Hypertension In Young Research Articles

P0040BASELINE CHARACTERISTICS AND ASSOCIATIONS WITH RENAL FUNCTION IN A GREEK COHORT OF POLYCYSTIC KIDNEY DISEASE

Abstract Background and Aims Recent advances in the treatment of Autosomal Dominant Polycystic Kidney Disease (ADPKD) highlight the interplay between the clinical and the laboratory profile of the disease. This study aims to present the baseline characteristics of patients followed in a large ADPKD cohort from a single center in Greece, and explore possible associations between demographic, clinical and laboratory parameters. Method Patients followed in a specialized outpatient PKD clinic from December 2018 up to December 2019 were recruited in this study. At enrollment, demographics, medical and family history and laboratory data were recorded using a standardized form. Estimated glomerular filtration rate (eGFR) was calculated and Magnetic Resonance Imagining for total kidney volume (TKV) measurement was performed. Results One-hundred three females and 83 males with a mean age±SD of 41.4 ± 13 years (18.8 % < 30 years) were enrolled. Overall, 60.8% of them were classified as Chronic Kidney Disease, (CKD) stage 1 and 2. The ADPKD was diagnosed at a mean age±SD of 26.5±12.5 years. Thirty four percent out of 186 patients were diagnosed before the age of 20 and 9% of them before the age of 10. A positive family history was present in 89% of patients. In this subgroup, the median age of the affected parent that reached end stage renal disease (ESRD) was 55 (range 28-87) years. Hypertension was diagnosed in 89% at a mean± SD age of 37.2 ± 10.5 years. Hepatic cysts were present in 79.3% of patients, urinary tract infections, nephrolithiasis, macroscopic hematuria and pain in 44.3%, 42.5%, 24.8% and 54.4% respectively. A history of intracranial bleeding in family was positive in 21.5%. In multivariable analysis, lower eGFR was associated with younger age at the time of APKD diagnosis (p < 0.002), younger age at hypertension diagnosis (p < 0.08) and greater values of TKV (p < 0.001), height adjusted TKV (p < 0.001) and Body Mass Index (BMI) (p = 0.02). Conclusion In this study, patients with ADPKD were diagnosed at a young age and hypertension developed early on the course of the disease. Both these factors together with higher values of BMI and TKV were independently associated with low eGFR.

MON-627 Number of Antihypertensives Required for Achieving BP Goals in Individuals with Diabetes and Hypertension-A Cross-Sectional Observational Study

BACKGROUND: The 2019 ADA Standards of Medical Care in Diabetes, recommends blood pressure (BP) target of <130/80 mmHg for individuals with diabetes and hypertension at higher cardiovascular (CV) risk and a BP target of <140/90 mmHg for individuals at lower risk for CV disease.1 Monotherapy can attain goal BP in some patients with diabetes and hypertension. This is most likely to occur in those with BP that are only modestly above goal. However, combination therapy is eventually required in most patients.2 AIM: To assess the number of antihypertensives that are required for optimal control of BP in Indian patients with type 2 diabetes mellitus (T2DM) and hypertension. METHODS: Data was retrieved from the electronic database of a tertiary super-speciality hospital in Kolkata over a period of four weeks in July to August 2018. The inclusion criteria- T2DM patients with hypertension between 35 to 55 years of age. Patients with recent weight gain, recent use of SGLT 2 inhibitors and those with prior cardiac events were excluded from the study.The study included 2000 adult patients with T2DM with normal renal function. Of these, 58% were male patients. The mean age was 48 years. The mean HbA1c was 7.4% during the period of observation. Patients were being treated with oral hypoglycaemic agents (OHA) (except SGLT 2 inhibitors which might affect BP) or insulin. All patients were receiving statins. The antihypertensives that were considered were analysis were telmisartan, amlodipine, and hydrochlorothiazide. RESULTS: The number of T2DM Hypertensive patients requiring 3 or more drugs were 640 (32 %). Out of the 640 patients, 300 patients (15 %) required higher dose of telmisartan 80 mg.A total 980 patients (49%) required a combination of two drugs (telmisartan and amlodipine) for optimal BP control. Out of these 980 patients, 360 patients (18%) required higher dose of telmisartan i.e. 80 mg. One hundred and eighty patients (9%) required a combination of telmisartan and hydrochlorothiazide. Out of these 180 patients, 80 patients (4%) required higher dose of Telmisartan i.e. 80mg. Two hundred patients (10 %) required only one drug i.e. telmisartan for achieving optimal BP. Out of these 200 patients, 110 patients (5.5 %) required the higher dose of telmisartan i.e. 80 mg CONCLUSION: The optimal control of BP is mandatory in T2DM patients in order to reduce cardiovascular events as well as microvascular complications. As evident from our study majority of patients required more than one antihypertensive, 32% required triple drug therapy and 49 % required dual therapy for optimal BP control. Regular monitoring of BP and timely up-titration of antihypertensives are of utmost importance to prevent future micro- and macro- vascular complications in young diabetic hypertensives.

Childhood socioeconomic hardship, family conflict, and young adult hypertension: The Santiago Longitudinal Study.

Stress derived from socioeconomic disadvantage can be damaging to mental and physical health. This study uses longitudinal data on a large prospectively studied cohort to examine how socioeconomic hardship during childhood leads to hypertension in young adulthood by its effects on family conflict, anxiety-depression, and body mass. Data are from 1,039 participants of the Santiago Longitudinal Study who were studied in childhood (M age 10 years), adolescence (14-17 years), and young adulthood (21-26 years). As young adults, 26% had elevated blood pressure or hypertension. Children from more economically disadvantaged families experienced higher levels of family conflict, which related to significant increases in anxiety-depression and body mass over time, both of which were directly linked to hypertension in young adulthood. Findings provide an understanding of how early-life adversity associated with socioeconomic hardship manifests as stress-related health problems in adulthood. Intervention efforts that target overweight/obesity and anxiety and depression that stem from childhood poverty might be useful for reducing the socioeconomic disparities in adult health.

Sympathetic overdrive in patients with impaired carbohydrate metabolism

Clinical studies have shown that sympathetic hyperactivation (sympathetic overdrive) is one of the main features of arterial hypertension, type 2 diabetes, and obesity, which are often found simultaneously.The landmark British Prospective Diabetes Study (UKPDS), which lasted 20 years, showed that beta-blockers reduce any-cause mortality by 23 % in patients with young and middle-aged hypertension, overweight or obese with diabetes 2 type. The researchers concluded that the advantage of long-term use of BB in this study is due to the fact that in a population of patients with obesity, diabetes mellitus, hypertension and an extremely high level of activity of the sympathetic system of β1-blockade is especially effective.An analysis of subsequent large-scale clinical trials of the effectiveness of beta-blockers (in particular, bisoprolol in CIBIS II) showed that in patients with heart failure and diabetes, these drugs reduce overall mortality by 16 %.The safety study of the use of bisoprolol in effective therapeutic doses in patients with type 2 diabetes mellitus and hypertension did not reveal a statistically significant negative effect of this highly selective β1-blocker on carbohydrate and lipid metabolism.

Obstructive sleep apnea and blood pressure in young hypertensives: does it matter?

Obstructive sleep apnea and blood pressure in young hypertensives: does it matter?

Factors Associated with Awareness, Treatment, and Control Rate of Hypertension among Korean Young Adults Aged 30-49 Years.

Background and ObjectivesHypertension awareness, treatment, and control have been substantially improved in the last decades worldwide, but hypertension management in younger adults is still challenged. We analyzed a nationally representative sample of Korea to investigate factors affecting hypertension management among the young Korean population.MethodsAmong 8,024 young adults aged 30–49 years from the 2014–2018 Korea National Health and Nutrition Examination Survey, 1,103 participants with hypertension were analyzed to identify factors associated with hypertension management status. Multiple logistic regression models were conducted separately by sex.ResultsYoung adults with hypertension showed a low rate of awareness (35.8%), treatment (30.9%), and control (23.0%). The older age (40–49 years), obese (body mass index ≥25.0 kg/m2), having diabetes mellitus (DM), and having past-history of cardiovascular disease were positively associated with awareness, and taking health examination in the past 2 years were positively associated with both treatment and control of hypertension among male. Young females who were older (40–49 years), rural residents, unemployed, not taking sodium over the recommended amount, having dyslipidemia, and having DM showed a higher likelihood of awareness. Young females who have not experienced unmet medical needs in the past year were more likely to be treated or controlled with hypertension.ConclusionsThe factors associated with hypertension awareness, treatment, and control were different by sex and age group. Enhancing attention on hypertension among young hypertension and encouraging them to visit clinics would be key strategies to improve hypertension management among the young hypertensive population.

P374 Prediction of an adverse cardiovascular response to physical exercise from resting echocardiography imaging in young adults with suboptimal blood pressure

Abstract Funding Acknowledgements British Heart Foundation (BHF) grants (PG/13/58/30397) Background Young adults with mildly elevated blood pressure are less likely to engage with physical activity. This may be because early hypertension alters myocardial response to moderate exercise, leading to greater perceived exertion and lower levels of enjoyment. As atrial and ventricular function are closely coupled we investigated whether subclinical atrial changes at rest may identify this myocardial response. Purpose To identify whether subclinical changes in left atrial function at rest predict response to exercise by performing left atrial deep-phenotyping in a cohort of young adults with a range of blood pressures. Methods Seventy-one full-term born young adults (25.25 ± 5.13 years) were enrolled in the Young Adult Cardiovascular Health sTudy (YACHT) to undergo baseline clinical and cardiovascular phenotyping including detailed blood pressure measurement. Cardiopulmonary exercise testing combined with echocardiography imaging was performed to assess the myocardial response to physical exercise at 40%, 60% and 80% of peak exercise load for all participants. Left ventricular ejection fraction and global longitudinal strain were measured from an apical four chamber view at each exercise load, and resting left atrial phasic function was assessed by conventional and speckle tracking echocardiography from apical four and two chamber views (figure 1). Results In this young cohort with a range of blood pressure (120.9 ± 12.96/70.85 ± 9.78 mmHg), resting left atrial reservoir and conduit function, but not left atrial structural measures, showed good correlation with left ventricular ejection fraction and global longitudinal strain during 40%, 60% and 80% of peak exercise. The association between resting left atrial conduit with left ventricular deformation at 60% of peak exercise intensity remained significant when adjusted for age, sex and mean arterial pressure (P = 0.007). Conclusion Left atrial phasic function at rest predicts left ventricular responses to physical exercise in this cohort of young adults, which may relate to early subclinical left atrial remodelling in early hypertension. These findings require validation in other cohorts and investigation of whether this exercise limitation can be overcome in young hypertensives. Abstract P374 Figure 1

Morphofunctional status of cardio-vascular system of rats with arterial hypertension

The aim: Was to clarify the general patterns of structural changes in the left ventricular myocardial capillaries in rats with spontaneous arterial hypertension. Materials and methods: Experiments were conducted on 50 ISIAH (inherited stress-induced arterial hypertension) line rats with arterial hypertension: juvenile young (45-day) and sexually mature (100-day) rats, as well as intact animals of the corresponding age. While extracted from the experiment rats of all experimental groups had their arterial pressure measured using a plethysmograph. Electron microscopic examination of the left ventricular myocardium and morphometric study of volumetric and quantitative densities, cross-section area, and form factor of micropinocytotic vesicles were conducted. Results: In sexually mature rats with arterial hypertension, a high level of pressure is maintained. In 45-day-old rats with arterial hypertension in endothelial cells of myocardial blood capillaries there is a hyperactivation of biosynthetic processes (euchromatic nucleus, large-sized mitochondria, ER canals, Golgi complex), which may be a manifestation of reactive processes in response to a non-stable increase in arterial pressure. In the 100-day rats with arterial hypertension, the mosaic of the ultrastructure of the myocardium blood vessels is preserved, but destructively-dystrophic changes become more expressive and involve not only the organelles but also the integrity of the endothelial cell itself. Destructively-dystrophic processes in rat capillaries are accompanied by compensatory and adaptive ones. This is manifested by activation of the transport of substances, both transendothelial and paracellular, and quantitative density of micropinocytotic vesicles increases statistically significantly. Conclusions: In myocardial capillaries of young (45-day) arterial hypertension rats, compensatory and adaptive changes are manifested by activation of biosynthetic processes in endothelial cells following a slight increase in micropinocytotic vesicles quantitative density and signs of destructive-dystrophic processes (minor edema and lysis of endothelial cell cytoplasm). In sexually mature (100-day) arterial hypertension rats in the blood capillaries of the myocardium, the destructive-degenerative changes increase is accompanied by preservation of signs of compensatory processes. Reducing the number of capillaries is offset by an increase in the number of micropinocytotic vesicles.

Excess Systolic Hypertension in Post-Menopausal Women Originates in Their Early-30s, a Decade Before the Decline of Estrogen Concentrations Decline

Background: In young adults blood pressure, hypertension rates, and CVD risk are lower in women than similarly aged men. However, soon after menopause hypertension and CVD rates converge with, and overtake those of men. Thus, by their mid-50s, most women are hypertensive, and CVD becomes the leading cause of death. While this age-related increase in blood pressure and hypertension is largely attributed to menopause, and the concomitant decrease in estradiol concentrations, there is little empirical evidence to support this hypothesis. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) and Coronary Artery Risk Development in Young Adults (CARDIA) study was analyzed by segmented regression analysis to determine the relationship between systolic blood pressure and age. Data from NHANES was further stratified by Body Mass Index (BMI) and antihypertensive drug use to determine their impact on blood pressure. Estradiol concentrations (NHANES 2013-2016) were graphed against age to determine the start of menopause. Findings: Segmented regression analysis determined that the age-related increase in systolic blood pressure and systolic hypertension began when the women were in their early-30s, a decade before estrogen concentrations decline. BMI and antihypertensive drug use modified the response, but not the overall trend. Interpretation: Contrary to the commonly cited hypothesis, the age-related increase in hypertension is not related to menopause, nor decreased estradiol concentrations. Rather, the rise in systolic blood pressure and hypertension begins over a decade earlier, in a woman’s early-30s. These finding suggest that monitoring, and perhaps prophylactic treatment, of hypertension should begin at least a decade before menopause. Funding Statement: No funding was received for this study, nor for preparing and submitting the manuscript. Declaration of Interests: The Authors states that there is no conflict of interest. Ethics Approval Statement: Ethical approval for the study was provided by the University of Florida Institutional Review Board.

Malignant hypertensive retinopathy - first clinical sign in young undiagnosed hypertensives

Malignant hypertensive retinopathy - first clinical sign in young undiagnosed hypertensives

Visceral fat, cardiometabolic risk factors, and nocturnal blood pressure fall in young adults with primary hypertension.

The aims of this study were to assess associations of body fat levels and distribution with metabolic profiles and 24-hour blood pressure in young adults with primary hypertension. Visceral fat (VF) was estimated using dual-energy X-ray absorptiometry. VF was highly significantly associated with a high frequency of overweight/obesity, impaired fasting glucose, increased levels of triglycerides and LDL-cholesterol, and lowered level of HDL-cholesterol. The value of systolic blood pressure (SBP) nocturnal fall was similar between patients receiving RAAS inhibitors, beta-blockers, and calcium channel blockers. In multiple regression, the VF/weight ratio after adjusting for age, gender, total fat, and chronotherapeutic drug delivery was associated with the percentage SBP nocturnal fall (β=-.3108; 95% CI: -0.5923; -0.0980; P=.013). In males, excess VF increased the odds by 2.3 times for non-dipping blood pressure. Our results suggest that in young adult hypertensives, the VF/weight ratio might be associated with non-dipping blood pressure.

Effects of WeChat combined with motivational interviewing in transitional care among young and middle-aged hypertension patients

Objective To explore the effects of WeChat combined with motivational interviewing in transitional care among young and middle-aged hypertension patients. Methods By convenient sampling, we selected 129 young and middle-aged hypertension inpatients who were hospitalized in a classⅢ grade A hospital from June 2017 to March 2018 as subjects. All of the patients were randomly divided into observation group (n=66) and control group (n=63) . In the control group we adopted routine health education and routine telephone follow-up after discharge. Apart from that, for the observation group we carried out transitional care by WeChat combined with motivational interviewing. The medication adherence was compared with the Morisky medication adherence scale, and the blood pressure control rate was observed and compared between the two groups. Results Three months after intervention, the medication adherence of two groups all improved compared with that before intervention; the score of medication adherence of observation group and control group was (4.7±1.7) and (3.8±1.5) respectively with a statistical difference (t=3.192, P<0.05) . After intervention, the blood pressure control rate of observation group and control group was 60.3% and 51.5% respectively with a statistical difference (χ2=5.645, P<0.05) . Conclusions Transitional care by WeChat combined with motivational interviewing can improve medication adherence and blood pressure control of young and middle-aged hypertension patients which is worthy of clinical application. Key words: Hypertension; Young and middle aged; Medication adherence; Motivational interviewing

Probability Analysis of Hypertension-Related Symptoms Based on XGBoost and Clustering Algorithm

In this paper, cluster analysis and the XGBoost method are used to analyze the related symptoms of various types of young hypertensive patients, and finally guide patients to target treatment. Hypertension is a chronic disease that is common worldwide. The incidence of it is increasing, and the age level of patients is decreasing year by year. Effective treatment of youth hypertension has become a problem in the world. In this paper, young hypertension patients are classified into two groups by cluster analysis; the proportion of different hypertension related symptoms in each group of patients is then counted; and after verifying the prediction accuracy of the XGBoost model with 10-fold cross-validation, the accuracy of clustering is calculated by the XGBoost method. The final result shows that there are significant differences in symptomatic entropy between patients with type II hypertension and those with type I hypertension. Patients with type II hypertension are more likely to have symptoms of ventricular hypertrophy and microalbuminuria. Through this analysis, patients can have preventive treatment according to their own situation, and this can reduce the burden of medical expenses and prevent major diseases. Applying the data analysis into the medical field has great practical significance.

Differences in serum steroid hormones concentrations in Spontaneously Hypertensive Rats (SHR) - an animal model of Attention-Deficit/Hyperactivity Disorder (ADHD).

Spontaneously hypertensive rats are the most common animal model used to study attention deficit hyperactivity disorder (ADHD). The present study investigated the levels of steroid hormones in the bloodstream of hypertensive rats and its normotensive control strain, Wistar-Kyoto rats, to check if there are any hormonal differences between both strains at the onset of ADHD. Plasma samples were collected from young (5-week-old) and mature (10-week-old) male hypertensive and normotensive rats to determine the serum level of testosterone, 17beta-estradiol, free estriol, progesterone, corticosterone and cortisol using ELISA kits. The results showed statistically significant increases in serum levels of testosterone and free estriol in 10-week-old hypertensive and normotensive rats when compared to 5-week-old animals. Moreover, the concentrations of progesterone, corticosterone and cortisol were significantly elevated in 10-week-old hypertensive rats when compared to 5-week-old animals of both strains as well as 10-week-old normotensive rats. Hormonal differences observed between 10-week-old hypertensive and normotensive rats were also accompanied by differences in the volumes of lateral ventricles as well as the third ventricle and cerebral aqueduct. In conclusion, elevated contents of progesterone, corticosterone and cortisol in hypertensive rats may be associated not only with ADHD but also with developing hypertension. This question needs further study.

Rationale and study design of the MyHEART study: A young adult hypertension self-management randomized controlled trial

Young adults (18–39 year-olds) with hypertension have a higher lifetime risk for cardiovascular disease. However, less than 50% of young adults achieve hypertension control in the United States. Hypertension self-management programs are recommended to improve control, but have been targeted to middle-aged and older populations. Young adults need hypertension self-management programs (i.e., home blood pressure monitoring and lifestyle modifications) tailored to their unique needs to lower blood pressure and reduce the risks and medication burden they may face over a lifetime. To address the unmet need in hypertensive care for young adults, we developed MyHEART (My Hypertension Education And Reaching Target), a multi-component, theoretically-based intervention designed to achieve self-management among young adults with uncontrolled hypertension. MyHEART is a patient-centered program, based upon the Self-Determination Theory, that uses evidence-based health behavior approaches to lower blood pressure. Therefore, the objective of this study is to evaluate MyHEART’s impact on changes in systolic and diastolic blood pressure compared to usual care after 6 and 12 months in 310 geographically and racially/ethnically diverse young adults with uncontrolled hypertension. Secondary outcomes include MyHEART’s impact on behavioral outcomes at 6 and 12 months, compared to usual clinical care (increased physical activity, decreased sodium intake) and to examine whether MyHEART’s effects on self-management behavior are mediated through variables of perceived competence, autonomy, motivation, and activation (mediation outcomes). MyHEART is one of the first multicenter, randomized controlled hypertension trials tailored to young adults with primary care. The design and methodology will maximize the generalizability of this study. Trial registrationClinicalTrials.gov Identifier: NCT03158051

Frequency of Primary Hyperaldosteronism in Young Hypertensives in a Tertiary Care Setting of Rawalpindi.

To determine the frequency of primary hyperaldosteronism in young hypertensives in hospital settings of Rawalpindi. Cross-sectional study. Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from June 2016 to May 2017. Two hundred and fifty patients with hypertension (blood pressure of more than 140/90 mm Hg) of both genders, with age between 17-40 years were recruited in the study. Patients on anti-hypertensive medications, renal function derangement, pregnant females and those labelled with secondary hypertension were excluded. Blood samples were taken for the analyses of plasma renin, aldosterone, electrolytes, and blood gases. Parametric quantitative variables were presented as mean + SD. Eight cases, out of a total 80 subjects fulfilling the inclusion criteria, were diagnosed with primary hyperaldosteronism and 72 with essential hypertension. Mean age of patients having primary hyperaldosteronism was 29.25 +7.1 years. The mean diastolic blood pressure of all patients was 90.3 +6.5 mm of Hg, while mean systolic blood pressure was 142.7 +10.5 mm of Hg. Frequency of primary hyperaldosteronism was found to be 10%, emphasising on the fact that it is not very uncommon in young hypertensives.

Salt Preference is Linked to Hypertension and not to Aging.

BackgroundSeasoning is one of the recommended strategies to reduce salt in foods. However, only a few studies have studied salt preference changes using seasoning.ObjectivesThe aim of this study was to compare preference for salty bread, and if seasoning can change preference in hypertensive and normotensive, young and older outpatients.MethodsOutpatients (n = 118) were classified in four groups: older hypertensive subjects (OH) (n = 32), young hypertensive (YH) (n = 25); older normotensive individuals (ON) (n = 28), and young normotensive (YN) (n = 33). First, volunteers random tasted bread samples with three different salt concentrations. After two weeks, they tasted the same types of breads, with seasoning added in all. Blood pressure (BP), 24-hour urinary sodium and potassium excretion (UNaV, UKV) were measured twice. Analysis: Fisher exact test, McNamer’s test and ANCOVA. Statistical significance: p < 0.05.ResultsSystolic BP, UNaV, and UKV were greater in HO and HY and they had a higher preference for saltier samples than normotensive groups (HO: 71.9%, HY: 56% vs. NO: 25%, NY; 6%, p<0.01). With oregano, hypertensive individuals preferred smaller concentrations of salt, with reduced choice for saltier samples (HO: 71.9% to 21.9%, and HY: 56% to 16%, p = 0.02), NO preferred the lowest salt concentration sample (53.6% vs. 14.3%, p < 0.01), and NY further increased the preference for the lowest one (63.6% vs. 39.4%, p = 0.03).ConclusionsOlder and younger hypertensive individuals prefer and consume more salt than normotensive ones, and the seasoned bread induced all groups to choose food with less salt. Salt preference is linked to hypertension and not to aging in outpatients.

Profile of Metabolic Syndrome in Newly Detected Hypertensive Patients in India: An Hospital-Based Study.

Background:Metabolic syndrome (MetS) is recognized as an emerging threat and interest of public health because the factors defining syndrome are associated with increased risk of mortality and morbidity. Hypertension further adds to risk factor leading to target organ damage. Recognizing the MetS in patients with hypertension provides a great opportunity for more aggressive treatment.Objective:The objective of the study is to estimate the prevalence and evaluate the metabolic profile of MetS in newly diagnosed adult hypertensive participants.Methodology:This is an hospital-based cross-sectional study. A total of 400 participants with newly detected essential hypertension were included in the study after detailed medical and laboratory investigations done to exclude the secondary hypertension. After the informed consent, a structured proforma was filled containing the demographic data; medical history; physiological parameters such as blood pressure, height, weight, and waist circumference; some laboratory investigations such as lipid profile and fasting blood glucose. Descriptive statistics such as mean and proportion were used. To compare the proportions, Chi-square test was used. Kappa agreement was utilized to know the level of agreement between various criteria defining MetS.Results:The prevalence of MetS according to the International Diabetes Federation criteria in the new hypertensive study participants was 50.5% more common in females. One-fourth of young hypertensives was having MetS. Hypertensive patients with MetS show risk factors at significantly higher range than their counterparts. High-density lipoprotein was the most common risk factor present apart from increased waist circumference. There was a wide variation in the prevalence of MetS in the Indian population by different criteria.Conclusion:Half of the new hypertensive patients had MetS and thus it becomes very important to screen all the hypertensives at the onset for MetS and treat them aggressively to decrease the cardiovascular events.

Abstract 16662: Microvesicle Release During Exercise-Induced Cardiovascular Stress in Young Adult Hypertension

Introduction: Microvesicles are elevated in the circulation during cardiac stress; a response that is blunted in those with cardiovascular disease. Microvesicles play both activating and regulatory roles in the pathogenesis of hypertension, and their release is believed to be a protective mechanism during cardiac stress. Hypothesis: We hypothesised that microvesicle release during exercise-induced cardiac stress differs in young adults with and without hypertension. Methods: Microvesicle release was measured in 106 participants (79 normotensive, 27 hypertensive). Blood samples were obtained during maximal exercise testing at three time-points: before, immediately post and following 20 minutes recovery. The level of microvesicle procoagulant activity was determined in all participants. Microvesicles were phenotyped by flow cytometry in a subset of participants. Results: Exercise was associated with a significant elevation in the total procoagulant activity of microvesicles (p&lt;0.001) and this increase was significantly higher in the normotensive group than the hypertensives (median(IQR) +0.7(0.0-2.1) vs -0.1(-0.4-0.4), p=0.001). Circulating procoagulant, platelet, endothelial, leucocyte, granulocyte and monocyte-derived microvesicles were shown to be elevated during exercise (p&lt;0.05). The elevation in endothelial and leucocyte microvesicle levels returned to baseline within 20 minutes recovery. The significant elevation in procoagulant, platelet, granulocyte and monocyte-derived microvesicles was only seen in the normotensive participants, not in those with hypertension. Furthermore, amongst the normotensive participants, those with a blunted release of platelet microvesicles had higher peak diastolic blood pressures (86.8±8.4 vs 73.5±14.5, p=0.028) during exercise and increased global arterial stiffness measured at rest by the cardio-ankle vascular index (CAVI: 6.1±0.6 vs 5.4±0.5, p=0.022). Conclusions: In young adult hypertension there is a blunted release of microvesicles during exercise-induced cardiac stress. Normotensive young adults with a blunted platelet microvesicle release demonstrate early markers of future hypertension risk with greater peripheral resistance and arterial stiffness.

Trial of Exercise to Prevent HypeRtension in young Adults (TEPHRA) a randomized controlled trial: study protocol

BackgroundHypertension prevalence in young adults has increased and is associated with increased incidence of cerebrovascular and cardiovascular events in middle age. However, there is significant debate regards how to effectively manage young adult hypertension with recommendation to target lifestyle intervention. Surprisingly, no trials have investigated whether lifestyle advice developed for blood pressure control in older adults is effective in these younger populations.Methods/DesignTEPHRA is an open label, parallel arm, randomised controlled trial in young adults with high normal and elevated blood pressure. The study will compare a supervised physical activity intervention consisting of 16 weeks structured exercise, physical activity self-monitoring and motivational coaching with a control group receiving usual care/minimal intervention. Two hundred young adults aged 18–35 years, including a subgroup of preterm born participants will be recruited through open recruitment and direct invitation. Participants will be randomised in a ratio of 1:1 to either the exercise intervention group or control group. Primary outcome will be ambulatory blood pressure monitoring at 16 weeks with measure of sustained effect at 12 months. Study measures include multimodal cardiovascular assessments; peripheral vascular measures, blood sampling, microvascular assessment, echocardiography, objective physical activity monitoring and a subgroup will complete multi-organ magnetic resonance imaging.DiscussionThe results of this trial will deliver a novel, randomised control trial that reports the effect of physical activity intervention on blood pressure integrated with detailed cardiovascular phenotyping in young adults. The results will support the development of future research and expand the evidence-based management of blood pressure in young adult populations.Trial RegistrationClinicaltrials.gov registration number NCT02723552, registered on 30 March, 2016.