HTN Patients Research Articles

Polymorbidity in hypertensive patients

Background.Hypertension (HTN) is often combined with other diseases, that significantly complicate its course, worsen the prognosis, interfere with the therapeutic and preventive measures. Therefore, assessing the development and structure of polymorbidity (PM) in hypertension is a relevant issue.Objective. To study the structure and degree of PM in hypertensive patients depending on age and gender.Design and methods. We conducted an analysis of 20 560 case histories of patients with HTN and without HTN (men and women), inhabitants of West Siberia-Novosibirsk region, who underwent examination and treatment at the clinic of the Federal Research Center of Fundamental and Translational Medicine in Novosibirsk. All identified diagnoses (nosological forms and classes according to the International Classification of Diseases of the 10th revision, ICD‑10) were considered. Transnosological PM was assessed by the average number of nosologies corresponding to the three-digit ICD‑10 rubric.Results. An increase in the PM index by 16,8 % was found in HTN patients compared to patients without HTN. Among HTN patients, there was an increase in the incidence of comorbid diseases of the circulatory system (in the 16–39 age group in men — by 46 %, in women — by 42,8 %), the endocrine system, eating disorders and metabolism (in the age group 16–39 years for men — by 19,3 %, for women — by 45,2 %), the musculoskeletal system, urinary system (for men) and neoplasms (for women) compared with patients without HTN.Conclusions. We found a high rate of transnosological PM in HTN patients was found and defined its structure.

Assessment of Left Ventricular Remodeling Index in Hypertensive Patients Using Two- and Three-Dimensional Transthoracic Echocardiography

Background: Hypertensive heart disease (HHD) and coronary artery disease (CAD) generally develop left ventricular remodeling. Therefore, it is of great importance for how to assess HHD and CAD’s left ventricular remodeling which can influence vital diagnosis, therapeutic decisions and prognosis. Aim of the Work: to assess left ventricular remodeling index in HTN patients compared to normal patients using 2D and 3D transthoracic echocardiography. Patients and Methods: This study included 120 subjects at Cardiology Department, Faculty of Medicine, Al-Azhar University during the period from October 2018 to June 2019. They were divided into two groups: Group A (Patient group): which included (100) hypertensive patient. Group B (Control group): which included (20) age and sex matched apparently healthy individuals. Results: There were no significant differences in age and sex inter-group. LVRI detected by RT3DE and 2DE showed significant differences inter-group (1.72±0.04 vs 1.94±0.07, 1.73±0.04 vs 2.17±0.05); and significant differences in patient (1.94±0.07 vs 2.17±0.05), but no significant differences in control group (1.72±0.04 vs 1.73±0.04). Correlation analysis indicated that there was a good positive correlation between LVRI detected by RT3DE and 2DE in control and patient groups (r=0.91, 0.79, all P<0.001). Conclusion: LVRI derived from RT3DE can provide more superiority to LVRI derived from 2DE as an index for evaluating left ventricular remodelling.

Increasing the diagnostic signifcance of the laser Doppler flowmetry in assessing skin microcirculation in hypertension

Background.Hypertension (HTN) is associated with impaired skin microcirculation. Laser Doppler flowmetry is an objective, quantitative, instrumental method that allows evaluating skin microcirculation. However, the method was not widely used clinically due to high variability of perfusion and small difference between healthy people and HTN patients and, as a consequence, low diagnostic signifcance.Objective.To provide the grounds for the approaches increasing the informative value of skin microcirculation measurement by laser Doppler flowmetry in HTN patients.Design and methods.The study involved HTN patients (n = 13, the median age was 60 (49; 63) years) and young otherwise healthy volunteers without HTN (n = 12, the median age 26 (25; 27) years). Microcirculation measurement was performed by laser Doppler flowmetry using LAKK-02 device. Registration of microcirculation on the forearm skin was carried out during the occlusionheating test. The Mann-Whitney test was used to compare the parameters in two groups. The diagnostic accuracy of the method for the inverse classifcation of the subjects was evaluated using ROC analysis.Results.In HTN patients, the median baseline perfusion was 3,1 (1,84; 4,31) perfusion units (PU), in healthy volunteers — 4,29 (3,66; 8,14) PU (p = 0,04). The median area under the microcirculation curve for the frst 2 minutes of heating in HTN patients was 1206,7 (813; 1449) PU × s, in healthy volunteers — 1552,3 (1310; 1624) PU × s (p = 0,035). In healthy volunteers, the heating increased the perfusion by 596 % (386%; 878%), and in HTN patients perfusion increased only by 265% (180 %; 318%) (p = 0,01). The relative increase in perfusion during postocclusion hyperemia with continued heating compared with the baseline in healthy volunteers was 651% (493 %; 999%), and in HTN patients — 302 % (182 %; 436%) (p = 0,005). Thus, when comparing the average parameters for each period in the occlusion-heating test, only basic perfusion showed signifcant differences. However, when changed from absolute to relative parameters (the increase in microcirculation in relation to the vasodilating effects), the difference was signifcant. Moreover, sensitivity achieved was 75 % and specifcity — 84,6% (the inverse classifcation of groups).Conclusions.The physiological (the local heating of the forearm skin at a rate of 2 degrees Celsius per second, a combination of vasodilating effects) and mathematical (the transition from absolute to relative values) approaches provided an increase of the informative value of the laser Doppler flowmetry, as well as its sensitivity and specifcity.

Blood Viscosity, Glycemic Markers and Blood Pressure: A Study in Middle-Aged Normotensive and Hypertensive Type 2 Diabetics.

Altered blood viscosity (BV) may affect blood pressure (BP) and develops further complications in diabetes. A case-control study was performed to examine the relationship of erythrocyte sedimentation rate (ESR), hematocrit, fibrinogen, and BV with glycemic markers and BP in middle-aged normotensive and hypertensive type 2 diabetic patients and healthy controls. A total of 145 participants between age group 30-50years divided into three groups; controls (n = 60), type 2 diabetes mellitus (T2DM, n = 55), and T2DM with hypertension (T2DM + HTN, n = 30). ESR and hematocrit were determined by Wintrobe's method. Plasma fibrinogen was measured using Lempert method and BV calculated using Merill's formula. T2DM and T2DM + HTN patients had higher fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), ESR, and fibrinogencompared to controls. In both male and female SBP, DBP, MAP, FPG, and HbA1c were significantly higher in T2DM and T2DM + HTN groups, compared to controls. Further, linear regression analysis revealed a positive association of ESR and fibrinogen with SBP, DBP, MAP, FPG, HbA1c, and positive diabetic status in all participants. Also, in the same analysis, BV showed a positive association with SBP, DBP, and MAP. The association of ESR and fibrinogenwith glycemic markers and BP in diabetes supporting the value of emerging marker's for early prediction of T2DM and hypertension.

Abstract P367: Adherence Assessment Via Comprehensive Identification and Quantitation of Circulating Medications with Significant Correlation to Lower Blood Pressure Observed in Hypertensive Patients

Employing a novel and proprietary comprehensive precision medicine clinical tool that is a LC/MS/MS-based platform (PrecisCMQ™), we analyzed the serum of HTN patients seeking emergency care (n=293) for the presence and quantity of 42 antihypertensive and cardiovascular medications. Patient self-reported adherence correlated with clinical tool-based adherence. Among patients prescribed &gt; 3 medications, clinical tool-based adherence in patients (n=74) who indicate they never miss a dose was 74%, versus 60% in patients (n=69) who reported missed doses (p = 0.009, two-sided t-test; median prescribed medications = 3.5). Patients were considered adherent when 80% of prescribed medications were detected and categorized as nonadherent otherwise. Among patients with &gt; 3 prescribed medications, we found adherent patients had lower SBP (9.7 mm Hg; 95% CI 1.8 - 17.6; p = 0.02) and lower DBP (6.9 mm Hg; 95% CI 1.9 - 12.1; p = 0.007) after adjusting for age, sex, BMI, and patient-reported adherence. No significant difference in BP was observed in patients prescribed &lt; 3 medications. By comparing medication clinical tool-based detections to prescribed medications listed in the EHR, 12% of the detected medications (68/549) were not recorded in the patients’ EHR. After accounting for the above covariates and the number of medications in the EHR, we observed that the total number of detected medications, including prescriptions not in the EHR, significantly correlated with both SBP (attributed to 4.8% of variation; p = 0.01) and DBP (patients prescribed &gt; 3medications; explaining 2.5% of BP variation; p = 0.05). Additionally, to assess whether patients with higher systemic medication concentrations had lower BP, we compared SBP and DBP to medication concentrations normalized to published reference ranges. After accounting for the above covariates and the number of detected medications, we observed a relationship between medication(s) concentration(s) and BP across all patients. Together, these results support the utility of clinical tool-based medication monitoring for assessing adherence and improving BP control in HTN patients.

Evaluation of the Second Diabetes Campaign Round for Diabetic Palestine Refugees at Unrwa Health Centers

Introduction: UNRWA has a mandate to provide assistance and protection to a population of around 5 million Palestine refugees (PRs) in Jordan, Lebanon, Syria, West Bank and Gaza. UNRWA is the main primary healthcare provider for them. DM is a common problem among PRs with a prevalence of 11.0%. A high percentage of these patients are obese (64.0%) or overweight (26.0%). In 2013, UNRWA conducted the first round of a DM campaign to raise DM patients’ awareness on healthy lifestyle and to improve their ability to manage DM. In 2014, a second round was conducted with the same aims. Method: Using a Quasi-experimental study, DM1, DM2 or DM2 and HTN patients’ diagnosed ≥ 1 year prior to study initiation were included. 1,600 participants from the 32 UNRWA’s largest health centers (HCs) were included. Each HC conducted weekly group sessions for six months, including education, healthy cooking, and physical exercise. Body measurements, 2hrPPGT, blood pressure and the attendance of sessions, were collected on a weekly basis. Demographical data, pre- and post- questionnaires and cholesterol levels were collected before and after the campaign. Paired T-test in SPSS Version 21 was used. Results: Out of 1,600 patients, 1,599 [1187 (74.0%) females and 412 (26.0%) males] completed the campaign; 576 (36.0%) patients had DM2, 960 (60.0%) had DM2 and HTN and 62 (4.0%) had DM1. After the campaign, the average weight loss was 2.6 kg (95% CI: 2.4-2.7). In addition, 22% lost ≥5%, 25% lost 3%-5%, and 30% lost 1%-3% of their weight. Significant improvements were seen in blood glucose, cholesterol and waist circumference (p≤0.001 for all). The attendance rate of the sessions was 70.6% in total. Conclusions: This campaign has focused on healthy lifestyle awareness raising using group sessions with various activities, has resulted in better DM care outcomes of PRs with DM. Such campaigns need to be sustained and expanded. Local community and NGOs partnerships observed during the campaign should be strengthened and sustained. Disclosure N.M. Abu Kishk: None. Y.M. Shahin: None. Y. Turki: None. J. Mitri: Research Support; Self; National Dairy Council, Kowa Pharmaceuticals America, Inc.. Research Support; Spouse/Partner; AbbVie Inc., Janssen Pharmaceuticals, Inc., Takeda Pharmaceuticals U.S.A., Inc., Gilead Sciences, Inc.. Consultant; Spouse/Partner; Janssen Pharmaceuticals, Inc., Merck &amp; Co., Inc., Biogen, AbbVie Inc.. A. Seita: None.

PP.15.21] CHANGES IN LEFT VENTRICULAR GEOMETRY AND DIASTOLIC FUNCTION IN PATIENTS WITH RESISTANT HYPERTENSION

Objective to evaluate differences of left ventricular (LV) geometry and diastolic function among resistant (rHTN) and controlled (HTN) hypertension patients. Design and method We studied 22 patients with true rHTN confirmed by office and ambulatory blood pressure monitoring (ABPM) despite the use of 3 antihypertensive medications with a diuretic. Ambulatory blood pressure monitoring identified 21 participants with controlled hypertension by triple therapy. Two groups of patients were comparable for age, sex and body mass index. All patients underwent examination including: biochemical evaluations, a complete echocardiographic study, office and ABPM and measurement of circulating concentration of aldosterone, renin, aldosterone-to-renin ratio and 24-hr urinary metanephrines. Results The patients with rHTN had significantly higher LV mass index (LVMI) compared with HTN patients (165.6 ± 8.0 vs. 135.2 ± 5.2 g/m2, p < 0.01). Among HTN patients the prevalence concentric and eccentric left ventricular hypertrophy (LVH) was 61.5% and 28.5%, respectively, and 43% of HTN patients had the moderate increase LVMI and in 47% of HTN patients were detected severe increase LVMI. Concentric LVH was found in all patients with rHTN while LVH was classified as the severe degree. Impairment of LV diastolic function has occurred in two groups but parameters E/e’ (10.1 ± 0.5 vs.7.0 ± 0.6, p < 0.01), isovolumic relaxation time (IVRT) (105.0 ± 4.8 vs. 84.3 ± 7.5 ms, p < 0.05) and deceleration time (DT) (191.5 ± 7.3 vs. 176.7 ± 6.3 ms, p < 0.05) were higher in patients with rHTN compared to HTN patients. Patients with rHTN had significantly higher plasma aldosterone (27.4 ± 2.4 vs. 11.4 ± 1.7 ng/dl, p < 0.01) and 24-hr urinary metanephrines (151.5 ± 8.1 vs. 107.8 ± 11.5, p < 0.01) than HTN patients. There were significant correlations between LVMI with systolic BP during the whole 24-hr period (r = 0.548, p < 0.001), IVRT with LVMI (r = 0.642, p < 0.001), relation wall thickness (r = 0.439, p < 0.01), early filling velocity/late filling velocity (E/A) with plasma aldosterone (r = 0.554, p < 0.01), DT with 24-hr urinary metanephrines (r = 0.713, p < 0.001) in all patients. Conclusions These results suggest that development concentric LV hypertrophy of severe degree with significant LV diastolic abnormalities is associated with uncontrolled 24 h systolic BP, aldosterone excess and increased sympathetic nervous activity in patients with resistant hypertension.

Effects of supervised exercise and dietary nitrate in older adults with controlled hypertension and/or heart failure with preserved ejection fraction

Aerobic exercise training is an effective therapy to improve peak aerobic power (peak VO2) in individuals with hypertension (HTN, AHA/ACC class A) and heart failure patients with preserved ejection fraction (HFpEF). High nitrate containing beetroot juice (BRJ) also improves sub-maximal endurance and decreases blood pressure in both HTN and HFpEF. We hypothesized that combining an aerobic exercise and dietary nitrate intervention would result in additive or even synergistic positive effects on exercise tolerance and blood pressure in HTN or HFpEF. We report results from two pilot studies examining the effects of supervised aerobic exercise combined with dietary nitrate in patients with controlled HTN (n = 26, average age 65 ± 5 years) and in patients with HFpEF (n = 20, average age 69 ± 7 years). All patients underwent an aerobic exercise training regimen; half were randomly assigned to consume a high nitrate-containing beet juice beverage (BRJ containing 6.1 mmol nitrate for the HFpEF study consumed three times a week and 8 mmol nitrate for the HTN study consumed daily) while the other half consumed a beet juice beverage with the nitrate removed (placebo). The main result was that there was no added benefit observed for any outcomes when comparing BRJ to placebo in either HTN or HFpEF patients undergoing exercise training (p ≥ 0.14). There were within-group benefits. In the pilot study in patients with HFpEF, aerobic endurance (primary outcome), defined as the exercise time to volitional exhaustion during submaximal cycling at 75% of maximal power output, improved during exercise training within each group from baseline to end of study, 369 ± 149 s vs 520 ± 257 s (p = 0.04) for the placebo group and 384 ± 129 s vs 483 ± 258 s for the BRJ group (p = 0.15). Resting systolic blood pressure in patients with HFpEF also improved during exercise training in both groups, 136 ± 16 mm Hg vs 122 ± 3 mm Hg for the placebo group (p < 0.05) and 132 ± 12 mm Hg vs 119 ± 9 mm Hg for the BRJ group (p < 0.05). In the HTN pilot study, during a treadmill graded exercise test, peak oxygen consumption (primary outcome) did not change significantly, but time to exhaustion (also a primary outcome) improved in both groups, 504 ± 32 s vs 601 ± 38 s (p < 0.05) for the placebo group and 690 ± 38 s vs 772 ± 95 s for the BRJ group (p < 0.05) which was associated with a reduction in supine resting systolic blood pressure in BRJ group. Arterial compliance also improved during aerobic exercise training in both the HFpEF and the HTN patients for both BRJ and placebo groups. Future work is needed to determine if larger nitrate doses would provide an added benefit to supervised aerobic exercise in HTN and HFpEF patients.

ROLE OF CEREBROVASCULAR AND CARDIOVASCULAR CO2-REACTIVITY IN THE PATHOGENESIS OF ARTERIAL HYPERTENSION

Intense emotions cause arousal of the central nervous system, sympathetic activation, blood pressure (BP) increase and hyperventilation. Continuous negative emotions coming with hyperventilation lead to increase in CO2-chemosensitivity that keeps chronic hypocapnia constant and results in BP dysregulation and stable arterial hypertension (AH). The key mechanism of a hypertensive effect of chronic hyperventilation probably lies in sensitivity changes of CO2-chemoreceptors. Respiratory training with periodic hypercapnia has potential therapeutic effect in HTN by restoring CO2-chemoreceptor sensitivity and increasing antioxidant activity. Hypocapnia violates autoregulation mechanisms. Cerebral blood vessels lose their ability to neutralize BP surges, which negatively affects chemoreceptor-related processes of respiratory and BP regulation. With the HTN progression, cerebrovascular dysregulation occurs depending on the BP level. Moreover, hypocapnia is accompanied by the reduction of intracranial venous tone which can lead to increased intracranial pressure and problems with BP regulation in the brain. The threshold level of cardiovascular CO2-reactivity is normally higher than the threshold level of cerebrovascular CO2-reactivity. The changes in cardiovascular CO2-reactivity occur already in the initial period of HTN. Compared to healthy people, hypertensive patients develop slower BP reaction to hyper/hypocapnia, and hypercapnia induced low BP does not restore to the baseline level that can result from the BP dysregulation. In general, cerebrovascular CO2-reactivity is decreased in HTN patients. However, the cerebrovascular vasodilator function is preserved better than the vasoconstrictor reserve demonstrating that cerebral vessel remodeling in HTN is characterized by luminal narrowing due to the vascular wall hypertrophy.

Increased sympathetic nerve activity and reduced cardiac baroreflex sensitivity in rheumatoid arthritis.

Key points Rheumatoid arthritis (RA) is a chronic inflammatory condition associated with an increased risk of cardiovascular mortality.Increased sympathetic nerve activity and reduced cardiac baroreflex sensitivity heighten cardiovascular risk, althogh whether such autonomic dysfunction is present in RA is not known.In the present study, we observed an increased sympathetic nerve activity and reduced cardiac baroreflex sensitivity in patients with RA compared to matched controls.Pain was positively correlated with sympathetic nerve activity and negatively correlated with cardiac baroreflex sensitivity.The pattern of autonomic dysfunction that we describe may help to explain the increased cardiovascular risk in RA, and raises the possibility that optimizing pain management may resolve autonomic dysfunction in RA. Rheumatoid arthritis (RA) is a chronic inflammatory condition associated with increased cardiovascular morbidity/mortality and an incompletely understood pathophysiology. In animal studies, central and blood borne inflammatory cytokines that can be elevated in RA evoke pathogenic increases in sympathetic activity and reductions in baroreflex sensitivity (BRS). We hypothesized that muscle sympathetic nerve activity (MSNA) was increased and BRS decreased in RA. MSNA, blood pressure and heart rate (HR) were recorded in age‐ and sex‐matched RA‐normotensive (n = 13), RA‐hypertensive patients (RA‐HTN; n = 17), normotensive (NC; n = 17) and hypertensive controls (HTN; n = 16). BRS was determined using the modified Oxford technique. Inflammation and pain were determined using serum high sensitivity C‐reactive protein (hs‐CRP) and a visual analogue scale (VAS), respectively. MSNA was elevated similarly in RA, RA‐HTN and HTN patients (32 ± 9, 35 ± 14, 37 ± 8 bursts min–1) compared to NC (22 ± 9 bursts min–1; P = 0.004). Sympathetic BRS was similar between groups (P = 0.927), whereas cardiac BRS (cBRS) was reduced in RA, RA‐HTN and HTN patients [5(3–8), 4 (2–7), 6 (4–9) ms mmHg–1] compared to NC [11 (8–15) ms mmHg–1; P = 0.002]. HR was independently associated with hs‐CRP. Increased MSNA and reduced cBRS were associated with hs‐CRP although confounded in multivariable analysis. VAS was independently associated with MSNA burst frequency, cBRS and HR. We provide the first evidence for heightened sympathetic outflow and reduced cBRS in RA that can be independent of hypertension. In RA patients, reported pain was positively correlated with MSNA and negatively correlated with cBRS. Future studies should assess whether therapies to ameliorate pain and inflammation in RA restores autonomic balance and reduces cardiovascular events.

Efficacy of Cryoballoon Pulmonary Vein Isolation in Patients With Persistent Atrial Fibrillation.

Cryoballoon PVI has emerged as an alternative to radiofrequency PVI for the treatment of paroxysmal AF. The optimal strategy for patients with persistent AF is unclear as data are limited. We analyzed a prospective registry of consecutive patients with persistent AF who underwent Cryoballoon PVI at a single center between 2011 and 2014. Patients were assessed for atrial arrhythmia recurrence after a 3-month blanking period at 6 months, 1 year, and 2 years postprocedure. Recurrence was based on typical symptoms, ECG, or event monitor evidence of AF. Kaplan-Meier analysis was used to estimate arrhythmia-free survival. Final analysis included 69 patients who underwent Cryoballoon PVI with a mean age 59.4 ± 8.1 years, 85.5% male, 53.6% HTN patients, CHA2DS2-VASC score 1.6 ± 1.2, and LA size 4.5 ± 0.6 cm. The single procedure atrial arrhythmia recurrence-free rate at 1-year postprocedure after a 3-month blanking period was 59% and 50% at a mean follow-up of 607 days. Of the recurrence-free group, 17% were taking previously ineffective antiarrhythmic medications. In comparing patients with persistent AF duration <1 year versus >1 year, there was a trend toward greater AF recurrence-free rates in the <1 year group (66% vs. 55%, P = 0.09). Cryoballoon PVI appears to be an effective initial strategy in treating persistent AF, with an AF recurrence-free rate of 59% at 1 year.

Возможности регистра в оценке лечения больных артериальной гипертензией в первичном звене (на примере поликлиники Саратовской области)

Aim ― to evaluate the quality of treatment among hypertensive patients in workers settlement of Saratovskaya oblast using an research and information system of a registry. Material and Methods ― Ambulatory cards of 88 patients with essential hypertension (aged 64.6±11.3 years, males – 40.5%) who visited therapist, general practitioner or cardiologist during one randomly selected day were analyzed retrospectively. To assess the treatment quality we used computer research and informal system of hypertension (Htn), coronary artery disease (CAD) and chronic heart failure (CHF) registry. The registry controls a performance of hypertension guidelines in Htn patients. Results ― Patients in the studied group were followed-up according to the guidelines. All patients visited polyclinic no less then four times during the previous year. 42% of patients were administered two or more antihypertensive drugs. However, about one third of hypertensives with uncontrolled blood pressure continued monotherapy. Patients in whom Htn was associated with CAD were prescribed with antiplatelets in 82% of cases, with statins – in 60% of cases and with beta-blockers – in 80% of cases. When Htn were associated with CHF, angiotensin converting enzyme inhibitors (ACE-Is) or angiotensin II receptor blockers (ARBs) were prescribed in 87% of cases. When patients suffered from Htn and atrial fibrillation oral anticoagulants were administered in 62% of cases. Conclusion ― Using the Htn, CAD and CHF Registry in primary care unit allows objective evaluation of clinical guidelines performance among Htn patients. It was revealed that combined antihypertensive treatment and separated recommended drugs in case of associated clinical conditions (statins in CAD, anticoagulants in atrial fibrillation) was administered sub optimally. Only half of patients with essential hypertension had their blood pressure controlled.

PP.41.21

Objective: Evidence suggests that uric acid is a possibly causal factor for human primary hypertension. Aim of our study was to investigate the relationship between hyperuricemia and severity of hypertension. Design and method: We studied 660 consecutive never treated newly diagnosed essential HTN patients (51 ± 13 years, 46.8% female), free of diabetes and overt cardiovascular or other systemic disease, who visited our antihypertensive outpatient clinic. All patients underwent office, home and 24-hour ABPM measurements. Subjects with isolated office hypertension were excluded from the study. Based on gender-specific upper limit of normal for uricemia (6.1 for females and 7.2 mg/dl for males), study population was categorized in normouricemic (NU, n = 583) and hyperuricemic (HU, n = 77). Results: Prevalence of hyperuricemia was 11.7%, significantly higher in males (16.2% vs. 6.5%, p < 0.001). In the whole population, uric acid levels were significant positive correlated with office and 24 hour systolic (r = 0.148 and 0.164, p < 0.001 for all) and diastolic (0.164 and 0.159, p < 0.001 for all) blood pressure levels. Moreover, HU compared to NU presented significantly higher levels of office and 24 hour systolic and diastolic blood pressure levels. Stage II and stage III BP categories were more prevalent in HU compared to NU, with 1/4 of HU being stage III hypertensives. Conclusions: Plasma uric acid levels are associated with higher levels of blood pressure and severe stages of hypertension are more prevalent in hyperuricemic patients.

Abstract 437: Racial/Ethnic Differences in Cardiovascular Disease Outcomes in Hypertensive Patients

Background: Higher rates of CVD have been found in Mexicans and some Asian American subgroups as well as African Americans. However, little is known about the association between HTN, a main risk factor of CVD, and CVD among rapidly growing minority groups. Our study aims to identify racial/ethnic differences in CVD outcomes in HTN patients across Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese), Mexican, African American, and non-Hispanic White (NHW) in a large, mixed payer ambulatory care setting in northern California. Study Design: We examined electronic health records of patients age 18 years or older with at least one primary care visit from 2008-2012. CVD was defined by ICD-9 codes while HTN was defined by ICD-9 codes, antihypertensive medication, or two or more abnormal blood pressure readings (&gt;140/90mm Hg). We estimated the rate of CVD incidence among HTN patients. Follow-up period was six years on average. Results: African Americans had the highest prevalence of HTN (51%, 2,715 out of 5,328), followed by NHWs (35%, 96,965 out of 276,133), Mexicans (34%, 3,867 out of 11,532), and Asian Americans (24%, 29,872 out of 124,139). Among these HTN patients, 9% (11,667 out of 133,419) developed CVD by the end of year 2012. HTN patients with CVD were more likely to be older, male, smoker and have a higher BMI. There was no significant difference in baseline BP levels. Compared to NHWs, both African American (OR=1.84, CI: 1.61-2.10) and Mexican HTN patients (OR=1.28, CI: 1.12-1.46) were at a higher risk of developing CVD after adjusting for age and gender, while Asian Americans were at a lower risk (OR: 0.81, CI: 0.79-0.86). Racial/ethnic differences also presented across the Asian American subgroups with Filipino and Asian Indian HTN patients at an elevated risk of developing CVD compared to other Asian American subgroups. Conclusions: Among HTN patients, there is heterogeneity across R/E minority groups in their risk of developing CVD. It might be differential utilization pattern such that Mexicans, Filipinos, and Asian Indian are likely to receive HTN treatment at more severe stage. Further studies are needed to better understand the pathways of CVD development among HTN patients of different race/ethnicity.

Abstract 239: Natural Language Processing Identifies Important Side-effects In Very Elderly Patients With Hypertension,

Background: Concerns for side-effects makes the identification of treatment targets of hypertension in the very elderly challenging. We sought to utilize natural language processing (NLP) to evaluate the prevalence of prespecified side-effects in a cohort of very elderly (≥80 years) patients. Methods and Results: We conducted a two-year, cross-sectional study involving 5169 very elderly patients with and without hypertension seen by primary or specialist providers. Hypertension patients had to have a prior hypertension ICD-9 code in the electronic medical records problem list and ≥2 office visits in 2008 and 2009. We used NLP to analyze extracted free text reports from last clinic visits between 2008 and 2009. Of the 10 prespecified side-effects, hypotension, fatigue, and dizziness were the commonest three conditions and hypotension was significantly higher in the HTN patients. Of the 2835 patients with no prior hypertension history and 2334 hypertension patients identified, the prevalence of each prespecified item in both groups were: acute renal failure (0.3% v 0.6%, p=0.13); syncope (2.8% v 2.2%, p = 0.17), dizziness (3.1% v 4.0%, p=0.09), history of fall (1.0% v 0.9%, p=0.65), fatigue (5.4% v 4.5%, p=0.19), femoral neck fracture (0.18% v 0.04%, p=0.16), palpitations (1.2% v 1.5%, p=0.35), hypotension (4.1% v 6.6%, p&lt;0.001), hyperkalemia (1.1% v 1.7%, p=0.04), hypokalemia (0.4% v 0.9%, p=0.01). At least one presumed side-effect was present in 17.5% of all 5169 patients. Among hypertension patients, there was no significant difference in the prevalence of the side-effects among patients with BP above (578) or below 140/90 (1756) except for acute renal failure (1.21% vs 0.40%, p = 0.03). Conclusion: Analysis of free-text outpatient notes using NLP showed that hypotension and potassium abnormalities were significantly more prevalent in very elderly patients with hypertension compared to similarly aged patients with no hypertension history.

Duration of hypertension is associated with cognitive function: a cross-sectional study in Chinese adults

Background Hypertension (HTN) is a very prevalent public health problem and as the population ages, cognitive impairment (CI) is also going to be a public health burden. However, the relationship between hypertension duration and cognitive function declination worldwide is still unknown. The aim of the study was to investigate the effects of HTN duration on CI in Chinese population. Methods At baseline, 1 386 HTN patients and 293 normotensive (NT) people were enrolled. The HTN patients were further divided into four subgroups (duration of HTN &lt;6 years, 6–10 years, 11–20 years, and &gt;20 years) according to the HTN duration and were screened for cognitive function with neuropsychological tests including mini-mental-stateexamination (MMSE) and clock-drawing-test (CDT) in comparison with the NT group. Results More HTN patients had CI (45.3%) than NT subjects (30.4%), and increased with HTN duration (P &lt;0.000 1). Compared with the scores of MMSE and CDT in the NT group, the declines were higher in the HTN patients (P &lt;0.000 1), and in the four HTN subgroups, both MMSE and CDT scores fall when the HTN duration increased (P &lt;0.05). Furthermore, in the HTN population without CI, the trend in alteration of CI was relatively mild but still existed (P &lt;0.05). Conclusion People with HTN are more likely to have CI and the possibility and aggravation increases the prolongation of HTN duration, both in amnesic and nonamnesic function.

Increased extracellular volume and altered mechanics are associated with left ventricular hypertrophy in hypertensive heart disease, not hypertension alone

Background Study purpose To detect differences in extracellular volume (ECV) and systolic strain in hypertensive patients with LVH as compared to hypertensive patients without LVH and age-matched controls. Background: Increased ECV due to diffuse myocardial fibrosis in hypertensive patients may be an underlying mechanism contributing to increased cardiovascular risk. Moreover HTN patients with left ventricular hypertrophy (LVH) are at higher risk of cardiovascular morbidity and mortality when compared to HTN Non-LVH subjects. We compared levels of ECV and systolic strain between HTN LVH, HTN Non-LVH and control subjects.

SAT0381 Diagnosis and Treatment of Acute Gouty Arthritis at a University Hospital Emergency Department

BackgroundAcute gouty arthritis (GA) attacks account for a substantial number of emergency department (ED) visits.ObjectivesEvaluate acute GA diagnosis and treatment patterns at a University Hospital ED.MethodsRetrospective chart review of consecutive...

High-circulating leptin levels are associated with increased blood pressure in uncontrolled resistant hypertension

Leptin and aldosterone have been associated with the pathophysiological mechanisms of hypertension. However, despite studies showing the association of leptin with intima-media thickness, arterial distensibility and sympathetic nerve activation, the relationship between leptin and blood pressure (BP) in resistant hypertension (RHTN) is unknown. We aimed to assess the correlation of plasma leptin and aldosterone levels with BP in uncontrolled controlled RHTN (UCRHTN) and CRHTN patients. Plasma leptin and aldosterone levels, office BP, ambulatory BP monitoring and heart rate were measured in 41 UCRHTN, 39 CRHTN and 31 well-controlled HTN patients. No differences were observed between the three groups regarding gender, body mass index and age. The UCRHTN group had increased leptin when compared with CRHTN and well-controlled HTN patients (38.2±21.4, 19.6±8.7 and 20.94±13.9 ng ml(-1), respectively; P<0.05). Aldosterone levels values were also statistically different when comparing RHTN, CRHTN and well-controlled HTN patients (9.6±3.8, 8.1±5.0 and 8.0±4.7 ng dl(-1), respectively; P<0.05). As expected, UCRHTN patients had higher heart rate values compared with CRHTN and well-controlled HTN patients (86.2±7.2, 83.5±6.7 and 83.4±8.5, respectively; P<0.05). Plasma leptin positively correlated with systolic (SBP) and diastolic BP (DBP), and aldosterone (r=0.43, 0.35 and 0.47, respectively; all P<0.05) in UCRHTN, but neither in the CRHTN nor in the HTN group. Simple linear regression showed that SBP, DBP and aldosterone may be predicted by leptin (r(2)=0.16, 0.15 and 0.19, respectively; all P<0.05) only in the UCRHTN subgroup. In conclusion, UCRHTN patients have higher circulating leptin levels associated with increased plasma aldosterone and BP levels when compared with CRHTN and HTN subjects.

Nonadherence to Statin Therapy: Discontinuation After a Single Fill

IntroductionAdherence to statin medications is known to be suboptimal. What is less known is the rate of discontinuation immediately after therapy has been initiated. The primary objective of this study was to determine what proportion of nonadherence in the first year of statin therapy was due to discontinuation after a single fill. MethodsWe identified new statin users within low-risk (hypertension [HTN]), medium-risk (coronary heart disease [CHD]), and high-risk (heart failure [HF]) cohorts during a 9-year period. All data came from administrative health care databases. ResultsThe cohorts included 9445 HTN, 1141 CHD, and 778 HF patients. At 1 year, the proportions of patients with less than 80% adherence to statin medications were 47.9% (HTN), 38.3% (CHD), and 50.0% (HF). Among all patients classified as nonadherent at 1 year, 18.0% of HTN, 16.3% of CHD, and 28.2% of HF patients had discontinued statin medications after only 1 dispensation. Within 3 months of starting statin therapy, 29.7%, 40.3%, and 47.5% of all nonadherent HTN, CHD, and HF patients, respectively, had discontinued the new statin medication. After regression analysis, the only independent covariate that was consistently associated with discontinuation after a single fill was receiving fewer medical follow-up visits. ConclusionsImmediate discontinuation after a single fill contributes disproportionately to statin nonadherence. This suggests an important time to prevent nonadherence is within the first month of treatment initiation.