Young Hypertensive Patients Research Articles

Current practice toward the use of antihypertensive agents in the management of hypertension – A cross-sectional study among Indian physicians

Objective: The objective of this study was to assess current practices and usage patterns of antihypertensive medications in managing hypertension (HTN) in India. Materials and Methods: A cross-sectional, observational digital study was conducted among health-care practitioners (HCPs) across India (November 2022–March 2023). Results: A total of 792 HCPs (cardiologists, consulting, and general physicians) participated in this study. According to 63.38% of HCPs, 20–50 essential HTN patients seek consultation weekly. The majority of patients were in the age range of 40–60 years (84.09%). A total of 67.55% of HCPs mentioned that systolic blood pressure (BP) ranged between 140 and 160 mmHg. Type 2 diabetes mellitus was the most common comorbidity among hypertensive patients (84.09%). In total, 53.79% and 37.37% of HCPs preferred angiotensin receptor blockers (ARBs)/angiotensin-converting enzyme and calcium channel blockers (CCBs) as the first choice of antihypertensive agents. The majority of HCPs (>69%) preferred prescribing a triple-drug fixed-dose combination (FDC) of CCBs + ARB + diuretics in hypertensive patients with coronary artery disease (CAD) and resistant HTN. The majority (89.90%) of HCPs preferred prescribing FDC of CCBs over monotherapy. Amlodipine (>55%) followed by cilnidipine (>32%) were preferred CCBs for young and older hypertensive patients. In patients with essential HTN without any CVD, amlodipine (72.85%) was the preferred CCB. Vascular selectivity (59.09%) and longer half-life (54.55%) were important factors for prescribing CCBs. Resistant HTN, inadequate BP control with monotherapy, and the presence of CAD were all (62.63%) important considerations for FDC with CCBs. The underutilization of CCBs in managing HTN (63.88%) was highlighted. Conclusion: Overall responses provide a comprehensive overview of the prevailing perception and the usage patterns of antihypertensive agents employed by HCPs in India.

Pheochromocytoma “the great masquerader” presenting as hypertensive retinopathy: A case report

At first glance, the ophthalmologist might seem to be invading a medical territory, not in their domain, when they write of Pheochromocytoma, but this is not true. Pheochromocytoma is an uncommon tumor that develops in chromaffin cells of the paraganglia or adrenal medulla which can give rise to malignant hypertension (systolic >200 mg Hg & diastolic >140). Pheochromocytoma-induced hypertension may present with many physical symptoms and signs, although sometimes the ocular features are the only clues that are present. Clinical suspicion of secondary hypertension should always be considered when fundus examination shows hypertensive retinopathy changes in a younger age group (18 years in our case). The patient, in our case, developed hypertensive retinopathy with macular star development due to Pheochromocytoma. It stresses the significance of a thorough search for a secondary cause of hypertension in young patients.

Treatment burden mediates the association between the number of comorbidities and health-related quality of life in young and middle-aged patients with hypertension and comorbidities

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Research Foundation of Korea grants funded by the Korea government (2021R1C1C100849812). Background The patient-reported outcome such as health-related quality of life (HRQoL) is important in providing patient-centered care to patients with hypertension. Previous studies have shown that comorbidities are negatively associated with HRQoL in patients with hypertension. To effectively improve their HRQoL, it is crucial to comprehend the mechanism of how comorbid diseases affect the HRQoL. Patients with multimorbidity experience an increased burden of treatment associated with simultaneously managing multiple chronic conditions. The treatment burden can contribute to poor HRQoL. Therefore, we hypothesize that treatment burden mediates the association between the number of comorbidities and HRQoL among patients with hypertension. Because most studies on the HRQoL of patients with hypertension have been conducted in older people, levels of treatment burden are different between older and younger patients, this study was conducted in young and middle-aged hypertensive patients with comorbidities. Purpose To examine the mediating effect of treatment burden on the association between the number of comorbidities and HRQoL in young and middle-aged hypertensive patients with comorbidities. Methods Hypertensive patients (age 19-54 years) with additional diseases completed the cross-sectional questionnaire survey. The number of comorbidities was measured based on self-report using the list of 20 or more chronic conditions. The treatment burden was measured with the 13-item Multimorbidity Treatment Burden Questionnaire, and high scores indicate a higher level of treatment burden. HRQoL was measured with the Patient-Reported Outcomes Measurement Information System-29 profile v2.1 (PROMIS-29 v2.1). The scores from the PROMIS-29 v2.1 were used to compute the PROMIS-Preference scores, which is a summary score of the HRQoL. The PROMIS-Preference scores ranged from 0 (bad health) to 1 (ideal health). To examine the mediating role of treatment burden on the relationship between the number of comorbidities and HRQoL, the mediation analysis was performed after adjusting for sex. This analysis was conducted using Mplus 8.8 with 5000 bootstrap samples. Results A total of 186 hypertensive patients with comorbidities (mean age 44.9 years; 72% male) were included in this study. Patients had an average of 2.6 additional chronic conditions along with hypertension. (SD: 1.7). The mean HRQoL score was 0.35 (SD: 0.21). The direct effect of the number of comorbidities on HRQoL was significant, and the indirect effect mediated by treatment burden was also significant (Figure). Conclusion We found that the treatment burden mediated the association between the number of comorbidities and HRQoL in young and middle-aged patients with hypertension and comorbidities. These findings suggest that strategies to lower the treatment burden are important to improve the HRQoL in this population.

Parameters Of Vascular Tone Regulation And Gene Polymorphism Associated With Cardiovascular Risk In Young Subjects

Introduction — The identification of preclinical stages of vascular pathology is the most promising for prevention of hypertension (HTN). It is important to investigate the polymorphism of genes which end products are involved in the regulation of blood pressure (BP) and predispose to vascular tone (VT) dysregulation. Objective — To investigate the clinical and prognostic significance of the AGT and AGTR1 polymorphic variants associated with increased cardiovascular risk in young subjects and patients with HTN. Methods — The study involved 2 independent groups: young healthy volunteers and hypertensive patients. The VT regulation was assessed by the active standing test. The polymorphism was identified using DNA pyrosequencing. Results — The C allele of the AGTR1 A1666C A>C variant was associated with lower HR in supine in both groups. The risk allele C of the M268T T>C polymorphism was associated with lower systolic BP and diastolic BP during the 1st minute of upright posture. The C allele of the AGTR1 A1666C A>C variant was associated with earlier onset of HTN. Conclusion — The identification of the AGTR1 A1666C A>C and AGT M268T T>C variants can be informative for clarifying the risk of HTN when the young subjects are examined, as well as the probability of early onset of HTN.

PREVALENCE OF SUBCLINICAL ATHEROSCLEROSIS IN YOUNG HYPERTENSIVES

Objective: Evaluate the structure and arterial function in young hypertensive patients and determine the prevalence increase of EIM and atherosclerotic plaques: degree, location, total burden and its relation with pulse wave velocity. Design and method: An observational study was carried out transversally, at a population between 20 and 50 years old. The arterial evaluation has been done with a transductor lineal of 10MHZ ultrasound scanner. Measurement of endothelial function was performed by flow-mediated vasodilatation in the humeral artery. Continuous variables are presented as medium and standard deviation percentages. The comparation of variables between groups were carried on with T students. To compare the distribution of categorical variables, Chi square was operated. Pearson's correlation coefficient was used for the relation between VOP and other continuous numerical variables. A P<0.05 was considered significant. Results: Between September of 2020 and December of 2021, 150 patients were studied, 35 of which were comprehended from 20 to 50 years of age inclusive. The age was 43,3 years (from 25 to 50 years), 19 were male (59%) and 13 were female (39%). The body mass index was 29.9 +- 4.86 (21-39.4) with a prevalence of overweight of 22% (7 patients) and obesity of 47% (15 patients). 14 patients (44%) dyslipidemia, 1 patient (3%) Diabetes mellitus, 2 patients (6,3%) hypothyroidism, 2 patients (6.3%) cerebral vascular accident and 2 patients (6.3%) active smoking. Among all patients, 87,5% of them (28 patients) presented in at least one arterial territory EIM equal or higher to percentile 75. Atherosclerotic plaque was observed in 12 patients (37,5%) Endothelial function was decreased in 16 patients (50%) and pulse wave velocity was abnormal in 4 patients (12.5%). Cardiovascular risk was estimated in 10 years according to Framingham; 84.3% (27 patients) showed a low risk and plaque in 42% (8 patients). The 15.6% (5 patients) showed intermediate risk and plaque in 80% (4 patients). Conclusions: The prevalence of subclinical atherosclerosis in young hypertensive patients with low and moderate risk is high, has very poor correlation with risk scores, and has a clear correlation with alterations in arterial function.

Correlation of lipid profile with diastolic dysfunction in normotensive young patients under 40 years of age

Background: Diastolic dysfunction in young adults is associated with increased morbidity and mortality. The identification of risk markers associated with diastolic dysfunction could allow for targeted primary prevention efforts. Aims and Objectives: The aim of the study was to study whether dyslipidemia is associated with diastolic dysfunction independent of systemic hypertension in young patients under 40 years of age. Materials and Methods: This was a cross-sectional analytical study done from April 2021 to March 2022 in SSMC and SGMH Rewa (M.P.), 214 normotensive cases under 40 years of age were taken as cases by simple random sampling. Sample size calculated by standard formula with confidence level of 95% and margin of error was <5%. Lipid profiles (S. Triglyceride [TG], S. Cholesterol, and S. low-density lipoprotein [LDL]) of all the patients were checked. 2D echocardiogram of patients was done to check for diastolic dysfunction. All data were compiled and compared with the previous studies. Results: We found that the prevalence of diastolic abnormalities in adults under 40 years of age was 21.9%. It was found that there was significant correlation between dyslipidemia and presence of diastolic dysfunction in patients. Patients with higher than normal levels of S. TG, S. Cholesterols, and S. LDL were found to have more prevalence of diastolic dysfunction then patients with normal levels of S. TG, S. Cholesterols, and S. LDL. Higher grades of diastolic dysfunction were found in patients with dyslipidemia as compared to patients without dyslipidemia. High levels of TG and LDL and even Borderline high levels of LDL can be good predictors of diastolic dysfunction. Conclusion: Dyslipidemia is associated with diastolic dysfunction in young patients even without systemic hypertension.

Structural equation modeling for associated factors with self-care behavior among young and middle-aged hypertensive patients: a cross-sectional study

Background Self-determination theory (SDT) states that the self-care behaviors of patients with chronic illnesses are affected by an autonomy-supportive healthcare climate, satisfaction of autonomy, competence, and relatedness. Autonomy-supportive healthcare climate means to provide interpersonal conditions that support the person's volition, initiative, and integrity. Objective The aim of this study was to explore the structural relationships of an autonomy-supportive healthcare climate, as well as the perception of illness consequences, autonomy, competence, and relatedness with self-care behaviors among adult outpatients with hypertension. Design A cross-sectional survey was conducted in 2020 across three hospitals outpatient clinics in South Korea. Methods A questionnaire package containing instruments measuring the perception of autonomy-supportive healthcare climate, autonomy, competence, relatedness, perception of illness consequence, self-care behaviors, sociodemographic data, and disease-related characteristics among the patients. The hypothetical model was derived from the SDT. Data were analyzed to test the hypothetical model and propose the final model. Results Complete survey data was provided by 228 participants. Overall, the findings supported the hypothesized model (Goodness-of-Fit Index = 0.90 and Comparative Fit Index = 0.99). An autonomy-supportive healthcare climate and autonomy, competence, and relatedness directly influenced the self-care behaviors of adult hypertensive patients. However, the perception of illness consequences did not have a significant direct effect on self-care behavior. Conclusion Improving the autonomy-supportive healthcare climate, as well as positive perception of illness consequences, autonomy, competence, and relatedness among patients positively affects self-care behavior. Thus, an authentic partnership between healthcare providers and hypertensive patients is required to enhance trust, cooperation, and adaptation, consequently improving self-care behaviors among patients. Impact Statement Autonomy-supportive healthcare climate was both directly and indirectly associated with self-care behavior that mediates autonomy, competence, and relatedness among young and middle-aged hypertensive patients.

Diagnostic yield of cerebral angiography for intracranial hemorrhage in young patients: A single-center retrospective analysis.

Intracranial hemorrhage (ICH) secondary to hypertension (HTN) classically occurs in the basal ganglia, cerebellum, or pons. Vascular lesions such as aneurysms or arteriovenous malformations (AVMs) are more common in younger patients. We investigated the utility of diagnostic subtraction angiography (DSA) in young hypertensive patients with non-lobar ICH. A retrospective review (2013-2022) identified young (18-60 years) patients who underwent DSA for ICH. HTN history, ICH location, presence/absence of subarachnoid hemorrhage (SAH), and computed tomography angiography (CTA) findings were collected. The main outcome was DSA-positivity, defined as presence of an AVM, aneurysm, Moyamoya disease, reversible cerebral vasoconstriction syndrome, or dural arteriovenous fistula on DSA. Two hundred sixty patients were included, and the DSA-positivity rate was 19%.DSA-positivity was lower in hypertensive patients with ICHs in the cerebellum, pons, or basal ganglia compared to the rest of the patient sample (9% vs 26%, p = 0.0002, Fisher's exact test). We developed the ICH-Angio score (0-5 points) based on CTA findings, ICH location, HTN history, and presence of SAH to predict risk of underlying vascular lesions. DSA-positivity was lower in those with a score of 0 (0/62; 0%) compared to a score of 1 (5/52; 10%), 2 (17/48; 35%), 3 (10/20; 50%), 4 (5/6; 83%), or 5 (3/3; 100%). The ICH-Angio score was able to non-invasively rule out an underlying vascular etiology for ICH in up to one-third of patients. HTN, ICH location, CTA findings, and associated SAH can identify patients at low risk for harboring underlying vascular lesions.

Level of knowledge on the effect of fast foods on health among young hypertensive patients in Bangladesh

Young people make up a sizable share of the global population, and most of them reside in developing nations. They consume too much fast food and obesity at a young age is becoming a worldwide epidemic, putting them at risk for nutritional issues from a physiological as well as psychological perspective. Eating fast food has several negative effects on health. Bangladesh's circumstance is not any different. Thus, this study was conducted to identify the level of knowledge on the effect of fast foods on health among young hypertensive patients in Bangladesh. In a tertiary-level cardiology hospital in Dhaka, Bangladesh, 150 young (20 to 35 years old) hypertension patients participated in a descriptive-type cross-sectional study from November to December 2022. Every stage of the study protected the respondents' anonymity, and participants were made aware that they could withdraw from the program at any point while data was being collected. In total, 25.3 percent of respondents had a good knowledge of the impact of fast food on health, compared to 46.0 percent who had moderate knowledge. It was also found that respondents' knowledge level was substantially correlated with their level of education, occupation, and monthly household income. Given this, various measures should be implemented, such as the implementation of health education programs in communities, schools, and universities, to increase the level of public awareness of the effects of fast food on health.

PS-C34-12: MAJOR CLINICAL CHARACTERISTICS OF RENAL ARTERY FIBROMUSCULAR DYSPLASIA IN CHINESE HYPERTENSIVE PATIENTS

Background: Fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory vascular disease that most commonly affects renal arteries. There is growing awareness of this disease entity. However, most of the previous studies have been from US or European populations. Methods: Consecutive hypertensive patients with renal artery stenosis caused by FMD underwent catheter-based angiography, followed at two Chinese referral centers in China between January 2000 and December 2021. Results: Of 245 study participants, with a mean diagnosed age of 26.9 ± 9.9 years, 137 (55.9%) were female, 38 (15.5%) were children. All patients had diagnosed hypertension at a mean age of 23.4 ± 8.4 years. 73.5% were focal and 15.2% were multivessel. Aneurysms, arterial dissections, and total occlusions were found in 21.6%, 4.1% and 12.2% of patients, respectively. Patients with multifocal FMD, compared to those with focal FMD, were older (26.0 vs.23.7 years, P = 0.021) and more often female (70.8% vs. 50.6%, P = 0.004), had a higher proportion of renal artery dissection (9.2% vs. 2.2%, P = 0.014), lower proportion of kidney atrophy (18.5% vs.31.1%, P = 0.013), and had fewer antihypertensive drugs (1.7 vs. 2.1, P = 0.002). After a median of 6.9 years follow-up, multifocal FMD had a higher cure rate of hypertension than focal FMD after revascularization (71.2% vs.55.2%, P = 0.033). Conclusions: Chinese patients with renal artery FMD had different characteristics from Caucasians, especially in adults. In Chinese, renal artery FMD occurred primarily in the young hypertensive patients with little sex predilection, and was frequently focal, which showed a worse blood pressure outcome than multifocal.

AW-NI-5: COST-EFFECTIVENESS OF INTENSIVE VERSUS STANDARD BLOOD-PRESSURE CONTROL AMONG HYPERTENSIVE PATIENTS IN TAIWAN: A SIMULATION MODELLING STUDY

Objective: Based on the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial and A Randomized Trial of Intensive versus Standard Blood-Pressure Control (SPRINT) trial, the 2022 Taiwan hypertension guidelines recommend the definition of hypertension as 130/80mmHg and a universal BP target of < 130/80 mmHg. Based on the guidelines, we aimed to analyze the lifetime cost-effectiveness of intensive versus standard blood-pressure control from the perspective of Taiwan national payer. Design and method: A simulation model was employed to apply the SPRINT treatment effects for hypertensive patients aged 50–54 and 55–64 years and STEP treatment effects for those aged 65–74 and 75+ years. The medical costs and utility were extracted from national sources or published data to a hypothetical cohort of SPRINT-eligible and STEP-eligible patients in Taiwan. Incremental cost-effectiveness ratio (ICER) against the willing-to-pay threshold at the one-time gross domestic product (GDP) per capita was used to evaluate whether intensive versus standard blood-pressure control was cost-effective. Results: Intensive blood-pressure control produced more lifetime medical costs than standard control, i.e., US$39,348–22,978 versus US$20,239–33,414, while intensive treatment also contributed to more quality-adjusted life-year (QALY), i.e., 7.60–16.28 versus 7.37–15.74. ICER values of intensive versus standard treatment were approximate US$10,989 (NT$329,670), US$11,220(NT$336,600), US$11,485(NT$344,550), and US$11,865(NT$355,950) per QALY gained for hypertensive patients aged 50–54, 55–64, 65–74, and 75+ from the perspective of Taiwanese national payer. Simulation results indicated that intensive treatment is very likely to be cost-effective, i.e., all probabilities are greater than 99.8% below the willing-to-pay threshold of US$36,000 (NT$1,080,000). Conclusions: In this simulation study, intensive blood-pressure control in the Taiwanese population produced fewer cardiovascular events and acceptable costs per QALY gained, enormously below the willing-to-pay threshold. The cost-effectiveness of intensive blood-pressure control was consistent across different ages, and the advantage was more predominant in younger hypertensive patients.

Isolated Systolic Hypertension in Young Patients

The international society of hypertension, like other societies, defines isolated systolic hypertension (ISAH) as a brachial arterial pressure value greater than 140 mmHg of systolic values and less than 90 mmHg of diastolic values .

ПЕРВИЧНЫЙ АЛЬДОСТЕРОНИЗМ: СОВРЕМЕННЫЕ ПОДХОДЫ К ДИАГНОСТИКЕ

Primary aldosteronism is characterized by aldosterone secretion that is independent of renin and angiotensin II. The deleterious effects of primary aldosteronism are mediated by excessive activation of the mineralocorticoid receptor that results in the hypertension, hypokalemia, and it also increases the risk for cardiovascular and kidney disease, as well as death. Current evidence suggests that the prevalence of primary aldosteronism is much greater than previously recognized and milder forms of renin-independent aldosterone secretion may be common. These forms may be missed. This review focused screening in those at increased risk of primary aldosteronism. An approach to evaluating screening results was presented. Family aldosteronism should be considered in young hypertensive patients with a family history of primary aldosteronism. Genetic testing is appropriate in these patients. Careful interpretation of screening data, recent achievements in hormone assays and sampling methods and their clinical relevance are discussed. Confirmatory tests and evaluation of their results are considered. The optimal approach to distinguish unilateral from bilateral primary aldosteronism is by adrenal vein sampling that is the only reliable method to select patients for surgery. More effective strategy to diagnose PA should lead to early detection of PA and could decrease the cardiovascular complications of the patients.

Assessment Of Left Ventricular Systolic Function By Speckle Tracking Echocardiography In Young Hypertensive Patients

Assessment Of Left Ventricular Systolic Function By Speckle Tracking Echocardiography In Young Hypertensive Patients

Family doctor responses to changes in target stringency under financial incentives

Healthcare providers may game when faced with targets. We examine how family doctors responded to a temporary but substantial increase in the stringency of targets determining payments for controlling blood pressure amongst younger hypertensive patients. We apply difference-in-differences and bunching techniques to data from electronic health records of 107,148 individuals. Doctors did not alter the volume or composition of lists of their hypertension patients. They did increase treatment intensity, including a 1.2 percentage point increase in prescribing antihypertensive medicines. They also undertook more blood pressure measurements. Multiple testing increased by 1.9 percentage points overall and by 8.8 percentage points when first readings failed more stringent target. Exemption of patients from reported performance increased by 0.8 percentage points. Moreover, the proportion of patients recorded as exactly achieving the more stringent target increased by 3.1 percentage points to 16.6%. Family doctors responded as intended and gamed when set more stringent pay-for-performance targets.

Beneficial effects of RAS blockers in prediabetics with a hypertension-An observational cohort study

Hypertensive patients have a high prevalence of prediabetes and type II Diabetes mellitus. As per International Diabetic Federation, it has been estimated that more than 470 million people will have prediabetes by 2030. Approximately 5-10% of prediabetes progresses to overt diabetes mellitus, with the same proportion converting back to normoglycemia. In patients who are on Renin-Angiotensin System [RAS] blockers either an Angiotensin converting enzyme inhibitor (ACEI) or an Angiotensin receptor blocker (ARB) would slow down the progress of prediabetic state to overt or frank diabetes mellitus. This was a prospective, observational cohort study and a total of 125 hypertensive patients with impaired glucose tolerance were included in the study who were either on ACE inhibitor or ARB monotherapy. An oral Glucose Tolerance Test (GTT) was done at baseline for screening prediabetic patients, then a periodical assessment of glycemic indices, (fasting blood sugar, 2 hr postprandial blood sugar, and glycosylated hemoglobin), lipid profile, and complication status during the study period were evaluated every 3 months for18months. At the end of 1½ years, for patients belonging to the age group 18-54 years the FBS, PPBS, and HbA1C levels decreased significantly when the RAS blocking drugs (ACEIs and ARBs) were used continuously for 1 year and then they got stabilized. The beneficial effect was seen more in the younger age group 18-54 years old patients. Male above 54 years and females above 49 were resistant to the beneficial effects. In hypertensive patients with impaired glucose tolerance, the blockade of RAS with either ACE inhibitor or ARB has a significant preventive effect on the progression of Type II DM. It may be concluded from the finding of the present study that younger hypertensive patients (18-54 years) of either sex if found to be pre-diabetic may be administered ACEI or ARB as suitable for them. The treatment should be continued vigorously for one year and then it may be maintained to continue the beneficial effect.

The Relationship Of Depression-Anxiety Inspection And Hypertension In Newly Diagnosed Young Hypertensive Patients

Aim: Hypertension (HT) is a very important risk factor for cerebrovascular, renal and various vascular diseases, especially
 cardiovascular diseases. It is seen in almost 1/3 of the adult world population and its incidence is gradually increasing.
 95% of HT is essential and various reasons are emphasized in the etiology. Conditions that cause psychological stress,
 especially depression; Although the relationship between them is not clear, it was seen as a risk factor for HT. Because
 they will live with HT for a long time, early diagnosis and treatment is important, especially in young patients. Predisposing
 factors should also be taken into account in treatment. Anxiety and depression, which are called increased sympathetic
 activity in young people, can be a trigger for HT. In this study, we wanted to investigate the susceptibility to depressionanxiety in newly diagnosed young hypertensive patients. According to the result, we thought that we could make new
 recommendations in the treatment of HT.
 Materials and Methods: 175 patients under the age of 45 with newly diagnosed HT and 125 individuals under 45 without
 any health problems were included in the study. Those diagnosed with HT with secondary reasons and those with chronic
 diseases such as coronary artery disease (CAD), diabetes mellitus (DM), chronic renal failure (CRF), congestive heart failure
 (CHF) were excluded from the study. Testing was performed with the Hospital Depression Anxiety Scale (HDAS). In this test
 for both anxiety and depression; 0-7 points were considered normal, 8-10 points were considered borderline, and over 11
 points were considered abnormal.
 Results: When the results were evaluated, there was no difference between the groups in terms of age, gender, and
 routine biochemical tests. Both depression and anxiety scales were found to be significantly higher in the HT group. In
 young hypertensive patients, we have seen that HT and depression-anxiety frequently coexist.
 Conclusion: In this case, we should definitely examine the psychological stress states of young patients we diagnosed with
 HT. It would be appropriate to refer patients who we think may have depression and anxiety for psychological support and
 treatment. When psychological problems are treated, HT may improve without the need for antihypertensive treatment.
 Thus, we can develop new approaches in HT treatment.

HEPATIC STEATOSIS INDEX IS INDEPENDENTLY RELATED TO HYPERTENSION MEDIATED ORGAN DAMAGE IN PATIENTS WITH FIRST DIAGNOSED AND NEVER TREATED ESSENTIAL HYPERTENSION AND SMOKING HABIT

Objective: Non-alcoholic fatty liver disease (NAFLD) is closely related to the metabolic syndrome, arterial hypertension and overall cardiovascular (CV) disease. We aimed to investigate if those first diagnosed and never-treated patients with essential hypertension at high risk for NAFLD, measured by the Hepatic Steatosis Index (I), already have an impaired CV risk profile estimated by increased blood pressure burden and accompanied by the presence of hypertension-mediated organ damage (HMOD). Design and method: We studied 254 non-diabetic, first diagnosed and never-treated young hypertensive patients, [mean age=51 + 11 years, 59% males, 31% smokers]. Ambulatory blood pressure monitoring (24 h ABPM), CV risk factors [smoking, obesity (BMI), hyperlipidemia and HMOD [aortic stiffness (PWV), left ventricular diastolic dysfunction (EEa), cardiac hypertrophy (LVMI), coronary arteries microcirculation (CFR), carotid intima-media thickness (cIMT) and endothelial dysfunction (PBR5–25)] were estimated in each patient before treatment initiation. HIS was calculated as 8 times (ALT/AST ratio) + BMI (+2, if female; + 2, if diabetes mellitus). Results: The whole hypertensive population was divided regarding I median value=39.3 in Group A (high risk NAFLD group, n = 127, age = 50 + 10) and Group B (low risk NAFLD group, n = 127, age = 52 + 11). Group A had increased BMI (32 + 5 vs. 27 + 3, p < 0.001), systolic night-time ABPM (128 + 15 vs. 124 + 11, p = 0.04), Chol (217 + 40 vs. 206 + 35, p = 0.01) and Trigl (141 + 79 vs. 112 + 65, p = 0.002), E/Ea (7 + 2 vs. 6 + 2, p = 0.4) and LVMI (83 + 17 vs. 79 + 15, p = 0.03) compared to Group B while all other studied demographic/laboratory/ABPM/HMOD parameters (PWV, MAU, CFR and cIMT) were similar. I was related to BMI (p < 0.001) and office BP, systolic (p < 0.001) and diastolic (p = 0.01), in total population as well as to LVMI (r = 0.24, p = 0.03) in smokers. Finally, in multiple regression analysis, we noted that I was independently associated with LVMI (beta = 0.28, p = 0.05) only in male smokers. Conclusions: Our findings underscore the augmented CV risk (smoking, obesity, hyperlipidemia, BP burden and HMOD) in people with first diagnosed arterial hypertension who are at high risk for NAFLD. As successful antihypertensive treatment may lead to HMOD regression, there is still time for those patients to be treated for hypertension disease and hyperlipidemia and quit smoking, in order to reduce future CV risk

POS-054 UTILITY OF PLASMA EXCHANGE AND RITUXIMAB IN PERIOPERATIVE PERIOD AMONG PATIENTS OF COMPLEMENT-ASSOCIATED RENAL DYSFUNCTION UNDERGOING TRANSPLANTATION: REPORT OF THREE RARE CASES

POS-054 UTILITY OF PLASMA EXCHANGE AND RITUXIMAB IN PERIOPERATIVE PERIOD AMONG PATIENTS OF COMPLEMENT-ASSOCIATED RENAL DYSFUNCTION UNDERGOING TRANSPLANTATION: REPORT OF THREE RARE CASES

SMOKING HABIT IS NOT RELATED WITH HYPERTENSION MEDIATED ORGAN DAMAGE IN YOUNG PATIENTS WITH FIRST DIAGNOSED AND NEVER TREATED ESSENTIAL HYPERTENSION

Objective: Early onset arterial hypertension (AH) is associated with a considerably increased risk for cardiovascular (CV) disease. Cigarette smoking represents a significant CV risk factor. Aim of this study is the investigation of any differences between smokers and non smokers first diagnosed and never treated young patients with essential hypertension regarding the burden of blood pressure and the presence of hypertension-mediated organ damage (HMOD). Design and method: We studied 272 non-diabetic, first diagnosed and never-treated young hypertensive patients, [median age=43(39-48), 68% males]. Ambulatory blood pressure monitoring (24 h ABPM), CV risk factors [smoking, obesity (BMI), hyperlipidemia and HMOD [aortic stiffness (PWV), left ventricular diastolic dysfunction (EEa), cardiac hypertrophy (LVMI), coronary arteries microcirculation (CFR), carotid intima-media thickness (cIMT) and endothelial dysfunction (PBR5-25)] were estimated in each young patient before treatment initiation. Results: Young patients’ population was divided regarding smoking habit in smokers group [n = 105, age = 43(38–47), 75 males)] and non-smokers [n = 167, age = 43 (39–48), 119 males]. LDL-C levels, triglycerides, 24 h and daytime systolic ABPM, systolic and diastolic BP variability (BPV) and systolic BP load (BPL) during daytime were increased in smokers compared to non-smokers. No significant differences between smokers and non-smokers regarding age, BMI, E/Ea, LVMI, PWV, MAU, CFR, cIMT and PBR5–25 were found. However, the incidence of LVH (13% vs. 6%, p = 0.04) and impaired CFR (p = 0.05) was increased in smokers compared to non-smokers. In multiple regression analysis, we noted that 24 h systolic ABPM was independently associated with PWV (beta = 0.31, p < 0.001), LVMI (beta = 0.32, p < 0.001) and CFR (beta = -0.18, p = 0.01) regardless of smoking habit. Conclusions: In young people with first diagnosed arterial hypertension, HMOD is independently related to BP burden, irrespective of smoking habit. As HMOD may regress with successful antihypertensive treatment, there is still time for those young patients to treat hypertension disease and hyperlipidemia and quit smoking, in order to reduce future CV risk.