pressure (SLE-Control microbes: 126±4 mmHg, p=0.03). Renal injury, as assessed by urinary albumin excretion at the conclusion of the study, was not significantly different among the groups (p=0.3523). Circulating autoantibodies and immunoglobulins were also measured at the conclusion of the study. Anti-dsDNA IgG was elevated in SLE mice compared to control (Control: 149±38 vs. SLE: 527±114 kU/mL, p=0.02), and were significantly lower in SLE mice treated with control microbes (SLE-Control microbes: 126±4 mmHg, p=0.03). Circulating IgM was also elevated in SLE mice (Control: 0.053±0.008 vs. SLE: 0.32±0.04 mg/mL, p<0.0001), and FMT lowered IgM in SLE mice that received FMT (0.19±0.03 mg/mL, p=0.0069). These data suggest that gut microbiota present in NZBWF1 mice contribute to both autoantibody production and the development of hypertension, and that interventions to alter the microbiora could have a beneficial impact on disease activity in SLE patients. NIH NIGMS P20GM104357 to UMMC Department of Physiology and Biophysics, NIH NHLBI R00HL146888 to Erin Taylor This is the full abstract presented at the American Physiology Summit 2023 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.

The role of laparoscopic adrenalectomy in the treatment of large pheochromocytomas (>6cm): A meta-analysis and systematic review.

The effectiveness and safety of laparoscopic adrenalectomy (LA) under different routes for the treatment of large pheochromocytomas (PCC) is unknown. This meta-analysis and systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines. Three databases were systematically searched, including Medline, PubMed, and Web of Science. The time frame of the search was set from the creation of the database to October 2022. Perioperative outcomes were divided into two groups according to tumor size: SMALL group (≤6cm in diameter), LARGE group (>6cm in diameter). Eight studies including 600 patients were included. In the LA group, complications was comparable in both groups (SMALL group and LARGE group), and the LARGE group had longer operative time [OT WMD=32.55, 95% CI (11.17, 53.92), P<0.01], length of stay [LOS WMD=0.82, 95% CI (0.19, 1.44), P<0.05], more estimated blood loss [EBL WMD=85.26, 95% CI (20.71, 149.82), P<0.05], hypertension [OR=3.99, 95% CI (1.84, 8.65), P<0.01], hypotension [OR=1.84, 95% CI (1.11, 3.05), P<0.05], and conversion [OR=5.60, 95% CI (1.56, 20.13), P<0.01]. In the transabdominal laparoscopic adrenalectomy (TLA) group, OT, LOS, EBL, complications, hypertension and hypotension were the same in both groups. In the retroperitoneal laparoscopic adrenalectomy (RLA) group, complications and hypotension were the same in both groups, while the LARGE group had longer OT [WMD=52.07, 95% CI (26.95, 77.20), P<0.01], LOS [WMD=0.51, 95% CI (0.00, 1.01), P<0.05], more EBL [WMD=92.99, 95% CI (27.70, 158.28), P<0.01] and higher rates of hypertension [OR=6.03, 95% CI (1.95, 18.61), P<0.01]. LA remains a safe and effective approach for large PCC. TLA is superior to RLA.

Culturally-tailored cookbook for promoting positive dietary change among hypertensive Filipino Americans: a pilot study.

Among all Asian American subgroups, Filipino-Americans have consistently been shown to have the highest rates of hypertension, raising risks of heart attack and stroke. Despite this alarming fact, little has been done to investigate culturally-sensitive interventions to control hypertension rates in this vulnerable population. To address the lack of culturally-relevant lifestyle options for blood pressure management currently available to the Filipino community, this exploratory pilot study used a design thinking approach informed by culinary medicine to develop a culturally-tailored, heart-healthy, and low sodium recipe cookbook for Filipino Americans with hypertension and evaluate its feasibility as a hypertension intervention. Our team developed a cookbook using participatory methods and design thinking, utilizing input from five Filipino culinary experts and a Registered Dietitian. The cookbook incorporates traditional Filipino recipes, excerpts from community members' interviews, and nutrient analyses. Twenty Filipinx-identifying individuals* who self-reported physician-diagnosed hypertension were recruited from Filipino community-based organizations, enrolled into this study, provided with the cookbook, and asked to cook at least one recipe. Pre- and post-intervention surveys were conducted and centered around behavior change and features of the cookbook. This study provided evidence for the cookbook's acceptability and feasibility, with participants' open-ended responses revealing that the recipes, nutrition labels, illustrations, and cultural aspects of the cookbook increased motivation to achieve dietary change, including reducing sodium in their diet to improve their blood pressure. Participant responses also indicated positive behavior change as a result of using the cookbook, with participants reporting increased likelihood of adopting recommended actions to lower their BP after utilizing the cookbook ( = 80.83%), compared to before ( = 63.75%, p < 0.008), according to Hypertension Self-Care Management scaled scores. In conclusion, the results of this pilot study demonstrated acceptability of this unique cookbook and provide preliminary findings consistent with increased motivation in participants to make dietary changes and improve personal health, drawing attention to the importance of considering future culturally-tailored health interventions. Next steps should include a robust, randomized controlled trial design comparing measured blood pressure outcomes of an intervention vs. control group. *Filipinx is an inclusive term representing the gender identities of all participants in our study.

Retrospective analysis of SGLT2 inhibitors in heart failure with preserved ejection fraction.

Heart failure (HF) is one of the leading causes of cardiovascular morbidity and mortality. HF with preserved ejection fraction (HFpEF), or diastolic failure, accounts for half of all HF cases and differs from HF with reduced ejection fraction (HFrEF). Patients with HFpEF are typically older, female, and commonly seen with chronic kidney disease (CKD), one of the leading independent risk factors for mortality in these patients. Unfortunately, drugs that had shown significant improvements in mortality in HFrEF have not shown similar benefits in HFpEF. Recently, sodium glucose transporter 2 inhibitors (SGLT2i) have been shown to reduce cardiovascular morbidity and mortality in HFrEF patients and slow down CKD progression. This study aimed to elucidate the impact of this drug class on mortality and risk of end stage renal disease in patients with HFpEF, which is currently unclear. We retrospectively analysed the Research Data Warehouse containing electronic health records from de-identified patients (n=1266290) from the University of Mississippi Medical Center from 2013 to 2022. HFpEF patients had an average follow-up of 4±2years. Factors associated with increased all-cause mortality during HFpEF included age, male sex, and CKD. Interestingly, the only treatments associated with significant improvements in survival were angiotensin converting enzyme inhibitors/angiotensin receptor blockers and SGLT2i, regardless of CKD or diabetes status. Additionally, SGLT2i use was also associated with significant decrease in the risk of end stage renal disease. Our results support the use of SGLT2i in an HFpEF population with relatively high rates of hypertension, CKD, and black race and suggests that improvements in mortality may be through preserving kidney function.

Noncommunicable Disease Conditions and HIV in Rural and Urban South Africa: 2005-2015.

Hypertension, obesity, hyperlipidemia, and type 2 diabetes contribute primarily to noncommunicable disease deaths and together with human immunodeficiency virus contribute largely to mortality in South Africa. Our longitudinal study provides the necessary data and insights over a 10-year period to highlight the areas where improved management is required in urban and rural localities. This study included 536 rural and 387 urban Black participants aged 32 to 93 years from the North-West province, South Africa. Disease prevalence, treatment, and control were determined in 2005 and were re-evaluated in 2015. Multiple measures analyses were used to determine the trends of blood pressure and waist circumference. The initial prevalence of hypertension was 53.2%, obesity was 23.6%, hyperlipidemia was 5.1%, diabetes was 2.9%, and human immunodeficiency virus was 10.7% in 2005. By 2015, the rural population had higher rates of hypertension (63.7% versus 58.5%) and lower rates diabetes (4.3% versus 7.9%) and hyperlipidemia (6.6% versus 18.0%) with similar obesity rates (41.7% versus 42.4%). The average blood pressure levels of urban hypertensives decreased (Ptrend<.001), whereas levels were maintained in the rural group (Ptrend=.52). In both locations, treatment and control rates increased from 2005 to 2015 for all conditions (all ≥6.7%), except for diabetes in which a decrease in control was observed. Waist circumference increased (Ptrend>.001) in both sex and locality groups over the 10-year period. Although average blood pressure of urban hypertensive individuals decreased, urgent measures focused on early identification, treatment, and control of the respective conditions should be implemented to decrease the burden of noncommunicable diseases.

A Prospective Observational Study Examining the Real-World Clinical and Treatment Outcomes of Parkinson’s Disease Psychosis in the United States

AbstractIntroductionPsychosis is a common feature of Parkinson’s Disease (PD), affecting approximately 50% of PD patients during their disease course. The INSYTE study was the first prospective, real-world, observational study examining the outcomes of both treated and untreated patients with PD Psychosis (PDP).MethodsPDP patients were enrolled from 76 US academic centers and community sites from 03/21/2017 to 03/08/2021. Patients were included in the final analytical cohort if they had a baseline visit and at least 1 follow-up visit within 3 years; due to the variability of follow-up for each patient within the 3-year period, all study outcomes were assessed in patients with at least one baseline and two follow-up visits within 1 year. No specific visit schedule was imposed; all interactions were established by the investigators. Questionnaires were completed at follow-up visits and assessments focused on PDP treatment utilization, treatment patterns, clinical outcomes, caregiver burden, quality of life, and resource utilization.Results760 patients were initially enrolled; 635 patients (84%) were included in the final study group, and 441 patients (69%) were included in the analysis. 281 patients (64%) had no antipsychotic treatment at enrollment (untreated group) vs 160 (36%) who had received an antipsychotic at enrollment (treated group). At enrollment, patients in the untreated vs treated group, respectively, had a mean PD duration of 8.05 vs 10.23 years, mean duration of PDP features of 2.20 vs 3.10 yrs, and had a PDP diagnosis for a mean of 1.42 vs 2.16 yrs. Most patients in the untreated group (n=221, 77%) received no antipsychotics through follow-up. The groups were balanced in terms of age (mean 73.9 vs 73.4 yrs) and sex (65.1% vs 63.1% male). The untreated group had higher rates of hypertension (44.5% vs 36.8%) and diabetes (12.8% vs 8.8%); however, the treated group had higher rates of depression (25.6% vs 41.3%) and anxiety (22.8% vs 26.9%). The percent change from baseline at 12 months in total psychosis, hallucination, and delusion scores for the untreated group showed greater worsening than the treated group: 32.3% vs 29.3%; 29.3 % vs 25.0%; and 29.3 % vs 25.0%, respectively, as did daytime sleepiness scores (51.6% vs 40.8%). Measures of PD severity (non-motor and motor MDS-UPDRS scores) and health-related quality of life showed less worsening for the untreated group vs treated group at 12 months. Caregiver burden (per the ZBI) was lower in the untreated group vs the treated group (81.5% vs 90.0%).ConclusionsIn this descriptive analysis, untreated patients had shorter duration of PD, fewer PDP symptoms at baseline, and lower rates of mental health comorbidities vs treated patients. The untreated PDP patients had greater worsening in their psychosis and sleepiness scores at 12 months versus the treated group, yet remained untreated. Future studies are needed to better understand clinicians’ rationale for withholding PDP treatment.FundingAcadia Pharmaceuticals, Inc

The incremental significance of heart rate recovery as a predictor during exercise-stress myocardial perfusion SPECT imaging in individuals with suspected coronary artery disease.

Major adverse cardiac events (MACE) are more likely to occur when abnormal heart rate recovery (HRR). This study aimed to assess the incremental predictive significance of HRR over exercise stress myocardial perfusion single-photon emission computed tomography (MPS) results for MACE in individuals with suspected coronary artery disease (CAD). Between January 2014 and December 2017, we continually gathered data on 595 patients with suspected CAD who received cycling exercise stress MPS. HRR at 1, 2, 3, and 4 min were used as study variables to obtain the optimal cut-off values of HRR for MACE. The difference between the peak heart rate achieved during exercise and the heart rate at 1, 2, 3, and 4 min was used to calculate the HRR, as shown in HRR3. Heart rate variations between two locations in time, such as HRR2 min-1 min, were used to establish the slope of HRR. All patients were followed for a minimum of 4 years, with MACE as the follow-up goal. The associations between HRR and MACE were assessed using Cox proportional hazards analyses. Patients with MACE were older (P = 0.001), and they also had higher rates of hypertension, dyslipidemia, diabetes, abnormal MPS findings (SSS ≥ 5%), medication history (all P < 0.001), and lower HRR values (all P < 0.01). Patients with and without MACE did not significantly vary in their HRR4 min-3 min. The optimal cut-off of HRR1, 2, and 3 combined with SSS can stratify the risk of MACE in people with suspected CAD (all P < 0.001). HRR 1, 2, and 3 and its slope were linked to MACE in multivariate analysis, where HRR3 was the most significant risk predictor. With a global X2 increase from 101 to 126 (P < 0.0001), HRR3 demonstrated the greatest improvement in the model's predictive capacity, incorporating clinical data and MPS outcomes. HRR at 3 min has a more excellent incremental prognostic value for predicting MACE in patients with suspected CAD following cycling exercise stress MPS. Therefore, incorporating HRR at 3 min into known predictive models may further improve the risk stratification of the patients.

Association between obstructive sleep apnea and 24-h urine chemistry risk factors for urinary stone disease

The effect of obstructive sleep apnea (OSA) on 24-h urine parameters and resultant kidney stone risk is unknown. We sought to compare urinary lithogenic risk factors among patients with kidney stone disease with and without OSA. We performed a retrospective cohort study of adult patients with nephrolithiasis undergoing both polysomnography and 24-h urine analysis. Measures of acid load including gastrointestinal alkali absorption, urinary titratable acid, and net acid excretion were calculated from 24-h urine. We performed univariable comparisons of 24-h urine parameters between those with and without OSA and fit a multivariable linear regression model adjusting for age, sex, and BMI. Overall, there were 127 patients who underwent both polysomnography and a 24-h urine analysis from 2006 to 2018. There were 109 (86%) patients with OSA and 18 (14%) without. Patients with OSA were more commonly male, had greater BMI and had higher rates of hypertension. Patients with OSA had significantly higher levels of 24-h urinary oxalate, uric acid, sodium, potassium, phosphorous, chloride, and sulfate; higher supersaturation of uric acid; higher titratable acid, and net acid excretion; and lower urinary pH and supersaturation of calcium phosphate (p < 0.05). The difference in urinary pH and titratable acid, but not net acid excretion, remained significant when adjusting for BMI, age, and gender (both p = 0.02). OSA is associated with changes in urinary analytes that promote kidney stone formation, similar to those observed with obesity. After accounting for BMI, OSA is independently associated with lower urine pH and increased urinary titratable acid.

Abstract P378: Design of the Equity in Prevention and Progression of Hypertension by Addressing Barriers to Nutrition and Physical Activity (EPIPHANY) Study: A Cluster Randomized Trial

Introduction: High rates of hypertension and poverty in the rural South contribute to health disparities with Black adults experiencing higher rates of cardiovascular disease than White adults. Clinical trials have shown that lifestyle interventions like the Dietary Approaches to Stop Hypertension diet and increasing physical activity reduce the risk for hypertension. However, suboptimal implementation indicates a need to identify mechanisms of prevention in rural populations impacted by negative social determinants of health that can make achieving healthy lifestyle behaviors more challenging. Methods and Results: The EPIPHANY (Equity in Prevention and Progression of Hypertension by Addressing barriers to Nutrition and Physical activitY) Study is a cluster randomized controlled trial testing a multilevel intervention designed to reduce community and individual barriers to a healthy lifestyle to lower blood pressure (BP) among rural, Black adults. EPIPHANY is enrolling and randomizing 20 churches in the Black Belt region of Alabama. Health education fairs offered to all churches are being used to screen and enroll Black adults with elevated BP or stage 1 hypertension (120-139 mm Hg and diastolic BP &lt;90 mm Hg) who are not recommended for antihypertensive medication, according to the 2017 American College of Cardiology/ American Heart Association BP guideline. Participants (n=240) in churches randomized to the control condition are offered access to online resources including cooking demonstrations and exercise classes. Participants (n=240) in churches randomized to the intervention are receiving access to online resources; telephone-based peer support for lifestyle modification, goal setting and problem solving; funding for churches to develop programs to address food access and/or barriers to physical activity; and training of church members to serve as peer health advocates to deliver training for church members on lifestyle modification. We will employ a Type 1 Hybrid Implementation-effectiveness design to assess the effectiveness and implementation of this multi-level intervention, using the RE-AIM framework. BP, social determinants of health, psychosocial factors, physical activity and diet are being assessed. The EPIPHANY trial began recruitment in August 2022 and has enrolled 18 and 25 Black adults in the first two churches randomized to the control and intervention conditions, respectively, and recruited four churches for the next wave of screenings. Conclusion: The EPIPHANY study is designed to prevent hypertension among rural, Black adults by addressing structural and individual barriers to lifestyle modification through peer support. The study could provide evidence for a feasible, scalable and sustainable approach to preventing hypertension in rural, underserved communities.

Faktor Risiko Hipertensi Pada Masyarakat Usia Dewasa &amp; Lansia Di Tambaksari Surabaya

Background: Surabaya city has a high rate of hypertension, one of the region which has highest incidents of hypertension is Rangkah, Tambaksari. The number of hypertension incidents in Tambaksari placed 5th ranks of region which has largest hypertension incidents.&#x0D; Aims: The aim of this study is to analyze the risk factors for hypertension in Rangkah Village, Tambaksari District, Surabaya City&#x0D; Methods: Discriptive analytical research using cross sectional approach. The sample in this study were 44 respondents.&#x0D; Results: The majority of respondents who were at high risk of hypertension are women (60%), pre-adult age group (46%), have primary school education (36.2%), have jobs in the private sector (46%) with the majority of income &gt; IDR. 2,000,000,- . There were significant relationship between nutritional status (p-value= 0.000; OR=3.097), physical activities (p-value= 0.031, OR=1.582), large coffee consumption (p-value= 0.037, OR=1.537), and stress (p-value = 0.031, OR = 1.582) with the risk of hypertension in the Rangkah area, Tambaksari, Surabaya City.&#x0D; Conclusion: There were significant relationship between nutritional status, physical activities, heavy coffee consumption and stress with the risk of hypertension in the Rangkah area, Tambaksari, Surabaya City.

Impact of COVID 19 Pandemic on Stroke Rate, Risk Factors, Clinical Presentation and outcome, in Hadramout, Republic of Yemen

Background and Objective: The COVID-19 pandemic affected medical care systems including stroke care, globally. In this study, we investigated the impact of the COVID-19 outbreak on stroke care in Hadramout, in terms of rate of admission, access to care, risk factors, clinical presentation, and outcome. Materials and Methods: A hospital-based cross-sectional study comparing all stroke patients admitted to Ibn-seena University Hospital (ISTH), Mukalla, Hadramout, during two periods, May 1–October 31, 2020, during the pandemic of COVID-19 (COVID-19 group), and from May 1 to October 31, 2019 (pre-COVID-19 group). Data collected from patients’ medical record files into a master sheet, and were processed by the Statistical Package for Social Sciences software. Results: There were 117 stroke patients admitted in COVID-19 pandemic in 2020, and 213 patients admitted in the same period in 2019. Stroke admission declined by 45.1% (Odds Ratio [OR]=0.30, 95% confidence interval [CI] [95% CI]: 0.22–0.42, p&lt;0.0001) with no age and sex differences. Hypertension (HTN) and diabetes mellitus were more frequent in COVID-19 group than the pre-COVID-19 group (OR=1.74, 95% CI: 1.08–2.80, p=0.02) and (OR=1.81, 95% CI: 1.14–2, 88, p=0.01), respectively. No significant difference in other risk factors was found. Patients in COVID-19 group arrived the hospital more late than the patients in pre-COVID-19 group (OR=2.63, 95% CI: 1.64–4.21, p&lt;0.0001). Dysphasia and altered consciousness including coma were more common in COVID-19 group compared with pre-COVID-19 group (OR=4.5, 95% CI: 2.18–9.08, p&lt;0.0001) and (OR=3.2, 95% CI: 2.00–5.12, p&lt;0.0001), respectively. Hospital stay was greatly reduced among COVID-19 group as compared with pre-COVID-19 group (02.9±0.31 days vs. 8.6±0.92 days, p&lt;0.0001) Mortality rate was higher among COVID-19 group than the pre-COVID-19 group (41.9% vs. 27.2%, p=007). Conclusion: The number of stroke patients admitted during the COVID-19 pandemic decreased, they arrived late and spent shorter hospital stays while having higher rates of HTN, diabetes, and impaired consciousness with a high mortality rate.Key words: Cerebrovascular accident, COVID-19, Hadramout, Stroke, Yemen

Abstract WP187: Takotsubo Cardiomyopathy And Subsequent Risk Of Major Adverse Cardiovascular Events: A Cluster Analysis

Introduction: Takotsubo Cardiomyopathy (TCM) is a form of transient regional left ventricular dysfunction. The risk of MACE after TCM is poorly understood but appears to be higher. Predictors of cardiovascular (CV) events remain unclear. Methods: Retrospective study of patients admitted to London Health Sciences Centre hospitals with TCM between 2014 and 2021. Clinical data were collected. MACE during follow-up (FU) included stroke, acute coronary syndrome, admission for heart failure or CV death. Outcomes were assessed until the end of FU. A two-step cluster analysis was used to stratify patients' phenotypes. Variables for clustering included: TCM aetiology, age, sex, hypertension, dyslipidemia, smoking, previous stroke, diabetes, chronic kidney disease, ejection fraction, atrial fibrillation (AF), and antithrombotics. A Cox proportional-hazards model was used to determine the association between clusters and MACE. Results: We included 152 patients (88.8% females). Median age was 72.5 [65.5-80.0] years and aetiologies were emotional stress (31.6%), neurogenic (6.6%), acute medical conditions (23.7%), and unknown (38.2%). Overall, 80% received antithrombotic drugs post-TCM. At a median FU of 22.0 [8.2-44.5] months, 11.8% of the patients experienced a MACE. Cluster 1 (n=41) included more male patients (31.7%), and the highest rate of hypertension (100%), dyslipidemia (92.7%), smoking (31.7%), previous stroke (14.6%), and antiplatelet use (82.9%). Cluster 2 (n=21) included older patients (78 [73.5-84.5] years) with the highest prevalence of diabetes (23.8%), AF (95.2%) and anticoagulation (71.4%). Cluster 3 (n=90) included younger patients (69 [62.7-84.0] years) with the lowest burden of CV risk factors (CHA 2 DS 2 VASc 2.0 [1.0-2.2]) and antithrombotic therapy (68.9%). Cluster 1 was associated with increased risk of MACE (OR 2.9; 95%CI 1.1-7.3; p=0.02) and stroke (OR 4.9; 95%CI 1.1-20.6; p=0.02). Conclusion: CV events are relatively frequent after a diagnosis of TCM, affecting over one-tenth of patients. We identified a high-risk phenotype, predominantly characterized by male sex, a higher burden of CV comorbidities, and low anticoagulation rates, which was associated with an increased risk of MACE and stroke after TCM.

Abstract 142: Higher Risk Of Stroke Recurrence In Elderly With Prediabetes: A Nationwide Analysis Of Over 200,000 Hospitalizations From 2016 To 2019

Background: Prediabetes (preDM) is known to double the risk of strokes and also predicts poor functional outcomes. With rising prevalence of preDM among the elderly population in the US, this study aimed to analyze the risk and trends in secondary stroke in elderly with preDM. Methods: We queried the National Inpatient Sample (2016-2019) to identify secondary stroke (with prior stroke/transient ischemic attack, TIA) hospitalizations in elderly population (≥65 years) with vs. without preDM by using ICD-10 codes after excluding patients with diabetes mellitus. Trends and risk of recurrent stroke events, demographics, comorbidities, and outcomes were compared between two cohorts (preDM+ vs. preDM-). Results: Overall prevalence of secondary stroke in geriatric preDM population for 2016-2019 was 2.01% (4045/201120, 50.8% female, 68.4% white) with preDM+ cohort often consisting of younger (median 77 vs 81yrs), male vs females (49.2% vs 44.8%), blacks (14.7% vs 10.7%), Hispanics (8.9% vs 5.4%), Asian/Pacific Islanders (7.2% vs 2.6%) (p&lt;0.001). There were declining trends in recurrent any/ischemic strokes among overall/preDM- cohort but nondeclining in preDM+ cohort Table 1a . The preDM+ cohort often had higher rates of hypertension, hyperlipidemia, obstructive sleep apnea, obesity and peripheral vascular disease. Multivariate analysis adjusted for confounders showed higher odds of any stroke (aOR:1.74, 95%CI:1.58-1.92) and ischemic strokes (aOR:1.83, 95%CI:1.64-2.03) (p&lt;0.001) in preDM+ cohort vs. preDM- cohort [Table 1b] with prior history of stroke/TIA. The rates of transfer to short term hospitals and home health care requirements were higher among preDM+ cohort (3.2% vs. 2.9% &amp; 18.7% vs. 17%). Conclusion: The study shows an increased risk of recurrent/secondary strokes (mainly ischemic) among elderly patients with preDM. Findings emphasize the need for strategies to achieve tighter glycemic control to mitigate risk of future cerebrovascular events.

Sex differences and risk factors in recurrent ischemic stroke.

Recurrent ischemic stroke (RIS) is associated with increased mortality and poor outcomes. Therefore, secondary prevention is critical for reducing the risk of recurrent stroke. Previous studies have found sex differences in risk factors in patients with first-ever stroke; however, the results have been inconsistent for recurrent stroke. Therefore, this study aimed to investigate whether there are significant sex differences in the clinical characteristics and risk factors for recurrent ischemic stroke. We retrospectively studied 787 patients with recurrent ischemic stroke after first-ever stroke confirmation using magnetic resonance imaging (MRI) after visiting a regional tertiary hospital between 2014 and 2020. Demographic characteristics, laboratory findings, and risk factors were compared between the male and female patients. In addition, multivariate logistic regression was performed to identify the independent factors associated with stroke recurrence in male patients. Among the 787 patients, 466 (59.2%) were males. Males were younger than females (67.6 vs. 71.9 years). Females had higher rates of hypertension, diabetes mellitus, dyslipidemia, and overweight than those of males. However, the alcohol drinking and smoking rate were significantly higher in males than that in females. There were no statistically significant sex-based differences in the laboratory findings. Among males, hypertension, alcohol drinking, smoking and dyslipidemia was a significant risk factor for ischemic stroke recurrence. Hypertension and dyslipidemia were significant risk factors of recurrent ischemic stroke in both genders. Smoking and alcohol drinking were significant risk factors associated with ischemic stroke recurrence in males. Therefore, smoking cessation and alcohol abstinence are recommended after the first stroke to prevent recurrent ischemic stroke especially for males. Diabetes was a significant risk factor of ischemic stroke recurrence in females. More extensive studies are needed to understand the causal relationship of each factors with ischemic stroke recurrence according to sex differences and specification of preventive management is needed.

Epidemiology of obesity and high blood pressure among school-age children from military families: the largest report from our region

BackgroundFor the first time, we aimed to determine the epidemiology and associated factors of obesity and hypertension among children of military families in our region.MethodsIn this multi-centered study, children between the ages of 5 to 12 years old, entered the study. Data on baseline and clinical characteristics, history of disease and anthropometric measurements, were collected.ResultsAmong 504 children, 44.2% were males. Mean (SD) age of participants was 7.9 ± 1.9 years. Overall, 5% were obese and 9.9% were overweight. In total, 16.3% had elevated BP, 12.5% had stage one and 0.2% had stage two hypertension.Age (beta = 0.306, OR = 1.35, 95% CI:1.14—1.61), obesity/overweight (OR = 5.58, 95% CI:2.59—12.0), history of hypertension in mother (OR = 43.24, 95% CI:5.99—312.11), low birth weight (OR = 7.96, 95% CI:2.59—12.0), physical activity (OR = 0.27, 95% CI:0.10—0.72), and consumption of fast food more than once a week (OR = 3.36, 95% CI:1.82—6.19), were associated with risk of hypertension.Furthermore, age (beta = 0.346, OR = 1.41, 95% CI:1.21—1.64), history of childhood obesity in the father (OR = 3.78, 95% CI: 1.77—8.06) and mother (OR = 2.44, 95% CI:1.07—5.56), and physical activity (OR = 0.27, 95% CI:0.11—0.66), were associated with obesity.ConclusionAge, obesity/overweight, history of hypertension in the mother, birth weight, physical activity, and consumption of fast food, were associated with risk of hypertension. Moreover, age, history of childhood obesity in parents, and physical activity, were associated with obesity.Furthermore, we found that school-age children in military families have higher rates of hypertension and overweight compared to other reports from our region.

Assessment of prescribing patterns and medication errors related to prescriptions in hospitalized diabetes mellitus type-2 patients in Khyber Pakhtunkhwa, Pakistan

AbstractObjectivesDiabetes mellitus (DM type-2) is a common, non-transmittable disease that affects people all over the world. Polypharmacy and inappropriate prescribing are more common in diabetic individuals. One of the most critical and fundamental abilities a doctor requires is the ability to write prescriptions. In emerging countries like Pakistan, irrational drug prescribing is a major healthcare issue. This study aims to investigate the prescriptions errors in patients with DM type-2 prescriptions admitted in medical wards and outpatients’ visits departments at Khyber teaching hospital.MethodsIn the Khyber Teaching Hospital in Peshawar, a prospective study was done to determine medicine prescribing patterns and identify prescription errors in hospitalized patients with DM type-2. Over the course of two months, 86 patients’ prescriptions were collected from the hospital’s medical ward. The pattern of prescriptions was investigated using WHO-recommended indicators, and prescription mistakes were identified. DM type-2 was shown to be substantially more common in females than in males in this clinical investigation. For the data analysis, various statistical methods were used and data were visualized.Key findingsDM type-2 was more common in adults above the age of 65, according to age groups (51–60). It was revealed that the average number of medications per prescription was 8.37%. In this study, we discovered that patients with DM type-2 had higher rates of hypertension than those with other disorders. The percentage of prescriptions with generic names was 3.61%, antibiotics were 15.69%, and injectables were 47.22% of the total 720 medications prescribed. The dose strength was absent in 18.75% of the 720 medications, and 6.25% of the pharmaceuticals had an incorrect dosage form.ConclusionTo promote reasonable drug therapy, the prescription pattern and prescription errors have highlighted the necessity to build an accurate system of documenting and analysing therapy before issuing a prescription.

Outcomes of Patients With Atrial Fibrillation Following Thrombectomy for Stroke

Patients with atrial fibrillation (AF) treated with mechanical thrombectomy (MT) for acute ischemic stroke (AIS) have been reported to experience worse outcomes compared with patients without AF. To assess differences between patients with AF and their counterparts without AF treated with MT for AIS, focusing on safety outcomes, clinical outcomes, and baseline characteristics in both groups. A systematic literature review of the English language literature from inception to July 14, 2022, was conducted using Web of Science, Embase, Scopus, and PubMed databases. Studies that focused on patients with and without AF treated with MT for AIS were included. Multiple reviewers screened studies to identify studies included in analysis. Data were extracted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline to ensure accuracy. Data were pooled using a random-effects model. The primary outcome of interest was rate of modified Rankin Scale (mRS) scores of 0 to 2 at 90 days. Secondary outcomes of interest included rates of successful reperfusion, defined as thrombolysis in cerebral infarction (TICI) scores of 2b to 3, 90-day mortality, symptomatic intracranial hemorrhage (SICH), and baseline patient characteristics. Of 1696 initially retrieved studies, 10 studies were included, with 6543 patients. Patients with AF were a mean of 10.17 (95% CI, 8.11-12.23) years older (P < .001) and had higher rates of hypertension (OR, 1.89 [95% CI, 1.57-2.27]; P < .001) and diabetes (OR, 1.16 [95% CI, 1.02-1.31]; P = .02). Overall, there were comparable rates of mRS scores of 0 to 2 between patients with AF and patients without AF (odds ratio [OR], 0.72 [95% CI, 0.47-1.10]; P = .13), with significant heterogeneity among the included studies. After sensitivity analysis, the rate of mRS scores of 0 to 2 was significantly lower among patients with AF (OR, 0.65 [95% CI, 0.52-0.81]; P < .001). Successful reperfusion rates were similar between the groups (OR, 1.11 [95% CI, 0.78-1.58]; P = .57). The rate of SICH was similar between groups (OR, 1.05 [95% CI, 0.84-1.31]; P = .68). Mortality was significantly higher in the AF group (OR, 1.47 [95% CI, 1.12-1.92]; P = .005). In this systematic review and meta-analysis, patients with AF experienced worse 90-day outcomes, even in the setting of similar rates of successful reperfusion. This was likely associated with greater age and greater rates of comorbidities among patients with AF.

The impact of COVID-19 variant 501Y.V2 on maternal and perinatal mortality among pregnant South African women

Background/Aims The COVID-19 variant SARS COV 501Y.V2 was responsible for the second wave of COVID-19 in South Africa from October 2020 to March 2021. There are no studies that report on maternal mortality from this variant globally. This study's aim was to determine the impact of the variant on maternal deaths in the Ekurhuleni health district, South Africa. Methods A retrospective record review of all maternal deaths in COVID-19 positive cases in the Ekurhuleni health district from October 2020 to March 2021 was conducted. Demographic details, comorbidities and obstetric data were assessed. Results A total of 11 women who tested positive for COVID-19 died. In these cases, there were high rates of hypertension (67%), stillbirth (50%) and preterm caesarean section (67%). Laboratory abnormalities, including anaemia (64%) and high levels of lactic dehydrogenase (100%), aspartate transaminase (67%) and D-dimer (80%), were observed. Conclusions This study adds to the growing global knowledge of COVID-19 infections. Routine COVID-19 testing of all comorbid pregnant women at each antenatal visit is recommended. All pregnant women should be counselled to follow strict COVID-19 prevention protocols.

Incidence and Features of Acute Ischemic Stroke in Patients Hospitalized with COVID-19: A Multi-center Study in Turkey.

Acute ischemic stroke (AIS) is a devastating complication of COVID-19 with high morbidity and mortality. In this study, we reported the frequency, characteristics, and outcome of AIS in patients with COVID-19. This multicenter and cross-sectional study was conducted between April 2020 and February 2021. Among the hospitalized patients with COVID-19, the detailed characteristics of those with and without AIS were recorded and compared. Six hundred ninety-three patients were included in the study. Acute ischemic stroke was detected in 16 (2.31%) patients, the median age was 77 (range, 48-91) years, and 10 (62.5%) were female. The median NIHSS score at admission was 9 (range, 3-17). Total anterior circulation infarction (TACI) was the most common (37.5%) type and cardioembolism was the most common etiology (37.5%). Nine patients (56.25%) developed AIS within 24 hours of having COVID-19. COVID-19 severity was severe or critical in seven patients (43.75%). Eight patients died, and eight were discharged. Patients with AIS had a higher rate of hypertension, coronary artery disease, heart failure, a history of myocardial infarction, a history of cerebrovascular disease, severe and critical COVID-19, a higher mean age, and a longer ICU stay compared with those without AIS (p<0.001 for each). AIS can occur in patients with COVID-19 and is associated with mortality. Acute ischemic stroke is encountered at any stage of COVID-19, especially within the first 72 hours of the diagnosis, in older patients with comorbidities and severe COVID-19. There is an increased risk of AIS in patients with COVID-19 with a history of stroke.

PS-C03-5: REAL-WORLD DATA OF BLOOD PRESSURE IN DIALYSIS PATIENTS WITH AND WITHOUT DIABETES IN JAPAN USING THE WEB-BASED DATABASE

Objective: Diabetic nephropathy was the most common primary disease among patients undergoing dialysis, and the number is growing each year. Despite advancements in dialysis technique, cardiovascular complications and mortality in dialysis patients with diabetes remain higher than in those without diabetes. Furthermore, hypertension is commonly known to contribute to the development of cardiovascular complications in dialysis patients, and we aimed to compare the systolic blood pressure (SBP) in dialysis patients with and without diabetes using the Web-based Analysis of Dialysis Data Archives (WADDA) system database. Design and Methods: From 2014 to 2020, we enrolled dialysis patients who had their predialysis SBP measured using the WADDA system 2.1. We classified SBP and evaluated its trends over time by gender, age, and presence of diabetes using the Japanese Society of Hypertension guidelines 2019 (JSH2019). Furthermore, we looked at the relationship between SBP and cardiovascular death in patients with and without diabetes. Results: Dialysis patients with diabetes (n = 168,227) had a mean age of 69.2 (11.7) years versus 69.4 (13.3) years, a mean predialysis history of 5.5 (5.3) years versus 9.4 (9.3 years), and a mean dialysis SBP of 156.6 (25.0) mmHg versus 147.9 (23.6) mmHg, respectively. Dialysis patients with diabetes had higher rates of cardiovascular complications than those without diabetes. From 2014 to 2020, the percentage and absolute values of hypertension were higher in dialysis patients with diabetes than across all age groups and in both men and women. Patients with cerebrovascular death had a higher rate of hypertension, but there was no difference in the rate of grade I and II hypertension between the two groups. Conclusion: We summarized the recent trends in SBP of Japanese dialysis patients with and without diabetes using the WADDA system. Dialysis patients with diabetes had higher SBP than those without diabetes in all age groups and in both men and women. As a result, optimal blood pressure management for dialysis patients with and without diabetes is important for the prevention of cerebrovascular death.