Female Hypertension Research Articles

Rat Model of Menopausal/Andropausal Hypertension with Different Sensitivities to Non-Genomic Antihypertensive Responses of Female and Male Sex Steroids

Introduction: Hypertension is prevalent in older women and men, but the impact of sex differences is unclear. Methods: Blood pressure (BP) was evaluated weekly for 15 weeks using tail-cuff plethysmography in intact or gonadectomized female and male rats. Similarly, gonadectomized rats were subcutaneously treated daily for 15 weeks with estradiol in females or testosterone in males. Treatment with estrogen in males and androgen in females for BP was also examined. The non-genomic antihypertensive potency and efficacy of different sex steroids were determined; catheters were implanted in the carotid artery of hypertensive rats for BP recording with bolus injections in the jugular vein at cumulative doses (1 × 10−7−1 × 10−4M kg−1 min−1) of dehydroepiandrosterone (DHEA), estradiol, testosterone, or 5β-dihydrotestosterone (5β-DHT). Results: Data showed a time-dependent increase in BP after gonadectomy in female and male rats until hypertension values were reached. Males are more sensitive to the development of hypertension than females. The increases in BP in females and males were completely prevented by estradiol or testosterone, respectively. Testosterone completely prevented hypertension in females, whereas estradiol only partially in males. Antihypertensive potencies in conscious hypertensive rats were DHEA = 5β-DHT = testosterone >> estradiol, in females and DHEA = 5β-DHT >> testosterone >> estradiol in males. The efficacy was DHEA = 5β-DHT = testosterone >> estradiol in females and 5β-DHT = DHEA >> testosterone >> estradiol in males. Conclusion: Gonadectomized males developed hypertension faster than females, suggesting that androgen deficiency plays an important role in BP reduction. Antihypertensive responses of steroids are structure-dependent; estradiol demonstrated the lowest potency, whereas 5β-DHT was a potent antihypertensive without estrogenic and androgenic actions, suggesting it is as a therapeutic candidate for controlling hypertension in both sexes.

Adherence to guideline-recommended care of late-onset hypertension in females versus males: A population-based cohort study.

Sex-based disparities in cardiovascular outcomes may be improved with appropriate hypertension management. To compare the evidence-based evaluation and management of females with late-onset hypertension compared to males in the contemporary era. Design: Retrospective population-based cohort study. Ontario, Canada. Residents aged ≥66 years with newly diagnosed hypertension between January 1, 2010, and December 31, 2017. Sex (female vs. male). We used Poisson and logistic regression to estimate adjusted sex-attributable differences in the performance of guideline-recommended lab investigations. We estimated adjusted differences in time to the prescription of, and type of, first antihypertensive medication prescribed between females and males, using Cox regression. Among 111,410 adults (mean age 73 years, 53% female, median follow-up 6.8 years), females underwent a similar number of guideline-recommended investigations (adjusted incidence rate ratio, 0.997 [95% confidence interval [CI] 0.99-1.002]) compared to males. Females were also as likely to complete all investigations (0.70% females, 0.77% males; adjusted odds ratio, 0.96 [95% CI 0.83-1.11]). Females were slightly less likely to be prescribed medication (adjusted hazard ratio [aHR] 0.98 [95% CI 0.96-0.99]) or, among those prescribed, less likely to be prescribed first-line medication (aHR, 0.995 [95% CI 0.994-0.997]). Compared to males, females with late-onset hypertension were equally likely to complete initial investigations with comparable prescription rates. These findings suggest that there may be no clinically meaningful sex-based differences in the initial management of late-onset hypertension to explain sex-based disparities in cardiovascular outcomes.

Abstract P359: Greater NLRP3 in Males Results in a More Pro-Inflammatory T cell Profile, but Comparable Increases in Blood Pressure to Females with DOCA-Salt

T cells contribute to the development of hypertension, but what mediates T cell activation in hypertension is still being investigated. The NLRP3 inflammasome is a key mediator of the inflammatory response, and NLRP3 contributes to deoxycorticosterone acetate (DOCA)-salt hypertension in male mice. Little is known regarding the role of NLRP3 in hypertensive females, but we previously published that greater increases in blood pressure (BP) in male DOCA-salt rats vs females is associated with a more pro-inflammatory T cell profile. The goal of the current study was to test the hypothesis that greater NLRP3 activation in males contributes to greater increases in BP and a more pro-inflammatory T cell profile than in females. Methods: Initial studies measured NLRP3 and IL1-β mRNA expression in kidneys of uninephrectomized (UNX) male and female Sprague Dawley rats randomized to vehicle or DOCA treatment (n=5/group). Additional UNX male and female rats were randomized to DOCA plus vehicle or an NLRP3 inhibitor, MCC950 (10 mg/kg), for 3 weeks. BP was measured via telemetry (n=5/group). Kidneys were harvested for flow cytometric analysis of T cells. Data were compared via 2-way ANOVA. Results: DOCA increased renal NLRP3 and IL1-β mRNA in males and females (NLRP3: P treatment <0.0001, P sex =0.0014; IL1-β: P treatment <0.0001, P sex =0.05), and increases were greater in males (P interaction =0.04, P interaction =0.02, respectively). DOCA treatment increased BP in males (105±4 to 190±1 mmHg) and females (97±3 to 167±5 mmHg), and treatment with MCC950 attenuated DOCA-induced increases in BP in both sexes (males: 107±3 to 174±2 mmHg; females: 98±3 to 159±7 mmHg; P treatment =0.004). Terminal BP values were compared and while BP was higher in males, the impact of MCC950 was comparable between the sexes (P sex =0.0001; P interaction =0.4). However, MCC950 attenuated DOCA-induced increases in renal CD4 + T cells and Th17 cells to a greater degree in males than in females (CD4+: P treatment <0.001, P sex =0.03, P interaction =0.04; Th17 cells: P treatment <0.001, P sex =0.001, P interaction =0.04). Conclusions: NLRP3 contributes to the development of DOCA-salt induced increases in BP and inflammation in both males and females. However, males have greater NLRP3-mediated increases in renal T cells than females. The impact of this mechanism on renal function and the potential for targeted hypertensive therapies needs to be further examined.

Abstract P167: Sex Dependent Associations of the Gut Microbiota with Hypertension – A Prospective Cohort

Background: Whilst there is emerging evidence that the associations of the gut microbiota (GM) with hypertension differ between sexes, it remains uncertain whether the GM 1) is altered with antihypertensive-use, 2) can predict blood pressure (BP) trajectories, and 3) whether these associations are also sex-dependent. We therefore aimed to determine the sex-dependent associations of the GM with baseline hypertensive state in untreated versus treated participants and BP changes over time. Methods: A total of 451 community-dwelling middle-aged Hong Kong Chinese without symptomatic cardiovascular diseases were recruited (50% men, 14% on antihypertensive agents, mean age, 54.6±6.5 years). Shotgun metagenomic sequencing of stool samples and 24-hour ambulatory blood pressure monitoring (ABPM) were performed. The 24hr-ABPM was repeated on 139 returned subjects after 4 years. Statistical analysis was conducted with 4 covariate models that include age, sex, menopause status, body mass index (BMI), smoking, fasting glucose, triglyceride, cholesterol, sodium intake, and fatty liver status. Results: Amongst the 389/451 subjects not on antihypertensive agents, 167/389 (42.9%) had newly diagnosed hypertension at baseline. Females drove the significantly different b-diversity of the GM composition ( p <0.01) between the normotensives and hypertensives in the baseline study. Multiple GM species were significantly associated with hypertension. In sex stratified analysis, Faecalimonas umbilicate was significantly enriched in hypertensive females while Roseburia sp Am16-25 and Eubacterium ramulus were enriched in hypertensive males (all p <0.05-0.01). When comparing the 62 treated and 167 nontreated hypertensive subjects, the GM abundance, a-, and b-diversity were not significantly different. However, there were significant GM species associated with the use of antihypertensive medication. Notably, Lachnospiraceae bacterium and Flavonifractor plautii were significantly enriched in treated and untreated individuals, respectively (all p <0.05-0.001). During a mean follow up of 51.2±4.5 months, 73.2% of the 71 untreated subjects remained normotensive and were associated with enriched Bacteroides uniformis in their baseline metagenomic data under models adjusted for age, sex, and BMI. Conclusion: The GM displayed sex-dependent associations with hypertension within untreated and treated individuals and can potentially predict BP trajectory changes within a Chinese population.

P024 NEPAL TAKES ACTION FOR BLOOD PRESSURE SCREENING: RESULTS FROM MAY MEASURE MONTH 2022

Objective: To present the result of May Measure Month (MMM) 2022 in Nepal. Methods: An opportunistic cross-sectional survey of adults ≥ 18 years was conducted in 32 districts from Jun-October 2022. Trained volunteers administered the structured questionnaire into the local language and took 3 BP readings in a sitting position at 1-minute intervals. The mean of the second and third BP readings was calculated. Hypertension was defined as a systolic BP ≥ 140 mmHg or a diastolic BP ≥90 mmHg or being on antihypertensive medication. Ethical approval was obtained from the Nepal Health Research Council. Results: MMM 2022 included 13,125 participants. The mean age of the participants was 38.8(±16.1) years. There were 52.2% females. The mean was 118.6 mmHg ±15.8 for systolic BP, and 78.8 mmHg ±10.67 for diastolic BP. Around one-fifth (19.5%) of participants were found to be hypertensive. The odds of hypertension in young males were 1.49 times than females (OR=1.49, 95% CI: 1.37 to 1.63). Only about 43.5% of the population were aware, 37.5% were on medication and only 21.5% of hypertensive had controlled blood pressure (< 140/90 mm Hg). Less males were aware and on medication as compared to females (OR = 0.86, 95% CI: 0.74 -1.01). 26.3% hypertensive females have controlled blood pressure as compared to 17.7% in males (p<0.05). Among all participants, 11.3% (n= 1473) had their BP measured for the first time, and nearly 22.6% (n= 2953) did not measure it within the last one year. More than 90% of individuals taking medicine reported that they took medicine regularly and more than 80% reported that they did not pay for medicine. Conclusions: MMM seems to be a promising community-based program for increasing awareness and identifying high risk population. As more than 50% of participants were unaware of their hypertension status, there is an opportunity in Nepal to identify these patients and increase awareness by adopting nationwide screening campaign such as MMM.

Abstract P425: Role of 24h UNaK ratio in patients with hypertension and resistant hypertension by gender and race

RHTN is defined as blood pressure above goal despite using ≥3 antihypertensive medications. Patients with RHTN are at an increased risk for CVD compared to those with more easily controlled hypertension (HTN). High sodium intake and higher 24h urinary (U) sodium (Na) potassium(K) ratio is associated with higher CVD risk. The role of this ratio in RHTN has not been investigated. Methods: We conducted a cross-sectional analysis of a large cohort of 2397 black and white patients with RHTN who were referred to the RHTN Clinic at the University of Alabama at Birmingham and who underwent a 24h urine collection. Patients with HTN served as a control group. Results: Patients with RHTN had significantly higher 24h UNaK ratio than patients with HTN (3.2±1.6 vs 3.6 ±2.0, p <0.001 ) and had an earlier onset of HTN (38.8±13.7 years (yrs) vs 47.6±16.2 yrs, p=0.001) and longer duration 17.6±11.2 vs 12.0±10.7 yrs, p=0.001), higher BMI (32.6±7.2 vs 29.98±6.5 kg/m2), and 24-hourUNa (181±88 vs 164±77 mmol, p=0.01). Within the RHTN group (n=1340) females had a significant higher 24h UNaK ratio than males (3.5±1.9 vs 3.2±1.7, p =0.006) and blacks had a significant higher 24h UNaK ratio than whites (3.0±1.6 vs 3.9±2.0, p<0.001). Conclusion: Higher 24h UNaK ratio as index of higher sodium and lower potassium intakes were found in patients with RHTN as well as resistant hypertensive females and blacks and may explain certain higher CV risks in these populations.

A Systematic Review of Existing Data on Statin Use and New-Onset Type 2 Diabetes: The Need for Clear Answers

Background: The relationship between statins use and the development of new-onset type 2 diabetes mellitus (NOT2DM) has been a subject of ongoing debate and investigation. In February 2012, the Food and Drug Administration (FDA) disclosed that statin use could lead to a modest rise in glycosylated hemoglobin (HbA1c) and fasting blood glucose (FBG), potentially contributing to the development of diabetes. We systematically reviewed the available evidence and summarized the impact of statin use on NOT2DM. Aim: This systematic review aims to examine and provide a comprehensive overview of existing data relating to statin use and their association with the development of new-onset type 2 diabetes (NOT2DM). The primary objectives were to assess and explore: (1) the potential association between statin use and the development of new-onset diabetes; (2) the magnitude, extent, and incidence of new-onset diabetes due to statin use. The secondary objective was to explore the underlying mechanisms. Data Sources: PubMed, Scopus, Science Direct, Wiley, and Google Scholar and databases between January 2012 and February 2021. Data Extraction: The 2 reviewers Musa Basheer Mansour and Sara Elsheikh Ahmedana [MBM and SEA] independently assessed the qualities of the extracted studies and summarized data of the selected studies in tabulated forms for outcomes of interest and performed methodological and quality assessments based on review questions, citations, country of the study, aim, population characteristics, design, setting, sample size, sample technique, data source, measures, analysis, confounder variable and key observations for systematic review. We applied search keywords such as Statins, New-onset diabetes, Diabetes mellitus, Underlying mechanism, and incidents of diabetes. Results: A total of 66 studies were identified through database searches in the initial search, and 7 studies were included in this review. Of the 2,567,888 adult patients, 861,925 were nondiabetic patients on statin use, and 1,705,963 were diabetic on statin or non-statin users. We considered Hazard Ratios (HR), Odds Ratios (OR), and Confidence Intervals (CI) of each study for further analysis. The mean OR for three studies showed that each statin therapy resulted in a 68% increased risk of NOT2DM (OR, 1.683; 95% CI: 1.273-2.237). The significant relationship between statin use and the rising risk of NOT2DM was also confirmed by an average HR of 1.53 (95% CI: 1.2-1.7) for the remaining four studies. Recent and short-term use of statins, as well as time- and dose-dependent connections, were linked to an increased risk of NOT2DM in statin users compared to non-users. These risks were more prominent among older adults, normotensive males, hypertensive females, and individuals with low physical activity. Although no proven mechanisms were found, the possible processes are discussed. Conclusion: The systematic review found a significant level of risk of NOT2DM associated with statin use. The authors argued that the short-term diabetes risk caused by statin treatment was more prevalent among patients exposed to risk factors for diabetes. Although the precise mechanisms behind this association remain unclear, this research provides clinical practice with evidence-based guidelines. Additionally, conducting future research may be appropriate based on the gaps in knowledge identified from the results of this review.

A Systematic Review of Existing Data on Statin Use and New - Onset Type 2 Diabetes: The Need for Clear Answers

Background: The relationship between statins use and the development of new-onset type 2 diabetes mellitus (NOT2DM) has been a subject of ongoing debate and investigation. In February 2012, the Food and Drug Administration (FDA) disclosed that statin use could lead to a modest rise in glycosylated hemoglobin (HbA1c) and fasting blood glucose (FBG), potentially contributing to the development of diabetes. We systematically reviewed the available evidence and summarized the impact of statin use on NOT2DM. Aims and Objectives: This systematic review aims to examine and provide a comprehensive overview of existing data relating to statin use and their association with the development of new-onset type 2 diabetes (NOT2DM). The primary objectives were to assess and explore: (1) the potential association between statin use and the development of new-onset diabetes; (2) the magnitude, extent, and incidence of new-onset diabetes due to statin use. The secondary objective was to explore the underlying mechanisms. Data Sources: PubMed, Scopus, Science Direct, Wiley, and Google Scholar and databases between January 2012 and February 2021. Data Extraction: The 2 reviewers Musa Basheer Mansour and Sara Elsheikh Ahmedana [MBM and SEA] independently assessed the qualities of the extracted studies and summarized data of the selected studies in tabulated forms for outcomes of interest and performed methodological and quality assessments based on review questions, citations, country of the study, aim, population characteristics, design, setting, sample size, sample technique, data source, measures, analysis, confounder variable and key observations for systematic review. We applied search keywords such as Statins, New-onset diabetes, Diabetes mellitus, Underlying mechanism, and incidents of diabetes. Results: A total of 66 studies were identified through database searches in the initial search, and 7 studies were included in this review. Of the 2,567,888 adult patients, 861,925 were nondiabetic patients on statin use, and 1,705,963 were diabetic on statin or non-statin users. We considered Hazard Ratios (HR), Odds Ratios (OR), and Confidence Intervals (CI) of each study for further analysis. The mean OR for three studies showed that each statin therapy resulted in a 68% increased risk of NOT2DM (OR, 1.683; 95% CI: 1.273-2.237). The significant relationship between statin use and the rising risk of NOT2DM was also confirmed by an average HR of 1.53 (95% CI: 1.2-1.7) for the remaining four studies. Recent and short-term use of statins, as well as time- and dose-dependent connections, were linked to an increased risk of NOT2DM in statin users compared to non-users. These risks were more prominent among older adults, normotensive males, hypertensive females, and individuals with low physical activity. Although no proven mechanisms were found, the possible processes are discussed. Conclusion: The systematic review found a significant level of risk of NOT2DM associated with statin use. The authors argued that the short-term diabetes risk caused by statin treatment was more prevalent among patients exposed to risk factors for diabetes. Although the precise mechanisms behind this association remain unclear, this research provides clinical practice with evidence-based guidelines. Additionally, conducting future research may be appropriate based on the gaps in knowledge identified from the results of this review.

The association between dietary selenium intake and telomere length in hypertension.

Telomere length is closely linked to biological aging, oxidative stress, and the development of cardiovascular diseases. This study aimed to assess the association between dietary selenium intake and telomere length in individuals with hypertension. Data on dietary selenium intake were captured through the National Health and Nutrition Examination Survey (NHANES) computer-assisted dietary interview system (CADI). Telomere length determination entailed selecting blood samples from all participants in the NHANES database. The analysis was performed using Analysis System software, with Empower stats utilized for data analysis. Results showed that there was a significant association between dietary selenium intake and telomere length in hypertension, particularly within the female group. In female hypertension cases, a 1 mcg increase in dietary selenium intake corresponded to a telomere length increase of 1.19bp, even after adjusting for age, race, BMI, marital status, physical activity, energy intake, and stroke history. The relationship between dietary selenium intake and telomere length exhibited a linear pattern in female hypertension patients. This study identified a positive association between dietary selenium intake and telomere length in hypertension, particularly within the female group.

Association of psychological stress with wives' hypertension across over 10 million Chinese married female population aged 20-49years.

Psychological stress has been reported to be a potential risk factor for hypertension among females, but it remains unclear whether spousal chronic stress levels alter the risk of hypertension among women. We examined the associations between stress within the family and hypertension among married women. Reproductive-aged women who were planning for pregnancy and their husbands were recruited from the National Free Pre-pregnancy Checkup Projects (NFPCP) across 31 provinces in China in 2016 and 2017. Perceived stress of wives or husbands was measured with a 5-point Likert-type scale, and assessed from three domains: work/life-related stress, economic stress, and overall stress. Multivariable-adjusted logistic regression models were used to assess the associations between stress status and the prevalence of hypertension. Of 10,027,644 couples, 261,098 (2.60%) women had hypertension. The results showed that higher stress levels among themselves or their husbands were associated with a higher prevalence of hypertension in women ( Pfor trend <0.001). Compared with non-stressed participants, female participants with the highest stress themselves were at a greater risk of hypertension, with adjusted odds ratio (OR) of 1.31 (95% confidence interval [CI]: 1.25-1.37); and compared with participants whose husbands had no stress, those whose husbands had the highest stress level were at a higher risk of hypertension with adjusted OR of 1.24 (95% CI: 1.20-1.29). Moreover, compared with non-stressed status for both couples, only-wife-stressed, only-husband-stressed, and both-stressed couples were found to be significantly associated with increased risks of wives' hypertension, with adjusted ORs of 1.28 (95% CI: 1.25-1.31), 1.19 (95% CI: 1.17-1.21), and 1.28 (95% CI: 1.26-1.31), respectively. Moderate to severe stress in both spouses might be associated with female hypertension prevalence, which highlights the importance of paying attention to the psychological stresses of couples within the family.

Sex Differences and Role of Lysyl Oxidase Like 2 (LOXL2) in Angiotensin II-Induced Hypertension in Mice.

Hypertension, a disease with known sexual dimorphism, accelerates aging associated arterial stiffening, in part due to the activation of matrix remodeling caused by increased biomechanical load. In this study, we tested the effect of biological sex and the role of the matrix remodeling enzyme lysyl oxidase like 2 (LOXL2) in hypertension induced arterial stiffening. Angiotensin II (Ang II) was delivered using osmotic pumps in Loxl2+/- and WT male and female mice. Blood pressure and pulse wave velocity (PWV) were measured noninvasively to assess hypertension and aortic stiffness. Wire myography and uniaxial tensile testing were used to test aortic vasoreactivity and mechanical properties. Aortic wall composition was examined by histology and Western blotting. The effect of biomechanical strain on LOXL2 expression and secretion by vascular smooth muscle (VSMC) and endothelial cells (EC) was evaluated by uniaxial cyclic stretching of cultured cells. The role of LOXL2 catalytic function on VSMC alignment in response to mechanical loading was determined with LOXL2 inhibition and knockout. Ang II infusion induced hypertension in WT and Loxl2+/- mice of both sexes and increased PWV in WT males but not in Loxl2+/- males, WT females, or Loxl2+/- females. LOXL2 depletion protected males from Ang II mediated potentiation of vasoconstriction but worsened in females and improved aortic mechanical properties in both sexes. Histological analysis showed increased aortic wall thickness in hypertensive WT males but not females and increased intralamellar distance in both sexes, that was ameliorated in Loxl2+/- mice. Western blotting revealed increased collagen I, decreased collagen IV, and increased LOXL2 accumulation and processing in hypertensive mice. Hypertensive cyclic strain contributed to LOXL2 upregulation in the cell-derived matrix in VSMCs but not ECs. LOXL2 catalytic function facilitated VSMC alignment in response to biomechanical strain. In males, arterial stiffening in hypertension is driven both by VSMC response and matrix remodeling. Females exhibit a delayed onset of Ang II-induced hypertension with minimal ECM remodeling but with VSMC dysfunction. LOXL2 depletion ameliorates arterial stiffening and preserves functional contractility and aortic structure in male hypertensive mice. LOXL2 depletion improves aortic mechanics but worsens aortic contractility in hypertensive females. VSMCs are the primary source of LOXL2 in the aorta and hypertension increases LOXL2 processing and shifts to collagen I accumulation. Overall, LOXL2 depletion offers protection in young hypertensive males and females.

Relation between frailty and hypertension is partially mediated by physical activity among males and females in the Canadian Longitudinal Study on Aging.

Frailty reflects the heterogeneity in aging and may lead to the development of hypertension and heart disease, but the frailty-cardiovascular relationship and whether physical activity modifies this relationship in males and females are unclear. We tested whether higher frailty was positively associated with hypertension and heart disease in males and females and whether habitual movement mediated this relationship. The relationship between baseline frailty with follow-up hypertension and heart disease was investigated using the Canadian Longitudinal Study on Aging at 3-year follow-up data (males: n = 13,095; females: n = 13,601). Frailty at baseline was determined via a 73-item deficit-based index, activity at follow-up was determined via the Physical Activity Scale for the Elderly, and cardiovascular function was self-reported. Higher baseline frailty level was associated with a greater likelihood of hypertension and heart disease at follow-up, with covariate-adjusted odds ratios of 1.08-1.09 (all, P < 0.001) for a 0.01 increase in frailty index score. Among males and females, sitting time and strenuous physical activity were independently associated with hypertension, with these activity behaviors being partial mediators (except male-sitting time) for the frailty-hypertension relationship (explained 5-10% of relationship). The strength of this relationship was stronger among females. Only light-moderate activity partially mediated the relationship (∼6%) between frailty and heart disease in females, but no activity measure was a mediator for males. Higher frailty levels were associated with a greater incidence of hypertension and heart disease, and strategies that target increases in physical activity and reducing sitting may partially uncouple this relationship with hypertension, particularly among females.NEW & NOTEWORTHY Longitudinally, our study demonstrates that higher baseline frailty levels are associated with an increased risk of hypertension and heart disease in a large sample of Canadian males and females. Movement partially mediated this relationship, particularly among females.

Tribal differences in hypertension and cholesterol profiles in Aceh, Indonesia.

One of the factors that contributes to coronary heart disease and stroke is high blood pressure, or hypertension. Hypertension is influenced by race and sex. The objective of this study was to assess the hypertensive population in Aceh by tribal community and to examine the relationship between cholesterol history and hypertension. This study used incidental sampling as a non-probability sampling method, in which 152 participants were evaluated for the profile of hypertension with a history of cholesterol. Blood pressure was measured using a blood pressure measuring device. HDL, LDL, triglyceride, and total cholesterol levels were measured using LIPID Pro. Data analysis was performed using the Kruskal-Wallis and Mann-Whitney tests with p<0.05. The study population (N=152) consisted of 81 males (53%) and 71 females (47%) across the ethnicities of Aceh (64:42%), Gayo (19:13%), Alas (33:22%), and Aneuk Jamee (36:24%). In the male group, hypertension was associated with total cholesterol (r=0.03; p=0.78), HDL (r=0.20; p=0.07), and LDL (r=0.21; p=0.07) levels, whereas in the female group, hypertension was primarily correlated with LDL levels (r=0.20; p=0.09). In general, hypertension in males and females in the four tribes in Aceh is associated with HDL, LDL, and total cholesterol levels.

The Role of Blood Pressure Control in Prevention of Hematoma After Blepharoplasty.

Hematoma formation after blepharoplasty is serious and potentially vision-threatening, with hypertension being the primary risk factor. The aim of this paper is to assess perioperative blood pressure trends and rates of complication in patients undergoing a strict blood pressure protocol designed to keep perioperative systolic blood pressure below 120 mmHg. A retrospective chart review was performed of 32 patients undergoing face lift with conomitant blepharoplasty from January 2015 to July 2018. For each patient blood pressure readings obtained before, during, and after surgery were reviewed. Two-sample one-tail T-tests were performed, and p values less than 0.05 were considered statistically significant. The mean systolic blood pressure (SBP) for all patients was highest intraoperatively. Patients with known hypertension had higher mean SBPs than patients without hypertension across all phases of care, with a statistically significant difference in immediate preoperative SBP (p=0.05). Males had a higher average blood pressure immediately postoperatively (p=0.05). A previous diagnosis of hypertension in females was associated with a higher immediate preoperative SBP (p=0.07) as well as age over 65 (p=0.07). The overall rate of complications was 37.5%. No patients experienced hematoma. This study demonstrated that keeping blood pressure below 120 mmHg after surgery was an effective method of preventing hematoma after blepharoplasty, even in patients concurrently on anti-coagulative medications. Special attention to blood pressure control should be shown to patients with known risk factors such as a previous diagnosis of hypertension, male sex, or age greater than 65. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Ovariectomy Increases Blood Pressure and FosB Staining in the Central Autonomic Control Regions Independent of Chronic Intermittent Hypoxia

Chronic intermittent hypoxia (CIH) experimentally mimics the recurrent hypoxia characteristic of sleep apnea, and it induces sustained hypertension in male and ovariectomized (OVX) female rats but not intact females. While central autonomic control regions are known to mediate CIH-induced hypertension in males, their contribution to CIH hypertension in OVX females remains unclear. We tested the hypothesis that 7 days of CIH increases mean arterial pressure (MAP) and FosB staining in central autonomic regions in OVX but not intact female rats. Adult female Sprague Dawley gonadally intact (INT) or OVX rats were exposed to 7 days of CIH (10% O2 and 21% O2 cycle, every 6 mins, 8h/day) or continuous normoxia (CON). MAP was monitored by radiotelemetry. On day 8, the rats were sacrificed, and their brains were collected and processed for FosB immunohistochemistry. During the light/sleep phase, CIH increased MAP in INT females (n=7; 3.4 ± 0.4 mmHg) as compared to CON (n=6, ΔMAP 1.4 ± 0.3 mmHg; P=0.01 CON vs CIH). This difference was not observed during the dark/active phase (CON ΔMAP -1.7 ± 0.4 mmHg, CIH 0.5 ± 0.3 mmHg, P=0.07). In OVX females, CIH was not associated with significant increases in MAP during the light/sleep phase (CON (n=6) ΔMAP 0.3 ± 0.4 mmHg, CIH (n = 6) 2.1 ± 0.3 mmHg, P=0.10). During the dark phase, MAP was significantly increased in CON OVX and CIH OVX compared to their respective baselines but there were no differences between groups (CON ΔMAP 2.4 ± 0.3 mmHg, CIH 2.2 ± 0.4 mmHg, P=0.0002 vs baseline, P=0.8 CON vs CIH). OVX rats had higher baseline FosB staining in the median preoptic nucleus compared to intact female rats independent of CIH exposure (INT: CON (n = 6) 13 ± 3 cells/section, CIH (n = 6) 14 ± 2; OVX: CON (n = 6) 21 ± 3, CIH (n = 6) 23 ± 2, INT CON vs OVX CON, P &lt; 0.05, INT CIH vs OVX CIH P &lt; 0.05). Compared to CON, CIH significantly increased the number of FosB immunoreactive cells in the caudal nucleus of the solitary tract in INT but not OVX females (INT: CON, 7 ± 1 cells/section, CIH 11 ± 1; OVX CON 6 ± 1, CIH n=6, 9 ± 1; INT CON vs CIH, P=0.02; OVX CON vs CIH, P = 0.09). In the rostral ventrolateral medulla, there were no significant differences among any of the groups (INT: CON n=4, 19 ± 2 cells/section, CIH n=4, 20 ± 3; OVX: CON n=6, 18 ± 2, CIH n=6, 21 ± 2, all P&gt;0.05). In OVX females, CIH tended to increase MAP during both the light and dark phases. CON OVX females showed a trend for increased MAP during the dark phase, independent of CIH. CIH was not associated with increased FosB staining in either the median preoptic nucleus or the rostral ventrolateral medulla of OVX females This suggests that changes in MAP observed in CIH OVX females may not involve the same autonomic control regions as male rats exposed to CIH. Supported by RO1 HL155977. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

XX Chromosome Complement Predisposes Females to Obesity-induced, Leptin-mediated Aldosterone Production and Hypertension

Despite the historical dogma that premenopausal women are protected from cardiovascular disease, clinical and experimental evidence indicate that obesity abolishes this protection, placing women at increased risk for hypertension. Previously, our laboratory demonstrated that the adipokine leptin contributes to obesity-associated hypertension in both males and females but via sex specific mechanisms: leptin-mediated sympatho-activation in males and leptin-induced aldosterone production in females. However, the origin of these sex-specific mechanisms remains unknown. Therefore, we aimed to test the contribution of both sex hormones and chromosomes. Female sex hormones were preserved (sham) or depleted via ovariectomy (OVX) in lean control and obese female agouti yellow mice. Blood pressure (BP) recording via radiotelemetry indicated that obesity increased BP (2-way ANOVA, p&lt;0.0001) but OVX did not alter BP in agouti mice. Vascular function measured via mesenteric wire myography indicated obesity impaired (3-way ANOVA, p&lt;0.05) endothelial-dependent relaxation but OVX did not inflict further impairment in agouti mice. OVX did not alter plasma aldosterone levels or adrenal aldosterone synthase (CYP11B2) expression in agouti mice. Leptin receptor blockade (Allo-Aca) decreased BP (2-way ANOVA, p&lt;0.05), restored endothelial-dependent relaxation and decreased (2-way ANOVA, p&lt;0.05) adrenal CYP11B2 expression in both intact and OVX agouti mice indicating a preservation of leptin-mediated BP elevation in the absence of female sex hormones and ruling out sex steroids as the origin of the sex specific mechanisms. Additionally, neither estrogen, progesterone, a combination of estrogen and progesterone, or dihydrotestosterone increase CYP11B2 expression in primary isolated human adrenal cells in culture further supporting that sex hormones do not mediate aldosterone production. These data suggest female sex hormones are not the source for the sex difference prompting us to utilize the four-core genotype (FCG) mouse model to assess the role of sex chromosomes. In order to mimic obesity conditions, BP was recorded at baseline and in response to leptin infusion in OVX FCG XX and XY female mice (XXF and XYF). XX females displayed higher baseline BP than XY (XXF: 109.1±2.4 vs. XYF: 100.4±1.1 mmHg, p&lt;0.05) but leptin infusion increased BP and concurrently ablated the difference. Similarly, XXF displayed heightened plasma aldosterone (2-way ANOVA, 183.7±27 vs. 89.4±34 pg/mL, p&lt;0.05) but leptin infusion abolished the difference. Collectively, these results indicate that XX chromosome rather than female sex steroid hormones regulates aldosterone production, and that sex chromosomes are likely the source for the sexual dimorphism in the mechanism for hypertension associated with obesity. R01HL130301, R01HL155265 (E.J.B.) F31HL168963-01 (C.T.B.). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Effects of potassium supplementation and deficiency on the progression of salt-sensitive hypertension

While the physiological effects of sodium on blood pressure are well established, many of the effects of potassium remain unclear. Prior work found that increased potassium intake decreases blood pressure and risk of cardiovascular disease, improves vasodilation, has reno-protective effects, and can stimulate natriuresis. In this study, we examined how different sodium/potassium ratios affect the development of salt-sensitive hypertension, specifically examining changes in the kidney and the renin angiotensin aldosterone system (RAAS). We hypothesized that blood pressure would directly correlate to the Na+/K+ ratio and that there would be compensatory changes in RAAS and in expression of renal potassium channels, particularly inwardly rectifying potassium (Kir) channels. At 9 weeks of age, male and female Dahl SS rats were placed on a high salt (4% NaCl) diet for 5 weeks with normal potassium (NK, 0.36% K+), high potassium (HK, 1.41% K+), or potassium depleted (DK, &lt;0.0001% K+) diet. After 5 weeks of dietary intervention, DK animals were hypokalemic, and HK animals had significantly increased plasma potassium. Potassium supplementation attenuated the development of salt-sensitive hypertension in male rats fed the HK diet compared to NK; the DK group did not develop hypertension. Potassium supplementation did not attenuate blood pressure in female rats, who also had a higher mortality rate on the DK diet. Heart rates were unchanged in both male and female HK groups but were significantly lower in the DK groups of both sexes. After 5 weeks of diet, the total body weights of DK rats were significantly lower. The 2 kidney/total body weight ratios were not different between the HK and NK groups, but the kidneys of the DK group were significantly larger, likely due to their smaller body weights. Medullary protein casts in DK rats of both sexes were decreased but no renoprotective effects were observed in the HK group. Western blot analysis of renal potassium channels demonstrated no changes in the expression of ROMK, significantly increased Kir5.1 in DK males and females, and a significant increase in Kir4.1 and the alpha-subunit of the Na+/K+-ATPase in DK males. We analyzed RAAS metabolites from plasma samples collected at the endpoint: Ang I (1-10), Ang IV (3-8), and Ang (1-5) were significantly decreased in DK males and females, Ang II (1-8) and Ang III (2-8) were significantly reduced in DK males, and aldosterone was significantly increased in HK males and females. These results provide a comprehensive assessment of how various potassium diets affect the development of salt-sensitive hypertension in both males and females, which will provide a solid foundation for future mechanistic studies. R01DK129227, I01 BX004024, R35HL135749. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Salt Perception Threshold and Vascular Risk in Prehypertensive Women Compared to Normotensive and Hypertensive Women

Objectives: To evaluate and compare the Salt perception threshold and vascular stiffness in pre-hypertensive women with that of normotensive and hypertensive women. Materials and Methods: Study design – This was a cross-sectional study. A total of 440 adult females in the age group of 25–60 years from urban and rural areas were included in the study. After initial screening, the subjects were divided into three groups. Group I: Prehypertensive females; Group II: Hypertensive females; and Group III: Normotensive females. Salt perception threshold was determined by salt impregnated taste strips with sodium chloride at different concentrations. Vascular stiffness of the subjects was measured and compared using an oscillometric non-invasive arteriography. Results: The salt intake was higher by 2.1 g/day in Group I females and 5.6 g/day in Group II females when compared to Group III females. The salt detection threshold and SPT were higher significantly in pre-hypertensive females and much higher in hypertensive females compared to normotensive females. The mean values of brachial ankle pulse wave velocity (BaPWV) and carotid femoral pulse wave velocity (CFPWV) were found to be significantly higher in Group I females compared to normotensives. Conclusion: High SPT in prehypertensive females will lead to high consumption of salt to achieve taste satisfaction. A progressive reduction of salt in food is recommended in these females would significantly decrease the percent progression of pre-HTN to HTN decreasing the risk for cardiovascular morbidity.

Anthropometric markers and their cut-off point for the prediction of hypertension with lifestyle as a risk factor among Chiru tribe of North East India

ABSTRACT Background The increased prevalence of obesity, particularly central obesity, is closely associated with many metabolic complexions, including hypertension and diabetes. Objectives The present study investigates the cut-off points of some anthropometric measurements such as body mass index [BMI (kg/m2)], waist circumference [WC (cm)], waist-hip ratio (WHR), and waist-height ratio (WHtR) associated with high blood pressure. It determines the risk factors among the Chiru tribe of North East India. Methods The cross-sectional study was conducted in four villages in the hilly districts of Manipur. For the present study, 416 Chiru adults (209 males and 207 females) aged 20–79 years were included. Anthropometrics and blood pressure were measured using standard procedures. Statistical methods such as chi-square, Pearson correlation, and multivariate logistic regression were employed. Results The result indicates that the cut-off values to detect hypertension were 21.83 for BMI, 82.55 for WC, 0.92 for WHR, and 0.53 for WHtR. However, the cut-off values to detect hypertension in females were 23.92 for BMI, 86.48 for WC, 0.94 for WHR, and 0.55 for WHtR. Multivariate logistic regression analysis indicated that hypertension was an independently associated risk factor in both males and females with an age ≥ 50 years (OR = 18.52 and 10.12), physical activity (OR = 0.10 and 0.21), salt intake (OR = 7.81 and 3.36), and smoking (OR = 2.56 and 3.23), respectively. Conclusion It has been concluded that BMI, WC, WHR, and WHtR values can determine hypertension risk in the Chiru population. Age, smoking, physical activity, and salt intake were independent risk factors associated with high blood pressure.

Unraveling the Spectrum of Hypertension among Adult Women in an Urban Area of North India through Level of Prevention-based Color-coded Stratification

Objectives: The objective of this study was to investigate the prevalence of hypertension (HTN) in adult females at the Urban Health Training Center (UHTC) of a private medical college using a color-coded stratification based on levels of prevention. Materials and Methods: This cross-sectional study was conducted during June–July 2023 at UHTC, a private medical college. The sample size was calculated as 256. First, a basic health assessment of the study population was done. This focused on basic socio-demographic data of the adult women, their health status and blood pressure reading, risk profile, treatment-seeking behavior, etc. A proforma was developed to record the data. The principal investigator did a level of prevention-based color-coded stratification for HTN patient segmentation. Results: The majority of respondents were married (75.4%). Their literacy rate was 72%. The majority of the respondents were homemakers (58.2%). The mean age of the respondents was 38.23 years (range 18–75 years). Monthly household income ranged from Rs. 1,000 to 60,000, with a mean of Rs. 10,611.72. The average family size was 4.61 members. Some (22%) of the respondents fell into the “Health promotion” category (Green), indicating that they were free of HTN. About 39% of respondents were categorized under “Specific protection” (Blue), signifying that they were at risk of developing HTN; 14% were diagnosed with HTN cases without apparent complications, classified as “Early Diagnosis/Treatment” (Yellow). About 21% of respondents were placed in the “Disability Limitation” (Orange) category, indicating some complications, while 4.3% were identified as HTN patients needing “Rehabilitation” (Red) due to serious complications. Conclusion: This approach of the color-coded stratification based on levels of prevention among adult females of UHTC revealed the spectrum of HTN in the general community. Overall, 39% of the respondents had HTN. About two-fifths of respondents were at risk of developing HTN. This method has the potential to enhance the individualized management of HTN.