Hypertension In Blacks Research Articles

Food resources and kitchen skills plus aerobic training (FoRKS+) for black adults with hypertension: A pilot trial protocol

BackgroundMidlife hypertension is associated with cognitive decline and Alzheimer's disease and related dementia (ADRD), suggesting that blood pressure control may be a therapeutic target for dementia prevention. Given excess hypertension in non-Hispanic Black (NHB) adults, blood pressure control may also reduce ADRD disparities. We describe a pilot randomized controlled trial (RCT) to evaluate the feasibility and preliminary efficacy of a multicomponent lifestyle-based intervention versus enhanced usual care on cognition among middle-aged NHB adults. Methods and study designThe Food Resources and Kitchen Skills plus Aerobic Training (FoRKS+) study is a 2-arm, single-blinded trial that compares those receiving the FoRKS+ program (target N = 64) versus those receiving enhanced usual care (target N = 64) in local federally-qualified health centers. Key eligibility criteria include self-identified NHB adults between ages 35–75 with a mean systolic blood pressure ≥ 130 mm/Hg obtained from 24-h ambulatory blood pressure monitoring. The FoRKS+ program includes 5 weeks of hypertension self-management courses, 11 weeks of nutrition courses, and 12 weeks of aerobic training in dietitian and health coach-led virtual groups. We will collect data on primary cognitive outcomes, feasibility, hypothesized intervention mediators and moderators, and demographic and health covariates at baseline, near intervention weeks 16-, and 28 (primary outcome assessment), and week 52 follow-up. We will use mixed-effects modeling to examine intervention effects on cognition. DiscussionThis pilot RCT will examine the feasibility and preliminary effects of a multicomponent lifestyle intervention on cognitive function in NHB adults, which may have implications for reducing health disparities in ADRD.

MP75-14 ANTIHYPERTENSIVE CHOICES IN BLACK MEN CONTRIBUTE TO WORSENED RATES OF ED AND POOR HYPERTENSION CONTROL

You have accessJournal of UrologyCME1 Apr 2023MP75-14 ANTIHYPERTENSIVE CHOICES IN BLACK MEN CONTRIBUTE TO WORSENED RATES OF ED AND POOR HYPERTENSION CONTROL Denise Asafu-Adjei, Olivia Copelan, Cara Joyce, and Milan Patel Denise Asafu-AdjeiDenise Asafu-Adjei More articles by this author , Olivia CopelanOlivia Copelan More articles by this author , Cara JoyceCara Joyce More articles by this author , and Milan PatelMilan Patel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003349.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cardiovascular disease (CVD) is the leading cause of death in Black men in the U.S. Erectile dysfunction (ED) serves as an indicator of CVD. CVD disproportionately affects Black men, with hypertension being the leading contributor. Several studies have cited ED side effects as a major factor in antihypertensive noncompliance in Black men, further exacerbating hypertension and ED. For decades, guidelines have recommended thiazides and calcium channel blockers as first line therapies for hypertension in Blacks, despite these options being associated with increased rates of ED. A 2022 retrospective study by Holt et al showed that race-based hypertension guidelines yielded no clear benefits in patient outcomes. We aimed to assess the clinical characteristics and treatment patterns of hypertensive men with ED at an academic medical center. METHODS: All men presenting for an initial visit for ED (primary ICD-10 code N52.9) between October 2015-July 2022 were included for analysis. The electronic health record was queried for patient demographics, provider type, comorbidities, and major drug classes of antihypertensives. Adjusted odds ratios were estimated from multivariable logistic regression (any CVD and any medications) and ordinal logistic regression (number of CVD comorbidities) analyses. RESULTS: Of 2020 men who presented for ED, the mean age was 55±14, 49.7% were White (n=987, 49.7%), 24.8% Black (n=493), and 18.9% Hispanic (n=375). The most common cardiovascular comorbidity was hypertension (n=960, 47.5%). Underlying cardiovascular disease burden was generally higher among Black men. Black men had higher odds of being prescribed an antihypertensive (aOR vs White: 1.50, 95% CI: 1.16-1.93; aOR vs Hispanic: 1.96, 95% CI: 1.45-2.67). However, Black men were prescribed beta blockers and thiazides significantly more than White and Hispanic men. White men were prescribed angiotensin receptor blockers (ARBs) significantly more than Black and Hispanic men. CONCLUSIONS: This study mirrors the effects of race-based hypertension guidelines. ARBs have typically been more favorable antihypertensives when considering sexual function. In this study, we showed that Black men were prescribed ARBs at significantly lower rates compared to White and Hispanic men. Given the significant ED side effects has on hypertension compliance, shifting traditional treatment regimens could lead to improved rates of hypertension control and erectile function. ED sits in a unique position to impact how we solve the CVD crisis. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1085 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Denise Asafu-Adjei More articles by this author Olivia Copelan More articles by this author Cara Joyce More articles by this author Milan Patel More articles by this author Expand All Advertisement PDF downloadLoading ...

Should Estimated Glomerular Filtration Rate Be Adjusted for Race?

Should Estimated Glomerular Filtration Rate Be Adjusted for Race?

An assessment of ethnic and environmental influences on the phenotypes of hypertension

Abstract Background Hypertension is a growing global concern with developing countries now having the highest prevalence. Environmental factors such as socioeconomic status and diet, together with ethnicity-related factors may influence the development of hypertension and its complications such as left ventricular hypertrophy (LVH). However, the relative contributions of environment and ethnicity to these outcomes remain poorly understood. Purpose To test the hypothesis that black hypertensives living in Nigeria would have a higher prevalence of hypertensive target organ damage (i.e. LVH and dysfunction) compared with black hypertensives living in the UK. Methods We conducted a three-arm comparative study based on self-defined ethnicity and country of residence. We carried out detailed cardiovascular phenotyping in untreated Black hypertensives (n=53) living in Nigeria (BNig), untreated Black (BUK) hypertensives (n=25), and untreated White (WUK) hypertensives (n=59) living in the UK. We measured brachial and central blood pressure and undertook 2D echocardiography in all the participants. In addition, we collected serum and 24-hour urine biochemistry. Results The three groups had similar mean age and BMI (Table 1). The BNig group had significantly higher brachial SBP (P=0.01) and LV mass index (LVMI); P<0.001) compared with the BUK group. Furthermore, both BNig & BUK groups each had significantly higher brachial SBP (BNig: 162mmHg, BUK: 151mmHg) and LVMI (BNig: 100.9g/m2, BUK:86.4 g/m2) compared with the WUK group (Brachial SBP: 144mmHg, LVMI: 82.2g/m2). The prevalence of concentric LVH was similar in the two UK groups (BUK: 10%, WUK: 12%) but higher in the BNig group (41%). Septal early diastolic velocity was significantly lower in BNig group (7.0cm/s) compared to BUK (10.0cm/s) and WUK (10.0 cm/s). After adjusting for 24-hour sodium, brachial SBP (162mmHg) in the BNig group was still significantly higher compared with the other two groups [F(2,109)=13.805, BK (151mmHg, P=0.032), White UK (145mmHg, P<0.001)). However, after controlling for SBP, difference in LVMI persisted only between the BNig (EMM: 98.4 g/m2) versus WUK (EMM: 84.2 g/m2) groups, with no significant difference in BNig vs BUK (86.6g/m2, P=0.156) [F(2,128)=4.245, p=0.016]. Conclusion Our data suggest that higher SBP and salt intake do not explain all of the environmental differences in the prevalence of LVH and LV dysfunction in hypertensive patients drawn from different ethnicities and environments, suggesting that other factors are likely to play an important role. Further work is in a larger group is required to confirm these findings. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Niger Delta Development Commission

Longer Run Effects of Medicaid Expansion on Racial/Ethnic Disparities in Intermediate Health Outcomes Among a National Sample of FQHCs

Research ObjectivePrior to implementation of Medicaid expansion under the Affordable Care Act, 40% of federally qualified health center (FQHC) patients across the US were uninsured, 92% had incomes below 200% of the federal poverty level, and 65% were from racial/ethnic minority groups. While recent evidence has found that Medicaid expansion was associated with short‐term gains in insurance coverage and receipt of recommended services at FQHCs, there is limited evidence about the longer‐term impacts of expansion on health outcomes, and no known evidence about longer‐term impacts on racial/ethnic disparities in health outcomes. Thus, our objective was to assess the six‐year impact of Medicaid expansion on racial/ethnic disparities in intermediate health outcomes using nationally representative data on all FQHCs.Study DesignUsing the 2011–2019 Uniform Data System, we measured three available intermediate clinical quality measures that may be sensitive to Medicaid expansion: (1) percent of adult diabetic patients with a hemoglobin A1c level of less than 9%; (2) percent of adult hypertensive patients whose blood pressure was less than 140/90 mmHg; and (3) percentage of live births among FQHC prenatal care patients with normal birth weight (> = 2500 grams). The clinical quality measures were assessed for the full population and separately for each racial/ethnic group.We conducted staggered difference‐in‐differences (DID) analyses to compare outcomes in FQHCs located in expansion versus non‐expansion states. For each measure, a difference‐in‐difference was calculated using a linear probability model. All models included an indicator for whether the FQHC was ever in the expansion treatment group; an indicator for whether the FQHC was in a state that was actively implementing Medicaid expansion as of year y (the parameter of interest); a vector of time‐variant covariates; state and year fixed effects; and clustered errors at the FQHC‐level.Population Studied100% sample of all FQHCs in the US (N = 1042 after exclusions), representing over 20 million patients per year.Principal FindingsIn states that expanded Medicaid, the percent of FQHC patients without insurance declined substantially subsequent to expansion, with the largest declines occurring during the initial expansion year. The impact of expansion on outcomes took 2–3 years post‐expansion to be detected, where by year six, expansion was associated with the greatest magnitude of change in (1) blood pressure control among Black patients (difference‐in‐difference by year 6: 3.32 PP, 95% CI 0.64–5.99) and Hispanic patients (difference‐in‐difference by year 6: 2.44 PP, 95% CI 0.09–4.78) and (2) diabetes control among Hispanic patients (difference‐in‐difference in year 6: 3.53 PP, 95% CI 1.02–6.04). Racial/ethnic disparities decreased for White vs. Black hypertension control only. No statistically significant effect on birth weight was observed, although this appeared to be due to fewer pregnant women receiving prenatal care at FQHCs post‐expansion.ConclusionsThe first six years of Medicaid expansion were associated with increases in insurance coverage and improvement in two of three measured intermediate health outcomes among FQHC patients, especially for Black and Hispanic patients, but these changes took 2–3 years to be detected.Implications for Policy or PracticeFindings highlight the longer‐term, significant role of Medicaid expansion in improving health outcomes. Efforts to limit eligibility may compromise this progress.Primary Funding SourceAgency for Healthcare Research and Quality.

Abstract MP38: Identification Of A Gut Microbe That Attenuates The Blood Pressure Lowering Effect Of ACEi Quinapril

Introduction: Treatment resistant hypertension (rHTN) is present in ~20% of all hypertensive patients. rHTN is critical in African American patients who experience early onset, severe outcomes, and weak responsiveness to angiotensin converting enzyme inhibitor (ACEi). The mechanism for drug resistance is unknown. Gut microbiota harbors biotransformative enzymes such as esterase, which may hydrolyze ACEis, reducing absorption. Our study was to identify microbe responsible for ACEi resistance. Methods: 16-week-old male Spontaneously Hypertensive Rats (SHR) were gavaged with (N=12) or without (N=6) Vancomycin, Meropenem, and Omeprazole (VMO) 50 mg/kg/day for five days to deplete the gut microbiota. A single 8mg/kg dose of quinapril was given to SHR and SHR+VMO before blood pressure (BP) recording via telemetry. Quinapril catabolism was quantified by liquid chromatography-mass spectrometry. Bacterial esterase activity was monitored by hydrolysis of p-nitro-phenylbutyrate. Cecal microbiota was analyzed by 16S rDNA. Fecal microbiota were analyzed by metagenomics in 29 (16 black, 13 white) HTN patients. Results: Quinapril lowered BP more in the SHR+VMO than SHR ( P <0.0001). With a 50% reduction in bacterial 16S copy numbers ( P <0.0001), the SHR+VMO group showed (1) reduced Coprococcus ( P <0.0001); (2) lower esterase activity per gram of cecal microbiota to hydrolyze quinapril ( P =0.0065); (3) a 50% lower reduction in quinapril quantity (nmol) after incubation with 1mg of cecal lysate for 3 hr ( P <0.0001); (4) decreased bacterial genes in KEGG drug metabolism pathway ( P <0.0001). The abundance of Coprococcus positively correlated with genes in drug metabolism ( P <0.0001). Importantly, co-administration of quinapril with C. comes, a species in Coprococcus genus, reduced the BP-lowering effects of quinapril in the SHR ( P <0.0001). Comparison of human microbiota demonstrated a higher abundance of C. comes in the black hypertensives (poor ACEi responder) than the white (ACEi responder) ( P =0.0167). Conclusion: We, for the first time, demonstrate a previously unrecognized role of gut microbes in reducing ACEi effectiveness. This serves a foundation for expanding clinical management of antihypertensive drug resistance via manipulation of gut microbiota.

Unravelling racial differences in hypertensive heart disease by multiparametric cardiovascular magnetic resonance: a phenotype-wide association study

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Dr Georgiopoulos was supported by the Onassis Foundation under the special grant & support program for scholars" association members Introduction – Black Afro-Caribbean hypertensives (BAHs) are exposed to a higher risk of heart failure (HF) than white hypertensives (WHs). Arterial afterload is higher in BAHs due to increased arterial stiffness and vascular volume; BAHs develop more often left ventricular (LV) hypertrophy, dilatation and systolic dysfunction than WHs. However, it is unclear whether other racial differences concur to the more pronounced LV remodelling in BAHs. Methods – This cross-sectional study included hypertensive patients undergoing cardiovascular magnetic resonance for their clinical work-up (1.5T Aera Siemens-Healthcare). Clinical history and haemodynamic parameters were collected in all participants; a subset of patients had complete bio-humoral assay of the renin-angiotensin-aldosterone system (RAAs). Arm cuff pressure was measured during CMR. The CMR protocol included: i) Arterial afterload / LV arterial-coupling - pulse-wave-velocity (PWV), aortic (Ea) and LV elastance (Ees) by aorta anatomic and phase-contrast velocity-encoding imaging; ii) ventricular remodelling and function - LV and right ventricular (RV) volumes, mass, EF, LV peak-filling rate by short-axis cine images; global circumferential and longitudinal strains by cine feature tracking; iii) left atrial (LA) remodelling volumes and reservoir, conduit and booster functions by long-axis cine images; iv) tissue characterisation: T2 and pre/post-contrast T1 relaxation times, extracellular volume (ECV) by single mid-ventricular short-axis T1/T2-mapping. Results – 34 BAHs and 35 WHs (52 ± 12 vs 45 ± 14 years, P < 0.05; 61% vs 65% males P = NS) were included in the study. Baseline features are summarised in the Table. LV systolic dysfunction was more prevalent in BAH than WHs (P = 0.038). Of note, BAHs tended to have greater LV volumes and significantly higher LV mass and septal thickness than WHs. In BAHs, but not in WHs, PWV was associated with increased septal thickness after correction for blood pressure and age (β-value: 0.447, P = 0.02). Normalised RV mass was greater in BHA than WHs; RV mass suits for the identification of racial or circulating factors predisposing to hypertrophy being largely unaffected by systemic afterload. In our study LV diastolic function and LA volumes were similar between BAHs and WHs, and none of the subjects had conditions associated with pre-capillary pulmonary hypertension. Hence, higher RV-mass in BAHs pinpoints a racial susceptibility to myocardial hypertrophy. Finally, in a subset of patients with RAAs assays (n = 43), the aldosterone/renin ratio was higher in BAHs than WHs (67.04 [IQR: 19.37-209.73] vs 13.77 [IQR: 7.47-40.43], P = 0.01). Conclusion – BAHs have heightened LV remodelling than WHs because of racial predisposition to develop hypertrophy which also encompasses derangements in RAAs. Altogether, these findings may account for the greater risk for HF in BAHs than WHs.

Amlodipine or Lisinopril in Combination with Bendroflumethiazide in Clinic Blood Pressure Control among Hypertensive Tanzanians with Moderate to Severe Hypertension: A Comparison Study

Recent guidelines have suggested combination therapy as initial treatment in hypertensive patients with ≥ grade 2 hypertension, aiming to achieve target blood pressure (BP) goal faster and more effectively. Both calcium channel blockers (CCBs) and angiotensin converting enzyme inhibitors (ACEIs) are in the list of first-line antihypertensives, however the choice of the combination therapy is left to the discretion of the clinician, and there are concerns that ACEIs are less effective in BP reduction among black hypertensives.

Chlorthalidone or Hydrochlorothiazide for Treatment of Hypertension

Chlorthalidone or Hydrochlorothiazide for Treatment of Hypertension

A Qualitative Study: Hypertension Stigma Among Black Women.

The prevalence of hypertension (HTN) in Blacks is among the highest in the world. For Black women, 46% experience stage 2 HTN (blood pressure [BP] ≥140/90 mm Hg) as compared with 42% of Black men. Because of higher rates of stage 2 HTN, Black women have greater rates of cardiovascular disease and stroke. For reasons unknown, nonadherence to lifestyle modifications and antihypertensive medications continues. An understudied potential factor associated with poor adherence to the treatment regimen and negative health outcomes is stigma. The aim of this study was to gain insight and describe the psychological factor of stigma as an influence on poorly controlled HTN in Black women. Hypertensive Black women attending a 6-week self-management program were invited to participate in an open-ended questionnaire. Six groups were held with 62 women aged 24 to 70 years, with group size ranging from 10 to 15. Women anonymously wrote their answer to 2 questions to capture individual responses without group persuasion. Data were analyzed using thematic analysis. Five themes were generated inductively from the data and included (1) desire to get control, (2) shame and embarrassment, (3) obesity characterizations, (4) stereotype threats, and lastly, (5) disrupted normality. During member checking, younger participants were more vocal about stigma, whereas older participants did not view stigma as problematic. Hypertension stigma could potentially deter adherence to high BP treatment. Further research is needed to explore the prevalence of stigma in this population and its impact on behaviors that hinder BP control.

Traditional Vascular Risk Factors Account for Different Proportions of Ischemic Stroke Within Different Gender and Race Groups

Background Few studies have compared the proportion of ischemic strokes attributable to traditional vascular risk factors (population-attributable risk percent or PAR%) between genders and races. The PAR% is a function of the population prevalence and strength of association of a risk factor. Methods A population-based case-control study of ischemic stroke in young adults ages 18-49 in the Baltimore-Washington region was used to study the prevalence, odds ratios, and PAR% of hypertension, diabetes, and smoking among blacks and whites. Logistic regression was used to calculate age-adjusted odds ratios. All analyses were stratified by gender. Results There were 1044 cases and 1099 controls. Of the cases, 47% were black, 54% were women. Roughly a quarter to a third of all strokes in women were attributable to smoking. Due to the higher prevalence of hypertension and a higher odds ratio for hypertension in black men (OR 3.9, 95% CI 2.6-5.9) compared to white men (OR 1.8, 95% CI 1.3-2.6), there was a much higher PAR% for hypertension among black men than white men. See Table 1 for prevalence and Table 2 for PAR% stratified by gender and race. Conclusion Traditional vascular risk factors have the potential to explain a high proportion of ischemic stroke in young adults. The high proportion of strokes in women attributable to smoking underscores the need for targeted smoking cessation interventions in this population. Diabetes and, especially, hypertension are important contributors to the excess population burden of ischemic stroke among blacks. These findings support the value of early screening and treatment for hypertension in young blacks.

Short Term Cardiovascular Effects and Oxidative Status of Calcium and Vitamin D Supplementation of Postmenopausal Hypertensive Blacks Women

Short Term Cardiovascular Effects and Oxidative Status of Calcium and Vitamin D Supplementation of Postmenopausal Hypertensive Blacks Women

Abstract WMP53: Traditional Vascular Risk Factors Account for Different Proportions of Ischemic Stroke Within Different Gender and Race Groups

Introduction: Few studies have compared the proportion of ischemic strokes attributable to traditional vascular risk factors (population-attributable risk percent or PAR%) between genders and races. The PAR% is a function of the population prevalence and strength of association of a risk factor. Methods: A population-based case-control study of ischemic stroke in young adults ages 18-49 in the Baltimore-Washington region was used to study the prevalence, odds ratios, and PAR% of hypertension, diabetes, and smoking among blacks and whites. Logistic regression was used to calculate age-adjusted odds ratios. All analyses were stratified by gender. Results: There were 1044 cases and 1099 controls. Of the cases, 47% were black, 54% were women. Roughly a quarter to a third of all strokes in women were attributable to smoking. Due to the higher prevalence of hypertension and a higher odds ratio for hypertension in black men (OR 3.9, 95% CI 2.6-5.9) compared to white men (OR 1.8, 95% CI 1.3-2.6), there was a much higher PAR% for hypertension among black men than white men. See Table 1 for prevalence and Table 2 for PAR% stratified by gender and race. Conclusion: Traditional vascular risk factors have the potential to explain a high proportion of ischemic stroke in young adults. The high proportion of strokes in women attributable to smoking underscores the need for targeted smoking cessation interventions in this population. Diabetes and, especially, hypertension are important contributors to the excess population burden of ischemic stroke among blacks. These findings support the value of early screening and treatment for hypertension in young blacks.

ARMC 5 Variants and Risk of Hypertension in Blacks: MH- GRID Study.

BackgroundWe recently found that ARMC5 variants may be associated with primary aldosteronism in blacks. We investigated a cohort from the MH‐GRID (Minority Health Genomics and Translational Research Bio‐Repository Database) and tested the association between ARMC5 variants and blood pressure in blacks.Methods and ResultsWhole exome sequencing data of 1377 blacks were analyzed. Target single‐variant and gene‐based association analyses of hypertension were performed for ARMC5, and replicated in a subset of 3015 individuals of African descent from the UK Biobank cohort. Sixteen rare variants were significantly associated with hypertension (P=0.0402) in the gene‐based (optimized sequenced kernel association test) analysis; the 16 and one other, rs116201073, together, showed a strong association (P=0.0003) with blood pressure in this data set. The presence of the rs116201073 variant was associated with lower blood pressure. We then used human embryonic kidney 293 and adrenocortical H295R cells transfected with an ARMC5 construct containing rs116201073 (c.*920T>C). The latter was common in both the discovery (MH‐GRID) and replication (UK Biobank) data and reached statistical significance (P=0.044 [odds ratio, 0.7] and P=0.007 [odds ratio, 0.76], respectively). The allele carrying rs116201073 increased levels of ARMC5 mRNA, consistent with its protective effect in the epidemiological data.Conclusions ARMC5 shows an association with hypertension in blacks when rare variants within the gene are considered. We also identified a protective variant of the ARMC5 gene with an effect on ARMC5 expression confirmed in vitro. These results extend our previous report of ARMC5’s possible involvement in the determination of blood pressure in blacks.

Sodium Reduction, Metabolomic Profiling, and Cardiovascular Disease Risk in Untreated Black Hypertensives.

Dietary sodium restriction has multiple beneficial effects on cardiovascular health. The underlying mechanisms are not fully understood, and the roles of metabolomics have been rarely studied. We aimed to test the hypothesis that the reduction in dietary sodium intake would induce changes in metabolomic profiling among black hypertensives, and the changes would be associated with reduced blood pressure (BP) and improved skin capillary density. A total of 64 untreated black hypertensives were included from a randomized, double-blind, placebo-controlled cross-over trial of sodium reduction. The participants were given either 9 slow sodium tablets (10 mmol sodium per tablet) or placebo tablets daily for 6 weeks, they then crossed over to receive the other tablets for another 6 weeks, while on reduced sodium diet aiming at achieving daily sodium intake around 2.0 g. Untargeted metabolomic profiling was performed in paired serum samples, which were collected at the end of each period, so were BP and capillary density. Mixed-effects models were used. There were 34 metabolites identified with raw P's<0.05. Among those, 2 metabolites including β-hydroxyisovalerate and methionine sulfone were significantly increased with sodium reduction (false discovery rate =0.006 and 0.099, respectively). Increased β-hydroxyisovalerate was associated with reduced office systolic BP and ambulatory daytime systolic BP, whereas increased methionine sulfone was associated with reduced 24-hour diastolic BP, ambulatory nighttime diastolic BP, and increased skin capillary density. Our results suggest that dietary sodium reduction increases the circulating levels of β-hydroxyisovalerate and methionine sulfone. Further studies are warranted. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT00152074.

Association Between Sleep Apnea and Blood Pressure Control Among Blacks.

Blacks have a high prevalence of hypertension and uncontrolled blood pressure (BP), each of which may be partially explained by untreated sleep apnea. We investigated the association of sleep apnea with uncontrolled BP and resistant hypertension in blacks. Between 2012 and 2016, Jackson Heart Sleep Study participants (N=913) underwent an in-home Type 3 sleep apnea study, clinic BP measurements, and anthropometry. Moderate or severe obstructive sleep apnea (OSA) was defined as a respiratory event index ≥15, and nocturnal hypoxemia was quantified as percent sleep time with <90% oxyhemoglobin saturation. Prevalent hypertension was defined as either a systolic BP ≥130 mm Hg or diastolic BP >80mm Hg, use of antihypertensive medication, or self-report of a diagnosis of hypertension. Controlled BP was defined as systolic BP <130 mm Hg and diastolic BP <80 mm Hg; uncontrolled BP as systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg with use of 1 to 2 classes of antihypertensive medication; and resistant BP as systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg with the use of ≥3 classes of antihypertensive medication (including a diuretic) or use of ≥4 classes of antihypertensive medication regardless of BP level. Multinomial logistic regression models were fit to determine the association between OSA severity and uncontrolled BP or resistant hypertension (versus controlled BP) after multivariable adjustment. The analytic sample with hypertension (N=664) had a mean age of 64.0 (SD,10.6) years, and were predominately female (69.1%), obese (58.6%), and college educated (51.3%). Among the sample, 25.7% had OSA, which was untreated in 94% of participants. Overall, 48% of participants had uncontrolled hypertension and 14% had resistant hypertension. After adjustment for confounders, participants with moderate or severe OSA had a 2.0 times higher odds of resistant hypertension (95% confidence interval [CI], 1.14-3.67). Each standard deviation higher than <90% oxyhemoglobin saturation was associated with an adjusted odds ratio for resistant hypertension of 1.25 (95% CI 1.01-1.55). OSA and <90% oxyhemoglobin saturation were not associated with uncontrolled BP. Untreated moderate or severe OSA is associated with increased odds of resistant hypertension. These results suggest that untreated OSA may contribute to inadequate BP control in blacks.

Abstract P405: Racial Disparities in Ischemic and Hemorrhagic Post-stroke Mortality in United States Veterans

Introduction: Blacks and Hispanics have been shown to have higher stroke mortality than non-Hispanic whites. However, this may be due to higher incidence of strokes in blacks and Hispanics. Fewer studies have investigated health disparities in post-stroke mortality stratified by stroke type. We studied risk of mortality by race/ethnicity after either incident acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) in a national sample of patients from the Veteran’s Health Administration (VHA). Methods: We included patients with a first occurrence of an inpatient AIS or ICH in a VHA hospital between 2002-2007. We categorized patients as non-Hispanic white, non-Hispanic black, or Hispanic. Veterans with any prior stroke-related code were excluded. For each of AIS and ICH, we constructed a piecewise multivariate survival model for post event all-cause mortality. We separated follow-up intervals into &lt;30 day, 30-90 day, 90 day-1 year, and &gt;1 year post admission. Results: We identified 36,569 patients with an incident stroke in 2002-2007 (91% AIS, 9% ICH). The proportion of white, black, and Hispanic patients with AIS was 68%, 26%, and 6% respectively; and in ICH was 63%, 27%, and 10%. Compared to whites, blacks had better survival for AIS in the first 30 days, while Hispanics tended to have better survival in the 30-90 day and &gt;1 year intervals. With ICH, blacks had higher mortality in the first 30 days. (Table 1) Conclusion: Blacks experience better 30-day survival after AIS compared to whites, but worse 30-day survival after ICH. This may be driven by higher prevalence of hypertension in blacks leading to small vessel occlusion, which is associated with lower mortality, or poorer control of blood pressure in the setting of ICH, which is associated with higher mortality. Hispanic patients may have better long-term survival after stroke compared to whites, a ‘Hispanic paradox’ that has been shown in other studies. Stroke events should be stratified by ischemic and hemorrhagic type when evaluating for racial disparities in outcomes.

Abstract WP203: Frequency of Post-stroke Depression Among Hypertensive Black and Hispanic Stroke Survivors

Introduction: Post-stroke depression (PSD) is estimated to affect one-third of stroke survivors and is associated with long-term disability but scarce data exist in minority populations. This analysis examined the frequency and correlates of PSD in a cohort of Black and Hispanic stroke survivors. Methods: We analyzed baseline data from an ongoing clinical trial comprising 450 Blacks and Hispanics with recent stroke from New York City stroke centers. Participants were interviewed at baseline to assess depressive symptoms using the Patient Reported Outcomes Measurement Information System (PROMIS) Depression Measure. PSD was defined as a PROMIS score ≥55 indicating at least mild depression. Other data collected included demographics, clinical factors, health-related quality of life, functional independence (Barthel Index), stroke-related disability and executive functioning (Frontal Assessment Battery). Results: Data was available for 209 Hispanics and 202 Blacks. The sample was 44% female with average age 61.7±11.1 years. Socioeconomic status was low with 72.6% of participants having annual income &lt;$25,000 and 49.3% having less than high school education. PSD was identified in 32.4% of the sample. In bivariate analyses, participants with vs. without PSD were more likely to be female (54.2% vs. 39.2%, p=.003), on disability (44.0% vs. 25.9%, p&lt;.001) and have annual income &lt;$25,000 (81.6% vs 68.3%, p=.011). Participants with vs. without PSD also had lower baseline systolic BP (146.6±12.0 vs. 150.4±15.9, p=.005), were more likely to have ≥3 comorbid conditions (39.6% vs. 26.3%, p=.014), and had worse scores on all measures of physical disability, functional independence, cognitive function and quality of life (p≤.01). In multivariate analysis, PSD was associated with younger age, lower quality of life and not being married (p&lt;.05). In addition, foreign-born participants were more likely than US-born participants to have PSD (OR=3.34, 95% CI=1.40-7.97, p=.006). Conclusions: PSD was common in this cohort of minority stroke survivors and was associated with cognitive and physical disability. The finding of a higher rate in foreign-born survivors is novel and warrants further research regarding long-term effects of PSD in this population.

Diagnostic Thresholds for Blood Pressure Measured at Home in the Context of the 2017 Hypertension Guideline.

Most guidelines have recommended lower home blood pressure (BP) threshold when clinic BP threshold of 140/90 mm Hg is used for diagnosis of hypertension. However, home BP thresholds to define hypertension have never been determined in the general population in the United States. We identified home BP thresholds for stage 1 (BP ≥130/80 mm Hg) hypertension using a regression-based approach in the DHS (Dallas Heart Study; n=5768) and the NCMH study (North Carolina Masked Hypertension; n=420). Home BP thresholds were also assessed using outcome-derived approach based on the composite of all-cause mortality or cardiovascular events in the DHS cohort. For this approach, BP thresholds were identified only for systolic BP because diastolic BP was not associated with the outcome. Among untreated participants, the regression-derived thresholds for home BP corresponding to clinic BP for stage 1 hypertension were 129/80 mm Hg in blacks, 130/80 mm Hg in whites, and 126/78 mm Hg in Hispanics, respectively. The results are similar in the North Carolina cohort. The 11-year composite cardiovascular and mortality events corresponding to clinic systolic BP >130 mm Hg were higher in blacks than in whites and Hispanics (13.3% versus 5.98% versus 5.52%, respectively). Using a race/ethnicity-specific composite outcome in the untreated DHS participants, the outcome-derived home systolic BP thresholds corresponding to stage 1 hypertension were 130 mm Hg in blacks, 129 mm Hg in whites, and 131 mm Hg in Hispanics, respectively. Our data based on both regression-derived and outcome approach support home BP threshold of 130/80 mm Hg for diagnosis of hypertension in blacks, whites, and Hispanics.

A11974 SNX1 Loss Manifests with Increased Oxidative Stress and Hypertension

Objectives: Acute depletion of renal sorting nexin 1 (SNX1) results in blunted natriuretic response and hypertension in mice due to impaired dopamine D5 receptor (D5R) activity. We elucidated the molecular mechanisms for these phenotypes in Snx1−/− mice, which have a congenital absence of SNX1. Methods: Basal reactive oxygen species (ROS) levels, NOX activity, and blood pressure of Snx1−/− mice and the activity of cAMP and sodium transport of renal proximal tubule cells from hypertensive (HT) were measured. Results: These mice had increased renal expression of AT1R, NADPH oxidase (NOX) components, D5R, sodium-chloride cotransporter, and the antioxidant paraoxonase 2. Basal reactive oxygen species (ROS) levels, NOX activity, and blood pressure were also markedly higher in Snx1−/− mice, which were normalized by apocynin, a drug that prevents NOX assembly. HT renal proximal tubule cells from Caucasian males have deficient SNX1, impaired D5R endocytosis, and increased ROS compared with cells from normotensive (NT) male subjects. siRNA - mediated depletion of SNX1 in NT cells led to a blunting of agonist-induced increase in cAMP production and decrease in sodium transport, while gene rescue via over-expression of SNX1 in HT cells normalized the D5R agonist-mediated stimulation of cAMP production and inhibition of sodium transport. Three of the 12 single nucleotide polymorphisms interrogated for the SNX1 gene associated with poor blood pressure response to thiazide among hypertensive blacks. Conclusion: Our data demonstrate a new paradigm for the development of hypertension.