Duration Of Hypertension Research Articles

O03 THE SEVERITY OF COGNITIVE IMPAIRMENT IN PATIENTS WITH ESSENTIAL HYPERTENSION AND VARIOUS FORMS OF ATRIAL FIBRILLATION

Objective: comparative analysis of the severity of cognitive impairment in hypertensive patients with various forms of atrial fibrillation (AF). Materials and methods: During the observation period, 156 patients of both sexes with I–III degree of arterial hypertension (AH) were examined. The average age of patients was 63.8±9.07 years, duration of hypertension was 12.8±7.8 years. To analyze cognitive impairment in patients with AF 3 groups of patients were formed: Group I - hypertension and AF with a permanent form, n = 91, Group II - hypertension and AF with a paroxysmal form, n = 18, Group III - AH and persistent AF form, n=47. Cognitive functions were assessed using the Mini-Cog test, MOCA. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression levels. The results are presented as M±SD. Results: The analysis of psychological testing data showed that cognitive impairment is more pronounced in the group of patients with a permanent form of AF. Thus, the total score on the Mini-Cog test in group I of patients was 3.73±1.3 points, while in group II it was 4.0±1.11 points (p<0.05). According to MoCa scale, the total score was superior in group II patients, amounting to 19.7±6.14, while in group I this figure was 19.2±6.08 (p<0.05), and in group III is 18.8±7.22, which indicates a greater severity of cognitive impairment in patients with hypertension and AF with a permanent form and a persistent form. Cognitive functions such as memory are significantly better in group II compared to group I: 7.88±1.99 points versus 6.9±1.78 points, respectively (p>0.05), and decision-making function is significantly better in group III group. It should be noted that according to the HADS scale, the severity of anxiety and depression is higher in group III. Conclusion: A comparative analysis of psychological testing data taking into account the form of AF showed that cognitive impairment is more pronounced in patients with a permanent form of AF.

Abstract P325: Additive effect of nighttime blood pressure on left ventricular strain in patients with primary aldosteronism evaluated via cardiac magnetic resonance tissue tracking

Background: Primary aldosteronism (PA) induces left ventricular (LV) remodeling and increases the risk of high nighttime blood pressure (BP), which causes further heart damage. This study aimed to investigate whether nighttime BP aggravates LV deformation dysfunction and to identify independent factors affecting the global peak strain (PS) of LV remodeling in patients with PA compared to patients with essential hypertension (EH). Methods: A total of 280 patients with PA and 280 age- and sex-matched patients with EH who underwent cardiac magnetic resonance examination at the First Affiliated Hospital of Chengdu Medical College were included. According to the results of adrenal computed tomography and/or adrenal venous sampling, there were 154 patients with aldosterone-producing adenoma (APA) and 126 patients with idiopathic hyperaldosteronism (IHA). Twenty-four-hour ambulatory BP monitoring (ABPM), LV function, global strain parameters, and other clinical medical data were compared, and multivariate analysis was performed to identify the independent indicators of the LV PS. Results: No differences in age, sex, body mass index, clinical BP, 24-h mean BP, daytime BP, or duration of hypertension were found between the groups. Nighttime systolic BP (132 ± 17 vs. 126 ± 18 mm Hg, P < 0.05) and diastolic BP (85 ± 11 vs. 80 ±10 mm Hg, P < 0.05) were greater in PA patients than in EH patients. Compared with the EH controls, the PA patients had a lower LV global PS and peak diastolic strain rate (PDSR) in three directions. No significant differences were found in the PS (radial or longitudinal) or PDSR in the three directions between the APA and IHA groups. Furthermore, nighttime BP was an independent predictor of LV global radial, circumferential, and longitudinal PS. Conclusions: High nighttime BP may aggravate LV stiffness in patients with PA, resulting in decreased LV strain and function. Nighttime BP was independently correlated with LV global PS in patients with PA.

My journey on the path to understanding IgA nephropathy: From bench to bedside.

When Berger et al. first reported IgA nephropathy in 1968, the prognosis was generally thought to be benign. However, as more case data were accumulated, it became evident that not all patients with IgA nephropathy necessarily had a good prognosis. IgA nephropathy has a significant morbidity, culminating in end-stage kidney disease (ESKD) in about 40% of patients without treatment within 20 years of the diagnosis. Although almost 20% of patients remain stable in their renal function, 30%-40% of patients develop ESKD from its onset. The important factors of renal outcome in patients with IgA nephropathy is the severity of histopathological findings, heavy proteinuria, long duration of proteinuria, haematuria and hypertension.

P149 HYPERTENSION AS A SILENT KILLER: DOES OUR MANAGEMENT REACH THE RECOMMENDED TARGETS: SUDAN MMM 2022?

Introduction: Several explanations might address the failure of antihypertensive medications: poor compliance, excessive salt ingestion, drug interactions, or an unsuspected secondary cause for hypertension. Resistant hypertension, as an additional failure cause, is relatively rare, but all patients should be considered medically treatable until proven otherwise. Therefore, we aim to explore the blood pressure readings and the current control status in hypertensive Sudanese patients. Methods: Utilizing the MMM 2022 Sudan screening data, participants’ BP >18 years was measured using a standard device by trained physicians for three consecutive measures, and a single mean value was calculated excluding the first reading. Participants with a history of hypertension were included in the analysis. Continuous data was presented in mean and standard deviation, and categorical data was presented in frequencies and percentages. According to current guidelines, several antihypertensive medications used were counted for each patient. All participants completed a structured questionnaire after obtaining their approval. Results: The study included 2,292 participants with an established diagnosis of hypertension. The mean age at diagnosis was 46±13 years, around 60% were females, and the median duration of hypertension was 5 (2, 10) years. Of these, 936 (40.9%), 790 (34.5%), and 543 (23.7%) had blood pressure exceeding SBP≥140 mmHg, DBP≥90 mmHg, and BP≥140/90 mmHg, respectively. Table 1 shows the baseline characteristics for each group. Despite the guideline recommendations to control hypertension, 78 (14.4%) were not adherent to medications, and 56 (10.3%) were taking three or more antihypertensive drugs. Conclusions: BP screening enables future decisions to control hypertension-related burden. Adherence to the internationally recommended guidelines will lead to achieving BP targets and prevent undesired outcomes. The subgroup of resistant hypertensive patients needs close monitoring and appropriate medical evaluation.

Association between the incident hypertension duration and cognitive performance in older adults: data from the NHANES 2011–2014

BackgroundEstablished evidences have demonstrated that hypertension was associated with the cognitive impairment. But the associations between the duration of hypertension exposure and cognitive performance are still inconclusive.ObjectivesThe objective of this study was to assess the association between the duration of hypertension diagnosis and cognitive performance in older adults by the National Health and Nutrition Examination Survey (2011–2014).MethodsTo evaluate the relationship between the hypertension duration and cognitive performance, we conducted the logistic regression analysis. Furthermore, we also performed the Restricted cubic spline (RCS) analysis to assess the nonlinear relationship between the duration of exposure to hypertension and cognitive performance.ResultsInitially, total 19,931 participants were included in this study, and 2928 individuals were enrolled. With the increase of hypertension duration, more risk of cognitive impairment was observed in the Digit Symbol Substitution test (DSST) (OR = 1.012, 1.006–1.019), and a similar trend was observed in Animal Fluency test (AFT) (OR = 1.009,1.003–1.016). The RCS results showed that the hypertension duration pattern was linear associated with the risk of cognitive impairment in DDST (P for non–linearity = 0.758). Meanwhile, subgroups analysis of midlife hypertension, we revealed that linear association with the risk of cognitive impairment in DSST (P for non–linearity = 0.391) and CERAD (P for non–linearity = 0.849) among hypertension diagnose < 55 years populations.ConclusionCollectively, our finding indicates that longer duration of exposure to hypertension worsens the cognition performance, especially for middle-aged hypertension.

Impact of systemic hypertension on inner retinal layer thickness and macular microvasculature in patients with diabetic retinopathy.

To investigate the effects of hypertension (HTN) on inner retinal thickness and macular microvasculature in patients with diabetic retinopathy (DR). Subjects were classified into three groups: patients with type 2 diabetes mellitus (T2DM) (T2DM group), patients with DR (DR-HTN group), and patients with DR and HTN (DR + HTN group). The ganglion cell complex (GCC) thicknesses and the macular vessel density (VD) were compared. Linear regression analyses were performed to identify factors associated with the VD in the DR + HTN group. The mean GCC thicknesses were 112.2 ± 12.3, 109.2 ± 13.7, and 106.2 ± 11.2μm in the T2DM, DR-HTN, and DR + HTN groups, respectively (P = 0.045). The mean VDs were 25.4 ± 5.0, 24.3 ± 8.9, and 21.2 ± 7.1% (P = 0.014) for the superficial capillary plexus (SCP) and 25.9 ± 4.3, 22.9 ± 8.5, and 20.2 ± 6.6% (P < 0.001) for the deep capillary plexus (DCP) in the T2DM, DR-HTN, and DR + HTN groups, respectively. In multivariate analyses, the duration of HTN was a significant factor associated with the VD of both SCP (B = -0.24, P = 0.010) and DCP (B = -0.21, P = 0.016). Patients with both DR and HTN had a thinner GCC and lower VDs of SCP and DCP than those with DR alone. These outcomes could be associated with the synergistic ischemic effects in DR patients with HTN. Moreover, the duration of HTN in DR patients was significantly associated with macular VD in both SCP and DCP.

Determinants Affecting the Awareness of Hypertension Complications within the General Population in Saudi Arabia.

Hypertension imposes a significant public health burden. An increased awareness of hypertension complications within a population can positively impact patient care and prevent complications. This study seeks to assess the awareness of hypertension complications among the population of Bisha in Saudi Arabia in 2020. A cross-sectional study was conducted in 2020. A validated self-administered online-based questionnaire was sent to a sample of the adult population of Bisha to measure their awareness of hypertension complications. Almost three-quarters of the population (72.2%) were aware of hypertension complications. The awareness level was significantly higher among male participants (p < 0.001), those aged 31-40 years, those who were married, those working as police officers or in civilian jobs, those living in urban areas (p = 0.04), those with a university-level education (p = 0.03), those with a medium family income (SAR 5000-14,999) (p = 0.001), and those with a history of hospitalization because of causes other than hypertension (p = 0.05). Marital status was independently predictive of awareness (B = 0.851, Wald test = 12.179, p = 0.000) among the respondents. The study concludes that the awareness of hypertension complications among the Bisha population in Saudi Arabia was deemed acceptable. Factors such as marital status, age, gender, a family history of hypertension, the duration of hypertension, and medication adherence positively influenced this awareness and served as predictors of hypertensive awareness. The findings highlight the importance of health authorities in ensuring the widespread awareness of hypertension complications, particularly among hypertensive individuals.

Development and Validation of a Nomogram for Predicting Lacunar Infarction in Patients with Hypertension.

A considerable proportion of hypertensive patients may experience lacunar infarction. Therefore, early identification of the risk for lacunar infarction in hypertensive patients is particularly important. This study aimed to develop and validate a concise nomogram for predicting lacunar infarction in hypertensive patients. Retrospectively analyzed the clinical data of 314 patients with accurate history of hypertension in the Second Affiliated Hospital of Wannan Medical College from January 2021 to December 2022. All the patients were randomly assigned to the training set (n=220) and the validation set (n=94) with 7:3. The diagnosis of lacunar infarction in patients was confirmed using cranial CT or MRI. The independent risk factors of lacunar infarction were determined by Least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analysis. The nomogram was built based on the independent risk factors. The nomogram's discrimination, calibration, and clinical usefulness were evaluated by receiver operating characteristics (ROC) curve, calibration curve, and decision curve analysis (DCA) analysis, respectively. The incidence of lacunar infarction was 34.50% and 33.00% in the training and validation sets, respectively. Five independent predictors were made up of the nomogram, including age (OR=1.142, 95% CI: 1.089-1.198,P<0.001), diabetes mellitus (OR=3.058, 95% CI: 1.396-6.697,P=0.005), atrial fibrillation (OR=3.103, 95% CI: 1.328-7.250,P=0.009), duration of hypertension (OR=1.130, 95% CI: 1.045-1.222,P=0.002), and low-density lipoprotein (OR=2.147, 95% CI: 1.250-3.688,P=0.006). The discrimination with area under the curve (AUC) was 0.847 (95% CI: 0.789-0.905) in the training set and was a slight increase to 0.907 (95% CI: 0.838-0.976) in the validation set. The calibration curve showed high coherence between the predicted and actual probability of lacunar infarction. Moreover, the DCA analysis indicated that the nomogram had a higher overall net benefit of the threshold probability range in both two sets. Age, diabetes mellitus, atrial fibrillation, duration of hypertension, and low-density lipoprotein were significant predictors of lacunar infarction in hypertensive patients. The nomogram based on the clinical data was constructed, which was a useful visualized tool for clinicians to assess the risk of the lacunar infarction in hypertensive patients.

Identification of risk factors for postoperative persistent hypertension in patients with pheochromocytoma.

Surgical resection is the primary management for pheochromocytoma. However, some patients with pheochromocytoma still suffer from hypertension after successful adrenalectomy. The risk factors for postoperative persistent hypertension remain unclear. Thus the aim of the present study was to identify the risk factors of postoperative persistent hypertension in patients with pheochromocytoma concomitant with hypertension. We retrospectively analyzed 259 patients with pheochromocytoma who underwent adrenalectomy in our hospital between January 1, 2007, and December 31, 2018. Patients'demographics, comorbidities, and perioperative data were recorded. The odds ratio (OR) and 95% confidence interval were measured through binary logistic regression. The cutoff values and the area under the curve (AUC) for continuous risk factors of persistent hypertension after adrenalectomy were calculated through receiver operating characteristic curve analysis. Of the 259 patients, 40.9% (106/259) patients experienced postoperative persistent hypertension. Three independent risk factors of persistent hypertension in patients with pheochromocytoma after adrenalectomy were found to be older age (OR = 1.16, p = 0.037), longer duration of hypertension (OR = 3.10, p = 0.01), and concomitance with cardiovascular events (yes vs. no, OR = 17.17, p = 0.049). The cutoff value of age and duration of hypertension was 66 years (AUC = 0.741, p < 0.0001) and 27 months (AUC = 0.991, p < 0.0001), respectively. Collectively, older age, a longer duration of hypertension, and concomitance with cardiovascular events were independent risk factors of persistent hypertension in patients with pheochromocytoma after adrenalectomy. These findings may help in improving perioperative management and follow-up strategies.

An evaluation of lower urinary tract symptoms among patients with hypertension: A cross-sectional study.

Hypertension (HTN) is a prevalent and impactful health concern associated with cardiovascular morbidity and mortality. This research delves into the intricate relationship between HTN and lower urinary tract symptoms (LUTS), acknowledging the multifaceted nature of these conditions and their potential impact on individuals' quality of life. This cross-sectional study, conducted in Nablus, Palestine, employed convenient sampling to recruit hypertensive patients from the Ministry of Health clinics between September and December 2023. The inclusion criterion involved confirmed hypertensive patients, while the exclusion criterion included individuals with specific health conditions. The collected data included demographic, comorbidity, and lifestyle factor data. The study utilized the urogenital distress inventory 6 (UDI-6) and Incontinence Impact Questionnaire (IIQ)-7 short forms to assess urinary distress symptoms and the impact of urinary incontinence on quality of life. All the statistical analyses, including Pearson, Chi-square, Fisher's exact, Kruskal-Wallis, and Mann-Whitney tests, were performed with various tests for significance, and the significance level was set at P < 0.05. Among the 351 participants meeting the inclusion criteria, females (62.1%) and married individuals (83.5%) were the predominant participants. The majority were aged 58-67 (42.5%), had a high school education (39.0%), and had a body mass index (BMI) of 30-34.9 (30.2%). Significant correlations were found between UDI-6 scores and sex, age, marital status, education level, employment status, and comorbidities. The IIQ-7 score was significantly correlated with female sex, marital status, age, comorbidities, duration of HTN, employment status, and education level. Both the UDI-6 and IIQ-7 scores revealed considerable impacts on urinary symptoms and quality of life. A significant negative correlation (r = -0.579) between the IIQ-7 score and UDI-6 score emphasized the interconnectedness of urinary distress symptoms and their impact on quality of life (P < 0.001). These findings underscore the multifaceted nature of LUTS and their profound effects on hypertensive patients' well-being. Our study revealed a significant association between HTN and LUTS, especially among females and specific demographic groups. This emphasizes the need for comprehensive management. The observed negative impact on quality of life emphasizes the significance of adopting holistic approaches to address both conditions.

Impact of adrenalectomy on hypertension in patients with nonfunctional adrenal tumors: a retrospective study.

To investigate the impact of adrenalectomy on hypertension in patients with nonfunctional adrenal tumors. Between January 2020 and October 2022, patients with adrenal lesions were retrospectively screened for nonfunctional adrenal tumors at the Zhongnan Hospital of Wuhan University. All patients underwent detailed endocrinological examination and computed tomography to characterize the lesions. One year after discharge, follow-up blood pressure (BP) was assessed and compared to the blood pressure on admission. Univariate analysis and multivariate regression analysis were performed to determine factors predicting favorable hypertension outcomes after adrenalectomy. A total of 309 patients were found to be eligible, including 123 who underwent adrenalectomy. Patients who underwent adrenalectomy were stratified into two groups: (Bancos I (2022) Adrenal Incidentalomas: Insights Into Prevalence. Ann Intern Med 175:1481-1482. https://doi.org/10.7326/M22-2600 ) those with improved hypertension (n = 71), and (Fassnacht M, Tsagarakis S, Terzolo M, Tabarin A, Sahdev A, Newell-Price J et al. (2023) European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol 189:G1-42. https://doi.org/10.1093/ejendo/lvad066 ) those without improved hypertension (n = 52). In contrast, the blood pressure levels of conservatively treated patients remained relatively stable 1 year after discharge. Univariate analysis and multivariate regression analysis showed that body mass index (BMI) and duration of hypertension were significantly different between the hypertension improvement group and the non-improvement group (p < 0.05). Adrenalectomy has been shown to be effective in improving hypertension in certain patients with nonfunctional adrenal tumors. BMI and duration of hypertension were independent factors associated with favorable hypertension outcomes after adrenalectomy.

The Correlation of β-Adrenoreactivity of Erythrocyte Membranes with Clinical and Laboratory Parameters in Patients with Resistant Hypertension in the Presence and Absence of Type 2 Diabetes Mellitus

The peculiarity of the conjugation of β-adrenoreactivity of membranes (β-ARM) erythrocyte, as an indicator of the state of autonomic regulation of the cardiovascular system, with other clinical and laboratory indicators in drug-resistant arterial hypertension (RAH) with the absence and presence of type 2 diabetes mellitus (DM2) was investigated. It was shown that patients with RAH, regardless of the presence of DM2, were characterized by reduced adrenoreactivity, while the beta-ARM index of erythrocytes was more than 2 times higher than the reference values. The intergroup difference in the mean values of beta-ARM erythrocytes and the frequency of cases of exceeding the established reference values by this indicator did not have significant differences. In RAH, regardless of the presence of DM2, the beta-ARM erythrocytes index of erythrocytes is statistically significantly associated with the variability of blood pressure, the volume of daily diuresis and increased contractile capacity of the left ventricle. In addition, in the presence of DM2, the association of β-ARM erythrocyte with an increase in left ventricular elastance, heart rate variability, duration of arterial hypertension and DM2 was revealed. Thus, with the development of RAH in humans, the β-ARM erythrocyte indicator can be a new biomarker for personalized assessment of the activity of autonomic regulation of the cardiovascular system. CD2 expands the conjugacy of β-ARM erythrocyte with clinical and laboratory parameters.

Association of SDF-1-3' Gene A Variant with Diabetic Retinopathy in the Hungarian Population.

We investigated the association between the SDF-1-3' (c801G > A) variant and the development of diabetic macular edema (DME) or proliferative diabetic retinopathy (PDR) in a Hungarian cohort. SDF-1-3' (c801G > A) was genotyped in 103 patients with diabetic retinopathy and 31 age- and sex-matched non-diabetic controls. Central retinal and choroidal thickness was measured by swept-source optical coherence tomography. The distribution of heterozygous and homozygous SDF-1-3' (c801G > A) genotypes was similar in diabetic and control subjects. The SDF-3'(c801AA) genotype was associated with DME (n = 94 eyes, allele distribution p = 0.006, genotype distribution p = 0.01 OR: 2.48, 95% CL: 1.21-5.08) in both univariable and multivariable modelling, independent of duration and type of diabetes, HbA1C, hypertension and microalbuminuria (p = 0.03). DME occurred earlier in patients carrying the SDF-1 (c801A) allele (Kaplan-Meier analysis, log-rank test p = 0.02). A marginally significant association was found between the presence of the SDF-1 (c801A) allele and the development of PDR (n = 89 eyes, p = 0.06). The SDF-1-3' (c801A) allele also showed a correlation with central retinal (p = 0.006) and choroidal (p = 0.08) thickness. SDF-1-3' (c801G > A) is involved in the development of macular complications in DM independent of critical clinical factors, suggesting that SDF-1 may be a future therapeutic target for high-risk patients, especially those carrying the SDF-1 (c801A) allele.

Evaluation of bone mineral density (BMD) and trabecular bone score (TBS) in pheochromocytoma and paraganglioma; a multi-centric case-control study from India.

Pheochromocytoma and paraganglioma (PPGL) have been associated with low bone mineral density (BMD) and increased fracture risks. Sympathetic nervous system stimulation has been shown to increase bone resorption and decrease bone formation via β2 receptors. Chronic inflammation and increased cytokine production add to more bone loss. TBS (trabecular bone score) is an established surrogate marker for bone histomorphometry. BMD and TBS data in pheochromocytoma and PPGL are scarce. The aim was to assess the BMD and TBS in pheochromocytoma and PPGL and look for clinical and biochemical predictors. This case-control study had sample size of 58 (29 cases and controls each). BMI-, age-, and sex-matched controls were taken for comparison. Both cases and controls had undergone DXA scan and BMD {Z-scores and bone mineral concentration (BMC) in g/cm2} and TBS were analyzed. Detailed clinical histories and relevant biochemistry values were noted. The mean age of our case population was 29.5 ± 9.4years with a mean age of HTN onset at 26.86 ± 6.6years. Lumbar spine BMC (0.86 ± 0.14 vs 0.96 ± 0.15; p = 0.036), femoral neck Z-score (- 1.23 ± 1.07 vs - 0.75 ± 0.97; p = 0.003), and whole body BMC (0.91 ± 0.14 vs 1.07 ± 0.11; p = 0.000) were significantly low in cases compared to controls. Similarly, TBS was significantly lower in cases compared to controls (1.306 ± 0.113 vs 1.376 ± 0.083; p = 0.001). This study establishes both low bone mass and poor bone quality in an Indian pheochromocytoma and PPGL patient's cohort. Plasma-free nor-metanephrine and duration of hypertension were found to be most consistent predictive factors in multivariate regression analysis.

Impact of Hypertension Duration on the Cardiovascular Benefit of Intensive Blood Pressure Control.

The optimal timing for initiating intensive systolic blood pressure (SBP) treatment remains unclear. While longer hypertension duration is positively associated with increased cardiovascular disease risk, it is unknown whether patients with prolonged hypertension can derive similar benefits from intensive SBP treatment. From the STEP trial (Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients), 8442 participants with complete hypertension duration data were categorized by hypertension duration ≤5 years, 5 to 10 years, 10 to 15 years, and >15 years. The primary outcome was a composite of cardiovascular events. Hazard ratios were calculated using the Fine-Gray subdistribution hazard model. The incidences of the primary outcome increased significantly in patients with hypertension over 15 years than those <5 years in the standard SBP treatment group (adjusted hazard ratios, 1.68 [95% CI, 1.11-2.56]) but not in the intensive treatment group. Each 1-year increase in hypertension duration continuously increased the adjusted risk of major cardiovascular events by 4% (95% CI, 1.01-1.08) up to 20 years, plateauing at an adjusted hazard ratio of 2.27 (95% CI, 1.28-4.04). After intensive SBP treatment, the incidences of major cardiovascular events were similar across different hypertension duration groups, which were 2.22%, 1.69%, 3.02%, and 2.52%, respectively (P>0.05). Subgroup analyses indicated a potential sex difference in this relationship between hypertension duration and the primary outcome in the standard SBP treatment group (Pinteraction=0.05). Initiating intensive SBP treatment at any stage of hypertension duration could reduce cardiovascular disease risk to a comparable level. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03015311.

Relation between blood pressure time in range and composite cardiovascular outcomes in patients with primary aldosteronism: a retrospective case study.

To investigate the association between blood pressure (BP) time in range (TIR) and composite cardiovascular outcomes in patients with primary aldosteronism (PA). Between January 2019 and December 2021, 47 patients with PA were recruited from the First Affiliated Hospital of Xiamen University. Twenty-four-hour ambulatory BP monitoring (ABPM) and cardiovascular outcomes were assessed in all patients during the first diagnosis of PA. The mean age of the patients was 48.8 ± 11.4 years. Compared to PA without composite cardiovascular outcomes, the nighttime systolic BP TIR [31.2% (6.2%, 81.2%) vs. 11.5% (0.0%, 29.7%), p = 0.02] and defined daily dose (DDDs) of antihypertensive medication [2.0 (1.0, 2.8) vs. 1.0 (1.0, 2.0), p = 0.03] were lower in PA patients with composite cardiovascular outcomes, while higher glucose (5.0 ± 1.0 mmol/L vs. 5.9 ± 1.5 mmol/L) and prevalence of a history of alcohol intake was higher in PA patients with composite cardiovascular outcomes. There were no differences in age, sex, BMI, smoking, duration of hypertension, lipid levels, aldosteronism, clinic BP, 24-hour mean BP, daytime or nighttime BP, percentage of nocturnal SBP or DBP decline, 24-hour BP TIR, daytime BP TIR, or nighttime DBP TIR between the two groups. After adjusting for confounding factors, nighttime systolic BP TIR was significantly associated with composite cardiovascular outcomes (adjusted OR = 0.92 [95% CI 0.86, 0.99]) in multiple logistic regression analysis. Nighttime systolic BP TIR was significantly associated with composite cardiovascular outcomes in patients with PA.

Gender differences in the elastic properties of the arterial wall in patients with arterial hypertension during the age-related evolution

Age-related changes in the elastic properties of the arterial wall in patients with arterial hypertension increase the risk of CV events. Additional CV risk factors in women lead to gender differences in vascular stiffness. The aim: to determine changes in the elastic properties of the arterial wall in patients with hypertension depending on gender, with considering of the age-related changes. Materials and methods: 258 patients with arterial hypertension stage II were examined: 132 women (55.56±7.69 years) and 126 men (51.75±8.42 years). By age, patients were divided into 5 subgroups (37–45, 45–49, 49–54, 54–58 and 58–69 years). The following were assessed: pulse wave velocity in the aorta (PWVao), central systolic blood pressure in the aorta (SBPao), central pulse blood pressure (cPBP), augmentation index in the aorta (Aix ao) and on the brachial artery (Aix br), PWV index (PWVind), amplification blood pressure (BPamp), pulse blood pressure index (C/B indPBP). Results: In the absence of differences in peripheral hemodynamics in all groups, women aged 49-54 years had a magnification of the PWV by 2 m/s, and, in comparison with men, this difference was 1.65 m/s (p &lt;0.05). Aix br and Aix ao were also superior to men in all groups, and in 49-54 years old, this difference was greatest and amounted to 39 % and 20 %, respectively. At this age, SBPao was also significantly raised in women, with a difference of 15 mmHg relative to men (p=0.038). In all age groups, women had negative values of the BPamp in contrast to men. In women, PWV correlated with the duration of hypertension (r=0.21; p&lt;0.05), SBP (r=0.40), DBP (r=0.35), cPBP (r=0.43), in contrast to men, where PWVao was associated only with the heart rate (r=0.30). Conclusion: In women with hypertension, changes in vascular wall stiffness occur earlier than in men with significant growth at 49–54 years. In women, the elastic properties of arteries are associated with the level of blood pressure and duration of the disease, and in men - with the level of the heart rate

The Relationship between Self-Efficacy and Adherence to Drug Therapy in Hypertension Patients at the Medan Freight Health Center

This study examines the relationship between self-efficacy and medication adherence among 83 hypertensive patients at the Sering Community Health Center in Medan. Using a cross-sectional design, self-efficacy was assessed using the General Self-Efficacy Scale, and adherence was measured through self-reported medication adherence. The findings reveal a significant positive correlation between self-efficacy and medication adherence, highlighting that patients with higher self-efficacy are more likely to adhere to prescribed treatment regimens. Duration of hypertension emerged as a significant predictor of adherence. These findings underscore the importance of psychological factors in chronic disease management and suggest that interventions aimed at enhancing self-efficacy could improve adherence and health outcomes among hypertensive patients. Future research should explore longitudinal designs to establish causal relationships and consider cultural factors in intervention strategies.

Knowledge, attitude and practices towards prevention and early detection of chronic kidney disease and associated factors in Ethiopia: A cross-sectional study.

Early detection of chronic kidney disease (CKD) is important because it enables clinicians to initiate effective treatment, preventing loss of kidney function, and delaying or avoiding progression to kidney failure. This study was aimed to assess knowledge, attitude, and practices towards prevention and early detection of CKD and associated factors. Institution based cross-sectional survey was done at Adama Hospital Medical College, Ethiopia, between November 24/2021 and December 24/2021 among 190 hypertensive patients. Data were entered into EpiData version 4.2.0.0 and analyzed by Statistical Package for Social Sciences (SPSS) version 23. The level of good knowledge, positive attitude, and good practice was 40.5%, 53.7%, and 47.4%, respectively. Government employed (AOR = 3.30, 95%CI: 1.38, 7.90), having an average monthly income of ≥3000 ETB (61.43 US dollars) (AOR = 2.95, 95%CI: 1.31, 6.66), and having a duration of ≥4 years since diagnosis of hypertension (AOR = 2.37, 95%CI: 1.11, 5.06) were factors significantly associated with good knowledge. Government employed (AOR = 2.56, 95%CI: 1.12, 5.87), having duration of hypertension ≥4 years since diagnosis (AOR = 2.16, 95%CI: 1.07, 4.36) were factors significantly associated with positive attitude. Government employed (AOR = 4.16, 95%CI: 1.38, 12.58), having an average monthly income of ≥3000 ETB (61.43 US dollars) (AOR = 6.74, 95%CI: 2.93, 15.52), having good knowledge towards prevention and early detection of CKD (AOR = 2.57, 95%CI: 1.14, 5.80) were significantly associated with good practice. The level of good knowledge, positive attitude, and good practice towards was low. Educational programs on these issues are required to minimize the burdens.

Risk factors and a predictive model for left ventricular hypertrophy in young adults with salt-sensitive hypertension.

Salt-sensitive hypertension is common among individuals with essential hypertension, and the prevalence of left ventricular hypertrophy (LVH) has increased. However, data from early identification of the risk of developing LVH in young adults with salt-sensitive hypertension are lacking. Thus, the present study aimed to design a nomogram for predicting the risk of developing LVH in young adults with salt-sensitive hypertension. A retrospective analysis of 580 patients with salt-sensitive hypertension was conducted. The training set consisted of 70% (n=406) of the patients, while the validation set consisted of the remaining 30% (n=174). Based on multivariate analysis of the training set, predictors for LVH were extracted to develop a nomogram. Discrimination curves, calibration curves, and clinical utility were employed to assess the predictive performance of the nomogram. The final simplified nomogram model included age, sex, office systolic blood pressure, duration of hypertension, abdominal obesity, triglyceride-glucose index, and estimated glomerular filtration rate (eGFR). In the training set, the model demonstrated moderate discrimination, as indicated by an area under the receiver operating characteristic (ROC) curve of 0.863 (95% confidence interval: 0.831-0.894). The calibration curve exhibited good agreement between the predicted and actual probabilities of LVH in the training set. Additionally, the validation set further confirmed the reliability of the prediction nomogram. In conclusions, the simplified nomogram, which consists of seven routine clinical variables, has shown good performance and clinical utility in identifying young adults with salt-sensitive hypertension who are at high risk of LVH at an early stage.